NURSING CARE STUDY OF A PATIENT WITH TYPHOID FEVER

BY

NAME: ORJI AMARACHI GLORY

MATRIC NUMBER: 2020/128778/REGULAR
INDEX NUMBER: ……………………………………

DEPARTMENT OF NURSING SCIENCES

FACULTY OF HEALTH SCIENCES
ABIA STATE UNIVERSITY, UTURU

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS OF NURSING AND

MIDWIFERY COUNCIL OF NIGERIA FOR THE AWARD OF “REGISTERED
NURSE” CERTIFICATE.

NOVEMBER, 2024

i
 APPROVAL/CERTIFICATION

This is to certify that the client care by ORJI AMARACHI GLORY with index number

___________________________________________________ has been examined and

approved for the award of Registered Nurse Certificate

__________________________ __________________

Dr. Mrs. Nwokoro R.O Date

(Supervisor)

___________________________ __________________

Dr. Mrs. Emonye O.P Date

(Head of Department)

____________________________ __________________

External Examiner Date

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 ACKNOWLEDGEMENT

I am sincerely grateful to God Almighty for His mercies, love, grace, favour and
upliftment towards me. I appreciate the Head of Department, Dr. (Mrs.) Emeonye
O.P. for her motherly love and for impacting knowledge in me.
My greater appreciation goes to my supervisor, Dr. Mrs. Nwokoro R. O for her
patience in going through my work.
My profound gratitude goes to my lovely parents, Mr. & Mrs. Orji for their prayers,
love, advice and financial support towards me.
I appreciate my siblings for their love, care, prayers arid support and I pray that God
will bless and favour them.

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 Table of content

Introduction 1

Objective of Study 3

Patient’s Bio-Data 4

Family History 5

Socio-economic History 5

Past Health History 5

History of Present illness 5

Anatomy And Physiology Of The Gastrointestinal System 6

Comprehensive Literature On Typhoid Fever 10

Definition 10

Incidence 10

Causes, Transmission and Risk Factors 10

Clinical Manifestation 10

Symptoms 11

Pathophysiology 12

Diagnosis 12

Prevention 13

Treatment 13

Complication 14

Application Of The Nursing Process 15

Nursing History 15

Medical Management 15

Nursing Management Of Miss E M 16

Aims of Management 16

Nursing Diagnosis For Miss E. M 17

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Nursing Care Plan For Miss E.M 18

Pharmacological Review Of Drugs 20

Progress and Discharge Summary 23

Advice on Discharge 24

Recommendation 25

Conclusion 25

Reference 26

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 INTRODUCTION

Typhoid fever , otherwise known as enteric fever, is an acute illness associated with fever caused

by the Salmonella typhi bacteria. S. typhosa is a short, plump, gram negative rod that is

flagellated and actively motile. Contaminated food or water is the common medium of

contagion.

The disease follows four stages. The first stage is known as incubation period, usually 10-14

days in occurrence. In this stage generalization of the infection occurs. In the second stage,

aggregation of the macrophages and edema in focal areas indicates bacterial localization

(embolization) and resultant toxic injury which disappear after few days. The third stage of

disease is dominated by effects of local bacterial injury especially in the intestinal tract,

mesenteric lymph nodes, spleen, and liver. The fourth stage, or the stage of lysis, is the stage

wherein the infectious process is gradually overcome. Symptoms slowly disappear and the

temperature gradually returns to normal.

The symptoms of typhoid fever include high fever, chills, cough, muscle pain, weakness,

stomach pain, headache and a rash made up of flat, rose-colored spots. Diarrhea is a less

common symptom of a typhoid fever, although it is a gastrointestinal disease. Sometimes there

are mental changes, know as ‘typhoid psychosis’. A characteristic feature of typhoid psychosis is

plucking at the bedclothes if patient is confined to bed.

Risk factors for acquiring typhoid fever likely include improper food handling, eating food from

outside sources like carinderia, drinking contaminated water, poor sanitation and even poor

hygiene practices. War and natural disasters as well as weak, non existent of health care

infrastructure may also contribute. Both genders do have equal chances on acquiring such

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disease. Asian, African and Americans are at greatest risks of acquiring the disease since

geographical locations play a part.

Complications of typhoid fever are secondary conditions, symptoms, or other disorders that are

caused by typhoid fever. Complications include overwhelming infection, pneumonia, intestinal

bleeding, and intestinal perforation may eventually lead to death.

Typhoid fever is one of the most protean of all bacterial diseases thus laboratory procedures are

usually depended on to confirm or disprove suspicion of such disease. The place of blood

culture, serologic studies and bacteriologic examination feces and urine are useful in establishing

the diagnosis. Agglutination (Widal) for typhoid fever is done to determine antibody response

against different antigenic fractions of organisms.

Typhoid fever is treated with antibiotics which kill the Salmonella bacteria. Several antibiotics

are effective for the treatment of typhoid fever. The choice of antibiotics needs to be guided by

identifying the geographic region where the organism was acquired and the results of cultures

once available. Two new vaccines are currently licensed and widely used worldwide, a subunit

(Vi PS) vaccine administered by the intramuscular route and a live attenuated S typhi strain

(Ty21a) for oral immunization.

In most cases, typhoid fever is managed at home with antibiotics and bed rest. For

hospitalized patients, effective antibiotics, good nursing care, adequate nutrition, careful

attention to fluid and electrolyte balance, and prompt recognition and treatment of complications

are strategies to avert the possibility of death.

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 Objective/Purpose of Study

The following are the objectives of study to student nurse, client and significant others;

The students nurse will be able to:

1. Acquire knowledge and skills about the care for community patients with typhoid fever.

2. Make thorough nursing assessment of the client to be able to come up with an

appropriate plan of care.

3. Explain the pathophysiology of typhoid fever

4. Recognize the possible symptoms of typhoid fever manifested by the patient.

5. List ways of preventing typhoid fever.

6. Render appropriate nursing care, medicate properly and accurately the prescribed

medication.

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Patient’s Bio-Data

Name of Patient: Ms. E.M

Age: 14 yrs

Sex: Female

Marital Status: Single

Diagnoses Typhoid Fever

Ward Female Medical Ward

Religion: Christianity

Occupation: Student

Nationality Nigeria

State of Origin Abia State

Address: 54 Azikiwe street, Umuahia

Next of Kin: Mrs. R. M

Address of Next of Kin: 54 Azikiwe street, Umuahia

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Family History

Miss Esther Matthew is the 2nd child among five siblings (3 girls and 2 boys). The eldest is 17

years and currently working as a farmer. Mr. Matthew is her Father who is also a farmer. Mrs.

Esther who is the informant admits that there is no history of any familial disease in both

families. She also admitted that the family relationship is strong and stable. She seldom quarrels

with her husband and ensures that all her children are on the right track.

Socio-economic History

When asked about play, eating habits and life style of her daughter “Mrs. Mathew, verbalized the

following

 Miss Esther Mathew is socially interactive in nature.

 Patient loves eating (fruit, vegetable)

The family goes to church every Thursday and Sunday. She is presently enrolled Union

Secondary Schools, Isialangwa.

Past Health History

Patient has experienced cough common cold, chicken pox in the past. Patient has no known

allergies to food and drugs.

History of Present illness

She experienced fever and chills for about 9 days ago, Headache, lethargy, fatigue, body

weakness and pain within same period. Patient also experienced diarrhea. There were no also

reported accidents and injuries wherein she has been subjected to.

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 ANATOMY AND PHYSIOLOGY OF THE GASTROINTESTINAL SYSTEM

To aid in understanding the disease process, Anatomy and physiology provides the necessary

information about the normal function of certain body components, its structure and function.

The gastrointestinal tract (GIT) consists of a hollow muscular tube starting from the oral cavity,

where food enters the mouth, continuing through the pharynx, esophagus, stomach and intestines

to the rectum and anus, where food is expelled. There are various accessory organs that assist the

tract by secreting enzymes to help breakdown food into its component nutrients. Thus the

salivary glands, liver, pancreas and gall bladder have important functions in the digestive system.

Food is propelled along the length of the GIT by peristaltic movements of the muscular walls.

The primary purpose of the gastrointestinal tract is to break down food into nutrients, which can

be absorbed into the body to provide energy. First food must be ingested into the mouth to be

mechanically processed and moistened. Secondly, digestion occurs mainly in the stomach and

small intestine where proteins, fats and carbohydrates are chemically broken down into their

basic building blocks. Smaller molecules are then absorbed across the epithelium of the small

intestine and subsequently enter the circulation. The large intestine plays a key role in

reabsorbing excess water. Finally, undigested material and secreted waste products are excreted

from the body via defecation (passing of faeces). In the case of gastrointestinal disease or

disorders, these functions of the gastrointestinal tract are not achieved successfully. Patients may

develop symptoms of nausea, vomiting, diarrhoea, malabsorption, constipation or obstruction.

Gastrointestinal problems are very common and most people will have experienced some of the

above symptoms several times throughout their lives.

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Basic structure

The gastrointestinal tract is a muscular tube lined by a special layer of cells, called epithelium.

The contents of the tube are considered external to the body and are in continuity with the

outside world at the mouth and the anus. Although each section of the tract has specialised

functions, the entire tract has a similar basic structure with regional variations.

The wall is divided into four layers as follows:

Mucosa

The innermost layer of the digestive tract has specialised epithelial cells supported by an

underlying connective tissue layer called the lamina propria. The lamina propria contains blood

vessels, nerves, lymphoid tissue and glands that support the mucosa. Depending on its function,

the epithelium may be simple (a single layer) or stratified (multiple layers).

Areas such as the mouth and oesophagus are covered by a stratified squamous (flat) epithelium

so they can survive the wear and tear of passing food. Simple columnar (tall) or glandular

epithelium lines the stomach and intestines to aid secretion and absorption. The inner lining is

constantly shed and replaced, making it one of the most rapidly dividing areas of the body!

Beneath the lamina propria is the muscularis mucosa. This comprises layers of smooth muscle

which can contract to change the shape of the lumen.

Submucosa

The submucosa surrounds the muscularis mucosa and consists of fat, fibrous connective tissue

and larger vessels and nerves. At its outer margin there is a specialized nerve plexus called the

submucosal plexus or Meissner plexus. This supplies the mucosa and submucosa.

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Muscularis externa

This smooth muscle layer has inner circular and outer longitudinal layers of muscle fibres

separated by the myenteric plexus or Auerbach plexus. Neural innervations control the

contraction of these muscles and hence the mechanical breakdown and peristalsis of the food

within the lumen.

Serosa/mesentery

The outer layer of the GIT is formed by fat and another layer of epithelial cells called

mesothelium.

Peyer’s Patches

Numerous lymph nodes are found in the mucosa at irregular intervals throughout the length of

the small intestine. The smaller ones are known as solitary lymphatic follicles, and about 20 or

30 larger nodes situated towards the distal end of the ileum are called aggregated lymphatic

follicles (Peyer’s patches). These lymphatic tissues, packed with defensive cells are strategically

placed to neutralize ingested antigens (Ross and Wilson, 2016).

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Diagram showing organs of GIT.

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 COMPREHENSIVE LITERATURE ON TYPHOID FEVER

Definition

Typhoid fever, otherwise known as enteric fever, is an acute illness associated with

progressive fever, gastroenteritis, non-bloody diarrhea, profuse sweating transmitted by the

ingestion of food or water contaminated with the faeces of an infested person, which contain the

bacterium Salmonella typhi (Wikipedia, 2011).

Incidence

World health organization identifies typhoid as a serious public health problem. Its

incidence is highest in children and young adults between 5 and 19 years old. Both genders have

equal chances of acquiring the disease. Asian, African and American are at greatest risk of

acquiring disease since geographic location plays a part.

Causes, Transmission and Risk Factors

Typhoid fever is caused by a bacterium Salmonella typhi. The bacteria may be spread

through poor hygiene habits, and public sanitation conditions, and sometimes also by flying

insects feeding on faeces. Risk factors include living in developing country, poor sanitation, poor

toileting habits, poor drainage, improperly prepared food, areas with wells as sources of drinking

water, eating food from outside sources, war and natural disasters, as well as weak or non-

existent of health care infrastructure.

Clinical Manifestation

The disease follows four stages:

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(a) First stage is known as incubation period, usually 10-14 days in occurrence. In this stage

generalization of the infection occurs.

(b) Second stage: In the second stage aggregation of the macrophages and edema in focal

areas indicates bacterial localization (embolization) and resultant toxin injury which

disappear after few days.

(c) Third Stage: This stage of disease is dominated by effects of local bacterial injury

especially in the intestinal tract, mesenteric lymph nodes, spleen, and liver

(d) Fourth Stage: This is also referred to as the stage of lysis. It is the stage in which

infections process is gradually overcome. Symptoms slowly disappear and the

temperature gradually returns to normal.

The symptoms of typhoid fever include:

- high progressive fever

- chills, cough,

- muscle pain

- weakness

- stomach pain

- headache

- rash made up of flat, rose-colored spots

- non-bloody diarrhea (less common symptom)

- Sometimes there are mental changes, known as typhoid psychosis.

- Profuse sweating.

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Pathophysiology

Typhoid fever is a bacteremia in which the organism gains access to the blood stream

through the bowel, principally through the infected peyer’s patches of lymphoid tissue in the

lower portion of the ileum. The first week these patches are swollen; the second week they form

sloughs, which are often bile coloured; the third week the sloughs separate and leaves an

ulcerative surface, which then starts to heal by granulation. Since the organism reaches all parts

of the body through the blood stream, almost all organs at time may show pathologic changes

being those due to toxemia and high fever. Commonly, however, the heart liver, spleen, muscle

and mesenteric lymph glands may be either red or swollen, or else broken down into messy

matter.

The urine may be milky in appearance with the peculiar opalescence, which is due to the

presence of millions of typhoid bacilli in it. The causative organism invades the blood stream by

way of lymphatic tissues and is carried to all parts of the body. Early symptoms may vary, may

be vague with headaches, anorexia and malaise. As the disease progresses, there are joint pains,

abdominal discomfort, vomiting and usually constipation although there may be diarrhea, cough

and bronchitis occur in about 50% of the cases. During the first week, the body temperature rise

in step ladder pattern until it reaches about 1040f. Temperature drops at the end of third week

due to lysis. The temperature is irregular, with two (2) remissions in the morning. (smeltzer and

Bare, 2004).

Diagnosis

Diagnosis is made through the following:

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1. Clinical manifestation/presentation: The presenting signs and symptoms can be used to

make diagnosis.

2. Blood test: This include complete blood count and differential white blood cell count

3. Bone marrow

4. Stool cultures: Colour, consistency and mucus

5. Widal test: Demonstrates salmonella antibodies against antigens.

6. Urinalysis: Colour, albumin, sugar, transparency, PH, specific gravity

Prevention

Typhoid fever can be prevented through:

- Good sanitation and hygiene

- Good toileting habits

- Proper drainage

- Chlorination of drinking water obtained from wells.

- Food should be properly prepared

- Vaccination in endemic areas.

Treatment

(1) Administer Antibiotics: This include fluoroquinolone (ciprofloxacin), third generation

cephalosporins (ceftriaxone or cefataxime) and cotrimoxazole

(2) Administer Analgesic: Acetaminophen ( has both analgesic and antipyretic effects)

(3) Rehydration: This include oral rehydration therapy or intravenous infusion (pediatric

saline)

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Complication

The complication of typhoid fever includes:

(1) Overwhelming infection due to systemic spread

(2) Intestinal bleeding

(3) Pneumonia due to systemic spread

(4) Intestinal perforation due to penetration into Peyer’s patches.

(5) Death resulting from intestinal perforation

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 APPLICATION OF THE NURSING PROCESS

Nursing History

Miss E.M a 14-year-old female was admitted to the hospital ward on 8 May 2022 with a

diagnosis of typhoid fever. She reported having a high fever, headache, abdominal pain, and

diarrhea for the past week. She also had a history of traveling to the village two weeks before the

onset of symptoms. She denied any allergies, chronic illnesses, or previous hospitalizations. She

lives with her parents and two younger siblings, who are all healthy. She attends school regularly

and enjoys playing with her friends.

On admission, her vital signs were: temperature 39.5°C, pulse 110 beats per minute, blood

pressure 100/60 mmHg, respiratory rate 24 breaths per minute, and oxygen saturation 96% on

room air. She appeared pale, dehydrated, and lethargic. Her physical examination revealed a

coated tongue, enlarged spleen, and rose spots on her abdomen. Her laboratory tests showed a

positive Widal test, elevated white blood cell count, and low hemoglobin and platelet levels. She

was started on intravenous fluids and antibiotics (ceftriaxone and azithromycin) as per the

hospital protocol. She was also given paracetamol for fever control and oral rehydration solution

for electrolyte replacement.

Medical Management

The following drugs were ordered by the consultant:

i. Capsule Ciprofloxacin 500mg bd x 5/7

ii. Tab paracetamol 500mg tds x 3/7

iii. Tab vitamin C 200mg tds x 3/7

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 NURSING MANAGEMENT OF MISS E M

Aims of Management

1. Diagnose and treat the infection with appropriate antibiotics

2. Prevent and manage complications such as dehydration, bleeding, shock, and organ

failure

3. Prevent transmission and recurrence by improving hygiene, sanitation, and vaccination.

4. Provide health education and counseling to the patient and family about the causes,

symptoms, prevention, and treatment of typhoid fever

The following are interventions taken to improve the health of Miss Esther Mathew.

(1) Admission and Bed Rest: Patient is admitted for some hours and given adequate bed

rest. This is to reduce metabolic consumption and oxygen demand (to conserve energy).

(2) Observation:

- Observe patients vital signs: Temperature, pulse rate, blood pressure and respiratory rate.

- Feel patients skin for warmness and dryness.

- Observe lips and mouth for dryness.

(3) Nutrition

- Ensure adequate diet to meet increase metabolic demands

- Encourage intake of balanced fiber and bulk in diet to improve consistency of stool and

facilitate passage through colon.

(4) Reducing Hyperthermia

- Monitor patient’s vital signs to serve as baseline for future comparism.

- note presence/absence of sweating, to assess degree of hyperthermia

- Initiate tepid sponging: This facilitates heat loss through conduction and evaporation.

16
 - Undress and remove extra linens, to facilities heat loss by radiation.

- Administer prescribed paracetamol 500mg as antipyretic

(5) Alleviating pain due to insertion or intravenous line

- Determine possible pathophysiology/pscyhologic causes of pain, to assess etiology,

precipitating/ contributing factors

- Encourage verbalization of feelings about pain

- Administer analgesics as indicated

(6) Advice in discharge

(7) Resolving vomiting/fluid volume depict

- Prepare and administer oral rehydration solution

- Administer intravenous fluid of normal saline to alternate 5% dextrose solution

- Monitor and record patients intake and output

NURSING DIAGNOSIS FOR MISS E. M

The following nursing diagnosis was made throughout the period of hospitalization of Miss E.

M.

1. Acute pain related to presence of traumatized tissue evidenced by grimacing and

verbalization.

2. Hyperthermia related to disease process evidenced by temperature of 390c

3. Fluid volume deficit related to vomiting

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 NURSING CARE PLAN FOR MISS E.M

S/N Nursing Diagnosis Nursing Objectives Nursing Intervention Scientific Rationale Evaluation

1 Acute pain related to Patient will verbalize (1) Accept patient’s (1) Pain is subjective Patient verbalized

presence of reduction of pain from description of pain experience and cannot be felt reduction of felt

traumatized tissue a scale 5 to 1. Within 6 (2) Instruct patient to by others pain from a scale of

evidenced by hours of intervention position affected arm (2) To promote comfort 5 to 1 after 3 hours

grimacing and properly (3) This disrupts the pain of intervention

verbalization. (3) Encourage pathway

participation in diversional (4) inhibits prostaglandin

activities like socialization synthesis

or listening to music

(4) Administer

analgesic as prescribed

2 Hyperthermia related Patient’s temperature (1) expose patient to (1) This increase heat loss Patient temperature

to disease process will reduce by 10c fresh air environment and by radiation was reduced by 1ºc

evidenced by within 1 hour of fanning (2) It increases heat loss by within 1 hour of

18
 temperature of 390c intervention (2) tepid sponge the evaporation nursing

patient intermittently (3) To evaluate progress of intervention

(3) Observe and record intervention

vital signs every 30mins. (4) relieves fever by acting

(4) Administer in hypothalamic heat enter

prescribed drug

3 Fluid volume deficit Patient will not show (1) Place patient on nil (1) It allows intestine to Patient’s fluid

related to vomiting signs of dehydration per oral until vomiting rest. volume was

like dry lips within subsides (2) To replace lost fluid. restored within 48

48hrs of intervention (2) administer (3) To assess progress of hours of nursing

intravenous fluid e.g. N/S intervention intervention

alternated with 5%

dextrose solution

(3) Monitor and record

patients intake and output

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 PHARMACOLOGICAL REVIEW OF DRUGS

i. Capsule Ciprofloxacin 500mg bd x 5/7

ii. Tab paracetamol 500mg tds x 3/7

iii. Tab vitamin C 200mg tds x 3/7

Name of Drug Class Indication Dosage/Route Side Effects Contraindicatio Nursing

n Responsibility

Ciprofloxaxin Antibiotics Infections 500mg bd Anemia, Nausea, Hypersensitivity, Nursing

caused by S. vomiting, renal disease, responsibilities include

typhi diarrhea, severe hepatic monitoring for adverse

abdominal pain, disorder effects, ensuring

itching, rashes, adequate hydration,

headaches and educating the

patient on the

importance of

completing the full

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 course of treatment

Paracetamol Non-opiod Mild pain or 500mg tds or Anemia, Hypersensitivity Nursing

analgesic, fever PRN leukopaenia, liver responsibilities include

anti-pyretic damage, jaundice, monitoring for adverse

rash, itching. effects, ensuring

adequate hydration,

and educating the

patient on the

importance of not

exceeding the

recommended dosage

Vitamin C water- vitamin C 200mg tds The drug can Allergy Nursing

soluble deficiency cause side effects responsibilities include

vitamin such as nausea, monitoring for adverse

vomiting, and effects, ensuring

stomach cramps adequate hydration,

and educating the

21
 patient on the

importance of taking

the drug as prescribed

22
Progress and Discharge Summary

Miss E.M, a 14-year-old female, was admitted to the hospital ward on 8 May 2022 with a

diagnosis of typhoid fever. She presented with symptoms of fever, abdominal pain, and

vomiting. Her vital signs on admission were: temperature 39°C, pulse 110 beats per minute,

blood pressure 100/60 mmHg, and respiratory rate 24 breaths per minute. She was hydrated with

intravenous fluids and given the following medications: capsule ciprofloxacin 500mg twice daily

for 5 days, tablet paracetamol 500mg three times daily for 3 days, and tablet vitamin C 200mg

three times daily for 3 days.

During her stay, she received nursing care based on the following diagnoses: acute pain related

to presence of traumatized tissue evidenced by grimacing and verbalization, hyperthermia related

to disease process evidenced by temperature of 39°C, and fluid volume deficit related to

vomiting. The nursing interventions included: assessing and monitoring her pain level and

administering analgesics as prescribed, monitoring her temperature and applying tepid sponge

baths as needed, encouraging oral fluid intake and recording her intake and output, providing

comfort measures and emotional support, and educating her and her family about typhoid fever

prevention and treatment.

She showed improvement in her condition and was discharged on 12 May 2022. Her vital signs

on discharge were: temperature 36.5°C, pulse 80 beats per minute, blood pressure 110/70

mmHg, and respiratory rate 18 breaths per minute. She was advised to complete the course of

antibiotics, avoid spicy and oily foods, drink plenty of water, and follow up with her primary

care provider in one week. She was also given a prescription for oral rehydration solution to take

at home as needed.

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Advice on Discharge

Advice was given in the following key areas

(1) Medication

- Advice patient to take home medication following right durg, frequency, disease and

timing

- Encourage patient to follow drug regimen especially antibiotics, to prevent resistance

(2) Environment

- Instruct patient to stay in calm, quiet

- Home environment must be free from slipping or accident hazards

(3) Treatment

- Inform patient to have a follow-check up after 1-2 weeks.

(4) Health Teaching

Inform patient about proper food handling techniques as necessary

- Stress the importance of proper hygiene like hand washing, toileting, tooth brushing and

bathing.

- encourage client to engage in range of motion exercises

- Instruct patient and significant others to drink only purified/boiled water.

- Advice patient to increase fluid intake for hydration purposes.

- Advise patient to avoid eating foods from outside sources.

(5) Instruct patient to report signs and symptoms of typhoid fever like high grade fever,

diarrhea etc.

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Recommendation

 Water should be boiled or chlorinated (water guard) before use as drinking water.

 Community should be informed and educated on the prevalence of typhoid fever and on

ways to prevent it.

 Proper sanitation and drainage is needed to prevent such disease.

 Local government should work on building manual borehole at the rate of one borehole

to 15 houses.

Conclusion

Typhoid fever is one of the most common worldwide illness most specifically in third world

(developing) countries such as ours, this is the question of sanitation since this disease is

transmitted through ingestion of food or water which is improperly prepared and contaminated

with faeces of an infected person.

25
 REFERENCE

Anne W, Allison G. Ross and Wilson Anatomy and Physiology in health and illness 10 th editon.
Elsevier limited Philadelpia 2016.

Billings, Diane McGovern, Medical-Surgical Nursing. The C.V mosby company y. 11830
westline industrial drive, T.S Louis, Missouri 1987.

Bullock, Barbara . Pathophysiology 4th edition. Lippincott williams and wilkins company,
Philadelphia, pennyslvania 2018.

Kozier, Barbara, et al. fundamentals of Nursing 5th edition, Addison longman inc. Singapore
2015.

Rotimi W. Nursing process: an effective tool for qualitative Nursing care 2 nd edition . creative
books, Ibadan, Nigeria 2019.

Smeltzer M, Bare, et al. Brunner and suddarth, Textbook of Medical surgical Nursing 12 th
edition. Lippincott williams and wilkins company, Philadelphia, pennyslvania 2018.

Internet
Wikipedia. http://en.wikipedia.org/wiki/typhoid_fever

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