WORLD CITI COLLEGES ANTIPOLO CITY

WORLD CITI’S COLLEGE OF NURSING

Case Study on

TYPHOID FEVER

Station Unit (QMHCH)

Prepared by:

III-A Group A2

ETRATA, SHEENAH MELISSA G.

BSN 04-00466

Prepared to:

Mr. DANILO CASTILLO

Clinical Instructor

Date submitted: August 14, 2006

INTRODUCTION

BACKGROUND

Typhoid fever, also known as enteric fever, is a systemic infection by Salmonella

typhi or by the related but less virulent Salmonella paratyphi. Since ancient times, these

bacteria have thrived during wartime and during the breakdown of basic sanitation.

Archeologists have found S typhi in Athenian mass graves from the era of the

Peloponnesian Wars, implicating it as the cause of the Great Plague of Athens. S typhi

persists mostly in developing nations where sanitation is generally poor. Although

sporadic outbreaks occur in developed nations, most individuals with typhoid fever in

such areas have recently returned from travel to an endemic region.

Of all Salmonella serotypes, only S typhi and S paratyphi are pathogenic

exclusively in humans. Typhoid fever is a severe multisystemic illness characterized by

the classic prolonged fever, sustained bacteremia without endothelial or endocardial

involvement, and bacterial invasion of and multiplication within the mononuclear

phagocytic cells of the liver, spleen, lymph nodes, and Peyer patches. Typhoid fever is

potentially fatal if untreated.

People are typically infected with S typhi and S paratyphi through food and

beverages contaminated by a chronic stool carrier. Less commonly, carriers may shed the

bacteria in urine. Individuals may also be infected by drinking sewage-contaminated

water or by eating contaminated shellfish or faultily canned meat.

Salmonella is a genus in the family Enterobacteriaceae that has more than 2300

serotypes previously described in the Kauffman-White schema. Salmonellae are gram-

negative, flagellate, nonsporulating, facultative anaerobic bacilli that ferment glucose,

reduce nitrate to nitrite, and synthesize peritrichous flagella when motile. All but S typhi

produce gas upon sugar fermentation.

Salmonellae are grouped based on the somatic O antigen and further divided into

serotypes based on flagellar H and surface virulence (Vi) antigens. In particular, S typhi,

the cause of typhoid fever, has O and H antigens, an envelope (K) antigen, and a

lipopolysaccharide macromolecular complex called endotoxin that forms the outer

portion of the cell wall. S typhi, S paratyphi C, and Salmonella Dublinare the only

Salmonella serotypes that carry Vi antigen. Based on DNA studies, all salmonellae are

now considered one of two species: Salmonella enterica (formerly called Salmonella

choleraesuis) and Salmonella bongori. S enterica has 6 subspecies (I, II, IIIa, IIIb, IV,

VI); S bongori has one (V). S typhi and S paratyphi are S enterica I subspecies, serotypes

typhi and paratyphi

DEFINITION

Is a genital infection caused by Salmonella Typhi, involving primarily the lymphoid

tissues (Peyer’s Patches) of the small intestine, is a bacteria infection transmitted by

contaminated water, milk, shellfish or other foods.

CAUSATIVE AGENT: Salmonella Typhi, S. Typhi

SYNONYM: Enteric Fever, Typhus Abdominali

MODE OF TRANSMISSION: Direct or indirect contact with patient or carrier.

Principal vehicles are food and water. Contamination is usually by hands of carrier. Flies

are vector.

SYSTEM AFFECTED: (Typhoid Fever) Gastrointestinal, Pulmonary, Skin/exocrine

INCUBATION PERIOD: 5-40 days (mean: 10-20 days) Varies: average 2 weeks, usual

range 1 to 3 weeks.

PERIOD OF COMMUNICABILITY: As long as typhoid bacilli appear in excreta:

usually from appearance of prodromal symptoms from first week throughout

convalescence.

ETIOLOGY AND EPIDEMIOLOGY: Caused by Salmonella Typhi/Typhosa;

Salmonellosis - which is harbored in human excreta.

- the causative agent is a gram negative motile and nonperforming

bacillus

- the organism is pathogenic only for man

- it is identified by biochemical reactions and serological groupings ad

typing of its antigen O (sematic), H ( flagellar) and Vi (carbohydrate

envelop)

- it is a hardy organism and easily survives in natural habitat like water

or in organic material.

- SOURCES OF INFECTION

- a. Spread chiefly by carrier, patient’s who have recovered from the

fever but whose stools; urine may spread these bacilli for years.

- b. The ingestion of infected oysters or shellfish taken from waters

contaminated by offshore sewage disposal depots.

- c. Certain drugs substance of animal origin may be contaminated; a

potential danger.

- MODE OF TRANSMISSION

- Fecal oral route

- a. Contracted from contaminated foods, milk, products, seafood and

shellfish and by drinking contaminated water.

- b. Files- may be a vector in transmission of the disease

- c. Asymptomatic carriers, especially food handlers0 are responsible for

infecting a large number of cases.

- INCIDENCE

- a. World-wide distribution

- b. Endemic particularly in areas of low sanitation levels like urban

deprived communities.

- c. It occurs anytime of the year but especially from May-August

- d. The infection is generally milder in the young.

- e. Commonly seen in the individual between 16 and 30 years of age,

but all ages may be affected including the very young.

- f. There is increase incidence during foreign travel (certain areas of the

developing world) and in microbiology laboratories.

OBJECTIVES

GENERAL OBJECTIVES:

Gain knowledge and understanding about Typhoid Fever

SPECIFIC OBJECTIVES:

a. To determine the possible causes of Typhoid Fever

b. To understand the disease process.

c. To determine the proper nursing interventions and proper treatment for the

disease.

THEORETICAL FRAMEWORK

Myra Levine

She advocated that nursing is a human interaction and put forth 4 conservation

principles of nursing which are concerned with the unity and integrity of the individual.

1. Conservation Of Energy

In order for our body to function accordingly it must utilize energy.

Energy inputs such as food, oxygen and fluids are essential for the human body to

produce energy output.

Conservation of energy must be considered important in dealing with

adult undergoing typhoid fever. Proper oxygenation, fluids and

nourishment should be provided to facilitate maintenance of health.

2. Conservation Of Structural Integrity

The human body is composed boundaries (skin, mucous membranes) that

must be sustained to facilitate health and prevent harmful agents from entering the

body.

It is important to emphasize that when dealing with adults, aseptic

technique be strictly followed. This is protect adult form further

contamination of microorganism.

3. Conservation of Personal Integrity

The nursing intervention is based on conservation of individual clients

personality

Every individual has a sense of identity, self worth and self-esteem,

which must be preserved and enhanced by nurse.

Our duty as nurse not only focuses on the physical needs of our

patients but also its psychological, emotional and spiritual needs as

well. Whether we are giving service to and infant or an adult we must

never forget to minister to their needs with the outmost respect.

4. Conservation of Social Integrity

Social integrity of the client reflects to the community in which he

functions.

Family plays a big role in rendering effective care on the patient. Or

duty is to educate and explain to the family the condition of the patient

and at the time help them be involved in rendering care.

`

Conservation of Structural IntegrityConservation of

Personal integrityADULT

Conservation of Social Integrity

Conservation of energy

NURSING ASSESSMENT

PATIENT’S PROFILE

Demographic data of patient

Name of the Hospital: Queen Mary Help of Christian Hospital

Hospital Code: *******

Hospital No: ******

Patient’s Name: Mrs. E. R

Sex: Female

Birthday: May 4 1974

Age: 32 years old

Birthplace: Binangonan Rizal

Father’s Name: Mr. R. R.

Mother’s Name: Mrs. P. R.

Nationality: Filipino

Religion: Roman Catholic

Admitting Physician: Dr. J. M.,MD

Admitting Clerk: Mr. T.M.A

Admission Date: July 30, 2006

Type of Admission: Old

Admission Diagnosis: Typhoid Fever

Chief Complaint

Fever and Vomiting

History of Past Illness

During my shift. I interviewed my patient and report that she don’t have

any disease in the family

History of Present Illness

Two days prior to admission the patient experienced high grade fever, weakness,

discomfort, easy fatigability, severe headache vomiting due to these condition she

was advised to consult to a doctor to prevent further complications.

PSYCHOSOCIAL HISTORY

Mrs. E.R has good relationship with her family and friends. She used to go out

with her friends, watch movie, shopping, roam at the mall, eat together and chat. She

likes going out after work and meet her friends frequently. She work 8 hours a day and

able to have good working relationship with her co-workers and her boss as well. When

she is in high school she was voted as the class PRO because she can interact with

different kinds of people and when she stepped on college she was again voted as PRO.

During my shift I noticed that she used to talk a lot with her friends through her cell

phone.

PHYSICAL ASSESSMENT

Mc CAIN 13 Areas

I. SOCIAL STATUS

During my shift at Queen Mary Help of Christian Hospital I was

assigned in room 222, my patient’s name is Mrs. E. R. 32 years old. Married and

permanently living at Binangonan Rizal. She finishes college and now working as an

employee to a government agency. Her attending physician is Dr. J. M.,MD. She likes

going out with her friends, chatting. She is also fond of watching TV, collecting CD’s

DVD’s. At the hospital, she is approachable and easy to talk with. In spite of her

condition she always asks questions to every nurse who delivered her care. We had a

good client-nurse interaction with our patient.

II. MENTAL STATUS

Level of consciousness:

The patient is conscious and coherent; the client is oriented

to person, place and time. She’s aware of what is happening to her surroundings. She can

take actions and can respond to her environment/stimuli.

III. EMOTIONAL STATUS

. Patient reports concerns about existing condition, but is generally

calm.

IV. SENSORY STATUS

The patient’s senses are in its proper functioning.

Vision : His vision is clear, sclera is white, pupils dilated, iris is

Black.

Hearing : Can hear sounds audibly.

Taste : Can recognize the palate of his food well.

Touch : Can respond to stimuli, able to differentiate hot,

cold, and warm..

Smell : Can distinguish scents, smell and odor.

V. BODY TEMPERATURE

During the first interaction with the patient, she was

febrile. Her body temperature was 37.8◦C within

the normal range of 36.5-37.2◦C taken through axilla.

VI. MOTOR ABILITY

The patient is mobile; she can move her upper and lower

extremities in moderation. Cannot tolerate prolong, lengthy and

intense activities. Can walk at slower pace.

VII. RESPIRATORY STATUS

Patient has a normal RR of 20 and not using any respiratory aids.

VIII. CIRCULATORY STATUS

Patient has normal BP of 120/80 mmhg and a pulse rate of 92.

IX NUTRITIONAL STATUS

Prior to admission patient’s regular meal is more on

meat and vegetables (lutong ulam na nabibili sa palengke). Upon

admission, the patient was advised DAT as her diet.

X. ELIMINATION STATUS

The patient is able to excrete waste products from her

Digestive tract consciously. Is able to maturate.

Stool: Urine:

Consistency: Semi-solid Consistency: concentrated

& scanty.

Color: yellow Color: amber

Frequency: 1-2 times a day Frequency: 4-6 times.

10cc/hr

XI. REPRODUCTION

The patient has 2 children, the youngest is 19 years old and the

eldest is 21. She was married when he was 22 years of age and blessed her

having a child right away.

XII. STATE OF PHYSICAL REST AND COMFORT

Patient declared have an average sleep of 4-5 hours every night. She can’t

take a nap every afternoon because she has work. Restless and irritable due to his present

conditions suffered and not comfortable in lying position. She’s more comfortable

lying on bed on a high fowler’s position.

XIII. STATE OF SKIN AND APPENDAGES

The skin appears pale, cold and clammy. Has rashes, no pallor, no

edema. Has good skin turgor and integrity. Hair is fairly

distributed.

USUAL PATTERN OF DAILY LIVING

Before Hospitalization

Mrs. E. R. is a hardworking person and working on a government agency,

Her activities are, she used to cook at home, love to eat, she washed clothes and

clean the house during weekend and attend mass every Sunday. She also attends

her prayer meeting every Wednesday night after work. She used to go out with

her friends every night after work. She used to have vacation every summer, holy

week and Christmas season. She like to play badminton, volleyball, play cards ,

play archery with her high school peers, swimming with her husband and family.

During Hospitalization

During my Shift at Queen Mary under my CI Mr. Danillo Castillo, I was

assigned to room 222 my patient is Mrs. E. R.Mrs E. T is somehow quiet and

irritable especially with her existing condition but she is cooperative. She’s not

feeling well and fell tired easily. She wants to go home and wants to go back to

work.

ANATOMY AND PHYSIOLOGY

GASTROINTESTINAL TRACT

GI TRACT  

Your gastrointestinal, or "GI" tract, runs from your mouth all the way to your

anus.  It is essentially a very long and windy tube through which food is broken apart,

digested, and the nutrients absorbed into your system.  To get a good understanding of

the process which turns your lunch into a BM (Bowel Movement), lets follow the course

of a turkey sandwich with mayo and lettuce through your GI tract.

You start off by taking a bite out of the sandwich and your teeth chew it up.

Saliva (water and enzymes) from your salivary glands (parotid, sublingual, and sub

maxillary) moistens the food and begin to digest the starch in the bread.  A chewed up

ball of sandwich (bolus) in your mouth then is swallowed and travels down your

ESOPHAGUS. The ESOPHAGUS is a muscular tube about 22-30 cm long that passes

through the middle of your chest, through your diaphragm, and attaches to

your STOMACH.  A SPHINCTER - a muscle that works like the drawstring of a purse -

relaxes to let the food into your stomach, and then tightens to keep food from going back

up the esophagus.  Your stomach makes hydrochloric acid and enzymes which break

down the protein - in this case, the turkey. If the sphincter isn't working just right, one

gets the acidic stomach contents refluxing back into the esophagus.  This is Gastro-

Esophageal Reflux Disease, or GERD.  This is also known as heartburn. The stomach is

very muscular and also acts to grind up the food by squeezing and relaxing. Okay, our

turkey sandwich is now essentially mincemeat. What next?  

   

The stomach is connected to the SMALL INTESTINE, and another sphincter

opens to let the food through.  The small intestine is another hollow tube.  If fully

stretched out, it would measure between 15 and 34 feet.  It's divided into three sections. 

You can't tell where one section starts and the other stops with the naked eye - only under

a microscope. The three sections, in order, are: the DUODENUM, the JEJUNUM, and

the ILEUM.

Our chewed-up sandwich now enters the DUODENUM.  The LIVER makes bile,

which is green and helps the digestion of fats. Bile is stored in the GALL BLADDER,

and conveniently squirted into the DUODENUM when food enters. PANCREATIC juice

also enters the duodenum. The PANCREAS makes strong enzymes which help break

down the fats, carbohydrates, and proteins in the mayonnaise, bread, and turkey,

respectively. This is where most of our sandwich is fully broken down! The pancreatic

juice also contains bicarbonate, which neutralizes the strong hydrochloric acid the

stomach has contributed to the mixture.

The tail end of the DUODENUM, the JEJUNUM and the ILEUM absorb the

nutrients from the broken down food. They also reabsorb water from the food mixture,

and from all the saliva and other secretions that were used to break down the food.  The

small intestine also contains helpful bacteria which aid the digestion of certain vitamins.

It may take 2-4 hours for food to pass from one end of the small intestine to the other

PATHOPHYSILOGY/SYMPAHTOLOGY

Predisposing Factor:- Contaminated water, food or drink.

Ingestion of Salmonella Typhosa / typhi

Contaminated food/ water, feces. Fingers, fomites and flies.

GIT invading small intestinal mucosa

Transverse the intestinal lymphatics,Mesenteric

Peyers Patches (lower ileum)

Lymph flow

Thorasic duct

Blood stream

Etiologic agent in the blood circulation.

Bacteremia- secondary to the infection of liver, spleen bone marrow and lymph nodes

In the liver and kidneys, the focal necrosis of parecheymal cells at the site colonization lyphoid tissue hypertrophy abd hyperplasia.

‘

signs and symptoms:Sever headache

feverLoss of appetite

General discomfortRash (rose spots)

Abdominal pain with distention hepatomegaly

Constipation with diarrheaStools bloody

Slow, sluggish lethargic.

Assessment Nursing Diagnosis

Planning Intervention Rationale Evaluation

Subjective Cues: “Nang-hihina

talaga ako” as verbalized by the patient.

Objective Cues: vital signs Temp.- 37.2 RR- 20 cpm PR-92 bpm BP- 120/80

mm hg Irritable Weakness Fatigue Discomfort

Activity Intolerance related to generalized weakness as manifested by report of fatigue or weakness.

After 8 hours of nursing intervention, the patient will participate desired activities and report measurable increase in activity tolerance..

1. Identify presence of factors contributing to fatigue

2. Evaluate current limitations of deficit in light of usual status

3. Note patient reports of weakness fatigue, pain difficulty accomplishing tasks.

4. Identify activity needs versus desires.

5. Assess emotional /psychological factors affecting old current situation.

6. Monitor vital signgs, watching for changes in blood pressure, heart and

1. Serves as baseline data.

2. Provides comparative baseline

3. To identify degree of weakness, fatigue and pain.

4. To facilitate the needs and desires of patient and lessen irritability and discomfort.

5. Stress and depression may be increasing the effects of an illness or depression might be the result of being forced into inactivity.

After 8 hours of nursing intervention, patient is slightly participating in activities and reports increase in activity.

respiratory rate, note skin pallor/cyanosis and presence of confusion.

7. Adjust activity reduce intensity level or discontinue activity that cause undesired physiological changes.

8. Increase exercise/activity levels gradually: teach methods to conserve energy, sitting down instead of standing to brush hair.

9. Plan care with rest periods between activity

10. Provide positive atmosphere, while acknowledging difficulty of the situation for the patient

11. Encourage expression of

6. To assess changes that may affect patient health condition.

7. To prevent overexertion.

8. It provides to conserve energy.

9. T reduce fatigue

10. Helps to minimize frustration, rechannel energy.

11. TO assess emotional feelings of the patient.

12. To enhance ability to participate in activity.

13. To increase activity of the patient.

14. To establish individual goal and to reach agreement for the most

feelings contributing to/ resulting from condition.

12. Promote comfort measures and provide for relief of pain.

13. Plan for maximal activity with the patient’s ability.

14. Review expectations of patients providers and explore conflicts/differences.

15. Instruct pt/SO’s in monitoring response to activity in recognizing signs/symptoms.

16. Give pt information that provides evidence of daily/weekly progress.

17. Assist pt to learn and demonstrate

effective plan.

15. It indicate need to alter activity level.

16. To sustain motivation.

17. To prevent injuries.

18. To enhance sense of well being.

appropriate safety measures.

18. Encourage pt to maintain positive attitude suggest use of relaxation technique such as visualization/guided imaginary as appropriate.

Drug Name Action Indication Contraindication Adverse Reactions Nursing Responsibilities

Generic name: Chloramphenicol

Brand name:Chloromycetin

Classification:CloramphenicolDosage:

Inhibits protein synthesis; nay be bacteristatic or bactericidal depending on concentration..

Typhoid fever and other infectious caused by chlorampericol sensitive organism.

Trivial infection: anemia esp. aplastic anemia, history o hypersensitivity or toxic reactions, concurrent therapy with other bone marrow depressing

GI intolerance: neurologic reaction: hypersensitivity,superinfection; gray baby syndrome,reversible bone marrow depression, aplastic anemia.

If patient has more that a superficial infection anticipates using systemic therapy as well.

Adult and Children 50-100 mg/kg in 4 divided doses.

drugs. Pregnancy and lactation.

Drug Name Action Indication Contraindication Adverse Reactions

Nursing Responsibilities

Generic name:Amoxicilin

Brand name:Trimox,Amoxil,biomox

Classification:Penicillin-anti infective

Dosage:Adult Oral/IM 250-500 mg 5-8 hrly.

An aminopenicillin that inhibits cell wall synthesis during bacterial multiplication. Bacteria resist amoxicillin by producing penicillinanses- enzymes that hydrolite amoxicillin.

Respiratory tract, skin and soft tissue , veneral pelvic severe systemic infections, UTI, dental adscess.

Hypersensitivity to penicillin

Diarrhoea, indigestion, urtical or erythemtous rash, hepatitis.

If large doses are given or if therapy is prolonged, bacterial or fungal super infection may occur, especially in elderly, debilitated, or immuno suppressed patients.

Drug Name Action Indication Contraindication Adverse Reactions

Nursing Responsibilities

Generic name:Ciprofloxacin

Brand name:Xipro

Classification:quinoles

Inhibits bacterial DNA synthesis, mainly by blocking DNA gyrase; bactericidal.

Treatment of infections of the respi tract, sinuses, eyes,kidneys and UTI, genital organ,abdomen, skin and soft tissue, bones and

Hypersensitivity to ciprofloxacin otr othe quinoles.

Nausea, diarrhea, vomiting, dyspepsia, abdominal pain, anorexia, dizziness headache and tiredness,.

Long term theraphy may result in over growth of organism resistant to ciprofloxacin..

Dosage:Tab 125-750 mg orally bid

joints.

THE DO’s

Take the antibiotics as ordered and until finished. Increase fluid intake and stay on liquid diet until the diarrhea stops. Advance to high-calorie diet after diarrhea stops Isolate the patient or have him use a separate bathroom Scrub the bathroom with a bleach solution after use Wash hands thoroughly and frequently Use tepid sponge baths to reduce fever. Rest in bed until symptoms subside.

THE DON’Ts

Don’t skip doses or stop antibiotic until finished Don’t use aspirin or aspirin derivatives for fever because these medications irritate the intestinal tract. IF the water suplly is of questionable safety, don’t eat rwas fruits or vegetables unless you peel them yourself.

EVALUATION

PROGNOSIS

The mortality rate in typhoid fever is low provided early diagnosis

and management are made and no complication will occur.

DISCHARGE PLANNING

Prevention:

1. Isolation of patients

2. Care of exposed persons

3. Prevention

-Typhoid vaccine, 1 subcutaneously injection followed by 2nd injection $

or more weeks later; booster injection every 3 years for selected individuals.

- Vaccination should be under taken in individuals with risk of exposure

- Immunization- reduces the risk active disease.

4. Maintain Environmental Hygiene and Public Health Measures- are important

in the prevention of the disease.

a. Protect and purify water supplies.

b. Employs sanitary waste disposal techniques.

c. Pasteurize milk and dairy products; refrigerate while transporting.

d. Avoid eating fresh, uncooked vegetable and unpeel fruits (in endemic

areas) that have not been washed in iodinated or chlorinated water.

e. Ensure that food handlers use hand washing facilities.

5. The patient must followed with routine stool culture after recovery detect the

development of the carrier state- approximately 2%-5% of typhoid patients

become permanent carriers, harboring the organism and excreting it their urine

and stools.

a. carriers may be given ampicillin or amoxicillin to attempt to abolish

carrier state ( There is evidence that treating certain patients with salmonella in

their stools may prolong the carrier state)

b. Positive chronic carrier state – documented evidence of S. typhi in stool

or urine for 1 year or more.

c. Carriers must not become food or milk handlers.

HEALTH TEACHINGS

NURSING INTERVENTIONS:

1. Give supportive care- typhoid fever is a nursing challenge.

a. Maintain or restore fluid and electrolyte balance especially in infants.

b. Support the patient during period of toxemia- the patient may be

drowsy partially in continent or delirious.

c. Position the patient to prevent aspiration.

d. Watch for bladder distention – the patient may be lose of urge to void

during toxic state. Keep I and O record.

e. Encourage a high fluid intake- the patient may become dehydrated

from high insensible water loss, vomiting and/ or diarrhea and poor

oral intake.

f. Take rectal temperature every 2-4 hours- give fever sponge for

temperature of 40 degrees Celsius or higher.

g. Observe for retention of feces.

1. Enemas are given under low pressure to diminish change of

intestinal perforation.

2. Relieve ditention with rectal tube, inserted for a short time.

h. Give a high calorie, low residue diet during febrile stage.

i. Give non-gastric forming foods or non-irritating foods and vitamin B

complex.

2. Watch for complication which can occur after an apparent clinical cure.

a. Perforation of intestine- from erosion of one the ulcers;most common

during the 3rd week.

1. Symptoms: sharp abdominal pain- may stop suddenly,

abdominal rigidity and shock.

2. Treatment: Prepare for intestinal decompression procedures.

Intravenous fluids and surgical intervention if conservative

measures do not produce clinical improvement.

b. Intestinal Hemorrhage- from crosion of blood vessels in ulcerated and

small intestine ( occurs in 10% of patients)

1. Clinical manifestation: apprehensions,sewating; pallor,weak

rapid pulse, narrowing pulse rate:hypotension; bloody or taryy

stools.

2. Treatment: withhold food and give blood transfusion.

c. Other complications: thrombophlebitis, urinary infections, cholecystitis,

meningitis, osteomyelitis

3. Practice proper hand washing.

4. Employ sanitary waste disposal.

5. Protect and Purity Water supplies.

6. Pasteurize milk.

7. Proper food handling and preparation.

LABORATORY EXAMINATION

A. Hematology Test

Laboratory exam

Normal Values Results Clinical Significance

Hemoglobin 170-220g/l 161g/l As the number of RBC decreases, so does the Hgb concentration decreases due to insufficient oxygenation because of prolong labor. It may also indicate iron deficiency anemia.

Hematocrit 0.55-0.68% 0.39% The lower the percentage of the hematocrit in the cells the lower the RBC contents.

RBC 4.7-6.1mil/mm3 4.2 Decreased in RBC may indicate insufficient circulation of oxygen and carbon dioxide in the body

WBC 4.800-10,800/mm 11,200/mm Elevated WBC indicatesinfection

Neutrophils 40-74% 58Lymphocytes 19-48% 42Basophils 0-0.01 0.01Eosinophils 0-7% 2Platelets 130,000-

500,000/mm3234,000

B. Urinaysis (UA)

Color Amber Specific gravity 1.005-1.030pH 5.0-8.0Glucose (+)Sodium 10-40Potasiium < 8 mEq/lChloride < 8 mEq/lProtein Negative –traceOsmolarity 500-800

Research Paper helphttps://www.homeworkping.com/