Case Study Report On Salmonella Treatment In Clinical Setting
The parents state that the onset of symptoms starting shortly after they had their last meal at Caribbean Sea which is a seafood restaurant in the Caribbean where they had gone for vacation. After, this meal they were leaving to return home. Since, their return the patient has had an ample amount of loose watery stools and has had a fever that keeps increasing(patient is warm to touch).
On the way back to the U. S. after the trip the patient was continuously complaining of feeling nauseous and having a pounding headache(pain 8/10). Patient is tearful during interview due to stomach ache. Later on in the interview, she tells me that on their trip they ate out almost every night and had tried many seafoods as well as many exotic fruits. The last meal she had eaten cooked and raw tuna sushi. When questioned about other symptoms such as, chest pain, difficulty breathing, cough, fever, or chills the patient denied confidently. The patient’s past is overall healthy with no past medical history. Patient also has no past surgical history. Socially the patient attends school and participates in multiple different sports(soccer, swimming, and track). Patient has no known allergies. After reviewing the patient's GI symptoms yields positive findings for diarrhea, nausea, headache, and abdominal cramping.
All other systems in the body are negative for abnormalities. Objective DataVital signs taken at 0800: oral temperature 38. 7(101. 6 F) degrees Celsius, blood pressure 116/74 taken on right arm manually, heart rate 132 bpm apically(normal sinus rhythm), oxygen saturations 100% on room air, respirations 28, unlabored/chest is symmetrical. Patient is awake and oriented to self, time, and place. She appears tearful. Neuro check done, patient is neurologically intact with bilateral equal strength in upper and lower extremities. Lungs clear and bilateral in upper and lower lobes. No use of accessory muscles when breathing. Perfusion intact, capillary refill within normal limits; less than 3. Skin is pink, warm, dry, and intact. Patients mucous membranes are dry. Bowel sounds noted in all four quadrants(hyperactive-with the increase in intestinal motility, this is expected)). Patient complains of pain 9/10 in the abdomen. Patient is voiding normal amounts of clear yellow urine without difficulty(30 ml/hr). Last bowel movement noted at 0730, stool loose, watery diarrhea. No blood noted in the stool. Diagnostic values include the following: WBC 11,000, RBC 3. 7, Hemoglobin was 12. 2 and Hematocrit 38%, Platelets 215, Sodium 2. 8(dehydration from diarrhea), Potassium 4. 4. Patient is on no medications currently. A stool test was ordered for this patient. Since the return from the Caribbean vacation and the information given from the parent on this child, on the different foods eaten, and being in a foreign country from what I gather this patient is infected with Salmonella.
The results came back positive for Salmonellosis(infection) caused by the bacteria Salmonella enterica Serotype Newport due to the intake of undercooked seafood during vacation in the Caribbean.
Nursing Diagnoses
The first problem concerns the patient’s risk for dehydration. This 9 year old is at risk for deficient fluid volume related to the continuous loss of fluid as evidence by frequent loose watery stools(diarrhea). This patient's second problem has to do with pain in her abdomen. Acute pain related to newly diagnosed infection of the gastrointestinal tract as evidence by complains of pain 9/10 when assessed and elevated blood pressure, heart rate, and respirations.
Plan and Interventions
The patient’s plan of care and interventions will have to do with reducing the patients pain level, increasing the patient's fluid volume from fluid lost, making the patient comfortable during her stay, controlling the patient's nausea, and reducing any further risk of infection(sepsis) by discharge. Interventions will include assessing the client’s pain, including the location, characteristics, precipitating factors, onset, duration, frequency, quality, intensity, and severity using FACES scale. Pharmacological and Non pharmacological methods will be used to control pain. Pharmacological management being, analgesics/antipyretics for pain and fever like Tylenol (WebMD, 2016), antiemetics for nausea, antidiarrheals such as Loperamide(Mayo Clinic Staff, 2016) will help with the cramping, but it is often contraindicated because you want to remove bacteria and diarrhea is the bodies mechanism of removing the bacteria, and lastly IV fluids to correct dehydration and loss of electrolytes like an Isotonic solution such as 0. 9% normal saline (Klochko, 2018). Since this patient does not have a severe case of Salmonella, antibiotics will be held off, as their only used for patients at high risk for a more invasive case of the disease(Klochko, 2018). In children its common to let the infection run its course and clear out on its own (WebMD, 2016). Non pharmacological methods for this patient will include using heat over the stomach to soothe and relax the abdomen. Also, coloring and playing with toys as therapy to distract this little girl from the pain. Encouraging the patient to drink water will help with her dehydration as well. Assessing the patient's vital signs Q2hrs during her stay to notice any further elevation in heart rate, blood pressure, and respirations. Looking out for return of vital signs to normal range is important. Assessing the patients perianal area for any irritation or skin breakdown(NANDA International, 2018) from the constant diarrhea. The goal for this patient is to replenish the fluids lost, get her pain level down to a 0/10, and prevent any further complications by the time of discharge.
This patient's mobility status will be out of bed as tolerated with recommended bed rest for comfort. For this patient, she should be educated that the symptoms will subside on its own in about 5-10 days. For this infection it is most common to be discharged to home between 24- 48 hours as it is safer to be cared for at home rather than in the hospital for this infection. Teaching this patient the importance of good hygiene and handwashing will help prevent and control the spread of different types of illness. Lastly, bland foods will be recommended for this patient to help absorb some of the extra water going through the GI tract. Some foods include, toast, bananas, applesauce, and unseasoned crackers(Johnson, 2017).
Evaluation
Evaluation of the interventions and goals will take place during daily rounds at the patient’s bedside. The patient needs for discharge will be discussed with the patient and the parents. Evaluation of the medications prescribed for this patient will occur throughout shift and after administration. Evaluation of fluid volume status will be continuous throughout the shift. Monitoring of the vital signs will be done Q2 hours to assess for any further problems such as further infection, like sepsis. The patients pain will be evaluated by the cover nurse during hourly rounds, and the patients pain will be 0/10 by discharge. Patient will be educated on her infection and how she can prevent it in the future.
Education will be provided by verbal conversations and informative articles will be given to take home. No medications will be taken home for this patient but encouragement of fluid intake and education on foods recommended will be provided. The patient's goal to reduce her pain level by discharge was met, verbalization of pain 0/10. The patient's goal to increase her fluid volume from fluid lost through diarrhea by discharge was met. Skin is warm, dry, intact, and vital signs were within normal range. Patient goal of prevention of any further risk of infection(sepsis) by discharge was met. No further infection identified. Patient understands the discharge planning and understands that symptoms will subside in 5-10 days. Patient was told to contact health care provider if symptoms do not subside. SummaryIn summary, the patient in this case presentation had presented with Salmonellosis which is a gastrointestinal illness from a bacteria which is called Salmonella enterica Serotype Newport. That bacteria is a gram negative bacilli which is a bacteria that stains red after gram staining(Pommerville, 2013). This bacteria is found in the intestinal tract of humans but can also be found in raw meats, poultry, eggs and unpasteurized milk and it is often more common to occur around summertime(CDC, 2018). The CDC which is Center for Disease control estimates that there is about 1. 2 million illnesses, 23,000 complications, and 450 deaths in the United States every year, children are at the highest risk for developing this infection(CDC, 2018). This 9 year old patient acquired Salmonella through ingestion of raw meat(raw seafood) while on her vacation in the Caribbean(a commonly warm environment).
Other ways of acquiring the disease include, handling animals, drinking contaminated water, and coming in contact with feces from humans or animals(CDC, 2018). With a collaborative effort from the patient, the family, and entire healthcare team through planning, interventions and goals the patient’s outcomes were successful and positive. After education that was provided for the patient, she now knows how she can avoid Salmonella recurrence and what she needs to do to enhance her health status. Through the follow up plans and care that were made specific to this patient's, she has made a full recovery after being discharged 72 hours ago.
