Salmonellosis is a bacterial infection caused by gram-negative bacilli of the genus Salmonella. Sometimes classified as food poisoning because it is frequently acquired by ingesting food that has been contaminated with the Salmonella bacterium, salmonellosis occurs as either enterocolitis, bacteremia, localized infection, typhoid, or parathyroid fever. The most severe form of salmonellosis is typhoid, which can cause perforation or hemorrhage of the intestines, pneumonia, toxemia, acute circulatory failure, and cerebral thrombosis.
Once the Salmonella bacterium is ingested, it multiplies rapidly in the mucosal layers of the stomach and small intestine. The greater the number of organisms ingested, the shorter the incubation period; typically, incubation is 8 to 48 hours after ingestion of contaminated food or liquid, and symptoms usually last for 3 to 5 days. An inflammatory response in the tissues produces gastroenteritis. The infection may stop there, or the salmonella organisms may travel via the lymph and vascular system throughout the body. The dissemination of organisms produces lesions in other organs or, possibly, sepsis. Systemic lesions may result in appendicitis, peritonitis, otitis media, pneumonia, osteomyelitis, or endocarditis. Symptoms of intermittent fever, chills, anorexia, and weight loss indicate sepsis.
Salmonellosis is caused by any of more than 2000 serotypes of Salmonella bacteria. Typhoid is transmitted through ingestion of water that has been contaminated with the feces of infected persons.Salmonellosis may also be contracted by eating infected raw eggs or egg products or
uncooked meat or poultry, ingesting raw milk, or handling infected animals. Salmonella can survive for an extended period of time in water, sewage, ice, and food. Although cooking food thoroughly can reduce the risk of salmonellosis, it cannot eliminate it.
Nursing care plan assessment and physical examination
Establish a history of fever (often 102°F and higher), nausea, abdominal pain, vomiting, anorexia, and diarrhea that has persisted for at least 4 days. Ask about headache or constipation, which are symptoms of typhoid. The first symptoms generally appear between 8 and 48 hours after ingesting the bacteria; ask the patient about possible sources of the infection. Ask if the patient has had recent contact with an infected person or animal. Determine if the patient has ingested uncooked egg or meat products. If so, ask the patient whether the potentially contaminated food was prepared at home or at another location, such as a restaurant or public gathering. Elicit a history of recent travel to other countries that have endemic typhoid.
The patient appears to be weak and pale because of vomiting and diarrhea. Young children and debilitated patients may show signs of dehydration. Fevers range from 101°F to 105°F. Rose spots may appear on the trunk, and joints may be painful. Palpation of the abdomen may be difficult because of tenderness. Stools are usually greenishbrown, watery, and foul smelling. They contain mucus, pus, or blood.
The patient with salmonellosis feels ill and may be apprehensive about the diagnosis. The patient feels guilty if he or she has inadvertently exposed others to the disease through food preparation or angry if he or she has been exposed to the illness at a restaurant or other public gathering. Parents of young children are apt to be anxious and afraid for their child’s life.
Nursing care plan primary nursing diagnosis: Infection related to the presence of the infective organism.
Nursing care plan intervention and treatment plan
Patients with systemic infections are placed on the antibiotic that is most appropriate for their condition. Symptom management is accomplished by fluid and electrolyte replacement and control of fever. Because antidiarrheal and antispasmodic agents slow intestinal mobility, some experts do not recommend their use because they retard the intestinal transit of the infecting organisms.
The patient with salmonellosis is placed on bedrest during the acute phase and should be on enteric precautions until the diarrhea stops. Observe the patient’s stools for consistency and blood. Bleeding or abdominal pain may indicate the complication of bowel perforation; check for a sudden fall in temperature or blood pressure and a rising pulse rate. Many patients with Salmonella infection are not hospitalized but recover at home. Report Salmonella infection to the local health authority, particularly if the patient is employed in a food handling occupation.
Relieve pain and discomfort from diarrhea by using a heating pad on the abdomen and washing and lubricating the anus. Use universal precautions. Employ scrupulous hand-washing techniques before and after working with the patient who has salmonellosis. Wear gloves when you dispose of feces or any objects that have been contaminated by the patient’s feces. Provide regular skin and mouth care, and turn the patient often. While the patient is infected, allow her or him as much rest as possible between activities. Provide a restful atmosphere. To help reduce the patient’s temperature, apply tepid wet towels to the patient’s groin and axillae.
After joint abscesses have been drained, provide heat, elevation, and passive range-ofmotion exercises to decrease swelling and maintain mobility. Explain to the patient the need to report salmonella infections to the local health authority. To prevent future infections, instruct the patient and family to wash their hands thoroughly after defecation and before handling food. Also, instruct the patient to avoid raw eggs or foods prepared with raw eggs, to cook meat and poultry thoroughly, to refrigerate food below 46°F, and to wash the hands after handling animals.
Nursing care plan discharge and home health care guidelines
Instruct the patient and family about the cause, transmission, and symptoms of the disease and preventive measures. Teach the family how to care for the patient at home. Treat mild fever with antipyretics, and maintain a good fluid intake. Ice pops and soda may increase fluid intake for young children. Avoid the use of laxatives. Gradually increase the patient’s activity level as tolerated. Explain the need to report complications of bleeding, dehydration, or the return of symptoms to the physician at once. Be sure the patient understands any medications prescribed,
including dosage, route, action, and side effects. Stress the importance of completing the antibiotic regimen even after symptoms diminish.
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