Shigellosis by Nelson Munthali (DNC/RN)

GROUP 5 MEMBERS1. Alex Mbewe2. Monica Banda3. Rosella Munyenyembe4. Andrew Moyo5. Nelson Munthali6. Mtisunge Wandale7. Jacqualine Ntaba

PRESENTS SHIGELLOSIS

By ALEX ‘ SIAL’ MBEWE

BROAD OBJECTIVE

By the end of this presentation, learners should acquire knowledge on how to manage a patient with shigellosis.

SPECIFIC OBJECTIVESO Definition of shigellosisO Causes of shigellosisO Types O How it is spreadO PathophysiologyO Clinical manifestationsO Medical managementO Nursing managementO Complications

Definition

OThis is an acute bacterial infection of the lining of the intestines (especially large intestines)

CausesShigellosis is caused by a group

of bacteria called shigella (gram- negative organism)

Types

1. Shigella sonei – also called group D. it is responsible for most of the cases

2. Shigella flexineri Also called group B

3. Shigella dysenteriae Can lead to outbreaks in developing

countries

SPREADO Shigellosis is spread through fecal-

oral routeO People with shigellosis release it

through the stoolsO It spreads from one infected person

to contaminate water or food or directly to another person.

O Outbreaks are associated with poor sanitation, contaminated food or water and crowded living conditions

O Common among travelers in developing countries and workers or residents of refuge camps

CLINICAL MANIFESTATIONS

OUsually develop about 1-7 days (average 3 days) after you come into contact with the bacteria

OAcute (sudden) abdominal pain or cramping

OAcute (sudden) feverOBlood, mucus or pus in stoolsOCrampy rectal painONausea and vomiting

OWatery diarrhoeaOAbdominal tendernessODehydration with fast heart rate

and low BpO Loss of appetite

Diagnostic tests

OStool cultureOWhite blood cells in stoolsOElevated blood cell count (FBC)

PATHOPHYSIOLOGYO Once ingested, the bacteria survives the

gastric environment of the stomach and progresses to large intestines

O There, they attach to and penetrate the epithelial cells of the intestinal mucosa.

O After invasion, they multiply intracellulary and spread to neighboring epithelial cells, resulting in tissue destruction.

O It produces toxins that can attack the lining of the large intestines, causing swelling, ulcers on the intestinal wall and bloody diarrhoea.

Pathophysiology cont….

OSeverity of diarrhoea sets apart shigellosis from regular diarrhoea and it is usually associated with bloody or pus stained diarrhoea.

MEDICAL MANAGEMENTO The goal is to replace fluids and

electrolytesO Advise patient on dietO Self measure to avoid dehydration like

drinking electrolyte solution to replace fluids e.g. ORS

O Antibiotics only in severe cases e.g. ampicillin and ciprofloxacin 250mg BD IV-they shorten the length of illness

O Antidiarrhoea agents e.g. Loperamide 2mg BD

O I.V fluids 2-3 litres/24hrs e.g. R/LO Stop taking diuretics

NURSING MGTOASSESSMENT - History of stool pattern and

associated symptomsO FrequencyODurationOCharacterOConsistency of stools

O history of medication use of other drugs known to cause

diarrhoea e.g. laxativesOSocial history

NURSING MGT CONT……

OFamily historyORecent travel, stress, health

and family history of illnessOEating habits, appetite, food

intolerance especially milk and other dairy products

Objective data Lethargy Sunken eye balls Fever Pallor Dry mucous membranes Poor skin turgor Parienal irritational Malnutrition Concentrated urine

Physical examinationOVital signs and weight measurementOPatients’ skin is inspected for signs

of dehydrationOPoor turgor and dryness and area of

breakdown of the skinOAbdomen

• Distension• Bowel sounds• Palpate for tenderness

Nursing diagnosisODiarrhoea r/t acute infectious

process evidenced by frequent loose and liquid stools

OFluid and electrolyte imbalance r/t diarrhoea and vomiting

ONutritional imbalance; less than body requirements r/t loss of appetite, nausea, vomiting evidenced by weight loss

OAltered thermoregulation hyperthermia r/t to the infection as evidenced by rise of temperature to 38 degrees celsius

OAltered comfort (abdominal pain) r/t increased peristalsis evidenced by patient’s verbalization and facial expression

ORisk for anemia related to blood in stools

ORisk for altered skin integrity related to dehydration

ORisk for Hypovolemic shock r/t loss of fluids due to diarrhoea

Interventions O Commence IV fluids as ordered e.g. R/L – to

replace lost fluids and correct electrolyte balanceO Catheterize – to monitor input and output and balance fluidsO Enforce strict IP measures to avoid cross infectionO Provide small and frequent food to normalize

nutritional status and reduce peristalsis movement

O Administer prescribed antipyretics e.g. panadol 1g tds po. This will act on the prostagrandin of the hypotharamus hence it will reduce fever.

O Administer analgesics e.g. panadol 1g po tds to reduce pain .

complicationsO Intestinal perforationODehydrationOHypoglycemiaOComaORectal prolapseOHypovolemic shockOBacteremiaOPeritonitis

ReferencesO Lewis S.M., Heitkemper M.M and Dirksen

S.R. (2010). Medical surgical nursing assessment and management of clinical problems.(7thed) St Louis:C.V.Mosby

O Smeltzer S.C., Bare B.G and Hinke J.L (2010). Brunner & suddarth’s textbook of medical surgical nursing.(12th ed). Philadelphia:J.B Lippincott

O www.mayoclinic.com