If Salmonella is the cousin who wrecks your tummy for a week, typhoid fever is the cousin who stays for a month and makes everything dramatic. It sounds old school, but it keeps showing up in NCLEX-style questions because the signs are so distinctive. Let’s go through my notes, then test yourself at the end.
Table of Contents
What is Typhoid Fever?
Typhoid fever (enteric fever) is a systemic infection caused by Salmonella Typhi, a gram-negative bacillus. It is spread through food or water contaminated with feces from an infected person or a carrier.
- Spread by the fecal–oral route (contaminated food, water, and unwashed hands).
- Most common in areas with poor sanitation and unsafe water.
- Humans are the only host, and some people become chronic carriers (bacteria stay in the gallbladder).
- Watch Out For: intestinal hemorrhage, intestinal perforation, dehydration, sepsis.
- Safety Precaution: Standard precautions plus contact (enteric) precautions when there is diarrhea or incontinence.
Pathophysiology
After being swallowed, the bacteria pass through the intestinal wall and are taken up by macrophages, then travel through the lymph system and the bloodstream to the liver, spleen, bone marrow, and gallbladder. They invade Peyer’s patches in the small intestine, and that is how ulceration, bleeding, and perforation happen later in the illness.
- Incubation is usually about 1 to 3 weeks.
- Symptoms get worse in a stepwise pattern over the weeks.
Assessment and Diagnostic Findings
Clinical presentation: A fever that climbs step by step (high, sustained fever), headache, malaise, abdominal pain, and either constipation or diarrhea.
Physical exam
- Rose spots: small pink spots on the trunk and abdomen
- Relative bradycardia (pulse lower than expected for the fever)
- Enlarged spleen and liver
- Coated tongue
Laboratory findings
- Blood culture is the best test early in the illness.
- Stool and urine cultures may be positive later.
- CBC may show leukopenia.
NCLEX Tip: Fever with a slow heart rate and rose spots equals typhoid fever.
Medical Management
- Antibiotics such as azithromycin, ceftriaxone, or a fluoroquinolone. Choice depends on local resistance.
- Fluids, electrolytes, and nutrition support.
- Antipyretics for fever as ordered.
- Surgery for intestinal perforation.
- Chronic carriers may need a longer antibiotic course, and sometimes gallbladder removal.
- Prevention: typhoid vaccine for travelers and people in high-risk areas, safe water, and good sanitation.
Nursing Management
Nursing care focuses on hydration, nutrition, infection control, early detection of complications, and education.
- MONITOR: temperature pattern, heart rate, hydration status, stool, and abdominal assessment.
- Complication watch (usually week 3): sudden severe abdominal pain, rigid abdomen, black or bloody stools, or a sudden drop in temperature with a rapid pulse. Report immediately.
- Infection control: hand hygiene with soap and water, proper disposal of stool.
- Nutrition: small, frequent, soft meals, and adequate fluids.
- Education: Boil or use safe drinking water, wash fruits and vegetables, and wash hands before eating and after using the toilet. Carriers must not handle food for other people until cleared.
- Teach to finish the antibiotics.
NCLEX High-Yield Notes
- Caused by Salmonella Typhi, spread by the fecal–oral route.
- Blood culture is the best early test.
- Rose spots and relative bradycardia are classic.
- Perforation and hemorrhage are the most serious complications.
- Carriers should not work as food handlers until cleared.
Mnemonic (TYPHOID):
- Temperature rises step by step
- You will see rose spots on the abdomen
- Peyer’s patches are damaged
- Heart rate stays slow (relative bradycardia)
- Oral hygiene and handwashing
- Intestinal perforation is the big complication
- Drink safe water
