FOOD AND WATER RELATED BY YAA BOAHEMAA ADEROJU Food poisoning Food poisoning refers to consumption of food (solid or liquid) that is contaminated. The contamination could be in the form of micro-organisms (bacteria, viruses, parasites, fungi) or harmful chemical(DDT, kerosene, parazone, etc.) Food poisoning Food poisoning caused by micro-organisms are classified based on the kind of causative agent involved and some of them are; Typhoid Paratyphoid Cholera Dysentery Typhoid and Paratyphoid Fever Typhoid and paratyphoid fever are infections caused by related but different strains of bacteria. They are transmitted from person to person through the fecal-oral route That is when an infected or asymptomatic individual with poor hand hygiene passes the infection to another individual through food or water handling Etiology Causative organism of typhoid is bacteria called Salmonella typhi (S. typhi) Causative organism of paratyphoid is also a bacteria known as Salmonella paratyphi S. typhi or S. paratyphi are transmitted through ingestion of foods (solid or liquid) contaminated with S. typhi or S. paratyphi Decreased stomach pH Poor hygiene Pathophysiology Ingested S. typhi find their way into the distal ileum (Peyer patches), once they survive HCL and digestive fluids in the stomach S. typhi multiply in the ileum and then invade bloodstream and subsequently,other parts of the body like the gallbladder S. typhi re-enter into the intestines through the infected bile and reinfect the Peyer patches S. typhi that do not re-infect the host are shed in stool and can infect other hosts that ingest foods contaminated with faeces containing S. typhi Signs and symptoms Fever (>38ºC) Chills Headache Stomach ache Sweating Anorexia Lethargy Body aches Rose-coloured spots or rushes on chest and/or abdomen Confusion Medical management Since the causative organism (S. typhi) is bacteria, antibacterial are the first choice of treatment once typhoid is diagnosed Examples of antibiotics commonly used are Ceftriaxone, Ciprofloxacin, Azithromicin Symptomatic treatment include adjuvant medications like pain and antipyretics (paracetamol, NSAIDs) Laxatives (eg. Lactulose); if there is constipation Hydrating with IV fluids or ORS if there is dehydration or electrolyte imbalance Corticosteroid (eg. Dexamethasone); if there is complication like delirium, stupor, etc. Vaccination Nursing management Assessment (history taking, physical examination-vital signs, intensity of pain, constipation or dehydration, mental state, nutritional status, etc.) Reassuring patient Nursing management of hypothermia, pain, constipation or diarrhea, anorexia, and other symptoms that patient reports Monitoring fluid intake and output Educating patient on typhoid Administer prescribed medications as prescribed Cholera Cholera is an acute diarrhea infection Its incidence increases during raining season; especially in areas where sanitation is poor Causes of cholera Vibro cholerae is the causative agent for cholera Vibro cholerae is transmitted via eating or drinking foods or drinks that are contaminated with the bacteria The following also increases the probability of being infected with cholera Eating raw or undercooked foods Poor hygiene Reduced gastric pH Travelling Use of antacids, proton pump inhibitors, and histamine receptor blockers Pathophysiology Being able to bypass the stomach, Vibro cholerae establish themselves and colonize the small intestine, attaching themselves to the microvilli and producing endotoxins Cascade of activities leading to increased concentration of cAMP and resulting in increased permeability of electrolytes (Na+, K+, HCO3-) and water into the lumen of the intestines This results in diarrhea and subsequent dehydration as well as electrolyte imbalance Signs and symptoms Diarrhoea; mostly described as ‘rice water stool’ Nausea and vomiting Muscle cramps Dehydration Lethargy Medical management of cholera Antibiotics such as doxyciclin, ciprofloxacin, azithromycin ORS or IV hydration Vacination Nursing management of cholera Assessment (history taking, physical examination-vital signs, diarrhea, dehydration, etc.) Reassuring patient Nursing management of diarrhea, anorexia, and other symptoms that patient reports Monitoring fluid intake and output Monitoring patient’s weight daily Educating patient and family on cholera Administer prescribed medications as prescribed Dysentery Dysentery is an infectious diseases that causes bloody diarrhea Dysentery is classified based on the type of causative agent involved Bacillary dysentery, which is the common type od dysentery results from shigella bacteria. Bacillary dysentery is also known as Shigellosis Amoebic dysentery results from parasite; Entamoeba hystorica Risks of dysentery infection Eating contaminated food (solid or liquid) Bad hand hygiene habit Poor sanitation Pathophysiology Causative organisms of Dysentery (whether bacteria or amoeba) are transmitted through fecal-oral means Shigella bacteria inhabit colon and produce toxins Toxins damage endothelial cells in the microvasculature of the colon This causes bleeding in the colon resulting in fresh or red coloured diarrhea Signs and symptoms of dysentery Bloody dirrhoea Fever Nausea and vomiting Abdominal ache Weight loss Dehydration Electrolyte imbalance Medical management Bacilla dysentery usually resolves on its own within a week by shedding the bacteria in stool Symptomatic treatments are mostly implemented IV fluids to prevent dehydration and electrolyte imbalance Antipyretics for hyperthermia Pain relieving medications; especially NSAIDs, if not contraindicated Nursing management Assessment (history taking, physical examination-vital signs, diarrhea, dehydration, etc.) Reassuring patient Nursing management of diarrhea, hyperthermia, abdominal ache, anorexia, and other symptoms that patient reports Monitoring fluid intake and output Monitoring patient’s weight daily Educating patient and family on dysentery Administer prescribed medications as prescribed
