Transcript fever

PRESENTATION ON FEBRILE
DISORDER
FEVER
FEVER IS AN ELEVATION OF BODY
TEMPERATURE ABOVE NORMAL
WHICH RESULTS FROM AN
IMBALANCE BETWEEN THE HEAT
PRODUCED AND ELIMINATED
FROM THE BODY.
CAUSES OF FEVER
EXOGENOUS
ENDOGENOU
S
• BACTERIA
• FUNGI
• ANTIGEN-ANTIBODY
• MALIGNANCY
• GRAFT REJECTION
EXOGENOUS FACTOR :• INFECTION DUE TO BACTERIA OR FUNGI
• WHICH ACTIVATES THE PHAGOCYTES IN BONE MARROW
• RELEASE OF PYROGEN
• SYNTHESIS OF PROSTAGLANDINS
• THERMOREGULATION CENTRE IN THE ANTERIOR
HYPOTHALAMUS
• INCREASE IN BODY TEMPERATURE
FEVER MAY BE CLASSIFIED AS :ACUTE FEVER
• SHORT DURATION
• RISE UPTO 104°F
• ACCOMPANY
INFECTIONS LIKE
CHICKEN
POX,TONSILITIES,
PNEUMONIA,
MALARIA.
INTERMITTENT
• REPEATED
EPISODES OF
HIGH FEVER
• ALSO CALLED
RECURRENT
FEVER
• MALARIA
CHRONIC FEVER
• LONG DURATION
• TEMPERATURE
MAY REMAIN
LOW BUT FEVER
CONTINUE FOR
LONGER TIME
• TUBERCULOSIS
METABOLISM IN FEVER
 With the rise in body temperature above normal ( 98.4˚F or 37 ̊C )
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the following metabolic occurs inside the body . These changes are
in proportion to the elevation of body temperature above normal and
the duration of fever.
There is a 7% increase in BMR with every 1˚F increases in body
temperature or 13 % increase with every 1˚C rise in body
temperature. This change is more significant in patients suffering
from acute fever.
Glycogen and adipose tissue stores decrease significantly because of
increased energy expenditure.
Rate of protein catabolism increases.
Loss of body fluid in the form of excessive sweat & urine formation.
Increased loss of minerals.
Absorption of nutrients decreases.
SYMPTOMS OF FEVER
 Loss of appetite
 Loss of weight
 Headache
GENERAL DIETARY
CONSIDRATION
ENERGY-:
Increases about 50%.
Restlessness also increases the calorie requirement.
PROTEIN-:
About 100g protein or more is prescribed.
High protein beverages may be used as supplements to the regular meals.
CARBOHYDRATES-:
Glycogen stores are replenished by a liberal intake of carbohydrates.
Glucose is preferred.
FATS-:
Energy intake can be increased through the use of fats.
Fried foods & rich pastries may retard digestion.
MINERALS-:
A sufficient intake of salt is necessary.
Fruit juices & milk are good sources.
VITAMINS-:
Requirement of vitamin A & ascorbic acid with B-complex vitamins are increased.
Oral therapy interfere with the synthesis of B- complex vitamins.
FLUID-:
Liberal fluid intake is preferred.
Daily, 2500-3000 ml of fluid is necessary.
EASE OF DIGESTION-:
Blend, readily digested food should be used.
The food may be soft & of regular consistency.
Fluid diet can be used initially
INTEVALS OF FEEDING-:
Small quantities of food at interval will permit adequate nutrition.
Soft or liquid foods as desired should be offered.
Sufficient intake of fruits & salt is essential.
ACUTE FEVER-TYPHOID
 Infectious disease caused by a bacteria- Salmonella typhi
 Salmonella schottmulleri causes parathyroid B.
 The infection is transmitted through the fecal-oral route.
SOURCES OF INFECTION
SOURCE OF INFECTION
CONTAMINATED FOOD
CONTAMINATED DRINKING
WATER OR MILK
CARRIERS OF THE DISEASE
FAECES & URINE OF THE
PATIENT
CAUSATIVE ORGANISM:SALMONELLA TYPHI
Do not multiply in water.
May survive for over a
month , in ice & ice cream.
Grow rapidly in milk.
Gram- negative
Motile
Grows best at human
temperature.
INCUBATION PERIOD: 10-14 days
DEVELOPMENT OF DISEASESMALL
INTESTINE
BACTERIA
ATTACH TO
INTESTINAL
WALL
PENETRATION
MULTIPLY IN
LYMPHNODES
GENERALISED
SYMPTOMS
LIBERATION OF
ENDOTOXIN
LYSIS OF
BACTERIA BY
ANTIBODIES
REACH BLOOD
STREAM
FEVER
BACTERIA
MOVES TO
LIVER
GALL BLADDER
CONTINUE…..
Secreated into
the intestine
Establish a
secondary
infection
Diarrhoea
Person may
become chronic
carrier
Bacterial
excreation
occur for weeks
TRANSMISSION OF DISEASE
DIAGNOSIS OF TYPHOID FEVER
 Diagnosis is made by any blood , bone marrow or stool
cultures and with the Widal test.
 The Widal test is time consuming and oftentimes when
diagnosis is reached it is too late to start an antibiotic
regimen.
SYMPTOMS AND SIGNS : Continued , high inflammation of the intestine.
 Formation of intestinal ulcers
 Loss of tissue proteins
 Disturbance in water electrolyte balance
 Hemorrhage
 Enlargement of spleen
 Payer’s patches or flat patches of lymphatic tissue.
 Diarrhea or constipation
 Severe stomach ache
 Abdominal absorption of nutrients decrease
 Feeling of headache & anorexia.
TREATMENT :Treatment of typhoid includes-:
 Rest in bed
 Keeping the patient warm
 Antibiotic therapy
 A modified diet
DIETARY MANAGEMENT : To maintain adequate nutrition
 To restore positive nitrogen balance
 To provide relief from symptoms
 To correct & maintain water & electrolyte balance
 To avoid irritation of intestinal tract
 ENERGY-:
 BMR increases by about 50%
 Restlessness also increases the energy expenditure
 Increase energy by 10-20%
 PROTEIN-:
 Increased to 1.5- 2 times than normal i.e. 1.5- 2g protein /kg
body wt/day
 Protein foods of high biological value should be included
 CARBOHYDRATES-:
 A liberal intake of carbohydrate is suggested
 For protein sparing action
•Well cooked, easily digestible carbohydrates should be included.
•More of glucose can be used.
DIETARY FIBRE:•All harsh, irritating fiber should be avoided
FATS:•Emulsified fat should be given
•Fried food should be restricted
MINERALS:•Salty soups, broths, fruit juices, milk etc should be included
•Fe supplementation is also important
VITAMINS:•Increase the amount of vitamin A & C
•Requirement of vitamin B also increases
FLUID:•Liberal intake of fluid is necessary
•Fluid may be included in the form of beverages,
soups, juices, plain water etc.
DIET AND FEEDING PATTERN: As the patient is actually ill and anorexic , a high
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energy , high protein , full fluid diet is recommended.
Small meals at frequent intervals of 2-3 hours.
Sufficient intake of fluids and salt should be ensured.
Easily digested and absorbable:Bland ,low fiber , soft diet should be recommended.
Adequate nutrition:Well cooked , well mashed , semi-sold foods should be
given.
FOODS TO BE USED IN RESTRICTED
AMOUNTS OR AVOIDED
 HIGH FIBRE FOODS LIKE- WHOLE GRAIN
CEREALS, & THEIR PRODUCTS, e.g. Whole wheat
flour, & cracked wheat, whole pulses & pulses with
husk.
 All raw vegetables & fruits
 Fried fatty foods
 Chemical irritants such as- condiments, spices, pickles,
relishes, chutneys, & strongly flavored vegetables like
cabbage, capsicum etc.
FOODS TO BE INCLUDED: Plenty of fluids like- juices & soups
 Milk & milk based beverages
 Low fiber foods such as- refined cereals, & their products,
dehusked pulses, well cooked fruits, vegetable in soft & puree
form & potatoes
 Foods providing protein of high biological value e.g.- eggs,
fish, poultry
 Plain gelatin based desserts, sugars, honey, jam.
MALARIA: CAUSATIVE ORGANISM
PLASMODIUM
P. VIVAX
P. MALARIAE
P. OVALE
P. FALCIPARUM
MALARIA : Is transmitted from human to human by the bite of
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female anopheles mosquitoes.
Induced malaria occurs due to congenital transmission
or transmission by blood transfusion.
MALARIA SIGNS AND SYMPTOMS :Typical malarial attacks show sequentially over 4-6
hrs.
Shaking chills, fever to 41°C or higher & the sweating
stage.
Fatigue, headache, dizziness, GI symptoms, myalgia,
backache & dry cough.
CHRONIC FEVER-TUBERCULOSIS
TUBERCULOSIS
 Is a chronic infectious
disease
 Major cause of illness &
death in the
underdeveloped
countries
 Caused by a bacteria
Mycobacterium
tuberculosis.
CAUSE :POVERTY
IGNORANCE
MALNUTRIT
ION
POOR
SANITATION
UNHYGIENIC
CONDITION
CAUSATIVE ORGANISM:-
 The bacteria most affects the lungs, leading to
pulmonary tuberculosis.
 Infection may be localized in other organs likelymphnodes or kidneys or may be generalised.
 Small, non-motile, aerobic organism
 Gram positive
CLINICAL FEATURES : Pulmonary tuberculosis is accompanied by wasting of
tissues , exhaustion , cough, expectoration ( cough
with respiratory secretion ) and fever.
ACUTE
PHASE
CHRONIC
PHASE
RESEMBLE
PNEUMON
IA
HIGH
METABOLI
C RATE
HIGH
FEVER
LOW
GRADE
FEVER
CONT…..
 As the disease progresses the patient begins to exhibit loss of
appetite , pain in chest ,fatigue , weight loss , night sweats and a
persistent , worsening cough.
 If the blood vessel is eroded in the lungs , the sputum coughed
up by the patient may become streaked with blood , also the
tubercle bacilli may gain access to the blood and transported to
various part of the body, establishing numerous secondary foci of
infection.
 Death ultimately results when sufficient damage has occurred in
the lungs or other vital organs.
 Lymphnodes and kidneys can also be affected.
 There is increased catabolism of tissue protein and increased loss
of water from the body due to perspiration, increased loss of
sodium chloride and potassium salt from body.
TRANSMISSION :TRANS
MISSION
AIR
COUGH
AND
SNEEZE
ASYMPTOMATIC
SALIVA OF
INFECTED
PERSON
DIAGNOSIS : Diagnosis relies on
 Radiology (commonly chest X-rays), a tuberculin skin
test,
 blood tests, as well as microscopic examination and
 Microbiological culture of bodily fluids.
TREATMENT : Refampicin , isoniazid , Pyrazinamide, & ethambutol are
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the drugs used
These drugs are supplied free to the patients
Treatment lasts for a minimum period of nine months
Rest, antibiotic therapy & fresh air along with nourishing
food.
Social contacts are also screened and treated if necessary.
Antibiotic resistance is a growing problem in (extensively)
multi-drug-resistant tuberculosis.
Prevention relies on screening programs and vaccination,
usually with Bacillus Calmette-Guérin vaccine.
DIETARY MANAGEMENT :Objectives of dietary management are-:
 To reduce mortality by providing nutrients required by
the body’s immune mechanism
 To control weakness & loss of weight
 To accelerate convalescence
ENERGY:Energy needs are increased to minimize weight
loss
Energy intakes are increased by 300-500kcal/day
PROTEIN:Increase the protein intake
Protein foods of high biological value should be
included
About 1.2-1.5 of protein/kg body weight/day must
be included
CARBOHYDRATES & FAT:Enough carbohydrate is required to meet the energy
Abundant carbohydrate help in protein sparing action
Too much fat should be avoided.
MINERALS:Liberal amount of Ca should be included in the diet.
Fe supplements should be given.
VITAMINS:Liberal amount of vitamins should be provided.
Diet should provide as much as retinol as possible.
Additional amount of ascorbic acid is recommended
Good amount of vitamin D is
included.
B- complex vitamins need also
increase.
Provide supplements of vitamin B-6
& foliate.
DIET & FEEDING PATTERN: A high protein, high energy, full fluid diet is given.
 Meals should be simple, easily digestible, well
prepared & tempting
 Force feeding is harmful
 Too much fat should be avoided.
 All pulses should have a cereal-pulse combination
 Cheap sources of vitamin C must be given
 Seasonal vegetables must be given.
REFRENCES : NUTRITION AND DIETETICS BY KUMUD
KHANNA
 NORMAL THERAPUTIC NUTRITION BY
PROUDFIT,F.T AND REVISED BY ROBINSON
 DIETETICS BY B.SRI LAKSHMI
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