Republic of the Philippines

ISABELA STATE UNIVERSITY

City of Ilagan Campus

FOOD POISONING
Food poisoning, also called foodborne illness, is illness caused by eating contaminated food. Infectious organisms — including bacteria, viruses and parasites — or
their toxins are the most common causes of food poisoning. Infectious organisms or their toxins can contaminate food at any point of processing or production.
Contamination can also occur at home if food is incorrectly handled or cooked. Contamination of food can happen at any point of production: growing, harvesting,
processing, storing, shipping or preparing. Cross-contamination — the transfer of harmful organisms from one surface to another — is often the cause. This is
especially troublesome for raw, ready-to-eat foods, such as salads or other produce. Because these foods aren't cooked, harmful organisms aren't destroyed before
eating and can cause food poisoning. Many bacterial, viral or parasitic agents cause food poisoning.

PATHOPHYSIOLOGY
PREDISPOSING FACTORS

 Chronic illnesses that can cause breaks in skin which may be used as portal of entry of bacteria.
 The bacteria are passed from feces of people or animals to other people or animals. The bacteria often spread through contaminated foods
 Undercooked food such as meat, fish, and poultry.
 Poor sanitation of food storage that can could lead contaminating food.
 Poor self-hygiene and polluted environment.
 Poor waste management of domestic pets such as dogs and cats.
 Community that has no proper or sharing comfort room.

PRECIPITATING FACTORS
 Ingestion of preformed toxin – the preformed toxin may be present in contaminated food. Major offenders are Staphylococcus aureus, Vibrio, and Clostridium
perfringens. Symptoms develop within hours consisting of explosive diarrhea and acute abdominal pain.
 Infection by toxigenic organism – the organisms proliferate in the gut lumen and elaborate an enterotoxin. Symptoms occur within hours consisting of diarrhea
and dehydration if it involves a secretory enterotoxin, or dysentery if the primary mechanism is a cytotoxin.
 Infection by entero-invasive organism – the organism proliferates, invade, and destroy mucosal epithelial cells, leading to dysentery.
 Contaminated foods are often animal in origin.
 NCP 2
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis
Subjective Data Imbalance After 8 hours of Obtain dietary history After 8 hours of
- Patient stated that nutrition: Less nursing nursing
she changed her than body intervention the Assess nutritional needs related to age intervention the
diet in the past 2 requirements client will: and growth phase, presence of client has:
days to include only related to congenital anomalies, or metabolic or
soups and fluids. insufficient - Demonstrate malabsorption problems. - Demonstrate
dietary intake. progressive progressive
Objective Data weight gain Ascertain client’s understanding of To determine informational weight gain
Gender: Female toward goal. individual nutritional needs and ways needs of client/SO. toward goal.
Age: 63 years - Verbalize client is meeting those needs. - Verbalize
Height: 5’3” understandin understanding
Weight. (admit): 150lb g of causative Assess drug interactions, disease This may affect appetite, food of causative
Weight. (transfer) 142 factors when effects, allergies, and use of laxatives intake, or absorption. factors when
lb. known and or diuretics. known and
necessary necessary
 Red blood cells - 1.6 interventions. Auscultate presence of character of To determine ability and interventions.
 White blood cells - - Demonstrate bowel sounds. readiness of intestinal tract to - Demonstrate
304.0 behavior and handle digestive processes. behavior and
 Hemoglobin - 3.1 lifestyle lifestyle
 Hematocrit - 11 changes to changes to
 Neutrophils - regain and/or Review indicated laboratory data regain and/or
121.60 maintain maintain
 Lymphocytes - appropriate Emphasize importance of well- appropriate
21,77.70 weight. balanced, nutritious intake. Provide weight.
 Monocytes - 235.7 information regarding individual
 Platelet - 750,000 nutritional needs.
 Reticulocyte -
33,600 Review drug regimen, side effects, and
potential interactions with other
medications and over-the-counter
drugs.
 Nursing Care Plan
NCP 1
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis
Subjective Data Risk for bleeding After 8 hours of Assess the client’s risk, noting After 8 hours of
- The patient stated related to nursing possible medical diagnoses or nursing
that for the past insufficient interventions disease processes that may lead interventions client
couple of days her knowledge of client will: to bleeding as listed in risk is free of signs of
stool has been dark bleeding Be free of signs of factors. active bleeding as
and tarry and her precautions active bleeding as evidenced by stable
stomach has been evidenced by Note the client’s gender. While bleeding disorders are vital signs and
upset and “queasy”. stable vital signs common in both men and mucous membranes
and mucous women, women are affected free of pallor, and
Objective Data membranes free more owing to the increased risk usual mentation and
Gender: Female of pallor, and of blood loss related to urinary output.
Age: 63 years usual mentation menstrual cycle and pregnancy
Height: 5’3” and urinary complications/delivery Has displayed
Weight. (admit): 150lb output. procedures. laboratory results
Weight. (transfer) 142 for clotting times
lb. Display laboratory Evaluate the client’s medication The use of medications such as and factors within
results for clotting regimen. nonsteroidal anti- normal range for
 Red blood cells - 1.6 times and factors inflammatories (NSAIDs), individual.
 White blood cells - within normal anticoagulants, corticosteroids, Has identified
304.0 range for and certain herbals (e.g., Ginkgo individual risks and
 Hemoglobin - 3.1 individual. biloba), predispose client to engaged in
 Hematocrit - 11 bleeding. appropriate
 Neutrophils - 121.60 Identify individual behaviors or lifestyle
 Lymphocytes - risks and engage To document expanding bruises changes to prevent
21,77.70 in appropriate or hematomas or reduce the
 Monocytes - 235.7 behaviors or frequency of
 Platelet - 750,000 lifestyle changes Evaluate and mark the bleeding episodes.
 Reticulocyte - to prevent or boundaries of soft tissues in
33,600 reduce the enclosed structures, such as a
frequency of leg or abdomen.
bleeding episodes.
Assess vital signs, including This to determine if an
blooding pressure, pulse, and intravascular fluid deficit exists.
respirations. Measure blood Note: fit, young people may lose
pressure lying/sitting/standing 40% of their blood volume
as indicated to evaluate for before the systolic blood
orthostatic hypotension; pressure drops below blood
monitor invasive hemodynamic volume before the systolic blood
parameters when present. pressure drops below 100 mm
Hg, whereas the elderly may
become hypotensive with
volume loss of as little as 10%

Hema-test all secretions and To determine possible sources

excretions for occult blood of bleeding.

Note client report of pain in This can help to identify

specific areas, and whether pain bleeding into tissues, organs, or
is increasing, diffuse or localized. body cavities.

Review laboratory data (e.g.,

complete blood count [CBC], This is to evaluate bleeding risk.
platelet numbers and function, The common problem in life-
and other coagulation factors threatening anemia is a sudden
such as Factor I , Factor II, reduction in the oxygen-carrying
prothrombin time [PT], partial capacity of the blood.
thrombroplastin time [PTT], and Depending on the etiology, this
fibrinogen) may occur with or without
reduction in the intravascular
volume. It is generally accepted
that an acute drop in
hemoglobin to a level of 7 to 8
g/dL is symptomatic.

To determine the presence of

Prepare the client for or assist injuries or disorders that could
with diagnostic studies such as cause internal bleeding.
x-rays, computed tomography
(CT) or magnetic resonance
imaging (MRI) scans,
ultrasounds, or colonoscopy.
These agents will most likely be
Instruct at-risk client and family withheld for a period of time
regarding: prior to elective procedures to
 Specific signs of bleeding reduce potential for excessive
requiring healthcare provider blood loss.)
notification, such as active
bright bleeding anywhere,
prolonged epistaxis or
trauma in a client with
known factor bleeding
tendencies, black tarry
stools, weakness vertigo,
syncope and so forth.
 Need to inform healthcare
providers when taking
aspirins and other anti-
coagulants (e.g., Lovenox,
Coumadin, Plavix, Xeralto,
Eliquis), especially when
elective surgery or other
invasive procedure is
planned.
 Drug Study
Drug Study 1
Drug Name Action Dosage/Route Indication/Uses Contraindication Adverse Reaction Nursing Management

Generic: May inhibit PO RA, Contraindicated in patient hypertensive CNS: dizziness, Black Box Warning
Ibuprofen prostaglandin Capsule: 200 osteoarthritis, to drug and in those with angioedema, headache, Drug can cause
synthesis, top mg arthritis syndrome of nasal polyps, or nervousness. Cv potentially fatal
Brand: advil, produce anti- Oral drops: bronchospastic edema, fluid arrhythmias. Only
Mild to
advil liquid-gel, inflammatory, 40mg/mL, 50 reaction to aspirin or other NSAIDs. retention. skilled personnel
moderate pain:
caldolor, analgesics, mg/1.25mL Black Box Warning: Contraindicated for EENT: tinnitus. trained in identification
moderate to
children’s and Oral the treatment of perioperative pain after GI: abdominal pain, and treatment of acute
severe pain as
advil, antipyretic suspension: CABG surgery.  bloating, ventricular
an adjunctive to
children’s effects. 40mg/mL, Black Box Warning: NSAIDs can increase constipation, arrhythmias,
opioid
motrin Jr 100mg/5ml risk of heart attack or stroke in patients decreased appetite, particularly
analgesics:
strength, Tablets: with or without heart disease or risk diarrhea, dyspepsia, polymorphic
fever reduction
ibuprofen, 100mg, factors for heart disease. epigastric distress, ventricular tachycardia,
in children.
infants, advil 200mg, flatulence, heartburn, should give drug.
concentrated 400mg, Mild to Black Box Warning: Risk of heart attack nausea, non-
drops, junior Tablets moderate pain, or stroke can occur as early as the first necrotizing Before therapy, correct
strength dvil, (chewable) 50 fever weeks of using an NSAID. Risk appears enterocolitis, hypokalemia and
Nono-profen mg, 100mg Reliefs of signs greater at higher doses. Use lowest vomiting. hypomagnesemia to
pms- and symptoms effective dose for shortest duration GU: acute renal reduce risk of
ibuprofen. Injection: of juvenile possible. failure, azotemia, proarrhythmic.
800mg/8mL arthritis cystitis, hematuria.
Therapeutic (100mg/mL) Black Box Warning: NSAIDs may increase Hematologic: Black Box Warning
class: NSAID’s in single dose Migraine risk of serious GI adverse events, agranulocytosis, Patients with atrial
Pharmacologic vials. Clinically including bleeding, ulceration, and aplastic anemia, fibrillation lasting
class: NSAID’s significant perforation of the stomach or intestines, leukopenia, longer than 2 to 3 days
patent ductus which can be fatal. These events can neutropenia, must be adequately
arteriosus occur at any time during use and without pancytopenia, anticoagulated,
(PDA). warning symptoms. Elderly patients are thrombocytopenia, generally over at least
at greater risk for serious GI events. anemia, prolonged 2 weeks.
bleeding time.
·Ibuprofen lysine injection is Metabolic: Monitor ECG
contraindicated in preterm infants with hypokalemia, continuously during
significant renal impairment, proven or hypoglycemia. administration and for
suspected un-treated infection or Skin: pruritus, rash, at least 4 hours
necrotizing enterocolitis, injection site afterward or until QTc
thrombocytopenia, coagulation defects, irritation interval returns to
active bleeding, and congenital heart baseline; drug can
disease in whom patency of the ductus induce or worsen
arteriosus is necessary for satisfactory ventricular
pulmonary or systemic blood flow. arrhythmias.

Alert: NSAIDs increase risk of HF. Longer monitoring is

·Use cautiously in elderly patients and in required if ECG shows
patients with GI disorders, history of arrhythmia or patient
pep-tic ulcer disease, hepatic or renal has hepatic in-
disease, cardiac decompensation, HTN, sufficiency.
asthma, or intrinsic coagulation defects.
·Long-term NSAID use may result in renal Don't give class IA or
papillary necrosis and other renal injury. other class III
antiarrhythmics with
May increase risk of aseptic meningitis, infusion or for 4 hours
with fever and coma, particularly in afterward.
patients with SLE and related connective
tissue dis-ease. If signs or symptoms of PATIENT TEACHING
meningitis occur, consider whether
they're related to ibuprofen therapy. Tell patient to report
adverse reactions
Overdose S&S: Abdominal pain, nausea, promptly.
vomiting, lethargy, drowsiness,
headache, tinnitus, nystagmus, CNS Instruct patient to alert
depression, seizures, hypotension, nurse of discomfort at
bradycardia, tachycardia, atrial injection site.
fibrillation, metabolic acidosis, coma,
acute renal failure, hyperkalemia,
respiratory depression and failure.
 Drug Study 2
Drug Name Action Dosage / Indication/Uses Contraindication Adverse Reaction Nursing Management
Route
Generic: A selective PO First-line treatment of Contraindicated in CNS: headache, asthenia, PREGNANCY-LACTATION-
Anastrozole nonsteroidal postmenopausal patients pain, dizziness, REPRODUCTION
aromatase Adults: 1 women with hormone hypersensitive to depression, paresthesia,  Drug can cause fetal harm.
Brand: inhibitor that mg PO receptor-positive or drug or its anxiety, insomnia, stroke.  Contraindicated in women
Arimidex significantly daily. hormone receptor- components. CV: hot flashes, who are or may become
lowers estradiol unknown locally thromboembolic disease, pregnant.
Therapeutic levels, which AVAILABLE advanced or Use cautiously in chest pain, peripheral  Women of childbearing
Class: inhibits breast FORMS metastatic breast patients with edema, HTN, potential should use effective
Antineoplastics cancer cell Tablets:1 cancer preexisting ischemic vasodilation, cardiac contraception during therapy
growth in mg heart disease ischemia. and for at least 3 weeks after
Pharmacologic postmenopausal Advanced breast EENT: cataracts, final dose.
Class: women. cancer in pharyngitis, sinusitis.  It isn't known if drug appears
Aromatase postmenopausal GI: nausea, vomiting, in human milk. Patient
inhibitors women with disease diarrhea, constipation, shouldn't breastfeed during
progression after abdominal pain, therapy and for 2 weeks after
tamoxifen therapy anorexia, dry mouth, final dose.
dyspepsia.
Adjunctive treatment GU: vaginal dryness, NURSING CONSIDERATIONS
of postmenopausal pelvic pain, UTI.  Give drug under supervision
women with hormone Metabolic: weight gain, of a pre-scriber experienced
receptor-positive early increased ap petite. in use of antineoplastics.
breast cancer Musculoskeletal: bone  Patients with hormone
pain, back pain, arthritis, receptor-negative disease
Risk reduction for arthralgia, osteoporosis, and patients who didn't
breast cancer in fractures. respond to previous
postmenopausal Respiratory: dyspnea, tamoxifen therapy rarely
women bronchitis, cough. respond to anastrozole.
Skin: rash, sweating.  For patients with advanced
Other: lymphedema, breast cancer, continue
flulike symptoms. anastrozole until tumor
progresses.
 Use drug only in
 postmenopausal women.
 Rule out pregnancy before
starting drug.
PATIENT TEACHING
 Instruct patient to report
adverse reactions, especially
difficulty breathing, chest
pain, or skin lesions or
blisters.
 Tell patient to take
medication at the same time
each day.
 Stress needs for follow-up
care.
 Counsel female patient about
risks of pregnancy during
therapy and advise her to use
effective contraception
during therapy and for at
least 3 weeks after final dose.
 Advise patient not to
breastfeed during treatment
and for 2 weeks after final
dose.
 Tell patient that drug lowers
estrogen level, which may
lead to decreased bone
strength and increased risk of
fractures.
 Contaminated food handling or storage

Warmth, moisture, a

Less common causes of food

Classic bacterial food poisoning Increased multiplication of bacteria or virus poisoning

Ingestion of preformed bacterial toxins Ingestion of bacteria

Meat, salad, Fried rice, milk Meat, gravy Canned food

cream Poultry, Milk Seafood, Produce

Staphylococcus Bacillus cereus Clostridium Clostridium

Aureus Perfringens Botulinum
Campylobacter Shigella
Enterotoxin
secretions Emetic Diarrhea Enterotoxin Botulinum
toxin toxin secretions neurotoxin
Non-invasive Secretion Intracellular
Disruption of ß barrels in Acetylcholine bacteria of
Toxin stimulation of invasion of
epithelial cell epithelial cell blockage on adhere to cytolethal
vagus nerve intestine
tight junctions membrane peripheral nerve intestinal distending
endings in stomach synapses.
wall
Increased fluid in +/- Shiga
Increased medullary Diplopia,
center stimulation intestinal lumen Epithelial damage toxin
Dysphagia,
Dyspnea, secretion

Nausea, Vomiting Abdominal cramps, Diarrhea Weakness,

Death Fever, Bloody Diarrhea