1. GROUP 5 MEMBERS
1. Alex Mbewe
2. Monica Banda
3. Rosella Munyenyembe
4. Andrew Moyo
5. Nelson Munthali
6. Mtisunge Wandale
7. Jacqualine Ntaba

2. PRESENTS
SHIGELLOSIS
By ALEX ‘ SIAL’ MBEWE

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

4. SPECIFIC OBJECTIVES
O Definition of shigellosis
O Causes of shigellosis
O Types
O How it is spread
O Pathophysiology
O Clinical manifestations
O Medical management
O Nursing management
O Complications

5. Definition
O This is an acute bacterial infection
of the lining of the intestines
(especially large intestines)
Causes
Shigellosis is caused by a group of
bacteria called shigella (gram-
negative organism)

6. 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

7. SPREAD
O Shigellosis is spread through fecal-oral
route
O People with shigellosis release it through
the stools
O 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

8. CLINICAL MANIFESTATIONS
O Usually develop about 1-7 days (average 3
days) after you come into contact with the
bacteria
O Acute (sudden) abdominal pain or
cramping
O Acute (sudden) fever
O Blood, mucus or pus in stools
O Crampy rectal pain
O Nausea and vomiting

9. O Watery diarrhoea
O Abdominal tenderness
O Dehydration with fast heart rate and
low Bp
O Loss of appetite

10. Diagnostic tests
O Stool culture
O White blood cells in stools
O Elevated blood cell count (FBC)

11. PATHOPHYSIOLOGY
O 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.

12. Pathophysiology cont….
O Severity of diarrhoea sets apart
shigellosis from regular diarrhoea
and it is usually associated with
bloody or pus stained diarrhoea.

13. MEDICAL MANAGEMENT
O The goal is to replace fluids and electrolytes
O Advise patient on diet
O 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/L
O Stop taking diuretics

14. NURSING MGT
O ASSESSMENT
- History of stool pattern and
associated symptoms
O Frequency
O Duration
O Character
O Consistency of stools
O history of medication
 use of other drugs known to
cause diarrhoea e.g. laxatives
O Social history

15. NURSING MGT CONT……
O Family history
O Recent travel, stress, health and
family history of illness
O Eating habits, appetite, food
intolerance especially milk and
other dairy products

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

17. Physical examination
O Vital signs and weight measurement
O Patients’ skin is inspected for signs of
dehydration
O Poor turgor and dryness and area of
breakdown of the skin
O Abdomen
• Distension
• Bowel sounds
• Palpate for tenderness

18. Nursing diagnosis
O Diarrhoea r/t acute infectious process
evidenced by frequent loose and liquid
stools
O Fluid and electrolyte imbalance r/t
diarrhoea and vomiting
O Nutritional imbalance; less than body
requirements r/t loss of
appetite, nausea, vomiting evidenced by
weight loss
O Altered thermoregulation hyperthermia r/t
to the infection as evidenced by rise of
temperature to 38 degrees celsius

19. O Altered comfort (abdominal pain) r/t
increased peristalsis evidenced by
patient’s verbalization and facial
expression
O Risk for anemia related to blood in
stools
O Risk for altered skin integrity related to
dehydration
O Risk for Hypovolemic shock r/t loss of
fluids due to diarrhoea

20. Interventions
O Commence IV fluids as ordered e.g. R/L – to
replace lost fluids and correct electrolyte balance
O Catheterize – to monitor input and output and
balance fluids
O Enforce strict IP measures to avoid cross
infection
O 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.

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

22. complications
O Intestinal perforation
O Dehydration
O Hypoglycemia
O Coma
O Rectal prolapse
O Hypovolemic shock
O Bacteremia
O Peritonitis

23. References
O 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