Nursing Care Plan - Diarrhea : Assessment and Diagnosis

Nursing Care Plan for Diarrhea

Diarrhea is a disease characterized by increased frequency of defecation more than usual (more than 3 times / day) accompanied by a change in stool consistency (a liquid), with / without blood and / or mucus (Suraatmaja, 2007).

Around the world there are approximately 500 million children suffer from diarrhea each year, and 20% of all deaths in children living in developing countries associated with diarrhea and dehydration. Diarrheal disorders can involve the stomach and intestines (gastroenteritis), small intestine (enteritis), colon (colitis) or colon and intestines (enterocolitis). Diarrhea is usually classified as acute and chronic diarrhea (Wong, 2009).

Diarrhea is a condition of increased fecal weight (more than 200 mg / day) which can be attributed to increased fluid, the frequency of bowel movement, not feeling the perianal, and a sense of urgency for bowel movements with or without fecal incontinence. Diarrhea is divided into Acute and Chronic diarrhea. Acute diarrhea lasts 2 weeks or less, while chronic diarrhea duration of more than 2 weeks. Further discussion regarding devoted chronic diarrhea (Hooward, 1995 cit Sutadi 2003).


Classification

According to WHO (2005) diarrhea can be classified to:

• Acute diarrhea, ie diarrhea lasting less than 14 days.
• Dysentery, the diarrhea is accompanied by blood.
• Persistent diarrhea, the diarrhea that lasts more than 14 days.
• Diarrhea accompanied by severe malnutrition.

According to Ahlquist and Camilleri (2005), diarrhea divided into:

• Acute, if less than 2 weeks, persistent if it lasts for 2-4 weeks. More than 90% of the causes of acute diarrhea are the causative agents of infectious and will be accompanied by vomiting, fever and abdominal pain. 10% were caused by the treatment, intoxication, ischemia and other conditions.
• Chronic, if it lasts more than 4 weeks. In contrast to acute diarrhea, a common cause of chronic diarrhea caused by non-infectious causes such as allergic and others.

According Kliegman, Marcdante and Jenson (2006), states that based on the amount of loss of fluid and electrolytes from the body, diarrhea can be divided into:

• Diarrhea without dehydration: At this rate of diarrhea sufferers do not become dehydrated because of diarrhea frequency is still within tolerable limits and there are no signs of dehydration.
• Diarrhea with mild dehydration (3% -5%): At this level patients with diarrhea 3 times or more, sometimes vomiting, thirsty, have decreased urination, decreased appetite, activity has begun to decline, the pressure pulse is normal or tachycardia minimum and a physical examination within normal limits.
• Diarrhea with moderate dehydration (5% -10%): In this situation, the patient will experience tachycardia, urinating less or no, irritability or lethargy, eye and large fontanel becomes concave, reduced skin turgor, mucous membranes of the lips and mouth and the skin appears dry, reduced tear and the elongated capillary refill (greater or equal to 2 seconds) with skin cold and pale.
• Diarrhea with severe dehydration (10% -15%): In this situation, the patient has lost a lot of fluid from the body and is usually in a state of patients experienced tachycardia with weak pulse, hypotension and pulse pressure spreads, no urine output, eyes and large fontanel becomes very concave, no tear production, not being able to drink and the situation began to apathy, decreased consciousness and also the very elongated capillary refill (greater or equal to 3 seconds) with a cold and pale skin.

Nursing Care Plan for Diarrhea

Assessment

1. Identity
Noteworthy is the age. Episodes of diarrhea occurred in the first 2 years of life. Highest incidence is 6-11 months age group. Most bacteria stimulate gut immunity against infection, it helps explain the decline insidence disease in older children. At the age of 2 years or more of active immunity begins to form. Most cases are due to intestinal infection and asymptomatic enteric bacteria spread mainly clients are not aware of the infection. Economic status also influential, especially from the diet and treatment.

2 The main complaint
Defecate more than 3 times, vomiting, diarrhea, bloating, fever.

3. History of present illness
Defecating yellow-green color, mixed with mucus and blood or mucus only. Watery consistency, frequency is more than 3 times, spending time: 3-5 days (acute diarrhea), more than 7 days (prolonged diarrhea), more than 14 days (chronic diarrhea).

4. Past medical history
Never before have diarrhea, use of antibiotics or corticosteroids long term (candida albicans changes from saprophyte become parasites), food allergies, respiratory infections, UTI, OMA measles.

5. History of nutrition
At toddler age children are given food as in adults, the portion given 3 times per day with additional fruit and milk. Malnutrition in children toddler age are particularly vulnerable. The way good food management, food hygiene and sanitation, hand washing habits.

6. Family health history
There is one family that is experiencing diarrhea.

7 History of environmental health
Food storage at room temperature, less hygiene, neighborhood.


Nursing Diagnosis for Diarrhea

1. Diarrhea
2. Hyperthermia
3. Deficient Fluid Volume
4. Anxiety: parents
5. Deficient Knowledge : on diarrheal disease
6. Decreased cardiac output
7. Ineffective breathing pattern
8. Activity intolerance

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Nursing Care Plan for Endocarditis

Nursing Diagnosis for Endocarditis

Endocarditis is an inflammation of the endocardium (the membrane that lies in the heart).

Causes

Endocarditis more often caused by bacteria, fungi, or other microorganisms, can be caused by the operation; resulting from intravenous injection using dirty needles or through wounds found on the skin and mucous. Organisms can run in the blood flow towards the heart. As a result, the heart valves become inflamed, valves become damaged, and the formation of blood clots in the infected area. A person who has suffered injury or illness in the endocardium the easier it is for people suffering from endocarditis. This caused a blood clot from the surface of a wound can adsorb microorganisms, which can reproduce more and more on the injured area. Intravenous drug could cure endocarditis.

Symptoms

Endocarditis can be found in the acute or subacute form. In the subacute form, general and non-specific symptoms, including stiffness, fever, and pain. On physical examination, the evidence is just an abnormality of heart murmurs. Acute endocarditis is less happening can occur suddenly and cause a short breathing, fever, high fever, rapid heartbeat and irregular. Infection can be easily expanded and can destroy the valves of the heart, causing heart failure.


Test and Diagnosis

Various test and diagnosis done is:

• Blood test.
• Echocardiogram.
• Electrocardiogram.
• X-ray of the chest.
• CT and MRI scans.

Nursing Diagnosis for Endocarditis

1. Acute pain related to systemic effects of the infection.
2. Risk for decreased cardiac output related to disturbances in heart valve and the endothelium.
3. Risk for Imbalanced Body Temperature.
4. Risk for Ineffective Tissue perfusion related to embolization

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Cephalalgia

Cephalalgia is a condition of pain in the head: sometimes a pain in the back of the neck or back top, also known as headache. These diseases include the grievances of the disease is often raised.

Headache is a universal problem, with a prevalence of nearly 99%, and is the most common reason for neurological referral. Headaches can have little clinical significance, but also may be a sign of the presence of life-threatening diseases. Pain in the head caused by traction / withdrawal, migration, inflammation, spasme of blood vessels, or distention of the head or neck structures that are sensitive to pain.

One type of headache that is often the Complaint is headache or migraine. Migraine attack feels tormented and sometimes sudden. Migraine sufferer will feel pain and throbbing like beaten and pulled and is usually accompanied with GI tract disorders such as nausea and vomiting. Patients tend to be more sensitive to light, sound and scent. It was certainly very disturbing and can inhibit the activity of the patients.

Migraine attacks can occur several times a year to a few times a week, with attacks usually 1-2 hours long. Migraine or headache the actual cause is not yet known with certainty. However, the predicted type of headache is caused due to a brain hiperaktifitas electric impulses that increase blood flow in the brain which results in dilation of the blood vessels of the brain and the process of inflammation (inflammatory lesions). There is also a tension-type headaches (tension type headache, or TTH) characteristics are both sides of the head as diremas with strong, but not accompanied by other symptoms (no nausea, vomiting, light sensitivity, etc.).

Most headaches are primary that is, without any underlying diseases such as migraine, cluster, and tension type headaches. However there is also a headache caused by an underlying disease process or condition or commonly called secondary headaches, which this case should be the focus early in the diagnostic evaluation of headache. Manifestation of an underlying systemic disease can help in the diagnosis of the etiology of headache and should always be sought. Because if up late can be fatal.

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Constipation Care Plan - Nursing

Constipation

Constipation is a disorder of the digestive system where a person experiencing excessive hardening of feces making it difficult to remove and can cause great pain in patients. Constipation is pretty great also called obstipation. And severe obstipation can cause fatal intestinal cancer for patients.

Causes

Constipation or constipation is a complaint on the digestive system of the most common and is found in the wider community including around us. Even estimated that around 80% of people have experienced constipation or constipation. Common causes of constipation or constipation that is around us, among others:

• Lack of body fluids or dehydration.
• Hot suffer.
• Stress or depression and compact enough activity.
• Influence of hormones in the body (eg in menstruation or pregnancy).
• Bowel less elastic (usually because it is in the pregnancy or old age).
• Anatomic abnormalities in the digestive system.
• Lifestyle and irregular eating patterns (such as poor diet).
• Side effects from drinking something that contains a lot of calcium or aluminum (eg antidiare drugs, analgesics, and antacids).
• Lack of vitamin C intake and lack of fiber.
• Is a symptom of disease (eg, typhus and hernia).
• Often withhold stimulus to defecate in a long time.
• Emotion, because the emotion or anxiety intestines spasm, sehigga pertaltik intestine and large intestine absorbs stopped returning fluid feces. Consequently stool becomes hard.
• Rarely or less work.
• Advantages of fiber consumption.
• The advantages of eating meat. Especially red meat because it was difficult to digest and has a lot of iron. Iron is the substance that makes the hardening of feces, making it dark and black.
• Of drug abuse, such as drug laxatives. For example, the application of mineral oil is useful for launching peristaltic motion. Eventually the intestines become accustomed to and dependent on the drug, resulting in a slow intestinal reactions, and inhibits intestinal peristalsis self.
• Frozen foods save time and energy, but cause many health problems. Frozen foods have very low fiber and a lot of preservatives that can disrupt the bowel movement. Like ice cream barely contain fiber so it can help regulate bowel movements combined with sugar and milk in it can harden the stool.
• Eating certain fruits or vegetables that can compress excess dirt naturally like bananas.

Signs and symptoms

Symptoms and signs will vary from person to person, because of diet, hormones, lifestyle and shape of the large intestine of each person is different, but usually the symptoms and signs commonly found on most or sometimes some patients are as follows :

• Stomach feels full, and even feels numb manure pile (if manure has accumulated about 1 week or more, patients with stomach looks like being pregnant).
• Feces become harder, warm, darker, a little more than usual amount (less than 30 grams), and can even form a small bow when it is severe.
• At the time of bowel removed or discarded hard stools, sometimes must mengejan or pressing his stomach in advance so as to remove the feces (even to suffer hemorrhoid and cold sweat).
• Heard noises in the stomach.
• The anus feels full, and as something hampered accompanied with pain as a result of frictional heat and hard stools.
• Frequency throw up wind accompanied a more disagreeable odor than usual (even sometimes patients may have trouble or can not totally get rid of the wind).
• A decline in the frequency of bowel movements, and increased bowel transit time (usually defecate be 3 days or more).
• Sometimes experiencing nausea and even vomiting if it is severe.
• Back pain when feces accumulated quite a lot.
• Bad breath.

As for the psychological symptoms that can occur in the patients with constipation, among others:

• Lack of confidence
• Prefers to be alone or away from the vicinity.
• Still feel hungry but when eating faster satiety (especially when pregnant stomach will feel heartburn) because the space in the stomach is reduced.
• Emotion is increasing rapidly.
• Often pounding so fast that lead to emotional stress so vulnerable headaches or even fever.
• The body does not fit, uncomfortable, tired, tired quickly, and droop so lazy to do things sometimes even sleepy.
• Less zealous in carrying out the activity.
• Daily activities have been disrupted as a body feels overburdened resulting quality and decreased work productivity.
• Can decrease appetite.

Prevention

• Do not junk at an arbitrary point.
• Avoid foods that are high in fat and sugar.
• Drink at least 1.5 to 2 white liters of water (about 8 glasses) of fluid a day and others every day.
• Sports, such as walking (jogging) can be done. At least 10-15 minutes for light exercise, and at least 2 hours for a heavier workout.
• Familiarize defecate regularly and do not like to hold a bowel movement. No need to force a bowel movement every day when there is no stimulus for the digestive cycle every person differently.
• Consumption of foods that contain enough fiber, such as fruits and vegetables.
• Sleep at least 4 hours a day.
• Add herbal flavor in food, except chili.
• Diet is not excessive.
• Consuming anti-inflammatory foods, such as avocado, apples, and coconut.

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Nursing Care Plan for Deficient Fluid Volume (Hypovolemia)

Definition

Extracellular Fluid Volume Deficient or hypovolemia (FVD) is isotonic body fluid loss, which is accompanied by loss of sodium and water in the same relative amount. Volume deficits often termed isotonic dehydration that should be used for conditions of relatively pure water loss resulting in hypernatremia.



Etiology

Factors that affect the body's fluid and electrolyte balance, among others:

Age:

Fluid intake needs vary depending on age, because age affects the surface area of the body, metabolism, and weight. Infant and children are more susceptible to interference than the fluid balance adulthood. In old age often occurs due to fluid balance disorders with impaired renal function or heart.

Climate:

People who live in areas that are hot (high temperature) and low air humidity has an increased loss of body fluids and electrolytes through sweat. While someone who indulge in a hot environment can lose up to 5 L of fluid per day.

Stress:

Stress can increase cell metabolism, blood glucose, and the breakdown of muscle glykogen. This mechanism can increase sodium and water retention so that when prolonged can increase blood volume.

Diet:

Diet affects the intake of fluids and electrolytes. When inadequate nutritional intake, the body will burn protein and fat so it will spare protein and serum albumin will be decreased even though both are indispensable in the process fluid balance so that this will lead to edema.



Clinical manifestations

Clinical signs and symptoms which may be obtained on the client with hypovolemia include: dizziness, weakness, fatigue, syncope, anorexia, nausea, vomiting, thirst, mental confusion, constipation, oliguria. Depending on the type of fluid loss. Hypovolemia may be accompanied by acid-base imbalance, or osmolar electrolyte. Depletion (CES) severe, can lead to hypovolemic shock.

Compensatory mechanisms of the body on the condition of hypovolemia, is to be an increase in the sympathetic nervous system stimulation (increased frequency of heart, inotropic [contraction of the heart] and vascular resistance), thirst, release of antidiuretic hormone [ADH], and the release of aldosterone. The condition can lead to hypovolemia long acute renal failure.



Complication

• Loss of abnormal GI: vomiting, NG suction, diarrhea, intestinal drainage.
• Abnormal skin loss: excessive diaphoresis secondary to fever or exercise, burns, cystic fibrosis.
• Abnormal kidney loss: diuretic therapy, diabetes insipidus, osmotic diuresis (polyuria form), adrenal insufficiency, osmotic diuresis (uncontrolled diabetes, post-use of contrast agents.
• Spasium third or plasma to interstitial fluid displacement: peritonitis, intestinal obstruction, burns, acites.
• Hemorragia.
• Changes in input: coma, lack of fluids.

Nursing Care Plan for Deficient Fluid Volume (Hypovolemia)

Assessment

• Intake-output.
• Weight.
• Breath sounds.
• Edema.
• Check skin turgor.

Nursing Diagnosis

1. Deficient Fluid Volume: less than body requirements related to diarrhea, gastric fluid loss, diaphoresis, polyuria.
2. Impaired skin integrity related to dehydration and or edema.

Outcomes:

Individuals will:

1. Increasing fluid intake of at least 2000 ml / day (unless contraindicated).
2. Telling the need to increase fluid intake during stress or heat.
3. Maintain urine specific gravity within normal limits.
4. Showed no signs and symptoms of dehydration.

Interventions:

1. Assess the preferred and non-preferred; give a favorite drink in the diet limits.
2. Plan objectives fluid intake (eg, 1000 ml during the morning, afternoon 800 ml, and 200 ml of the evening).
3. Assess individual understanding of the reasons to maintain adequate hydration and methods to achieve goals fluid intake.

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NCP Cholera - 6 Nursing Diagnosis and Interventions

Nursing Care Plan for Cholera

Cholera, a severe diarrheal disease caused by the bacterium Vibrio cholerae, has plagued human populations for centuries. This waterborne illness poses significant public health challenges, particularly in regions with inadequate sanitation and limited access to clean water. This article explores the causes, symptoms, transmission, and global efforts in the prevention and management of cholera.

Causes and Transmission:

1. Vibrio cholerae, the bacterium responsible for cholera, typically thrives in contaminated water and food sources. The primary mode of transmission is through the ingestion of contaminated water or food, often via the consumption of raw or undercooked seafood, or contaminated fruits and vegetables.
2. Once ingested, the bacterium releases a toxin that affects the small intestine, leading to rapid and profuse watery diarrhea—a hallmark symptom of cholera. The severity of the disease can range from mild to severe, with severe cases potentially progressing to life-threatening dehydration without prompt intervention.

Symptoms:

1. Watery Diarrhea: Cholera is characterized by the sudden onset of profuse, painless, and watery diarrhea, often described as "rice-water stool."
2. Vomiting: Individuals with cholera may experience vomiting, contributing to fluid loss and dehydration.
3. Dehydration: Rapid fluid loss can lead to severe dehydration, accompanied by symptoms such as sunken eyes, dry mucous membranes, lethargy, and a rapid heart rate.
4. Muscle Cramps: Dehydration can cause muscle cramps and weakness.

Nursing Assessment for Cholera

1. Assess the status of dehydration (skin color, temperature, acral, skin turgor, mucous membranes, eyes, crown, body temperature, pulse, respiration, behavior, weight loss).
2. Observe for manifestations of acute diarrhea
   • A sudden attack of diarrhea
   • Fever
   • Anorexia, nausea, vomiting
   • Weight loss
   • Pain and abdominal cramps, abdominal distension
   • Increased bowel sounds / hyper-peristaltic
   • Malaise
   • Bowel movements more than 3 times a day, liquid stool consistency, with / or without mucus and blood
3. Assess the psychosocial status of families
4. Assess the level of knowledge of family
   • Knowledge of diarrhea at home
   • Knowledge of dietary
   • Knowledge about the prevention of recurrent diarrhea

Nursing Diagnosis for Cholera

1. Deficient fluid volume related to excessive fluid loss through the stool or emesis
2. Imbalanced Nutrition: Less Than Body Requirements related to loss of fluids through diarrhea, inadequate intake
3. Risk for infection related to microorganisms that penetrate the gastrointestinal tract.
4. Impaired Skin Integrity: perianal, related to irritation from diarrhea
5. Anxiety related to separation from parents, unfamiliar environment, a stressful procedure.
6. Interrupted Family Processes related to crisis situations, lack of knowledge about diseases, treatment of clients.

Nursing Interventions for Cholera


Deficient fluid volume related to excessive fluid loss through the stool or emesis

Goal :

• Maintain adequate hydration

Expected outcomes:

No signs of dehydration: elastic skin turgor, sunken fontanel not, the patient is not agitated, mucous membranes moist, no weight loss.

Nursing Interventions and Rational:
1) Record Intake Output every 24 hours.
R / Knowing the status of dehydration and evaluate the effectiveness of interventions.

2) Measure the child's weight every day.
R / observe dehydration.

3) Measure vital signs and evaluation of skin turgor, mucous membranes, mental status.
R / observe dehydration.
4) Tell the family to give the child a drink gradually.
R / improve hydration.

collaboration:
5) Give oral rehydration solution (ORS).
R / rehydration and replacement of fluid loss through the stool.

6) Provide and monitor IV fluids as indicated (collaboration).
R / replacement fluid loss.

7) Observe the results of the electrolyte.
R / know the level of hydration and the effectiveness of interventions.


Imbalanced Nutrition: Less Than Body Requirements related to loss of fluids through diarrhea, inadequate intake

Goal :

• consume adequate nutrition intake.

Expected outcomes:

• No weight loss (weight stable)
• Eating out 1 serving.
• No nausea, vomiting.

Nursing Interventions and Rational:

1) Evaluation of nutritional status and weight loss
R / Identifying the need for further intervention.

2) Notify and motivation of mothers / families to continue breast-feeding.
R / breast milk reduces the severity and duration of disease and provide additional nutrients.

3) Tell the mother to give the child to eat small meals but often
R / increase food intake.

4) Observe and record the response to feeding.
R / know the tolerance of feeding.

 

 

Bibliography:

1. Ali, M., Nelson, A. R., Lopez, A. L., & Sack, D. A. (2015). Updated global burden of cholera in endemic countries. PLoS Neglected Tropical Diseases, 9(6), e0003832. doi: 10.1371/journal.pntd.0003832
2. Clemens, J. D., Nair, G. B., Ahmed, T., Qadri, F., Holmgren, J., & Cholera Symposium Participants. (2017). Cholera. The Lancet, 390(10101), 1539-1549. doi: 10.1016/S0140-6736(17)30559-7

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Bladder Cancer - Nursing Diagnosis : Imbalanced Nutrition and Deficient Knowledge

Nursing Care Plan for Bladder Cancer

1. Imbalanced Nutrition: Less Than Body Requirements
related to:

hyper-metabolic-related cancer, the consequences of chemotherapy, radiation, surgery (anorexia, gastric irritation, lack of sense of taste, nausea), emotional distress, fatigue, inability to control pain


characterized by:

• inadequate intake,
• loss of sense of taste,
• loss of appetite,
• weight down to 20% or more below the ideal,
• decreased muscle mass and subcutaneous fat,
• constipation,
• abdominal cramping.

Goal:

• Showed a stable weight, normal laboratory results and no sign of malnutrition.
• Stated understanding of the need for adequate intake.
• Participate in the management of diet-related illness.

Interventions :

• Monitor food intake every day, whether eating in accordance with the needs of the client.
• Measure weight, triceps size and observed weight loss.
• Assess pale, slow wound healing and parotid gland enlargement.
• Encourage clients to consume high-calorie foods with adequate fluid intake. Instruct too little food to clients.
• Control of environmental factors such as foul odors or noise. Avoid foods that are too sweet, fatty and spicy.
• Create a pleasant dining atmosphere for example, a meal with friends or family.
• Encourage relaxation techniques, visualization, moderate exercise before eating.
• Encourage open communication about anorexia problems experienced by clients.

Collaboration:

• Observe laboratory studies such as total lymphocytes, serum transferrin and albumin.
• Give treatment as indicated.
• Attach a nasogastric tube for enteral feeding, balanced with infusion.

Rational:

• Provide information about nutritional status.
• Provides information about the addition and weight loss.
• Showed very poor nutritional state.
• Calories are energy sources.
• Prevent nausea and vomiting, excessive distension, dyspepsia which causes a decrease in appetite and reduce harmful stimulus which can increase anxiety.
• In order for the client to feel like being at home alone.
• To induce a feeling of wanting to eat / arouse appetite.
• In order to overcome together (with a dietitian, nurse and client).
• To determine / establish the occurrence of nutritional deficiencies as a result of the course of disease, treatment and care of the client.
• Facilitate the intake of food and beverages with maximum results and right as needed.

2. Deficient Knowledge about the disease, prognosis and treatment
related to:

• lack of information,
• misinterpretation,
• cognitive limitations.

characterized by:

• often asked,
• stating the problem,
• statement misconceptions, is not accurate in mengikiuti instruction / prevention of complications.

Goal:

• Can accurately say about diagnosis and treatment at the level of proximity ready.
• Following the procedure well and explain the reasons to follow those procedures.
• Having the initiative of changing lifestyles and participate in treatment.
• In cooperation with the furnisher.

Interventions:

• Review understanding of the client and family about the diagnosis, treatment and consequences.
• Determine the client's perception about cancer and its treatment, tell the client about the experience of other clients who have cancer.
• Give accurate and factual information. Answer the questions specifically, avoid unnecessary information.
• Provide guidance to client / family before following the treatment procedure, the old therapy, complications. Be honest with the client.
• Encourage clients to provide verbal feedback and correct misconceptions about the disease.
• Review client / family about the importance of optimal nutrition status.
• Encourage clients to assess the oral mucous membranes regularly, note the presence of erythema, ulceration.
• Encourage clients to maintain the cleanliness of the skin and hair.

Rational:

• Avoid duplication and repetition of the client's knowledge.
• Lets do justification to errors as well as errors of perception and conception of understanding.
• Assist the client in understanding the disease process.
• Assist clients and families in making treatment decisions.
• Knowing the extent of understanding the client and client's family about the disease.
• Increasing knowledge of the client and family regarding adequate nutrition.
• Reviewing the development of the processes of healing and signs of infection and problems with oral health can affect the intake of food and beverages.
• Improving the integrity of the skin and head.

Source : http://nursing-care-plan.blogspot.com/2014/01/imbalanced-nutrition-and-knowledge.html

Imbalanced Nutrition Less Than Body Requirements - NCP for Typhoid Fever

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