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Salmonella Nursing Guide

This course is intended as a Quick Reference for Salmonella and will cover an overview as well as nursing considerations utilizing the nursing process.

Etiology and Epidemiology

Salmonella Definition

Salmonella is a group of rod-shaped, gram-negative bacteria that can thrive in both aerobic and anaerobic environments. Salmonella belongs to the Enterobacteriaceae family. They exist in the gastrointestinal tract of humans and other animals. Some species of Salmonella do not cause symptoms, while others can cause a mild to serious infection. In humans, this infection is referred to as Salmonellosis. Individuals usually become infected after consuming contaminated food or water (World Health Organization, 2018). 

Causes include ingesting (U.S. Food & Drug Administration [FDA], 2020): 

  • Raw or undercooked animal products, such as eggs, meat, and poultry products 
  • Raw or unpasteurized dairy products 
  • Raw fruits and vegetables 

Individuals may also contract Salmonella by handling contaminated food products and then accidentally transferring the bacteria from their hands to their mouths. The bacteria can also be spread to other people, surfaces, and objects if individuals get Salmonella on their hands or clothes and then proceed to touch other people or things (FDA, 2020). 

Pet food can also be a source of Salmonella and can be spread when an individual touches it. Pet food that contains raw food products is more likely to contain Salmonella than pet food that has been processed (FDA, 2020). 

Pets can also carry and spread Salmonella to humans and other animals. This is especially true when dealing with animals such as turtles, lizards, and snakes. Turtles usually carry the bacteria on their outer skin and shell surfaces. Handling the habitats of these pets can also put an individual at risk for contracting the bacteria (FDA, 2020). 

One Salmonella outbreak related to pet turtles ended on September 29, 2021. The outbreaks affected 87 individuals, with 43 people infected with the Salmonella typhimurium strain and 44 people infected with Salmonella poona. The infection involved 20 states and the District of Columbia. There was one death reported in Pennsylvania. 76% of the individuals who were infected reported contact with pet turtles. Of the individuals who reported the size of their pet turtle, 82% stated that the pet turtles they had contact with had shells less than 4 inches long. (CDC, 2021b) 

 

Steps to prevent Salmonella infection when handling pets include (CDC, 2021c): 

  • Thoroughly wash your hands after handling pets or their habitat. 
  • Ensure that children wash their hands properly. 
  • Pet supplies should be kept clean, and cleaning them should occur outside, if possible. 
  • If you choose to clean pet supplies inside, use a laundry sink or bathtub. Disinfect all areas after cleaning supplies. Avoid using the kitchen sink to clean pet supplies. 
  • For individuals who have a turtle as a pet, instruct them to: 
    • Avoid buying turtles with shells less than 4 inches long. 
    • Only purchase or adopt from reliable sources. 
    • Be aware that a pet turtle may not be an appropriate pet for your home if household members are younger than 5 years old, older than 65 years old, or have a compromised immune system. 

General risk factors for Salmonella infection include (CDC, 2021): 

  • Summer months (June, July, and August) 
  • Children under 5 years old 
  • Infants who are not breastfed 
  • Adults over the age of 65 years old 
  • Individuals with impaired immune systems (more likely to have more severe illness) 
  • Medications such as antacids (decreased acid enables Salmonella to survive) 

Salmonella infects about 1 million people, leads to over 26,000 hospitalizations, and causes 420 deaths in the U.S. every year (CDC, 2021). 

 

Salmonella ICD-10 Code (unspecified): A02.9

 

Salmonella Diagnosis 

Signs and symptoms include (CDC, 2019): 

  • Onset is usually 6 hours to 6 days 
  • Duration usually persists for 4 to 7 days 
  • Diarrhea (sudden onset and may be bloody) 
  • Abdominal cramps 
  • Fever (almost always present) 
  • Headache 
  • Nausea 
  • Vomiting 

The three most common symptoms are sudden onset of diarrhea (which may be bloody), fever, and abdominal cramps. The diarrhea associated with Salmonella may last several days and may lead to dehydration. Salmonella may persist in the stool for several weeks, even after the diarrhea has resolved. Most individuals do recover completely, but it may take several months before their bowel habits to return to normal. 

 

If the salmonella infection become systemic, it can impact the bloodstream, bone, joint, brain, nervous system, or other internal organs. Invasive Salmonella infections (CDC, 2019): 

  • Can be severe and potentially life-threatening 
  • Occur in approximately 8% of individuals with laboratory-verified Salmonella 
  • May cause: 
    • Bacteremia 
    • Meningitis 
    • Osteomyelitis 
    • Septic arthritis 
  • Are not usually fatal 
  • Occur more often in the very young or in older adults 
  • Occur more often in individuals with an impaired immune system 

 

Salmonella Treatment & Management 

Treatment protocols: 

  • Fluid replacement via oral route if tolerated or IV fluid replacement 
  • Most individuals should not receive antibiotics 

Antibiotics are recommended for (CDC, 2019): 

  • Immunocompromised individuals with the following conditions: 
    • HIV 
    • Organ transplants 
    • Cancer 
    • Current or recent chemotherapy 
    • Sickle cell disease 
    • Hemoglobinopathies 
    • Cirrhosis 
    • On corticosteroids 
    • On immunosuppressive agents 
  • Individuals older than age 50 with the following conditions: 
    • Cardiac conditions 
    • Valvular disorders 
    • Endovascular abnormalities 
    • Severe joint disease 
  • Individuals with severe diarrhea (nine to ten stools per day) 
  • Individuals with a high or persistent fever 
  • Individuals with a condition requiring admittance to an inpatient health care setting 
  • Individuals 65 years or older 

Medications may include (Owens & Warren, 2021): 

  • Antibiotics 
    • Tend to increase adverse effects 
    • Prolong Salmonella detection in stools 
    • Do not shorten the length of gastrointestinal symptoms 
    • When appropriate, fluoroquinolones or cephalosporins such as ciprofloxacin (Cipro®, Cipro® XR) and ceftriaxone (Rocephin®) may be used 
  • Antidiarrheals 
    • Use sparingly as these agents can prolong the infection 
    • Loperamide (Imodium®) 
    • Diphenoxylate and atropine (Lomotil®) 
  • Glucocorticoids 
    • Used in cases of severe complications such as central nervous system (CNS) involvement or disseminated intravascular coagulation (DIC), as well as severe enteric or typhoid fever 
    • Dexamethasone (Decadron®) 

 

Nursing Considerations 

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for Salmonella are listed below. 

 

Assessment 

Assess the individual’s history of present illness. Inquire about the presence of fever, as an elevated temperature is almost always present. Assess onset and duration of signs and symptoms. Watch for signs of dehydration and treat promptly. 

Inquire about possible sources of infection. Determine if the individual has had any recent contact with an infected person or animal. Inquire if the individual has consumed uncooked eggs or meat products. Determine if the individual ingested this food at home or at an alternate location, such as a restaurant. Find out if the individual has any history of recent travel. 

 

Nursing Diagnosis/Risk For 

  • Activity intolerance 
  • Infection related to the presence of infectious agent 
  • Altered nutrition: Less than body requirements 
  • Diarrhea related to bacterial infection 
  • Fluid volume deficit 
  • Hyperthermia 
  • Pain 

 

Interventions 

  • Administer medications as ordered. 
  • Explain the diagnosis, side effects, and treatment. 
  • Give oxygen as needed per order. 
  • Take infection precautions. 
  • Insert and maintain IV therapy per protocol and order. 
  • Recommend/offer meticulous skin and oral care. 
  • Monitor for: 
    • Adverse reaction or complications 
    • Intake and output 
    • Lab results 
    • Treatment response 
    • Vital signs 
  • Correct electrolyte disturbances. 
  • Establish oxygen, monitors, IV lines, blood for labs, and stool for culture. 
  • Control pain, nausea, vomiting, and diarrhea, if necessary. 

 

Expected Outcomes 

  • Decrease in episodes of diarrhea 
  • Manage pain effectively 
  • Maintain normal body weight 
  • Maintain normal fluid and electrolyte balance 
  • Resolve infection 

 

Individual/Caregiver Education 

  • Review diagnosis and treatment. 
  • Discuss medications and potential side effects. 
  • Call if any complications or adverse effects arise. 
  • Follow up with the private healthcare provider. 

Prevention guidelines include (CDC, 2021a): 

  • Set your refrigerator at 40°F or below and know when to dispose of food. 
  • Ensure that perishable food is refrigerated within 2 hours. If the food has been exposed to temperatures of 90°F or higher, the food should be stored in the refrigerator within 1 hour. 
  • Avoid thawing food on the counter as bacteria can rapidly develop in the parts of the food that reach room temperature. Thaw frozen food safely in the refrigerator, in cold water, or in the microwave. 
  • Separate uncooked meats from produce and cooked foods to prevent the transfer of any bacteria. 
  • Stress the importance of handwashing for 20 seconds. 
  • Clean cooking utensils thoroughly. 
  • Cook foods at proper temperatures to prevent bacterial growth. 
  • Wash hands after contact with animals. 
  • Wash hands after handling human and animal feces. 
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Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2027

 

Course Contributor 

The content for this course was revised by Elizabeth Vaccaro, BSN RN, MSCN. 

Elizabeth Vaccaro earned her Bachelor of Science in nursing from Kean University. She is certified as a Multiple Sclerosis Nurse Educator. Elizabeth has worked in a variety of healthcare settings from the hospital to the pharmaceutical industry which has allowed her to have a great appreciation for all the challenges that span the healthcare field. She has practiced in the hospice setting for nine years in a variety of roles from Case Manager, Educator, and Director of both inpatient and home care hospice. 

 

Resource 

 

References