47358424 case study in dengue compile

DENGUE PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1NOVEMBER 17, 2010 4

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INTRODUCTION

Dengue hemorrhagic fever is a severe, potentially deadly infection spread by certain species of

mosquitoes (Aedes aegypti). Globally, 2.5 billion people live in areas where dengue viruses can be

transmitted. In the Philippines, Hemorrhagic fever was first reported in 1953. In 1958, it became a notifiable

disease in the country and was later reclassified as Dengue hemorrhagic fever.

Dengue is a primary disease in the tropical and subtropical region. It is caused by one of four

different but related viruses. It is spread by the bite of mosquitoes, most commonly the mosquito Aedes

aegypti.

It is characterized by increased vascular permeability, hypovolemia and abnormal blood clotting me

chanisms. WHO case definition for DHF: 1) fever or history of recent fever, 2) thrombocytopenia (platelet co

unt equal to or less than 100 x 10 /cu mm),

3) hemorrhagic manifestations such as petechiae or overt bleeding phenomena, and

4) evidence of plasma leakage due to increase vascular permeability.

Illness is biphasic; it begins abruptly with fever, and in children, with mild upper

respiratory complaints often anorexia, facial flush and mild GI disturbances. Coincident with defervescence

and decreasing platelet count, the patient’s condition suddenly worsens, with marked weakness, severe res

tlessness, facial pallor and often diaphoresis, severe abdominal pain and circumoral cyanosis. GI hemorrha

ge is an ominous prognostic sign that usually follows a prolonged period of shock.

Dengue occurrence is sporadic throughout the year. Epidemic usually occurs during the rainy seas

ons June November. Peak months are September and October. It occurs wherever vector mosquito exists.

Currently vector control is the available method for the dengue and DHF prevention and control but

research on dengue vaccines for public health use is in process.

1SAN LAZARO HOSPITAL



OBJECTIVES

General objectives

This case presentation aims to identify and determine the general health problems and

needs of the patient with a final diagnosis of dengue hemorrhagic fever with warning signs. This will further

expand our knowledge on this particular disease. We may be able to extend to our client a holistic

approach of care and services that would somehow contribute to the improvement of the client's current

status. It also aims to develop in us, student nurses the proper nursing care needed in order to provide an

effective nursing management in a hospital set-up until the client is ready for discharge.

Specific objectives

PATIENT BASED:

a. Educate the client for somehow that will contribute to the progress of his condition.

b. Promote an environment conducive for optimal health.

c. Emphasize the importance of maintaining a balance diet.

NURSE CENTERED:

Collects related facts regarding the clients personal data and family illness, past and present

medical history and to examine client thoroughly in order to come up with an accurate physical

assessment.

To review the Anatomy and Physiology and to understand better pathophysiology of the problem,

for us to know the risk factors of this case.

To know the drug properties as well as the diagnostic procedure in order to know the effects of the

drug to be administered. And also to be able to select the appropriate nursing intervention.

To enhance our knowledge about proper nursing management as well as its rationale that we take

into great considerations.

To help motivating the patient to continue the health care provided by health workers.

PATIENT‘S PROFILE



DEMOGRAPHIC HISTORY:

Patient’s Name: Boy XX

Age: 9 years old

Gender: Male

Address: Tanauan, Batangas

Educational Attainment: Elementary Level (Out of School)

Religion: Catholic

Nationality: Filipino

Dialect: Tagalog

Date of Admission: November 8, 2010

Chief Complaint: High Grade Fever

Admitting Diagnosis: Dengue with Warning Signs

Principal Diagnosis: Dengue

Admitting Hospital: San Lazaro Hospital

HEALTH HISTORY:

History of Present Illness

Early in the morning (Nov. 7, 2010), the child played outside their house and returned home at

lunch time. The afternoon on that day, the eldest brother noticed something strange and different and as

quoted by the eldest brother “nanghihina na siya noong dumating ng bahay, nanibago kami kasi malikot

siya. Hinawakan ko siya, napansin ko mainit ang katawan nya at para bang na dengue sya!” Afraid that

this is fatal,the brother immediately rushed the child on the hospital. They traveled from Batangas to Manila

( cannot afford Batangas hospital) he was admitted to San Lazaro Hospital (Nov.8, 2010) Patient X initial

temperature was 38degrees Celsius with petechial rash during tourniquet test. He was diagnosed Dengue

fever with warning sign. They got a sample blood from the patient and ordered an IVF and was referred to

Pavillion 4-Extension of Pediatric Ward.

Past Medical and Surgical History

No previous hospital confinement. The usual colds, minor cough and slight fever that a normal

child gets at his age. The treatment is usually rest, hot soup, and sometimes over the counter drugs.



The patient was fully immunized child

Vaccine Minimum Age at 1st

dose

No. of doses Age received Interpretation and

analysis

BCG Birth or anytime

after birth

1 After birth BCG was given at

earliest possible

age to protect the

possibility of TB

meningitis and

other TB infectious

in which infants are

prone.

DPT 6 weeks 3 1 month and 2

weeks

An early start of

DPT reduces the

chance of severe

pertussis

OPV 6 weeks 3 1 month and 2

weeks

The extent of

protection against

polio is increase

the earlier the OPV

is given

Hep B At birth 3 At birth An early start of

Hep B reduces the

chance of the child

to be infected and

become a carrier.

This vaccine also

prevents liver

cirrhosis and liver

cancer.

Measles 9 months 1 9 months This vaccine

prevents death,



malnutrition,

pneumonia and

diarrhea.

Family Health History

(+) Heart Disease

(+) Hypertension

(-) Diabetes

(-) Asthma

Social Health History

The patient has 7 siblings, a deceased father and a jobless mother. The eldest sister is the only working

individual in the family and she is the breadwinner. They lived in a small upcoming city in Batangas. The

family belongs to the lower bracket of the society. As for the patient lifestyle, as soon as he wakes he is out

of the house. He comes home before dawn. The patient is undernourished , out of school all because of

financial difficulties .

They are loved by their neighbors and the patient has lots of friends his age



PERSON’S REVIEW OF SYSTEM

PERSON’S REVIEW OF

SYSTEM

PRIOR TO

HOSPITALIZATION

DURING

HOSPITALIZATION

INTERPRETATION AND ANALYSIS

1.) PSYCHOLOGICAL

Self Perception-Self-

Concept Pattern

Role Relationship Pattern

As a child, he was not

giving priority to his own

health; he just wants to

play with his friends.

According to the child, he

feels weak after playing

which is not usually happen

to him. His brother rushed

him to San Lazaro Hospital

even though it was far from

Batangas.

He has a happy family with

During hospitalization, the

patient was under

observation. The relatives

noticed that the child is

sometimes unresponsive

and sad. He said that he

missed her mother who was

not there for him because

her mother was 9 months

pregnant.

When he was in the

It is not usual to child to confine him in the

hospital because all he wants to do is to play with

his friends so her emotional and psychological

status was disturbed.

Self-concept involves all perceptions. A positive

self-concept is essential to person’s mental and

physical health. Individuals with positive self-

concept are better able to cope up in problems

and resist psychological and physical illnesses.

Harold Shryock, MD (Modern Medical Guide)

Having a family beside him makes him stronger.



Sexuality and Reproductive

Pattern

7 siblings, his father died

last June2010 and her

mother was pregnant. He

was contented to their life

but when his father died

because of heart attack,

their life changed. Before,

his father was the one

supporting their family

needs.

In Tanauan, Batangas they

are near to the hospital but

because it was too

expensive they traveled to

Manila and confined the

chills to San Lazaro

Hospital.

The child was unaware to

his reproductive and

sexuality pattern. He was

hospital, his brother and

relatives supported him

emotionally and financially.

They are the one beside

him everyday. The family

can buy medications and

IVF appropriate for the

patient’s treatment.

There are no changes to his

sexuality and reproductive

pattern.

Because family is the one responsible in the

child’s care.

Based on the Erikson’s theory of psychosocial

development “states that all families have certain

tasks and survival and continuity and specific

tasks related to the sequential stage of

development throughout the life of the family”.

Taylor, Lilis and Le Mone ( Fundamentals of

Nursing 5th Edition pg 30)

Sexuality is the degree to which a person exhibits

and experiences maleness or femaleness in

physically, emotionally and mentally. Sexuality is



Cognitive Perceptual

Pattern

not yet circumcised

because of young age.

The child has no problem in

hearing and vision. He has

a good communication

skills and awareness.

The child verbalized that

“masakit ang tiyan ko,” with

pain scale of 6/10. There

are no management done

yet except for diversional

activities for the client. The

aunt said that the child

behavior was changed.

defined not only by a person’s genitalia but also

the attitudes and feelings about it.

Harold Shryock, MD (Modern Medical Guide)

Cognitive- Concrete operations (ages 7 to 11).

As physical experience accumulates,

accomodation is increased. The child begins to

think abstractly and conceptualize, creating

logical structures that explain his or her physical

experiences.

Barbara Kozier (Fundamentals of Nursing)

Psychosocial Stage 4 - Industry vs. Inferiority-

Through social interactions, children begin to

develop a sense of pride in their accomplishments

and abilities.

Psychosexual-During the phallic stage, the

primary focus of the libido is on the genitals.

Children also discover the differences between


http://psychology.about.com/od/pindex/g/def_phallicstg.htm


Coping Stress Tolerance

Pattern

Value Belief Pattern

He has a good

developmental stage.

Pyschosoial development-

the client is in stage of

Industry vs. Inferiority. He

can compete to his

playmates.

Pyshosexual- he is in

phallic stage where he

knows male and female.

Cognitive- Concrete

Operations

Major life changes in his

life- when his father died

last june 2010.

He is a Roman Catholic, he

attended mass every

Sundays.

When he was in the

hospital, the child become

quiet.

His became inferior

because of his disease. He

doesn’t want to

communicate and interact.

During hospitalization, he

does not pray.

males and females.


Stress is a condition in which person responds to

changes in the normal balanced state. It can

affect physically, emotionally, socially and

spiritually.

Barbara Kozier (Fundamentals of Nursing pg

1013-1014)

Spiritual beliefs and practices are associated with



all aspects of person’s life, including health and

illness.

Carol Taylor (Fundamentals of Nursing 5th edition

pg 977)

2.) ELIMINATION Bowel Elimination: once a

day at night

Urinary Elimination: 3-4

times a day every morning,

afternoon and evening.

He doesn’t feel any

discomfort during urination

and defecation.

Bowel Elimination: not yet

defecating duting our shift

Urinary Elimination: 3times

during 7-3 shift.

He doesn’t feel any

discomfort during urination

and defecation. And his

urine color is clear.

The amount of urine expelled from the bladder

depends on how much fluid has been taken into

the body and how much of this has been

eliminated. Same as in stool expulsion, this

depends on how much food and kind of food you

eat.

Harold Shryock, MD (Modern Medical Guide pg

199 and 244)

3.)REST AND ACTIVITY

Activity- Exercise Pattern He was a playful child so it

was his daily activity. Since

he was stop to his study,

he just help her mother to

household chores, he knew

how to clean their house.


patient usually lying in bed.

He walks only when going

to the bathroom. And he sits

on his bed when he will eat

meals and take his

Because of his disease his activity was limited.

And he preferred to sleep than to interact with his

relative.

Exercise plays a major role in health

maintenance. It boasts body strength as well as



Sleep-Rest Pattern

In terms of:

Feeding- he can eat on his

own.

Hygiene- he can take a

bath without assistance of

others, can wear and

remove clothing.

Toileting- he can recognize

urging in defecating and

urinating.

The child sleeps early in

the evening from 7pm to

5am. He woke up early to

play with his friends. He

does not take any

supportive aids to sleep.

medications. The doctor

ordered him to have an

enough bed rest to avoid

fatigue. But in terms of:

Feeding- his brother assist

him.

Hygiene- he cannot take a

bath, so only wiping his

body.

Toileting- no changes.


child is always sleeping.

mind ability. It promotes a feeling of zest and well

being and provides greater vigor for the day’s

activities.


45)

Because of the symptoms he experienced, he

preferred to sleep so that he will feel comfortable.

Sleep in some way restores the body’s normal

level of activity and balance. Sleep can also be a

form of comfort and relaxation.

Barbara Kozier (Fundamentals of Nursing pg

1115-1124)

4.) SAFE ENVIRONMENT He does not have any

allergic reactions to food

and medications. He has a

There were no changes.

According to his brother,

According to Maslow’s Hierarchy of Needs-

Security needs are important for survival, but they

are not as demanding as the physiological needs.



good skin turgor.

Sometimes he has many

wounds because of

playing. They live in city

like town.

“hindi naming alam kung

saan siya nakagat ng

lamok, kasi kung saan-saan

siya pumupunta.”

Examples of security needs include a desire for

safe neighborhoods and shelter from the

environment.


5.) OXYGENATION He doesn’t have any

problem in oxygenation, he

does not experience

dyspnea while walking.

During hospitalization, his

nails are pale. But he doe

not use his accessory

muscles while breathing.

Respiration includes ventilation and breathing

which is the movement of air into and out of the

lungs.

Essentials of Anatomy and Physiology 6th Edition

(pg. 417)

6.) NUTRITION He has a good appetite in

all kinds of foods. Her

mother and sister was the

one preparing their foods.

According to the brother of

the patient, “kinakain niya

lahat ng pagkain kasi kung

ano lang ang nakahain sa

bahay, kahit na gulay at

isda.” . And he was not

taking vitamins

When he was in the

hospital, the doctor ordered

a ‘diet as tolerated except

dark colored foods’. He

recalled his past 24 hours

foods:

Breakfast –Pandesal

Lunch – 1 cup rice with

a piece of fried fish and

It is very important to a person to eat nutritious

foods because it is one of the factors that will

affect the health. The ideal state of health comes

partly from sufficient protein and carbohydrates in

the diet, adequate supply of minerals and

vitamins to be well nourished person.


46)



supplements. The patient

he can able to swallow and

chew foods.

veggies.

Dinner- 1 cup of rice

and fried fish.

He has a fair appetite.



PHYSICAL ASSESSMENT

DATE OF ASSESSMENT: November 9,, 2010 11:00am

General Survey:

Client was conscious and coherent, lying in bed with an IV line regulated to 80 gtts per min. hooked at the right side of his arm. His hair is

well-groomed and no body odor being noted during assessment. Patient was cooperative and responds to questions appropriately. He exhibits

moderate lower tone of voice but enough to understand during conversation assisted by his elder brother and he has a proper thought association

and has a sense of reality.

Vital Signs:

Vital signs Normal Actual Findings Interpretation/Analysis

Blood pressure 100/60 100/80 On the disease process any condition affects the cardiac output, blood

volume, blood viscosity has direct effect on the bold pressure. The

patient was not in distress during the assessment

(Kozier, B. (2004). Fundamentals of Nursing p. 510).

Temperature 36.5-37.5 37.8 Febrile due to increase of inflammation as evidenced by an increase in

the number of WBC from the normal value of 4.8 - 10.8 to 2.33.

Inflammation is a local, nonspecific defensive response of the tissues to

an injurious or infectious agent. It is an adaptive mechanism that

destroys or dilutes the injurious agent, prevents further spread of the

injury, and promotes the repair of damaged tissue.



(Kozier, B. (2004). Fundamentals of Nursing p. 634)

Pulse rate 55-90 102 The pulse rate increases as a response to the lowered blood pressure

that results from peripheral vasodilation associated with elevated body

temperature and because of the increase metabolic rate.

(Kozier, B. . Fundamentals of Nursing, 7th edition p. 496).

Respiratory rate 12-25 26 Several factors influence the respiratory rate. Those that increase the

rate include increases in metabolism, stress (readies the body for fight

or flight), increased environmental temperature, and lowered oxygen

concentration at increased altitudes.

In the case of our patient it is increased because of stress and

increased environmental temperature.

(Kozier, B. (2004). Fundamentals of Nursing p. 506).

Skin

PARTS METHOD NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION / ANALYSIS



Skin Inspection

Observation

Palpation

Skin color varies from light to deep

brown; from ruddy pink to light pink,

from yellow overtimes to olive.

Generally uniform except in areas

exposed to sun; areas of lighter

pigmentation (palms, lips nail beds) in

dark skin people. Moisture in the skin

folds and the axillae (varies with

environmental temperature, and

activity).

No edema, abrasions, lesion.

Temperature is uniform and w/in

normal range

Dark brown with excessive moisture

in the upper extremities and

petechial rashes.

Generally uniform except in areas

exposed to sun; areas of lighter

pigmentation (palms, lips nail beds)

in dark skin people.

No edema, abrasions, lesion.

Temperature is not w/in the normal

range, the skin is moist and warm to

touch.

Excessive moisture indicates

hyperthermia as evidenced

by an increase in the body

temperature from the normal

range of 35.5-37.5 to 37.8.

While petechial rashes

indicates the Herman’s sign,

the pathognomonic sign of

dengue.

The skin is warm to touch

because of the localized

hyperthermia due to

inflammation as evidenced

by an increase in the WBC

count

( Fundamentals of Nursing

by Kozier, pp.535,540,1071)

Nails Inspection Convex curvature; angle of nail plate

about 160o

- with smooth texture

- color is highly vascular& pink in light

Convex, smooth in texture, color is

pinkish and is highly vascular.

Blanch test: Prompt return of usual

Normal findings accdg. To Kozier

page 543’



skinned clients; dark skinned clients

may have brown or black

pigmentation in longitudinal streaks

with intact epidermis on tissue

surroundings

- blanch test- prompt return of pink or

usual color 3-5 sec. Kozier, 2008

color (after 3 sec.)

Head


Hair Inspection

Palpation

Evenly distributed hair over

the scalp with thickness,

variable amount of body

hair. No infection or

infestation.

Hair is evenly distributed to

different parts of the body and it

is thick. No infection or

infestation noted.

The mother of the patient attend to his

need during hospitalization, it results to

good hygiene, the condition of the patient

limits his activities but despite of that

relatives are there for him to assist his

needs.

(Fundamental of Nursing by Kozier,

p541)

Scalp Inspection

Palpation

White, clean, free from

masses, lumps scars, lice,

nits, dandruff, and lesions

no area of tenderness

White, clean, free from masses,

lumps scars, lice, nits, dandruff,

and lesions no area of

tenderness

Skull Inspection

Palpation

Rounded( normocephalic &

symmetrical, with frontal,

Round (normocephalic), smooth

skull contour.

Normal findings according to

Kozier page 544.



parietal, occipital,

prominences)

smooth, uniform, absence

of modules or masses

Smooth, absence of nodules or

masses.

Eyes


Eyebrows Inspection Symmetrically aligned.

Equally distributed, curled

slightly outward

Hair is evenly distributed skin

intact and aligned.

Symmetrically aligned and

equal movement.

Normal findings.

With age, eyebrows become bristly and

coarse.

(Kozier, B. Fundamentals of Nursing, 7th

edition, p. 548).

Eyelashes Inspection Equally distributed, Curled

slightly outward

Eyelashes are equally

distributed, it is thick and is

curled outward.

Normal findings.

Eyelashes should be curled outward to

sweep foreign particles away from the eyes.

Eyelids Inspection The skin is intact, no

discharge and no

discoloration. The lids

close symmetrically blinks

involuntary and with

bilateral blinking.

Lids closes symmetrically,

bilateral blinking and no

visible sclera above corneas,

and upper and lower borders

of cornea are slightly

covered when lids are open.

Normal findings according to Kozier page

548.

Sclera and

Conjunctiva

Inspection Shiny, smooth & pink or

red in color

Both sclerae are shiny and

smooth.

Extremely red color of both conjunctivae

indicates inflammation as evidenced by the



Palpebral conjunctivae are

extremely red.

body temperature of 37.8 and an increase

in the WBC count. .


edition, p.548).

Cornea Inspection transparent, shiny &

smooth, details of the iris

are visible

Transparent shiny and

smooth.

Normal findings

(Kozier, B. Fundamentals of Nursing 7th

edition, p. 550).

Pupils and iris Inspection Black in color, equal in

size, normally 3-7 mm in

diameter, sound- smooth

border iris flat & sound.

Pupils constrict when

looking at near object and

dilate when looking at far

objects.

Iris brown in color, equal in

size and round in shape. Iris

is flat and round. Pupil

diameter is 4mm.

Patient’s pupils constrict

when looking at near objects

and dilate when looking at

far objects.

Normal findings.

Pupils equally reactive to light and

accommodates symmetrically.


edition, p. 550).

Extraocular

muscle tests

Inspection Both eyes coordinated,

move in unison with

parallel alignment.

Within normal findings. Normal findings.

(Kozier, B. (2004). Fundamentals of Nursing

p. 554).

Visual Acuity Inspection Able to read newsprint

with 20/20 vision on

snellen chart.

The patient can read

writings that was given to

him for visualization .

Normal findings.


edition, p. 552).



Ears


Auricles Inspection

Palpate

The color is same as facial

skin, symmetrical, the

auricles aligned with outer

cantus of the eye.

Mobile, firm and not

tender, pinna recoils after

it is folded.

The color is same as facial

skin, symmetrical, the

auricles aligned with outer

cantus of the eye.

Mobile, firm and not tender,

pinna recoils after it is

folded.

Normal Findings

Kozier, B Fundamentals of Nursing 7th

edition, p. 556

Ear Canal Inspection Distal third contains hair

follicles and glands. Dry

cerumen, grayish-tan color

or sticky, wet cerumen in

various shades of brown.

Distal third contains hair

follicles and glands. Dry

cerumen, grayish-tan color

or sticky, wet cerumen in

various shades of brown.

Normal Findings

Kozier, B. Fundamentals of Nursing, 7th

edition, p. 556

Hearing Acuity Inspection Normal voice tones

audible. Sound is heard in

both ears or localized at

the center of the head

(Weber Negative).

Air conducted hearing is

greater than bone

conducted hearing

(positive Rinne)

Normal voice tones audible.

Sound is heard in both ears

or localized at the center of

the head.

Normal Findings

according to Kozier page 558



Nose

PARTS METHOD NORMAL FINDINGS ACTUAL FINDINGS ANALYSIS

Nose Inspection Symmetric and straight

No discharge in flaring

Uniform in color

Not tender, no lesion

Symmetric in shape. No

discharge or flaring, uniform

in color. (-) tenderness and

lesions.

Patient can breathe normally through nose

and no discharges. He can also identify

common odors like alcohol.


560-561

Facial Sinuses Palpation No tenderness No tenderness noted. Normal findings according to Kozier page

560-561

Septum Inspection Air moves freely as the

client breathes through the

nares. Nasal septum intact

& in midline

Nasal septum intact and in

midline.


560-561

Mouth


Lips Inspection

Palpation

Uniform pink color

Soft, moist, smooth

texture

Symmetry of contour

Ability to purse lips

Uniform pink color

Soft, moist, smooth texture

Symmetry of contour

Ability to purse lips

Normal findings accdg. to Kozier, p.563



Buccal mucosa Inspection Uniform pink color

Soft, moist, smooth

texture

Uniform pink color

Soft, moist, smooth in texture.

Normal findings accdg. to Kozier, p.563

Gums Inspection Pink gums, moist, firm

texture to gums.

Pinkish gums, no retraction,

moist and firm.

Gums are pinkish in color.

Normal findings

(Fundamentals of Nursing by Kozier, p564)

Tongue Inspection

Palpation

Central position

Pink color, moist,

slightly rough; then,

whitish coating

Smooth; lateral margins;

no lesions

Raised papillae

Moves freely, no

tenderness

Smooth tongue base

with prominent veins.

Central position, pink in color,

moist, moves freely, no

lesions, tenderness and

nodules.

Normal


Teeth Inspection 24 pediatric teeth

smooth, white, shiny

tooth enamel

pink gums moist.

Missing tooth, with 22

smooth, yellow, shiny tooth

enamel

pink gums moist.

Normal Findings




Uvula Inspection Soft, moist, smooth

texture Pink and

smooth.

Soft, moist, smooth texture

Pink and smooth.

Normal Findings


Tonsils Inspection No discharge. Tonsils of

normal size.

Pink and smooth

posterior wall.

No discharge. Tonsils of

normal size.

Pink and smooth posterior

wall.

Normal Findings


Neck


Neck Inspection

Palpation

Proportional to size of

the head, symmetrical

and straight. Freely

movable without

difficulty.

No palpable lumps or

tenderness

The trachea is in the

Central placement in

midline of neck, spaces

are equal on both sides.

Muscles equal in size, head

centered, coordinated

smooth movement, head

was flexed, hyperextend,

laterally flexes, laterally

rotates, no noted palpable

lymph nodes, trachea in

central placement in midline

of neck spaces are equal on

both sides, thyroid gland

moves with deglutition.

Patient has unlimited ROM.

There are no palpable lymph nodes. Head

can easily flex and rotates. Trachea is in the

central placement and no indication of

possible neck tumor nor thyroid enlargement

Muscles in the neck like sternocleidomastoid

and trapezius draw the head to the side and

elevate the chin and elevate the shoulders to

shrug them.

The trachea, thyroid gland, anterior cervical



nodes and carotid artery lie within the anterior

triangle.

(Fundamentals of nursing by Kozier p566)

Upper extremities

PARTS METHOD NORM AL FINDINGS ACTUAL FINDINGS INTERPRETATION / ANALYSIS

Shoulders Inspection

Palpable

Able to tolerate wide

range of motion. No

difficulty upon bending

and stretching. . No

lesions, no scars and no

deformity.

Able to do ROM. Normal Findings

Arms and

forearms

Inspection

Palpable


range of motion. No


and stretching. No


deformity.

Able to do ROM exercises

without difficulty in doing.

Have some scars but no

deformity.

Both arms have equal strength, patient can

move arms against gravity and against full

resistance.

(Fundamentals of Nursing by Kozier p1068)

Elbows Inspection

Palpable


range of motion. No






1061




deformity.

Wrist Inspection

Palpable


range of motion. No




deformity.




1061

Hands and

Fingers

Inspection

Palpable


range of motion. No




deformity.


without difficulty in doing in

the left hand.

With the presence of IV line

in the right hand it makes

difficult to move.


1061

Thorax


Chest size and

shape

Inspection Anteroposterior to

transverse chest is

symmetrical.

Anteroposterior to transverse

chest symmetrical.

Normal


Breath sounds Auscultation Bronchovesicular

breathe sound.

Patient has a clear,

bronchovesicular breath

Normal.




sound.

Posterior Palpation

Percussion

Full and symmetric chest

expansion. Fremitus

tactile most clearly at the

apex of the lungs

Quiet, rhythmic and

effortless respiration.

Vesicular and

bronchovesicular breath

sound.

Notes resonate, except

over scapula, the lowest

point of resonance is at

the diaphragm.

Vocal nor tactile fremitus,

Bronchovesicular breathe

sound.

Notes resonate, except over

scapula, the lowest point of

resonance is at the

diaphragm


578-579

Anterior Inspection

Palpation

Quiet, rhythmic and

effortless respiration.


expansion. Same as

posterior vocal fremitus,

fremitus is normally

decreased over heart

Quiet rhythmic and effortless.


expansion.


578-579



Percussion

and breast tissue.

Notes resonate down to

the 6th rib at the level of

the diaphragm but are

flat over areas of heavy

muscle and bone, dull on

areas the heart and the

liver, and tympanic over

the underlying stomach.

Breast

PARTS METHOD NORNAL FINDINGS ACTUAL FINDINGS ANALYSIS

Breast Inspection

Palpation

No masses and lumps No masses and lumps Normal findings

(Kozier, 2008)

Areola Inspection

Palpation

Dark in color in contrast

to surrounding skin. No

masses, lumps and

lesions.

Dark in color in contrast to

surrounding skin. No masses,

lumps and lesions.

Normal Findings

(Kozier, 2008)

Nipples Inspection

Palpation

Size is proportional. No

discharged or

secretions.

Size is proportional. Normal findings.



(Kozier, 2008)

Abdomen


Skin integrity Inspection Unblemished skin, uniform in color. Unblemished skin,

uniform in color

Normal findings Kozier page 592-

598

Contour and

symmetry

Inspection Flat, rounded.

Symmetric contour.

Flat, symmetric contour. Normal findings Kozier page 592-

598

Movement Inspection Symmetric movements caused by

respiration.

Symmetric movement

caused by respiration, no

visible vascular pattern.


598

Bowel sounds Auscultation Audible bowel sounds Audible bowel sounds Normal findings Kozier page 592-

598

Umbilicus Inspection Clean Clean Normal findings Kozier page 592-

598

Bladder Palpation Not palpable Not palpable Normal findings Kozier page 592-

598

Liver Palpation May not be palpable.

Border feels smooth

No enlargement. Not

palpable


598

Genitalia



Patient refuses to be assessed but according to the patient he was not circumcise yet.

Lower Extremities

PARTS METHOD NORMAL

FINDINGS

ACTUAL FINDINGS INTERPRETATION / ANALYSIS

Hip Inspection Able to perform wide

range of motion. No

masses, scars and

deformity.

Able to perform minimal range of motion

exercise no masses and deformities.

Normal findings

(Fundamentals of Nursing by

Kozier p1068)

Leg Inspection

Palpation

Able to perform wide

range of motion. No

masses, scars and

deformity.

Able to perform wide range of motion.

Has flakes and scars but has no deformity.

Normal findings


Kozier pg. 495)

Knee Inspection

Palpation


range of motion. No

masses, scars and

deformity.

Able to perform wide range of motion.

No masses and deformity but have some round

and oval shape of scars of about 1cm in size.

Normal findings


Kozier (2004) p. 497)

Foot and toes Inspection

Palpation


range of motion. No

masses, scars and

deformity.

Comfortable to perform wide range of motion.

No masses and deformity .

Normal


Kozier,(2004) p.496)

Peripheral Palpation Symmetric full Symmetric full pulsation Normal findings



pulse pulsation (by Kozier, (2004) p496)



. ANATOMY AND PHYSIOLOGY

Blood Basics

Blood is a collection of specialized cells

suspended in straw-colored liquid called plasma.

Blood delivers oxygen and nutrients in the body

cells, collect waste, distribute hormones, spread

heat around the body to control the temperature

and play part in fighting infection and healing

injuries.

Blood forms about one-twelfth of the body

weighing of an adult, amounting to about 11 pints

(5 liters) in volume. Roughly 50-55 percent of the

blood is plasma, the liquid only-portion in which

cellular components are distributed. Plasma is 90% containing dissolve substances such as glucose(blood

sugar), hormones, enzymes, and also waste products such as urea and lactic acid.

Plasma also contains proteins such as

albumins, fibrinogen(important clotting factor) and

globular proteins or globulins help transport lipids,

which are fatty substance such as cholesterol.

Gamma globulins are mostly disease-fighting

substances that are known as antibodies. The

remaining 45-50% of blood is made up of 3 types

of specialized cells. Red cells or erythrocytes carry

oxygen; various white cells known as leukocytes

are part of defense system and cellular fragment

(platelets or thrombocytes) involved in the process

of clotting.

Two types of blood vessels carry blood throughout our bodies:



1. Arteries carry oxygenated blood (blood that has received oxygen from the lungs) from the heart to

the rest of the body.

2. Blood then travels through veins back to the heart and lungs, where it receives more oxygen.

As the heart beats, you can feel blood traveling through the body at pulse points — like the neck and the

wrist — where large, blood-filled arteries run close to the surface of the skin.

The blood that flows through this network of veins and arteries is whole blood, which contains three types

of blood cells:

1. red blood cells (RBCs)

2. white blood cells (WBCs)

3. platelets

In babies and young kids, blood cells are made within the bone marrow (the soft tissue inside of bones) of

many bones throughout the body. But, as kids get older, blood cells are made mostly in the bone marrow of

the vertebrae (the bones of the spine), ribs, pelvis, skull, sternum (the breastbone), and parts of the

humerus (the upper arm bone) and femur (the thigh bone).

The cells travel through the circulatory system suspended in a yellowish fluid called plasma, which is 90%

water and contains nutrients, proteins, hormones, and waste products. Whole blood is a mixture of blood

cells and plasma.

Red Blood Cells

Red blood cells (also called erythrocytes) are shaped like slightly indented, flattened disks. RBCs contain

the iron-rich protein hemoglobin. Blood gets its bright red color when hemoglobin picks up oxygen in the

lungs. As the blood travels through the body, the hemoglobin releases oxygen to the tissues.

The body contains more RBCs than any other type of cell, and each has a life span of about 4 months.

Each day, the body produces new RBCs to replace those that die or are lost from the body.

White Blood Cells



White blood cells (also called leukocytes) are a key part of the body's system for defending itself against

infection. They can move in and out of the bloodstream to reach affected tissues. Blood contains far fewer

WBCs than red blood cells, although the body can increase WBC production to fight infection. There are

several types of WBCs, and their life spans vary from a few days to months. New cells are constantly being

formed in the bone marrow.

Several different parts of blood are involved in fighting infection. White blood cells called granulocytes and

lymphocytes travel along the walls of blood vessels. They fight germs such as bacteria and viruses and

may also attempt to destroy cells that have become infected or have changed into cancer cells.

Certain types of WBCs produce antibodies, special proteins that recognize foreign materials and help the

body destroy or neutralize them. The white cell count (the number of cells in a given amount of blood) in

someone with an infection often is higher than usual because more WBCs are being produced or are

entering the bloodstream to battle the infection.

After the body has been challenged by some infections, lymphocytes "remember" how to make the specific

antibodies that will quickly attack the same germ if it enters the body again.

Platelets

Platelets (also called thrombocytes) are tiny oval-shaped cells made in the bone marrow. They help in the

clotting process. When a blood vessel breaks, platelets gather in the area and help seal off the leak.

Platelets survive only about 9 days in the bloodstream and are constantly being replaced by new cells.

Important proteins called clotting factors are critical to the clotting process. Although platelets alone can

plug small blood vessel leaks and temporarily stop or slow bleeding, the action of clotting factors is needed

to produce a strong, stable clot.

Platelets and clotting factors work together to form solid lumps to seal leaks, wounds, cuts, and scratches

and to prevent bleeding inside and on the surfaces of our bodies. The process of clotting is like a puzzle

with interlocking parts. When the last part is in place, the clot happens — but if even one piece is missing,

the final pieces can't come together.

When large blood vessels are severed (or cut), the body may not be able to repair itself through clotting

alone. In these cases, dressings or stitches are used to help control bleeding.



Nutrients in the Blood

Blood contains other important substances, such as nutrients from food that has been processed by the

digestive system. Blood also carries hormones released by the endocrine glands and carries them to the

body parts that need them.

Blood is essential for good health because the body depends on a steady supply of fuel and oxygen to

reach its billions of cells. Even the heart couldn't survive without blood flowing through the vessels that

bring nourishment to its muscular walls.

Blood also carries carbon dioxide and other waste materials to the lungs, kidneys, and digestive system to

be removed from the body.

Blood cells and some of the special proteins blood contains can be replaced or supplemented by giving a

person blood from someone else via a transfusion. In addition to receiving whole-blood transfusions,

people can also receive transfusions of a particular component of blood, such as platelets, RBCs, or a

clotting factor. When someone donates blood, the whole blood can be separated into its different parts to

be used in this way.



BOOK BASED PATHOPHYSIOLOGY:


MODIFIABLE

Environmental conditions

NON MODIFIABLE

GeographicalRainy season

Age

Dengue virus circulates in the blood

Dengue virus is inoculated into humans within 3-14 days

Aedes aegypti acquires virus from a host

The virus is transferred into the susceptible host via bite of the

mosquito

8-12 days of viral replication on mosquito’s salivary glands

Virus disseminate rapidly into the blood

Itchiness/ redness in the area

Stimulates leukocytes especially B lymphocytes

Production and secretion of Ig’s & monocytes/

macrophages, neutrophils

Leukocytosis



Stimulates leukocytes and pyrogen release

Release of cytokines w/c consists of vasoactive agents such as IL, TNF, UK,

platelet activating factors

Recognition of dengue viral antigen on infected monocyte by cytotoxic T

cells

Monocytes/macrophages perform phagocytosis through Fc receptor

within the cells. Dengue virus replicates in the cells of monocytes/

macrophages

Antibodies bind to the viral antigens

Direct cellular destruction & infection of bone marrow & immunological

shortened platelet survival

Fever DiaphoresisWarm flushed skinMalaiseHeadache

Thrombocytopenia

Causes depressed platelet synthesis

Leukopenia


CLIENT BASED PATHOPHYSIOLOGY


MODIFIABLE

Environmental conditions

NON MODIFIABLE

GeographicalRainy season

Age

Dengue virus circulates in the blood

Dengue virus is inoculated into humans within 3-14 days

Aedes aegypti acquires virus from a host

The virus is transferred into the susceptible host via bite of the

mosquito

8-12 days of viral replication on mosquitos salivary glands

Virus disseminate rapidly into the blood

Itchiness/ redness in the area

Stimulates leukocytes especially B lymphocytes

Production and secretion of Ig’s & monocytes/

macrophages, neutrophils

Leukocytosis

Pleural effusion Edema

Capillary permeability

Dengue hemorrhagic fever

EpistaxisGum bleedingMelenaHematocheziaHematuria Abdominal pain



Stimulates leukocytes and pyrogen release

Release of cytokines w/c consists of vasoactive agents such as IL, TNF, UK,

platelet activating factors

Recognition of dengue viral antigen on infected monocyte by cytotoxic T

cells

Monocytes/macrophages perform phagocytosis through Fc receptor

within the cells. Dengue virus replicates in the cells of monocytes/

macrophages

Antibodies bind to the viral antigens

Direct cellular destruction & infection of bone marrow & immunological

shortened platelet survival

Fever DiaphoresisWarm flushed skin

Thrombocytopenia

Causes depressed platelet synthesis



Dengue hemorrhagic fever

Abdominal painMelena

Leukopenia


LABORATORY REPORTS

Diagnostic Procedures

HEMATOLOGY

Hematology is the branch of internal medicine, physiology, pathology, clinical laboratory work, and pediatrics that is concerned with the

study of blood, the blood-forming organs, and blood diseases.

Name: Indepenso, Ryan Patient I.D. 020238

Age: 9 Sex: Male Hospital Number: 0134623

COMPONENTS RESULT Unit Normal Interpretation and Analysis

WBC 2.33 10^9/L 4.8-10.8 Virus attacks WBC and this is a normal finding In a patient with

dengue.

RBC 4.79 10^9/L 4.7-6.1 Normal

Hemoglobin 13.04 g/L 13-17 Normal

Hematocrit 40.78 % 40-52 Normal

MCV 85.15 Hq 87-98 Mean corpuscular volume (MCV) is a measurement of the average size

of your RBCs. When the MCV is decreased, your RBCs are smaller

than normal (microcytic) as is seen in iron deficiency

MCH 27.23 Pq 28-33 Mean corpuscular hemoglobin (MCH) is a calculation of the average

amount of oxygen-carrying hemoglobin inside a red blood cell.

Macrocytic RBCs are large so tend to have a higher MCH, while

microcytic red cells would have a lower value.

MCHC 31.98 g/L 33-36 Decreased MCHC values (hypochromia) are seen in conditions where



the hemoglobin is abnormally diluted inside the red cells, such as in iron

deficiency anemia and in thalassemia.

Platelet 90 10^9/L 150-400 Destroys the body’s capacity to produce new platelets

RDW 13.09 % 11.4-19.0 Normal

Neutrophil 60.3 % 40-70 Normal

Lymphocytes 32.3 % 19-48 Normal

Eosinophil 0.7 % 2-8 Refer to Wbc

Monocytes 5.5 % 3-9 Normal

Basophils 1.2 % 0-2 Normal



DRUG STUDY:

Drug Name Dosage,

Frequency,

Route

Action Indication Adverse Effect Contraindication Nursing Responsibilties

Generic:

Omeprazole

Brand:

Losec†‡, Prilosec,

Zegerid

Pharmacologic

Class: proton

pump inhibitor

Pregnancy

Category: C

Dosage: 20 mg

Frequency: OD

Route: IV

Inhibits activity of

acid (proton)

pump and binds

to hydrogen-

potassium

adenosine

triphosphatase at

secretory surface

of gastric parietal

cells to block

formation of

gastric acid.

GERD,

pathologic

hypersecretory

conditions,

duodenal ulcer,

helicobcter

pylori infection,

frequent

heartburn

CNS: headache,

dizziness,

asthenia.

GI: diarrhea,

abdominal pain,

nausea, vomiting,

constipation,

flatulence.

Musculoskeletal:

back pain.

Respiratory:

cough, upper

respiratory tract

infection.

Skin: rash.

Contraindicate in

patients with

hypersensitivity

with the drug.

Dosage adjustments

may be necessary in

Asians and patients with

hepatic impairment.

Drug increases its

own bioavailability with

repeated doses. Drug is

unstable in gastric acid;

less drug is lost to

hydrolysis because drug

increases gastric pH.

Caution patient to

avoid hazardous

activities if he gets dizzy.



Drug Name Dosage,

Frequency,

Route

Action Indication Adverse Effect Contraindication Nursing Responsibilties

Generic Name:

Acetaminophen

Brand Name:

Paracetamol

Classification:

Paraminophenol

derivative

Pregnany

Category:

B

Dosage:250 g

Fraquency:

Q4, prn

Route:

Per Orem

Thought to

produce

analgesia by

blocking pain

impulses by

inhibiting

synthesis of

prostagalandin in

the CNS or of

other substances

that sensitize

pain receptors to

stimulation. The

drug may relieve

fever through

central action in

To relieve mild

to

moderate pain

due

to things such

as

headache,

muscle

and joint pain,

backache and

period pains. It

is

also used to

bring

down a high

temperature.

Hematologic:haem

olytic anmia,

leukopeia,

neutropenia

Hepatic: Jaundice

Metabolic:

Hyperglycema

Skin: rash,

urticaria

Hypersensitivity

to

acetaminophen.

Assessment & Drug

Effects

Monitor for S&S of:

hepatotoxicity, even

with moderate

acetaminophen doses,

especially in

individuals with poor

nutrition.

Patient & Family Education

Do not take other

medications (e.g., cold

preparations)

containing

acetaminophen



the hypothalamic

heat-regulating

center.

For

this reason,

paracetamol

can be

given to children

after

vaccinations

to prevent post-

immunisation

pyrexia (high

temperature).

Paracetamol is

often included in

cough, cold and

flu

remedies

without medical

advice; overdosing

and chronic use can

cause liver damage

and other toxic

effects.

Tell patients to consult

prescriber before giving

drug to children younger

than 2.

Do not use for fever

persisting longer than

3 days, fever over 39.5°

C (103° F), or

recurrent fever unless

directed by prescriber.



URSING CARE PLAN

1. Hyperthermia

CUESNURSING

DIAGNOSISINFERENCE

EXPECTED

OUTCOMESINTERVENTIONS RATIONALE EVALUATION

SUBJECTIVE:

“Mainit po ang

pakiramdam ko.”

OBJECTIVE:

-Flushed skin

-Warm to touch

Vital signs taken

as follows:

T: 37.7˚C

PR: 102 bpm

RR: 26 cpm

BP: 100/80 mmHg

Hyperthermia

related to illness

as evidenced by

temperature of

37.7˚C

Exogenous

pyrogens (Dengue

virus)

Host cells

Endogenous

pyrogens

Hypothalamus

change in set

point

Fever (increase in

core temperature

to new set point)

After 30 minutes

of nursing

interventions, the

temperature of the

client will be

lowered to at least

37.5˚C or within

normal range of

37˚C

INDEPENDENT:

-provide tepid sponge

bath

-promote surface

cooling by means of

undressing

-provide cool

environment

-instruct client to

minimize movement

or maintain bed rest

-promotes heat

loss by

evaporation and

conduction

-promotes heat

loss by means

of radiation and

conduction

-promotes heat

loss by means

of convection

-to reduce

metabolic

demands of

After 30 minutes

of nursing

interventions, the

goal was not met

as evidenced by

the increase in

temperature of the

client rose to

37.8˚C.



-discuss importance of

adequate oral fluid

intake particularly to

the parents

DEPENDENT:

-administer IV fluids

as ordered

-to prevent

dehydration

-to prevent

dehydration

2. ACUTE PAIN

Cues Nursing Inference Expected Nursing Rationale Evaluation



diagnosis outcome interventions

Subjective:

I have severe

abdominal pain

Objectives:

Exhibited facial

grimace upon

body movement

Pain scale of 8/10

Vital signs taken

as follows:

Temp: 37.8 c

PR: 102 bpm

RR: 26 cpm

BP: 100/80mmHg

Acute pain related

to upper GI

bleeding

secondary to

dengue

hemorrhagic fever

Bite of infected

mosquito

Virus entered into

the blood

Virus attacks the

blood

Plasma leakage

Bleeding

Short term:

After one hour of

nursing

intervention, the

patient will:

~ Verbalize

gradual relief or

reduction of pain

Long term:

After two days of

nursing

intervention, the

patient will:

~ Verbalize

adequate relief of

pain or ability to

cope with

incompletely

relieved pain.

Independent

1.Assess pain

characteristics and

Severity

2. Encourage

verbalization of

feelings of pain

3. Provide comfort

measures and

encourage relative

to perform touch

therapy

4. Encourage and

assist to do deep

breathing exercise

1.To identify extent

of pain

2. Pain is

subjective and can

only be

experienced and

expressed by the

patient

3. To provide a

non pharmacologic

pain management

4 For relaxation

and can contribute

to pain relief

Short term:

After one hour of

nursing intervention,

the patient was able to:

~ Verbalize gradual

relief or reduction of

pain as evidenced by

absent of facial grimace

upon body movement.

Goal was met

Long term:

After two days of

nursing intervention,

the patient was able to:

~ Verbalize adequate

relief of pain as

evidenced by pain

scale of 4/10



pain ~ Demonstrate

non pharmacologic

ways to lessen

pain

5. Teach the

client and

significant

others about

non

pharmacologic

ways to lesson

pain

6. Notify physician

if regimen is

inadequate

Collaborative:

1. Administer

medications as

prescribed.

2. Assist with

laboratory and

diagnostic studies

as indicated.

5. To maximize

their opportunities

for self control

over

manifestations of

pain

6. To meet pain

control goal.

.

1.To relief or

maintain

acceptable level of

pain

2. To determine

changes

indications of

healing or

~ Demonstrate non

pharmacologic ways to

lessen pain

Goal was met.



complications and

to identify

precipitating

factors



DIAGNOSTIC EXAMINATIONS

Tourniquet Test

It is a test to determine the vascular resistance and platelet function. It an ancillary test but not considered as a confirmatory test.

Place the cuff of a sphygmomanometer around the arm in the usual manner and inflate to a pressure halfway between systolic and diastolic levels. Maintain compression for five minutes and wait two minutes or more before observation. Describe an area 1-square inch on the volar surface of the forearm 1-1/2 inches distal from the antecubital fossa. Count the petechiae within this prescribed area. A positive tourniquet test is > 20 petechiae.

Total White Blood Cells Count

In case of dengue, this test will reveal leukopenia. The presence of leukocytosis and neutrophilia excludes the possibility of dengue and bacterial infections (leptospirosis, meningoencephalitis, septicemy, pielonephritis etc.) must be considered.

Thrombocytopenia (< 100.000 /mm3)

Total platelets count must be obtained in every patient with symptoms suggestive of dengue for three or more days of presentation. Leptospirosis, measles, rubella, meningococcemia and septicemy may also course with thrombocytopenia.

Hematocrit (micro-hematocrit)

According to the definition of DHF, it is necessary that there is a presence of hemoconcentration (hematocrit elevated by > 20%); when it’s not possible to know the previous value of hematocrit, we must regard as significantly elevated the results > 45%.

Bleeding Parameters

Bleeding Time = 1-3 minutes Clotting Time = 3-5 minutes

Prothrombin Time = 12-15 seconds

Activated Partial Thromboplastin Time = 30-40 seconds



MEDICAL MANAGEMENT

Supportive and symptomatic treatment should be provided.

For fever, give paracetamol for muscle pains. For headache, give analgesic. Do not give aspirin.

Rapid replacement of body fluid is the most important treatment.

Includes intensive monitoring and follow-up.

Give ORESOL to replace fluid as in moderate dehydration at 75ml.kg in 4-6 hours or up to 2-3L in

adults. Continue ORS intake until patient’s condition improves.

IVF (PLR)

Intravenous fluid therapy is recommended when danger signs are present, especially during

defervescence. Crystalloids (D5LRS or D5NSS or PLRS or PNSS) can be given at 5-15

ml/kg/hour, with periodic adjustment according to patient's subsequent response. The vital signs

and urine output are important parameters to monitor response to IVF therapy. When the patient is

in shock, IVF must be given at a faster rate and bigger volume, the 20/20 rule, that is, 20ml/kg in

20-30 minutes. After adequately replacing the fluid losses, maintenance IVF therapy should be

instituted. D5LRS or D5IMB if < 2 yrs old may be used and should be given at 3 ml/kg/hr up to 2-3

liters per day in adults. Patients usually require IVF therapy for 24-48 hours

H2-antagonists – anti-ulcer (proton pump, antacids)

Plasma Expanders –Dextran

Blood Transfusion:

1. Platelet Concentration

2. PRBC

3. Fresh Whole Blood

4. Fresh Frozen Plasma

5. Cryoprecipitate

Monitor platelet count and hematocrit level

Baseline platelet count should be available at any stage of dengue hemorrhagic fever. Serial

determinations may be required during the defervescence stage to anticipate the onset of shock or

to detect occult bleeding. After recovery with fluid replacement, platelet count and hematocrit may

be repeated just before discharge.

NURSING MANAGEMENT

Provide a comfortable, dim and quiet room for rest.



Advise to increase oral fluid intake.

Watch out for bleeding manifestations.

For hemorrhage – keep the patient at rest during bleeding episodes. For nose bleeding, maintain

an elevated position of trunk and promote vasoconstriction in nasal mucosa membrane through an

ice bag over the forehead. For melena, ice bag over the abdomen. Avoid unnecessary movement.

Observe signs of shock such as low pulse, cold clammy perspiration, prostration. Dorsal

recumbent position facilitates circulation.

Diet – DAT EDCF and drinks.



DISCHARGE PLANNING (METHODS)

M – Instruct the patient’s mother the importance of compliance to medicines to achieve appropriate

therapeutic effects. Take Paracetamol for fever, if the patient’s temperature is 38 degrees Celsius and

above and Vitamin C to increase immune system.

E – Tell the patient that he may have to decrease his activities and may not be allowed to do any hard

exercises for faster recovery.

T – Emphasized the proper treatment if the signs and symptoms of DHF reoccur. Proper TSB (Tepid

sponge bath) if there is a fever, increasing the fluid intake except for colored drinks and seek the

professional health team.

H – Advice the patient’s mother to guide and follow the balance diet and to have adequate rest and sleep

of his son. Instructed the patient’s mother to provide insect repellants (natural or synthetic) for him and

emphasized the environmental cleanliness is a must. Advise patient to seek medical help if the sign and

symptoms

occur:

Shortness of breath ▪Symptoms of underlying disorders (wheezing, coughing)

Swelling of the feet or ankles ▪ Intolerance

Chest discomfort

- For some complications of DHF

O – Instructed patient to have follow-up checked-up @ OPD 2 weeks

after discharge from the hospital.

D - Suggest the patient to eat healthy foods from all of the 5 food

groups: fruits, vegetables, breads, dairy products, meat and fish.

Eating healthy foods may help her feel better and have more energy.

She may be told to eat foods that are low in fat and salt.

S - Advise patient to always pray to our lord and never lose hope in

any obstacle that we may encounter.



EVALUATION

We met the objective we post at the beginning of this case study. We gained knowledge

about the related factor hinged in Communicable Disease like Dengue, through our clients we are able to

apply the nursing intervention needed for their situation. With this, as our fundamental foundation, we can

provide the expected care management and health teaching for our clients with this kind of condition. In

addition to this the case study, it also identify and determine the general problems and needs of the patient

with Dengue. The proper evaluation concerning the nursing management of client has also been aptly

accomplished. This presentation was able to help the patient promote health, prevention of disease and

medical understanding of such condition through the application of nursing skills.

RECOMMENDATION

The absence of danger signs allows the treatment of dengue hemorrhagic fever at home. Hospitalized

patients may be sent home if they have remained afebrile for at least 72 hours or if the danger signs have

resolved. However Primary prevention of dengue mainly resides in mosquito control. We can eliminate

vector by changing water and scrubbing sides of lower vases once a week, destroying the breeding places

of mosquito by cleaning surroundings, having a proper disposal of rubber tires, empty bottles and cans and

cleaning all stagnant water and water containers and make sure to cover these. The Department of Health

has a new program called the 4S: (a) Search and destroy (b) Self-protection measure (c) Seek early

consultation (d)Say yes to defogging during an outbreak.

For the Nursing student who will be assigned to San Lazaro wherein they will encounter

communicable diseases such as Dengue can gain knowledge by reading this case study we prepared. This

case presentation is an appropriate tool that will meet the current information needs of individuals, and

guide to promote health. They must be first equipped with the proper basic knowledge about the Anatomy

and Physiology of the system involved in this case. This case presentation also recommended to nursing

students who have patients with Dengue to use this presentation as an instrument or a source of

background knowledge about the said problem.



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47358424 case study in dengue compile

Documents

dengue viruses

dengue vaccines

homework help http

optimal health

objectives general objectives

general health problems

primary disease

related viruses