INTRODUCTION

Dengue Fever is caused by one of the four closely related, but antigenically distinct, virus
serotypes Dengue type 1, Dengue type 2, Dengue type 3, and Dengue type 4 of the genus
Flavivirus and Chikungunya virus. Infection with one of these serotype provides immunity to
only that serotype of life, to a person living in a Dengue-endemic area can have more than one
Dengue infection during their lifetime. Dengue fever through the four different Dengue serotypes
are maintained in the cycle which involves humans and Aedes aegypti or Aedes albopictus
mosquito through the transmission of the viruses to humans by the bite of an infected mosquito.
The mosquito becomes infected with the Dengue virus when it bites a person who has Dengue
and after a week it can transmit the virus while biting a healthy person. Dengue cannot be
transmitted or directly spread from person to person. Aedes aegypti is the most common aedes
specie which is a domestic, day-biting mosquito that prefers to feed on humans.

INTUBATION PERIOD: Uncertain. Probably 6 days to 10 days

PERIOD OF COMMUNICABILITY: Unknown. Presumed to be on the 1st week of illness when

virus is still present in the blood

CLINICAL MANIFESTATIONS:

First 4 days:
>febrile or invasive stage --- starts abruptly as high fever, abdominal pain and
headache; later flushing which may be accompanied by vomiting, conjunctival
infection and epistaxis
th th
4 to 7 day:
>toxic or hemorrhagic stage --- lowering of temperature, severe abdominal pain,
vomiting and frequent bleeding from GIT in the form of melena; unstable BP,
narrow pulse pressure and shock; death may occur; vasomotor collapse
7th to 10th day:
>convalescent or recovery stage --- generalized flushing with intervening areas of
blanching appetite regained and blood pressure already stable

MODE OF TRANSMISSION:

Dengue viruses are transmitted to humans through the infective bites of female Aedes
mosquito. Mosquitoes generally acquire virus while feeding on the blood of an infected person.
After virus incubation of 8-10 days, an infected mosquito is capable, during probing and blood
feeding of transmitting the virus to susceptible individuals for the rest of its life. Infected female
mosquitoes may also transmit the virus to their offspring by transovarial (via the eggs)
transmission.

Humans are the main amplifying host of the virus. The virus circulates in the blood of
infected humans for two to seven days, at approximately the same time as they have fever. Aedes
mosquito may have acquired the virus when they fed on an individual during this period. Dengue
cannot be transmitted through person to person mode.

CLASSIFICATION:

1. Severe, frank type

>flushing, sudden high fever, severe hemorrhage, followed by sudden drop of
temperature, shock and terminating in recovery or death
2. Moderate
>with high fever but less hemorrhage, no shock present
3. Mild
>with slight fever, with or without petichial hemorrhage but epidemiologically
related to typical cases usually discovered in the course of invest or typical cases
GRADING THE SEVERITY OF DENGUE FEVER:

Grade 1:
>fever
>non-specific constitutional symptoms such as anorexia, vomiting and abdominal
pain
>absence of spontaneous bleeding
>positive tourniquet test
Grade 2:
>signs and symptoms of Grade 1: plus
>presence of spontaneous bleeding: mucocutaneous, gastrointestinal
Grade 3:
>signs and symptoms of Grade 2 with more severe bleeding: plus
>evidence of circulatory failure: cold, clammy skin, irritability, weak to
compressible pulses, narrowing of pulse pressure to 20 mmhg or less, cold
extremities, mental confusion
Grade 4:
>signs and symptoms of Grade 3, declared shock, massive bleeding, pulse less
and arterial blood Pressure = 1 mmhg (Dengue Syndrome/DS)

SUSCEPTABILITY, RESISTANCE, AND OCCURRENCE:

>all persons are susceptible

>both sexes are equally affected
>age groups predominantly affected are the pre-school age and school age
>adults and infants are not exempted
>peak age affected: 5-9 years old

DF is sporadic throughout the year. Epidemic usually occurs during rainy seasons (June –
November). Peak months are September – October. It occurs wherever vector mosquito exists.

DIAGNOSTIC TEST:

Tourniquet test
>Inflate the blood pressure cuff on the upper arm to a point midway between the
systolic and diastolic pressure for 5 minutes.
>Release cuff and make an imaginary 2.5 cm square or 1 inch square just below
the cuff, at the antecubital fossa.
>Count the number of petechiae inside the box. A test is positive when 20 or more
petechiae per suare are observed.

Dengue haemorrhagic fever (DHF), a potentially lethal complication, was first

recognized in the 1950s during the dengue epidemics in the Philippines and Thailand, but today
DHF affects most Asian countries and has become a leading cause of hospitalization and death
among children in several of them.

Last June 16, 2008, I encountered a patient with such kind of infection. This patient has
caught my attention and has given the opportunity to study his case. The objective of this study is
to help me understand the disease process of Dengue Fever and to orient myself for appropriate
nursing interventions that I could offer to the patient. This approach enables me to exercise my
duties as student nurse which is to render care. I was given the chance to improve the quality of
care I can offer and to pursue my chosen profession as future nurse.

I humble myself to present my studied case and submit myself for further corrections to
widen the scope of my knowledge and understanding.
DENGUE PREVENTION:

There is no vaccine to prevent dengue. Prevention centers on avoiding mosquito bites

when traveling to areas where dengue occurs and when in U.S. areas, especially along the Texas-
Mexico border, where dengue might occur. Eliminating mosquito breeding sites in these areas is
another key prevention measure.

Avoid mosquito bites when traveling in tropical areas:

 Use mosquito repellents on skin and clothing.

 When outdoors during times that mosquitoes are biting, wear long-sleeved shirts and
long pants tucked into socks.
 Avoid heavily populated residential areas.
 When indoors, stay in air-conditioned or screened areas. Use bednets if sleeping areas
are not screened or air-conditioned.
 If you have symptoms of dengue, report your travel history to your doctor.

Eliminate mosquito breeding sites in areas where dengue might occur:

 Eliminate mosquito breeding sites around homes. Discard items that can collect rain
or run-off water, especially old tires.
 Regularly change the water in outdoor bird baths and pet and animal water containers.
 PATIENT’S PROFILE

NAME : Jay-Mark Legisniana Lorenzo

AGE : 8 y/o

GENDER : Male

ADDRESS : 022 Libertad St. Centro, Solana

DATE OF BIRTH : January 08, 2000

PLACE OF BIRTH : Solana, Cagayan

OCCUPATION : N/A (still a student)

NATIONALITY : Filipino

CIVIL STATUS : Single

RELIGION : Roman Catholic

CHIEF COMPLAINT : Fever

FINAL DIAGNOSIS : Dengue Fever

ATTENDING PHYSICIAN : Dra. Magdalena Velarde

DATE ADMITTED : June 14, 2008

TIME ADMITTED : 2:30 PM

ADMITTING INSTITUTION: Saint Paul Hospital

 NURSING HISTORY

Present Health History:

Three days prior to admission the patient has fever and loss his appetite. According to the
SO of the patient, they went to consult a physician during the first day of his fever. The physician
prescribed Paracetamol for the patient. On the third day, the patient still had the said symptoms.
He went back for a check-up. He had CBC and was determined that he has dengue. The patient
then was admitted immediately to Saint Paul Hospital on June 14, 2008.

Past Health History:

According to the SO of the patient the patient did not yet experienced having serious
health problems other than fever, colds and cough. He had no previous hospitalization.

Family Health History:

According to the SO of the patient, their family has the history of Hypertension.
 GORDON’S 11 FUNCTIONAL HEALTTH PATTERN

HEALTH PERCEPTION-HEALTH MANAGEMENT PATTERN

Before hospitalization:
The patient perceived his health in the state of good condition. He perceives
health as wealth and he values his health a lot. He manages his health by practicing
proper hygiene and eating nutritious food.

During hospitalization:
He sees himself as a total ill person because he cannot do anymore the things he
usually does like playing with his siblings. He rely his present condition with the help of
the therapeutic personnel and by following the prescribed medications. The patient
perceived that he is not healthy because of his condition.

NUTRITIONAL-METABOLIC PATTERN

Before hospitalization:
The patient eats 3 times a day and with afternoon snacks after coming from
school. According to the SO of the patient, he eats meat, fish and also vegetables. He
doesn’t have any allergies on foods and drugs. His appetite is moderate and usually
depends on the food being served. He didn’t complain any difficulty in swallowing.

During hospitalization:
The patient has loss his appetite and hasn’t eaten a lot. He is on a DAT (Diet as
Tolerated) EDCF (Except Dark Colored Foods).

ELIMINATION PATTERN

Before hospitalization:
The patient does not have any problem on his elimination pattern. He usually
urinates 4-5 times a day without any difficulty. He added that the color of his urine is
light yellow. He didn’t feel any pain in urination. The patient defecates once a day usually
early in the morning before going to school with yellow to brown color. He verbalized
that sometimes however, it is hard in consistency with dark color, which generally
depends on what he eats.

During hospitalization:
The patient urinates 2-3 times a day. The color of her urine is yellow. The patient
defecates once every two days.

ACTIVITY-EXERCISE PATTERN

Before hospitalization:
He could perform activities of his daily living. According to him, he often plays
with his siblings and this serves as a form of exercise for him.

During hospitalization:
His activity was limited lying on bed but the patient is given his bathroom
privileges.

SLEEP-REST PATTERN

Before hospitalization:
 He has the normal 6-8 hours sleep. He also has his nap time for 1-2 hours a day.
Sleeping and watching the television are his form of rest.

During hospitalization:
He doesn’t have the adequate time of sleep since he is disturbed with the nurses
that enter the room every now and then, and because of the environmental changes of his
surroundings. He also has inadequate time to rest since he doesn’t have enough time to
sleep.

COGNITIVE-PERCEPTUAL PATTERN

Before hospitalization:
He is normal in terms of his cognitive abilities. He has good memory and
reasoning skills. He can easily comprehend on things. In terms of his perceptual pattern,
he has no problems with his senses.

During hospitalization:
He was normal as before in his cognitive and perceptual pattern. He responds
clearly and well understood. He has no sensory deficit; He responds appropriately to
verbal and physical stimuli and obeys simple commands.

SELF-PERCEPTION – SELF-CONCEPT PATTERN

He sees himself as a person with a good personality. He has been a good friend, brother
and a son. He said he has to be a good person in order not to hurt others. He also describes
himself as a typical type of student and person.

ROLE-RELATIONSHIP PATTERN

Before hospitalization:
He has a close relationship with his family. They were five siblings in their
family. He was at the middle. I was also able to ask his mother about his being a son and
she confessed that he is a good son but at times he doesn’t obey her. He is also a
responsible student and knows all his duties as a friend.

During hospitalization:
He had more time to bond with his family. He said that it was a nice feeling to
know that your family is so supportive to him. He learned to appreciate the beauty of
having a family that gives you strength and support no matter what.

SEXUALITY-REPRODUCTIVE PATTERN

According to him, he doesn’t think of the things like having a girlfriend and getting
married yet. He is still young for such matters.

COPING-STRESS TOLERANCE PATTERN

Before hospitalization:
He does not fully identify his situations having stress but he always tell her
parents when something is wrong.

During hospitalization:
He shares his problems to his family. He verbalizes his feelings.

VALUE-BELIEF PATTERN
 He is a Roman Catholic devotee. He always goes with his family every Sunday to go to
mass. He was taught by his family to believe and have fear to GOD. They usually believe in
quack doctors.
 PHYSICAL ASSESSMENT

Date assessed: June 18, 2008

General assessment: conscious and coherent
Initial vital signs: T=36.2° C, RR=23, BP=90/60, PR=70

Area Assessed Technique Normal Findings Actual Findings Evaluation

Skin
Color Inspection Light brown, Light brown skin Normal
tanned skin (vary
according to race)
Soles and palms Inspection Lighter colored Lighter colored Normal
palms, soles palms, soles
Moisture Inspection/ Skin normally dry Skin normally dry Normal
Palpation
Temperature Palpation Normally warm Normally warm Normal
Texture Palpation Smooth and soft Smooth and soft Normal
Turgor Palpation Skin snaps back Skin snaps back Normal
immediately immediately
Skin
appendages
a. Nails Inspection Transparent, Transparent, Normal
smooth and convex smooth and convex
Nail beds Inspection Pinkish Pale Due to
decreased
blood flow
Nail base Inspection Firm Firm Normal
White color of nail Returns within 2-3 Normal
bed under pressure seconds
Capillary refill Inspection/ should return to
Palpation pink within 2-3
seconds
b. Hair
Distribution Inspection Evenly distributed Evenly distributed Normal
Color Inspection Black Black Normal
Texture Inspection/ Smooth Smooth Normal
Palpation
Eyes
Eyes Inspection Parallel to each Parallel to each Normal
other other
Visual Acuity Inspection PERRLA- Pupils PERRLA- Pupils Normal
(penlight) equally round react equally round react
to light and to light and
accommodation accommodation
Eyebrows Inspection Symmetrical in Symmetrical in Normal
size, extension, hair size, extension, hair
texture and texture and
movement movement
Eyelashes Inspection Distributed evenly Distributed evenly Normal
and curved outward and curved outward
Eyelids Inspection Same color as the Same color as the Normal
skin skin

Blinks involuntarily Blinks involuntarily

and bilaterally up to and bilaterally up to Normal
20 times per minute 18 times per minute
 Do not cover the Do not cover the
pupil and the pupil and the sclera, Normal
sclera, lids lids normally close
normally close symmetrically
symmetrically
Conjunctiva Inspection Transparent with Transparent with Normal
light pink color light pink color
Sclera Inspection Color is white Color is white Normal
Cornea Inspection Transparent, shiny Transparent, shiny Normal
Pupils Inspection Black, constrict Black, constrict Normal
briskly briskly
Iris Inspection Clearly visible Clearly visible Normal
Ears
Ear canal Inspection Free of lesions, Free of lesions, Normal
opening discharge of discharge of
inflammation inflammation

Canal walls pink Canal walls pink Normal

Hearing Acuity Inspection Client normally Client normally
hears words when hears words when Normal
whispered whispered
Nose
Shape, size and Inspection Smooth, symmetric Smooth, symmetric
skin color with same color as with same color as Normal
the face the face

Nares Inspection Oval, symmetric Oval, symmetric

and without and without Normal
discharge discharge

Mouth and
Pharynx
Lips Inspection Pink, moist Light pink, dry, Lack of fluid
symmetric symmetric intake
Buccal mucosa Inspection Glistening pink soft Glistening pink soft Normal
moist moist
Gums Inspection Slightly pink color, Slightly pink color,
moist and tightly fit moist and tightly fit Normal
against each tooth against each tooth
Tongue Inspection Moist, slightly Moist, slightly
rough on dorsal rough on dorsal Normal
surface medium or surface medium or
dull red dull red
Teeth Inspection Firmly set, shiny Firmly set, shiny Normal
With tooth decay
Hard and soft Inspection Hard palate- dome- Hard palate- dome-
palate shaped shaped Normal
Soft Palate- light Soft Palate- light
pink pink
Neck
Symmetry of Neck is slightly Neck is slightly
neck muscles, Inspection hyper extended, hyper extended, Normal
alignment of without masses or without masses or
trachea asymmetry asymmetry
Neck ROM Inspection Neck moves freely, Neck moves freely, Normal
without discomfort without discomfort
Thyroid gland Palpation Rises freely with Rises freely with Normal
swallowing swallowing
Thorax and Auscultation Clear breath sounds Clear breath sounds Normal
Lungs
Abdomen Inspection Skin same color Skin same color Normal
with the rest of the with the rest of the
body body

Bowel sounds Auscultation Normal

Clicks or gurling Clicks or gurling
sounds occur sounds occur
irregularly and irregularly and
range from 5-35 per range from 20 per
minute minute

Extremities

Symmetry Inspection Symmetrical Symmetrical Normal

Skin color Inspection Same with the color Same with the color Normal
of other parts of the of other parts of the
body body

Hair distribution Inspection Evenly distributed Evenly distributed Normal

Skin Palpation Warm to touch Warm to touch Normal

Temperature

Presence of Inspection No lesions No lesions Normal

lesion
ROM Inspection Moves freely Able to move but Due to body
without discomfort with assistance weakness

Neurology
system
Level of Inspection Fully conscious, Fully conscious,
consciousness respond to respond to Normal
questions quickly, questions quickly
perceptive of perceptive of events
events

Behavior and Inspection Makes eye contact Makes eye contact

appearance with examiner, with examiner,
hyperactive hyperactive Normal
expresses feelings expresses feelings
with response to the with response to the
situation situation
 LABORATORY EXAMINATIONS

HEMATOLOGY REPORT
Date: June 14, 2008

PARAMETER NORMAL ACTUAL FINDINGS ANALYSIS

FINDINGS
White Blood Cells 5-10 x 10^g/L 3.9 x 10^g/L Decreased due to
inadequate
inflammatory
defenses to suppress
infection and humoral
immunity takes place
Hemoglobin M: 13.0-18.0 g/dL 10.2 g/dL Decreased due to poor
oxygen supply
Hematocrit 39-54 % 31 % Decreased due to poor
oxygen supply
Segmenters 0.60-0.70 0.73 Increased; indicate
high glucose level in
the blood
Lymphocytes 0.20-0.30 0.27 normal
Platelet Count 150-450 x 10^g/L 163 x 10^g/dL Normal

HEMATOLOGY REPORT
Date: June 15, 2008, AM

PARAMETER NORMAL ACTUAL FINDINGS ANALYSIS

FINDINGS
White Blood Cells 5-10 x 10^g/L 2.9 x 10^g/L Decreased due to
inadequate
inflammatory
defenses to suppress
infection and humoral
immunity takes place
Hemoglobin M: 13.0-18.0 g/dL 9.5 g/dL Decreased due to poor
oxygen supply
Hematocrit 39-54 % 29 % Decreased due to poor
oxygen supply
Segmenters 0.60-0.70 0.65 Normal
Lymphocytes 0.20-0.30 0.35 Increased due to the
body’s increased
immune system
Platelet Count 150-450 x 10^g/L 145 x 10^g/dL Hemolysis
ABO/ Rh Type: O Rh positive

FECALYSIS REPORT
Date: June 15, 2008

PARAMETER NORMAL ACTUAL FINDINGS ANALYSIS

FINDINGS
Physical Properties
Color Yellow Brown Due to the presence of
bacteria
 Consistency Semi-formed Loose Due to presence of
bacteria
Bacteria: Occasional
Occult Blood: Negative
Remarks: No ova/intestinal parasite seen

URINALYSIS REPORT
Date: June 15, 2008

PARAMETER NORMAL ACTUAL FINDINGS ANALYSIS

FINDINGS
Color Yellow Amber Yellow normal
Transparency Clear to slightly clear normal
turbid
Reaction 4.5-8 6.5 normal
Specific Gravity 1.005-1.030 1.020 normal
Sugar Negative Negative normal
Protein Negative Negative normal
Squamous Epithelial Few Occasional normal
Cells
Red Blood Cells Few 0-2 normal
Pus Cells Few 0-2 normal
Amorp. Few Occasional normal
Urates/Phosphates

HEMATOLOGY REPORT
Date: June 15, 2008, PM

PARAMETER NORMAL ACTUAL FINDINGS ANALYSIS

FINDINGS
White Blood Cells 5-10 x 10^g/L 2.7 x 10^g/L Decreased due to
inadequate
inflammatory
defenses to suppress
infection and humoral
immunity takes place
Hemoglobin M: 13.0-18.0 g/dL 9.5 g/dL Decreased due to poor
oxygen supply
Hematocrit 39-54 % 29 % Decreased due to poor
oxygen supply
Segmenters 0.60-0.70 0.68 normal
Lymphocytes 0.20-0.30 0.32 Increased due to the
body’s increased
immune system
Platelet Count 150-450 x 10^g/L 125 x 10^g/dL hemolysis

HEMATOLOGY REPORT
Date: June 16, 2008, AM

PARAMETER NORMAL ACTUAL FINDINGS ANALYSIS

FINDINGS
White Blood Cells 5-10 x 10^g/L 3 x 10^g/L Decreased due to
inadequate
inflammatory
defenses to suppress
infection and humoral
 immunity takes place
Hemoglobin M: 13.0-18.0 g/dL 9.7 g/dL Decreased due to poor
oxygen supply
Hematocrit 39-54 % 29 % Decreased due to poor
oxygen supply
Segmenters 0.60-0.70 0.69 normal
Lymphocytes 0.20-0.30 0.36 Increased due to the
body’s increased
immune system
Platelet Count 150-450 x 10^g/L 110 x 10^g/dL hemolysis

HEMATOLOGY REPORT
Date: June 16, 2008, PM

PARAMETER NORMAL ACTUAL FINDINGS ANALYSIS

FINDINGS
White Blood Cells 5-10 x 10^g/L 4.8 x 10^g/L Decreased due to
inadequate
inflammatory
defenses to suppress
infection and humoral
immunity takes place
Hemoglobin M: 13.0-18.0 g/dL 10.3 g/dL Decreased due to poor
oxygen supply
Hematocrit 39-54 % 31 % Decreased due to poor
oxygen supply
Segmenters 0.60-0.70 0.57 Decreased; indicate
low glucose level in
the blood
Lymphocytes 0.20-0.30 0.43 Increased due to the
body’s increased
immune system
Platelet Count 150-450 x 10^g/L 95 x 10^g/dL hemolysis

HEMATOLOGY REPORT
Date: June 17, 2008, AM

PARAMETER NORMAL ACTUAL FINDINGS ANALYSIS

FINDINGS
White Blood Cells 5-10 x 10^g/L 5 x 10^g/L Normal
Hemoglobin M: 13.0-18.0 g/dL 10 g/dL Decreased due to poor
oxygen supply
Hematocrit 39-54 % 30 % Decreased due to poor
oxygen supply
Segmenters 0.60-0.70 0.68 Normal
Lymphocytes 0.20-0.30 0.32 Increased due to the
body’s increased
immune system
Platelet Count 150-450 x 10^g/L 85 x 10^g/dL hemolysis

HEMATOLOGY REPORT
Date: June 17, 2008, PM

PARAMETER NORMAL ACTUAL FINDINGS ANALYSIS

FINDINGS
White Blood Cells 5-10 x 10^g/L 10 x 10^g/L Normal
Hemoglobin M: 13.0-18.0 g/dL 11.4 g/dL Decreased due to poor
oxygen supply
Hematocrit 39-54 % 35 % Decreased due to poor
oxygen supply
Segmenters 0.60-0.70 0.53 Decreased; indicate
low glucose level in
the blood
Lymphocytes 0.20-0.30 0.47 Increased due to the
body’s increased
immune system
Platelet Count 150-450 x 10^g/L 101 x 10^g/dL hemolysis
 REVIEW OF ANATOMY AND PHYSIOLOGY

BLOOD

Blood is considered the essence of life because the uncontrolled loss of it can result to
death. Blood is a type of connective tissue, consisting of cells and cell fragments surrounded by a
liquid matrix which circulates through the heart and blood vessels. The cells and cell fragments
are formed elements and the liquid is plasma. Blood makes about 8% of total weight of the body.

Functions of Blood:
>transports gases, nutrients, waste products, and hormones
>involve in regulation of homeostasis and the maintenance of PH, body temperature, fluid
balance, and electrolyte levels
>protects against diseases and blood loss

PLASMA

Plasma is a pale yellow fluid that accounts for over half of the total blood volume. It
consists of 92% water and 8% suspended or dissolved substances such as proteins, ions,
nutrients, gases, waste products, and regulatory substances.

Plasma volume remains relatively constant. Normally, water intake through the GIT
closely matches water loss through the kidneys, lungs, GIT and skin. The suspended and
dissolved substances come from the liver, kidneys, intestines, endocrine glands, and immune
tissues as spleen.

FORMED ELEMENTS

Cell Type Description Function

Erythrocytes (RBC) Biconcave disk, no nucleus, 7- Transport oxygen and carbon
8 micrometers in diameter dioxide
Leukocytes (WBC):

Neutrophil Spherical cell, nucleus with Phagocytizes microorganism

two or more lobes connected
by thin filaments, cytoplasmic
granules stain a light pink or
reddish purple, 12-15
micrometers in diameter

Basophil Spherical cell, nucleus, with Releases histamine, which

two indistinct lobes, promotes inflammation, and
cytoplasmic granules stain heparin which prevents clot
blue-purple, 10-12 formation
micrometers in diameter

Eosinophil Spherical cell, nucleus often Releases chemical that reduce

bilobed, cytoplasmic granules inflammation, attacks certain
satin orange-red or bright red, worm parasites
10-12 micrometers in diameter

Lymphocyte Spherical cell with round Produces antibodies and other

nucleus, cytoplasm forms a
thin ring around the nucleus,
6-8 micrometers in diameter
chemicals responsible for
destroying microorganisms,
responsible for allergic
reactions, graft rejection,
tumor control, and regulation
 of the immune system

Monocyte Spherical or irregular cell, Phagocytic cell in the blood

nucleus round or kidney or
horse-shoe shaped, contain
more cytoplasm than
lymphocyte, 10-15
micrometers in diameter
Platelet Cell fragments surrounded by
a cell membrane and
containing granules, 2-5
micrometers in diameter
leaves the circulatory system
and becomes a macrophage
which phagocytises bacteria,
dead cells, cell fragments, and
debris within tissues
Forms platelet plugs, release
chemicals necessary for blood
clotting

PREVENTING BLOOD LOSS

When a blood vessel is damaged, blood can leak into other tissues and interfere with the
normal tissue function or blood can be lost from the body. Small amounts of blood from the body
can be tolerated but new blood must be produced to replace the loss blood. If large amounts of
blood are lost, death can occur.

BLOOD CLOTTING

Platelet plugs alone are not sufficient to close large tears or cults in blood vessels. When a
blood vessel is severely damaged, blood clotting or coagulation results in the formation of a clot.
A clot is a network of threadlike protein fibers called fibrin, which traps blood cells, platelets and
fluids.

The formation of a blood clot depends on a number of proteins found within plasma
called clotting factors. Normally the clotting factors are inactive and do not cause clotting.
Following injury however, the clotting factors are activated to produce a clot. This is a complex
process involving chemical reactions, but it can be summarized in 3 main stages; the chemical
reactions can be stated in two ways: just as with platelets, the contact of inactive clotting factors
with exposed connective tissue can result in their activation. Chemicals released from injured
tissues can also cause activation of clotting factors. After the initial clotting factors are activated,
they in turn activate other clotting factors. A series of reactions results in which each clotting
factor activates the next clotting factor in the series until the clotting factor prothrombin activator
is formed. Prothrombin activator acts on an inactive clotting factor called prothrombin.
Prothrombin is converted to its active form called thrombin. Thrombin converts the inactive
clotting factor fibrinogen into its active form, fibrin. The fibrin threads form a network which
traps blood cells and platelets and forms the clots.

CONTROL OF CLOT FORMATION

Without control, clotting would spread from the point of its initiation throughout the
entire circulatory system. To prevent unwanted clotting, the blood contains several
anticoagulants which prevent clotting factors from forming clots. Normally there are enough
anticoagulants in the blood to prevent clot formation. At the injury site, however, the stimulation
for activating clotting factors is very strong. So many clotting factors are activated that the
anticoagulants no longer can prevent a clot from forming.

CLOT RETRACTION AND DISSOLUTION

After a clot has formed, it begins to condense into a denser compact structure by a
process known as clot retraction. Serum, which is plasma without its clotting factors, is squeezed
out of the clot during clot retraction. Consolidation of the clot pulls the edges of the damaged
vessels together, helping the stop of the flow of blood, reducing the probability of infection and
enhancing healing. The damaged vessel is repaired by the movement of fibroblasts into damaged
area and the formation of the new connective tissue. In addition, epithelial cells around the
wound divide and fill in the torn area.

The clot is dissolved by a process called fibrinolysis. An inactive plasma protein called
plasminogen is converted to its active form, which is called plasmin. Thrombin and other clotting
factors activated during clot formation, or tissue plasminogen activator released from
surrounding tissues, stimulate the conversion of plasminogen to plasmin. Over a period of a few
days the plasmin slowly breaks down the fibrin.
 DRUG STUDY

ISOPRINOSINE
Dosage : 2 tsp TID 250 mg
Classification: Antivirals
Indication:Rhinovirus; herpes genitalis; measles; encephalitis; influenza; herpes zoster; herpes
simplex; type A & B hepatitis; AIDS related complex; neoplastic diseases; anergy and
hypoergy prior to major surgery
Action:
>Synthetic antiviral: it stimulates T-lymphocytes; used for HIV and Hepatitis
>non-toxic immune system stimulant
Adverse Reactions:
>Transient increase in urine and serum uric acid level; very rarely skin rashes; pruritis;
GI upset; nausea; fatigue; malaise
Contraindications:
>Hypersensitivity. Patients w/ adnormally low neutrophil counts (< 0.75 x 10x9/L), or
abnormally low haemoglobin levels (< 7.5 g/dL or 4.65 mmol/L)
Nx Considerations:
>Monitor increase in serum uric acid level, gout, urolithiasis or renal dysfunction;
pregnancy and lactation
>Monitor hematological parameters
Patient Teaching:
>Inform patient that the drug must be taiken 1 hour apart on an empty Stomach
>Instruct the patient to notify prescriber if unusual effects occurs

AMOXICILLIN
Dosage : 375 mg TID
Classification : Antibiotic
Indication: Infections due to susceptible strains; helicobacter pylori infections in combination
with other agents; post-exposure prophylaxis against bacillus anthracis; Chlamydia
trachomatis in pregnancy
Action: Bactericidal: inhibits synthesis of bacterial cell wall, causing cell death
Adverse Reactions:
>CNS – lethargy, hallucinations, seizures
>GI – glossitis, stomatitis, gastritis, sore mouth, furry tongue (black hairy), nausea,
vomiting, diarrhea (bloody), enterocolitis,pseudomembranous colitis, nonspecific
hepatitis
>GU – nephritis
>Hematologic – anemia, thrombocytopenia, leucopenia, neutropenia, prolonged bleeding
time
>Hypersensitivity – rash, fever, wheezing, anaphylaxis
>Others – superinfections: oral and rectal moniliasis, vaginitis
Contraindications:
>Contraindicated with allergy to cephalosporins or penicillins, or other allergens
>Use cautiously with renal disorders and lactation
Nx Considerations:
>Culture infected area prior to treatment; reculture area if response is not expected
>Give in oral preparations only; amoxicillin is not affected by food
>Continue therapy for at least 2 days after signs of infection have disappeared;
continuation for 10 full days is recommended
>Use corticosteroids or antihistamines for skin reactions
Patient Teaching:
>Take this drug around-the-clock
>Take the full course of therapy; do not stop because you feel better
>This antibiotic is specific for this problem and should not be used to self-treat other
infections
 >Eat frequent small meals to avoid GI effects; frequent mouth care may prevent sore
mouth
>Report unusual bleeding or bruising, sore throat, fever, rash, hives, severe diarrhea,
difficulty of breathing

PARACETAMOL
Dosage: 250 mg/5ml q 4° RTC
Classification: Nonopioid Analgesics & Antipyretics
Indication: Mild pain or fever
Action: Produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in
the CNS or of other substances that sensitize pain receptors to stimulation. The drug may
relieve fever through central action in the hypothalamic heat-regulating center.
Adverse Reactions:
Hematologic: Hemolytic Anemia, Neutropenia, Leukopenia, Pancytopenia
Hepatic: Jaundice
Metabolic: Hypoglycemia
Skin: Rash, Urticaria
Contraindications:
 Contraindicated in patients hypersensitive to drug.
 Use cautiously in patients with long-term alcohol use because therapeutics doses
cause hepatotoxicity in these patients.
Nx Considerations:
 ALERT: Many OTC and prescription products contain acetaminophen; be aware of
this when calculating total daily dose.
 Use liquid form for children and patients who have difficulty in swallowing.
 In children, don’t exceed five doses in 24 hours.
Patient Teaching:
 Tell parents to consult prescriber before giving drug to children younger than age 2.
 Advise patient or parents that drug is only for short-term use; urge them to consult
prescriber if giving to children for longer than 5 days or adults for longer than 10
days.
 ALERT: Advise patient or caregiver that many OTC products contain acetaminophen,
which should be counted when calculating total daily dose.
 Tell patient not to use for marked fever (temperature higher than 103.1°F [39.5°C]),
fever persisting longer than 3 days, or recurrent fever unless directed by prescriber.
 ALERT: Warn patient that high doses or unsupervised long-term use can cause liver
damage. Excessive alcohol use may increase the risk of liver damage. Caution long-
term alcoholics to limit acetaminophen intake to 2g/day or less.
 Tell breast-feeding woman that acetaminophen appears in breast milk in low levels
(less than 1% of dose). Drug may be used safely if therapy is short-term and doesn’t
exceed recommended doses.
Interactions
o Drug-Drug
- Barbiturates, Carbamazepine, Hydantoins, Rifampin, Sulfinpyrazone: high doses or
long-term use of these drugs may reduce therapeutic effects and enhance hepatotoxic
effects of acetaminophen. Avoid using together.
- Lamotrigine: may decrease lamotrigine level. Monitor patient for therapeutic effects.
- Warfarin: may increase hypoprothrombinemic effects with long-term use with high
doses of acetaminophen. Monitor INR closely.
- Zidovudine: may decrease zidovudine effects. Monitor patient closely.
o Drug-Herd
- Watercress: may inhibit oxidative metabolism of acetaminophen. Discourage use
together.
o Drug-Food
- Caffeine: may enhance analgesic effects of acetaminophen. Products may combine
caffeine and acetaminophen for therapeutic advantage.
 o Drug-Lifestyle
- Alcohol use: may increase risk of hepatic damage. Discourage use together.

RELESTAL
Dosage: 1 tsp every 6°
Classification: Antidiarrheals
Content: Dicycloverine HCl
Indication: Children’s cholic, functional gut disturbances, renal and biliary coloc
Administration: May be taken before or after meals
Contraindications: Closed-angle glaucoma; urinary or GI obstruction, intestinal atony, paralytic
ileus, asthma, myasthenia gravis, ulcerative colitis, hiatus hernia, ulcerative
colitis and hepatic or renal colic
Adverse Reactions: Increased intraocular pressure, cyclopegia, mydriasis, dry mouth, blurred
vision, flushing, urinary hesitancy & retention, tachycardia, palpitations,
constipation, elevated body temperature, CNS excitation, rash, vomiting,
photophobia
Drug Interactions: Anticholinergic activity may be increased by other parasympatholytics.
Guanethidine, histamine and reserpine can antagonize the inhibitory effect of
anticholinergics on gastric acid secretion.
Antacids may impair absorption.

PRED 10
Dosage: tsp 3x a day after meal
Classification: Corticosteroid Hormones
Content: Prednisone
Indication: Treatment of endocrine, rheumatic & hematologic disorders, allergic & edematous
states, collagen, dermatologic & opth, resp & neoplastic diseases. Suppression of
inflammatory disorders.
Administration: Take immediately after meals
Contraindications: Gastric and duodenal ulcers, systemic fungal & certain viral infections,
glaucoma, psychoses or severe psychoneuroses; live vaccines; hypersensitivity
to glucocorticoids
Special Precautions: Heart failure, recent MI or HTN, DM, epilepsy, glaucoma, hypothyroidism,
hepatic failure, osteoporosis, peptic ulceration, psychoses or severe
effective disorders & renal impairment
Adverse Reactions: Fluid, electrolyte, visual & psychic disturbances, Cushingoid state,
hirsutism, growth retardation, skin atrophy, facial erythema, aseptic
osteonecrosis, amenorrhea
Drug Interactions: Live vaccines

APPEBON
Dosage: 1 tsp BID
Classification: Appetite Stimulants
Content: Per 5 ml Buclizine HCl 5mg, vitamin B1 10 mg, vitamin B6 5mg, vitamin B12 25mcg,
lysine HCl 500mg
Indication: Poor appetite, underweight, anorexia nervosa. For nutritional support in post-
operative cases, metabolic disorders and convalescence
Administration: With food
Contraindications: Angle closure glaucoma, prostate hypertrophy & primary hemachromatosis
Special Precautions: May impair ability to drive or operate machinery; pregnancy
Adverse Reactions: Drowsiness & dulling of mental alertness, dry mouth, headache, nausea,
jitteriness, tiredness
Drug Interactions: Reduce the effectiveness of levodopa; CNS depressants; alcohol
 LEARNING FEEDBACK DIARY

NAME: Dorina Lorraine B. Binarao AREA: St. Paul Hospital Floor 1

CLINICAL INSTRUCTOR: Ms. Shane B. Santos, RN DATES: June 16, 17, 18, 23 & 24, 2008

OBJECTIVES:
At the end of the rotation, I will be able to:
 To upgrade my knowledge on clinical setting
 To familiarize myself with the hospital setting
 To deliver health care services.
 To build rapport with the patients, SOs, staff nurses, clinical instructor and student nurses.
 To enhance my skill on therapeutic communication

The first rotation of my duty was in St. Paul Hospital and unexpectedly my schedule is night
shift. I’m nervous at the first night of duty because I still don’t know what to expect in a hospital setting.
The first night was like an orientation for us. We were only tasked to do the vital signs taking and
plotting. We weren’t allowed yet to do the charting and giving of medications.
The patients given to us were in the Holy Family Ward. My first patient was a three year old boy
whose chief complaint was contusion hematoma. It was good that I was paired with a Chinese student
because I have someone to help me in taking the vital signs. The only disadvantage of having paired with
her is that it is difficult to explain everything to her because language difference.
Having a night duty has positive and negative factors. The positive or advantage of night duty is
that you are not toxic with many things to do. At night shift, you also have the time to browse the chart of
the patient. The negative or disadvantage part is that you have to make yourself awake for about eight
hours. Another disadvantage is that it is difficult to interview and assess the patient because it is his/her
time to sleep and rest. Interaction among the group is really needed to keep all of us awake.
In next nights of our duty, we had our patients staying in Sto. Niño Ward. We were
already tasked to do charting. Doing the charting every night enhances my skill and ability in
doing it. Interviewing the SOs of the patient assigned to me was not difficult because they were
so cooperative and kind. I was lucky to have patients that don’t have lot of tantrums even if they
are still kids.
Experiencing the clinical or hospital setting makes me feel excited of my future job. I
believe that I must do everything correctly for the benefit of my patients. It is a good and
relieving feeling that the patient you handle will be discharged immediately.
The most unforgettable experience of my first rotation of duty was that someone died.
My heart that time was like stubbed with a knife that I can’t breathe. Through this case, I
instilled in my mind that I must be relax and do the things necessary to revive a life. Panicking
during such case will not do anything good.
 The first rotation of duty had left me with so many experiences that taught me a lot of
things to remember.

A
CASE
STUDY
ON
DENGUE
FEVER
Submitted by:
Dorina Lorraine B. Binarao
Vicky
(BSN3 RLE Group G)
 Submitted to:
Ms. Shane B. Santos, RN