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 ith one of these serotype provides i!!unity to only that serotype of life, to a person living in a Dengue"ende!ic area can have !ore than one Dengue infection during their lifeti!e. Dengue fever through the four different Dengue serotypes are !aintained in the cycle hich involves hu!ans and #edes aegypti or #edes albopictus !os$uito through the trans!ission of the viruses to hu!ans by the bite of an infected !os$uito. %he !os$uito beco!es infected ith the Dengue virus hen it bites a person ho has Dengue and after a eek it can trans!it the virus hile biting a healthy person. Dengue cannot be trans!itted or directly spread fro! person to person. #edes aegypti is the !ost co!!on aedes specie hich is a do!estic, day"biting !os$uito that prefers to feed on hu!ans. I&%'(#%I)& *+,I)D'ncertain. *robably . days to 1/ days

*+,I)D )F C)00'&IC#(I1I%2- 'nkno n. *resu!ed to be on the 1st eek of illness hen virus is still present in the blood C1I&IC#1 0#&IF+3%#%I)&3First 4 days4febrile or invasive stage """ starts abruptly as high fever, abdo!inal pain and headache5 later flushing hich !ay be acco!panied by vo!iting, con6unctival infection and epista7is th th 4 to 8 day4to7ic or he!orrhagic stage """ lo ering of te!perature, severe abdo!inal pain, vo!iting and fre$uent bleeding fro! 9I% in the for! of !elena5 unstable (*, narro pulse pressure and shock5 death !ay occur5 vaso!otor collapse 8th to 1/th day4convalescent or recovery stage """ generali:ed flushing ith intervening areas of blanching appetite regained and blood pressure already stable 0)D+ )F %,#&30I33I)&Dengue viruses are trans!itted to hu!ans through the infective bites of fe!ale #edes !os$uito. 0os$uitoes generally ac$uire virus hile feeding on the blood of an infected person. #fter virus incubation of ;"1/ days, an infected !os$uito is capable, during probing and blood feeding of trans!itting the virus to susceptible individuals for the rest of its life. Infected fe!ale !os$uitoes !ay also trans!it the virus to their offspring by transovarial <via the eggs= trans!ission. >u!ans are the !ain a!plifying host of the virus. %he virus circulates in the blood of infected hu!ans for t o to seven days, at appro7i!ately the sa!e ti!e as they have fever. #edes !os$uito !ay have ac$uired the virus hen they fed on an individual during this period. Dengue cannot be trans!itted through person to person !ode. C1#33IFIC#%I)&1. 3evere, frank type 4flushing, sudden high fever, severe he!orrhage, follo ed by sudden drop of te!perature, shock and ter!inating in recovery or death 2. 0oderate 4 ith high fever but less he!orrhage, no shock present 3. 0ild 4 ith slight fever, ith or ithout petichial he!orrhage but epide!iologically related to typical cases usually discovered in the course of invest or typical cases

9,#DI&9 %>+ 3+?+,I%2 )F D+&9'+ F+?+,9rade 14fever 4non"specific constitutional sy!pto!s such as anore7ia, vo!iting and abdo!inal pain 4absence of spontaneous bleeding 4positive tourni$uet test 9rade 24signs and sy!pto!s of 9rade 1- plus 4presence of spontaneous bleeding- !ucocutaneous, gastrointestinal 9rade 34signs and sy!pto!s of 9rade 2 ith !ore severe bleeding- plus 4evidence of circulatory failure- cold, cla!!y skin, irritability, eak to co!pressible pulses, narro ing of pulse pressure to 2/ !!hg or less, cold e7tre!ities, !ental confusion 9rade 44signs and sy!pto!s of 9rade 3, declared shock, !assive bleeding, pulse less and arterial blood *ressure @ 1 !!hg <Dengue 3yndro!eAD3= 3'3C+*%#(I1I%2, ,+3I3%#&C+, #&D )CC',,+&C+4all persons are susceptible 4both se7es are e$ually affected 4age groups predo!inantly affected are the pre"school age and school age 4adults and infants are not e7e!pted 4peak age affected- B"C years old DF is sporadic throughout the year. +pide!ic usually occurs during rainy seasons <Dune E &ove!ber=. *eak !onths are 3epte!ber E )ctober. It occurs herever vector !os$uito e7ists. DI#9&)3%IC %+3%%ourni$uet test 4Inflate the blood pressure cuff on the upper ar! to a point !id ay bet een the systolic and diastolic pressure for B !inutes. 4,elease cuff and !ake an i!aginary 2.B c! s$uare or 1 inch s$uare 6ust belo the cuff, at the antecubital fossa. 4Count the nu!ber of petechiae inside the bo7. # test is positive hen 2/ or !ore petechiae per suare are observed. Dengue hae!orrhagic fever <D>F=, a potentially lethal co!plication, as first recogni:ed in the 1CB/s during the dengue epide!ics in the *hilippines and %hailand, but today D>F affects !ost #sian countries and has beco!e a leading cause of hospitali:ation and death a!ong children in several of the!. 1ast Dune 1., 2//;, I encountered a patient ith such kind of infection. %his patient has caught !y attention and has given the opportunity to study his case. %he ob6ective of this study is to help !e understand the disease process of Dengue Fever and to orient !yself for appropriate nursing interventions that I could offer to the patient. %his approach enables !e to e7ercise !y duties as student nurse hich is to render care. I as given the chance to i!prove the $uality of care I can offer and to pursue !y chosen profession as future nurse. I hu!ble !yself to present !y studied case and sub!it !yself for further corrections to iden the scope of !y kno ledge and understanding.

D+&9'+ *,+?+&%I)&%here is no vaccine to prevent dengue. *revention centers on avoiding !os$uito bites hen traveling to areas here dengue occurs and hen in '.3. areas, especially along the %e7as" 0e7ico border, here dengue !ight occur. +li!inating !os$uito breeding sites in these areas is another key prevention !easure. #void !os$uito bites hen traveling in tropical areas 'se !os$uito repellents on skin and clothing. Fhen outdoors during ti!es that !os$uitoes are biting, ear long"sleeved shirts and long pants tucked into socks. #void heavily populated residential areas. Fhen indoors, stay in air"conditioned or screened areas. 'se bednets if sleeping areas are not screened or air"conditioned. If you have sy!pto!s of dengue, report your travel history to your doctor. +li!inate !os$uito breeding sites in areas here dengue !ight occur +li!inate !os$uito breeding sites around ho!es. Discard ite!s that can collect rain or run"off ater, especially old tires. ,egularly change the ater in outdoor bird baths and pet and ani!al ater containers.

PATIENTS PROFILE &#0+ #9+ 9+&D+, #DD,+33 D#%+ )F (I,%> *1#C+ )F (I,%> )CC'*#%I)& &#%I)&#1I%2 CI?I1 3%#%'3 ,+1I9I)& C>I+F C)0*1#I&% FI&#1 DI#9&)3I3 Day"0ark 1egisniana 1oren:o ; yAo 0ale /22 1ibertad 3t. Centro, 3olana Danuary /;, 2/// 3olana, Cagayan &A# <still a student= Filipino 3ingle ,o!an Catholic Fever Dengue Fever Dra. 0agdalena ?elarde Dune 14, 2//; 2-3/ *0 3aint *aul >ospital

#%%+&DI&9 *>23ICI#& D#%+ #D0I%%+D %I0+ #D0I%%+D -

#D0I%%I&9 I&3%I%'%I)&-

NURSING HISTORY *resent >ealth >istory%hree days prior to ad!ission the patient has fever and loss his appetite. #ccording to the 3) of the patient, they ent to consult a physician during the first day of his fever. %he physician prescribed *araceta!ol for the patient. )n the third day, the patient still had the said sy!pto!s. >e ent back for a check"up. >e had C(C and as deter!ined that he has dengue. %he patient then as ad!itted i!!ediately to 3aint *aul >ospital on Dune 14, 2//;. *ast >ealth >istory#ccording to the 3) of the patient the patient did not yet e7perienced having serious health proble!s other than fever, colds and cough. >e had no previous hospitali:ation. Fa!ily >ealth >istory#ccording to the 3) of the patient, their fa!ily has the history of >ypertension.

GORDONS 11 FUNCTIONAL HEALTTH PATTERN HEALTH PERCEPTION-HEALTH MANAGEMENT PATTERN (efore hospitali:ation%he patient perceived his health in the state of good condition. >e perceives health as ealth and he values his health a lot. >e !anages his health by practicing proper hygiene and eating nutritious food. During hospitali:ation>e sees hi!self as a total ill person because he cannot do any!ore the things he usually does like playing ith his siblings. >e rely his present condition ith the help of the therapeutic personnel and by follo ing the prescribed !edications. %he patient perceived that he is not healthy because of his condition. NUTRITIONAL-METABOLIC PATTERN (efore hospitali:ation%he patient eats 3 ti!es a day and ith afternoon snacks after co!ing fro! school. #ccording to the 3) of the patient, he eats !eat, fish and also vegetables. >e doesnGt have any allergies on foods and drugs. >is appetite is !oderate and usually depends on the food being served. >e didnGt co!plain any difficulty in s allo ing. During hospitali:ation%he patient has loss his appetite and hasnGt eaten a lot. >e is on a D#% <Diet as %olerated= +DCF <+7cept Dark Colored Foods=. ELIMINATION PATTERN (efore hospitali:ation%he patient does not have any proble! on his eli!ination pattern. >e usually urinates 4"B ti!es a day ithout any difficulty. >e added that the color of his urine is light yello . >e didnGt feel any pain in urination. %he patient defecates once a day usually early in the !orning before going to school ith yello to bro n color. >e verbali:ed that so!eti!es ho ever, it is hard in consistency ith dark color, hich generally depends on hat he eats. During hospitali:ation%he patient urinates 2"3 ti!es a day. %he color of her urine is yello . %he patient defecates once every t o days. ACTIVITY-EXERCISE PATTERN (efore hospitali:ation>e could perfor! activities of his daily living. #ccording to hi!, he often plays ith his siblings and this serves as a for! of e7ercise for hi!. During hospitali:ation>is activity as li!ited lying on bed but the patient is given his bathroo! privileges. SLEEP-REST PATTERN (efore hospitali:ation-

>e has the nor!al ."; hours sleep. >e also has his nap ti!e for 1"2 hours a day. 3leeping and atching the television are his for! of rest. During hospitali:ation>e doesnGt have the ade$uate ti!e of sleep since he is disturbed ith the nurses that enter the roo! every no and then, and because of the environ!ental changes of his surroundings. >e also has inade$uate ti!e to rest since he doesnGt have enough ti!e to sleep. COGNITIVE-PERCEPTUAL PATTERN (efore hospitali:ation>e is nor!al in ter!s of his cognitive abilities. >e has good !e!ory and reasoning skills. >e can easily co!prehend on things. In ter!s of his perceptual pattern, he has no proble!s ith his senses. During hospitali:ation>e as nor!al as before in his cognitive and perceptual pattern. >e responds clearly and ell understood. >e has no sensory deficit5 >e responds appropriately to verbal and physical sti!uli and obeys si!ple co!!ands. SELF-PERCEPTION SELF-CONCEPT PATTERN >e sees hi!self as a person ith a good personality. >e has been a good friend, brother and a son. >e said he has to be a good person in order not to hurt others. >e also describes hi!self as a typical type of student and person. ROLE-RELATIONSHIP PATTERN (efore hospitali:ation>e has a close relationship ith his fa!ily. %hey ere five siblings in their fa!ily. >e as at the !iddle. I as also able to ask his !other about his being a son and she confessed that he is a good son but at ti!es he doesnGt obey her. >e is also a responsible student and kno s all his duties as a friend. During hospitali:ation>e had !ore ti!e to bond ith his fa!ily. >e said that it as a nice feeling to kno that your fa!ily is so supportive to hi!. >e learned to appreciate the beauty of having a fa!ily that gives you strength and support no !atter hat. SEXUALITY-REPRODUCTIVE PATTERN #ccording to hi!, he doesnGt think of the things like having a girlfriend and getting !arried yet. >e is still young for such !atters. COPING-STRESS TOLERANCE PATTERN (efore hospitali:ation>e does not fully identify his situations having stress but he al ays tell her parents hen so!ething is rong. During hospitali:ation>e shares his proble!s to his fa!ily. >e verbali:es his feelings. VALUE-BELIEF PATTERN

>e is a ,o!an Catholic devotee. >e al ays goes ith his fa!ily every 3unday to go to !ass. >e as taught by his fa!ily to believe and have fear to 9)D. %hey usually believe in $uack doctors.

PHYSICAL ASSESSMENT Date assessed Dune 1;, 2//; Ge!e"a# assess$e!t conscious and coherent I!%t%a# &%ta# s%'!s %@3..2H C, ,,@23, (*@C/A./, *,@8/ A"ea Assessed S-%! Color 3oles and pal!s 0oisture %e!perature %e7ture %urgor S-%! a..e!da'es a. &ails &ail beds &ail base Capillary refill b. >air Distribution Color %e7ture E/es +yes ?isual #cuity Te()!%*+e Inspection Inspection InspectionA *alpation *alpation *alpation *alpation N,"$a# F%!d%!'s 1ight bro n, tanned skin <vary according to race= 1ighter colored pal!s, soles 3kin nor!ally dry &or!ally ar! 3!ooth and soft 3kin snaps back i!!ediately %ransparent, s!ooth and conve7 *inkish Fir! Fhite color of nail bed under pressure should return to pink ithin 2"3 seconds +venly distributed (lack 3!ooth *arallel to each other *+,,1#" *upils e$ually round react to light and acco!!odation 3y!!etrical in si:e, e7tension, hair te7ture and !ove!ent Distributed evenly and curved out ard 3a!e color as the skin A(t+a# F%!d%!'s 1ight bro n skin 1ighter colored pal!s, soles 3kin nor!ally dry &or!ally ar! 3!ooth and soft 3kin snaps back i!!ediately %ransparent, s!ooth and conve7 *ale Fir! ,eturns ithin 2"3 seconds E&a#+at%,! &or!al &or!al &or!al &or!al &or!al &or!al

Inspection Inspection Inspection InspectionA *alpation Inspection Inspection InspectionA *alpation Inspection Inspection <penlight= Inspection

&or!al Due to decreased blood flo &or!al &or!al

+venly distributed (lack 3!ooth *arallel to each other *+,,1#" *upils e$ually round react to light and acco!!odation 3y!!etrical in si:e, e7tension, hair te7ture and !ove!ent Distributed evenly and curved out ard 3a!e color as the skin

&or!al &or!al &or!al &or!al &or!al

+yebro s

&or!al

+yelashes +yelids

Inspection Inspection

&or!al &or!al

(links involuntarily (links involuntarily and bilaterally up to and bilaterally up to &or!al 2/ ti!es per !inute 1; ti!es per !inute

Con6unctiva 3clera Cornea *upils Iris Ea"s +ar canal opening

Inspection Inspection Inspection Inspection Inspection Inspection

Do not cover the pupil and the sclera, lids nor!ally close sy!!etrically %ransparent ith light pink color Color is hite %ransparent, shiny (lack, constrict briskly Clearly visible Free of lesions, discharge of infla!!ation Canal alls pink Client nor!ally hears ords hen hispered 3!ooth, sy!!etric ith sa!e color as the face )val, sy!!etric and ithout discharge

Do not cover the pupil and the sclera, &or!al lids nor!ally close sy!!etrically %ransparent ith light pink color Color is hite %ransparent, shiny (lack, constrict briskly Clearly visible Free of lesions, discharge of infla!!ation Canal alls pink Client nor!ally hears ords hen hispered 3!ooth, sy!!etric ith sa!e color as the face )val, sy!!etric and ithout discharge &or!al &or!al &or!al &or!al &or!al &or!al

&or!al &or!al

>earing #cuity N,se 3hape, si:e and skin color &ares

Inspection

Inspection

&or!al

Inspection

&or!al

M,+t) a!d P)a"/!0 1ips (uccal !ucosa 9u!s %ongue

Inspection Inspection Inspection Inspection

%eeth >ard and soft palate Ne(3y!!etry of neck !uscles, align!ent of trachea

Inspection Inspection

*ink, !oist sy!!etric 9listening pink soft !oist 3lightly pink color, !oist and tightly fit against each tooth 0oist, slightly rough on dorsal surface !ediu! or dull red Fir!ly set, shiny >ard palate" do!e" shaped 3oft *alate" light pink &eck is slightly hyper e7tended, ithout !asses or asy!!etry

1ight pink, dry, sy!!etric 9listening pink soft !oist 3lightly pink color, !oist and tightly fit against each tooth 0oist, slightly rough on dorsal surface !ediu! or dull red Fir!ly set, shiny Fith tooth decay >ard palate" do!e" shaped 3oft *alate" light pink &eck is slightly hyper e7tended, ithout !asses or asy!!etry

1ack of fluid intake &or!al &or!al &or!al &or!al &or!al

Inspection

&or!al

&eck ,)0 %hyroid gland %hora7 and 1ungs #bdo!en

Inspection *alpation #uscultation Inspection

&eck !oves freely, ithout disco!fort ,ises freely ith s allo ing Clear breath sounds 3kin sa!e color ith the rest of the body Clicks or gurling sounds occur irregularly and range fro! B"3B per !inute

&eck !oves freely, ithout disco!fort ,ises freely ith s allo ing Clear breath sounds 3kin sa!e color ith the rest of the body Clicks or gurling sounds occur irregularly and range fro! 2/ per !inute

&or!al &or!al &or!al &or!al

(o el sounds

#uscultation

&or!al

E0t"e$%t%es 3y!!etry 3kin color Inspection Inspection 3y!!etrical 3y!!etrical &or!al

3a!e ith the color 3a!e ith the color &or!al of other parts of the of other parts of the body body +venly distributed Far! to touch &o lesions 0oves freely ithout disco!fort +venly distributed Far! to touch &o lesions #ble to !ove but ith assistance &or!al &or!al &or!al Due to body eakness

>air distribution 3kin %e!perature *resence of lesion ,)0 Ne+",#,'/ s/ste$ 1evel of consciousness

Inspection *alpation Inspection Inspection

Inspection

Fully conscious, respond to $uestions $uickly, perceptive of events 0akes eye contact ith e7a!iner, hyperactive e7presses feelings ith response to the situation

Fully conscious, respond to &or!al $uestions $uickly perceptive of events 0akes eye contact ith e7a!iner, hyperactive &or!al e7presses feelings ith response to the situation

(ehavior and appearance

Inspection

LABORATORY EXAMINATIONS >+0#%)1)92 ,+*),% Date- Dune 14, 2//; *#,#0+%+, Fhite (lood Cells &),0#1 FI&DI&93 B"1/ 7 1/IgA1 #C%'#1 FI&DI&93 3.C 7 1/IgA1 #&#123I3 Decreased due to inade$uate infla!!atory defenses to suppress infection and hu!oral i!!unity takes place Decreased due to poor o7ygen supply Decreased due to poor o7ygen supply Increased5 indicate high glucose level in the blood nor!al &or!al

>e!oglobin >e!atocrit 3eg!enters 1y!phocytes *latelet Count

0- 13./"1;./ gAd1 3C"B4 J /../"/.8/ /.2/"/.3/ 1B/"4B/ 7 1/IgA1

1/.2 gAd1 31 J /.83 /.28 1.3 7 1/IgAd1

>+0#%)1)92 ,+*),% Date- Dune 1B, 2//;, #0 *#,#0+%+, Fhite (lood Cells &),0#1 FI&DI&93 B"1/ 7 1/IgA1 #C%'#1 FI&DI&93 2.C 7 1/IgA1 #&#123I3 Decreased due to inade$uate infla!!atory defenses to suppress infection and hu!oral i!!unity takes place Decreased due to poor o7ygen supply Decreased due to poor o7ygen supply &or!al Increased due to the bodyGs increased i!!une syste! >e!olysis

>e!oglobin >e!atocrit 3eg!enters 1y!phocytes

0- 13./"1;./ gAd1 3C"B4 J /../"/.8/ /.2/"/.3/

C.B gAd1 2C J /..B /.3B 14B 7 1/IgAd1

*latelet Count 1B/"4B/ 7 1/IgA1 #()A ,h %ype- ) ,h positive

F+C#123I3 ,+*),% Date- Dune 1B, 2//; *#,#0+%+, P)/s%(a# P",.e"t%es Color &),0#1 FI&DI&93 2ello #C%'#1 FI&DI&93 (ro n #&#123I3 Due to the presence of bacteria

Consistency

3e!i"for!ed

1oose

Due to presence of bacteria

(acteria)ccasional )ccult (lood- &egative ,e!arks&o ovaAintestinal parasite seen ',I&#123I3 ,+*),% Date- Dune 1B, 2//; *#,#0+%+, Color %ransparency ,eaction 3pecific 9ravity 3ugar *rotein 3$ua!ous +pithelial Cells ,ed (lood Cells *us Cells #!orp. 'ratesA*hosphates &),0#1 FI&DI&93 2ello #!ber Clear to slightly turbid 4.B"; 1.//B"1./3/ &egative &egative Fe Fe Fe Fe #C%'#1 FI&DI&93 2ello clear ..B 1./2/ &egative &egative )ccasional /"2 /"2 )ccasional #&#123I3 nor!al nor!al nor!al nor!al nor!al nor!al nor!al nor!al nor!al nor!al

>+0#%)1)92 ,+*),% Date- Dune 1B, 2//;, *0 *#,#0+%+, Fhite (lood Cells &),0#1 FI&DI&93 B"1/ 7 1/IgA1 #C%'#1 FI&DI&93 2.8 7 1/IgA1 #&#123I3 Decreased due to inade$uate infla!!atory defenses to suppress infection and hu!oral i!!unity takes place Decreased due to poor o7ygen supply Decreased due to poor o7ygen supply nor!al Increased due to the bodyGs increased i!!une syste! he!olysis

>e!oglobin >e!atocrit 3eg!enters 1y!phocytes *latelet Count

0- 13./"1;./ gAd1 3C"B4 J /../"/.8/ /.2/"/.3/ 1B/"4B/ 7 1/IgA1

C.B gAd1 2C J /..; /.32 12B 7 1/IgAd1

>+0#%)1)92 ,+*),% Date- Dune 1., 2//;, #0 *#,#0+%+, Fhite (lood Cells &),0#1 FI&DI&93 B"1/ 7 1/IgA1 #C%'#1 FI&DI&93 3 7 1/IgA1 #&#123I3 Decreased due to inade$uate infla!!atory defenses to suppress infection and hu!oral

>e!oglobin >e!atocrit 3eg!enters 1y!phocytes *latelet Count

0- 13./"1;./ gAd1 3C"B4 J /../"/.8/ /.2/"/.3/ 1B/"4B/ 7 1/IgA1

C.8 gAd1 2C J /..C /.3. 11/ 7 1/IgAd1

i!!unity takes place Decreased due to poor o7ygen supply Decreased due to poor o7ygen supply nor!al Increased due to the bodyGs increased i!!une syste! he!olysis

>+0#%)1)92 ,+*),% Date- Dune 1., 2//;, *0 *#,#0+%+, Fhite (lood Cells &),0#1 FI&DI&93 B"1/ 7 1/IgA1 #C%'#1 FI&DI&93 4.; 7 1/IgA1 #&#123I3 Decreased due to inade$uate infla!!atory defenses to suppress infection and hu!oral i!!unity takes place Decreased due to poor o7ygen supply Decreased due to poor o7ygen supply Decreased5 indicate lo glucose level in the blood Increased due to the bodyGs increased i!!une syste! he!olysis

>e!oglobin >e!atocrit 3eg!enters 1y!phocytes *latelet Count

0- 13./"1;./ gAd1 3C"B4 J /../"/.8/ /.2/"/.3/ 1B/"4B/ 7 1/IgA1

1/.3 gAd1 31 J /.B8 /.43 CB 7 1/IgAd1

>+0#%)1)92 ,+*),% Date- Dune 18, 2//;, #0 *#,#0+%+, Fhite (lood Cells >e!oglobin >e!atocrit 3eg!enters 1y!phocytes *latelet Count &),0#1 FI&DI&93 B"1/ 7 1/IgA1 0- 13./"1;./ gAd1 3C"B4 J /../"/.8/ /.2/"/.3/ 1B/"4B/ 7 1/IgA1 #C%'#1 FI&DI&93 B 7 1/IgA1 1/ gAd1 3/ J /..; /.32 ;B 7 1/IgAd1 #&#123I3 &or!al Decreased due to poor o7ygen supply Decreased due to poor o7ygen supply &or!al Increased due to the bodyGs increased i!!une syste! he!olysis

>+0#%)1)92 ,+*),% Date- Dune 18, 2//;, *0 *#,#0+%+, Fhite (lood Cells &),0#1 FI&DI&93 B"1/ 7 1/IgA1 #C%'#1 FI&DI&93 1/ 7 1/IgA1 #&#123I3 &or!al

>e!oglobin >e!atocrit 3eg!enters 1y!phocytes *latelet Count

0- 13./"1;./ gAd1 3C"B4 J /../"/.8/ /.2/"/.3/ 1B/"4B/ 7 1/IgA1

11.4 gAd1 3B J /.B3 /.48 1/1 7 1/IgAd1

Decreased due to poor o7ygen supply Decreased due to poor o7ygen supply Decreased5 indicate lo glucose level in the blood Increased due to the bodyGs increased i!!une syste! he!olysis

REVIE1 OF ANATOMY AND PHYSIOLOGY BLOOD (lood is considered the essence of life because the uncontrolled loss of it can result to death. (lood is a type of connective tissue, consisting of cells and cell frag!ents surrounded by a li$uid !atri7 hich circulates through the heart and blood vessels. %he cells and cell frag!ents are for!ed ele!ents and the li$uid is plas!a. (lood !akes about ;J of total eight of the body. Functions of (lood4transports gases, nutrients, aste products, and hor!ones 4involve in regulation of ho!eostasis and the !aintenance of *>, body te!perature, fluid balance, and electrolyte levels 4protects against diseases and blood loss PLASMA *las!a is a pale yello fluid that accounts for over half of the total blood volu!e. It consists of C2J ater and ;J suspended or dissolved substances such as proteins, ions, nutrients, gases, aste products, and regulatory substances. *las!a volu!e re!ains relatively constant. &or!ally, ater intake through the 9I% closely !atches ater loss through the kidneys, lungs, 9I% and skin. %he suspended and dissolved substances co!e fro! the liver, kidneys, intestines, endocrine glands, and i!!une tissues as spleen. FORMED ELEMENTS Ce## T/.e +rythrocytes <,(C= 1eukocytes <F(C=&eutrophil 3pherical cell, nucleus ith t o or !ore lobes connected by thin fila!ents, cytoplas!ic granules stain a light pink or reddish purple, 12"1B !icro!eters in dia!eter 3pherical cell, nucleus, ith t o indistinct lobes, cytoplas!ic granules stain blue"purple, 1/"12 !icro!eters in dia!eter *hagocyti:es !icroorganis! Des("%.t%,! (iconcave disk, no nucleus, 8" ; !icro!eters in dia!eter F+!(t%,! %ransport o7ygen and carbon dio7ide

(asophil

,eleases hista!ine, hich pro!otes infla!!ation, and heparin hich prevents clot for!ation

+osinophil

3pherical cell, nucleus often ,eleases che!ical that reduce bilobed, cytoplas!ic granules infla!!ation, attacks certain satin orange"red or bright red, or! parasites 1/"12 !icro!eters in dia!eter 3pherical cell ith round nucleus, cytoplas! for!s a thin ring around the nucleus, ."; !icro!eters in dia!eter *roduces antibodies and other che!icals responsible for destroying !icroorganis!s, responsible for allergic reactions, graft re6ection, tu!or control, and regulation

1y!phocyte

of the i!!une syste! 0onocyte 3pherical or irregular cell, nucleus round or kidney or horse"shoe shaped, contain !ore cytoplas! than ly!phocyte, 1/"1B !icro!eters in dia!eter Cell frag!ents surrounded by a cell !e!brane and containing granules, 2"B !icro!eters in dia!eter PREVENTING BLOOD LOSS Fhen a blood vessel is da!aged, blood can leak into other tissues and interfere ith the nor!al tissue function or blood can be lost fro! the body. 3!all a!ounts of blood fro! the body can be tolerated but ne blood !ust be produced to replace the loss blood. If large a!ounts of blood are lost, death can occur. BLOOD CLOTTING *latelet plugs alone are not sufficient to close large tears or cults in blood vessels. Fhen a blood vessel is severely da!aged, blood clotting or coagulation results in the for!ation of a clot. # clot is a net ork of threadlike protein fibers called fibrin, hich traps blood cells, platelets and fluids. %he for!ation of a blood clot depends on a nu!ber of proteins found ithin plas!a called clotting factors. &or!ally the clotting factors are inactive and do not cause clotting. Follo ing in6ury ho ever, the clotting factors are activated to produce a clot. %his is a co!ple7 process involving che!ical reactions, but it can be su!!ari:ed in 3 !ain stages5 the che!ical reactions can be stated in t o ays- 6ust as ith platelets, the contact of inactive clotting factors ith e7posed connective tissue can result in their activation. Che!icals released fro! in6ured tissues can also cause activation of clotting factors. #fter the initial clotting factors are activated, they in turn activate other clotting factors. # series of reactions results in hich each clotting factor activates the ne7t clotting factor in the series until the clotting factor prothro!bin activator is for!ed. *rothro!bin activator acts on an inactive clotting factor called prothro!bin. *rothro!bin is converted to its active for! called thro!bin. %hro!bin converts the inactive clotting factor fibrinogen into its active for!, fibrin. %he fibrin threads for! a net ork hich traps blood cells and platelets and for!s the clots. CONTROL OF CLOT FORMATION Fithout control, clotting ould spread fro! the point of its initiation throughout the entire circulatory syste!. %o prevent un anted clotting, the blood contains several anticoagulants hich prevent clotting factors fro! for!ing clots. &or!ally there are enough anticoagulants in the blood to prevent clot for!ation. #t the in6ury site, ho ever, the sti!ulation for activating clotting factors is very strong. 3o !any clotting factors are activated that the anticoagulants no longer can prevent a clot fro! for!ing. CLOT RETRACTION AND DISSOLUTION #fter a clot has for!ed, it begins to condense into a denser co!pact structure by a process kno n as clot retraction. 3eru!, hich is plas!a ithout its clotting factors, is s$uee:ed out of the clot during clot retraction. Consolidation of the clot pulls the edges of the da!aged vessels together, helping the stop of the flo of blood, reducing the probability of infection and enhancing healing. %he da!aged vessel is repaired by the !ove!ent of fibroblasts into da!aged *hagocytic cell in the blood leaves the circulatory syste! and beco!es a !acrophage hich phagocytises bacteria, dead cells, cell frag!ents, and debris ithin tissues For!s platelet plugs, release che!icals necessary for blood clotting

*latelet

area and the for!ation of the ne connective tissue. In addition, epithelial cells around the ound divide and fill in the torn area. %he clot is dissolved by a process called fibrinolysis. #n inactive plas!a protein called plas!inogen is converted to its active for!, hich is called plas!in. %hro!bin and other clotting factors activated during clot for!ation, or tissue plas!inogen activator released fro! surrounding tissues, sti!ulate the conversion of plas!inogen to plas!in. )ver a period of a fe days the plas!in slo ly breaks do n the fibrin.

DRUG STUDY I3)*,I&)3I&+ Dosage - 2 tsp %ID 2B/ !g Classification- #ntivirals Indication-,hinovirus5 herpes genitalis5 !easles5 encephalitis5 influen:a5 herpes :oster5 herpes si!ple75 type # K ( hepatitis5 #ID3 related co!ple75 neoplastic diseases5 anergy and hypoergy prior to !a6or surgery #ction43ynthetic antiviral- it sti!ulates %"ly!phocytes5 used for >I? and >epatitis 4non"to7ic i!!une syste! sti!ulant #dverse ,eactions4%ransient increase in urine and seru! uric acid level5 very rarely skin rashes5 pruritis5 9I upset5 nausea5 fatigue5 !alaise Contraindications4>ypersensitivity. *atients A adnor!ally lo neutrophil counts <L /.8B 7 1/7CA1=, or abnor!ally lo hae!oglobin levels <L 8.B gAd1 or 4..B !!olA1= &7 Considerations40onitor increase in seru! uric acid level, gout, urolithiasis or renal dysfunction5 pregnancy and lactation 40onitor he!atological para!eters *atient %eaching4Infor! patient that the drug !ust be taiken 1 hour apart on an e!pty 3to!ach 4Instruct the patient to notify prescriber if unusual effects occurs #0)MICI11I& Dosage - 38B !g %ID Classification - #ntibiotic Indication- Infections due to susceptible strains5 helicobacter pylori infections in co!bination ith other agents5 post"e7posure prophyla7is against bacillus anthracis5 Chlamydia trachomatis in pregnancy #ction- (actericidal- inhibits synthesis of bacterial cell all, causing cell death #dverse ,eactions4C&3 E lethargy, hallucinations, sei:ures 49I E glossitis, sto!atitis, gastritis, sore !outh, furry tongue <black hairy=, nausea, vo!iting, diarrhea <bloody=, enterocolitis,pseudo!e!branous colitis, nonspecific hepatitis 49' E nephritis 4>e!atologic E ane!ia, thro!bocytopenia, leucopenia, neutropenia, prolonged bleeding ti!e 4>ypersensitivity E rash, fever, hee:ing, anaphyla7is 4)thers E superinfections- oral and rectal !oniliasis, vaginitis Contraindications4Contraindicated ith allergy to cephalosporins or penicillins, or other allergens 4'se cautiously ith renal disorders and lactation &7 Considerations4Culture infected area prior to treat!ent5 reculture area if response is not e7pected 49ive in oral preparations only5 a!o7icillin is not affected by food 4Continue therapy for at least 2 days after signs of infection have disappeared5 continuation for 1/ full days is reco!!ended 4'se corticosteroids or antihista!ines for skin reactions *atient %eaching4%ake this drug around"the"clock 4%ake the full course of therapy5 do not stop because you feel better 4%his antibiotic is specific for this proble! and should not be used to self"treat other infections

4+at fre$uent s!all !eals to avoid 9I effects5 fre$uent !outh care !ay prevent sore !outh 4,eport unusual bleeding or bruising, sore throat, fever, rash, hives, severe diarrhea, difficulty of breathing *#,#C+%#0)1 Dosage- 2B/ !gAB!l $ 4H ,%C Classification- &onopioid #nalgesics K #ntipyretics Indication- 0ild pain or fever #ction- *roduce analgesia by blocking pain i!pulses by inhibiting synthesis of prostaglandin in the C&3 or of other substances that sensiti:e pain receptors to sti!ulation. %he drug !ay relieve fever through central action in the hypothala!ic heat"regulating center. #dverse ,eactions>e!atologic- >e!olytic #ne!ia, &eutropenia, 1eukopenia, *ancytopenia >epatic- Daundice 0etabolic- >ypoglyce!ia 3kin- ,ash, 'rticaria Contraindications Contraindicated in patients hypersensitive to drug. 'se cautiously in patients ith long"ter! alcohol use because therapeutics doses cause hepatoto7icity in these patients. &7 Considerations #1+,%- 0any )%C and prescription products contain aceta!inophen5 be a are of this hen calculating total daily dose. 'se li$uid for! for children and patients ho have difficulty in s allo ing. In children, donGt e7ceed five doses in 24 hours. *atient %eaching %ell parents to consult prescriber before giving drug to children younger than age 2. #dvise patient or parents that drug is only for short"ter! use5 urge the! to consult prescriber if giving to children for longer than B days or adults for longer than 1/ days. #1+,%- #dvise patient or caregiver that !any )%C products contain aceta!inophen, hich should be counted hen calculating total daily dose. %ell patient not to use for !arked fever <te!perature higher than 1/3.1HF N3C.BHCO=, fever persisting longer than 3 days, or recurrent fever unless directed by prescriber. #1+,%- Farn patient that high doses or unsupervised long"ter! use can cause liver da!age. +7cessive alcohol use !ay increase the risk of liver da!age. Caution long" ter! alcoholics to li!it aceta!inophen intake to 2gAday or less. %ell breast"feeding o!an that aceta!inophen appears in breast !ilk in lo levels <less than 1J of dose=. Drug !ay be used safely if therapy is short"ter! and doesnGt e7ceed reco!!ended doses. Interactions o Drug"Drug " (arbiturates, Carba!a:epine, >ydantoins, ,ifa!pin, 3ulfinpyra:one- high doses or long"ter! use of these drugs !ay reduce therapeutic effects and enhance hepatoto7ic effects of aceta!inophen. #void using together. " 1a!otrigine- !ay decrease la!otrigine level. 0onitor patient for therapeutic effects. " Farfarin- !ay increase hypoprothro!bine!ic effects ith long"ter! use ith high doses of aceta!inophen. 0onitor I&, closely. " Pidovudine- !ay decrease :idovudine effects. 0onitor patient closely. o Drug">erd " Fatercress- !ay inhibit o7idative !etabolis! of aceta!inophen. Discourage use together. o Drug"Food " Caffeine- !ay enhance analgesic effects of aceta!inophen. *roducts !ay co!bine caffeine and aceta!inophen for therapeutic advantage.

o Drug"1ifestyle " #lcohol use- !ay increase risk of hepatic da!age. Discourage use together. ,+1+3%#1 Dosage- 1 tsp every .H Classification- #ntidiarrheals Content- Dicycloverine >Cl Indication- ChildrenGs cholic, functional gut disturbances, renal and biliary coloc #d!inistration- 0ay be taken before or after !eals Contraindications- Closed"angle glauco!a5 urinary or 9I obstruction, intestinal atony, paralytic ileus, asth!a, !yasthenia gravis, ulcerative colitis, hiatus hernia, ulcerative colitis and hepatic or renal colic #dverse ,eactions- Increased intraocular pressure, cyclopegia, !ydriasis, dry !outh, blurred vision, flushing, urinary hesitancy K retention, tachycardia, palpitations, constipation, elevated body te!perature, C&3 e7citation, rash, vo!iting, photophobia Drug Interactions- #nticholinergic activity !ay be increased by other parasy!patholytics. 9uanethidine, hista!ine and reserpine can antagoni:e the inhibitory effect of anticholinergics on gastric acid secretion. #ntacids !ay i!pair absorption. *,+D 1/ Dosagetsp 37 a day after !eal Classification- Corticosteroid >or!ones Content- *rednisone Indication- %reat!ent of endocrine, rheu!atic K he!atologic disorders, allergic K ede!atous states, collagen, der!atologic K opth, resp K neoplastic diseases. 3uppression of infla!!atory disorders. #d!inistration- %ake i!!ediately after !eals Contraindications- 9astric and duodenal ulcers, syste!ic fungal K certain viral infections, glauco!a, psychoses or severe psychoneuroses5 live vaccines5 hypersensitivity to glucocorticoids 3pecial *recautions- >eart failure, recent 0I or >%&, D0, epilepsy, glauco!a, hypothyroidis!, hepatic failure, osteoporosis, peptic ulceration, psychoses or severe effective disorders K renal i!pair!ent #dverse ,eactions- Fluid, electrolyte, visual K psychic disturbances, Cushingoid state, hirsutis!, gro th retardation, skin atrophy, facial erythe!a, aseptic osteonecrosis, a!enorrhea Drug Interactions- 1ive vaccines #**+()& Dosage- 1 tsp (ID Classification- #ppetite 3ti!ulants Content- Pe" 2 $# (ucli:ine >Cl B!g, vita!in (1 1/ !g, vita!in (. B!g, vita!in (12 2B!cg, lysine >Cl B//!g Indication- *oor appetite, under eight, anore7ia nervosa. For nutritional support in post" operative cases, !etabolic disorders and convalescence #d!inistration- Fith food Contraindications- #ngle closure glauco!a, prostate hypertrophy K pri!ary he!achro!atosis 3pecial *recautions- 0ay i!pair ability to drive or operate !achinery5 pregnancy #dverse ,eactions- Dro siness K dulling of !ental alertness, dry !outh, headache, nausea, 6itteriness, tiredness Drug Interactions- ,educe the effectiveness of levodopa5 C&3 depressants5 alcohol

LEARNING FEEDBAC3 DIARY &#0+- Dorina 1orraine (. (inarao C1I&IC#1 I&3%,'C%),- 0s. 3hane (. 3antos, ,& )(D+C%I?+3#t the end of the rotation, I ill be able to %o upgrade !y kno ledge on clinical setting %o fa!iliari:e !yself ith the hospital setting %o deliver health care services. %o build rapport ith the patients, 3)s, staff nurses, clinical instructor and student nurses. %o enhance !y skill on therapeutic co!!unication as in 3t. *aul >ospital and une7pectedly !y schedule is night hat to e7pect in a hospital setting. ere only tasked to do the vital signs taking and as a three year old boy ith a Chinese student ith #,+#- 3t. *aul >ospital Floor 1 D#%+3- Dune 1., 18, 1;, 23 K 24, 2//;

%he first rotation of !y duty %he first night

shift. IG! nervous at the first night of duty because I still donGt kno as like an orientation for us. Fe

plotting. Fe erenGt allo ed yet to do the charting and giving of !edications. %he patients given to us hose chief co!plaint ere in the >oly Fa!ily Fard. 0y first patient as good that I as paired as contusion he!ato!a. It

because I have so!eone to help !e in taking the vital signs. %he only disadvantage of having paired her is that it is difficult to e7plain everything to her because language difference.

>aving a night duty has positive and negative factors. %he positive or advantage of night duty is that you are not to7ic ith !any things to do. #t night shift, you also have the ti!e to bro se the chart of the patient. %he negative or disadvantage part is that you have to !ake yourself a ake for about eight hours. #nother disadvantage is that it is difficult to intervie and assess the patient because it is hisAher ti!e to sleep and rest. Interaction a!ong the group is really needed to keep all of us a ake.

In ne7t nights of our duty,

e had our patients staying in 3to. &iQo Fard. Fe as not difficult because they

ere ere

already tasked to do charting. Doing the charting every night enhances !y skill and ability in doing it. Intervie ing the 3)s of the patient assigned to !e are still kids. +7periencing the clinical or hospital setting !akes !e feel e7cited of !y future 6ob. I believe that I !ust do everything correctly for the benefit of !y patients. It is a good and relieving feeling that the patient you handle ill be discharged i!!ediately. %he !ost unforgettable e7perience of !y first rotation of duty 0y heart that ti!e as like stubbed as that so!eone died. ith a knife that I canGt breathe. %hrough this case, I so cooperative and kind. I as lucky to have patients that donGt have lot of tantru!s even if they

instilled in !y !ind that I !ust be rela7 and do the things necessary to revive a life. *anicking during such case ill not do anything good.

%he first rotation of duty had left !e things to re!e!ber.

ith so !any e7periences that taught !e a lot of

A CASE STUDY ON DENGUE FEVER

Submitted by: Dorina Lorraine B. Binarao Vicky (BSN3 RLE Group G)

Submitted to: M . S!ane B. Santo " RN