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DHF ..

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Published by: George Mikhail Labuguen on Mar 03, 2011
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Republic of the Philippines DIVINE WORD COLLEGE OF BANGUED

Bangued, Abra

A Case study on DENGUE

Presented to: MISS. RUBY RAMOS RN. MAN
Clinical Instructor

Presented by: George Mikhail Labuguen BSN-III

I.INTRODUCTION A. BACKGROUND OF THE STUDY Dengue hemorrhagic fever (DHF) is an acute febrile diseases transmitted by mosquitoes, which occur in the tropics, can be life-threatening, and is caused by four closely related virus serotypes of the genus Flavivirus, family Flaviviridae. It was identified and named in 1779. It is also known as breakbone fever, since it can be extremely painful. Unlike malaria, dengue is just as prevalent in the urban districts of its range as in rural areas. Each serotype is sufficiently different that there is no cross-protection and epidemics caused by multiple serotypes (hyperendemicity) can occur. Dengue is transmitted to humans by the Aedes (Stegomyia) aegypti or more rarely the Aedes albopictus mosquito. The mosquitoes that spread dengue usually bite at dusk and dawn but may bite at any time during the day, especially indoors, in shady areas, or when the weather is cloudy. The disease manifests as fever of sudden onset associated with headache, muscle and joint pains (myalgias and arthralgias²severe pain that gives it the nickname break-bone fever or bonecrusher disease), distinctive retro-orbital pain, and rash. The classic dengue rash is a generalized maculopapular rash with islands of sparing. A hemorrhagic rash of characteristically bright red pinpoint spots, known as petechiae can occur later during the illness and is associated with thrombocytopenia. It usually appears first on the lower limbs and the chest; in some patients, it spreads to cover most of the body. There may also be severe retro-orbital pain, (a pain from behind the eyes that is distinctive to Dengue infections), and gastritis with some combination of associated abdominal pain, nausea, vomiting coffeegrounds-like congealed blood, or severe diarrhea.

A physical examination may reveal:
y y y y y y y

Enlarged liver (hepatomegaly) Low blood pressure Rash Red eyes Red throat Swollen glands Weak, rapid pulse

mosquito repellent containing DEET. and if possible. . Use personal protection such as fullcoverage clothing. travel during periods of minimal mosquito activity. netting. Mosquito abatement programs can also reduce the risk of infection. the only treatment is to treat the symptoms. y y y y y A transfusion of fresh blood or platelets can correct bleeding problems Intravenous (IV) fluids and electrolytes are also used to correct electrolyte imbalances Oxygen therapy may be needed to treat abnormally low blood oxygen Rehydration with intravenous (IV) fluids is often necessary to treat dehydration Supportive care in an intensive care unit/environment Possible Complications y y y y y Encephalopathy Liver damage Residual brain damage Seizures Shock Prevention There is no vaccine available to prevent dengue fever.Tests may include: y y y y y y y y y y Arterial blood gases Coagulation studies Electrolytes Hematocrit Liver enzymes Platelet count Serologic studies (demonstrate antibodies to Dengue viruses) Serum studies from samples taken during acute illness and convalescence (increase in titer to Dengueantigen) Tourniquet test (causes petechiae to form below the tourniquet) X-ray of the chest (may demonstrate pleural effusion) Treatment Because Dengue hemorrhagic fever is caused by a virus for which there is no known cure or vaccine.

. The disease is now endemic in more than 100 countries.d) To the Student Nurse For her to know all the appropriate interventions that should be rendered to patients having this kind of condition.MORTALITY AND MORBIDITY The WHO says some 2. C. all the procedures that must be done. RATIONALE FOR CHOOSING THE CASE The researcher chose this case because the researcher wants to have sufficient knowledge about Dengue Hemorrhagic Fever. the drugs. and to be educated about Dengue Hemorrhagic Fever so as to become an effective nurses in the future. it will help her to understand her condition and cope up with her situation as well as to learn and understand the effects of drugs administered to her.b) To the Family This study will help to determine and be knowledgeable regarding the different measures that must be done to prevent one from having the condition. C. C.c) To the Community This study will help everyone in the community to be knowledgeable about this illness and will be able to provide preventive measures in order to avoid this condition.5 billion people. to know all the possible complications. in order to be acquainted with regards to the clinical manifestations of the condition and its causes. to know the appropriate treatment and diagnostic procedures that must be done and identify appropriate nursing interventions needed and must be rendered to the patient experiencing and who may experience such condition. C.a) To the Patient This study is significant to the patient because she will acquire information from the facts shared by the researcher. B. to share and impart the necessary information that may be helpful in eradicating the occurrence of the condition. are now at risk from dengue and estimates that there may be 50 million cases of dengue infection worldwide every year. and the kind of management it requires. SIGNIFICANCE OF THE STUDY C. two fifths of the world's population.

.C. SCOPE AND DELIMITATION This study consists of the information regarding dengue hemorrhagic fever. I wasn¶t able to get the result of the urinalysis because it wasn¶t in yet. the anatomy and physiology of the system involved. It contains the patient¶s data. D. the medical history of the patient. the physical assessment.d) To the Nursing Education This study is useful for the students in nursing education for they will obtain relevant information on the subject which is Dengue Hemorrhagic Fever. the nursing care plans needed for this condition. the medical management.

II.PATIENT¶S PROFILE/BIOGRAPHICAL DATA: Name: Address: Age: Sex: Civil Status: Single Religion: Roman Catholic Nationality: Filipino Birthday: Name of Hospital: San Lazaro Hospital Room and Bed No.: Pedia Dept. / Bed No.: Hospital code: Date of Admission: Time of Admission: Admitting Diagnosis: Dengue Fever Admitting Physician: Chief Complaints: Fever . Hospital No.

According to him she had experienced all common illnesses such as colds. According to the father they have no complain regarding the place where they live. C. D. She has no allergies on foods and drugs and that she hasn¶t encountered any accident yet. they are all girls. Present History of Illness Seven days prior to admission the patient developed on and off fever with associated headache and loss of appetite. fever occurred again with associated rashes in the upper and lower extremities. Then two days prior to admission the patient is no fever but still with loss of appetite. MEDICAL HISTORY A. They consulted at MCU wherein CBC with PC was done and when the result was in it revealed that she has low platelet count that¶s why they transferred at San Lazaro Hospital. Her father told the researcher that her maternal side has a history of hypertension while her maternal side has no significant hereditary disease and that she is the only member of the family who has experienced Dengue Hemorrhagic Fever. she was fully immunized when she was a child. He said the patient is a Grade V student and loves to play online games right after school. and fever and had also experienced primary complex when she was a child that caused her to be hospitalized way back then and the medication prescribed was Salbutamol. . loves to play outside with their neighbors. E. One day after. Family History of Illness According to the father of the patient she is the eldest among the 3 siblings. cough. Environmental History The patient peacefully lives with her family and with the brother of her mother in an apartment in Caloocan. Past Medical History According to the father of the patient.III. Socio-Economic History The father of the patient said that they never considered using herbal drugs. The father and mother works as a factory worker. B.

nits. symmetrical in all planes gently curved  White. no involuntary muscle movement  Parallel and evenly placed. both eyes black and clear Black. non protruding with amount of secretions. clear. symmetrical. thick shiny. thick and raise and lower eyebrows at the same time without difficulty Black. facial expressions that is dependent on the true mode or true feelings. symmetrical in all planes gently curved Free from lumps. evenly distributed. square/heart shaped. no scars. free from lumps. involuntary muscle movement Parallel and evenly placed.IV. raise and lower eyebrows at the same time without difficulty. evenly distributed and parallel  Black evenly distributed and turned outward Proportional to the size of the body Round with prominence in the frontal and occipital area. no Scars with some visible dandruff Black. parallel. evenly distributed and covers the whole scalp. symmetrically. non protruding with amount of secretions. symmetrical. smooth and free from wrinkles. dandruff and lesions  Black. free from split ends  Oblong or oval. parallel & thick. evenly distributed and turned outward Normal Normal Scalp  Inspectio n  Inspectio n  Inspectio n Hair Presence of dandruff related to poor hygiene Normal Face Normal Eyes  Inspectio n Normal Eye brows  Inspectio n Normal Eyelash es  Inspectio n Normal .PHYSICAL ASSESSMENT TOOL Body part assessed /examin ed Head Physical assessment skill  Inspectio n  Palpatio n Normal findings Actual findings Analysis  Proportional to the size of the body  Round with prominence in the frontal and occipital area. both eyes black and clear  Black. facial expressions are dependent on the true mod or feelings. covers the whole scalp and thick Oval shape. symmetrically.

moist and freely movable Normal Due to poor hygiene Normal Tongue Neck Proportional to the size Normal of the body. slightly halitosis with some carries Large. color is uniform. moist. no discharge Midline. flat. red/pink. no retraction  Inspe  32 permanent teeth. ation masses or areas of tenderness  Rang  Freely movable without e of difficulty motion (chinchest) (earshoulder)  Inspe  Normal bilateral ction expansion  Palp ation  Ausc ultation  Inspe ction  No deformities and hematoma  No adventitious breath sounds  Skin is unblemished. no discharge/ flashing  Inspectio  Pinkish. bean shaped. no scar. color is the same as the surrounding area. Normal parallel. symmetrical n patent. symmetrical and straight No palpable lumps. lip n margin well defined  Smooth and moist  Inspe  Pinkish. bean shape. color is the same as the surrounding area. no discharge/ flashing Dry Due to dehydration Dark pink in color. smooth. symmetrical movement Proportional to the head. color is uniform. slightly distended Normal Lung Abdom en Normal Normal . wellaligned. ction Moist & freely movable  Inspe  Proportional to the size ction of the body. symmetrical and straight  Palp  No palpable lumps. symmetrical Normal patent. red/pink.Ears  Inspectio n Nose Mouth/ Lips Gums Teeth  Parallel. well ction aligned free from carries of filling to halitosis  Inspe  Large/medium. No swelling. clear  Inspectio  Midline. no retraction Complete teeth. no scar. Normal masses or areas of tenderness Freely movable without Normal difficulty Chest Normal bilateral expansion No deformities and hematoma No adventitious breath sounds Skin is unblemished. ction no swelling. symmetrical. symmetrical proportion to the size of the head.

tan. warm Males: thick Females: softer elastic  Freely movable 5 fingers in each hands Presence of gurgling sounds Normal Soft abdomen. no tenderness. muscle  Inspectio n Due to decreased blood flow Normal >Performs with relative case >Range of motion bend straight Skin color varies (brown). in each foot. Normal  Freely movable 5 5 fingers in each foot. no tenderness. fingers Nails are unclean. brown) skin is smooth. fine hair evenly distributed. no masses. transparent nails with pink nail beds and white tips Poor hygienic measure . no lumps Palms are pale Normal Due to decrease blood flow  Inspection  Inspectio n Freely movable 5 fingers in each hands Nails are pale Normal Fingern ail Elbow Lower extremi ties Legs Toes and nails  Nails are transparent. tymphani predominates because of presence of air in the stomach and intestines  Soft abdomen. evenly distributed. no masses. no lumps  Palms. pinkish. sole and dorsal surface is smooth. smooth and convex with pink nail beds & white tips  Inspectio  Performs with relative case n  Range of motion bend straight  Inspe Skin color varies (pinkish. ction fine hair. Ausc ultation Palms and dorsal surface s Fingers  Perc ussion & palpation  Inspectio n  There are gurgling sounds.

Eyes ___Difficulty with vision ___Double vision (diplopia) ___Watering or discharge ___Eye pain ___Redness or swelling ___Glaucoma . psoriasis. Head ___Frequent or severe headache ___Dizziness (Vertigo) ___History of head injury ___Syncope (Faintness) 5. REVIEW OF SYSTEM Part I 1. hives) ___Change in mole ___Excessive moisture ___Excessive bruising ___Lesion ___Pigment or color change ___Excessive dryness ___Pruritus ___Rash 3. Hair ___Recent loss Nails ___Change in shape ___Brittleness ___Change in color ___Change in texture 4. General Over Health State ___Weight gain for the past 3 month¶s ___Weight loss for the past three month¶s ___Fatigue ___Weakness or malaise ___Fever ___Chills ___Night sweats 2.V. Skin ___History of Skin Diseases (eczema.

Mouth and throat ___Mouth pain ___bleeding gums ___Lesion in mouth or tongue ___Hoarseness of voice ___Tonsillectomy ___Use of dentures. bridges ___Frequent sore throat ___Toothache ___Difficulty in swallowing ___Altered taste ___Use of dental braces Last dental check-up: Date:________ 9.___Cataracts ___Loss of vision ___Wearing glasses or contact lens (specify) 6. Nose and Sinuses ___Discharge ___Sinus pain ___Change in sense of smell ___Allergic rhinitis ___Severe colds ___Nose bleeding ___Nasal Obstruction ___Infections ___Ringing of ears ___Hearing loss 8. Breast ___Pain ___Nipple discharge ___Rash ___Lump ___Nipple retraction ___History of breast diseases (specify: . Ears ___Earaches ___Discharge ___Vertigo ___Use of hearing aid 7.Neck ___Pain ___Lumps or swelling ___Limitation of motion ___Enlarged or tender nodes 10.

Color_____. e. pneumonia. Respiratory System ___History of lung disease (specify. asthma.g. bronchitis. tuberculosis) _________ ___Chest pain with breathing ___Wheezing of noisy breathing ___Shortness of breathing ___Cough ___Sputum production. Cardiovascular System ___Chest pain ___Palpitation ___Dyspnea: ___on exertion ___on lying ___During the night ___Frequent urination during the night ___Edema ___History of heart Diseases ___Hypertension ___Anemia Date of last ECG or other heart test. emphysema. or swelling in the axial Part II 1. Amount_____ ___Hemoptysis ___Toxin or pollution exposure Last Chest X-ray: Date__________ 2. lump. blood test and results ..___Any surgery on breasts (Frequency ___Last mammogram (results ___Performs breast self-examination ___Tenderness.

specify:_____________________________ ___Flatulence ___Constipation ___Diarrhea ___Black stools ___Rectal bleeding ___Hemorrhoids ___Use of antacids ___Use of laxatives 5. numbness and tingling. Urinary System ___Frequency ___Urgency ___Nocturia ___Dysuria . pallor. swelling of legs ___Discoloration in hands or feet (bluish red. Gastrointestinal System _¥__Loss of appetite to eat ___Food intolerance.3. Peripheral Vascular System ___Coldness. specify:______________________________________ ___Dysphagia ___Odynopagia ___Heartburns ___Indigestion ___Pain associated with eating ___Abdominal pain ___Nausea and vomiting ___History of abdominal disease. mottling) ___Varicose veins ___Pain on the legs on walking and exercise relieved by rest (intermittent claudication) ___History of thrombophlebitis ___Ulcers in the lower extremities 4.

Male Genital system ___Penis or testicular pain ___Penile Discharge ___Hernia ___Sores of lesions ___Lumps ___Performs self-testicular exam How Frequent? _____________ B. and foul. cheesy. suprapubic. Female Genital System ___Amenorrhea (Absence of menstruation) ___Menorrhagia (Excessive bleeding during menstruation) ___Vaginal itching ___Vaginal discharge (specify characteristics e.g. region. groin. ect) specify _____________ ___ Postmenopausal bleeding Age at menarche period: _______________________________________ Last menstrual period: __________________________________________ Last Gynecologic Check-up date: _____________________________________ Last Pap smear: Date ______________________________________________ Results:_______________________________________________ . blood tinged) _______ ___ Menopausal signs and symptoms (e. Specify:_________ ___Pain in flank. specify:___________________________ A. yellowish. specify_____ ___Pollakuria ___Oliguria ___Narrowed stream of urine ___Incontinence ___Hx of Urinary Disease.___Polyuria ___Hesitancy of training ___Change in color. whitish. hot flushes. Emotional liability.g. greenish. or low back pain ___Hx of surgery in the urinary system.

stiffness ____Joint deformity ____Limitation of motion of joints ____Noise with joint motion (Crepitus) ____Muscle pain.6. Neurologic System ____Hx of seizure disorder ____Hx of fainting and blackouts ____Tic or tremor ____Coordinator problems ____Memory disorder: specify__ ____Nervousness ____Depression ____Hallucination: Specify:_______ ____Hx of stroke ____Weakness in any body part. Specify______________________________________ 7. Musculoskeletal System ____ History of arthritis ____History of gout ____Pain. Specify:____ ____Paralysis ____Paresthesia ___Disorientation: specify:________ ___Mood change ___Hx oh mental health dysfunction .g. (E. slipped disc) ____performs exercise Specify______________________ how frequent?______________________ ____Difficulty with performing ADL Specify_________________________________ ____Any mobility aids used. cramps ____muscle weakness ____problem with walking ____Back pain ____Stiffness and limitations of motion of muscles ____ History of disc disease.

Hematologic system ___Bleeding tendency of skin or mucous Membrane ___Lymph node swelling ___Blood transfusion ___Excessive bruising ___Exposure to toxic agents or radiation ___Reactions to blood transfusion Specify:____________________ ___Hx of blood disorders. ___Change in skin pigmentation or texture ___Weight gain with loss of appetite to eat ___abdominal hair distribution ___Tremors ___Polyuria ___Polyphagia ___Intolerance to heat or cold ___Excessive sweating ___Weight loss w/ increased appetite to eat ___Nervousness ___Enlarged neck ___Need foe hormone therapy. Endocrine System ___Hx of DM ___polydypsia ___Hx of thyroid dse. dose. Specify:_________________________ 9. frequency) _____________________________ . Specify:________________________ ___Need for OHD (name.8.

She urinates and passes stool regularly. She plays with her siblings and neighbors often. . C. D. She maintains her health by practicing proper hygiene and eating nutritious foods. She seldom eats and only drinks water.ACTIVITY-EXERCISE PATTERN Before hospitalization: Performs ADL. PATTERNS OF FUNCTIONING/FUNCTIONSL HEALTH PATTERNS A. She love to play online games During hospitalization: She cannot perform all the things she usually does when he was still well. During hospitalization: She has difficulty in passing stool. During hospitalization: The patient has loss of appetite and doesn¶t want to eat at times.HEALTH PERCEPTION AND HEALTH MANAGEMENT PATTERN Before hospitalization: The patient perceived her health in the state of good condition. She eats 3 times a day plus her snacks after going to school. During hospitalization: She sees herself as a total ill person because she cannot do anymore the things she usually does.ELIMINATION PATTERN Before hospitalization: The patient doesn¶t have any problem regarding her elimination pattern.NUTRITIONAL-METABOLIC PATTERN Before hospitalization: She doesn¶t have any allergies on foods and drugs.VI. B. She is only lying in bed. She relies herself to medical practitioners and her family. She values her health a lot.

During hospitalization: She had less time to bond with their family because of her condition. She responds clearly and understands. F. J. I. She does well her responsibilities at home and school. Watching the television.COGNITIVE-PERCEPTUAL PATTERN Before hospitalization: She is normal in terms of his cognitive abilities. She can easily comprehend on things.E.COPING-STRESS TOLERANCE PATTERN Before hospitalization: She tells her parents if she feels that there is something wrong with her. During hospitalization: .SEXUALITY-REPRODUCTIVE PATTERN She said having a boyfriend at her age is still a big No No! She said she¶s still young for such maters. The fact that she¶s not alone in the room is already a factor for sleep deprivation. During hospitalization: She cannot sleep well because of the environment. During hospitalization: She was normal as before in her cognitive and perceptual pattern. They are 5 in the family. A good daughter to her parents and a good sister to her siblings.SLEEP-REST PATTERN Before hospitalization: She sleeps on time and gets enough sleep. G. playing online games are her form of rest. She has good memory. In terms of his perceptual pattern she has no problems with her senses.SELF-PERCEPTION ± SELF-CONCEPT PATTERN She sees herself as a God-fearing person. Her father said that she is a responsible daughter since she is the eldest she guides her sisters.ROLE-RELATIONSHIP PATTERN Before hospitalization: She is close with her family. H.

VII. soft. K.VALUE-BELIEF PATTERN They don¶t believe in quack doctors. She s a Roman Catholic and goes t mass often with her family. HEALTH LABORA INTERVEN TEACHING TORY TIONS S >Monitor I & >CBC with O every shift PC and record > U/A >Monitor TPR every 4° 11-30-10 to include BP >ff up U/A refer if < 90/60 > Watch out for bleeding. hypotension and change in sensorium CONSULTA TIONS >Paraceta mol 250 mg/8ml 11-30-10 8ml q 4° >PNSs @ T 37. CLINICAL PATHWAY: ASSESSME NT 11-29-10 >Conscious and coherent >symmetrica l chest ()murmur >flabby.8°C 115cc/hr >Sucralfate 1g/tab 1tab q 6° INTRAVE NOUS FLUID >PNSSx145 cc/hr MEDCAT ION DIET >soft diet except dark colored foods. She as taught to believe and fear God. .She verbalizes her feelings. (-) edema. full and equal pulses >(+) 11-30-10 petechial rashes on upper and lower extremities > (-) bowel movement for 1 week. (+) epigastric tenderness >(-) cyanosis.

56 10^9/L 4.0-16.34 .40 .00 1.49 Segmenters .60 -6. Minoza.5-11 Result 4.37 Unit 10^12/L g/dL mmol/L Normal Values 4.53 12.36-.86-2.1 Leukocytes NUMC .36 .04 . M.86 0.32-0.58 .VIII.4 26 0.47 Lymphocytes .33 10^9/L fL pg 150-400 80-96 fL 27-31 pg 0.0 1.20 12.D Component Erythrocytes NUMC Hemoglobin Hemoglobin SUBSTC Erythrocytes VOLFR 4. LABORATORY: LABORATORY: Hematology DATE: November 29. Helen Rose A.64 Monocytes Thrombocytes NUMC y y y MCV MCH MCHC 76 81. 2010 REQUESTING PHYSICIAN: Dr.

IX. The blood leaving the aorta is full of oxygen. PATHOPHYSIOLOGY AND SCHEMATIC DIAGRAM OF THE DISEASE . As blood begins to circulate. ANATOMY AND PHYSIOLOGY OF SYSTEM/ORGAN INVOLVED\ The circulatory system is made up of the vessels and the muscles that help and control the flow of the blood around the body. This is important for the cells in the brain and the body to do their work. X. capillaries and veins. The aorta is the largest artery in the body. The oxygen rich blood travels throughout the body in its system of arteries into the smallest arterioles. The main parts of the system are the heart. This process is called circulation. arteries. it leaves the heart from the left ventricle and goes into the aorta.

Increased vascular permeability. bleeding. Mosquito bite Virus transmitted and multiplies in the bloodstream Creates multiple lesions in the bloodstream Increased capillary fragility Allows fluid shifting from one compartment to another Ascites. LIST OF NURSING DIAGNOSIS NURSING DIAGNOSIS >Hyperthermia related to JUSTIFICATION >For the researcher CUES S >´Ang init ng pakiramdam . Hematocencentration XII. Illness begins abruptly with a minor stage of 2-4 days duration followed by rapid deterioration. non-indigenous adults and children. and release of vasoactive amines. and possible DIC maybe mediated by circulating dengue antigen-antibody complexes. In the process of immune elimination of infected. DHF/DSS usually occurs during a second dengue infection in persons with pre-existing actively or passively (maternally) acquired immunity to a heterologous dengue virus serotype. Symptoms begin after a 5-10 days incubation period. edema. proteases and lymphokines maybe released and activate complement coagulation cascades and vascular permeability. Classic dengue primarily occurs in non-immune.Dengue viral infections frequently are not apparent. activation of compliment.

. XIII. hyperthermia. flushed skin. >Encouraged the use of personal protection such as clothing.8°C). Health Teachings: >Emphasized the importance of proper hygiene. as verbalized by the patient. pale. as verbalized by the Father. weak in appearance. O>>weight loss >pale >weak in appearance >dry mucous membrane >>Imbalanced Nutrition: Less than Body Requirements related to inability to ingest food as manifested by weight and dry mucous membrane. hyperthermia will be the priority because it can cause convulsions when it gets off hand. O>Temp.8°C >Flushed skin >warm to touch S>´Hindi siya nakakakain ng mabuti kasi palagi siyang walng gana´. DISCHARGE PLANNING Medicines: >Advised to take medicines prescribed only by the physician. evidenced by increased body temperature (37. Treatment: >Encouraged to increase oral fluid intake. mosquito repellant. >This is the second priority because its improvement cannot be seen in a short span of time unlike the loss. >Emphasized the importance of good environmental sanitation. and warm to touch. Exercise: >Encouraged to have adequate rest and sleep. And netting. >Encouraged to eat nutritious foods rich in Vit C to boost immune system.ko´. presence of circulating toxins.:37.

Follow Up: >Emphasized routine follow up check up. Alice Murr . >Advised to refer immediately to a physician whenever possible signs and symptoms or when complications arise. BIBLIOGRAPHY > Public Health Nursing in the Philippines Book > Comprehensive Communicable Disease Nursing Handbook by: Aaron Tuesca Untalan >Nurse¶s Pocket Guide: Diagnoses. Prioritized Interventions. Diet: >Encouraged to eat foods rich in Vit. XIV. C to help strengthen the immune system. >Advised to eat nutritious foods. and Rationales by Marilynn Doenges. Spiritual Advice: >Encouraged to pray that her condition may get better.

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