Professional Documents
Culture Documents
TABLE OF CONTENTS
1. Introduction 2. Objectives of the study -general objectives -specific objectives 3. Theoretical framework 4. Nursing health history -demographic data -history of present illness -past medical history -family history -social history -environmental history -genogram 5. Gordons level of functioning 6. Physical assessment 7. Laboratory exams 8. Anatomy and physiology 9. Pathophysiology 10. medical/surgical intervention 11. Drug study 12.nursing care plan 12. Discharge plan 12. Bibliography
INTRODUCTION
This case is a about a 13 years old boy who was admitted at Capitol medical center on September 21, 2012 with a chief complaint of fever and was diagnosed with dengue.
Dengue fever is a disease cause by a family of viruses that are transmitted by Aedes mosquitoes. This mosquito transmits the disease by biting an infected person and then biting someone else. The mosquitoes that transmit dengue live among human and breeds in discarded tires, flower pots, old drums and water storage containers close to human dwellings.
Unlike the mosquitoes that cause malaria, dengue mosquitoes bit during the day. Symptoms such as headache, fever, exhaustion, severe joint and muscle pain, swollen glands (lymphadenopathy), and rash. The presence (the "dengue triad") of fever, rash, and headache (and other pains) is particularly characteristic of dengue fever
MANILA, Philippines -- Global warming may have contributed to a 43 percent rise in the number of dengue cases in the Philippines for the first half of the year. The biggest increase in the country was seen in Metro Manila, where there was an almost 200 percent increase. "The increase in the number of dengue cases may be attributed to the constantly changing climate brought by global warming as well as congestion in urban areas," World Health Organization officials earlier this year warned climate change was increasing the incidence of dengue fever and other infectious diseases in the country. There is no known cure or vaccine for dengue fever, which is transmitted by the white-spotted mosquito.
General objectives
the main goal of the study is for me to have an additional knowledge related to pneumonia and to develop my skills in assessing a patient with pneumonia
Specific objectives
interpret data gathered from the patient identify and explain etiology of the underlying condition
discuss the anatomy and physiology of the related disease trace the pathopysiology of the disease explain how the theoretical framework relates to the patients present condition discuss the Gordons pattern of functioning and physical assessment obtained classify the drugs being taken by the patient carry out interventions that were discussed in the nursing care plan
THEORETICAL FRAMEWORKS
Environmental theory
Florence nightingale was born on May 12 1820. She was the founder of modern nursing and the first nursing theorist. Also known as "The Lady with the Lamp She was the first to propose nursing required specific education and training. Her contribution during Crimean war is well-known.
Natural laws Mankind can achieve perfection Nursing is a calling Nursing is an art and a science Nursing is achieved through environmental alteration Nursing requires a specific educational base Nursing is distinct and separate from medicine
Ventilation and warming Light, Noise Cleanliness of rooms/walls Health of houses Bed and bedding Personal cleanliness Variety Chattering hopes and advices Taking food. What food?
Nightingale's documents contain her philosophical assumptions and beliefs regarding all elements found in the metaparadigm of nursing. These can be formed into a conceptual model that has great utility in the practice setting and offers a framework for research conceptualization
4-digm
Nursing Nursing is different from medicine and the goal of nursing is to place the patient in the best possible condition for nature to act. Nursing is the "activities that promote health (as outlined in canons) which occur in any caregiving situation. They can be done by anyone." Person People are multidimensional, composed of biological, psychological, social and spiritual components. Health Health is not only to be well, but to be able to use well every power we have. Disease is considered as dys-ease or the absence of comfort. Environment "Poor or difficult environments led to poor health and disease". "Environment could be altered to improve conditions so that the natural laws would allow healing to occur."
In a relation to the patient, In the case of the patient wherein she manifested dengue, it can be correlated with the theory of nightingale where in the environment of the patient is a factor leading to recovery, having a clean environment, well organized house, nurturing environment and taking fruits and vegetables, the body could repair itself.
Eat 3 meals per day and sometimes take midnight snacks. And consume 5-6 glasses of water per day The patient defecates once a day without any discomfort and it is well formed. he usually urinates 4 or 5 times a day without any pain or discomfort Have no regular exercise but he plays basketball and badminton. The client sleeps 6 to 7 hrs without difficulties. Usually sleeps 11pm to 5 am.
3. Elimination pattern
There are no many changes in patients nutritional and metabolic pattern. And the client has proper diet and fluid intake There are no many changes in patients elimination pattern
The patient lies on bed most of the time, and not allowed to mobilize as much due his IV. The client has no choice but to sleep and rest, but he has difficulty of sleeping because of the nurses and doctors rounds Patients easily understands and cooperates well
There is minimal activities due to his hospitalization The clients sleeping routine has been changed. Patients sleep was disturbed because of the nurses and doctors rounds There are no changes in clients cognitive and perceptual pattern. The client can express himself but doesnt communicates well The patients is irritable because of her condition, but can cooperate with the others The patient is independent but
The patient is not that approachable but very cooperative, he is always surrounded by his family The patient is always accompanied by his
lives with his mother, father and brothers 9. Sexuality reproductive 10. Coping/stress tolerance the patient is not sexually active The patient doesnt encounter much problem, and his always happy The client is a roman catholic. he goes to mass every Sunday with his family, and pray every night before going to sleep
oldest brother, and his relatives visits once in awhile The patient doesnt perform any sexual activities the patient seems bored and somehow unhappy, and he plays laptop to entertain himself The clients still have time to pray every night together with his brother
somehow depends on his brother due to his condition There is still no changes in the patients sexuality reproduction The client is not comfortable because he is hospitalized and wanted to go home soon The client is religious and even though he is hospitalized he had time pray
PHYSICAL ASSESSMENT
General findings height weight temperature Pulse rate Respiratory rate Blood pressure Normal 45-53 45.3-49.8 36.5-37.5 60-100 12-20 90/60 to 130/90 Findings 52 54 36.6 80 20 100/70 Analysis Height is in the normal range Weight is not in the normal range Temperature is in the normal range Pulse rate is in the normal range Respiratory rate is in the normal range Blood pressure is in the normal range
Technique
Normal findings
Findings
Analysis
Inspection
Moisture Temperature
Light brown, tanned skin (may vary according to race) Inspection/palpation Skin normally dry Palpation Normally warm
Light brown in color, has pink rashes Normally dry Warm to touch
Due to dengue
Normal Normal
Palpation Palpation
Smooth and soft Skin snaps back immediately Transparent, smooth and convex Pinkish Firm Evenly distributed Black to light brown Warm to touch and tenderness Pinkish and slightly rough Perform w/o any difficulty Perform without any difficulty Generally round
smooth and soft Skin snaps back immediately Transparent, smooth and convex Pinkish Firm Evenly distributed black
Normal Normal
Inspection
Normal
Nails bed Nails base Hair distribution Color Upper extremities Arms Palms and dorsal surface Shoulders Elbows Skull Eyes Eyes Eyebrows
Palpation/inspection Palpation/inspection
Warm to touch and tenderness Pinkish and slightly rough Perform w/o any difficulty Perform without any difficulty Generally round
Inspection Inspection Non protruding Symmetrical in size, extension, hair texture and movement Evenly distributed Non protruding Symmetrical in size, extension, hair texture and movement Evenly distributed
Normal Normal
Inspection Inspection Same color as skin Same color as skin Inspection Transparent with light pink color Color white Free of Lesions, discharge or inflammation Client normally hears words when whispered. Nose in the Transparent with light pink color Color white Free of Lesions, discharge or inflammation Client normally hears words when whispered. Nose in the
Sclera Ears
Inspection Inspection
Normal Normal
Hearing acuity
Inspection
Normal
Nose
Inspection
Normal
midline; no discharges; no bone or cartilage deviation noted. neck Inspection/palpation No visible mass or lumps; symmetrical; no jugular venous distension. Lymph nodes inspection May not be palpable; nontender IF PALPABLE; less than 1cm in size. Thyroid Inspection Normally nonpalpable; no nodules palpable Thorax Lungs Auscultation Illustrate voluntary sound Cardiovascular Inspection Pulse visible; no lift or heaves. Abdomen inspection
midline; no discharges; no bone or cartilage deviation noted. Normal No visible mass or lumps; symmetrical; no jugular venous distension. Normal May not be palpable; nontender IF PALPABLE; less than 1cm in size. Normal Normally nonpalpable; no nodules palpable
Normal Illustrate voluntary sound Normal Pulse visible; no lift or heaves. Normal Skin color is Uniform color to uniform, no the rest of the lesions; some may skin have presence of striae or scars Equal in size; no Equal in size; no edema; no edema; no crepitus crepitus
lower extremities
Inspection
Normal
Hematocrit Erythrocytes
0.40-0.48 4.5-5.0
Nuetrophils
0.37
0.55-0.65
Lymphocytes
0.53
0.25-0.40
Analysis/interpretation Normal Normal Normal Normal Normal Normal The no. of WBC count decreased indication of vulnerable to potential serious infection which is dengue Normal Normal Normal Normal Normal
PHYSICAL CHARACTERISTIC
Bright red (oxygenated) dark red/purplish (unoxygenated). Much more dense than pure water. pH range from 7.35 to 7.45 (slightly alkaline). Slightly warmer than body temperature 38.Celsius. Typical volume in adult male 5-6 liters typical volume in adult female 4-5 liters typically 8% of body weight
COMPONENTS OF BLOOD
The blood is considered to be the only fluid tissue in the body. It is complex connective tissue in which formed elements are suspended in a nonliving fluid matrix called plasma. The plasma is the liquid part of the blood and is approximately 90% water. 3 formed elements in the blood 1. Erythrocytes- responsible for blood gas transport 2. Leukocytes defends body from infection or disease 3. Platelets- needed for normal blood clotting
(in this case, platelets are the ones mostly affected by the dengue virus so this will be our focus)
The hemocytoblast stem cells develop into lymphoid or myeloid stem cells. Myeloid stem cells by then will developed as platelets or other formed elements depending on the response of the changing body needs and different stimuli. Like any other formed elements in the blood, platelet production is stimulated by the hormones. The hormone thrombopoietin accelerates the production of platelets but only little is known about how this process is regulated
PLATELETS Platelets are not cells in a strict sense. They are fragments of bizarre multinucleated cells of megakaryocytes. They appear as darkly stained and irregularly shaped. The nominal platelet count is 150,000 500,000 per cubic millimeter.
PHYSIOLOGY OF PLATELETS Platelets are responsible for normal blood clotting. If we are going to live without it, a single cut would lead us out to death. There is a process called hemostasis wherein platelets have a major role. Hemostasis means stooping of bleeding. It happens when a blood vessel breaks or injured. Hemostasis occurs in three major phases which occur in rapid sequence. 1. Vascular spasms occur the immediate response of the body to blood vessel injury
2. Platelet plug forms when the endothelium is broken, the collagen fibers are exposed that leads to clinging of the platelets to the damage site and making them sticky. Platelets released more chemicals that attract more platelets to the site of damage. 3. Coagulation event occurs A. Injured tissues released tissue factors (TF), substances that plays an important role in clotting. B. PF3 which is a phospholipid, coats the surfaces of the platelets, interacts with the TF, Vit K, calcium ions and other protein clotting factor C. Prothrombin activator for conversion of prothrombin to thrombin which is an enzyme. D. Thrombin joins fibrinogen proteins to form long hair like molecules of insoluble fibrin which forma netlike meshworks that traps RBCs and forms the basis of the clot.
PATHOPHYSIOLOGY (BOOK-BASED)
Precipitating factors Environmental conditions (stagnant water as breeding sites) Dengue carrier mosquitoes Activity (student)
Bite to skin from dengue carrier mosquito (itchiness and redness at the bite area)
Dengue virus is inoculated in the blood with 8 -14 days incubation period
Virus disseminates rapidly in the blood stimulating WBCs and B lymphocytes and produces antibodies and macrophages
Macrophages performs phagocytosis; dengue virus replicates within the cells, antibodies attach to viral antigents
Release of cytokines and other platelet activating factors that stimulates WBCs and pyrogen release
DENGUE s/s: High grade fever Flushed skin Headache Pink rashes on the skin
If Treated: HYDRATION: IV infusion; increased fluid intake Drug therapy: antipyretic (Paracetamol) Careful monitoring condition
If not treated: Complications such: Intense bleeding Severe hypertension Pulmonary edema Shock Liver cirrhosis
RECOVERY
DEATH
DRUG STUDY
DRUG Paracetamol (biogesic) 500mg/tab 1 tab PRN MECHANISM OF ACTION
Produce analgesia by blocking pain impulses by inhibiting prostaglandin synthesis in the CNS or of other substances that sensitize pain receptors to stimulation. The drug may relief fever through central action in the hypothalamic heat regulating center.
INDICATION
Relief of fever, minor aches and pains
CONTRAINDICATION
Anemia, cardiac and pulmonary disease. Hepatic or severe renal disease
SIDE EFFECTS
Allergic skin reactions and GI disturbances
NURSING RESPONSIBILITIES
Assess for allergy Reassess the Pts vital signs
-to prevent dehydration because increased in temperature causes fluid loss such as sweating
Dependent: Give paracetamol (biogesic) as prescribe by the physician Paracetamol are classified as analgesics and antipyretics which acts on the hypothalamus to regulate normal body temperature
Discharge plan
DISCHARGE PLANNING
Discharge Planning Diet: Encourage nutritious foods like vegetables, meat and fruits.> Instruct the family members to give the client protein rich foods such as meat, fish, eggs and nuts, vitamin K rich foods such as green leafy vegetables, vit C rich foods(guava and tomatoes and other citrus fruits), carbohydrates rich food (breads and rice) Medications: Give acetaminophen in case the temperatures increases. Give oresol to replace fluid in the body. Remind to take the prescribed medicine, having a written reminder of the correct medication, time to take, and the right frequency of the medicine on the way home to establish assurance of medication compliance. Dont give aspirin and NSAIDs, they increase the risk of bleeding. Any medicines That decrease platelet count should be avoided. Exercise: Instruct to avoid excessive activities that may result to stress. Just advised to perform range of motions and repetitive body movements for promotion of optimum Treatment: Currently, no medications are available to treat dengue hemorrhagic fever. > Increased oral fluid intake. >Admission to an intensive care unit>Intravenous fluids and electrolytes >Oxygen therapy> Transfusions of blood and platelets as needed> Bed rest Out-Patient Follow-Up Care >Instruct the family members to have a check-up or to consult physician once a while to monitor patients condition and for detection of recurrences and other complications that may arise on to it. Health Teaching: (for prevention)> D- discuss the possible source of infection of the disease.> Eeducate the family/patient on how to eliminate those vectors.> N- Never stocked water in a container without cover.> G- Gallon, container and tires must have proper way of disposal.> U- Use insecticides at home to kill or reduce mosquito
Bibliography
books
Principles of Anatomy and Physiology Gerard J. Tortora (Author), Bryan H. Derrickson Laboratory Manual for Anatomy and Physiology[Spiral-Bound] Connie Allen (Author), Valerie Harper (Author)
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