St. Anne College Lucena Inc.

Diversion Road G- Gulang Lucena City

In Partial Fulfillment for Academic Requirements In Related Learning Experience

A Case of Dengue Hemorrhagic Fever

Prepared by: Joy Rachel D. Tabernilla Margaret R. Maano Rose Ann Marbida Lalaine R. Andal Gerwin Perlas BSN IV-B

Presented to: Nursing Faculty

October, 2010

TABLE OF CONTENTS
I.

OBJECTIVES…………………………………………………………............ ..............................2 a. General Objectives b. Specific Objectives PATIENT PROFILE……………………………………………………………………… …………………….…..2 a. Biographical data of the patient b. Clinical data of the patient HISTORY…………………………………………………………................. ............................4 a. Nursing History i. Chief Complain ii. Admitting Diagnosis iii. Physical Examination iv. Final Diagnosis b. Present Health History i. 24 hours recall of events ii. Signs and symptoms experienced by the patient c. Past Health History i. Hospitalizations ii. Surgical Managements iii. Allergies 1. Foods 2. Drugs iv. Others NUTRITION………………………………………………………….............. .......................4 a. 24 hours food recall b. Regular/Routine diet c. Intake and output d. Vices and habits DISEASE ENTITY………………………………………………………………………… …………….5 a. Definition b. Etiology c. Transmission d. Occurrence/Epidemiology e. Anatomy of the organ involved PATHOPHYSIOLOGY………………………………………………………… ……………………..11 MANAGEMENT……………………………………………………………… ……………………….12 a. Medical Management b. Nursing Management c. Pharmacologic Management LABORATORY………………………………………………………….......... ......................14 a. Blood analysis
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II.

III.

IV.

V.

VI. VII.

VIII.

NURSING CARE PLAN…………………………………………………………………………….b. X. DISCHARGE PLAN…………………………………………………………………………… …….17 3 . Ultrasound IX. X-ray c.

2010 at 1:30 pm Case #: 462679 Membership: Self pay Type of admission: New Hospital: St. abdominal pain Diet: NPO Room: 332-b Attending Physician: Dra. Nursing History 4 . Biographical data of the patient Name: Age: Gender: Date of Birth: Civil Status: Nationality: Address: Marinduque Religion: N. Clinical data of the patient Diagnosis: R/I DHF Chief Complain: fever and rashes. OBJECTIVES a. knowledge and right attitude about the case dengue hemorrhagic fever and its managements. Roman Catholic b. To enhanced our knowledge and learning regarding the disease identity. we could be able to share it with our fellow students. students will be able to: To define the case and its effects to human body. Date and Time of Admission: July 10.P. To have a complete details or background about the patients profile and nutritional status. b.       II. A. C. 9years old Female September 19. SPECIFIC OBJECTIVES: Upon accomplishment of this study. Anne General Hospital III.d R. Through this. 2000 Child Filipino Gitnang Bayan Mogpog. PATIENT PROFILE a. specifically the involve systems To develop skills regarding the care of patient with dengue hemorrhagic fever and its managements. To review the anatomy and physiology of the client. 2010 at 7:48 pm Date and Time of Discharge: July 17. M. the main goal of the study is to develop skills.I. GENERAL OBJECTIVES: In the light of knowledge.HISTORY a. To identify the possible complication that may occur during the early and late phases of disease.

i. 24 hours Recall of Events The mother of the child stated that prior to admission. Chief Complain: fever and rashes. the patient experienced 3 days fever and develop pruritic-erythematous rashes on upper and lower extremities. >Hair is dry. GENERAL ASSESMENT: • conscious and coherent • cooperative • with oxygen inhalation at 3LPM via nasal canula • weigh f 24 kilograms VITAL SIGNS: Temperature: 38.5 degrees celcius PR: 109bpm RR: 26bpm BP: 90/60 mmHg b. ii. Signs and symptoms experienced by the patient  Fever 5 . 3 times watery stool. Final Diagnosis:  DHF grade II b. Physical Examination: a. REVIEW OF SYSTEM CHEST & LUNGS: >with symmetrical chest expansion >Not in respiratory distress >with rashes GASTRO-INTESTINAL: >with soft non tender abdomen upon palpation >with complain of pain of lower abdomen GENITO-URINARY: >Bladder is not distended >with diarrhea. Admitting Diagnosis: R/I DHF iii. not brittle and generally color black EARS: >no discharges noted EYES: >with pinkish conjunctiva >with anicteric sclera NOSE: >no nasal discharge THROAT/MOUTH :> with dry pale lips >with slightly moist oral buccal mucosa SKIN: >with macula-papula rashes c. PHYSICAL ASSESSMENT HEAD: >Skull is symmetrical. moderate in amount EXTREMITIES :> range of motion is normal >with rashes on upper and lower extremities >with capillary refill of 4-5 seconds iv. Present Health History i. abdominal pain ii.

Regular/Routine diet Patient regular diet was more on processed foods and chicken with sometimes fish. some protein and with fewer fats. pruritic-erythematous rashes  abdominal pain  vomiting c. 1 piece fried chicken  Breakfast.4x watery Vomiting.UO BM.5 660cc 1680cc 2000cc 8am Input Output -3x. b. Amt 4x. She doesn’t like to eat vegetables. Hospitalizations: none ii. Girth. Girth 13 inch 1867cc 1587cc 550cc 4x. c.24. Surgical Managements: none iii. NUTRITION a. Past Health History i.abd.3x mod. Foods: egg white 2.4x watery Vomiting.2x mod.lugaw with 1 piece bread  Lunch. Immunization: complete v.2x mod. Drugs: no known allergies iv.1 cup of rice.3x watery Vomiting. her parents gave her what she wants.UO BM.Jollibee burger steak with rice The patient daily consumption was more on carbohydrates. Amt 07/ 12/ 10 – - 4pm 6 pm 07/ 13/ 10 – 6 am 4pm 07/ 14/ 10 07/ 15/ 10 6 .2x watery Vomiting. Intake and output Date and Time 07/ 11/ 10 – 6 pm -BM. Since she is the youngest.abd. 24 hour food recall 24 hours prior to admission patient had taken the following foods:  Dinner.2x mod.UO BM. amt 4x. IV. amt 4x. Allergies 1.

2. Other contributory mosquitoes: a. and bones. the joints. 3. and often rash associated with pain behind the eyes. By bite of an infected mosquito. Aedes scutellaris simplex 7 . sometimes fatal manifestation of dengue virus infection characterized by a bleeding diathesis and hypovolemic shock. she always went to computer shop with her cousins to play online games. Aedes albopictus may contribute to trnsmission of engue virus in rural areas. DISEASE ENTITY a. betamax and fishball. Etiology  Flaviviruses 1. Transmission 1. Aedes polynensis b.  Arboviruses group B c. Definition Dengue fever is an acute febrile disease caused by infection with one of the serotypes of dengue virus which is transmitted by mosquito genus Aedes. Vices and habits The patient love to eat junk foods while in school every snack time and buy street foods like isaw. a family of Togaviridae are small viruses that contain single strand RNA. fever. 3. V. principally the Aedes Egypti 2.Dengue hemorrhagic fever is a severe. b. 4. It refers to a benign form of disease with systemic symptoms. After school.07/ 16/ 10 250cc 2x BM brownish soft 1600cc d.

injury. In the last 50 years. For instance. in the present decade. the head contains more hair follicles than anywhere else. prevents entry of bacteria. In addition. • • • is a sensory organ.3 on the revision of the International Health Regulations (IHR). from urban to rural settings. the soles of the feet and the palms of the hands are much thicker. stores water and fat.5 billion people live in dengue endemic countries. Anatomy of the organs involved i. Throughout the body. which includes dengue as an example of a disease that may constitute a public health emergency of international concern with implications for health security due to disruption and rapid epidemic spread beyond national borders. An estimated 50 million dengue infections occur annually and approximately 2. incidence has increased 30-fold with increasing geographic expansion to new countries and.17 urged greater commitment to dengue by WHO and its Member States. with each layer performing specific functions: • epidermis • dermis • subcutaneous fat layer epider mis The epidermis is the thin outer layer of the skin and consists of three parts: • • stratum corneum (horny layer) This layer consists of fully mature keratinocytes which contain fibrous proteins (keratins). texture) vary. Integumentary Sytem The skin is the body's largest organ. The outermost layer is continuously shed. color. e. Of particular significance is the 2008 World Health Assembly resolution WHA58. and infection. The stratum corneum prevents the entry of most foreign substances as well as the loss of fluid from the body. prevents water loss. The skin is made up of the following layers. while the soles of the feet contain none. keratinocytes (squamous cells) 8 . the skin also: • • regulates body temperature. In addition to serving as a protective shield against heat. Occurrence/Epidemiology Dengue is the most rapidly spreading mosquito-borne viral disease in the world. the skin's characteristics (thickness. covering the entire body. The 2005 World Health Assembly resolution WHA55. light.d.

forming new keratinocytes that replace the cells that are shed from the skin's surface. The lymph. subcuti The subcutis is the deepest layer of skin. which distributes lymph. The epidermis also contains melanocytes. lymph nodes. on the other hand. veins and capillaries). to and from cells in the body to help fight diseases and help stabilize body temperature and pH to maintain homeostasis. consisting s of a network of collagen and fat cells. hormones. This system may be seen strictly as a blood distribution network. as well as other vertebrates.• This layer. basal layer The basal layer is the deepest layer of the epidermis. just beneath the stratum corneum. blood cells. The most primitive animal phyla lack circulatory systems. Basal cells continually divide. Two types of fluids move through the circulatory system: blood and lymph. have a closed cardiovascular system (meaning that the blood never leaves the network of arteries. The lymphatic system. The subcutis. etc. is an open system. but some consider the circulatory system as composed of the cardiovascular system. and the lymphatic system. which distributes blood. heart. and blood vessels form the cardiovascular system. made by fibroblasts. The dermis contains the following: • • • • • • • blood vessels lymph vessels hair follicles sweat glands collagen bundles fibroblasts nerves The dermis is held together by a protein called collagen. This layer also contains pain and touch receptors. containing basal cells. helps conserve the body's heat and protects the body from injury by acting as a shock absorber. and lymph vessels form the lymphatic system. gases. which are cells that produce melanin (skin pigment). ii. The cardiovascular 9 . While humans. contains living keratinocytes (squamous cells). Circulatory System The circulatory system is an organ system that passes nutrients (such as amino acids and electrolytes). which mature and form the stratum corneum. some invertebrate groups have an open cardiovascular system. The blood. dermis The dermis is the middle layer of the skin.

to the lungs. from which it is pumped through the pulmonary semilunar valve into the pulmonary arteries which go to the lungs. a "loop" through the rest of the body to provide oxygenated blood. Oxygen deprived blood from the vena cava enters the right atrium of the heart and flows through the tricuspid valve into the right ventricle. Lymphatic System Lymphatic system plays a large role in immune function and circulation. distance-wise. such as dendritic cells. and the systemic circulation. which consists of plasma. The lymphatic system has multiple interrelated functions: • it is responsible for the removal of interstitial fluid from tissues • it absorbs and transports fatty acids and fats as chyle to the circulatory system • it transports immune cells to and from the lymph nodes in to the bone • The lymph transports antigen-presenting cells (APCs). where it enters the left atrium before flowing through the mitral valve into the left ventricle. An average adult contains five to six quarts (roughly 4.system and the lymphatic system collectively make up the circulatory system. oxygen-rich blood from the left ventricle is pumped out via the aorta. and platelets. Pulmonary circulation The Pulmonary circulation is the portion of the cardiovascular system which transports oxygen-depleted blood away from the heart. 10 . • The lymph also carries lymphocytes from the efferent lymphatics exiting the lymph nodes. Pulmonary veins return the now oxygen-rich blood to the heart. Systemic circulation Systemic circulation is the portion of the cardiovascular system which transports oxygenated blood away from the heart. It includes: the pulmonary circulation.7 to 5. red blood cells. c. d. Cardiovascular System The main components of the human cardiovascular system are the heart and the blood vessels. Then. Systemic circulation is. to the rest of the body. and on to the rest of the body.7 liters) of blood. transporting blood to every part of the body. Also. and returns oxygen-depleted blood back to the heart. the digestive system works with the circulatory system to provide the nutrients the system needs to keep the heart pumping. much longer than pulmonary circulation. and returns oxygenated blood back to the heart. to the lymph nodes where an immune response is stimulated. a "loop" through the lungs where blood is oxygenated. white blood cells.

In adults. a) Red Cells 11 .lymphocyte Removal of waste such as carbon dioxide. dead cells. Once this condition occurs. The waste products are carried to the lymph nodes to be broken down and eliminated. This build-up of protein-rich lymph fluid is known as lymphedema. and lactic acid Immunological functions. Four of the most important ones are red cells. As the lymph vessels move fluid out of the tissues.It consists of lymph vessels located just under the skin. including the transport of hormones and the signaling of tissue damage Regulation of body pH Regulation of core body temperature Hydraulic functions • • • • • • • Normally. and other waste products. including circulation of white blood cells. and large protein molecules are collected. resulting in swelling and thickening of the skin. which is one part of the body's self-repair mechanism (the act of blood clotting when one gets cut to stop the bleeding) Messenger functions. This essential fluid carries out the critical functions of transporting oxygen and nutrients to our cells and getting rid of carbon dioxide. meeting up with lymph nodes located in your neck. while the protein rich fluid is transported back to the heart to rejoin circulation. Blood Blood performs many important functions within the body including: • Supply of oxygen to tissues (bound to hemoglobin. this amounts to 4-5 quarts of blood. which is carried in red cells) • Supply of nutrients such as glucose. 7-8% of human body weight is from blood. white cells. Blood is a highly specialized tissue composed of many different kinds of components. platelets. When the lymph vessels are unable to transport lymph fluid back into circulation it accumulates. waste products. it plays a vital role in our immune system and in maintaining a relatively constant body temperature. and fatty acids (dissolved in the blood or bound to plasma proteins a – erythrocytes b . armpits. and detection of foreign material by antibodies Coagulation. and plasma. the swelling may increase if an effective treatment program is not initiated iii. and groin area. urea. In addition.neutrophil c – eosinophil d . amino acids. bacteria. ammonia.

In this latter trait. though some types live as much as a year. There are actually many specialized sub-types of them that participate in different ways in our immune responses.000 iron-rich hemoglobin molecules. The description of white cells presented here is a simplification. exist in variable numbers and types but make up a very small part of blood's volume--normally only about 1% in healthy people. They also can release coagulating chemicals which cause clots to form in the blood that can plug up narrowed blood vessels. or erythrocytes. inches) Hemoglobin is the gas transporting protein molecule that makes up 95% of a red cell. or thrombocytes. b) White Cells White cells. most notably in the spleen. Each red cell has about 270. c) Platelets Platelets. leukocyte 12 . They occur elsewhere in the body as well. liver. Leukocytes are not limited to blood. Some white cells (called lymphocytes) are the first responders for our immune system. which is at the base of the neck. are relatively large microscopic cells without nuclei. They seek out. They also have the function of getting rid of dead or dying blood cells as well as foreign matter such as dust and asbestos. and lymph glands.Red cells. Others are produced in the thymus gland. are cell fragments without nuclei that work with blood clotting chemicals at the site of wounds. The red color of blood is primarily due to oxygenated red cells.000. Red cells remain viable for only about 4 months before they are removed from the blood and their components recycled in the spleen. There are more than a dozen types of blood clotting factors and platelets that need to interact in the blood clotting process. and fungi so that they can be removed. Red cells normally make up 40-50% of the total blood volume. Other white cells (called granulocytes and macrophages) then arrive to surround and destroy the alien cells. Individual white cells usually only last 18-36 hours before they also are removed. thereby plugging the rupture in the vascular wall. they are similar to the primitive prokaryotic cells of bacteria. and bind to alien protein on bacteria.0003 about 2-3 million cells per second. They transport oxygen from the lungs to all of the living tissues of the body and carry away carbon dioxide. and (right) (left). The Human erythrocytes or red cells are produced continuously in our "red cells" bone marrow from stem cells at a rate of (cell diameter about . identify. viruses. or leukocytes. Most are produced in our bone marrow from the same kind of stem cells that produce red blood cells. Recent research has shown that platelets help fight infections by releasing proteins erythrocyte thrombocyte (center). They do this by adhering to the walls of blood vessels.

protecting. producing blood for the body. Bones are connected to each other by ligaments. The contraction of the triceps and relaxation of the biceps produces the effect of straightening the arm. Like the red and white blood cells. and some other chemicals. Bodily movement is carried out by the interaction of the muscular and skeletal systems. They have a lifespan of 9-10 days. sugar. antibodies. Iii. platelets are produced in bone marrow from stem cells. Muscles are connected to bones by tendons. Plasma also contains blood clotting factors. hormones. and storing minerals. It is likely that plasma contains some of every protein produced by the body--approximately 500 have been identified in human plasma so far. 55% of our blood's volume is made up of plasma. Vital organs are protected by the skeletal system. platelets stimulate the immune system. protein and salt solution which carries the red cells. d) Plasma Plasma is the relatively clear. and other proteins. minerals. As the heart pumps blood to cells throughout the body. Normally. The brain is protected by the surrounding skull as the heart and lungs are encased by the sternum and rib cage. 13 . vitamins. Skeletal System The Skeletal System serves many important functions. they are often grouped together as the musculo-skeletal system. yellow tinted water (92+%). allowing bodily movement. In addition. plasma brings nourishment to them and removes the waste products of metabolism. This produces a bend at the elbow. sugars. enzymes. platelets. Its 206 bones form a rigid framework to which the softer tissues and organs of the body are attached. Where bones meet one another is typically called a joint. About 95% of it consists of water. lipids. fat. For this reason. Individual platelets are about 1/3 the size of red cells. Muscles which cause movement of a joint are connected to two different bones and contract to pull them together.that kill invading bacteria and some other microorganisms. white cells. it provides the shape and form for our bodies in addition to supporting. An example would be the contraction of the biceps and a relaxation of the triceps.

6 million red blood cells are produced each second by the bone marrow to replace those worn out and destroyed by the liver.Blood cells are produced by the marrow located in some bones. it will be withdrawn from the bones to replenish the supply. When the supply of these minerals within the blood is low. When an excess is present in the blood. Bones serve as a storage area for minerals such as calcium and phosphorus. buildup will occur within the bones. 14 . An average of 2.

melena stool Dengue Hemorrhagic Fever grade II Decreased WBC Headache body Signs and symptoms: weakness Nausea and vomiting Abdominal pain 15 . flushed decreased WBC Destruction and infection of red bone marrow causing platelet lyses Signs and symptoms: Decreasing Platelet Bleeding. Pathophysiology Non-modifiable Factor: Modifiable factor: Environmental conditions Immunocompromised Sweaty skin Age Gender Bite from mosquito (Portal of Entry in the Skin) Aedes aegypti Redness & itchiness in the area Virus goes to the blood/circulation and replicate Infect cells and generate cellular response Immune response Release of cytokines which consist of vasoactive agents such as interleukins. urokinase and platelet activating factors which stimulates WBCs and pyrogen release patechiae Signs and symptoms: Febrile: 38. tumor necrosis factor.VI.5C warm skin.

albumin . Na. SGOT. K >IVF to follow D5 0. 25kg Pulse 109bpm Temperature 38. PTT.O >To follow D5LR 1L@ 30gtts/min >Revise Isoprenosin 500/tab ¾ tab TID 16 7-11-10 5:38pm 7-11-10 6:35 pm 7-12-10 7-12-10 .10 Platelet 15 Doctors order >Please admit under the service of Dra.6 c 9:30am Hemoglobin 14. CXR PA L view >D5 0. Cruz consultation. SGPT.3NaCl 1L x 14hrs >Increase present IVF to 24 gtts/min >Monitor VS w/ BP q4 >Close monitoring >To start Ranitidine (Zantac) 25mg IV q12 >Assess hydration status >Increase IVF rate to 30gtts/min >Please relay latest BP T. platelet count for PT. Medical Management Progress notes 7-10-10 Wt.3 NaCl 500cc x 3hrs >Paracetamol 250mg/tab q4 PRN >Watch out for any signs of bleeding >Monitor VS q4 >Refer Telephone order >Repeat CBC w/ platelet tomorrow AM >IVF to follow D5LR 1L x 16hrs >Revise Paracetamol 250mg to 325mg/tab 1tab q4 RTC (+) abdominal pain Telephone order >Metronidazole Flagyl 25mg 1ml Suspension 10ml TID >OMX 1 cap gel BID >Watch out for bleeding >Isoprenpsin 250mg/5ml susp. 7. RBS. MANAGEMENT a. for crea.5ml TID >For repeat CBC.VII. blood typing.42 WBC 2. >Diet avoid highly colored foods >For CBC w/ platelet count.3 Hematocrit 0.

platelet count tom AM >Continuous close monitoring 7-13-10 7-14-10 (+) abdominal pain 7-14-10 7-14-10 Hematocrit 0.25cc/kg day good urine out put BP 90/60 – 100/80 (-) fever Platelet 236 Telephone order >IVF D5IMB 500cc x 16gtts/min >Please weight patient daily and record please >IVF to follow D5IMB 500cc x 16gtts/min >For repeat CBC.(-) fever AM (+) vomiting and LBM Good pulse 7-12-10 7-13-10 (+) abdominal pain (+)LBM (+)abdominal distention BP 90/70bpm >Continue meds T.8cc kg/hr Hematocrit 0.5mg IV at 5pm today then q12 >Detect for BP L 90/60 >Decrease IVF to 2gtts/min >For repeat CBC.O >Hold Isoprenosin 500mg/tab ¾ tab TID >Revise Paracetamol to q4 PRN for fever >Run PNSS 100cc now for ultrasound of whole abdomen >Ranitidine IV to consume the shift to Famotidine 20mg IV q12 >Monitor Input and Output q4 record pls. platelet count now >IVF to follow D5 0.O: IVF to follow D5LR 1L x 30gtts/min >Famotidine 20mg IV now Telephone Order >May not given 6am dose of Famotidine >Hook Oxygen inhalation via nasal cannula at 1 Lpm >Give Furosemide 125mg IV now >Detect if BP is 90/60 >Repeat CBC.39 Platelet 118 (-) fever 8pm yesterday 75% of maintenance 56. platelet count tom >Continue meds >maintain 02 support @ ILMP via nasal canula >Same IV to follow >Present IVF to consume then we remaining 17 .3NaCl 1L x 25gtts/min >Give Furosemide 12. measure abdominal girt every shift and record Close monitoring T.38 Platelet 74 Reddish urine -yelowish Furosemide Stil w/ fever (+) abdominal pain 7-15-10 Urine output 2.

c. Nursing Management 1. Monitor vital signs especially temperature.  Advised house spraying.  Treat mosquito nets with insecticides. Pharmacologic Management  Paracetamol 250mg/tab 1 tab every 4 hours PRN revised to Paracetamol 325 mg/tab 1 tab every 4 RTC 18 . etc should be disposed off or destroyed. hemoglobin and hematocrit count.  Surface wells should be well-maintained so that mosquitoes do not breed in the vicinity. pineapple. Assess patient condition 2. 5ml once a day Ascorbic acid + Ziac (Ceelin plus) supp 5ml once a day 7 days follow up check up on july 24. 5. Instruct to increase fluid intake and advise to eat fruits rich in vitamin C like oranges. bottles. 3. Instruct to avoid highly colored foods. Monitor platelet.  Avoid too many hanging clothes inside the house. 6. 2010 15pm c/o Blue Gate Clinic b. Render health teachings to eliminate vector such as:  Water from flower pots should be changed at least once a week  All containers storing water should be covered with a tight lid  Discarded container-like objects like tyres. Emphasize importance of proper hygiene and proper garbage disposal.(-) abdominal pain 7/17/10 + cough BP 100/70 Good urine out put PNSS x16 gtts/min to consume >D/C 02 support >D/C furocemid >D/C OMX >Fumontedin IV to consume >For possible discharge tom & input and output monitoring Present IVF to consume the D/C May go home home meds Metronidazole (FLAGYL) 25 mg/ml susp 10 ml 3x a day for 4 more days Multivitamins (Cherifer) Susp. 7. PR and BP. coconut shells. 4. bayabas and fruit juices.

42 4.8 144 Interpretation normal normal normal ↓-viral infection ↓-bleeding • 07/ 11/ 10 – 06:30 am Determinants Results Normal Interpretation 19 .5 mL TID revised Isoprenosine 500mg/tab ¾ tab TID     OMX 1 cap BID Ranitidine (Zantac) 25mg IV every 12 hours Famotidine 20mg IV every 12 hours Furosemide 125mg IV now then every 12 hours VII.40 4.5.400 x 10 g/L Interpretation normal normal normal ↓-viral infection normal • 07/ 10/ 10 Determinants Results Hemoglobin Hematocrit RBC WBC Platelet 13.0.4 x 10 g/L F.39 4.45 F.5-10 x 10 g/ L 150.1 0.400 x 10 g/L Interpretation normal normal ↓.2.45 F.0.2.2.45 F.5-10 x 10g/ L 150. Blood analysis (hematology) • 07/ 09/ 10 Determinants Results Hemoglobin Hematocrit RBC WBC Platelet 13.29 3.3 0.37.12-15 mg/ dL F.12-15 mg/ dL F.12-15 mg/ dL F.1 4.0.anemia ↓-viral infection normal • 07/ 10/ 10 – 9:00 am Determinants Results Hemoglobin Hematocrit RBC WBC Platelet 14.37.4.0.37.5-10 x 10 g/ L 150.15 150 Normal Values F.4 x 10 g/L F.0.05 190 Normal Values F.0.3 2.400 x 10 g/L Normal Values F.5.4.4 x 10 g/L F.5.4. Metronidazole(Flaygl) 25mg/mL suspension 10mL TID  Isoprenosine 250 mg/5mL suspension 7.3 0. Laboratory a.

0.5.0.4.4.86 F.40 F.4 x 10 g/L F.5.37.400 x 10 g/L Interpretation normal normal normal normal ↓-bleeding Interpretation normal normal normal normal ↓-bleeding • 07/ 15/ 10 – 03:27 am Determinants Results Normal Values Hemoglobin 10.4 x 10 g/L F.42 F.45 F.9 0.2.5.4.6 F.45 RBC 4.8 F.2.0.4 x 10 g/L WBC 6.12-15 mg/ dL F.0.5 7.4.6 0.5-10 x 10 g/ L 150.41 4.37.4 x 10 g/L F.38 4.0.37.5-10 x 10 g/ L Platelet 64 150.0.2 72 A positive Normal Values F.18 3.5-10 x 10 g/ L 150.12-15 mg/ dL Hematocrit 0.37.45 F.45 RBC 4.2.0.0.37.12-15 mg/ dL F.5.12-15 mg/ dL Hematocrit 0.2.12-15 mg/ dL F.0.5.Hemoglobin Hematocrit RBC WBC Platelet 12.2.400 x 10 g/L • 07/ 14/ 10 Determinants Results Hemoglobin Hematocrit RBC WBC Platelet 9.45 F.400 x 10 g/L Interpretation normal normal normal ↓-viral infection ↓-bleeding • 07/ 13/ 10 – 03:56 am Determinants Results Normal Values Hemoglobin 13.39 4.4 x 10 20 Interpretation normal normal normal .9 0.4.65 3.5-10 x 10 g/ L 150.0.39 F.400 x 10 g/L normal normal ↓-anemia ↓-viral infection ↓-bleeding • 07/ 12/ 10 – 06:24 am Determinants Results Hemoglobin Hematocrit RBC WBC Platelet ABO blood type RH 13.7 100 Values F.0 74 Normal Values F.3 F.

4.37. X.0. Wall is not thickened. Pancreas and Spleen are intact with no focal lesion seen. gallbladder.2.1 F.12-15 mg/ dL Hematocrit 0.400 x 10 g/L normal ↓-bleeding • 07/ 16/ 10 – 06:16 am Determinants Results Normal Values Hemoglobin 13.WBC Platelet 10 118 g/L F.40 F. kidney and urinary bladder sonogram Please correlate clinically 21 . spleen.6 F. mediastinum. Ultrasound Report (07/ 13/ 10) There is moderate amount of free fluid seen at the abdomen area more on upright posterior recess. The liver is Normal is size with homogenous echotexture intrahepatic duct and common bile are not dilated.5.400 x 10 g/L b. pancreas.0.5-10 x 10 g/ L 150.45 RBC 4.42 F. diaphragm and costrophrenic sinuses appear physiologic Normal soft tissue and osseous structures in the chest wall CONCLUSION: Essentially normal chest findings c.4 x 10 g/L WBC 9. The Right Kidney measures 89x36x45 mm with a cortical thickness of 14mm While Left Kidney measures 87x36x35 mm with a cortical thickness of 13 mm Both Kidney shows intact cortimedullary order and central echo complexes No stone are noted within Appendix is slightly dilated to 4 mm Urinary bladder is well distended and echo free IMPRESSION: The possibility of an acute appendicitis is not totally rolled out Suggest surgical consult Ascites more on the Right posterior recess Normal liver. Gallbladder measures 41x11 mm with no stone seen.5-10 x 10 g/ L Platelet 236 150.RAY (07/10/ 10) Interpretation normal normal normal normal normal Description: The lung fields are clear with normal lung roots The heart.

O-OPD  Instruct patient that they return to have a check-up at least 7 days after discharged on July 24. coconut shells.TREATMENT  Instruct the importance of treatment regimen.  Advised house spraying. DISCHARGE PLAN M.METHOD  Instruct home meds such as:  Metronidazole 25mg/mL 10mL 3x a day for 4 more days  Multivitamins (Cherifer) suspension 5mL once a day  Ascorbic Acid + Zinc (Ceelin Plus) suspension 5mL once a day E. H.  Encourage to use mosquito net at night while sleeping.X. T. 2010 1 to 5 pm at Blue Gate Clinic.  Surface wells should be well-maintained so that mosquitoes do not breed in the vicinity. 22 .  Avoid too many hanging clothes inside the house.EXERCISE/ENVIRONMENT  Encourage to have enough sleep and rest to promote faster recovery.HEALTH TEACHING  Water from flower pots should be changed at least once a week  All containers storing water should be covered with a tight lid  Discarded container-like objects like tyres.  Encourage to do simple exercise such as walking. etc should be disposed off or destroyed.  Treat mosquito nets with insecticides. D-DIET  Encourage patient to eat high protein and high calorie foods to enhance faster recovery. bottles.

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