SILLIMAN UNIVERSITY

College of Nursing
Dumaguete City
Nursing Care Management 103

CASE ANALYSIS ON THE NURSING CARE OF A CHILD WITH DENGUE

HEMMORAGIC FEVER AND URINARY TRACT INFECTION

SUBMITTED TO: Kathleah B. Caluscusan SUBMITTED BY: Lorraine I Apale

Faith Marie Z. Torralba
 SILLIMAN UNIVERSITY
College of Nursing
Dumaguete City
Nursing Care Management 103

VISION AND MISSION

Vision
A leading Christian institution committed to total human development for the well being of society
and environment.

Mission
 Infused into the academic learning the Christian faith anchored on the gospel of Jesus
Christ.
 Provide an environment where Christian fellowship and relationship can be nurtured and
promoted.
 Provide opportunities for growth and excellence in every dimension of the University life in
order to strengthen character, competence, and faith.
 Instill in all members of the University community an enlightened social consciousness and a
deep sense of justice and compassion.
 Promote unity among peoples and contribute to national development.

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July 30, 2017

Mrs. Kathleah B. Caluscusan

Clinical Instructor, Pediatrics Rotation
College of Nursing
Silliman University
Dumaguete City

Dear Asst. Prof Kathleah:

We Lorraine I Apale and Faith Marie Z. Torralba, level III students of Silliman University College of Nursing, would like to ask
your permission to presence the case of Azel Ray Saberon Radones, who was admitted for dengue hemorrhagic fever and
urinary tract infection on July 10, 2017, at Silliman University Medical Center in partial fulfillment of the requirements in
NCM103. This study is essential to expand our knowledge, enhance our skill and gain a positive attitude in providing quality
and holistic care.

We will assure to you that patient’s confidentiality will be kept, and all date gathered will be used for educational purposes
only. We hope for your kind approval.

Respectfully yours,

Lorraine I. Apale
Faith Marie Z. Torralba

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Approved by:
Kathleah B. Caluscusan

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 ACKNOWLEDGEMENT

This case study of our patient has greatly helped us in gaining more knowledge and skills in the field we have chose.
This would not have been possible if not for the people who have been very kind enough to render their time, concern, and
support.
We would like to express our gratitude to:
First, we would like to thank God Himself and His sovereign activity, His guidance, protection and control over the whole
rotation.
To our dearest parents who supported us from the beginning to achieve our dreams to become registered nurses
someday.
We would like to thank Mrs. Kathleah, for being so supportive, compassionate, and understanding towards us.
For the brilliant authors of the books and articles who provided us significant information regarding our case and to the
Silliman Library and Learning Resource Center who provided us the access to the books we needed.
To the Pediatrics Staff of SUMC, from the physicians, nurses, and nursing aids, we thank you for aiding us and making
our pediatrics experience full of learning. For the time they had spared for us which enable us to gain more knowledge and

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skills and gave us the opportunity to meet our patient who is the subject of this case study. We our so honored to have
worked with them and praise for their passion for being a health care personnel.
To our friends who encouraged and gives us suggestions in making this paper we completed.
And last but not the least, we extends our deepest gratitude to our patient for trusting us and being wit us through the
experience. We would not have a case to study. Thank you for opening up yourself to us, and for letting us learn from your
case.

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 Table of Contents

VISION AND MISSION 2

ACKNOWLEDGEMENT 4
INTRODUCTION 8
ANATOMY AND PHYSIOLOGY OF THE PEDIATRICS CHILD 13
DEMOGRAPHIC DATA 23
GENOGRAM 24
GROWTH AND DEVELOPMENT 25
FUNCTIONAL HEALTH PATTERN 31
PHYSICAL ASSESSMENT OF CHILD 42
PATHOPHYSIOLOGY 45
DOCTORS’S ORDER 50
LABORATORY RESULTS 53

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NURSING MANAGEMENT 57
MEDICATIONS 59
NURSING CARE PLAN 62
Related Articles 70
Reference 72

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 INTRODUCTION
Dengue Fever

Dengue fever is a mosquito borne tropical disease caused by the dengue virus. Symptoms typically begin
three to fourteen days after infection. This may include a high fever, headache, vomiting, muscle and joint
pains, and a characteristic skin rash. Recovery generally takes two to seven days. In a small proportion of
cases, the disease develops into the life threatening dengue hemorrhagic fever, resulting in bleeding, low levels
of blood platelets, and blood plasma leakage, or into dengue shock syndrome, where dangerously low blood
pressure occurs.
Dengue is spread by several species of mosquito of the Aedes type, principally A. aegypti. The virus has five
different types; infection with one type usually gives lifelong immunity to that type, but only short-term
immunity to the others. Subsequent infection with a different type increases the risk of severe complications.
A number of tests are available to confirm the diagnosis including detecting antibodies to the virus or its RNA.

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A novel vaccine for dengue fever has been approved and is commercially available in a number of countries.
Other methods of prevention are by reducing mosquito habitat and limiting exposure to bites. This may be
done by getting rid of or covering standing water and wearing clothing that covers much of the body.
Treatment of acute dengue is supportive and includes giving fluid either by mouth or intravenously for mild or
moderate disease. For more severe cases blood transfusion may be required.[2] About half a million people
require admission to hospital a year. Nonsteroidal anti-inflammatory drugs (NSAIDs) such
as ibuprofen should not be used.
Dengue has become a global problem since the Second World War and is common in more than
110 countries. Each year between 50 and 528 million people are infected and approximately 10,000 to 20,000
die. The earliest descriptions of an outbreak date from 1779. Its viral cause and spread were understood by
the early 20th century.[ Apart from eliminating the mosquitoes, work is ongoing for medication targeted
directly at the virus. It is classified as a neglected tropical disease.

Urinary Tract Infection

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Urinary tract infections are the second most common bacterial disease and ranks as the 16 th most frequently
reported problem to general practitioners. It affects kidneys, ureters, bladder and urethra. Most infections
involve the lower urinary tract — the bladder and the urethra. Inflammation of he urinary tract may be
attributable to a variety of disorders but bacterial infection is by far the most common. Escherichia coli is the
most common pathogen leading to a UTI. Fungal and parasitic infections while uncommon, may also cause
UTIs. UTIs from these causes are sometimes observed in patients who are immunosuppressed, have diabetes
mellitus, or have undergone multiple courses of antibiotic therapy. They also may be seen in persons living or
having travelled to certain developing countries.

Women are more likely to develop UTIs than men, due to anatomical differences; the urethra is shorter in
women than in men, and it is closer to the anus, making it more likely that bacteria are transferred to the
bladder, with over 50 percent of all women will experience at least one UTI during their lifetime, with 20-30
percent experiencing recurrent UTIs. Pregnant women are not more likely to develop a UTI than other women,
but if one does occur, it is more likely to travel up to the kidneys; this is because of anatomical changes
during pregnancy that affect the urinary tract. As a UTI in pregnancy can prove dangerous for both maternal

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and infant health, most pregnant women are tested for the presence of bacteria in their urine, even if there
are no symptoms, and treated with antibiotics to prevent spread.

Most UTIs are not serious, but some can lead to serious problems, particularly with upper urinary tract
infections. Recurrent or long-lasting kidney infections (chronic) can cause permanent damage, and some
sudden kidney infections (acute) can be life-threatening, particularly if septicemia (bacteria entering the
bloodstream) occurs.

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Placement: NCM 103, Level III
Time Allotment: 2 hours
Topic: Dengue fever and urinary tract infection
Topic Description: This case presentation concentrates on the concept of the care provided to the child with dengue fever
and urinary tract infection
Central Objectives: At the end of our case presentation, the learners will acquire knowledge and skills by knowing the
concepts and how to take care of a child with dengue fever and urinary tract infection and at the same time garnering a
positive attitude.
Specific Objectives:
Within our 2 hours of case presentation, the learners will:

1. Review related concepts on lectures learned in Nursing Care Management 103.

2. Be familiar with all the medications given to the child including their indications, side effects, and the
nursing management needed.
3. Analyze critically the nursing care plans.
4. Participate in open forum.

Objectives for our case study:

1. Expand our knowledge and skills on taking care of a patient with Dengue and Urinary Tract Infection
2. Understand the anatomy and physiology of the system organs involved in Dengue and UTI
3. Know the therapeutic management and nursing management of the diseases

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 4. Apply the knowledge we have learned to the actual hospital setting

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 ANATOMY AND PHYSIOLOGY OF THE PEDIATRICS CHILD

INTEGUMENTARY SYSTEM

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The skin is the largest organ of the body and forms the major barrier between the internal organs and the external
environment. The skin accounts for toughly 16% of body’s weight. As the body’s first line of defense, the skin is continuously
subjected to potentially harmful environmental agents, including solid matter, liquid, gases, sunlight and microorganisms.
Although the skin may become bruised, lacerated, burned or infected, it has remarkable properties that allow for a
continuous cycle of healing, shedding and cell regeneration. The skin is composed of three layers, the epidermis (outer layer),
the dermis (iinner layer), and the subcutaneous fat layer.

EPIDERMIS

The Epidermis covers the body and it is specialized in areas to form the various skin appendages: hair, nails and glandular
structures. The keritinocytes of the epidermis produce a fibrous protein called Keratin, which is essential to the protective
function of the skin. In addition to the keratinocytes, the epidermis has three other types of cells that arise from its basal
layer: melanocytes the produce a pigment called melanin, which is responsible for skin color, tanning and protecting against
UV radiation.

BASAL LAMINA
Also called the basement membrane is a layer of intercellular and extracellular matrices that serves as an interface between
the dermis and the epidermis. It provides for adhesion of the dermis to the epidermis and serves as a selective filter for
molecules moving between the two layers. It is also a major site of immunoglobulin and complement deposition in skin
disease.

DERMIS

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The dermis is the connective tissue layer that seperates the epidermis from the subcutaneous fat layer. It supports the
epidermis and serves as its primary sourfce of nutrition. Two layers of the dermis, the papillary dermis and the reticular
dermis, are composed of cells, fibers, ground substances, nerves and blood vessels. The main component of the dermis is
collagen, a group of fibrous proteins. Collagen represents 70% of dry skin weight and serves as the major stress-resistant
material of the skin.

SUBCUTANEOUS TISSUE
It consists primarily of fat and connective tissues that lend support to the vascular and neural structures supplying the outer
layers of the skin. There is controversy about whether the subcutaneous tissue should be considered an actual layer of the
skin.

SWEAT GLANDS
There are two types of sweat glanss: eccrine and apocrine. Eccrine sweat glands transport sweat to the outer skin surface to
regulate body temperature. Apocrine sweat glands on the other hand secrete an oily substance. When mixed with bacteria on
the skin surface they produce body odor.

SEBACEOUS GLANDS
They are located over the entire skin surface except for the palms, soles, and sides of the feet. They secrete a mixture of lipids,
including triglycerides, cholesterol and wax. This mixture is called sebum; it lubricates hair and skin. It prevents undue
evaporation of moisture from the stratum corneum during cold weather and helps to conserve body heat.

HAIR
It is a structure that originates from hair follicles in the dermis. Most hair follicles are associated with sebaceous glands, and
these structures combine to form the pilosebacous unit. Hair is a keratinized structure that is pushed upward from the hair
follicle. Hair has been found to go through cyclic phases identified as anagen or the growth phase, catagen or the atrophy
phase, and telogen or the resting phase or no growth.

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NAILS
Nails are hardened keratinized plates called fingernails and toenails that protects the fingers and toes and enhace dexterity.
The nails grow out from a curved transvers groove called the nail groove. The underlying epidermis attached to the nail plate
is called the nail bed. Like hair, nails are the end product of dead matrix cells that are pushed outward from the nail matrix.
Unlike hair, nails grow continuously rather than cylically unless permanently damaged or diseased.

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MUSCULOSKELETAL

CARTILAGE
Cartilage is a firm but flexible type of connective tissue consisting of cells and intercellular fibers embedded in an amorphous, gel-like material. It
has a smooth and resilient surface and a weight-bearing capacity exceeded only by that of bone. Cartilage is essential for growth before and after
birth. It is able to undergo rapid growth while maintaining a considerable degree of stiffness.

BONE
Bone is connective tissue in which the intercellular matrix has been impregnated with inorganic calcium salts so that it has great tensile and
compressible strength but is light enough to be moved by coordinated muscle contractions. The intercellular matrix is composed of two types of

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substances – organic matter and inorganic salts. The organic matter, including bone cells, blood vessels, and nerves, constitutes approximately
one third of the dry weight of bone; the inorganic salts make up the other two thirds. The organic matter consists primarily of collagen fibers
embedded in an amorphous ground substance. The inorganic matter consists of hydroxyapatite, an insoluble macrocrystalline structure of
calcium carbonate and calcium fluoride. Bone may also take up lead and other heavy metals, thereby removing these toxic substances from the
circulation. This can be viewed as a protective mechanism.

Types of bones:
Osteogenic cells – Undifferentiated cells that differentiate into osteoblasts. They are found in the periosteum, endosteum and epiphyseal growth
plate of growing bones.

Osteoblasts – Bone-building cells that synthesized and secrete the organic matrix of bone. Osteoblasts also participate in the
calcification of the organic matrix.
Osteocytes – Mature bone cells that function in the maintenance of bone matrix. Osteocytes also play an active role in
releasing calcium in the blood.

Osteoclasts – Bone cells responsible for the reabsorption of bone matrix and the release of calcium and phosphate from bone.

SKELETAL JOINTS

Articulations or joints are sites where two or more bones meet to hold the skeleton together and give it mobility. There are two
types of joints: Synarthroses, which are immovable joints and diarthroses, which are freely movable joints. All limb joints are
synovial diarthroidal joints, which are enclosed in a joint cavity containing synovial fluid. The articulating surfaces of synovial
joints are covered with a layer of avascular cartilage that relies on oxygen and nutrients contained in the synovial fluid.
Regeneration of articular cartilage of synovial joints is slow and healing of injuries of ten is slow and unsatisfactory.

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GENITOURINARY SYSTEM

The male genitourinary system is composed of the paired gonads, or testes, genital ducts, accessory organs and penis. The
dual function of the testes is to produce male sex androgens mainly testosterone and spermatozoa. The internal accessory
organs produce the fluid constituents of semen and the ductile system aids in the storage and transport of spermatozoa. The
penis functions in urine elimination and sexual function.

TESTES AND SCROTUM

The testes or male gonads are two egg-shaped structures located outside the abdominal cavity in the scrotum. The testes
develop in the abdominal cavity and then descend through the inguinal canal into a pouch of peritoneum in the scrotum. As
testicular descend the testes pull their arteries, veins, lymphatics, nerves and conducting excretory ducts with them. After

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descent of the testes, the inguinal canal closes almost completely. Failure of this canal to close predisposes to the
development of an inguinal hernia later in life.

GENITAL DUCT SYSTEM

Internally, the testes are composed of several hundred compartments or lobules. Each lobule contains one or more coiled
seminiferous tubules. These tubules are the site of sperm production. As the tubules lead into the efferent ducts, the
seminiferous tubules become the rete testis. From the rete testis, 10,000 to 20,000 efferent ducts emerge to join the
epididymis, which is the final site for sperm maturation.

ACCESSORY ORGANS
The male accessory organs consist of the seminal vesicles, the prostate gland, and the bulbourethral glands. Spermatozoa are
transported through the reproductive structures by movement of the seminal fluid, which is combined with secretions from
the genital ducts and accessory organs. The spermatozoa plus the secretions from the genital ducts and accessory organs
make up the semen. The seminal vesicles consist of two highly tortuous tubes that secrete fluid for the semen. Each of the
paired seminal vesicles is lined with secretory epithelium containing an abundance of fructose, prostaglandins and several
other proteins. The fructose secreted by the seminal vesicles provides the energy for sperm motility. The prostaglandins are
thought to assist in fertilization by making the cervical mucous more receptive to sperm and by causing reverse peristaltic
contractions in the uterus and fallopian tubes to move the sperm toward the ovaries.

PENIS
The penis is the external genital organ through which the urethra passes. Anatomically, the external penis consists of a shaft
that ends in a tip called glans. The loose skin of the penis shaft folds to cover the glans, forming the prepuce, or foreskin. The
glans of the penis contains many sensory nerves, making this the most sensitive portion of the penile shaft. It is the foreskin
that is removed during circumcision. The cylindrical body or shaft of the penis is composed of three masses of erectile tissue
held together by fibrous strands and covered with a thin layer of skin.

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CARDIOVASCULAR SYSTEM

The main function of circulatory system, which consists of the heart and blood vessels, is transport. The circulatory system delivers oxygen and
nutrients needed for metabolic processes to the tissues, carries waste products from cellular metabolism to the kidneys and other excretory
organs for elimination, and circulates electrolytes and hormones needed to regulate body function.

PULMONARY AND SYSTEMIC CIRCULATIONS

The circulatory system consists of the heart, which pumps blood; the arterial system, which distributes oxygenated blood to the tissues; the
venous system, which collects deoxygenated blood from the tissues and returns it to the heart; and the capillaries where exchange of gases
nutrient and waste takes place. The circulatory system is divided into two parts: the low-pressure pulmonary circulation, linking circulation and
gas exchange in the lungs, and the high-pressure systemic circulation, providing oxygen and nutrients to the tissues. Blood flows down a pressure
gradient from the high-pressure arterial circulation to the low-pressure venous circulation. The circulation is a closed system, so the output of
the right and left heart must be equal over time for effective functioning of the circulation.

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PRINCIPLES OF BLOOD FLOW
Blood flow is directly related to the difference in pressure between the inlet and outlet of a vessel and is inversely related to the resistance to
flow through that vessel. Resistance to flow through a vessel is inversely related to the fourth power of the vessel radius. Small decreases in
vessel radius cause large increases in resistance to flow. At any given intraluminal pressure, the tension in a vessel wall is greater in the vessel
with the greater radius.

THE HEART
The heart is a four-chambered pump consisting of two atria and two ventricles. Heart valves control the direction of blood flow from the atria to
the ventricles from the right side of the heart to the lungs and from the left side of the heart to the systemic circulation. The myocardium or
muscle layer of the atria ventricle produces the pumping action of the heart. Intercalated disks between cardiac muscles cells contain gap
junctions that allow for immediate communicayion of electrical signal from one cell to another so the cardiac muscle acts as a single unit or
syncytium. The cardiac cycle is divided into two major periods: systole, when the ventricles are contracting and diastole, when the ventricles are
relaxed and filling. The cardiac output or amount of blood that the heart pumps each minute is determined by the amount of blood pumped with
each beat. Cardiac reserve refers to the maximum percentage of increase in cardiac output that can be achieved above the normal resting level.
The work of the heart is determined by the volume if blood it pumps out and the pressure that it must generate to pump the blood out of the
heart.

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 DEMOGRAPHIC DATA

Name: Radones, Azel Ray Saberon Civil Status: Single Sex: M

Educational Attainment: Elementary Address: Malon, Siaton Negros Oriental
Religion: SAD Occupation: Student
Room and Bed No.: MPH-M Doctor(s) in charge: Dr. Natividad T. Sevillo, MD
Nationality: Filipino Date and Time of Admission: 07/10/17 2:40 pm

Chief Complaint(s): Fever for 4 days, Urinary Tract Infection

Diagnosis: Dengue, UTI

General impression(s): Received patient on bed, awake, weak and slightly disoriented. Quiet, soft
spoken and not interested in answering questions. Limitations in body movement noted. Skin is
warm to touch; capillary refills take more than 3 seconds to return. Skin is dry and lips are

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chapped. Face is pale. Covered in blankets to keep warm. Presence of dark circles around the eye
noted.

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 GENOGRAM

Alive
Alive Alive 57
- Asthmatic Deceased 60

Alive Alive Father

36 42 39 Alive Alive - On- call
Teacher
Mother Alive 38 41 construction
37 35 worker

- Asthmatic

Patient
7 Alive Deceased
Alive Alive
5 9
Male

Female

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 GROWTH AND DEVELOPMENT
PHYSICAL GROWTH

The term school-age refers to ages 7-12 years old. These years represent slow cognitive growth and development, and
slow physical growth. The development of a school-age child is subtler and may be marked by mood swings; what the child
enjoys on one occasion may not be acceptable on the next. Children of school age may also be more influenced by the
attitudes of their friends than previously. They may choose not to do something that was previously enjoyable because no
friends are interested in the activity. The school- age period is usually the first time children begin to make truly independent
judgments.

School-age children’s average weight gain is approximately 3 to 5 lb (1.3 to 2.2 kg); the increase in height is 1 to 2 in
(2.5 to 5 cm). Children who did not lose the lordosis and knock-kneed appearance of toddlers during the preschool period lose
these now. Posture becomes more erect (Goldson & Reynolds, 2008). By 10 years old, fine motor coordination becomes
refined, because brain growth is complete. An adult vision is achieved because the eye globe reaches its final shape.
Malocclusion or malalignment of the teeth may happen when eruption of permanent teeth and growth of the jaw do not
correlate with the final head growth. The immunoglobulins IgG and IgA reach adult levels, and lymphatic tissue continues to
grow up until about age 9.

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 SEXUAL MATURATION

The hypothalamus transmits an enzyme to the anterior pituitary gland to begin production of gonadotropic hormones,
which activate changes in testes and ovaries and produce puberty. Timing of the onset of puberty varies widely, between 10
and 14 years of age. The length of time it takes to pass through puberty until sexual maturity is complete also varies. Sexual
maturation in girls usually occurs between 12 and 18 years; in boys, between 14 and 20 years. Puberty is occurring
increasingly earlier, however, and, in a class of 10-year-old sixth graders, it is not unusual to discover that more than half of
the girls are already menstruating. 

Prepubertal girls are usually taller, by about 2 in (5 cm) or more, than preadolescent boys because their typical growth
spurt begins earlier. Noticeable change in pelvic contour occurs for girls and hips become broader. Consciousness on breast
development develops at this stage for girls. Nipples darken and increase in size. The average age which first period occurs is
12.4 years. Vaginal secretions may be present for girls. For boys, testicle development occurs at this stage so as the increase
size of the genitalia. Hypertrophy of breast tissue (gynecomastia) can occur in prepuberty especially for stocky or obese boys.
Pubic hair for boys grows, but beard and chest hair. Ejaculation during sleep called nocturnal emissions occur for boys
because seminal fluid is produced.

TEETH

Permanent teeth erupt during the school age period meaning they lose deciduous teeth. At the age of 6 and 12 years, the
average child gains 28 teeth average child gains 28 teeth: the central and lateral incisors; first, second, and third cuspids;
and first and second molars.

GROSS MOTOR DEVELOPMENT

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 At the age of 6, children endlessly jump, tumble, skip, and hop. They have enough coordination to walk a straight line.
Many can ride a bicycle. They can skip rope with practice. Gender differences usually begin to manifest in play. The
movements of 8-year-olds are more graceful than those of younger children. Nine-year-olds are on the go constantly, as if
they always have a deadline to meet. They have enough eye and hand coordination. By 10 years of age, they are more
interested in perfecting their athletic skills. At age 11, they start to feel awkward because of their growth spurt and drop out
of sports activities. At the age of 12, they plunge into activities with intensity and concentration. They often enjoy
participating in sports events.

FINE MOTOR DEVELOPMENT

They can easily tie their shoelaces at 6.. They can cut and paste well and draw a person with good detail. They can print,
although they may routinely reverse letters. At 7, they concentrate on fine motor skills even more than they did the year
before. This has been called the “eraser year” because children are never quite content with what they have done. They set too
high a standard for themselves and then have difficulty performing at that level.

By 8 years of age, children’s eyes are developed enough so they can read regular-size type. This can make reading a
greater pleasure and school more enjoyable. They learn to write script rather than print. They enjoy showing off new skills. By
age 9, their writing begins to look mature and less awkward.

Older school-age children begin to perform at varying levels, depending on each teacher’s expectations. School involves
more challenging science and mathematics courses than previously and includes good literature. This may be a child’s first
exposure to reading as a fun experience rather than just as an assignment and may be the time a child is interested to
reading.

PLAY

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 Play becomes rough for 6 year olds, but when they discover reading as an enjoyable activity, they spend more quiet
times with books. Many children spend hours playing video games, this may help them foster a healthy sense of competition
or create isolation from others. At 7, they start playing imaginative play, because they start to need props for their play. This
continues as the child received encouragement on imagination. At the age of 8, skills for sorting and cataloging are developed.
At this age, children start collecting. Competitiveness develops at the age of 10. They become more interested on the rules of
the game and fairness in the competition. Music and artistic expression also become important during this time.

LANGUAGE DEVELOPMENT

Six year olds talk in full sentences, using language easily and with meaning. They define objects by their use. Most 7
year olds can tell the time in hours, but they may have trouble with concepts such as “half past” and “quarter to,” especially
with the prevalence of digital clocks and watches. They know the months of the year and can name the months in which
holidays fall. They can add and subtract and make simple change. As children discover dirty jokes at about age 9, they like to
tell them to friends or try to understand those told by adults. They use swear words to express anger or just to show other
children they are growing up. By 12 years of age, a sense of humor is apparent. They can carry on an adult conversation,
although stories are limited because of their lack of experience.

EMOTIONAL DEVELOPMENT

Erickson viewed the development task of the school-age period as developing industry versus inferiority, or
accomplishment rather than inferiority. During this stage, the child learns how to do things well and asks for confirmation
whether he/she is doing a good job. When the child is given praises, rewards or being encouraged while doing work or after,
their sense of industry grows. Parents who do not show appreciation to their child’s work may cause them to develop a sense

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of inferiority rather than pride and accomplishment. The child’s world grows to include school setting and the community
environment, success and failures in these settings make a great impact in the child’s life.

SOCIALIZATION

Six-year-old children play in groups, but when they are tired or under added stress, they prefer one-to-one contact.
Seven-year-olds are increasingly aware of family roles and responsibility. Promises must be kept, because 7-year-olds view
them as definite, firm commitments. These children tattle because they have a strong sense of justice. Eight-year-olds actively
seek the company of other chil- dren. Most 8-year-old girls have a close girlfriend; boys have a close boyfriend. Girls begin to
whisper among themselves as they share secrets with close friends. Nine-year-olds take the values of their peer group very
seriously. They are much more interested in how other children dress than in what their parents want them to wear. This is
typically the gang age because children form clubs, usually “spite clubs.” Although 10-year-olds enjoy groups, they also enjoy
privacy. They like having their own bedroom and be away from their siblings. Gilrs become interested in boys and vice versa
at the age of 11, they tend to be insecure at this age. Twelve-year-olds feel more comfortable in social situations than they did
the year before. Boys experience erections on small provocation so may feel uncomfortable being pushed into boy–girl
situations until they know how to control their bodies better.

COGNITIVE DEVELOPMENT

The period from 5 to 7 years of age is a transitional stage where children undergo a shift from the preoperational
thought they used as preschoolers to concrete operational thought or the ability to reason through any problem they can
actually visualize. Children can use concrete operational thought because they learn several new concepts, such as
decentering where the ability to project oneself into other people’s situations and see the world from their viewpoint rather
than focusing only on their own view. Accommodation, the ability to adapt thought process to fit what is perceived.

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Conservation, the ability to appreciate that change in shape doesn’t necessarily mean change in size and class inclusion, the
ability to understand that objects can belong to more than one classification. These cognitive developments lead to some of
the typical changes and characteristics of the school-age period.

MORAL AND SPIRITUAL DEVELOPMENT

School-age children begin to mature in terms of moral development as they enter a stage of preconventional reasoning,
sometimes as early as 5 years of age. They concentrate on fairness. School-age children begin to learn about the rituals and
meaning behind their religious practices, so the distinction between right and wrong becomes more important to them than it
was when they were preschoolers.

THE SCHOOL-AGE CHILD

Erickson viewed the development task of the school-age period as developing industry versus inferiority, or accomplishment
rather than inferiority. During this stage, the child learns how to do things well and asks for confirmation whether he/she is
doing a good job. When the child is given praises, rewards or being encouraged while doing work or after, their sense of
industry grows. Parents who do not show appreciation to their child’s work may cause them to develop a sense of inferiority
rather than pride and accomplishment. The child’s world grows to include school setting and the community environment,
success and failures in these settings make a great impact in the child’s life.

We did a coloring activity when we were taking care of our patient. We gave him praises such as “Wow tsadaa mu color nimo
beh.” He was so happy when he finished coloring the book and showed it to his parents and grandmother. He gets anxious
when his mother or father is away from his sight. He was shy when he first met us. He also gets shy when his mother
changes his underwear or when he pees.

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 FUNCTIONAL HEALTH PATTERN

USUAL FUNCTIONAL PATTERNS INITIAL APPRAISAL ONGOING APPRAISAL

I. Health Perception – Health Management Vital signs: Vital signs:

Pattern T = 38.8 C T: 37.3 C
- Mother had no problems during HR = 159 bpm HR: 85 bpm
pregnancy BP = 90/60 Mmhg BP: 90/60mmhg
- Only son RR = 24 cpm RR: 20 cpm
- Mother verbalized that he had complete After
- Vaccinations in Siaton T: 36.5C
- No previous experience with surgeries or HR: 90cpm
other operations BP: 100/70mmhg
- Mother says that child will take RR: 20cpm
Paracetamol if he has fever and also that
he usually vomits saliva IV Fluids: IV Fluids
- Child’s cough and colds usually lasts a #1 IVF with D5 0.3% NaCl 1L run @ 57 #3 IVF with D5 0.3% Nacl 1L run @
week gtts/min ! L metacarpal vein, running 24gtts/min @ L metacarpal vein,
- No falls or any accidents well no signs of infiltration running well, no signs of infiltration
- No one smokes at home #2 D5 0.3% NaCl 1L run @ 57 gtts/min #4 D5 0.3 Nacl 1L @ 15 gtts/min @ L
- Admitted for high fever for 4 days @ L metacarpal vein, running well, no metacarpal vein, running well, no

34
- First hospitalization signs of infiltration signs of infiltration
- Friday: Vomited food
- Saturday: Vomited water Medications: Medications:
- Sunday – Vomited phlegm - Paracetamol (tempra) 250g/15ml q4h Cefrixone (Keprix) 2gm IVTT x 30ml
- Monday – Vomited saliva on the way to prn for fever OD
the hospital - Cefrixone (Keptrix) 2.4 gm IVTT OD
- Some mucous secretions ANST
- Mother mentioned family history of Urinalysis:
Asthma Urinalysis: Physical: Dark yellow
Physical – Dark yellow Transparency: Hazy
Chemical: Chemical:
Transparency: Hazy Specific gravity 1.010
Specific gravity: 1.030 pH: 5.5
pH: 6.0 Bilirubin (-)
Bilirubin (-) Urobilinogen (-)
Urobilinogen (-) Glucose (-)
Glucose (-) Ketone (-)
Ketone (+) Protein (-)
Nittrites (+) Nitrites (-)
Protein (+) Blood (Trace)
Blood (+) Leukocytes (2+)
Leukocytes (2+)
Mircoscopia: Urine Flow Cytometry:
Pus = 18-21 Parameter SI Ref.
Bacteria: Moderate RBC 10/uL 0-11
Mucus threads: Moderate WBC 12/uL 0-11

35
 Red cells: 840 Hyaline cast 0/uL 0-1
Cyst: (-) Bacteria 20/uL 0-11
Epithelial cells: Few Epithelial cells 1/uL 0-11
Crystals: (-)

Hematology:
Result Range
CBC 11.0 13-16% Hemoglobin 11 13-16
Hematocrit 33.0 42-50% Hematocrit 35.7 42-50
WBC count 9.0 4.0-10 WBC count 205,000 40-10
T/cumm Neutrophil 55-70
Neutrophil 67 55-70% Lymphocyte 11 20-35
Lymphocyte 23 20-35% Basophil 0 0-1
Basophil 0 0-1% Monocyte 11 1-6
Eosinophil 11 1-4
Platelet 100,000 150-450 T

Sodium 141 135-145

Potassium 4.10 3.6-5.0

36
 Monocyte 9 1-6%
Eosinophil 1 1-4%
Platelet count 90,000 150-450
T/cumm
RBC count 3.66 4.3-6.0
M/cumm

Blood type: O RH: Positive

Chest X ray Pal - Procedure

Findings: Lung field clear
Heart and great vessels
II. Nutritional – Metabolic Pattern are within normal size DAT – To avoid dark colored foods
- Breastfed from birth until 2 years of age and configuration Skin has returned to normal color
- Birth weight was 6.6 lbs Sulci and diaphragm are Capillary refill 3 seconds
- Mother verbalized that “Dili siya pilian in tact Appetite has returned
ug pagkaon.” Bony thorax and Breakfast:
Vitamins: Celine and Neutroplex visualization of soft ¾ cup rice
- Verbalized that “Ganahan ko ug sabaw tissue are unremarkable ½ serving fish
and Kalamunggay.” Impression: normal 1 banana
- Allergic to chicken and eggs chest ½ cup poweraid blue
Breakfast:
½ cup rice Snack: About 15 pieces of popcorn
1 serving vegetable Lunch:
½ milk - DAT – to avoid dark colored ½ rice
Snack: - Current weight 23.6kg ½ serving pancit

37
Junk food - Mother verbalized, “Wala siya gana.” ½ serving pork
Lunch: - Mother continued “Ganina kay gamay
½ cup rice ra kaayo iya gikaon. Wala niya hutda
1 bowl sabaw ag pagkaon nga gihatod.”
1 serving vegetable - Capillary refill: 5 sec IV Fluids:
Dinner: - Pale hands, feet and conjunctiva #3 D5 0.3 Nacl 1L running @ 27
1 cup rice - Breakfast: gtts/min.
1 bowl sabaw 4 spoonful of rice #4 D5 0.3 Nacl 1L run @ 15 gtts/min
½ serving fried fish 1/3 banana
¼ cup Powerade blue Medications:
-Snack: None Ceffrixone (Keptrix) 2g IVTT x 30ml OD
-Lunch:
III. Elimination Pattern ¼ cup rice
- Mother verbalized that child urinates ½ bowl sabaw
every 3-4 hours ½ piece of macaroon Output: Urine
- Usually pale yellow in color and clear 7/12
- Mother verbalized that he defecates IV Fluids: 7-3 shift = 220mL pale yellow, clear
about 3-4x a week #1 IVD with D5 0.3% Nacl 1L run @ 57
- Has not defecated since admission gtts/min Output: Stool
#2 D5 0.3% Nacl 1L run @ 57 gtts/min “Nalibang siya ganing buntag.” The
Medications: mother verbalizes
- Paracetamol (tempra) 250g/15ml q4H
- Cefrixone (keprx) 2.4 gm IVTT OD Some perspiration, no unusual odors
ANST noted

Urinalysis:

38
 Output: Urine Physical
7/10 – concentrated urine Chemical:
7-3 shift: 650mL dark yellow, slightly Specific Gravity: 1.010
hazy pH 7
3-11 shift: 500mL yellow, clear Bilirubin (-)
7/11 Urrobilinogen (Normal)
7-3 shift: 750mL pale yellow, clear Glucose (-)
3-11 shift: 630mL pale yellow, clear Ketone (-)
Nitrates (-)
Output: Stool Protein (-)
- Mother verbalizd that he defecated Blood (Traces)
once and that it was “Gagmay, brown Leukocytes (-)
ang color unya medyo humok-humok.”
-Skin is dry, no perspiration or unsual
oders noted

Urinalysis
Physical: Dark yellow
Transparency: Hazy
Chemical:
Specific gravity 1.030
IV. Activity – Exercise Pattern pH: 6 7/12
- Bathes, feeds, uses toilet, dresses, eat Bilirubin (-) Receptive to instructions
and clothes by himself. Urobilinogen (-) Prefers to be either on the bed or
- Typical day consists of: getting up for Glucose (-) sitting down
school, going to school, going home, Ketone (+) Is ready to go home

39
playing with neighbors doing homework Nitrites (-) Watches Jungle Book Movie with
then goes to bed. Protein (+) parents
Mother verbalized “Murag dili ra siya mag Blood (+)
dula-dula kaayo kay dili raman pud Leukocytes )2+) RR = 20cpm
mansa iyang sinina.” PR = 85 bpm
- “ganahan siya maligo ug dagat sa likod BP = 90/60 bpm
sa among balay.” Says mother
- “sig era sila mag kuyog sa iyang ig-agaw
nga babae.” 7/10
- Prefers to be laying down in bed than
sitting or standing up
- Tired and weak, not in the mood to
answer questions

V. Sleep and rest pattern
- Usual sleep pattern: 9pm – 10pm to
waking up at 5:30am-6am
- Around 8 hours of sleep total
7/11
- Awake and more lively
- Responds well to questions
- Warming up to student nurses
- Ambulatory, walks to and from
bathroom without problems
-Enjoys coloring Spiderman in coloring
book
- Feels restless when lying on the bed 7/12
for too long - Eye bags less prominent
- Reflexes are appropriate to age - Looks tired
Vital signs: - Prefers to sit on chair with head

40
- Prefers to sleep on back or side
- Rarely has nightmares
- Sleeps closest to the wall, followed by
father then mother at the edge
- Wakes up and gets anxious when no one
is next to him
RR = 20 cpm without use of accessory leaning on bed
muscles - Total hours of sleep: 10 hrs
PR = 89 bpm normal heart sounds - Mother and father sleep on nearby
BP= 100/70mmhg bed
- Tired, isn’t as responsive but will
speak when spoken to
- Interacts with mother, is responsive
to her
7/10
- Eye bags are prominent
- Side lying with blanket to keep him
warm
- Doesn’t maintain eye contact when
spoken to

VI. Cognitive and perception
- Easy child
- Quiet soft spoken
- Responds when spoken to
- No problems with hearing, vision or
touch, no glasses or hearing and aid
- Feels anxious when accompanied by
new faces
- No stuttering
- No pain or discomfort
7/11
- Went to bed at 9pm then woke up at
6am
- Total hours of sleep: 9hours
- Interrupted sleep when nurse comes
for a skin test
- Lays around in bed, encouraged to
nap
- Oriented to time and place
- Interacting more w/ his father
- Spends most of the time lying down;
restless
- “Uli nata.” He whines

41
- Grade 2
VII. Self perception – self concept
- Mother verbalized that “Lambing kaayo
siya.”
- Also says “Dili siya ganahan biyaan.”
- Best friend is his cousin, ho he plays
with after school
- “Naa raman siyay mga friends sa school”
Mother says
- Fears being left alone, needles and the
dark
- Doesn’t need father or mother to wait for
him at the school gate anymore
VIII. Role relationship pattern
- Lives with mother, father and aunt
- Only child
- Mother’s boy
- Neighbors with his best friend
42
- Oriented to time and place
- Slow to answer questions due to - Watches movie with mother and
weakened state father to alleviate boredom
- Warms up to student nurses by the Lays on the bed, tries to nap but can’t
second day is friendly
-Enjoys coloring Spiderman
- Almost started crying hen mother was
going to leave him with grandmother
- “Ayaw ko biyae.” He said
- After talking he calms down
- Eventually warms up to student
nurses
- Eye contact when spoken to; still gets - Father is left with child, mother is
shy but is responsive not around until later in the morning
- Reaches out to mother when she Father is quiet, soft spoken
returns - Cuddles w/ child and talks with him
- Enjoys swimming with his cousin on the - Gets embarrassed when he has to Mother comes back and they watch a
beach urinate movie, “The Jungle Book.”
- Adjusting to the new school and making
new friends
- “G mingaw ko sa akong teacher.”
- If mad or angry at mother, usually says
“Dili na ta amiga, ma.” Or “Dili nako
ganahan nimo.”
- Promises are very important to him, no - Mother and father attending to his
matter how little it is needs
- Lola comes later in the morning to
relieve parents
IX. Sexuality – reproductive pattern - Ayaw lagi ko biyae.” The child yells
- Is aware that he is a male when parents go to procdss paperwork.
- Plays with pusil-pusil or with toy trucks - Is not used to being alone
and cars - Looks for mother even when sheis
- Plays with boys in his class, says his only going to the bathroom.
mother
- Plays with cousin, who is a girl

X. Coping stress tolerance

- Mother mentions that he will throw - Mother mentions that she prays to
tantrums when he doesn’t get what he God for her son’s healing
wants - Watches a movie to pass the time
- Says “Dili nata amigo.” When he is mad - Gets embararased when he has to - Lies in bed

43
-Will cry when he is disappointed urinate
Mother will try to stand firm on her - “Maulaw ko.”
decisions - Lets mother or father change his
- Child will give him silent treatment but underwear.
will calm down after awhile

XI. Value belief pattern

- Religion is very important - Was frustrated when mother and
- Mother mentions that he “prayed to God father left him alone with grandma -“Nagpasalamat sa Ginoo nga wala nay
on the way here.” - Lied in bed ad didn’t talk to anyone hilanat.” When told of the temperature
- Family goes to chores every Sunday - Eventually calmed down and relaxed
- Child’s health is very important because
he is the only child
- Wants to be a Police officer when he
grows up, because of his uncle
- Vital signs
BP = 90/60 mmHg
T = 38.8 C
02 = 99%
Wt – 23.6 kg
RR = 24 cpm - Mother mentions that “Nag pray mi
HR = 159 bpm ganina.”
-“Kanus-a ta mang uli.”
- Wants to sleep in his own bed
- “Dili sako malig oug dagat.”

44
 PHYSICAL ASSESSMENT OF CHILD
SKIN, HAIR AND NAILS

Skin is slightly pale, warm, and dry.

No lesions or excoriations noted.
Hair is black, military cut, clean, shiny.
Hair is distributed evenly on scalp.
No hair noted on axillae.
Thin hair noted on extremities distributed equally.
Nails form 160degree angle at base, are hard, smooth, and immobile. Nail beds slightly pale in color without clubbing.
Cuticles are smooth, no detachment of nail plate.
Little dirt present on nails.

HEAD AND NECK

Head symmetrically round, hard, and smooth without lesions or bumps.

Face oval, smooth, and symmetrical.
Neck symmetric with centered head position and no bulging masses.
Has smooth, controlled, full range of motion of neck.
Thyroid gland nonvisible but palpable when swallowing.
Lymph nodes nonpalpable.

EYE AND EAR

45
Extraocular movements smooth with no nystagmus.
No redness, discharge, or crusting noted on lid margins.
Conjunctiva and sclera appear moist and smooth.
Sclera white with no lesions or redness.
No swelling or redness over lacrimal gland.
Cornea is transparent, smooth, and moist with no opacities, lens is free of opacities.
Irises are round and evenly colored.
Pupils are equal in size.
Ears are equal in size bilaterally.
Auricles are aligned with the corner of each eye.
Small amount of moist yellow cerumen in external canal.

MOUTH AND NOSE

Lips are slightly pale, chapped and without lesions.
Nose somewhat large but smooth and symmetric to the rest of the face.
Able to sniff/breathe through each nostril.
No purulent drainage noted.
CHEST
Bilateral breasts moderate in size, pendulant, and symmetric.
Chest skin pale, pink with light brown areola.
Nipples everted bilaterally.
Free movement of breasts with position changes of arms and hands.
No dimpling, retraction, lesions, or inflammation noted.
Axillae free of rashes and hair.
No masses or tenderness noted.
No discharge noted from nipples.

46
Lymph nodes are non-palpable.
ABDOMEN
Skin of abdomen is free of striae, scars, lesions, or rashes.
Umbilicus is located at the midline with no bulging.
Abdomen is flat and symmetric with no bulges or lumps.
No peristaltic movements seen.
Percussion reveals generalized tympany all over four quadrants.
No tenderness in any quadrant with light palpation.
Umbilicus and surrounding area free of masses, swelling, and bulges.

MUSCULOSKELETAL
Gait smooth, with equal stride and good base of support.
Full range of motion with no pain or tenderness.
Upper and lower extremities are symmetric without lesions, nodules, deformities, or swelling noted.
Full smooth range of motion against gravity and resistance

47
 PATHOPHYSIOLOGY: DENGUEHEMMORAGIC FEVER

48
49
50
51
52
 PATHOPHYSIOLOGY: URINARY TRACT INFECTION

53
 DOCTORS’S ORDER

Order Significance
Take vital signs These measurements are taken to help assess the general
physical health of a person, gives clues to possible diseases,
and show progress towards recovery. This provides baseline
data that will serve as basis of comparison in the future in
case there are alterations prompt medications may be
performed.
DAT Diet as tolerated is usually advised in relation to surgery.
Once a surgical procedure is complete, individuals are given
only liquids, such as water. The diet progresses to solid foods
in the form of purees, chunks and finally a regular diet. Diet
as tolerated is a term that indicates that the gastrointestinal
tracts is tolerating food and is ready for advancement to the
next stage.
CBC A complete blood count (CBC) is a blood test used to evaluate
your overall health and detect a wide range of disorders,
including anemia, infections, and other problems. A complete

54
 blood count test measures several components and features
of your blood, including: red blood cells, which carry oxygen.
Urinalysis Urinalysis is used to detect and assess a wide range of
disorders, such as urinary tract infection, kidney diseases
and diabetes. Involves examining appearance, concentration
and content of urine.
Chest X ray Chest X ray is an imaging test that uses small amounts of
radiation to produce pictures of the organs, tissues, and
bones of the body. When focused on the chest, it can help
spot abnormalities or diseases of the airways, blood vessels,
bones, heart, and lungs
Medications:
Paracetamol (tempra) 250g/15ml q4h prn for fever Pain relief results from inhibition for prostaglandin synthesis
in CNS, with subsequent blockage of pain impulses. Fever
reduction may result from vasodilation and increased
peripheral blood from the hypothalamus, which dissipates
heat and lowers body temperature.
Cefrixone (Keptrix) 2.4 gm IVTT OD ANST Antibiotic that works by interfering with the bacteria’s cell
wall formation. This weakens the cell wall, causing it to
rupture, and kills the bacteria.

55
 LABORATORY RESULTS

URINALYSIS
Physical Dark yellow
Transparancy Hazy
Specific Gravity 1.030
Chemical:
pH 6.0
Bilirubin Negative
Urobilinogen Negative
Glucose Negative
Ketone Positive
Nitrites Positive
Protein Positive
Blood Positive
Leukocytes 2+
Microscopic:
Pus 18-21
Bacteria Moderate
Red Cells 840

56
 Cysts Negative
Epithelial Cells Few
Crystals Negative
Urinalysis
Physical Dark Yellow
Transparency Hazy
Chemical:
Specific gravity 1.010
pH 5.5
Bilirubin Negative
Urobilinogen Negative
Glucose Negative
Ketone Negative
Nitrites Negative
Blood Traces
Leukocytes 2+

Urine Flow Cytometry

Parameter SI Ref.
RBC 10/uL 0-11
WBC 12 0-11
Hyaline cast 0/uL 0-1
Bacteria 20/uL 0-11
Epithelial cells 1/uL 0-11

57
 Hematology
Results Range
CBC 11.0 12 – 16%
Hematocrit 33.0 42 – 50%
WBC count 4.0 4.0 – 10T/cumm
Neutrophil 67 55 – 70%
Lymphocyte 23 20 – 35%
Basophil 0 0 – 1%
Monocyte 9 1 – 6%
Eosinophil 1 1 – 4%
Platelet Count 90,000 150 – 450 T/cumm
RBC Count 3.66 4.3 – 6.0 M/cumm

Hematology
Hemoglobin 11 13 - 16
Hematocrit 35.7
WBC count 205,000 40
Neutrophil 55-7-
Lymphocyte 11 20-35
Basophil 0 0-1
Monocyte 11 1-6
Eosinophil 11 1-4

58
 Platelet 100,000 150 – 450

Sodium 141 135 – 135 - 145

Potassium 4.10 3.6 – 5.0

Blood Type O
RH Positive

Chest X ray Pal - Procedure

Findings: Lung field clear
Heart and great vessels are within normal size and
configuration
Sulci and diaphragm are in tact
Bony thorax and visualization of soft tissue are
unremarkable
Impression: normal chest

59
 NURSING MANAGEMENT

Procedure Rationale
 Monitoring of vital signs

 Encourage rest

 Encourage increase in water intake of at least 2,000 to

3,000 ml

 Perform tepid sponge bath

 Administer medications such as antipyretics and

antibodies as ordered by the doctor

 Monitor for skin rashes

 Assess capillary refill

60
  Monitor IV site

 Assess skin turgor

 Teach patient and significant other about nutritious food

61
 MEDICATIONS

Generic Name: Paracetamol

Brand Name: Tempra
Classification: Analgesic, Antipyretic
Action: Unclear, Pain relief results from inhibition for prostaglandin synthesis in CNS, with subsequent blockage of pain
impulses. Fever reduction may result from vasodilation and increased peripheral blood from the hypothalamus, which
dissipates heat and lowers body temperature.
Indication: Mild to moderate pain caused by fever, headache, muscle ache
Contraindication: Hypersensitivity to drug.
Dosage: 250g/15ml q4h prn for fever
Side Effects:
CNS: Headache
CV: Chest pain, dyspnea, myocardial damage when doses of 5–8 g/day are ingested daily for several weeks or when
doses of 4 g/day are ingested for 1 yr
GI: Hepatic toxicity and failure, jaundice
GU: Acute kidney failure, renal tubular necrosis
Hematologic: Methemoglobinemia—cyanosis; hemolytic anemia—hematuria, anuria; neutropenia, leukopenia,

62
pancytopenia, thrombocytopenia, hypoglycemia
Hypersensitivity: Rash, fever
Nursing Responsibilities:
Do not exceed the recommended dosage.
Consult physician if needed for children < 3 yr; if needed for longer than 10 days; if continued fever, severe or
recurrent pain occurs (possible serious illness).
Avoid using multiple preparations containing acetaminophen. Carefully check all OTC products.
Give drug with food if GI upset occurs.
Discontinue drug if hypersensitivity reactions occur.
Treatment of overdose: Monitor serum levels regularly, N-acetylcysteine should be available as a specific antidote;
basic life support measures may be necessary.

63
Generic Name: Cefuroxime
Brand Name: Keptrix
Classification: Antibiotic
Action: Broad-spectrum, usually bactericidal, antibiotic; kills bacteria by inhibiting cell wall synthesis
Indication: infections in the lower respiratory and urinary tract, skin, blood, meningitis, gonorrhea; prevention or resolution
of infection.
Contraindication: Hypersensitivity to drug.
Dosage: 2.4 gm IVTT OD ANST
Side effects: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth,
face, lips, or tongue); black or bloody stools; decreased urination; fever, chills, or sore throat; hearing loss; seizures; severe
diarrhea, nausea, or vomiting; stomach pain or cramps; unusual bruising or bleeding; vaginal irritation or discharge; vein
swelling at the injection site; yellowing of the skin or eyes.
Nursing Responsibilities:
Determine history of hypersensitivity reactions to cephalosporin, penicillin and history of allergies particularly to
drugs before therapy is initiated
Report onset of loose stools
Absorption is enhanced by food
Notify prescriber about rashes or super infections

64
 NURSING CARE PLAN

CUES/EVIDENCES NURSING OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

DIAGNOSIS

Subjective: Ineffective At the end of my Goal met:

Patient verbalized thermoregulation care, the patient - Patient
“Nag lain ako related to will have a verbalized
paminaw.” hyperthermia decreased “Na arang-
Patient verbalized, secondary to dengue temperature as - Monitor vital
arang na
“Medyo gibati pud hemorrhagic fever evidenced by: signs
ko ug - Vital signs akong
- Encourage
pagpamugnaw.” maintained gibati.”
rest
- Patient
at normal - Encourage
interacts
range increase in
Objective: and
- - Verbalized water intake
Vital signs: communicat
T= 38.8 C that he feels of at least
comfortable es well and
PR= 159 bpm 2,000 to
- -Lower or started to
HR= 24 cpm 3,000 ml
- Patient looked decereased answer
- Perform tepid

65
 tired in sponge bath questions
- Eyebags were temperature - Administer
prominent medications
under his such as
eyes antipyretics
- Patient was and as
lying on bed ordered by
and preferred the doctor
to lay on his - Monitor for
bed than skin rashes
sitting up - Assess
- Closed his capillary
eyes from refill
time to time
- Doesn’t
answer as
much when
being asked
questions
- Mother
verbalized
“Init jud kayo
siya sukad pa

66
 atong
sabado.”

67
CUES/EVIDENCES NURSING OBJECTIVES INTERVENTIONS RATIONALE EVALUATION
DIAGNOSIS

Subjective: Deficient fluid At the end of our -

- Patient volume related to care, the patient
verbalized vomiting secondary will have a
“Bali nako to dengue blanced nutrition
hemorrhagic fever as evidenced by:
suka ana
- Vital signs
pang
maintained
Saturday.”
at normal
- Patient
range
verbalized
- Patient takes
“ako kinaon
adequate
kay ako
amount of
rapud
calories or
guinasuka.”
nutrients
- “Last ko ni
- Improved
suka kay
skin integrity
gahapon.”
and mucous
Objective:

68
Vital signs: membrane
T= 38.8 C
PR= 159 bpm
HR= 24 cpm
- Patient looked
tired, eyebags
are prominent
under his
eyes
- Patient looked
pale and
sluggish
- Patient’s skin
was dry and
scaly and his
lips were dry
and chapped
- Patient was
lying on his
bed the whole
time and
closed his
eyes from

69
 time to time

70
CUES/EVIDENCES NURSING OBJECTIVES INTERVENTIONS RATIONALE EVALUATION
DIAGNOSIS

Subjective: Imbalanced At the end of my Goal met:

Mother verbalized, nutrition: less than care, the patient - Patient
“Wala siya’y gana body requirements will maintain a verbalized
mukaon.” related to lack of balanced nutrition “Na arang-
“ganina kay gamay appetite and as evidenced by: - Monitor vital - To obtain
arang na
ra kayo iya gikaon. vomiting - Vital signs signs baseline data
Wala niya hutda ag akong
maintained - Monitor IV
pagkaon nga gibati.”
at normal site
gihatod diri.” - To replace - Patient
range - Encourage
fluid loss from interacts
adequate
- Improved the body and
Objective: intake of
skin integrity - To keep communicat
Vital Signs: fluid at least
and mucous mouth moist es well and
Vital signs: 2,000 to
membrane and help started to
T= 38.8 C 3,000 ml if
PR= 159 bpm improve answer
not
HR= 24 cpm appetite questions
contraindicat
- As data
- Patient ed
supporting a
- Assess skin
appears to be change of less
turgor
weak and nutritional

71
 sluggish needs
- Skin is dry - To maintain
and ashy - Teach adequacy and
- Lips are patient and quality of
chapped significant intake of
- Prefers to lay other about nutrients
in bed rather nutritious needed
than sitting food
up
- Speaks with
low voice and
rarely
answers
questions
being asked
- Nods no when
food is being
offered

72
 Related Articles
Bortolussi, R, Finlay, J, Robinson, J, Lang, M. (2012) Urinary tract infections in infants and children: diagnosis and
management. Pediatrics Child Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173959/

Recent studies have resulted in major changes in the management of urinary tract infections (UTIs) in children. The present
statement focuses on the diagnosis and management of infants and children >2 months of age with an acute UTI and no
known underlying urinary tract pathology or risk factors for a neurogenic bladder. UTI should be ruled out in preverbal
children with unexplained fever and in older children with symptoms suggestive of UTI (dysuria, urinary frequency,
hematuria, abdominal pain, back pain or new daytime incontinence). A midstream urine sample should be collected for
urinalysis and culture in toilet-trained children; others should have urine collected by catheter or by suprapubic aspirate.
UTI is unlikely if the urinalysis is completely normal. A bagged urine sample may be used for urinalysis but should not be
used for urine culture. Antibiotic treatment for seven to 10 days is recommended for febrile UTI. Oral antibiotics may be
offered as initial treatment when the child is not seriously ill and is likely to receive and tolerate every dose. Children <2 years
of age should be investigated after their first febrile UTI with a renal/bladder ultrasound to identify any significant renal

73
abnormalities. A voiding cystourethrogram is not required for children with a first UTI unless the renal/bladder ultrasound
reveals findings suggestive of vesicoureteral reflux, selected renal anomalies or obstructive uropathy.

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Hasan, S., Jamdar, S., Alalawi., Beaiji, S. (2016). Dengue virus: A global human threat: review of literature. Journal of

International Society of Preventive & Community Dentistry. Retrieved from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4784057/

Dengue is an acute viral illness caused by RNA virus of the family Flaviviridae and spread by Aedes mosquitoes. Presenting

features may range from asymptomatic fever to dreaded complications such as hemorrhagic fever and shock. A cute-onset

high fever, muscle and joint pain, myalgia, cutaneous rash, hemorrhagic episodes, and circulatory shock are the commonly

seen symptoms. Oral manifestations are rare in dengue infection; however, some cases may have oral features as the only

presenting manifestation. Early and accurate diagnosis is critical to reduce mortality. Although dengue virus infections are

usually self-limiting, dengue infection has come up as a public health challenge in the tropical and subtropical nations.

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management. Pediatrics Child Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173959/
Hasan, S., Jamdar, S., Alalawi., Beaiji, S. (2016). Dengue virus: A global human threat: review of literature. Journal of
International Society of Preventive & Community Dentistry. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4784057/
Hinkle, J., Cheever. (2014). Medical surgical nursing. (13th ed). Philadelphia, PA: Lippincott Williams & Wilkins.

Lewis, S., Dirksen, S., Heitkemper, M. (2014). Medical – surgical nursing: assessment and management of clinical problem. St.
Louis, Missouri: Elsevier Inc.
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Porth, C., Matfin. (2009). Pathophysiology concepts of altered health states. (8th ed). Philadelphia, PA: Lippincott Williams &
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Porth, C. (2005). Pathophysiology concepts of altered health states (7 th ed). Philadelphia, PA: Lippincott Williams & Wilkins.
WHO Library Cataloguing-in-Publication Data. (2012). Handbook for clinical management of dengue. Retrieved from:
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