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I.
INTRODUCTION
A. OVERVIEW
Dengue is a mosquito-borne disease cause by any one of four closely related

dengue viruses (DENV -1,-2,-3 and -4). Infection with one serotype of DENV provides
immunity to that serotype for life, but provides no long-term immunity to other
serotypes. Thus, a person can be infected as many as four times, once with each
serotype.
Dengue Hemorrhagic Fever, also known as Severe Dengue, was first recognized
in the 1950s during dengue epidemics in the Philippines and Thailand. Today, severe
dengue affects most Asian and Latin American countries and has become a leading
cause of hospitalization and death among children in these regions. Typical cases of
DHF are characterized by four major clinical manifestations: high fever, hemorrhagic
phenomena, and often, hepatomegaly and circulatory failure.
Infected humans are the main carriers and multipliers of the virus, serving as as
source of the virus for uninfected mosquitoes. Patients who are already infected with the
dengue virus can transmit the infection (4-5 days, maximum 12) via Aedes mosquitoes
after their first symptoms appear.
Reference: World Health Organization (WHO) 2011. Retrieved from: http://who.int.com
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Mode of Transmission
1. Bite of an infected mosquito, principally the Aedes Aegypti.

a. Aedes aegypti is a day-biting mosquito (they appear two hours after sunrise
and two hours before sunset).
b. It breeds in an areas of stagnant water.
c. It has limited, low flying movement.
d. It has fine whole dots at the base of the wings and white bands on the legs.
2. Aedes Albopictus may contribute to the transmission of the dengue virus in rural
areas.
3. Other contributory mosquitoes:
a. Aedes polynensis
b. Aedes scutellaris simplex
Incubation Period
The incubation period is 3-14 days; commonly 7-10 days.
Period of Communicability
1. Patients are usually infective to the mosquito from a day before the febrile period
to the end of it.
2. The mosquito becomes infective from day 8 to 12 after the blood meal and
remains infective throughout its life.
Sources of Infection
1. Infected persons- the virus is present in the blood of patients during the acute
phase of the disease and will become a reservoir of the virus, sucked by
mosquitoes, which may then transmit the disease.
2. Standing water- any stagnant water in the household and its premises are usual
breeding places of these mosquitoes.
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Dengue Hemorrhagic Fever (DHF)
This severe form of dengue virus infection id manifested by fever, hemorrhagic,

diathesis, hepatomegaly and hypovolemic shock.
Classification According to Severity
Grade 1
There is fever accompanied with non-specific constitutional symptoms and the
only hemorrhagic manifestations is positive (+) in the tourniquet test.
Grade 2
All signs of Grade 1, plus spontaneous bleeding from the nose, gums,, and GIT,
are present.
Grade 3
There is the presence of circulatory failure, as manifested by a weak pulse, narrow
pulse pressure, hypotension, cold, clammy skin, and restlessness.
Grade 4
There is profound shock, and undetectable blood pressure and pulse.
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Complications
1. Dengue Fever
a. Epistaxis; menorrhagia
b. Gastrointestinal bleeding
c. Concomitant gastrointestinal disorder (peptic ulcer)
2. DHF
a. Metabolic acidosis
b. Hyperkalemia
c. Tissue anoxia
d. Hemorrhage into the CNS or adrenal glands
e. Uterine bleeding may occur
f. Myocarditis
3. Severe manifestations
Dengue encephalopathy is manifested by increasing restlessness, apprehension or
anxiety, disturbed sensorium, convulsions, spacity, and hyporeflexia.
Reference: Handbook of Common Communicable and Infectious Disease, 3 rd edition;Dionesia Mondejar-NavalesRN. Maed, p. 71-73
Vaccine
Dengvaxia, world’s first dengue vaccine was approved in Mexico. The Federal
Commission for the Protection against Sanitary Risks (COFEPRIS) has approved
Dengvaxia®, tetravalent dengue vaccine, for the prevention of disease caused by all four
dengue virus serotypes in preadolescents, adolescents and adults, 9 to 45 years of age
living in endemic areas.
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It took the multinational pharmaceutical company Sanofi Pasteur more than 20
years to develop the vaccine with clinical trials in five Asian and five Latin American
countries where dengue is endemic.
The vaccine was launched in the Philippines since it was the only country where
all three phases of the clinical development were conducted.
Health authorities said the vaccine will have side effects, including fever,
headache, muscle pain, weakness, redness and swelling.
The DOH also said that the medical breakthrough is no excuse to stop the fight
against dengue. Communities should work towards prevention by cleaning possible
mosquito breeding sites.
Health Secretary Janette Garin said the agency would get a discounted price for
the vaccine that would be used in the vaccination program starting March.
The DOH will begin vaccinating Grade 4 students in public schools in Metro
Manila, and in Southern and Central Luzon. The vaccine will be given in three doses,
with six-month intervals.
It will give the vaccine to over a million students this year but the health
department is planning to hold a nationwide vaccination on 2017.
Reference: http://www.sanofipasteur.com/en/articles/dengvaxia-world-s-first-dengue-vaccine-approved-in-mexico.aspx; Lyon, France
- December 9, 2015
B. STATISTICS
Local
The number of dengue cases in the country spiked from around 120,000 in 2014
to over 200,000 in 2015.
Despite the sharp increase in dengue cases, the Department of Health (DOH) said
there was no corresponding increase in the number of deaths--with 598 in 2015 compared
to 465 in 2014.
The DOH estimated that some 220 Filipinos a day may be infected by the disease.
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Reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222740/ Lulu Bravo ,* Vito G. Roque, Jeremy Brett , Ruby
Dizon, and Maïna L'Azou, 2014 Nov 6
International
The incidence of dengue has grown dramatically around the world in recent
decades. The actual numbers of dengue cases are underreported and many cases are
misclassified. One recent estimate indicates 390 million dengue infections per year (95%
credible interval 284–528 million), of which 96 million (67–136 million) manifest
clinically (with any severity of disease). Another study, of the prevalence of dengue,
estimates that 3900 million people, in 128 countries, are at risk of infection with dengue
viruses.
Member States in 3 WHO regions regularly report the annual number of cases. In
2010, nearly 2.4 million cases were reported. Although the full global burden of the
disease is uncertain, the initiation of activities to record all dengue cases partly explains
the sharp increase in the number of cases reported in recent years.
Other features of the disease include its epidemiological patterns, including
hyper-endemicity of multiple dengue virus serotypes in many countries and the alarming
impact on both human health and the global and national economies.
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Cases across the Americas, South-East Asia and Western Pacific exceeded 1.2
million in 2008 and over 3 million in 2013 (based on official data submitted by Member
States). Recently the number of reported cases has continued to increase. In 2013, 2.35
million cases of dengue were reported in the Americas alone, of which 37 687 cases
were of severe dengue.
Reference: http://www.who.int/mediacentre/factsheets/fs117/en/ May, 2015
C. SCOPE AND LIMITATION
We handled our patient last January 30, 2016 on our 6am to 2pm shift, bed #15,
Female-Ward at Laguna Medical Center under the supervision of Gloria Ramos,
Ph.D,MAN, RN.
We received the patient lying on bed with IVF Sodium Chloride 0.9 1 L on right
metacarpal vein. The exposure of our duty comprised Nurse-Patient-Interaction, Head-
to-Toe Assessment, IV regulation, vital signs monitoring and recording, drug
administration via oral route, IV drug medication study and charting.
To have further assessment, our group conducted a home visit on February 25,
2015 in the residence of Patient DLB in Lumban, Laguna. First and foremost, we asked
consent and stated the purpose of the home visit. As we gathered data and information
about the patient and his progress, the patient as well as the family members participated
and cooperated hospitably.
D. OBJECTIVES
General Objective:
At the end of the case study, the Level III nursing students will be able to
expound and incorporate all the ideas and knowledge gained to the nursing approach in
providing valid and outmost care connected with the patient diagnosed of Dengue
Hemorrhagic Fever.
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Specific Objectives:
As supported by our main objective, the level 3 student nurses will be able to:
1. Familiarize with the background of what Dengue Hemorrhagic Fever is all about;
2. Recognize predisposing and precipitating factors that may increase the development
of Dengue Hemorrhagic Fever;
3. Review and understand the Anatomy and Physiology of the Circulatory system and
Lymphatic system.
4. Explain and illustrate the pathophysiology of Dengue Hemorrhagic Fever;
5. Determine what specific laboratory results that may lead to Dengue Hemorrhagic
Fever;
6. Describe the potential complications related to Dengue Hemorrhagic Fever;
7. Develop a comprehensive nursing care plan, with a principle of SMART, that is

applicable to the client diagnosed with Dengue Hemorrhagic Fever;
8. Provide a well-develop Health Teaching using the METHODS formula to

promote positive continuity of care to the patient after discharge which would be in great
help for his continuity of care to the patient after discharge which would be in
great help for his condition.
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II. PATIENT’S PROFILE
Hospital Number: 137170

Patient’s Name: Patient DLB
Address: Segundo Pulo, Lumban, Laguna
Gender: Male
Birthday: 11/22/2001
Age: 14 y/o
Birthplace: Lumban, Laguna
Nationality: Filipino
Civil Status: Single
Religion: Roman Catholic
Educational Level: Grade 8
Allergies: (+) Penicillin
Admitting Time: 6:30am

Admitting Date: 01/29/16
Admitting Diagnosis: Severe Dengue
Admitting Physician: Dra. Abadier
Chief Complaint: Epistaxis, headache, nausea and vomiting

and body malaise
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III. PATIENT’S HISTORY
A. Past History
According to Patient DLB, he had experienced cough, cold, fever and

chicken pox before. He has no history of hospitalization but seeks medical
advice to clinics in their barangay and other clinic to the near towns.
B. Present History
 5 days prior to admission, the patient experienced on and off fever. The
patient drinks tawa-tawa extract and antipyretic medications like biogesic and
tempra to relieve fever.
 After a day, when the patient is still with fever, the patient decided to seek
medical attention in a small Clinic in Unson. They checked the platelet count
which is 187 X10/L and blood pressure of 100/80mmHg. Then he was given a
prescribed medication of Biogesic 500mg for his fever.
 Two days prior to hospitalization, the patient is still with fever. He consults to
his paediatrician, Dra. Aquino and checked again for the platelet count that
has a result of 24 x10/L so he was advised to go to the hospital.
 One day prior to admission, the patient was experiencing fever, loss of
appetite and epistaxis so the family decided to take him to Laguna Medical
Center, Sta. Cruz, Laguna.
 January 29, 2016, at 6:30am he was admitted with a diagnosis of Severe
Dengue by attending physician Dra. Abadier with a blood pressure of
100/78mmHg.
Patient’s vital signs during our shift whereas follows:

Temperature: 38.2 °c
Pulse Rate: 98 bpm
Respiratory Rate: 20 cpm
Blood Pressure: 100/60 mmHg
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C. Psychological
Patient is unable to answer some of the questions properly because he

cannot recall what happened during hospitalization. Nevertheless, the patient
demonstrates an understanding and acceptance concerning on the health teaching
about the health condition he experienced.
D. Family History
There is no history of dengue cases within patient's family members except

with his two cousins who lived in the same Barangay.
E. Spiritual
Patient DLB’s religious affiliation is Roman Catholic. He stated that their

family do not usually go to church but always pray and ask guidance for them.
F. Sociocultural
The patient consults to hilot as one of their health care provider. Prior to
admission, patient DLB sipped tawa-tawa extract and had self-medication of advil,
biogesic, and tempra as a relieved for fever. He also consults in health care clinic
in their town.
G. Exercise
Patient is usually staying in their bedroom after school and during weekends.
But at times he used to walk in going to school that is about 1km away from their
residence.
H. Nutritional
The patient eats vegetables like radish, cabbage and mongo beans more
often than not. He said that he just consumes what is served by his mother and
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does not usually fond of eating junkfoods or processed foods. He drinks 6-8
glasses of water a day.
I. Developmental
Erik Erikson’s stages of psychosocial development are a comprehensive

psychoanalytic theory that identifies a series of eight stages, in which a healthy
developing individual should pass through infancy to late adulthood. All stages are
present at birth but only begin to unfold according to both natural scheme and one’s
cultural and ecological upbringing. Each stages builds upon the successful completion
of earlier stage.
STAGE DESCRIPTION RESULT JUSTIFICATION
The adolescent is It was attained by The patient

Ages 12 to 18 years
newly concerned the patient. accomplished the
old
with how they ability to settle in the
appear to others. school. He ponders the
Superego identity is roles he wants to do in
the accrued the future. He knows
confidence that the what he wants to do
Identity
outer sameness and and he expresses
Vs.
continuity prepared himself in the way he is
Role Confusion
in the future are known to be. He
matched by the manages to spend time
sameness and with his family and had
continuity of one’s good relationship with
meaning for oneself, his classmates and
as evidenced in the knows his priorities.
promise of a career.
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J. Hygiene
Before Hospitalization During Hospitalization After Hospitalization
Patient takes a bath every The patient is unable to go The patient takes a bath
day before going to school to the bathroom by himself once a day and brushes his
and brushes his teeth twice due to muscle weakness so teeth every morning and
a day. He performs hand the family members prefer before going to bed. He
washing before meal and to perform sponge bath demonstrates hand
he usually eat with the use when he was in the washing with soap and
of spoon and fork instead hospital. He brushed his running water.
of the use of his bare teeth once a day and does
hands. not wash his hands during
hospitalization.
K. Elimination
Urination Urination Urination

The patient voids 5-6 Patient has no urinary Patient voids 5-6 times a
times a day, yellowish in catheter inserted. He voids day, approximately 600ml
color and with moderate 3-4 times per shift, and yellowish in color.
amount. transparent in color and
with an estimated amount Defecation
Defecation of 600 ml. The patient’s stool is light
Patient usually defecate brown in color and formed
twice a day, light brown in Defecation in appearance. He
color and formed in During hospitalization, the defecates twice daily.
appearance. patient defecates 5-6 times
a day, black in color.
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L. Sleep and Rest

Patient is able to sleep at 9 The patient sleeps at 7pm, The patient is able to sleep
in the evening and wakes but wakes up every time with his normal sleeping
up 5 in the morning to he feels tenderness and has pattern and has no
prepare for school. He has uncomfortable sensation. difficulty resting.
adequate rest every day.
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IV. NUTRITIONAL ASSESSMENT
24 hour Food Recall
Before Hospitalization After Hospitalization
1. What time did you go to “I slept as early as 7pm but Patient stated that he sleeps
bed the night before? not continuous, sometimes I at 9pm in the evening.
woke up when I feel
uncomfortable.”
Was this the usual time? “No. I usually go to sleep “Yes.”

around 9pm.”
2. What time did you get “Around 8am.” “I woke up 6 in the

up yesterday? morning.”
Was this the usual time? “No. I usually wake up

earlier.” “Yes, it is.”
When was the first time “At lunch time.”

you had anything to eat “I had my breakfast at
or drink? 6:30am.”
What did you have and “Just a piece of biscuit and

how much? sipped as small amount of “I ate a cup of rice and one
water. hotdog.”
3. When did you eat again? “The next meal was my “I ate my snack at 10am.”
dinner.”
4. Where? “In our house.” “In our house.”
What and how much? “I drink a half glass of “I had 3 pieces of bread and
water and one spoonful of one glass of ice tea.”
rice with egg pugo.”
5. When did you eat next? “At 10 pm.” “Lunchtime.”
What did you eat and “A piece of tasty.” “1 ½ cup of rice and
how much? sinigang.”
6. Did you eat or drink “I had a glass of water and “Yes. I ate at 6:30 in the
anything else? half bottle of gatorade.” evening.”
a. Anything from 1st “None.” “I drink a glass of water
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meal to 2nd meal? about 150ml.”
b. Anything from 2nd to “None.” “I drink a half glass of

3rd meal? water.”
c. Anything from 3rd “None.”
meal to bed time? “I had a glass of water.”
7. Was this day’s food “Yes.” “No.”

intake differing from
usual?
“I lose my appetite and feel
If so, why? nauseated every time I eat.”
8. Is weekend eating “Sometimes.” “At times.”

different?
If so, why? “It depends on what food is “It depends on what food is
available in our house.” available in our house.”
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V. PHYSICAL ASSESSMENT
Area Method Findings Post-Findings Interpretation

Hair Inspection Hair is black Hair is black and Normal
and equally equally
distributed distributed
Palpation No signs of No signs of Normal
tenderness and tenderness and
nodules while nodules while
palpating palpating
Skin Inspection Generalized Dengue virus induces bone
pallor marrow suppression. Since bone
marrow is the manufacturing
center of blood cells its
suppression causes deficiency
of blood cells leading to low
hemoglobin count.
Paleness is caused by reduced

blood flow or a decreased
number of red blood cells.
Reference: K. Kafeel (2011). Retrieved from:

http://www.onlymyhealth.com/cause-low-
platelet-count-in-dengue-fever-1301653922
The presence of the virus

Presence of (arbovirus) within the blood
hematoma on vessels, especially those feeding
the upper right the skin, causes changes to
arm these blood vessels. The vessels
swell and leak because of
increase capillary permeability.
As the blood vessels become
more damaged the blood vessels
start to leak. When blood leaves
the circulatory system and
becomes stagnant, there is
almost immediate clotting.
Reference: C. Dewit. Dengue Fever (2006).

Retrieved from:
http://www.encyclopedia.com/topic/dengue_fev
er.aspx
C. Davis. Hematoma (2015). Retrieved from:
http://www.emedicinehealth.com/hematoma/pag
e2_em.htm
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Palpation Warm to touch With moist skin Warm to touch because of the
and with good body’s compensation to the
skin turgor virus.
The patient’s body temperature
was 38.2 °c.
Reference: W. Lloyd. (2013). Retrieved from:
http://www.healthgrades.com/symptoms/clamm
y-skin
Nails Inspection Nail surface is Nail surface is Normal
slightly curved slightly curved
No clubbed No clubbed
finger finger
Palpation Capillary refill Capillary refill Damage to an artery or vein
of more than 3 of less than 3 sec allows blood to escape the
sec With pinkish nail circulatory system. Thus, a low
beds hemoglobin count cause
With pale nail alteration in blood flow.
beds
Eyes Inspection With pale With moist and Damage to an artery or vein
conjunctiva pinkish allows blood to escape the
conjunctiva circulatory system. Thus, a low
Pupil Equally Pupil Equally hemoglobin count cause
Round Reactive Round Reactive alteration in blood flow.
to Light and to Light and
Accommodatio Accommodation
n With equally
With equally distributed eye
distributed eye lid and eye
lid and eye lashes
lashes
Palpation No signs No signs Normal
tenderness tenderness when
when palpating palpating
Ears Inspection Symmetrical, Symmetrical, no Normal
no presence of presence of
discharge or discharge or
redness redness
Can react to Can react to
sound sound
No presence of No presence of
cerumen cerumen
Palpation No tenderness No tenderness Normal
and nodules and nodules
Nose Inspection No nasal No nasal Normal
and discharge discharge
Sinuses No redness and No redness and
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inflammation inflammation
No nasal No nasal
deviation deviation
Palpation No tenderness No tenderness Normal
upon palpation upon palpation
Mouth Inspection Dry lips Moist and If the amount of fluid in the
pinkish mucus intravascular space is decreased,
membrane the body compensates. (fluid
Can able to depletion)
move the tongue
With pale in all direction Damage to an artery or vein
palate Uvula is at the allows blood to escape the
midline circulatory system. Low
Can able to hemoglobin count cause
move the alteration in blood flow.
tongue in all
direction
Uvula is at the
midline
No presence of
inflammation in
oral mucosa
Palpation No tenderness No presence of Normal
when palpating inflammation in
for the soft and oral mucosa
hard palate No tenderness
With intact gag when palpating
reflex for the soft and
hard palate
With intact gag
reflex
Neck Inspection No swelling and No swelling and Normal
no venous no venous
distention distention
Palpation No masses No masses Normal
lymph nodes lymph nodes and
and thyroid thyroid gland
gland enlargement
enlargement
Lungs Inspection symmetrical symmetrical Normal

and anterior chest anterior chest
Thorax wall wall
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With no With no signs of Normal
difficulty of difficulty of
breathing breathing
Percussion Resonance in Resonance in Normal
sound sound
Auscultation With clear With clear Normal
breath sounds breath sounds
With Systolic of With systolic of Normal
100 mmHg and 120 mmHg and
Diastolic of Diastolic of 80
60mmHg mmHg
Abdom Inspection No abdominal No abdominal Normal
en distention with distention with
no signs of no signs of
tenderness or tenderness or
masses masses
Auscultation Bowel sound Bowel sounds Normal
heard heard
RLQ= 7 RLQ= 5
RUQ= 6 RUQ= 7
LUQ= 9 LUQ= 5
LLQ= 8 LLQ= 9
Percussion With tympanic With tympanic Normal
Palpation Abdomen is Abdomen is soft Normal
soft With no signs of
With no signs tenderness or
of tenderness or masses
masses
Muscle Inspection Able to obey Able to obey The dengue virus causes of
command command measurable muscle weakness.
and Palpation
muscle strength The muscle can move the joint
muscle of 5/5 it crosses through a full range of
strength of 4/5 motion against gravity moderate
resistance.
Extremi Inspection Presence of Has no signs of It caused by capillary fragility.
petechiae in lesions The blood vessels start to leak
ties
upper and and cause bleeding. Petechiae
lower
(small skin hemorrhages).
extremities
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VI. ANATOMY AND PHYSIOLOGY
Blood
Blood is made up of liquid (called plasma) and solid cells. Blood cells are made in
the bone marrow. Bone marrow is the soft, spongy substance in the centre of bones.
Structure
In adults, the most active bone marrow is found in the pelvic bone, shoulder
bones, back bones (vertebra), ribs, breast bone and skull. Immature blood cells in the
bone marrow are called stem cells. Stem cells can also be found in smaller amounts in the
bloodstream. These are called peripheral blood stem cells.
All of our blood cells develop from stem cells. The process of blood cell
development is called hematopoiesis. In the earliest stage of blood cell development,
stem cells begin to develop either along the lymphoid cell line or the myeloid cell line. In
both cell lines, the stem cells become blasts, which are still immature cells.
Lymphoid cell line

Lymphoid stem cells develop into lymphocytes (also called lymphoblasts).
Lymphocytes are another type of white blood cell (also called leukocytes). Lymphocytes
help fight infection and destroy abnormal cells.
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Myeloid cell line
Myeloid stem cells develop into red blood cells, platelets and some types of white
blood cells. Red blood cells carry oxygen to all tissues of the body. Platelets form clots in
damaged blood vessels to stop bleeding.
Myeloid stem cells develop into 2 different types of white blood cells, called
granulocytes and monocytes. These white blood cells destroy bacteria and other foreign
invaders and help to fight infection.
Functions
The main function of blood is to carry nutrients, gases, waste products, cells and
hormones. Each type of blood cell has a specific job.
 Red blood cells carry oxygen from the lungs to the rest of the body. They also
carry carbon dioxide from the body to the lungs so it can be breathed out.
 Platelets form blood clots in damaged vessels to stop bleeding.
 White blood cells help prevent and fight infection by destroying bacteria, viruses
and other foreign cells or substances.
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Types of white blood cells
White blood cells are the cells that help the body fight infection. There are a
number of different types and sub-types of white blood cells which each have different
roles to play.
The three major types of white blood cells are:
 Granulocytes
 Monocytes
 Lymphocytes
Granulocytes
There are three different forms of granulocytes:
 Neutrophils
 Eosinophils
 Basophils
Granulocytes are phagocytes, that is they are able to ingest foreign cells such as
bacteria, viruses and other parasites.
Granulocytes are so called because these cells have granules of enzymes which help to
digest the invading microbes. Granulocytes account for about 60% of our white blood
cells.
Neutrophils are by far the most prevalent of these cells. Each neutrophil cell can
ingest up to between around 5 and 20 bacteria in its lifetime.
Eosinophils are involved in allergic reactions and can attack multicellular
parasites such as worms.
Basophils are also involved in allergic reactions and are able to release histamine,
which helps to trigger inflammation, and heparin, which prevents blood from clotting.
Monocytes
Monocytes can develop into two types of cell:
Dendritic cells are antigen-presenting cells which are able to mark out cells that are
antigens (foreign bodies) that need to be destroyed by lymphocytes.
Macrophages are phagocyte cells which are larger and live longer than neutrophils.
Macrophages are also able to act as antigen-presenting cells.
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Lymphocytes
Lymphocytes are cells which help to regulate the body's immune system.
The main types of lymphocytes are:
 B lymphocytes (B cells)
 T lymphocytes (T cells)
 Natural Killer Cells
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VII. PATHOPHYSIOLOGY
Precipitating Factors
Predisposing Factors
 Environmental conditions (open
 Geographical area-tropical island
spaces with water)
in the Pacific (Philippines)  Presence of 2 Dengue cases in
the community
Aedes Mosquito
(Carrier of Dengue Virus)
Bite from mosquito to skin

(Portal of Entry)
Virus will circulate in the

blood
Infection primarily targets

the reticulo endothelial
system (blood,bone
marrow, lymph nodes)
Production of immune
mediators Release of cytokines
Activation of immune Stimulate WBC and

response Pyrogens
Destructive actions of the virus or Fever 38.2°C

Viral replication and
Cellular destruction bone marrow precursor cells
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Muscle
weakness
4/5
Thrombocytopenia Lymphopenia Leukopenia

Platelet Count=38x109 /L Lymphocytes=2.29 % WBC=3.83 x 109 /L
Low Low Low
Capillary fragility Petechiae
Hemoglobin=86
Epistaxis g/L
RBC=2.69x 1012 /L
Hematocrit=23.9 %
GI
Bleeding
↑ Capilliary
Release of Histamine Melena
permeability
↑ Glomerular
Permeabilty
Plasma leakage
↑ Amount of
plasma protein
DENGUE HEMORRHGIC
FEVER
Urinalysis Result:
(+) 4 protein
2-4 hpf RBC
Few Bacteria
URINARY TRACT INFECTION
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VIII. MEDICAL MANAGEMENT
Date Doctor’s Order Interpretation

Day 1  Please admit to  Hospital policy designates the exact
January 29, 2016, medicine ward procedure that should be followed when
6:30 am admitting the patient to the holding area or
operating room suite. Admission will help
Epistaxis to monitor the client’s condition. The
Dengue admitting procedure is continued with
Hemorrhagic reassessment of the patient and allowance of
fever time for last minute question. (references:
Typhoid fever M edical-Surgical Nursing 5th edition by Lewis,
Heitkemper &Dirksen Chapter 17, page 380)
4:00 pm  Secure consent  Informed consent is the patient’s

(+) epistaxis
autonomous decision about whether to
undergo a procedure. Before signing the
consent, the risks and benefits of the
procedure must be explained in terms the
patient could easily understand. This is to
prepare patient psychologically and the
health care workers from battery. (references:
M aternal and Child Health Nursing 6th edition by Adelle
Pilliteri Chapter 24, page 658 and Brunner & Suddarth’s
Textbook of M edical-Surgical Nursing 13th edition by
Janice L. Hinkle & Kerry H. Cheever Chapter 17 page
406)
 TPR every shift  The recording of Temperature, Pulse rate,

and Respiration are part of physical
examination. Acute changes and trends over
time are documented and unexpected
changes and values that deviate significantly
from a patient’s normal values are brought
to the attention of the patient’s primary
health care provider. (references: Brunner &
Suddarth’s Textbook of M edical-Surgical Nursing 13th
edition by Janice L. Hinkle & Kerry H. Cheever Chapter 5
page 67)
 Dark colored foods may alter the color of

 DAT except dark the stool of the patient. It is advice to patient
colored food which will undergo fecalysis exam to
determine Blood Occult in the stools.
Highly colored foods, dark green leafy
vegetables and Iron supplements are
avoided as these tend to interfere with the
Page | 27
test. (reference: Nutrition and Diet Therapy
for Nursing
2011 by Adela Jamorabo-Ruiz Chapter 13 page 301-302)
TVF:
 D5LR 1L × 60
gtts/min × 2  D5LR is an hypertonic solution that is
cycles given to prevent dehydration. Dengue is a
disease of DEHYDRATION. Much like a
Diarrhea except that the body fluids don’t
come out with the patient’s stool but
through PLASMA LEAKAGE. Imagine
that the arteries and veins of a patient have
thousands of pinpoint holes due to the
body's reaction to the Dengue virus,
causing the fluids inside the blood vessels
to sip out. (reference: Fundamentals of Nursing 8th
edition of 2008 Volume 2 by Snyder, Berman, Kozier
and Erb Chapter 52 Fluid, Electrolyte and Acid – Base
Balance page 1456)
Laboratories:
 Complete blood  CBC is done to the patient to test if there is
count with PC, blood loss. To look for low platelet count
typing typical of the later stages of the illness and
to detect the decrease in hemoglobin,
hematocrit, and red blood cell (RBC) count
(evidence of anemia) that would occur with
blood loss associated with severe dengue
fever. (references: cell medicine, 24th edition by
Golman and Schater page 345)
 Urinalysis is done to the patient to detect

 Urine analysis
possible abnormalities in the urinary tract.
It is ordered to determine presence of
bacteria or blood (hematuria) in the urine
of the patient.( reference:M edical Surgical Nursing
8th edition volume 2, Chapter 45 Urinary System page
1150 )
 Hematocrit  A blood sample's hematocrit or the red

monitoring at blood cell volume percentage, and become
every 6 hours a point of reference of its capability of
delivering oxygen. The patient’s
hematology result of Hct: 37.1 % as of 01-
29-2016. (reference: retrieved from
https://en.wikipedia.org/wiki/Hematocrit )
Page | 28
Medications:
 Ascorbic acid 500  Supplemental therapy in some GI diseases,
mg 1 tab BID during long term parenteral nutrition.
Increases protection
mechanism of the immune system thus,
resistance to infection. (Reference: Davis’s Drug
Guide for Nurses fifth edition 2010 (ascorbic acid, page
105)
 Inhibits activation of plasminogen thereby

 Tranexamic acid
preventing the conversion of plasminogen
500 mg TIV
to plasmin.
every 8 hours x 3
Treatment for bleeding. Patient
days
experienced epistaxis and melena. Reference:
Davis’s Drug Guide for Nurses fifth edition
2010(tranexamic acid, page 1179)
 For transfusion of  Platelet transfusions are used to prevent

platelet 6 units spontaneous bleeding or to stop established
properly typed bleeding in patients with a deficiency in
and cross matched platelet number or function. In Dengue
patients, transfusion is done when platelet
count is 10000-20000/ul and
thrombocytopenic bleeding is present. All
the patients of Dengue Shock syndrome
require platelet support. The patient’s
platelet revealed 8x 109 /L as of 01-29-
2016 and positive for epistaxis. Doctors
use blood typing and cross matching to
make sure that the patient receiving a blood
transfusion is getting the correct type of
blood. Crossmatching is used by a doctor
to make sure that the specific donor blood
that will be used during a transfusion does
not react with a patient’s blood.
(reference:http://ijtm.in/view_article.php?id=21)
 If platelet  Plasma contains all of the coagulation

concentrate not factors. Fresh frozen plasma (FFP) infusion
cross matched can be used for reversal of anticoagulant
may transfused effects. Plasma transfusion is
FFP 4 units recommended in patients with active
bleeding. The patient experienced nose
bleeding. FFP does not need to be cross-
matched but should be ABO compatible.
(reference:
http://www.aafp.org/afp/2011/0315/p719.html)
Page | 29
 Godex 1 cap 300  To prevent damage to liver, one of the
mg PO BID complication of DHF. Godex acts by
transporting excess, long-chain fatty acids
into the mitochondria to produce high
amounts of energy to produce high
amounts of energy to provide cell
protection and fast treatment of liver
disease.(http://www.mergersdrugfil.com.ph/index.php
/godex-ds )
 Omeprazole 40  Treatment and prevention of

mg TIV OD hypersecretions of stomach acid.
Omeprazole is used to prevent upper
gastrointestinal tract bleeding. Due to
patient’s lost appetite with DHF it will
cause abdominal pain. (retrieve from
:http://www.mayoclinic.org/drugs-
supplements/omeprazole-oral-route/description/drg-
2006683)
 Ceftriaxone 1g  To treat infection. Interferes with bacterial

TIV every 12 cell wall synthesis by inhibiting cross-
hours linking of peptidoglycan strands.
Peptidoglycan makes the cell membrane
rigid and protective. Without it, bacterial
cells rupture and die. The patient’s
urinalysis revealed a presence of few
bacteria in urine as of Jan. 31, 2016.
(reference : Jones and Bartlett Nurse’s Drug Handbook
2015 (ceftriaxone page 223)
 Intake and output  Accurate intake and output is necessary for

every shift determining fluid replacement needs and
reducing risk of fluid overload and reflects
circulating fluid shifts, and response to
therapy. Dengue Hemorrhagic Fever can
cause fluid shifting from intracellular spaces
to intravascular space that leads to
dehydration. (references: Nursing Care Plan 8th edition
of 2010 by M arlynn E. Doenges Capter 10 page 542)
Page | 30
 Vital sign every 1  The vital signs are body temperature,
hour and record pulse, respirations and blood pressure,
which should be looked at in total, are
checked to monitor the function of the
body which may alter the normal function
of the body.(Reference: Fundamentals of Nursing 8th
Edition of 2008 Volume 1 by Berman, Snyder, Kozier
and Erb Chapter 29 Vital signs page. 527)
 For close  The vital signs are body temperature,

monitoring pulse, respirations and blood pressure,
which should be looked at in total, are
checked to monitor the function of the
of the body. Since the patient’s blood count
Notify Dra. especially the hemoglobin and platelet is
Abralzado decreasing he needs more attentive care.
(Reference: Fundamentals of Nursing 8th Edition of 2008
Refer Volume 1 by Berman, Snyder, Kozier and Erb Chapter 29
Vital signs page. 527)
 D5LR is an hypertonic solution that is

 IVF to following given to prevent dehydration. Dengue is a
D5LR 1L x 70 disease of DEHYDRATION. Much like a
gtts/min x 2 cycles Diarrhea except that the body fluids don’t
Balance page 1456)
 Give  Management for Dengue shock syndrome.

Hydrocortisone Corticosteroids are potent anti-
250 mg IV now inflammatory agents that have a wide
range of effects on immunological
processes and have found use in a broad
spectrum of diseases (Reference : Jones and
Bartlett Nurse’s Drug Handbook 2015( hydrocortisone
page 256)
Day 2  Diphenhydramine  To prevent allergic reaction after blood

January 30, 2016 50 mg TIV now transfusion. Acts on blood vessels, GI,
3:00 am respiratory system by competing with
Page | 31
histamine for 𝐻1 –receptor site; decreases
BP 100/70 allergic response by blocking histamine.
PR 86 (Reference : Jones and Bartlett Nurse’s Drug Handbook
2015 ( diphenhydramine page 325)
RR 21
(-) PC  Hydrocortisone  Management for Dengue shock syndrome.
10:00 am 100 mg TIV now
(+) black stool Corticosteroids are potent anti-
2:00 pm epistaxis inflammatory agents that have a wide
range of effects on immunological
4:00 pm processes and have found use in a broad
Severe dengue spectrum of diseases (Reference : Jones and
Bartlett Nurse’s Drug Handbook 2015( hydrocortisone
Restless page 256)
(+) epistaxis
(+) petechia
(+) hematoma  Secure and  Platelet transfusions are used to prevent
right forearm transfuse 5 units spontaneous bleeding or to stop established
Poor pulse platelet properly bleeding in patients with a deficiency in
(+) epigastric typed platelet number or function. In Dengue
tenderness patients, transfusion is done when platelet
Clear breath count is 10000-20000/ul and
sounds thrombocytopenic bleeding is present. All
the patients of Dengue Shock syndrome
6:00 pm require platelet support. Doctors use blood
BP 126/79 typing to make sure that the patient
O2sat 99% receiving a blood transfusion is getting the
Full pulses correct type of blood.
(reference:http://ijtm.in/view_article.php?id=21)
 Secure and  Platelet transfusions are used to prevent

transfuse either 5 spontaneous bleeding or to stop established
units Platelet bleeding in patients with a deficiency in
Concentrate or 5 platelet number or function. On the other
units Fresh Frozen hand,. Fresh frozen plasma (FFP) infusion
Plasma can be used for reversal of anticoagulant
(whichever is effects. Plasma transfusion is
available) recommended in patients with active
properly typed bleeding. The patient experienced nose
and cross bleeding and presence of blood in the stool.
(reference:http://ijtm.in/view_article.php?id=21,
matched) http://www.aafp.org/afp/2011/0315/p719.html)
 Regulate  To prevent dehydration causes by Dengue

accurately present virus.
hydration rate
Page | 32
 Facilitate  Paracetamol is an antipyretics use to
paracetamol IV decreases fever by inhibiting the effects of
150mg/ml PRN pyrogens on the hypothalamus heat
fever regulating centers & by a hypothalamic
action leading to sweating &
vasodilatation. (reference: retrieved from
https://www.scribd.com/doc/36795690/Drug-Study-
Paracetamol)
 Tepid sponge bath  Tepid sponge bath is considered as one of

care out the best cooling treatments. This method is
companion
recommended for febrile individuals,
(please facilitate) especially those with fever ranging from
102.2F or higher. It is effective in relieving
fever by reducing high temperature and
also helpful in alleviating pain
or discomfort. (reference:
https://www.scribd.com/doc/38235959/Tepid-Sponge-
Bath)
 Hook to O2  Administration of oxygen helps increase

support via nasal the percentage of oxygen in inspired air.
canulla x 3 cpm The goal of oxygen administration is to
supply the patient with adequate oxygen to
maximize oxygen carrying ability of the
blood. Patient’s hemoglobin revealed 69
g/L (low). References: M edical Surgical Nursing by
LweisHeitkemper Dirksen, Fifth Edition at pages 689)
 Transfer to ICU  Seriously ill patients require close

please observation and monitoring. Since the
patient’s blood profile is continuously
decreasing the doctor ordered to transfer
him to ICU.
(reference:http://www.cpmc.org/learning/documents/icu-
ws.html)
 Appraised mother  The family should have an accurate

knowledge about the medical condition of
her child to alleviate stress. It allows the
individual to accept and minimize reaction
to difficult situations. (Reference:
http://www.hindawi.com/journals/nrp/2011/392705/)
Page | 33
 IVF to follow  D5LR is an hypertonic solution that is
D5LR 1L x 70gtts given to prevent dehydration. Dengue is a
2 cycles disease of DEHYDRATION. Much like a
Balance page 1456)
 Omeprazole 40  Treatment and prevention of

mg IV OD hypersecretions of stomach acid.
gastrointestinal tract bleeding. Due to
patient’s lost appetite with DHF it will
cause abdominal pain. (retrieve from
2006683)
 Fecalysis with  Since the patient was diagnosed of dengue

occult hemorrhagic fever, these examination finds
out to see if there was melena in the stool
of the patient. ( reference: Brunner and Suddarth’s
Textbook of Medical Surgical Nursing Twelfth Edition by
Smeltzer, Bare, Hinkle and Cheever page 987)
 Tranexamic acid
 Inhibits activation of plasminogen thereby
500g IV run q 8
preventing the conversion of plasminogen
to plasmin.
Treatment for bleeding. Patient
experienced epistaxis and melena.
(Reference: Davis’s Drug Guide for Nurses fifth edition
2010(tranexamic acid, page 1179)
 Vitamin K 1 amp  To treat bleeding.The patient manifested

IV every 8 hours epistaxis and black tarry stool at 2:00 pm
as of Jan. 30, 2016. Required for hepatic
synthesis of blood coagulation factors II
(prothrombin), VII, IX, and X. An
Page | 34
antihemorrhagic actor that promotes
hepatic formation of active prothrombin.
(Reference: Davis’s Drug Guide for Nurses fifth edition 2010
(vitamin K, page 970)
 Used because it has little to no effect on the

 Line no 1L PNSS tissues and make the person feel hydrated
500cc then
preventing hypovolemic shock
maintain at
or hypotension. (reference:
55gtts/min (5 https://www.scribd.com/doc/109761163/PNSS-drug-
cycles) study)
 Line no 2 D5LR  D5LR is an hypertonic solution that is

1L x 55gtts/min given to prevent dehydration. Dengue is a
(5) disease of DEHYDRATION. Much like a
Refer for next to sip out. (reference: Fundamentals of Nursing 8th
IVF and Erb Chapter 52 Fluid, Electrolyte and Acid – Base
Balance page 1456)
 For Fresh Whole  Plasma contains all of the coagulation

Blood transfusion factors. Fresh frozen plasma (FFP) infusion
properly typed can be used for reversal of anticoagulant
and crosmatched effects. Plasma transfusion is
x 5 hrs 2 doses, recommended in patients with active
6hrs bleeding. The patient experienced nose
(reference:
 To prevent fluid overload that may be

 Furosemide 20mg imposed by the additional blood volume
PO every after delivered during transfusion. Inhibits the
Blood transfusion reabsorption of sodium and chloride from
the loop of Henle and distal renal tubule.
(Reference: Davis’s Drug Guide for Nurses fifth edition
2010(Diuretics (Loop), page 392)
 Please monitor  The vital signs are body temperature,
Page | 35
vital sign blood pulse, respirations and blood pressure,
pressure every 1 which should be looked at in total, are
hour and record checked to monitor the function of the
of the body.(Reference: Fundamentals of Nursing 8th
Refer Edition of 2008 Volume 1 by Berman, Snyder, Kozier
and Erb Chapter 29 Vital signs page. 527)
 The PTT is used primarily to investigate

 Hold vitamin K,
unexplained bleeding or clotting. It may be
and do please PT, ordered along with a prothrombin time
PTT
(PT) test to evaluate hemostasis, the
process that the body uses to form blood
clots to help stop bleeding. These tests are
usually the starting points for
investigating excessive bleeding or clotting
disorders. (reference: retrieved from
https://labtestsonline.org/understanding/analytes/aptt/tab/
test/)
 Intake and output  Accurate intake and output is necessary for

every shift determining fluid replacement needs and
reducing risk of fluid overload and reflects
circulating fluid shifts, and response to
therapy. Dengue Hemorrhagic Fever can
cause fluid shifting from intracellular spaces
to intravascular space that leads to
dehydration. (references: Nursing Care Plan 8th edition
of 2010 by M arlynn E. Doenges Capter 10 page 542)
 CBC is done to the patient to test if there is

 Complete blood
count every 8 blood loss. To look for low platelet count
hours typical of the later stages of the illness and
to detect the decrease in hemoglobin,
hematocrit, and red blood cell (RBC) count
(evidence of anemia) that would occur with
blood loss associated with severe dengue
fever. (references: cell medicine, 24th edition by
Golman and Schater page 345)
 Liver function tests are one of the blood

 Please include tests that are performed to assess the
SGPT/SGOT ( function of the liver. Liver damage is
Serum Glutamic detected initially by performing a simple
Pyruvic blood test that determines the level of
Transaminase), various liver enzymes present in the blood.
SGOT ( Serum Liver damage is one of the complication of
Page | 36
Glutamic Dengue Hemorrhagic Fever.(reference:
Oxaloacetic retrieved from http://www.med-health.net/Sgot-Sgpt.html)
Transaminase) on
next CBC
extraction
 Administration of oxygen helps increase

 O2 at 6 cpm via
face mask the percentage of oxygen in inspired air.
The goal of oxygen administration is to
supply the patient with adequate oxygen to
maximize oxygen carrying ability of the
blood. The patient’s hemoglobin revealed
69 g/L (low). (References: M edical Surgical Nursing
by LweisHeitkemper Dirksen, Fifth Edition at pages 689)
 IVF line no. 1  Used because it has little to no effect on the

PNSS at 55 tissues and make the person feel hydrated
gtts/min (5) x 2 preventing hypovolemic shock
https://www.scribd.com/doc/109761163/PNSS-drug-
study)
 D5LR is an hypertonic solution that is

 fused no. 2 D5LR
at 25gtts/min (2) given to prevent dehydration. Dengue is a
x 2 hours disease of DEHYDRATION. Much like a
Refer come out with the patient’s stool but
Balance page 1456)
Day 3  IVF line 1 PNSS  Used because it has little to no effect on the
January 31, 2016 tissues and make the person feel hydrated
at 25gtts/min x
12:29 am preventing hypovolemic shock
(2) x 4 hours
BP 113/62 https://www.scribd.com/doc/109761163/PNSS-drug-
PR 98 study)
T 37.4
O2sat 99% 
 Line 2 D5LR at D5LR is an hypertonic solution that is
Page | 37
(+) mild headache 25gtts/min (2) x 4 given to prevent dehydration. Dengue is a
6:00 am hours disease of DEHYDRATION. Much like a
BP 114/67 Diarrhea except that the body fluids don’t
(-) Bleeding come out with the patient’s stool but
8:00 am
(-) melena
(-) epistaxis that the arteries and veins of a patient have
Awake thousands of pinpoint holes due to the
Confused body's reaction to the Dengue virus,
No epigastric causing the fluids inside the blood vessels
tenderness Refer to sip out. (reference: Fundamentals of Nursing 8th
Full pulse edition of 2008 Volume 2 by Snyder, Berman, Kozier
Clear breath sounds Balance page 1456)
10:00 pm
Coherent
Full pulse  Paracetamol 1  Paracetamol is an antipyretics use to
No epistaxis amp 150mg/ml decreases fever by inhibiting the effects of
IV every 4 hours pyrogens on the hypothalamus heat
regulating centers & by a hypothalamic
Paracetamol)

 Continue present For supportive Drug; supports body
function until other treatments or the
management
body’s treatments or body’s response can
take over; because medication is a
substance administered for the diagnosis,
cure treatment or relief of symptoms of for
prevention of disease. (Reference: Fundamentals
of Nursing 8th Edition of 2008 by Berman, Synder,
Kozier and Erb Chapter 35 M edications page 830
 Continue  Paracetamol is an antipyretics use to

paracetamol PRN decreases fever by inhibiting the effects of
pyrogens on the hypothalamus heat
regulating centers & by a hypothalamic
Paracetamol)
 Facilitate Fresh  Plasma contains all of the coagulation

Whole Blood factors. Fresh frozen plasma (FFP) infusion
transfuse 2nd dose can be used for reversal of anticoagulant
effects. Plasma transfusion is
Page | 38
recommended in patients with active
bleeding. The patient experienced nose
(reference:
Day 4  PNSS 1L x 15  Used because it has little to no effect on the

February 01, 2016 gtts/min (1) tissues and make the person feel hydrated
8:30 am preventing hypovolemic shock
Coherent https://www.scribd.com/doc/109761163/PNSS-drug-
BP 100/60 study)
PR 99
37  D5LR is an hypertonic solution that is
(-) Epistaxis  D5LR 1L x 15 given to prevent dehydration. Dengue is a
9:30 gtts/min (1) disease of DEHYDRATION. Much like a
(-) bleeding
Balance page 1456)
 May go home  Discharge planning is the process of

Day 5 February 2, preparing a client to receive one level of
2016 6:00 am care for another within or outside of the
current health care agency; usually refers
(-) bleeding
to the client leaving hospital for home.
Platelet 198 ( Fundamentals of Nursing 8th Edition of 2008 by
Berman, Synder, Kozier and Erb Chapter 7 Community -
based nursing and care continuity page 113 )
Home Meds:
 Godex 1 cap  To prevent damage to liver, one of the
300mg BID x 5 complication of DHF. Godex acts by
days transporting excess, long-chain fatty acids
into the mitochondria to produce high
amounts of energy to produce high
amounts of energy to provide cell
protection and fast treatment of liver
disease.(http://www.mergersdrugfil.com.ph/index.php
/godex-ds )
Page | 39
 Cefixime 200mg  Cefixime is a cephalosporin antibiotic used
cap BID x 7 days to treat infections such as urinary tract
infections, because the patient’s urinalysis
revealed presence of few bacteria in
urine.(reference: retrieved from
https://www.nlm.nih.gov/medlineplus/druginfo/meds/a69
0007.html)
 Omeprazole 20
 Treatment and prevention of
mg cap OD
hypersecretions of stomach acid.
gastrointestinal tract bleeding. (retrieve from
2006683)
 Ascorbic acid 500

mg tab OD  Supplemental therapy in some GI diseases,
during long term parenteral nutrition.
Increases protection
mechanism of the immune system thus,
resistance to infection. (Reference: Davis’s Drug
Guide for Nurses fifth edition 2010 (ascorbic acid, page
105)
Page | 40
VIX. LABORATORY TEST
Urinalysis
Date: Jan. 31, 2016
Provides important clinical information about kidney formation and help diagnose other
diseases.
( Brunner and Suddarth’s T extbook of Medical Surgical Nursing 13 th Edition by Smeltzer, Bare, Hinkle and Cheever chapter 53
Assessment of Kidney and Urinary Function page 1518 )
Test Reference Result Implication

Value
Physical Light Normal
Properties Yellow
Transparency Slightly Normal
Hazy
Chemical
Properties
pH 5–9 7.0 Normal
Specific Gravity 1.005 - 1.015 Normal
1.030
Sugar Negative Negative Normal
Protein Negative +4 The glomerulus is the network of capillaries
(<10mg/d in the kidneys that filters low molecular
L/100ml) weight solutes such as urea, glucose, and
salts, but normally prevents passage of
protein or cells from blood into filtrate. Due
increased glomerular permeability; this
permeability allows increased amounts of
plasma proteins (sometimes very large
amounts) to pass into the filtrate.
Reference: A.Shah. Proteinuria (2013)
http://www.merckmanuals.com/professional/genitourinary -
disorders/symptoms-of-genitourinary-disorders/proteinuria
Leukocytes Negative Negative Normal
Nitrite Negative Negative Normal
Urobilinogen Normal Normal Normal
Blood Negative Negative Normal
Ketone Negative Negative Normal
Bilirubin Negative Negative Normal
Ascorbic Acid Negative Negative Normal
Microscopic
examination
RBC Negative 2– 4/hpf Due to increase in vascular permeability it
will leads to leakage of RBC.
Reference: National Institute of Allergy and Infectious Diseases,
NIH: Volume 2
Pus Cells (WBC) Negative 2– 4/hpf Occurrence of pus cells in urine Page
may| 41
be
taken to be an indicator of an infection,
either on the upper or the lower urinary
tract.
( Retrieved from: http://www.newhealthguide.org/Pus-Cells-in-
Urine.html )
Mucus threads Few If they are present in large amounts then this
means there is some underlying infection in
any part of the urinary tract. If the mucus
threads in urine are associated with red
blood cells (blood), bacteria or yeast then
this indicates to some sort of infection,
irritation or other problems.
(Retrieved from: http://bestwebhealth.org/Mucus-T hreads-In-
Urine--What-Does-It-Mean-And-How-T o-T reat.html )
Amorphous - -
Phosphates
Bacteria Negative Few Bacteria in urine can suggest infection due
to vascular permeability.
Interpretation Nursing Responsibility

Presence of protein, RBC and WBC in the 1. Use clean container.
urine cause by increase in capillary 2. Obtain first morning sample
permeability thus permitting plasma 3. Immediately send specimen to the
protein and blood cells to pass into the laboratory with proper label.
urine.
( Medical Surgical Nursing 8 th Edition page 1138 ) ( Medical Surgical Nursing 8 th Edition page 1146 )
Page | 42
Complete Blood Count
Date: 01-29-2016
Test Result Normal Interpretation Implication

Range
WBC 3.83 4.00-10.00 Low WBC is made in the bone
marrow and circulates in the
bloodstream. Dengue virus
induces the suppression of the
bone marrow that results of
producing not enough WBC
to defend against bacterial
infections.
Reference:
http://www.medicinenet.com/script/main/art.
asp?articlekey=6017
Neutrophils 2.52 2.00-7.00 Normal
Lymphocytes 0.83 0.80-4.00 Normal
Monocytes 0.43 0.12-1.20 Normal
Eosinophils 0.04 0.02-0.50 Normal
Basophils 0.01 0.00-0.10 Normal
Neu% 65.7 50.0-70.0 Normal
Lym 21.8 20.0-40.0 Normal
Mon 11.2 3.0-12.0 Normal
Eos 1.1 0.5-5.0 Normal
Bas 0.2 0.0-1.0 Normal
RBC 4.43 4.00-5.50 Normal
HGB 140 120-160 Normal
HCT 40.0 40.0-54.0 Normal
MCV 90.3 80.0-100.0 Normal
MCH 31.6 27.0-34.0 Normal
MCHC 350 320-360 Normal
RDW-CV 10.4 11.0-16.0 Low A low RDW means that the
red blood cells vary very little
in size.
Red cell distribution width
(abbreviated as RDW) and
Coefficient Variation
(abbreviated as CV) is a
measurement of the amount
that red blood cells vary in
size. Red blood cells help
carry oxygen in the blood.
Reference:
http://www.medfriendly.com/red-cell-
distribution-width.html
RDW-SD 34.9 35.0-56.0 Low A low RDW means that the
Page | 43
in size.
Standard Variation
(abbreviated as SD) is a
Reference:
PLT 11 170-400 Low Dengue virus induces bone
marrow suppression. Since
bone marrow is the
manufacturing center of blood
cells its suppression causes
deficiency of blood cells
leading to low platelet count.
Reference:
K. Kafeel (2011). Retrieved from:
MPV 6.2 6.5-12.0 Low Mean platelet volume
(MPV) reflects the average
size of platelets present in a
person's sample of blood.
MPV is low with low platelet
count due to dengue virus
affecting production by the
bone marrow.
Reference:
https://labtestsonline.org/understanding/analy
tes/platelet/tab/faq/
PDW 18.8 9.0-17.0 High Platelet Distribution Width
(PDW) PDW is the variability
in the size of platelets.
Normally PDW increases
with MPV. The patient shows
a low MPV but a high PDW.
Due to the bone marrow
suppression.
Reference:
https://allaboutblood.com/tag/pdw/
PCT 0.007 0.108- Low Low PCT (procalcitonin)
0.282 values (<0.25 µg/L) in
patients with clinical signs of
infection (CAP, UTI) indicate
a low probability for blood
Page | 44
culture proof of bacterial
infection. One major
advantage of PCT compared
to other parameters is its early
and highly specific increase in
response to bacterial
infections and sepsis.
Reference:
http://www.procalcitonin.com/default.aspx?tr
ee=_2_2
P-LCR 7.6 11.0-45.0 Low P-LCR means Platelet large
cell ratio. It provides
information about the
underlying conditions of
thrombocytopenia .
Reference:
http://www.ehj.eg.net/article.asp?issn=1110-
1067;year=2014;volume=39;issue=3;spage=
134;epage=138;aulast=Elsewefy
Date: 01-30-2016

Range
WBC 4.86 4.00-10.00 Normal
Neutrophils 1.65 2.00-7.00 Low Neutrophils are major players
in the body's defense against
bacterial infections.
Neutrophils are made in
the bone marrow and circulate
in the bloodstream. Dengue
virus induces the suppression
of the bone marrow that results
of producing not enough
neutrophils to defend against
Reference:
http://www.medicinenet.com/script/main/art.as
p?articlekey=6017

Neu% 33.9 50.0-70.0 Low Neutrophils are manufactured
in bone marrow — the spongy
tissue inside some of our larger
bones. Anything that disrupts
neutrophil production can
Page | 45
result in neutropenia. The
dengue virus induces bone
marrow suppression.
Reference:
http://www.mayoclinic.org/symptoms/neutrope
nia/basics/causes/sym-20050854
Lym 44.0 20.0-40.0 High It is high because of the
bacteria presence in the urine
of the patient. Lymphocytes
provide a means for immunity
against antigens.
Reference:
http://biology.about.com/od/cellbiology/ss/lym
phocytes.htm
Mon 21.6 3.0-12.0 High Monocytes play important
roles in the immune defense,
inflammation and tissue
remodelling and it do so by
phagocytosis, antigen
processing and presentation
and by cytokine production. It
is high because of the bacteria
presence in the urine of the
patient.
Reference:
http://www.monocytes.de
Eos 0.4 0.5-5.0 Low A low eosinophil level is
usually not a cause for concern
and is actually quite
common. They are very helpful
in defending the body
against parasites. Eosinophils
can be too low due to
administration of steroids.
Steroids are any of a large
number of hormone substances
with a similar and basic
chemical structure. Hormones
are natural chemicals produced
by the body and
released into the blood that
have a specific effect on tissues
in the body.
The patient is administered by
Hydrocortisone.
Reference:
http://www.medfriendly.com/eosinophil.html
RBC 2.22 4.00-5.50 Low Red blood cells circulate in the
blood and carry oxygen
Page | 46
throughout the body. They are
produced in the bone
marrow and then released into
the bloodstream as they
mature. Dengue virus damage
the bone marrow that results to
low RBC production.
Reference:
https://labtestsonline.org/understanding/analyte
s/rbc/tab/test/
HGB 69 120-160 Low RBCs contain hemoglobin,
which carries oxygen
throughout your body. It is low
because the patient
experienced epistaxis and
melena. It is low because the
patient experienced epistaxis
and melena. Moreover, the
marrow suppression
HCT 20.0 40.0-54.0 Low The hematocrit is routinely
ordered as a part of
the complete blood count
(CBC). It may also be ordered
by itself or with a hemoglobin
level as part of a general health
examination. It results from
decrease production of
hemoglobin and damage to
bone marrow.
Reference:
https://labtestsonline.org/understanding/analyte
s/hematocrit/tab/test/
MCV 90.0 80.0-100.0 Normal
MCH 31.1 27.0-34.0 Normal
RDW-CV 10.6 11.0-16.0 Low A low RDW means that the red
blood cells vary very little in
size.
size. Red blood cells help carry
oxygen in the blood.
Reference: http://www.medfriendly.com/red-
cell-distribution-width.html
Page | 47
RDW-SD 34.8 35.0-56.0 Low A low RDW means that the red
blood cells vary very little in
size.
Standard Variation
(abbreviated as SD) is a
size. Red blood cells help carry
oxygen in the blood.
bone marrow is the
Reference:
MPV 9.2 6.5-12.0 Normal
Normally PDW increases with
MPV. The patient shows a low
MPV but a high PDW. Due to
the bone marrow suppression.
Reference:
0.282 values (<0.25 µg/L) in patients
with clinical signs of infection
(CAP, UTI) indicate a low
probability for blood culture
proof of bacterial infection.
One major advantage of PCT
compared to other parameters
is its early and highly specific
increase in response to
bacterial infections and sepsis.
Reference:
http://www.procalcitonin.com/default.aspx?tre
e=_2_2
P-LCR 34.2 11.0-45.0 Normal
Page | 48
Date: 01-31-2016

Range
WBC 5.91 4.00-10.00 Normal
tissue inside some of our
larger bones. Anything that
disrupts neutrophil production
can result in neutropenia.
Reference:
http://www.mayoclinic.org/symptoms/neutro
penia/basics/causes/sym-20050854
Lym 33.8 20.0-40.0 Normal
Mon 16.3 3.0-12.0 High Monocytes perform their
functions by surrounding and
engulfing bacteria (a process
known as phagocytosis).
Monocytes can engage in
phagocytosis by coating the
foreign material with
complement or antibodies.
High Monocytes happen for

several reasons such as stress,
inflammation, a fever from a
virus, severe infection
(because more macrophages
are needed to fight it),
premature cell death in living
tissue, diseases that result
from abnormal activity of the
immune system, and
regeneration of red blood
cells.
Reference:
http://www.medfriendly.com/monocyte.html
Eos 0.3 0.5-5.0 Low A low eosinophil level is
usually not a cause for
concern and is actually quite
common. They are very
helpful in defending the body
Page | 49
against parasites. Eosinophils
can be too low due to
administration of steroids.
Steroids are any of a large
number of hormone
substances
with a similar and basic
chemical structure. Hormones
are natural chemicals
produced by the body and
released into the blood that
have a specific effect on
tissues in the body.
The patient is administered by
Hydrocortisone.
Reference:
http://www.medfriendly.com/eosinophil.html
RBC 2.69 4.00-5.50 Low Red blood cells circulate in
the blood and carry oxygen
the bone marrow that results
to low RBC production.
Reference:
tes/rbc/tab/test/
throughout your body. It is
low because the patient
marrow suppression.
level as part of a general
health examination. It results
from decrease production of
Page | 50
bone marrow.
Reference:
tes/hematocrit/tab/test/
MCV 88.9 80.0-100.0 Normal
MCH 32.0 27.0-34.0 Normal
in size.
Reference:
RDW-SD 35.0 35.0-56.0 Normal
bone marrow is the
Reference:
MPV 9.1 6.5-12.0 Normal
in the size of platelets. Due to
the bone marrow suppression.
Reference:
0.282 values (<0.25 µg/L) in
Page | 51
Reference:
ee=_2_2
P-LCR 34.7 11.0-45.0 Normal
Date: 01-31-2016

Range
WBC 5.79 4.00-10.00 Normal
Lymphocytes 2.29 0.80-4.00 Low It is low because the dengue
virus induces the bone
marrow suppression.
Reference:
http://biology.about.com/od/cellbiology/ss/ly
mphocytes.htm
tissue inside some of our
larger bones. Anything that
disrupts neutrophil production
can result in neutropenia.
Reference:
http://www.mayoclinic.org/symptoms/neutro
penia/basics/causes/sym-20050854
Lym 39.6 20.0-40.0 Normal
Mon 20.2 3.0-12.0 High Monocytes play important
roles in the immune defense,
inflammation and tissue
remodelling and it do so by
phagocytosis, antigen
processing and presentation
and by cytokine production. It
is high because of the bacteria
presence in the urine of the
patient.
Reference:
http://www.monocytes.de
Eos 0.8 0.5-5.0 Normal
RBC 3.31 4.00-5.50 Low Red blood cells circulate in
the blood and carry oxygen
Page | 52
the bone marrow that results
to low RBC production.
Reference:
tes/rbc/tab/test/
marrow suppression
level as part of a general
health examination. It results
from decrease production of
bone marrow.
Reference:
tes/hematocrit/tab/test/
MCV 86.8 80.0-100.0 Normal
MCH 30.8 27.0-34.0 Normal
in size.
Page | 53
RDW-SD 35.3 35.0-56.0 Normal
bone marrow is the
Reference:
MPV 9.6 6.5-12.0 Normal
Normally PDW increases
with MPV. Due to the bone
marrow suppression.
Reference:
0.282 values (<0.25 µg/L) in
Reference:
ee=_2_2
P-LCR 35.4 11.0-45.0 Normal
Page | 54
Hematology
Date: 01-28-2016
Test Result Normal Interpreta Implication

Range tion
Hemoglobin 16.4 13-17 Normal
Hematocrit 50.2 40-52% Normal
RBC 5.45 4.7- Normal
6.1ml/mm3
WBC 2500 4800- Low WBC is made in the bone
10000/mm3 marrow and circulate in the
bloodstream. Dengue virus
induces the suppression of the
bone marrow that results of
producing not enough WBC
to defend against bacterial
infections.
Reference:
asp?articlekey=6017
DIFFERENTIAL
COUNT
Neutrophils 77 40-74% High Neutrophils are major players
in the body's defense against
Neutrophils are made in
the bone marrow and circulate
in the bloodstream. Dengue
virus induces the suppression
of the bone marrow that
results of producing not
enough neutrophils to defend
against bacterial infections.
Reference:
asp?articlekey=6017
Lymphocytes 21 20-40% Normal
Eosinophils - - -
Monocytes 2 3-7% Low Monocytes are a type of white
blood cell that fight certain
infections and help other
white blood cells which is
also regulate immunity
against foreign substances.
Monocytes are produced in
the bone marrow and then
enter the blood. A low number
Page | 55
of monocytes in the blood
(monocytopenia) can be
caused by anything that
decreases the overall white
blood cell count
(see Neutropenia and see
also Lymphocytopenia), such
as a bloodstream infection or
a bone marrow disorder.
Reference:
https://www.merckmanuals.com/home/blood-
disorders/white-blood-cell-
disorders/monocyte-disorders
Platelet count 24000 130-500000 Low Dengue virus induces bone
bone marrow is the
Reference:
Bleeding time - - -
Clotting time - - -
MCV 92.2 80-96FL Normal
MCH 30.1 27-33PG Normal
MCHC 32.7 32-36% Normal
Date: 01-29-16

values
Hemoglobin - 11.5-14.8
Hematocrit 37.1 38-44% Low The hematocrit is routinely
(CBC). It may also be
ordered by itself or with a
hemoglobin level as part of a
general health examination.
It results from decrease
production of hemoglobin
and damage to bone marrow.
Reference:
https://labtestsonline.org/understanding/anal
ytes/hematocrit/tab/test/
Platelet count 18 250- Low Dengue virus induces bone
Page | 56
510x10/L marrow suppression. Since
bone marrow is the
manufacturing center of
blood cells its suppression
causes deficiency of blood
cells leading to low platelet
count.
Reference:
Date: 01-29-16

values
Hemoglobin - 11.5-14.8 -
Hematocrit 41.6 38-44% Normal
Platelet count 12 250- Low Dengue virus induces
510x10/L bone marrow
suppression. Since bone
marrow is the
blood cells its
suppression causes
leading to low platelet
count.
Reference:
http://www.onlymyhealth.com/cause-
low-platelet-count-in-dengue-fever-
1301653922
Date: 01-30-16

values
Hematocrit 21% 38-44% Low The hematocrit is routinely
hemoglobin level as part of
a general health
damage to bone marrow.
Page | 57
Reference:
https://labtestsonline.org/understanding/a
nalytes/hematocrit/tab/test/
bone marrow is the
count.
Reference:
1301653922
Date: 01-30-16

values
Hemoglobin - 11.5-14.8
Hematocrit 35.7% 38-44% Low Hematocrit is the
amount of red blood
cells in your blood. It is
experienced epistaxis
and melena. Moreover,
the dengue virus induces
bone marrow
suppression.
Platelet count 8 250- Low Dengue virus induces
510x10/L bone marrow
suppression. Since bone
marrow is the
blood cells its
suppression causes
leading to low platelet
count.
Reference:
1301653922
Page | 58
Date: 01-30-16

values
Hematocrit 29.7% 38-44% Low The hematocrit is routinely
a general health
damage to bone marrow.
Reference:
https://labtestsonline.org/understanding/a
nalytes/hematocrit/tab/test/
bone marrow is the
count.
Reference:
1301653922
Date: 02-01-2016

values
Hemoglobin 98 115-148 Low RBCs contain hemoglobin,
melena. It is low because
the patient experienced
epistaxis and melena.
Moreover, the dengue virus
induce bone marrow
suppression.
Hematocrit 29% 38-44 Low The hematocrit is routinely
Page | 59
a general health
bone marrow.
Reference:
https://labtestsonline.org/understanding/an
alytes/hematocrit/tab/test/
RBC 3.35 38-54 Low RBCs contain hemoglobin,
melena. Moreover, the
marrow suppression.
Platelet 88 250-510 Low Dengue virus induces bone
bone marrow is the
count.
Reference:
platelet-count-in-dengue-fever-
1301653922
WBC 7-9 4-11 Normal
Segmented 52 45-55 Normal
neutrophils
Lymphocytes 40.3 38-45 Normal
Monocytes 7-5 3-6 High Monocytes perform their
functions by surrounding
and engulfing bacteria (a
process known as
phagocytosis). Monocytes
can engage in phagocytosis
by coating the foreign
material with complement
or antibodies.
High Monocytes happen for

several reasons such as
Page | 60
stress, inflammation, a fever
from a virus, severe
infection (because more
macrophages are needed to
fight it), premature cell
death in living tissue,
diseases that result from
abnormal activity of the
immune system, and
regeneration of red blood
cells.
Reference:
http://www.medfriendly.com/monocyte.ht
ml
Date: 02-02-2016

Range
Hemoglobin 96 115-148 Low RBCs contain hemoglobin,
induces bone marrow
suppression.
Hematocrit 26.8 38-44 Normal
RBC 3.14 3.8-5.4 Normal
MCV 85 80-100 Normal
MCH 30.5 27-32 Normal
RDW-CV 13.5 11.0-16.0 Normal
RDW-SD - 37-54 Normal
Platelet 198 250-510 Normal
PCT 0.188 0.15-0.50 Normal
MPV 9.5 6-11 Normal
PDW 18.6 11-18 Normal
WBC 8.0 4-11 Normal
Segmented 54.1 45-55 Normal
neutrophils
lymphocytes 38.3 38-45 Normal
monocytes 7.6 3-6
Page | 61
Date: 02-03-16

values
Hemoglobin 9.9 11.5-14.8 Low RBCs contain hemoglobin,
induces bone marrow
suppression.
a general health
bone marrow.
Reference:
alytes/hematocrit/tab/test/.
Platelet count 294 250- Normal
510x10/L
Date: 02-03-16

values
Hemoglobin - 11.5-14.8 Low RBCs contain hemoglobin,
induces bone marrow
suppression.
Page | 62
a general health
bone marrow.
Reference:
alytes/hematocrit/tab/test/
Platelet count 351 250- Normal
510x10/L
TyphiDOT
Date: 01-29-16
Test Result
Salmonella IgG Negative
Salmonella IgM Negative
The patient TyphiDOT test is negative to Salmonella IgG and salmonella IgM.
The Typhidot test gave a sensitivity of 100 per cent and specificity of 80 per cent
when bacteraemic patients were analysed.
The TyphiDot is a DOT enzyme immunoassay that detects either IgM or IgG
antibodies against a specific antigen on the outer membrane protein of serotype Typhi.
Reference:
https://www.researchgate.net/publication/10894775_T yphidot_test_to_detect_IgG_IgM_antibodies_in_t yphoid_fever
Page | 63
DENGUE NS1 IgA/IgG/IgM
Date: 01-29-2016
Test Result
Dengue NS1 Positive
Dengue IgA Negative
Dengue IgG Positive
Dengue IgM Negative
The patient’s antibody test revealed positive in Dengue NS1 and Dengue IgG.
The non-structural protein 1 (NS1) of the dengue viral genome has been shown to
be useful as a tool for the diagnosis of acute dengue infections. Dengue NS1 antigen has
been detected in the serum of DENV infected patients as early as 1 day post onset of
symptoms (DPO), and up to 18 DPO.
Antibody tests, IgM and IgG- detect antibodies produced by the immune system
when a person has been exposed to the virus; these tests are most effective when
performed at least 7-10 days after exposure.
Reference:
http://www.cdc.gov/dengue/clinicalLab/laboratory.html
https://labtestsonline.org/understanding/analytes/dengue/tab/sample/
BLOOD TYPE TEST
Date: January 29, 2016
ABO Rhesus D
O (+)
Page | 64
X. PROBLEM PRIORITIZATION
1. Ineffective Tissue Perfusion
2. Hyperthermia
3. Imbalance Nutrition
4. Impaired Tissue Integrity
5. Risk for Injury
Page | 65
XI. NURSING CARE PLAN
Page | 66
Assessment Nursing Planning Intervention Rationale Expected Outcome
Diagnosis
O: Ineffective After 8 hours of nursing  Monitor vital  Serve as basis for After 8 hours of nursing
 Hemoglobin tissue intervention, the client signs. any alteration in intervention, the
perfusion will be able to: system functions. client was be able to:
results related to  Elevate head
revealed 69 decreased  Demonstrate of bed to about  To promote  Demonstrate different
hemoglobin different ways to 10 degrees. circulation and ways to improve
mg/dl as of
concentration improve blood venous drainage. blood oxygenation
01-30-16 in the blood. oxygenation and and circulation.
 BP: 100/60
circulation.  Discourage
strenuous  To avoid increasing  Verbalize
mmHg  Verbalize activities. oxygen demand. understanding
understanding of of condition and
 RR: 20 cpm
condition and  Provide health importance
 PR: 98 bpm importance teaching  To help client of treatment
of treatment regarding DHF. understand his regimen.
 Headache regimen. health condition.
 Generalized  Provide health  Demonstrate
 Demonstrate teaching on  To maintain increased tissue
pallor increased tissue perfusion.
drugs being compliance to
 Capillary perfusion. taken. meds.
refill of Collaborative:
more than 3
 Administer  To control
sec Tranexamic bleeding.
 With pale nail Acid 50mg IV
q8 as ordered.
beds
Page | 67
 With pale  Administer and  Maintain hydration
regulate IVF as and help wash
conjunctiva
ordered. away toxins.
and palate
 Administer  Packed RBC’s are
 Muscle
packed RBC’s adequate for stable
strength : as ordered. patients with
subacute/chronic
4/5
bleeding to
increase oxygen
carrying capability
 Monitor lab  Aids in

studies ( Hb, establishing blood
Hct, RBC replacement needs
count). & monitoring for
effectiveness of
therapy.
Page | 68
Assessment Nursing Diagnosis Planning Intervention Rationale Expected Outcome
Hyperthermia After 2 hours  Monitor  Serves as base After 2 hours

O: related to presence of nursing patient’s vital line data for of nursing
 Temp: 38.2 °c of Arbovirus in interventions, the signs. future interventions, the
patient’s body patient will be able comparison. patient will be able
 Warm to touch causing release of to: to:
 Chills pyrogens.  Note  Assess for
Manifest reduction chronological an causative/ Manifest reduction
 Weak in of core temperature d developmental contributing of core temperature
appearance from 38.2 to a age of client factor. from 38.2 to a
normal range of 36.5 normal range of 36.5
 Easy fatigability C- 37.5 C  Note presence/  To assess C- 37.5 C
 Dry lips absence degree of
of sweating. hyperthermia.
 Pale
 Initiate tepid  Facilitates heat
sponge bath. through
conduction and
evaporation.
 Promotes surface  Facilitates heat

cooling through loss by
undressing or radiation.
removing extra
linens.
 Encourage  To promote
adequate fluid heat loss and
intake. hydration.
Page | 69
 Encourage  To reduce
adequate metabolic
bedrest. consumption
and oxygen
demands.
 Instruct patient  To promote

and SO to report wellness.
signs and
symptoms
of hyperthermia
like flushed skin,
increasing
respiratory rate
and body
temperature.
Collaborative:
 To relieve high
 Administer
temperature by
Paracetamol 1
amp IV, as inhibiting the
ordered. synthesis of
prostaglandin
Page | 70
Diagnosis
S: “Wala akong Imbalanced ST: within 4 hours of  Assess and  To determine daily After giving
ganang kumain“ as nutrition less than giving nursing document nutrition needs. effective nursing
verbalized by the body intervention patient patient’s dietary interventions patient
patient. requirements will be able to history, patters will be able to
related to loss of experience an of ingestion, partially demonstrate
O: appetite. increase in the intolerance to behavior, lifestyle
 Lethargic amount or type of foods. changes to regain
nutrients ingested. appropriate weight.
 Easy
 Auscultate bowel  Hypermotility of
fatigability LT: within 8 hours of sounds. intestinal tract is
giving nursing common and is
 Weak in intervention and associated with
appearance medical management vomiting and
patient will be able to diarrhea, which
 Had 2 experience adequate may affect choice
crackers in nutrition through oral of diet/route.
intake.
shift
 Instruct  To promote god
 Pale pt. on good oral appetite.
hygiene before
 24 hours and after
dietary recall feedings.
 Emphasize the  Promotes comfort

importance of to the patient and
adequate encourages a good
Page | 71
nutrition. eating habit.
 Promote pleasant  For education of

relieving the patient for
environment appropriate
including recovery from
socialization. nutritional
imbalance.
Collaborative:
 Monitor  Reflects organ

BUN, protein, function and
prealbumin, or nutritional status
albumin, glucose, and needs.
nitrogen balance as
indicated.
 Advance diet  Careful

as tolerated, avoid progression of diet
dark colored foods. when intake is
resumed reduces
risk of gastric
irritation and to
provide accurate
assessment in
stool.
Page | 72
Assessment Nursing Diagnosis Planning Intervention Rationale Expected Outcome
Impaired tissue After 4 hours of  Provide  To ease patient’s After 4 hours of

O: integrity related to nursing comfortable anxiety and to nursing interventions
 Temp: 38.2 °c mechanical and interventions environment. help the patient the patient shall have
chemical factor of patient will recover faster for demonstrate
 Hematoma on skin test and blood demonstrate behavior to reduce
proper hygiene of
the upper right test; secondary to behavior to reduce the patient. the hematoma.
haematoma as the hematoma.
arm evidence by  Provide  For proper After 2 weeks of
 Capillary refill collection of blood After 2 weeks of comfort hygiene of the nursing interventions
on the upper right nursing measures by patient. the patient shall have
of more than 3 arm. interventions AM care, no presence of
sec presence of changing the hematoma.
hematoma will be linen and touch
 Weak in reduce. therapy.
appearance
 Provide safety  To avoid patient
 Dry lips by placing from injury.
 Headache- pillows at the
side of the bed.
Pain scale 5/10
 Pale
 Vital signs  To have baseline
 Muscle strength : monitor and data.
4/5 record.
Page | 73
 Identify  Suggest treatment
underlying options, desire/
condition ability to protect
involves in self and potential
tissue injury. self and potential
to recurrence of
tissue damage.
 Monitor  To changes
laboratory indicative of
studies. healing or
infection
complications.
 Help patient  To reduce

and family to discomfort and
identify improve quality of
effective life.
successful
coping
mechanism and
to implement
them.
Page | 74
Diagnosis
O: Risk for After 4 hours of  Establish rapport.  To gain patient’s After 4 hours of
injury related nursing trust and nursing management
 Weak in to abnormal management, the cooperation. the patient will
blood profile patient will demonstrate
appearance
as evidenced demonstrate  Monitor and record  For baseline data. behaviors to reduce
 Capillary refill by decreased behaviors to vital signs. risk factors and
platelet count. reduce risk factors protect self from
of more than 3 and protect self  Assess mood, coping  Aggressive and injury.
sec. from injury. abilities, and impulsive
personality styles behavior indicates
 Easy fatigability
(aggression and self harm to the
 Hematoma at impulse behavior). patient.
the right upper
 Observe for presence  Observing those
arm of petechiae, signs will help to
ecchymosis, bleeding reduce the risk for
 Delirium from one more sites. injury to the other
 Platelet count parts of the body.
results revealed 8  Maintain bed in a  Ensuring the
9
x10 /L as of 01- lowest position with patient’s safety.
wheels locked.
30-16
 Advise SO that those  To prevent further
self inflicting injury to the
materials such as patient.
Page | 75
(utensils, knife and
syringes) should be
keep.
 Encourage the SO  Leaving the

not to leave the patient unattended
patient unattended may increase
anxiety to the
patient.
Page | 76
XII. DRUGS
Page | 77
Name of Drug Dosage and Indications and Side Effects Mode of Classification Nursing Responsibilities
Frequency Contraindications Action
Generic Name: 50 mg Indication:  Dizziness Acts on blood Antihistamine  Medication may

Diphenhydramine PO To prevent allergic  Drowsiness vessels, GI, cause drowsiness.
TID reaction after blood  fatigue respiratory  Advised the
transfusion. system by patient to avoid
anxiety
Brand Name: activities requiring
 Nausea competing with
alertness until response
Benadryl Peak: 15-60 min Transfusion reaction histamine for
Onset: 1-4 hr of drug is unknown.
symptoms include: 𝐻1 –receptor  Inform the patient
Duration: 4-8 hr  back pain site; decreases that this drug may
Date ordered:
 blood in your urine allergic cause dry mouth.
01-30-2016
 chills  Frequent oral
response by
 fainting or dizziness rinses, good oral
blocking
 fever hygiene, and candy
 flank pain histamine.
that may minimize this
 skin flushing effect.
 Teach patient and
significant other that
Contraindications: this drug may cause
Hypersensitivity to 𝐻1 – drowsiness.
receptor antagonist,
acute asthma attack,
lower respiratory tract
disease, neonates.
Reference : Jones and Bartlett Nurse’s Drug Handbook 2015 ( diphenhydramine page 325)
Page | 78
Name of Drug Dosage and Indications and Side Effects Mode of Action Classification Nursing Responsibilities
Frequency Contraindication
s
Generic Name: 200 mg Indication:  Chills Interferes with Antibiotic  Be aware that an
Cefixime PO Treatment for  fever bacterial cell allergic reaction may
BID infection.  headache wall synthesis occur a few days after
Brand Name:  seizures by inhibiting the therapy starts.
Suprax Peak: rapid The patient’s  Abdominal final step in the  Assess bowel pattern
Onset: 2-6 hr urinalysis revealed cramps crosslinking daily.
 diarrhea
Date ordered: Duration: 24 hr a presence of few
 elevated
of peptidoglycan  Assess for signs of
02- 02- 2016 bacteria in urine as strands.
 liver function superinfection, such as
of Jan. 31, 2016. test results Peptidoglycan perineal itching, fever,
 hepatic failure makes cell malaise, redness, pain,
Contraindication  hepatitis membranes rigid swelling, drainage,
s:  hepatomegaly and protective. rash, diarrhea, and
Hypersensitivity to  jaundice Without it, cough or sputum
cephalosporin or  nausea bacterial cells changes.
their rupture and die.  Instruct patient and
Components. significant other to
complete the prescribed
course of therapy.
 Tell patient and S.O. to
report severe diarrhea
to prescriber
immediately.
Reference : Jones and Bartlett Nurse’s Drug Handbook 2015 (cefixime page 205)
Page | 79
Name of Drug Dosage and Indications and Side Effects Mode of Classificatio Nursing
Frequency Contraindications Action n Responsibilities
Generic Name: 1g Indication:  Abdominal Interferes with Antibiotic  Assess bowel

Ceftriaxone IV To treat infection. cramps bacterial cell pattern daily.
every 12 hours  elevated wall synthesis  Assess for
The patient’s by inhibiting
liver pharyngitis,
Peak: rapid urinalysis revealed a cross-linking of
function test ecchymosis,
Onset: end of presence of few peptidoglycan
Brand Name: results bleeding, and
bacteria in urine as of
Rocephin infusion  Edema strands. arthralgia; they
Jan. 31, 2016.
Duration: 12-24  Arthralgia Peptidoglycan may indicate a
hr Contraindications:  Allergic makes the cell blood dyscrasia.
Hypersensitivity to pneumonitis membrane rigid  Advise patient and
ceftriaxone, other , and protective. S.O. to report any
Date ordered:
cephalosporins, or  dyspnea Without it, hypersensitivity
02-02-16
their components bacterial cells reactions, such as
rupture and die. a rash, itching
skin, or hives, to
prescriber
immediately and
to stop taking the
drug.
Reference : Jones and Bartlett Nurse’s Drug Handbook 2015 (ceftriaxone page 223)
Page | 80
Name of Dosage and Indications and Side effects Mode of Action Classification Nursing
Drug Frequency Contraindications Responsibilities
Generic 1 amp Indication:  Gastric upset Required for Fat soluble

Name: 10mg/ml To treat bleeding.  Unusual taste hepatic synthesis vitamins  Monitor the
Vitamin K IV  Rash of blood patient for
every 8 hours The patient  Urticaria coagulation gastric upset.
Brand manifested  Flushing factors II  Monitor
name: epistaxis and black  Erythema (prothrombin), patient for the
Phytonadione Peak: 1-2 hr tarry stool at 2:00 VII, IX, and X. possible side
 Allergic
Onset: unknown pm as of Jan. 30, reactions An effects that
Date Duration: 2016. antihemorrhagic may occur.
ordered: unknown actor that  To report any
01-30-16 Contraindications: promotes hepatic signs and
Hypersensitivity to formation of symptoms of
benzyl alcohol active allergic
(Aquamephyton prothrombin. reactions.
only)
Reference: Davis’s Drug Guide for Nurses fifth edition 2010 (vitamin K, page 970)
Page | 81
Name of Dosage and Indications and Side effects Mode of Action Classification Nursing
Drug Frequency Contraindicatio Responsibilities
ns
Generic 40 mg Indication:  Weakness Suppresses gastric Anti-ulcer,  Inform the patient
Name: IV Treatment and  Dizziness secretion by proton pump and significant other
Omeprazole OD prevention of  Headache inhibiting inhibitor about the reason why
hypersecretions  Fatigue hydrogen; drug is given and how it
Peak: unknown of stomach acid.  Abdominal characterized as is process inside the
Brand Onset: 10-90 pain gastric pump patient's body.
Name: min Due to patient’s  Acid inhibitor  Monitor for diarrhea
Losec lost appetite with regurgitatio and abdominal pain.
Duration:
unknown
DHF it will n  Take the drug before
Ordered at: cause abdominal  Constipatio meals.
pain. n  Report severe
01-29-16
 Diarrhea headache, worsening
6:30 am Contraindicatio
 Flatulence of symptoms, fever,
ns: chills. Swallow the
01-30-16 Hypersensitivity  Nausea
 Vomiting capsules whole; do not
10:00 am chew, open, or crush
 Rash
them.
02-01-16  Itching
 Inform patient and
6:00 am S.O. that he/she may
experience these side
effects: Dizziness;
headache; nausea,
vomiting, diarrhea;
symptoms of URI,
cough.
Reference: Davis’s Drug Guide for Nurses fifth edition 2010 (omeprazole, page 878)
Page | 82
Name of Dosage and Indications and Side effects Mode of Classification Nursing
Drug Frequency Contraindications Action Responsibilities
Generic 500 mg Indication:  Dizziness Inhibits Anti-
Name: IV Treatment for  Hypotension activation of fibrinolytic  Assess for
Tranexamic every 8 hours bleeding.  Nausea plasminogen agent allergic reaction.
Acid Patient experienced  Vomiting thereby  Instruct patient
Peak: 2-15 epistaxis and  Diarrhea preventing the and S.O. to
Brand minutes melena. conversion of report untoward
Name: Onset: plasminogen to side effects.
Cyklokapron intermittent plasmin  Change the
Contraindication: position of the
Ordered at: Duration: 3 Contraindicated to
hrs. patient slowly to
patients who are prevent
01-29-16 allegic to orthostatic
6:30am Tranexamic Acid. hypotension.
01-30-16
2:48pm
02-02-16
6:00am
Reference: Davis’s Drug Guide for Nurses fifth edition 2010 (tranexamic acid, page 1179)
Page | 83
Name of Dosage Indications and Side effects Mode of Classification Nursing Responsibilities
Drug and Contraindications Action
Frequency
Generic 500 mg Indication:  Fatigue Increases Vitamin  Assess for signs
name: 1 tab Dietary supplement  Headache protection (water- of vitamin C
Ascorbic OD  Drowsiness mechanism of soluble) deficiency
acid Contraindication:  Nausea the immune (gingivitis and
Peak: Hypersensitivity to  Vomiting system thus, bleeding gums.
Brand unknown tartrazine  Diarrhea resistance to  Medication may
name: Onset:  Flushing infection. cause drowsiness.
Cecon
unknown  Advise patient to
Duration: take this
Date medication as
ordered: unknown
directed and not
to exceed dose
01-29-16 prescribed.
6:30 am
02-02-16
6:00 am
Reference: Davis’s Drug Guide for Nurses fifth edition 2010 (ascorbic acid, page 105)
Page | 84
Name of Drug Dosage Indications and Side Effects Mode of Action Classification Nursing
and Contraindications Responsibilities
Frequency
Generic 100 mg Indication:  Ataxia, Binds to intracellular Adrenocorticoid  Monitor

Name: IV Management for  behavioral glucocorticoid replacement weight, blood
Hydrocortisone TID Dengue shock changes, receptors and pressure,and
syndrome.  depresssion, suppresses Anti electrolyte
 dizziness, inflammatory and inflammatory levels regularly
Peak:  euphoria, immune responses by during therapy.
Corticosteroids are inhibiting neutrophil 
unknown potent anti-  fatigue, Expect
 headache, and monocyte hydrocortisone
Brand Name: Onset: 15 inflammatory accumulation at
 increased to worsen
Hydrocortone minutes agents that have a inflammation site and
intracranial infections or
Duration: wide range of suppressing their
pressure mask signs and
6-12 hrs. effects on phagocytic and symptoms.
immunological with
papilledema,
bactericidal activity  Caution patient
processes and have stabilizing lysosomal to avoid people
found use in a  insomnia, membranes with infections
Date ordered: broad spectrum of  malaise, suppressing antigen because drug
01-29-16 diseases (Kehrl  mood response of can suppress
1983). changes, macrophages and immune
 paresthesia, helper T cells system,
Though, the use of  seizures, inhibiting synthesis of increasing risk
corticosteroids in  psychosis, cellular mediators of of infection.
the management of  syncope inflammatory
dengue response, such as
haemorrhagic fever cytokines,
and dengue shock interleukins, and
syndrome is under prostaglandins.
debate.
Page | 85
Reference:
Guidelines for the
management of dengue fever
& dengue haemorrhagic fever
in adults. (2012).
http://www.cochranelibrary.c
om/enhanced/doi/10.1002/14
651858.CD003488.pub2
Contraindications:
 Allergy to any
component of
the drug.
 Antibiotic-
resistant
infections.
Reference : Jones and Bartlett Nurse’s Drug Handbook 2015( hydrocortisone page 256)
Page | 86
Name of Drug Dosage and Indications and Side effects Mode of Classification Nursing
Frequency Contraindications Action Responsibilities
Generic name: 1 amp Indication:  Skin rashes Inhibits the Antipyretic  Assess patient for
Paracetamol 150mg/ml Fever  Urticaria synthesis of fever, note
IV every  Hypoglycemi prostaglandins presence of
Brand name: 4 hours Contraindication: a that may serve associated signs
Acetaminophen PRN Hypersensitivity  Leukopenia as mediators (diaphoresis,
of pain and tachycardia, ands
Date ordered: Peak: 15 fever. malaise.
01-30-16 mins.  Be aware that long
6:00 am Onset: term use can cause
unknown liver damage.
01-31-16  Assess for allergic
12:29 am Duration: reactions.
4-6 hrs.
02-02-16
6:00 am
Reference: Davis’s Drug Guide for Nurses fifth edition 2010 (acetaminophen, page 5)
Page | 87
Name of Dosage and Indications and Side effects Mode of Classification Nursing Responsibilities
Drug Frequency Contraindications Action
Generic 20 mg Indication:  Dizziness Inhibits the Loop  Monitor BP before
name: IV To prevent fluid  Headache reabsorption diuretics and after
Furosemide every after overload that may  Tinnitus of sodium and administering the drug
blood be imposed by the  Hypotension chloride from  Monitor for S&S of
Brand transfusion additional blood  Nausea the loop of hypokalemia report
name: volume delivered  Vomiting Henle and muscle cramps on
Lasix Peak: 30-60 during transfusion.  Diarrhea distal renal weakness to
minute tubule. physician.
 Constipation
Date Onset: 1-2 hr Contraindication:
 Dry mouth  Make position
ordered: Hypersensitivity to changes slowly
01-30-16
Duration: 6-
medication  Rashes
8 hr because high doses of
4:00 pm antihypertensive
drugs taken
concurrently may
produce episodes of
dizziness or
imbalance.
 Instruct the patient
and S.O. to report
adverse reaction
promptly, nausea,
vomiting, diarrhea,
appetite loss and
visual disturbances
may be indicators for
drug toxicity.
Reference: Davis’s Drug Guide for Nurses fifth edition 2010 (Diuretics (Loop), page 392)
Page | 88
Name of Dosage Indications and Side effects Mode of Action Classification Nursing
Drug and Contraindications Responsibilities
Frequency
Generic 1 cap 300 Indication:  Nausea Chalagogues Hepatic  Maintain
name: mg To prevent damage to  Vomiting promotes the Protector adequate
Godex BID liver, one of the  Restlessness discharge of bile hydration.
x 5 days complication of DHF.  Anorexia from the system,
Brand  Dysphagia purging it
name: Peak: Dengue viral antigens  Tachycardia downward.
Cecon unknown have been found within
Onset: hepatocytes, and Chalagogues-
Date the virus appears to be action that has the
unknown
ordered: able to replicate in both specific effect
02-02-16 Duration: hepatocytes and kupffer of stimulating the
unknown cells, and dysregulated flow of bile from
host immune responses the liver.
may play an important
causative role in liver
damage.
Source:
HealthTap, https://www.healthtap.co
m/user_questions/532959-how-does-
dengue-fever-leads-to-hepatomegaly
Contraindications:
Hypersensitivity to
medication
Reference: Retrieved from: http://www.thefilipinodoctor.com/search-drug-details.php?keyword=Legalon&id=20031380&secid=20030656&sec1id=20020016&sec2id=20030005&sec3id=&sec4id=
Page | 89
XIII. DISCHARGE PLAN
 Medications:
 Present to the significant other all the take home medicines. Give emphasis to
the brand and generic name, therapeutic and side effects as well as its daily
dose and proper route.
1. Godex 1 cap two times a day (BID) ,for 5 days

2. Cefixime 200 mg 1 cap two times a day (BID ) for 7 days
3. Omeprazole 20mg 1 cap once a day (OD)
4. Ascorbic acid 500 mg 1 tab once a day (OD)
 Over the counter drugs may interfere with the effectiveness of the prescribed
drugs. It can also harm the patient if the drug is contraindicated.
 Inform the family to seek medical help immediately if adverse reactions to
allergies occur.
 Exercise:
 Instruct to avoid excessive activities that may result to stress.

 Just advised to perform range of motions and repetitive body movements for
promotion of optimum.
 Treatment:
 Remind to take the prescribed medicine, having a written reminder of the correct
medication, time to take, and the right frequency of the medicine on the way home to
establish assurance of medication compliance.
 Health Teaching:
1. Encourage to have adequate rest periods

2. Advice the patient to minimize drinking coffee.
Page | 90
3. Explain the action and side effects of the drugs to the patient.
4. Instruct on proper intake of home medicines
5. Inform the patient about the new discovered Dengue vaccine (Dengvaxia).
 Emphasize the importance of the acronym DENGUE:
D- discuss the possible source of infection of the disease.

E- educate the family/patient on how to eliminate those vectors.
N- never stocked water in a container without cover.
G- gallon, container and tires must have proper way of disposal.
U- use insecticides at home to kill or reduce mosquito.
E- encourage the family of the patient to clean the surroundings to
destroy the breeding places of mosquito.
 Out – patient- department:
 Instruct the patient and the guardian to have a check up or to consult physician
once a while to monitor patient’s condition and for detection of recurrences
and other complications that may rise on to it.
 Diet:
 Advise the patient to eat foods rich in iron such as green leafy vegetables
and animal organs like liver.
 Instruct the family members to give the patient protein rich foods such as
meat, fish, eggs and nuts, vitamin K rich foods such as green leafy
vegetables, vit. C rich foods(guava and tomatoes and other citrus fruits),
carbohydrates rich food (breads and rice).
 Advise to increase fluid intake to replace fluid loss.
 Spiritual:
 Encourage the patient to maintain his spiritual needs and advise to never
lose hope in any obstacle that he may encounter.
Page | 91
XIV. RECOMMENDATION
Our group recommends:
To our co- students
This study will help you to fully understand how dengue hemorrhagic fever
occurs, what are the symptoms and management to be given to patient with this type of
disease. You will also learn how risk factors such as people living or travelling to tropical
areas. This will serve as your guide in presenting case presentations in your future career.
To faculty members
This study will help you to recall all your knowledge and refreshes your idea
about dengue hemorrhagic fever. This may be helpful in teaching lessons of the faculty
members especially those who handle third year nursing students. We hope that this
would be a great help to all of you!
To our beloved readers
To our beloved readers who are curious about dengue hemorrhagic fever. This
will be very helpful to you because all the contents of this study were focused on the said
disease. Diet modifications and other health management to prevent occurrence of the
disease are also included.
Page | 92
XV. BIBLIOGRAPHY
A.Shah. Proteinuria (2013) http://www.merckmanuals.com/professional/genitourinary-

disorders/symptoms-of-genitourinary-disorders/proteinuria
Brunner and Suddarth’s Textbook of Medical Surgical Nursing 13th Edition by Smeltzer,
Bare, Hinkle and Cheever chapter 53 Assessment of Kidney and Urinary
Function page 1518 )
C. Dewit. Dengue Fever (2006). Retrieved from:

http://www.encyclopedia.com/topic/dengue_fever.aspx
C. Davis. Hematoma (2015). Retrieved from:

http://www.emedicinehealth.com/hematoma/page2_em.htm
Dengue Cases. Lulu Bravo ,* Vito G. Roque, Jeremy Brett Ruby Dizon, and Maï L'Azou,
2014 Nov 6. Retrieved by:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222740/
Dengue Incidence. Retrieved from: http://www.who.int/mediacentre/factsheets/fs117/en/

May, 2015
Dengvaxia. Lyon, France - December 9, 2015.

http://www.sanofipasteur.com/en/articles/dengvaxia-world-s-first-dengue-
vaccine-approved- in-mexico.aspx
Davis’s Drug Guide for Nurses fifth edition 2010
E. Esther. Typhoid Test (2009). Retrieved from:

https://www.researchgate.net/publication/10894775_Typhidot_test_to_detect_IgG
_IgM_antibodies_in_typhoid_fever
Handbook of Common Communicable and Infectious Disease, 3rd edition;Dionesia

Mondejar-NavalesRN. Maed, p. 71-73
Jones and Bartlett Nurse’s Drug Handbook 2015
Laboratory Guideline and Diagnostic Findings (2010). Retrieved from:

http://www.cdc.gov/dengue/clinicalLab/laboratory.html
M.Territo. Monocyte Disorders. https://www.merckmanuals.com/home/blood-

disorders/white-blood-cell-disorders/monocyte-disorders
Med Friendly. Red Blood Cell. Retrieved from: http://www.medfriendly.com/red-cell-

Medical Surgical Nursing 8th Edition page 1146
Page | 93
Neutropenia. Retrieved from:
http://www.mayoclinic.org/symptoms/neutropenia/basics/causes/sym-20050854
National Institute of Allergy and Infectious Diseases, NIH: Volume 2
K. Kafeel (2011). Retrieved from: http://www.onlymyhealth.com/cause- low-platelet-

count-in-dengue- fever-1301653922
R. Bailey. Lymphocytes (2016). Retrieved from:

http://biology.about.com/od/cellbiology/ss/lymphocytes.htm
Red Blood Cell Count. Lab Test Online. Retrived from:

https://labtestsonline.org/understanding/analytes/rbc/tab/test/
White Blood Cell. Retrieved from:
http://www.medicinenet.com/script/main/art.asp?articlekey=6017
World Health Organization (WHO) 2011. Retrieved from: http://who.int.com
Page | 94

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I.

Dengue is a mosquito-borne disease cause by any one of four closely related

1. Bite of an infected mosquito, principally the Aedes Aegypti.

The incubation period is 3-14 days; commonly 7-10 days.

This severe form of dengue virus infection id manifested by fever, hemorrhagic,

Classification According to Severity

C. SCOPE AND LIMITATION

4. Explain and illustrate the pathophysiology of Dengue Hemorrhagic Fever;

6. Describe the potential complications related to Dengue Hemorrhagic Fever;

7. Develop a comprehensive nursing care plan, with a principle of SMART, that is

8. Provide a well-develop Health Teaching using the METHODS formula to

Hospital Number: 137170

Admitting Time: 6:30am

Chief Complaint: Epistaxis, headache, nausea and vomiting

According to Patient DLB, he had experienced cough, cold, fever and

Patient’s vital signs during our shift whereas follows:

Patient is unable to answer some of the questions properly because he

There is no history of dengue cases within patient's family members except

Patient DLB’s religious affiliation is Roman Catholic. He stated that their

Erik Erikson’s stages of psychosocial development are a comprehensive

STAGE DESCRIPTION RESULT JUSTIFICATION

The adolescent is It was attained by The patient

Before Hospitalization During Hospitalization After Hospitalization

Before Hospitalization During Hospitalization After Hospitalization

Urination Urination Urination

Before Hospitalization During Hospitalization After Hospitalization

24 hour Food Recall

Before Hospitalization After Hospitalization

Was this the usual time? “No. I usually go to sleep “Yes.”

2. What time did you get “Around 8am.” “I woke up 6 in the

Was this the usual time? “No. I usually wake up

When was the first time “At lunch time.”

What did you have and “Just a piece of biscuit and

4. Where? “In our house.” “In our house.”

5. When did you eat next? “At 10 pm.” “Lunchtime.”

a. Anything from 1st “None.” “I drink a glass of water

b. Anything from 2nd to “None.” “I drink a half glass of

7. Was this day’s food “Yes.” “No.”

8. Is weekend eating “Sometimes.” “At times.”

Area Method Findings Post-Findings Interpretation

Paleness is caused by reduced

Reference: K. Kafeel (2011). Retrieved from:

The presence of the virus

Reference: C. Dewit. Dengue Fever (2006).

Lungs Inspection symmetrical symmetrical Normal

Lymphoid cell line

The main types of lymphocytes are:

Bite from mosquito to skin

Virus will circulate in the

Infection primarily targets

Activation of immune Stimulate WBC and

Destructive actions of the virus or Fever 38.2°C

Thrombocytopenia Lymphopenia Leukopenia

Capillary fragility Petechiae

URINARY TRACT INFECTION

Date Doctor’s Order Interpretation

4:00 pm  Secure consent  Informed consent is the patient’s

 TPR every shift  The recording of Temperature, Pulse rate,

 Dark colored foods may alter the color of

 Urinalysis is done to the patient to detect

 Hematocrit  A blood sample's hematocrit or the red

 Inhibits activation of plasminogen thereby

 For transfusion of  Platelet transfusions are used to prevent