Introduction

Philippine: Dengue Hemorrhagic Fever was first reported in 1953.

In 1958, hemorrhagic became a notifiable disease in the country and
was later reclassified as Dengue Hemorrhagic Fever. Dengue is
primarily a disease of the tropics, and the viruses that cause it are
maintained in a cycle that involves humans and Aedis Aegypti.
Infection with dengue viruses produces a spectrum of clinical illness
ranging from a nonspecific viral syndrome to severe and fatal
hemorrhagic disease.
Identification:
A severe mosquito transmitted viral illness endemic in the
tropics, much in South and Southeast Asia especially in the
Philippines. It is characterized by increased vascular
permeability, hypovolemia and abnormal blood clotting
mechanisms. WHO case definition for DHF:
1) fever or history of recent fever,
2) thrombocytopenia (platelet count equal to or less than
100 x 10 /cu mm),
3) hemorrhagic manifestations such as petechiae or overt
bleeding phenomena, and
4) evidence of plasma leakage due to increase vascular
permeability.
Illness is biphasic; it begins abruptly with fever, and in
children, with mild upper respiratory complaints often anorexia,
facial flush and mild GI disturbances. Coincident with
defervescence and decreasing platelet count, the patient’s
condition suddenly worsens, with marked weakness, severe
restlessness, facial pallor and often diaphoresis, severe
abdominal pain and circumoral cyanosis. GI hemorrhage is an
ominous prognostic sign that usually follows a prolonged period
of shock.

Background of the Study

I, as a student from Siena College Taytay, from the department of

Nursing is on duty in OB/GYNE ward under the supervision of Ms.
Mildred G. Glinoga experienced on the following dates: January 11, 12,
13 & January 18, 19, 20 of the year 2009 experienced and improved
skills, knowledge and hands - on this duty.

Rationale of the Study

Objective
 GENERAL:
As a student nurse from Siena College Taytay, Rizal, BSN 2A
from Group A5 aims to acquire proper knowledge skills and
attitude in performance pf holistic nursing action in caring for
 my patient who have experienced Miscarriage as a part of
competency based on nursing practice.
 SPECIFIC:
- To be able to understand Threatened Miscarriage
- To be able to describe theoretical explanation for
Miscarriage.
- To be able to provide holistic care.
- To be able to perform dependent, independent &
collaborative nursing intervention.
- To be able to depend the general & specific
Pathophysiology of Miscarriage
- To be able to comply with the patient’s needs.

Significance
This study will help the nursing profession by providing information
about the proper management and care for patients who have Dengue
Hemorrhagic Fever. It will also educate the people, especially those
who have Dengue Hemorrhagic Fever and vulnerable individuals to
seek medical care in order to prevent dengue Hemorrhagic Fever. It
will increase awareness about the importance of having a healthy
lifestyle.
This study will elaborate the interrelatedness of lifestyle habits and
developing Dengue
Hemorrhagic Fever.

Scope and Delimitation

I had my duty in San Lazaro Hospital, December6, 7, 8, 13, 14, 15. I

had met my patient in December 7, 2010 in Dengue Ward in San
Lazaro Hospital. I was able to assess the condition of my patient and
be able to ask questions needed for this case study.

Theoretical Framework
Sister Callista Roy

A person is an adaptive system . . . a whole comprised of parts that

function as a unity for some purpose”

Roy Adaptation system:

Adaptation is accomplished through these coping mechanisms that are
innate, “genetically determined . . . and automatic processes.
1. Self-Concept - refers to both the physical and the personal self.
The physical self is affected or threatened during invasive
procedures such as surgery. Anxiety, guilt, and distress are
responses within the personal self to physical or emotional
stressors.
2. Physiological mode - problems may arise in areas such as
exercise, nutritional metabolic pattern, elimination, fluid and
electrolytes, temperature regulation, and oxygenation.
3. Interdependence mode - problems may include feelings of
alienation, disengagement, loneliness, or disenfranchisement
that are experienced in various relationships.
4. Role function mode – as a nurse, in-charge with the patient; must
be adaptive also as a family member to the patient to provide
moral support and to keep the patient calm & at ease.
Nursing Assessment
o Personal Data/Demographical Profile
• Name: J.Domingo
• Residence: Caloocan City
• Age: 13 years old
• Sex: Male
• Religion: Catholic
• Civil Status: Single
• Ward: Dengue Ward
• Hospital No.: 545610
• Date of Admission: December 5, 2010
• Time of Admission: 1:25 PM
• Admitting Diagnosis: Dengue Hemorrhagic Fever Stage I
with warning signs
• Chief Complain: Fever

Impression & Diagnosis

 Impression
o Dehydrated and Restless but after some increase in fluid
intake feels better, takes also naps to rest.

History of Past Illness

Admitted in E. Rodriguez Hospital in 2009 due to tachycardia after
PE.

History of Present Illness

Doesn’t complain abdominal pain. No irritability noted.

Family History
No recent illness in the family reported.

Psychosocial History
Doesn’t have any difficulties in communicating along in the
neighborhood and even in the patients in the hospital.
Physical Assessment
Physical Assessment follows a methodical head to toe format in the
cephalocaudal assessment.

PHYSICAL ACTUAL
ASSESSMENT METHOD NORMAL FINDINGS ANALYSI
FINDINGS S
I. Head Inspection Hair is normally Hair is black Normal.
A. Hair lustrous, silky, in color. Thin The
strong and and smooth in patient
elastic. Tend to texture. No can still
increase in presence of take about
growth. No falling hair. even
falling hair. admitted
Softening and at the
thinning are hospital
common.

Inspection Symmetrical, There is no

B. Scalp Palpation rounded presence of Normal
normocephalic flakes.
No presence of Symmetrical,
flakes and rounded
lesions. No signs normocephali
of deformities. c. No signs of
deformities.

Inspection Face is normally Face is fair in Doesn’t

C. Face Palpation proportional and color. Skin express
symmetric. color is fine. any facial
Movements are Symmetric grimace
equal bilaterally. and indicating
proportional. pain.
Inspection Sclera is white Sclera is Eyes
D. Eyes in color. Bright white. Eyes shows
and not sunken looks away. observing
or bulge. Eyelids close environme
Symmetrical completely nt.
and free of and have
nystagmus. equal eyes.
Eyelids close PERRLA
completely. No (Pupils are
lesions, scaling Equal, Round,
or inflammation. Reactive to
PERRLA. Light and
 Accommodati
on).
Inspection Nose is midline Movements of Doesn’t
E. Nose Palpation in face, septum nares when indicate
is straight, and breathing are any
nares are patent. No tendernes
patent. No congestion or s,
discharge or foul odor. No obstructio
tenderness is tenderness on n and
present. sinuses. bleeding.
Turbinates are
pink and free of
edema. No
tenderness
palpated on
sinuses.

Inspection Lips appear pink Lips are Indicates

F. Lips Palpation and moist. No moist. No no
lesions are presence of dehydratio
present. lesions and n.
cyanosis.

Inspection Teeth are white Teeth are Patient is

G. Teet and no presence white and no still
h of presence of maintainin
staining and staining and g oral care
tartar. No dental tartar. even
carries. Few admitted
missing tooth in in the
the lower gum hospital.
line near the
molar teeth left.

Inspection Gums are pink Gums are pink No

H. Gum Palpation in color. No in color. No presemce
s bleeding and bleeding and of
gingivitis. gingivitis. gingivitis
due to
good oral
care
Inspection Speech is Speech is
I. Spee coherent. No coherent. Normal
ch presence of
slurring,
rambling,
 dysphagia and
aphasia

Ear are equally No cerumen is Patient is

J. Ears Inspection in size present. No having a
bilaterally. The presence of good
auricle aligns inflammation hygiene
with the corner and masses. itself even
of each eye and The pinna at the
within a 10- cross the eye hospital.
degree may be occiput line.
free, attached,
or soldered. The
skin is smooth
with no lesions,
lumps, or
nodules.
Tymphnic
membranes
clear; landmarks
visible.

Inspection Breath should No odor. Performing

K. Breat have no odor. oral
h hygiene
Inspection Throat pink, no Throat is pink
L. Thro redness or in color. No Normal
at exudates. redness and
exudates.

Inspection Smooth, no Smooth, no

M. Neck Palpation tender, small tender, small Normal
cervical lymph cervical lymph
nodes may be nodes is
palpable palpable
Inspection Symmetrical. No Symmetrical.
I. Thorax pain in moving. No pain in Normal
moving
Inspection Respiratory rate Respiratory
A. Breathin Percussion of 16–25 counts rate of 19 Normal
g Auscultatio per minute. counts per
n Lung sounds are minute. No
clear to presence of
 auscultation deep, shallow
bilaterally. breathing.
Lung sounds
are clear to
auscultation
bilaterally.

Auscultatio Heart rate of 60 Heart rate of

B. Heart n to 100 beats per 80 beats per Normal
Rate minute. minute.

Inspection No abnormal Respiration 19

C. Chest Palpation breathing per minute Normal
Auscultatio sounds upon relaxed and
n auscultation. No even. No
tenderness, and retracting or
no retractions bulging of
visible. intercostals
spaces. No
pain or
tenderness
noted on
palpation.
Inspection Abdomen is soft, No lesions. No
D. Abdo Palpation without masses abdominal Normal
men Interview and tenderness. pain, masses
Symmetrical and
contour with no tenderness is
lesions. Rash or present.
visible
peristaltic
waves. Normal
bowel sounds in
all four
quadrants; no
bruits.
 Inspection Joints are in full Color of nails
II. Limbs range of motion and nailbeds Normal
and no swelling, are pink.
redness or Temperature
tenderness. rate of 36.0°C
Muscle size and on both
strength is axillary. Joints
equal. Nails and are in full
nailbeds are range of
pink. Normal motion.
temperature of
36.5°C to
37.5°C.
Usual pattern of ADL
 Gordon’s Before During Analysis
Hospitalization Hospitalizatio
n
Health Doesn’t have any Doesn’t The patient
Perception and discomforts at complain at all. doesn’t have
Health all. Walks at He drinks water any problems
Management morning when a lot everyday regarding to his
Pattern buying breakfast. and eats what health.
is given to him.
Nutritional His typical food He eats a lot of The patient
Metabolic intakes are fruits during does not
Pattern vegetable, fruits, hospitalization experience
rice and meat. with minimal alterations in
His daily fluid meat and more his appetite
intake is 8-10 on soups and before and
glasses of water vegetables. He during his
a day. drinks at about hospitalization.
6-8 bottles of
water a day
(450ml per
bottle).
Elimination Defecates about He still Patient doesn’t
Pattern twice a day ever defecates have any
morning and about twice a changed in
afternoon. No day. Sometimes elimination
discomforts at morning and pattern.
when voiding. afternoon or
morning and
evening.
Activity He usually goes He sits and Patient is
Exercise to the computer wander around slightly bored
Pattern shop to play to keep his due to his
online games. body active. hospitalization.
When he is Plays card with
bored, plays with his older sister
the neighbors. and some of
the patient.
Sleep Rest Patient sleeps for As being Patient doesn’t
Pattern 3 hours at night hospitalized, hehave proper
because he was now sleeps at sleep pattern
always coming 7PM-6AM. He due to playing
home late after also takes naps computer
gaming. about 1-3PM. games. But as
confined, he
was back to his
old sleeping
pattern.
Cognitive Patient doesn’t Doesn’t have The patient is
Perceptual have any any problems in coherent and
Pattern difficulty in eyesight and no signs of
reading and hearing. disorientation
hearing. He is and confusion.
also a good
listener.
Self Perception He feels Patient is The patient is
Self concept contented in his positive in life optimist with