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Dengue is a mosquito-borne infection which in recent years has become a major international public health concern. Dengue is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas. Dengue haemorrhagic fever (DHF), a potentially lethal complication, was first recognized in the 1950s during the dengue epidemics in the Philippines and Thailand. By 1970 nine countries had experienced epidemic DHF and now, the number has increased more than fourfold and continues to rise. Today emerging DHF cases are causing increased dengue epidemics in the Americas, and in Asia, where all four dengue viruses are endemic; DHF has become a leading cause of hospitalization and death among children in several countries.
There are four distinct, but closely related, viruses that cause dengue (1, 2, 3 or 4) of a virus from genus Flavivirus. Recovery from infection by one provides lifelong immunity against that serotype but confers only partial and transient protection against subsequent infection by the other three. There is good evidence that sequential infection increases the risk of more serious disease resulting in DHF. Anyone who is bitten by an infected mosquito can get dengue fever. Risk factors for dengue hemorrhagic fever include a person's age and immune status, as well as the type of infecting virus. Dengue fever usually starts suddenly with a high fever, rash, severe headache, pain behind the eyes, and muscle and joint pain. The severity of the joint pain has given dengue the name "breakbone fever." Nausea, vomiting, and loss of appetite are common. A rash usually appears 3 to 4 days after the start of the fever. The illness can last up to 10 days, but complete recovery can take as long as a month.
Most dengue infections result in relatively mild illness, but some can progress to dengue hemorrhagic fever. With dengue hemorrhagic fever, the blood vessels start to leak and cause bleeding from the nose, mouth, and gums. Bruising can be a sign of bleeding inside the body. Without prompt treatment, the blood vessels can collapse, causing shock (dengue shock syndrome). Dengue hemorrhagic fever is fatal in about 5 percent of cases, mostly among children and young adults.
distribution of the four dengue viruses and of their mosquito vectors, the most important of which is the predominantly urban species Aedes aegypti. A rapid rise in urban populations is bringing ever greater numbers of people into contact with this vector, especially in areas that are favourable for mosquito breeding, e.g. where household water storage is common and where solid waste disposal services are inadequate.
OBJECTIVES STUDENT NURSE-CENTERED Short-term objectives: After 1 – 2 days of Nursing Interventions, the student nurses will be able to: Identify a patient for their case study Introduce themselves and state their purposes to the patient Establish rapport with the patient Gather the following data: demographic data history of past and present illness
Perform thorough physical assessment
Review and monitor diagnostic and laboratory results Actively participate with the different medical management for the patient and reinforce the teachings the physician has been made Apply independent, interdependent and dependent nursing responsibilities in every medical management Monitor and document the patient’s response to the disease process
Long-term objectives: After 3 – 4 days of Nursing Interventions, the student nurses will be able to: Identify modifiable and non-modifiable factors that may directly or indirectly cause the disease condition Review the pathogenesis of the disease condition and formulate patient-centered pathophysiology Review the signs and symptoms of the disease condition with rationale and identify specific signs and symptoms manifested by the patient. Relate the assessed pertinent data, diagnostic and laboratory results and abnormal findings of the patient to the disease process itself in order to give a clear picture of the disease condition Identify nursing diagnosis from the collected data, formulate nursing care plans, and perform nursing interventions and evaluation. Provide health teachings to each medical management received by the patient Do actual SOAPIEs
PATIENT-CENTERED Short-term objectives: After 1 – 2 days of Nursing Interventions, the patient will be able to: Acknowledge the presence of student nurses as part of the health care team responsible in taking care of his condition Develop trusting relationship with the student nurses
Actively participate in every medical and nursing management prescribed Participate during assessment and interview Develop good communication during the interview Ask and show interest during the course of nursing process Long-term objectives: After 3 – 4 days of Nursing Interventions. A. Current Trends about the disease condition Development of Dengue Vaccine . the patient will be able to: Understand how the disease came about/occurred Adhere with the health teachings given by the student nurses for each medical and nursing management Comply with the treatment regimen prescribed Identify measures to prevent complications from the disease Maintain trusting relationship with the student nurses during the whole course of treatment to gain strong compliance and attain optimum level of functioning.
By Yuri Pervikov* Department of Vaccines and Biologicals, World Health Organization, 1211 Geneva 27, Switzerland
Abstract The dengue viruses are estimated to cause several hundred thousand cases of dengue fever, dengue haemorrhagic fever and dengue shock syndrome annually. Attempts to prevent the infection focus on the development of a vaccine that would protect against all four serotypes of the dengue virus. Various biotechnological approaches are being explored, including the use of live attenuated or inactivated viruses, infectious clonederived vaccines, immunogens vectored by various recombinant systems, subunit immunogens and nucleic acid vaccine. Three candidate vaccines are undergoing clinical evaluation and several are at the stage of preclinical evaluation. A WHO steering committee is conducting activities aimed at accelerating the development of vaccines against dengue and Japanese encephalitis. Key words: Dengue vaccine, clinical evaluation, preclinical stage Introduction Dengue viruses are the most widespread arthropod-borne viruses. They are members of the flaviviridae family, which includes more then 70 related but distinct viruses. Among these are important aetiological agents such as those of yellow fever (YF), Japanese encephalitis (JE), West Nile encephalitis and tick-borne encephalitis. Dengue is one of the most important tropical infectious diseases. It is estimated that there are some 100 million cases of dengue fever, 500 000 cases of dengue haemorrhagic fever (DHF) and 25 000 deaths attributable to dengue annually(1). In recent decades the transmission of dengue viruses has intensified in many countries and the disease has extended its geographical range to previously unaffected areas of the South-East Asia Region, the Western Pacific Region and the Region of the Americas of the World Health Organization. In the past, the African Region and the Eastern Mediterranean Region were considered to have low incidences of dengue, but there was an upsurge of the disease in these regions during the early 1990s. Dengue has grown dramatically as a health, environmental and economic problem, now occurring in most countries. More than half the Member States of the United Nations, with a population of some 2500 million, are at risk. Dengue viruses are classified antigenically into four serotypes. Infection with one serotype results in lifelong immunity to it but there is no cross-protection against the others. Persons living in areas of endemicity can be infected with two, three and, probably, four dengue serotypes during their lifetime. Infection with any serotype can produce clinical illness, ranging from a non-specific febrile syndrome to severe and fatal DHF/dengue shock syndrome. An immunopathological response following secondary infection of humans with a heterologous serotype of dengue virus can be a risk factor for the more severe forms of the disease. This was recently confirmed in Cuba, where an 18-year interval between a dengue virus type 1 outbreak in 1977/1978 and a dengue virus type 2 outbreak in 1997 provided an opportunity to evaluate risk factors(2). All patients with severe forms of dengue, including cases of DHF and deaths, were born before the dengue virus type 1 epidemic, and nearly all experienced the secondary dengue virus infection. In contrast, almost all those who seroconverted without illness experienced the primary dengue virus infection. These observations could have implications for the development of a dengue vaccine because they suggest that a
safe vaccine should be polyvalent to avoid inducing monotype-enhancing immune responses that may lead to severe manifestations of the disease. No effective vaccine is available. Research into dengue vaccines focuses on the use of live attenuated or inactivated vaccines, infectious clone-derived vaccines, immunogens vectored by various recombinant systems, subunit immunogens, and nucleic acid vaccines. Tetravalent live attenuated vaccine The most advanced live attenuated tetravalent vaccine was developed in Mahidol University, Thailand, with the support of WHO's South-East Asia Regional Office. Attenuated viruses of all four serotypes were developed by serial passage of wild-type viruses in primary dog kidney (PDK) cells or other cell types(3). After intensive and stringent laboratory studies, including evaluation in animal models, the vaccine underwent clinical trials in Thailand in mono-, di-, tri- and tetravalent formats, which proved safe and immunogenic in adults and children. The vaccine proceeded to commercial development by agreement with Aventis Pasteur. A randomized, controlled, double-blind study was carried out to determine the safety and immunogenicity of batches of the vaccine produced by this company(4). All formulations were safe and tolerated in humans. Vaccines immunized with tetravalent vaccine gave multivalent antibody responses, the highest antibody titres being against dengue virus type 3. A phase 1 clinical trial of Aventis Pasteur vaccine was recently completed in Thailand. After two doses, seroconversion to all four serotypes was demonstrated in most vaccinated volunteers and antiviral activity remained quite stable for at least a year. Various reformulations of the tetravalent vaccine are being evaluated in an attempt to obtain a similar immune response to each serotype. Vaccine strains developed at MahidolUniversity are characterized by lower infection, dissemination rates and transmissibility in Aedes aegypti mosquitoes than those of the parent viruses(5). Moreover, the phenotypes of the vaccine strains were stable and unchanged by passage in humans and mosquitoes. Serial passages of dengue viruses in PDK cells were used for the development of dengue vaccine at the Walter Reed Army Institute of Research (WRAIR) in the USA. All four monovalent formulations elicited seroconversion in humans. The vaccine was well-tolerated, caused no clinically serious adverse events and induced the production of neutralizing antibodies to all four serotypes. Tetravalent formulations were prepared and evaluated in a monkey model. Challenge studies in rhesus monkeys demonstrated that most animals seroconverted after two doses of the vaccine. After virus challenge, viremia was measurable in 4 of 20 monkeys. In pilot studies in humans, three doses of tetravalent vaccine induced 50% and higher seroconversion to all four dengue serotypes. The dissemination rates of WRAIR vaccine viruses in mosquitoes were low and it is unlikely that these viruses would be transmitted under natural conditions(6). The next stages of the clinical trials are in progress. Chimeric vaccine Several research groups are successfully exploring infectious clone technology for the development of a dengue vaccine. The ChimeriVaxTM system, originally developed to construct JE vaccine, has now been applied to dengue viruses by Acambis in the USA. A chimeric YF-dengue type 2 virus (D2) was prepared, using a recombinant cDNA infectious clone of a YF vaccine strain (YF17D) as a backbone, into which the premembrane (PRM) and envelope (E) genes of dengue 2 virus were inserted(7). YF vaccine was selected as a backbone because of its excellent safety record during a long period of practical use. All monkeys vaccinated with ChimeriVax-D2 virus developed neutralizing antibodies and were protected against challenge with a wild-type dengue-2 virus. The high replication efficiency, attenuation phenotype in animal models, immunogenicity and protective efficacy, and genomic stability of ChimeriVax-D2 justify it as a novel candidate vaccine for evaluation in humans. YF/dengue viruses for three other serotypes have been constructed and are undergoing laboratory analysis and evaluation in animal models.
Another approach is based on the use of a dengue type 4 mutant containing a deletion in non-coding regions as a genetic background for the construction of a dengue chimeric vaccine(8). Viruses with deletion mutations are genetically more stable than the ones with point mutations and are less likely to revert to the genotype of the parent virus when propagated in vaccinees. On the basis of laboratory tests and work with a monkey model, some deletion mutants were defined as attenuated viruses. Phase 1 clinical trials of a 3' deletion mutant were carried out in adult humans. The results indicated that this dengue 4 deletion mutant was safe and immunogenic. It is planned to use this attenuated virus as the backbone for the construction of chimeric dengue viruses of serotypes 1, 2 and 3. The ultimate aim is to develop a tetravalent vaccine. Work at the Centers for Disease Control and Prevention in the USA showed that attenuation markers of dengue 2 vaccine strain PDK-53 were encoded by genetic loci outside the structural gene region(9). On this basis, chimeric dengue type 2/type 1 viruses were constructed which contained the non-structural genes of PDK-53 and structural genes of the dengue 1 strain(10). Chimeric virus retained the attenuation in vivo and in vitro markers and was immunogenic in mice, inducing the production of neutralizing antibodies against dengue 1. It is considered as a potential dengue 1 candidate vaccine. The results also suggest that the infectious clones from the PDK-53 vaccine are promising attenuated vectors for the development of chimeric flavivirus vaccines. DNA vaccines A candidate DNA vaccine expressing dengue virus type 1 PrM and E proteins was developed and used for the immunization of different kinds of monkeys(11,12). The candidate vaccine induced the production of virus-neutralizing antibodies and gave partial protection against challenge with homologous dengue virus. Intramuscular immunization of rhesus macaques was more immunogenic than intradermal immunization. Another study focused on the construction of a dengue vaccine containing PrM and E genes of the Guinea C strain of dengue type 2 virus(13). In immunized mice the candidate vaccine induced neutralizing antibody production and strong anamnestic responses to challenge. Further extensive preclinical and clinical trials are required before a decision can be made on the acceptability of DNA vaccine for practical use. Inactivated and subunit vaccines The success of inactivated flavivirus vaccines against JE in Japan and tick-borne encephalitis in Austria and Russia led to attempts to develop a killed dengue vaccine. However, early work in this area was unsuccessful because of difficulties in growing high titres of dengue virus in cell lines. It was recently shown that flaviviruses can grow to high titres in Vero cells(14). Dengue virus type 2 was grown in Vero cells and, after inactivation, purification and concentration, was used for the immunization of laboratory animals(15). The experimental vaccine induced the production of a protective level of antibodies in monkeys. This approach will probably allow the development of an effective inactivated dengue vaccine. Recombinant DNA techniques provided the possibility of cloning specific genes encoding for protective antigens and of expressing them in other host cells, including E.coli, yeast and insect cell systems. This technology has been used by several researchers for the development of subunit vaccines. Recombinant E protein of dengue 2 virus, produced in a baculovirus vector system, induced neutralizing antibody production and partial protection of immunized monkeys(16). Products from Drosophila cells appeared to be promising in the early stages of testing in animals(15). Further efforts are required to increase the immunogenicity of subunit vaccines by incorporating them into adjuvants or other systems for stimulating immune responses.
WHO activity in the development of dengue vaccine WHO has designated the dengue viruses as a high-priority target for accelerated vaccine development.Vaccinia virus as vector for dengue vaccine The use of genetically-modified vaccinia virus as a vector for genes encoding flavivirus vaccine antigen could have broad application for the genetic engineering of viral vaccine. and this character is genetically stable. to be used by laboratories involved in evaluating the immunogenicity of dengue vaccine. established in 1984. active participation in clinical trials of candidate vaccines. This involves the evaluation of new biotechnological approaches. the main purpose of the steering committee is to promote and facilitate the development of candidate vaccines with a view to expediting their introduction in developing countries. In the area of dengue vaccine. and the facilitation of vaccine introduction through the planning and assessment of low-cost vaccination schedules(19). Work is planned on constructing MVA recombinants expressing immunogenic E protein of other dengue virus serotypes. The steering committee on dengue and JE vaccines supports research projects aimed at standardizing immunological methods. In order to promote the evaluation of live attenuated vaccines in clinical trials. B. The safety of this vector was demonstrated in a large number of volunteers. This work is conducted by a steering committee on dengue and JE vaccines. a group of WHO experts has been developing guidelines for the safety of dengue vaccine. They could also help researchers to arrive at technical decisions before designing trial protocols. Monkeys repeatedly immunized with MVA recombinant expressing dengue 2 E protein have virus-neutralizing antibodies and are fully protected against challenge with homotypic dengue virus(18). The steering committee has supported some research projects that have led to the development of candidate vaccines now undergoing clinical evaluation. These guidelines could help public health officials to make decisions about conducting dengue vaccine trials in their countries. Reason for choosing the case . Modified vaccinia Ankara (MVA) vector with a restricted host range was developed for the construction of recombinants(17). MVA and recombinants derived from this virus do not replicate efficiently in human and most other mammalian cells. including the neutralization test for dengue viruses.
it is but our duty to provide appropriate nursing interventions in managing the disease. quality nursing care and providing health teachings to the patient on how to prevent further complications. Because of these there is a greater need of study about the disease so that we could give precautionary measures and possible preventions as well as treatment necessary for it. With major global demographic changes that have occurred. and waste management systems.The group has chosen DHF for our case study for the reason that we want to gain more knowledge and to generate a lot of learning experience for us. NURSING ASSESSMENT 1. These demographic changes have resulted in substandard housing and inadequate water. entailed with the virtue of care and patience. sewer. Furthermore. PESONAL DATA . all of which increase Aedes aegypti population densities and facilitate transmission of Aedes aegypti-borne disease. II. the most important of which have been uncontrolled are urbanization and concurrent population growth.
according to Mrs. Mrs. Mrs. same as through with her second baby. In these three families. they both get enough attention they need because their mother is plain housewife. Gue this earning is just enough for their family but since they lived in Mrs. OPV. She is the youngest among the two siblings of Mr.Gue was pregnant with her first baby she experienced normal signs and symptoms of being pregnant. Other expenses will be for the food and milk for the baby. They are composed of three families in one house. DPT. PERSONAL HISTORY When Mrs. the mother gave birth to her two children via normal delivery. Both of her pregnancy she practiced going to the “mananawas” then went to clinic on her 3rd trimester for her prenatal check up. She vomits every morning while on her first trimester and was always sleepy. Baby Deng was breastfeed for only one week for the reason she always vomits after she is fed. bornin on the 20th day of January 2007. Pampanga. PERTINENT FAMILY HISTORY Family Gue is an extended type of family. Baby Deng received her vaccine on their barangay health center. the eldest is 5 years old and Baby Deng is 5-month-old. She was rush to Ospital NIng Angeles (ONA) last January 5. mother and two siblings. She already received BCG. at Hacienda Dolores Porac. and HEPA B. . She is a natural born Filipino and a Roman Catholic. Sister Dang. Gue. 2008 with a chief complain of nose bleeding. 2. they still need to share their earnings for paying electricity and water bills. 3. and Mrs. Gue’s parent. Baby Dend’s Family is composed of a father. Gue the father is an electrician and he earns 3000 a month. Mr. Their house is a bungalow type of house and it is closely built to the other house. Gue. it has no drainage system and there is presence of stagnant water due to rain. Gue then decided to bottle-feed her baby. which mean she has complete immunization for her age.Baby Deng is a 5-month-old female infant.
such as food when she is hungry and comforting the baby when crying. an infant’s knowledge of the world is limited to their sensory perceptions and motor activities. the infant will develop a sense of trust only if the parent or caregiver is responsive and consistent with the basic needs being meet. sucking. mistrust. A fixation at this stage can result in problems with dependency or aggression. She was simply observing the people around her. grasping. This behavior was observed when the mother as well as other caregivers gave the necessity the child needs. This was manifested by Baby Deng when the group was gathering information from her mother. otherwise a sense of mistrust will develop. Sigmund Freud (Psychosexual Stage of Development) Baby Deng belongs to oral phase of Freud’s theory. The important event in this stage is feeding. such as looking. The need for care and food must be met with comforting regularity. Children utilize skills and abilities they were born with. According to Erikson. Jean Piaget (Cognitive Development) At her age she belongs to sensorimotror stage. and listening.Growth and development: Erik Erikson (Psychosocial Developmental) Baby Deng is a 5-month-old and she belongs to developmental task of trust vs. during which the child is forced to become less dependent upon caretakers. During this stage. . to learn more about the environment. Behaviors are limited to simple motor responses caused by sensory stimuli. In this stage the mouth is the primary erogenous zone through which pleasure is derived. The major conflict issue during this stage is the weaning process. The infant must first form a trusting relationship with the parent or caregiver.
PHYSICAL EXAMINATION January 5. Gue decided to bring her child to ONA for further assessment and to seek treatment for her child’s condition. Then her auntie has allergic Rhinitis. she seems like she receives gratification from what she doing.This was observed when she was thumb sucking. It was her first time to be hospitalized. cough and colds. Other members of the family occasionally experience mild fever. With her immediate family members. which the family manages with the use of antipyretic like paracetamol and drinking lots of water. Then physician then diagnosed Baby Deng with Dengue Hemorrhagic Fever II. Among her relatives her Grandmother on her father’s side has diabetes and her grandfather dies because of DM. Her past illnesses includes mild fever. both her sister and her mother got German measles and allowed the illness to eventually disappear without any intervention being done. 5. Mrs. 6. On the second day she had severe nose bleeding. Her grandmother on the mother’s side has hypertension. History of Present Illness Two days prior to admission. Baby Deng experienced occasional nose bleeding for the first day. The family then consults to their barangay health center for assistance and to acquire the appropriate medicine. 2008 (Admission) . 4. She also had German measles. History of Past Illness Presently Baby Deng was the only one in the family who is sick.
masses. Head-EENT: pink palpebral conjunctiva besides sclera. uniform in color Rashes observed on the left cheek Skin return to original position after being pinched Scars noted on upper and lower extremities • Hair Black in color Straight hair Hair is evenly distributed all over the scalp Hair strands are thin and not brittle Scalp has no nodules. RR: 30 cpm Skin: conscious. soft January 07. no retractions.Vital Signs: T: 36. tenderness and redness present • Nails Dirty and untrimmed fingernails and toenails Capillary refill time of < 2 seconds No clubbing and brittleness noted . w/ Normal Abdominal Breath Sounds. 2008 • General Appearance Weight: 7. PR: 120bpm.2ºC. Lymph Nodes: no palpable cervical Lungs: Chest expansion. Cardiovascular: no murmurs Abdomen: abdomen is flat. not in distress.5 kg Waist circumference: 19 inches • Skin Skin is intact.
swelling and discharges noted Sclera is White Eyeballs: symmetrical. nor deformities observed Pinna recoils back when it is folded • Mouth . lesion. smooth and shiny Pink palpebral conjunctiva No presence of nodules. aligned and do not bulge outward • Nose and Sinuses External nose is properly aligned in between eyes Presence of cough and colds No deformities. and tenderness noted No tenderness and swelling of sinuses noted • Ears and Hearing Symmetrical and aligned to the outer canthus of the ears No lesion and tenderness noted upon palpation No discharges. no lice noted Eyelashes: evenly distributed and curled outward Eyelids: symmetrical and have smooth texture Bulbar conjunctiva: is transparent.• Skull and Face Round normocephalic No lesion and nodules noted Face: no contusion or scars noted Symmetrical facial features and movements Client is able to smile • Eyes and Vision Eyebrows: evenly distributed and aligned. inflammation. discharges. lesion.
moist and with no lesion Light pink. and masses noted Absence of nodules and tenderness With rales on both lung fields • Heart With normal heart rate of 100bpm Full pulsation No abnormal heart sound noted upon auscultation • Abdomen . no cracks Inner lips and buccal mucosa are pinkish in color Gums are pink and no bleeding is noted Uvula is positioned midline Tongue: in central position Pinkish in color. no inflammation. spaces are equal on both sides Normal pulse rhythm • Chest and Lungs Chest is symmetrical No deformities. with no discharge and no swelling upon observation • Neck Neck is symmetrical Neck muscles: equal in size No masses noted Undistended jugular veins lymph nodes: not palpable noted Trachea in midline of neck. Outer lips are uniform. no discoloration of soft and hard palate Pink smooth tonsils.
2008 • Skin Skin is intact. Absence of scar and rash No tenderness and mass noted With tympanic sound heard upon percussion With audible borborygmi bowel sounds. masses. uniform in color No wounds and lesion noted Skin return to original position after being pinched • Hair Black in color straight hair Hair is combed Hair is evenly distributed all over the scalp Hair strands are thin and not brittle Scalp has no nodules. tenderness • Nails Dirty fingernails and toenails Capillary refill time of < 2 seconds No clubbing and brittleness noted . 10 sounds per minute upon auscultation • Extremities Extremities are symmetrical and have uniform skin color With scars on both leg secondary to chicken pox January 08.
aligned and do not bulge outward • Nose and Sinuses External nose is properly aligned in between eyes Presence of cough and colds No deformities. smooth and shiny Pink palpebral conjunctiva No presence of nodules. swelling and discharges noted Eyeballs: symmetrical. lesion. lesion. no lice Eyelashes: evenly distributed and curled outward Eyelids: symmetrical and have smooth texture Bulbar conjunctiva: is transparent. inflammation. and tenderness noted No tenderness and swelling of sinuses noted • Ears and Hearing Symmetrical and aligned to the outer canthus of the ears No lesion and tenderness noted upon palpation No discharges. • Eyes and Vision Eyebrows: evenly distributed and aligned. discharges.• Skull and Face Round normocephalic No lesion and nodules noted Face: no contusion or scars noted Symmetrical facial features and movements Client is able to smile. nor deformities observed Pinna recoils back when it is folded Firm and no infection noted • Mouth .
no inflammation. with no discharge and no swelling upon observation • Neck Neck is symmetrical Neck muscles: equal in size No masses noted Undistended jugular veins lymph nodes: not palpable Trachea in midline of neck. spaces are equal on both sides Pulsation of carotid artery felt Symmetric pulse volume Normal pulse rhythm • Chest and Lungs Chest is symmetric No deformities. no discoloration of soft and hard palate Pink smooth tonsils. and masses noted Absence of nodules and tenderness With rales on both lung fields • Heart With normal heart rate of 118bpm Full pulsation . Outer lips are uniform . no cracks Inner lips and buccal mucosa are pink in color Gums are pink and no bleeding is noted Uvula is positioned midline Tongue: in central position Pinkish in color. moist and with no lesion Light pink.
masses. 08 • Skin Skin is intact. uniform in color No wounds and lesion noted Skin return to original position after being pinched Absence of petechiae • Hair Black in color Straight hair Hair is evenly distributed all over the scalp Hair strands are thin and not brittle Scalp has no nodules. 16 sounds per minute upon auscultation • Extremities Extremities are symmetrical and have uniform skin color With scars on both legs secondary to chicken pox January 09. No abnormal heart sound noted upon auscultation • Abdomen Absence of scar and rash No tenderness and mass noted No signs of swelling With tympanic sound heard upon percussion With audible borborygmi bowel sounds. tenderness and redness present • Nails Dirty fingernails and toenails Capillary refill time of < 2 seconds .
swelling and discharges noted Eyeballs: symmetrical. lesion. discharges. smooth and shiny Smooth and pink palpebral conjunctiva No presence of nodules. nor deformities observed . inflammation. and tenderness noted Nostrils are patent No tenderness and swelling of sinuses noted • Ears and Hearing Symmetrical and aligned to the outer canthus of the eyes No lesion and tenderness noted upon palpation No discharges. lesion. no lice Eyelashes: evenly distributed and curled outward Eyelids: symmetrical and have smooth texture Bulbar conjunctiva: is transparent. redness. aligned and do not bulge outward Cornea: transparent and shiny • Nose and Sinuses External nose is properly aligned in between eyes No deformities. Pink in color nail beds No clubbing and brittleness noted • Skull and Face Round normocephalic No lesion and nodules noted Face: no contusion or scars noted Symmetrical facial features and movements Client is able to smile • Eyes and Vision Eyebrows: evenly distributed and aligned.
no cracks Inner lips and buccal mucosa are pink. no discoloration of soft and hard palate Pink smooth tonsils. Pinna recoils back when it is folded Firm and no infection noted • Mouth Outer lips are uniform. with no discharge and no swelling upon observation With good appetite • Neck Neck is symmetrical Neck muscles: equal in size No masses noted Smooth coordinated head movement without discomfort Undistended jugular veins Lymph nodes: not palpable No swelling and tenderness noted Trachea in midline of neck. shiny and soft Gums are pink and no bleeding is noted Uvula is positioned midline Tongue: in central position Pinkish in color. moist and with no lesion Moves freely Light pink. moist. no inflammation. spaces are equal on both sides No presence of infection and inflammation in thyroid glands Pulsation of carotid artery felt Symmetric pulse volume Normal pulse rhythm .
and masses noted Absence of nodules and tenderness • Heart With normal heart rate of 120bpm Full pulsation No abnormal heart sound noted upon auscultation • Abdomen Absence of scar and rash No tenderness and mass noted No signs of swelling With tympanic sound heard upon percussion With audible borborygmi bowel sounds. 19sounds per minute upon auscultation • Extremities Extremities are symmetrical and have uniform skin color With scars on both leg secondary to chicken pox Absence of body weakness .• Chest and Lungs Chest is symmetrical No deformities.
Baby deng has negative moro startle reflex as evidenced by absence of Reflex Description Toes fan upward when sole of the foot is stroked in an Appearance Babinski inverted J.Reflexes Disappearan ce Actual Finding Baby Deng has positive babinski reflex as evidenced by Birth 9 months fanning of toes when stroke the foot in an inverted J Arching of trunk toward stimulated side when infant is stroked along Galant spine Birth Neonatal Period manner. Baby deng has negative gallant reflex as evidenced by absence of arching of the trunk toward stimulated side when infant stroked along Moro Startle Sudden outward extension of arms with midline returns when Birth 4 months spine. .
sudden outward extension of arms with midline returns when startled by loud noise or rapid change in Baby deng has negative palmar reflex as evidenced Birth 4 months by absence of grasping of object with fingers when palm is touched Baby deng has positive plantar reflex as evidenced Birth 12 months by inward flexion of toes when balls of feet are touched Baby deng has positive rooting reflex as evidenced by turning Grasping of object with fingers when palm is Palmar touched Inward flexion of toes when balls of feet Plantar are touched Rooting Turning head towards stimulated side of cheek Birth 6 months .startled by loud noise or rapid change in position.
head towards stimulated Initiation of sucking when object is placed in Sucking mouth Birth indefinite side of cheek Baby deng has positive sucking reflex as evidenced by sucking when object is placed in Mimicking swimming movement when heel horizontally placed in Swimming water Birth 4 months mouth Baby deng has negative swimming reflex as evidenced by absence of mimicking swimming movement when heel horizontally placed in Walking Making stepping movements when held upright with feet touching a surface. First week and reappears at 4 or 5 months 12 months water Baby deng has positive walking reflex as evidenced by making stepping movements when held .
Baby Deng has positive righting reflex as evidenced by attempting to maintain head in upright position. .upright with feet touching Attempting to maintain head in upright Righting position Birth 24 months a surface.
of water. Turbidity of urine is any infection. Date Result in DO: January 5. of the patient’s urine is normal . The specific gravity within limit. DIAGNOSTIC AND LABORATORY PROCEDURES Diagnostic/ Laboratory Procedures Urinalysis Date Ordered.7. 2008 DR: January 5.003-1.005 gravity: 1. Excessive cellular material protein in or the a normal of kidney characteristic Specific 1. 2008 Indications or Purposes Analysis and Results Normal Values Interpretation of Results Light yellow urine indicates adequate Transparency: Slightly turbid Clear an intake It yields a large Color: light yellow Yellow amount possible of kidney information about and lower urinary tract infections.025 urine causes it.
Explain that the procedure is done to detect any alteration in kidney function and the presence of infection in the urinary tract. Prepare laboratory request and inform lab. Instruct patient to catch midstream urine in the container.pH: 6.5 – 8.0 The pH of the patient is within Albumin: negative Negative normal limit. During the procedure . Inform the patient that there is no special diet or fasting. Instruct proper hygiene and hand washing. Verify patient’s name in the chart with the actual patient.0 4. The albumin the patient normal of is Nursing Responsibilities: (Urinalysis) Before the procedure Check the doctor’s orders.
the pt or the pt’s SO should be notify that there would be no meals post midnight and the day before the test Prepare the pt. the pt. Provide privacy After the procedure Bring the specimen to the laboratory. and remind them that it is best to collect specimen at the mid urination to have a clean catch of the specimen. Explain the importance of the said procedure that this could be a help in assessing the pt’s condition The day before the procedure. Obtain results and secure it to the patient’s chart. could take meals if the doctor ordered to do so. After collecting the needed specimen. Document the time and procedure done. Diagnostic/ Laboratory Procedure Hematology Date ordered/ Date results in Indication or purpose Analysis/Interpreta Results Normal Values tion .
polycythemia and anemia Hematocrit ( Hct) 0.47 L/L Normal level indicates no . 135 120 – 160 gm/L Normal level indicates no presence of hydration. To determine oxygen carrying capacity of the blood.2008 0. 2008 The test is normally performed as part of a complete blood count. 2008 DR: January 05.37 – 0.39 DO: January 5. Hemoglobin serves as a vehicle for oxygen and carbon dioxide transport.Hemoglobin (Hgb) DO: January 05. It evaluates the hemoglobin content of erythrocytes.
DR: January 5.2008 DR: January 5.2008 It is routinely performed as part of a complete blood count.2008 counts which are capable of 9. It measures the percentage of RBCs in the total blood volume.2008 It is used to measure WBC DO: January 5. polycythemia and anemia WBC DO: January 5.8 5 -10 x 109 /L This a normal findings 96 150 – 400 x 109/L Platelet . It may also provide idea on patient’s fluid status presence of hydration.
VII. To looks at how long it takes for blood to clot. Partial thromboplastin time (PTT) DO: January 5. 2008 DR: January 5. 2008 DR: January 5. % activity :100% 11-15 seconds The patient has normal amounts of clotting factors VII and X.X.2008 fighting infection. 2008 Determine the activity and interaction of factors V.prottombi n and fibrinogen used to monitor patients taking certain medications as well as to help diagnose clotting disorders. Prothrombin time(PT) DO: January 5. 2008 To confirm visual estimate of platelet and morphology 13sec control:13 sec.DR: January 5. Dysfunction or low levels of platelets predisposes to bleeding.45 seconds. It The patient has increase PTT this indicate a clotting factor may be . 53sec control:38sec 28 .
2008 The test is normally 93 120 – 160 gm/L Low transport and exchange of oxygen to the tissues and .can help tell if you have bleeding or clotting problems missing or defective Diagnostic/ Laboratory Procedure Hematology Date ordered/ Date results in Indication or purpose Analysis/Interpreta Results Normal Values tion Hemoglobin (Hgb) DO: January 05.
28 0. It evaluates the hemoglobin content of erythrocytes.performed as DR: January 05.47 L/L Low RBC . carbon dioxide from the tissues Hematocrit DO: January 5.37 – 0. Hemoglobin serves as a vehicle for oxygen and carbon dioxide transport.2008 It is routinely 0. To determine oxygen carrying capacity of the blood. 2008 part of a complete blood count.
3 5 -10 x 109 /L The WBC is below normal limits. 2008 To confirm visual estimate of 89 150 – 400 x 109/L Dysfunction or low levels of platelets predisposes to .2008 It is used to measure WBC counts which are capable of fighting infection.2008 DR: January 5. It may also provide idea on patient’s fluid status /hemoglobin to the plasma level. It measures the percentage of RBCs in the total blood volume. 4. 2008 DR: January 5.2008 performed as part of a complete blood count.( Hct) DR: January 5. WBC DO: January 5. Patient has sign of infection Platelet DO: January 5.
2008 DR: January 05.platelet and morphology bleeding. Diagnostic/ Laboratory Procedure Hematology Date ordered/ Date results in Indication or purpose Analysis/Interpreta Results Normal Values tion Hemoglobin (Hgb) DO: January 05. 2008 The test is normally performed as part of a complete blood count. Hemoglobin 107 120 – 160 gm/L Low transport and exchange of oxygen to the tissues and carbon dioxide from the tissues .
37 – 0.47 L/L Low RBC /hemoglobin to the plasma level. It evaluates the hemoglobin content of erythrocytes.2008 DR: January 5.serves as a vehicle for oxygen and carbon dioxide transport. To determine oxygen carrying capacity of the blood. Hematocrit ( Hct) DO: January 5. It measures the 0. .2008 It is routinely performed as part of a complete blood count.32 0.
2008 DR: January 5.8 5 -10 x 109 /L The result is within normal limits .percentage of RBCs in the total blood volume. Platelet DO: January 5. 2008 To confirm visual estimate of platelet and morphology 180 150 – 400 x 109/L The result is within normal limits 7.2008 DR: January 5. It may also provide idea on patient’s fluid status WBC DO: January 5.2008 It is used to measure WBC counts which are capable of fighting infection.
Nursing Responsibilities :( Hematology) Before the procedure: Check the doctor’s orders. Explain to the patient that small amount of blood will be drawn from her and that blood will be tested to measure if her blood cells are within normal values and to detect some blood abnormalities such as anemia, polycythemia or detect infections. Inform the client that there are no fluid restrictions or fasting. Inform the patient that he will experience mild pain at the site of extraction during collection. Ensure that the patient understands the procedure. Prepare laboratory request and inform laboratory. Inform the client of the scheduled extraction. During the procedure: Provide comfort measures to decrease the client’s anxiety. Place the client in a comfortable position. Maintain aseptic technique. Assist medical technologist if necessary.
After the procedure: Instruct patient to apply slight pressure at the site of extraction for a few minutes. Place the patient in a comfortable position and leave his room quietly. Document the time and procedure done. Then, obtain results and secure it in the patient’s chart. Refer
III. ANATOMY AND PHYSIOLOGY The Blood Blood is a specialized bodily fluid (technically a tissue) that is composed of a liquid called blood plasma and blood cells suspended within the plasma. The blood cells present in blood are red blood cells (also called RBCs or erythrocytes), white blood cells (including and both leukocytes (also and called lymphocytes) thrombocytes). platelets
Plasma is predominantly water
containing dissolved proteins, salts and many other substances; and makes up about 55% of blood by volume. By far the most abundant cells in blood are red blood cells. These contain hemoglobin, an iron-containing protein, which facilitates transportation of oxygen by reversibly binding to this respiratory gas and greatly increasing its solubility in blood. In contrast, carbon dioxide is almost entirely transported extracellularly dissolved in plasma. White blood cells help to resist infections and parasites, and platelets are important in the clotting of blood. Blood is circulated around the body through blood vessels by the pumping action of the heart. Arterial blood carries oxygen from inhaled air to the tissues of the body, and venous blood carries carbon dioxide, a waste product of metabolism produced by cells, from the tissues to the lungs to be exhaled. Anatomically and histologically, blood is considered a specialized form of connective tissue, given its origin in the bones and the presence of potential molecular fibers in the form of fibrinogen.
including the transport of hormones and the signalling of tissue damage Regulation of body pH (the normal pH of blood is in the range of 7. including circulation of white cells. and detection of foreign material by antibodies Coagulation. amino acids and fatty acids (dissolved in the blood or bound to plasma proteins) Removal of waste such as carbon dioxide.45) Regulation of core body temperature • • • • • • • .Blood performs many important functions within the body including: • Supply of oxygen to tissues (bound to hemoglobin which is carried in red cells) Supply of nutrients such as glucose. urea and lactic acid Immunological functions.35 7. which is one part of the body's self-repair mechanism Messenger functions.
Some globulins. or thrombocytes. In the fetus. such as antibodies and complement. 7% proteins. are part of the immune system. and waste products. or erythrocytes. Red blood cells are 700 times more numerous than white blood cells and 17 times more numerous than platelets. Formed Elements About 95% of the volume of the formed elements consists of red blood cells (RBCs). and 2% other substances. The water balance between blood and tissues is determined by the movement of water into and out of the blood by osmosis. globulins. or leukocytes and cell fragments called platelets. spleen.Plasma Plasma is a pale yellow fluid that consists of about 91% water. and red bone marrow. nutrients. After birth. Production of Formed Elements The process of blood cell production is called hematopoiesis. thymus gland. The remaining 5% of the volume of the formed elements consists of white blood cells (WBCs). lymph nodes. Although the osmotic pressure of the blood results primarily from sodium chloride. hematopoiesis occurs in several tissues such as the liver. Fibrinogen constitutes 4% of plasma proteins and is responsible for the formation of blood clots. albumin makes an important contribution. Plasma proteins include albumin. Other globulins and albumin function as transport molecules because they bind to molecules such as hormones and carry them in the blood throughout the body. Albumin makes up 58% of the plasma proteins. but some white blood cells are produced in the lymphatic tissue. . Globulins account for 38% of the plasma proteins. such as ions. hematopoiesis is confined primarily to red bone marrow. gases. and fibrinogen.
decreasing its size and enabling it pass more easily through small blood vessels. When hemoglobin is exposed to . Consequently. Each protein. which accounts for about a third of the cell’s volume and is responsible for its red color. a redpigmented molecule. they are unable to divide. each of which ends with the formation of a particular type of formed element. The main component of a red blood cell is the pigmented protein hemoglobin. Red blood cells live for about 120 days in males and 110 days in females. which consists of four protein chains and four heme groups. In addition. the red blood cell can bend or fold around its thin center. During their development. Each heme contains one iron atom. The greater surface area makes it easier for gases to move into and out of the red blood cell. which is necessary for the normal function of hemoglobin. The development of each cell line is regulated by specific growth factors. Red Blood Cells Normal red blood cells are diskshaped cells with edges that are thicker than the center of the cell.All the formed elements of the blood are derived from a single population of cells called stem cells. These stem cells differentiate to give rise to different cell lines. Oxygen transport is accomplished by hemoglobin. is bound to one heme. red blood cells lose their nuclei and most of their organelles. The biconcave shape increases the surface area of the red blood cell compared with a flat disk of the same size. Function of Red Blood Cells The primary functions of red blood cells are to transport oxygen from the lungs to the various tissues of the body and to assists in the transport of carbon dioxide from the tissues to the lungs. called a globin.
Erythropoietin stimulates red bone marrow to produce more red blood cells. After each cell division.5% is transported dissolved in plasma. Low blood oxygen levels increase red blood cell production by increasing the formation of the glycoprotein erythropoietin by the kidneys. This mechanism returns blood oxygen levels to normal and maintains homeostasis by increasing the delivery of oxygen to tissue. the production of erythropoietin increases.oxygen. one oxygen molecule binds to the iron atom of each heme.5% of the oxygen transported in blood. the newly formed cells change and become more like a mature red blood cells. Carbon Dioxide transport involves by carbonate ions. hemoglobin. catalyzes a reaction that converts carbon dioxide and water into a hydrogen ion and a bicarbonate ion. Hemoglobin is responsible for 98. Red blood cells are the final cells produced from a series of cell division. Old. which increases red blood cell production.5 million red blood cells are destroyed every second. The enzyme carbonic anhydrase. about 2. bound primarily inside red blood cells. Fortunately. and plasma. Life History of Red Blood Cells Under normal conditions. Hemoglobin that is bound to oxygen is bright red in color. and a completely mature red blood cell is formed. when oxygen levels in the blood decrease. or damaged red blood cells are removed from the blood by macrophages located in the spleen and liver. new red blood cells are produced as rapidly as old red blood cells are destroyed. After the final cell division. Within the macrophage the globin part of the molecule is broken down into amino acids that are reused . Approximately 70% of the carbon dioxide in blood is transport in the form of bicarbonate ions. Stem cells form proerythroblasts. Thus. whereas hemoglobin without bound oxygen is a darker red color. the nucleus is lost from the cell. The increased number of red blood cells increases the ability of the blood ton transport oxygen. The remaining 1. which gives rise to the red blood cell line. abnormal.
White blood cells are named according to their appearance in stained preparations. White Blood Cells White blood cells or leukocytes are spherical cells that are whitish in color because they lack hemoglobin. They are larger than red blood cells. Two functions of white blood cells are (1) to protect the body against invading microorganisms and (2) to remove dead cells and debris from the tissues by phagocytosis. Those containing large cytoplasmic granules are granulocytes. Only small amounts of iron are required in the daily diet because the iron is recycled. . and those with very small granules that cannot be easily seen with the light microscope are agranulocytes. White blood cells can live the blood and move by ameboid movement through the tissues. and each has a nucleus although white blood cells are component of the blood. The iron released from heme is transported in the blood to the red bone marrow and is used to produce new hemoglobin. the blood serves primarily as a means to transport these cells to other tissues of the body.to produce other proteins.
The cytoplasm may look transparent because of fine granules that are faintly pink in color. Neutrophils are very active in phagocytosing bacteria and are present in large amount in the pus of wounds. Type Microscopic Appearance Approx. The term microphage arises due to the cells' active involvement in phagocytosis. their activity and death in large numbers forms pus. these cells are not able to renew their lysosomes used in digesting microbes and die after having phagocytosed a Neutrophil . hence the name polymorphonuclear leukocyte.There are three kinds of granulocytes: neutrophils. They are also known as polymorphonuclear leukocytes and microphages. They have a multilobed nucleus which may appear like multiple nuclei. % in humans 65% Description Neutrophils deal with defense against bacterial or fungal infection and other very small inflammatory processes and are usually first responders to microbial infection. Unfortunately. basophils and eosinophils and there are two kinds of agranulocytes: lymphocytes and monocytes.
Basophils are chiefly responsible for allergic and antigen response by releasing the chemical histamine causing inflammation. hay fever.explaining why they are found primarily in the pus. The most important causes Eosinophil 4% of eosinophilia include allergies such as asthma.or tri-lobed. and hives. The cytoplasm is full of granules which assume a characteristic pink-orange color with eosin stain.few pathogens . They are characterised by their large blue granules. and also parasitic infections. . Eosinophils are also the predominant inflammatory cells in allergic reactions. Generally their nucleus is bi-lobed. not in tissue. but it is hard to see because of the number of coarse granules which hide it. Eosinophils primarily deal with parasitic infections and an increase in them may indicate such. The nucleus is Basophil 1% bi.
T cells are able to kill virusinfected and tumor cells. • Natural killer cells: Natural killer cells are able to kill cells of the body which are displaying a signal to kill them. some B cells will retain the ability to produce an antibody to serve as a 'memory' system. and a relatively small amount of cytoplasm. (B cells not only make antibodies that bind to pathogens.Lymphocytes are much more common in the lymphatic system. but after an attack. The blood has three types of lymphocytes: • B cells: B cells make antibodies that bind to pathogens to enable their destruction.) Lymphocyt e 25% • T cells: T cells co-ordinate the immune response and are important in the defence against intracellular bacteria. but are much longer lived as they have an additional role: they . Monocytes share the "vacuum cleaner" (phagocytosis) function of neutrophils. Lymphocytes are distinguished by having a deeply staining nucleus which may be eccentric in location. as they have been infected by a virus or Monocyte 6% have become cancerous.
This prevention is accomplished in two ways: (1) The formation of platelet plugs. which play an important role in preventing blood loss. They are produced in the red bone marrow from megakaryocytes. which are large cells. each consisting of a small amount of cytoplasm surrounded by cell membrane. and (2) the formation of clots.present pieces of pathogens to T cells so that the pathogens may be recognized again and killed. They also possess abundant cytoplasm. or thrombocytes. Monocytes eventually leave the bloodstream to become tissue macrophages which remove dead cell debris as well as attacking microrganisms. Platelets Platelets. which seal holes in small vessels. Preventing Blood Loss . are minute fragments of cells. which helps seal off larger wounds in the vessels. or so that an antibody response may be mounted. Unlike neutrophils monocytes are able to replace their lysosomal contents and are thought to have a much longer active life. Small fragments of these cells break off and enter the blood as platelets. They have the kidney shaped nucleus and typically agranulated. Neither of these can be dealt with effectively by the neutrophils.
a plasma protein. which activate other platelets. Platelet Plugs A platelet plug is an accumulation of platelets that can seal up a small break in a blood vessel. Most platelet adhesion is mediated through von Willebrand’s factor. After platelets adhere to collagen. Fortunately. and new blood is produced to replace it. or blood can be lost from the body. Platelet adhesion results in platelets sticking to collagen exposed by blood vessel damage. when a blood vessel is damaged. If a large amount of blood is lost. such as ADP and thromboxane. A small amount of blood loss from the body can be tolerated. In the platelet release reaction. and release chemicals. and blood clotting minimize the loss of blood. Platelet plug formation is very important in maintaining the integrity of the circulatory system because small tears occur in the smaller vessels and capillaries many times each day. As platelets become activated. fibrinogen forms bridges . vascular spasm. which can bind to fibrinogen.When a blood vessel is damaged. Von Willebrand’s factor forms a bridge between collagen and platelets by binding to platelet surface receptors and collagen. Vascular Spasm Vascular spasm is an immediate but temporary constriction of a blood vessel resulting from contraction of smooth muscle within the vessel. The formation of a platelet plug can be described as a series of steps. but in actuality many of these steps occur at the same time. platelet clot formation. People who lack the normal number of platelets tend to develop numerous small hemorrhages in their skin and internal organs. In platelet aggregation. platelets release chemicals. which is a protein produced and secreted by blood vessel endothelial cells. change shape. Nervous system reflexes and chemicals produce vascular spasms. they express surface receptors called fibrinogen receptors. death can occur. they become activated. and platelet clot formation quickly closes them. This constriction can close small vessels completely and stop the flow of blood through them. blood can leak into other tissues and interfere with normal tissue function.
(b) chemicals such as thromboplastin. Blood Clotting Blood vessel constriction and platelet plugs alone are not sufficient to close large tears or clots in blood vessels. clotting would spread from the point of its initiation throughout the entire circulatory system. and fluid. results in the formation of a clot. Antithrombin and heparin inactivate thrombin. which prevent clotting factor from forming clot. This is a complex process involving many chemical reactions. Normally the clotting factors are inactive and do not cause clotting. 2. and fluid. The formation of a blood clot depends on a number of proteins found within plasma called clotting factors. A series of reactions results in which each clotting factor activates the next in the series until the clotting factor prothrombinase is formed. blood clotting. such as phospholipids. Activated platelets also produce chemicals. platelets. or coagulation. Control of Clot Formation Without control. released from injured tissues can cause activation of clotting factors.) Prothrombinase acts on an inactive clotting factor called prothrombin to convert it to its active form called thrombin. however. When a blood vessel is severely damaged. platelets. resulting in the formation of a platelet plug. After the initial clotting factors are activated. that are important for blood clotting. they in turn activate other clotting factors. 3. A clot is a network of threadlike protein fibers.) Thrombin converts the inactive clotting factor fibrinogen into its active form. A cot is a network of fibrin that traps blood cells. fibrin. the clotting factors are activated to produce a clot. Following injury. but it can be summarized in three main stages.between the fibrinogen receptors of numerous platelets. The blood contains several anticoagulants. 1. called fibrin that traps blood cells. and a threadlike protein. Without thrombin fibrinogen is not .) The chemical reactions can be started into two ways: (a) the contact of inactivate clotting factors with exposed connective tissue can result in their activation.
converted to fibrin. IV. If blood clots too quickly/easily then thrombosis may occur. THE PATIENT’S ILLNESS A. Conversely. In this case much blood may be lost from the blood vessels. This is blood clotting in an unbroken blood vessel. At an injury site. however. Normally there are enough anticoagulants in the blood to prevent clot formation. if blood takes too long to clot hemorrhage may occur. Enough clotting factors are activated so that the anticoagulants can no longer prevent a clot from forming. Away from the injury site there are enough anticoagulants to prevent clot formation from spreading. the activation of clotting factors is very rapid. which is dangerous and can lead to strokes or heart-attacks. which is also dangerous. Pathophysiology a1. Schematic Diagram (Book-Centered) . and no clot forms.
A person with dengue Source of infection Bitten by mosquito (aedes aegypti) Reservoir Bite a person without dengue Dengue virus invade the body As a defense mechanism. the body of the person produce antibody against invading pathogens Person bitten again by an infected aedes aegypti The pre-existing heterologous dengue antibody recognizes the infecting virus and forms an antigen-antibody complex Bound to and internalized by immunoglobulin FC receptor on the cell membrane of leukocytes especially macrophages The entry of the virus into the cell of the virus is not neutralized because the antibody is heterologous the virus is not neutralized .
increase of plasma leakage system Malfunction coagulation Leakage in plasma into extra vascular compartment Hematemesis. Petechiae Decreased blood volume Hypotension Shock Death .Forced to replicate inside the macrophages Facilitate infection The increased number of dengue virus infected in increase t-cell activation monocyte result Result of increase level of cytokines and chemical mediators The rapid increase in the level and the synergistic effects of the mediators and histamine results to: Increase vascular permeability.
Decreased HCT & HCG decreased BP narrowed PP .
aedes aegypti Mosquito bite Dengue virus enters the body. carried by circulation and multiplies Immune response by the body (activation of the defense mechanism of the body to foreign bodies) Fever Cytokine and Immune adherence . poor practices in protecting self against mosquitoes. Schematic Diagram (Client-Centered) Predisposing Factor: Dengue is a universal infection Precipitating Factor: Poor environmental sanitation (presence of stagnant and uncovered water).a2.
Prostaglandin Release Pain to platelets Extravasation injury/ of fluid Nasal mucosa Bone marrow Platelet damage Decreased tissue perfusion Epistaxis Maturational arrest of megakaryocytes Petichiae Thrombocytopenia Coagulation defect Bleeding Decreased Hct and Hbg Decreased blood volume .
Dengue fever is found mostly during and shortly after the rainy season in tropical and subtropical areas. Hemorrhagic manifestations may or may not occur. Other manifestations include pleural effusion and hypoalbuminemia. This disease is used to be called "breakbone" fever because it sometimes causes severe joint and muscle pain that feels like bones are breaking. with a geographical spread similar to malaria. is that malaria is often eradicated in major cities. in contrast with a significant number of cases after reinfection by another serotype may present with thrombocytopenia (< 100. One major difference. each serotype is sufficiently different that there is no cross-protection and epidemics caused by multiple serotypes (hyperendemicity) can occur.b. encephalopathy with normal cerebrospinal fluid. however. which feeds during the day. the spleen is not palpable. The early phase of illness is indistinguishable from dengue fever. Dengue is transmitted to humans by the Aedes aegypti (rarely Aedes albopictus) mosquito. Health experts have known about dengue fever for more than 200 years. Caused by one of four closely related virus serotypes of the genus Flavivirus. It is a specific syndrome that tends to affect children under 10. Synthesis of the Disease b. found in the tropics and Africa. the first usually preceeding the second. including Singapore. however (defervescence period). After 2 .5 days. but hepatic enlargement and tenderness is a sign of bad prognosis. whereas dengue is often found in urban areas of developed tropical nations. Taiwan or Brazil.1 Definition of the Disease Dengue hemorrhagic fever (DHF) are acute febrile diseases. . or Southeast Asian hemorrhagic fever and dengue shock syndrome. Thai. DHF is also called Philippine.000 /mm3) and hemoconcetration. a few cases in the first infection. family Flaviviridae.
b. b. both are equally affected. narrowing of the pulse pressure (< 20 mmHg).thrombocytopenia + hemoconcentration.DSS).thrombocytopenia + hemoconcentration. cold extremities.2 Predisposing or Precipitating Factors • • • • • • Water stored within household or stagnant water in premises. some cases may reach 15 days. Incubation period: 3 . Declared shock. presence hemoconcentration thrombocytopenia. The infection may occur at any age but it is common among school children with the peak between 4 and 6 years old. More frequent during rainy season or months. the pacient is considered to be seized by dengue hemorrhagic fever and classified according to the following World Health Organization classification: Grade I . Absence of spontaneous bleeding.6 days. Grade III thrombocytopenia mental + hemoconcentration. Grade II . When it comes to sex. Hemodynamic instability: filiform pulse. conffusion.Diffuse cappilary In leakage the of plasma of is responsible for the and hemoconcentration. the higher the infection rate. More prevalent in urban communities or localities. Presence of spontaneous bleeding. the more crowded the human population. patient pulseless and with arterial blood pressure = 0 mmHg (dengue shock syndrome . High human population density.3 Signs and Symptoms with Rationale . Grade IV .thrombocytopenia + hemoconcentration.
2008). -this was manifested by the patient a day prior to hospital admission (January 4. 2008). • Petechiae.January 7. -this was manifested by the patient prior to hospital admission until two days after the admission (January 4. . 2008 – January 7. -this was manifested by them patient upon admission to the hospital (January 5. 2008). 2008).this is caused by capillary fragility and thrombocytopenia.due to decreased appetite which makes her lessens her food intake that led to body malaise. 2008). 2008).due to gastric irritation.inflammation of the nose or sinuses and clotting disorder. • Epistaxis . -this was manifested by the patient two consecutive days prior to hospital admission (January 3.due to weakness being experienced and caused by other signs and symptoms of the disease. • Body Malaise.as a compensatory mechanism of the body in response to infection. -this was manifested by the patient the day of hospital admission until two days after the admission (January 5. • Vomiting. 2008 . • Decreased appetite. 2008 – January 4. -this was manifested by the patient upon hospital admission until the day of the admission (January 5.• Fever.
2008 D. Client Response to The Treatment No actual side effects were seen Management and Treatment IVF D5 0. CI.3% NaCl Plain normal saline solution contains 308 mosm/L (Na. 154 mEq/L) has pH of 4. Medical Date Ordered Date Performed Date Changed or Stopped D. To administer medication and nutrients to the body.C.0 and is usually supplied in volumes of 9L.: January 5. 250 cc and 100 cc.: January 5.5 to 7. common procedure Blood transfusions are done to replace blood lost No negative reaction.: not changed General Description Indications or Purposes It is used to treat dehydration and shifting of fluid from vascular system to the dehydration space.O. NGT Feeding.P. 154 me Q/L. 500 cc. Blood Transfusion D.O.: January 5. Medical Management a. THE PATIENT AND HIS CARE A. A blood transfusion is a safe.V. .1 IVF’s. 2008 D.
: not changed in which blood is given to you through an intravenous (IV) line in one of your blood vessels. A transfusion also may be done if your body can't make blood properly because of an illness. 2008 D.: January 5.C. during surgery or a serious injury. .P.2008 D.
’s response. During: 1. 4. Practice aseptic technique. Obtain the necessary materials. 4. 2. Record all procedure done . 5. 5.NURSING RESPONSIBILITIES: INTRAVENOUS FLUID (IVF) Prior: Verify doctor’s order. Explain the procedure to SO. swelling and tenderness. Check for patency of tubing. as ordered. Check for presence of air in the tubing if there is. 3. Check if IVF is infusing well. Monitor pt. Select a suitable vein for venipuncture. After: 1. Monitor IV flow and pt. 3. Check IVF level. for evidence of IV infiltration’s r/t complication such as pain. 2. remove immediately. Adjust the rate of fluids appropriate to needs of pt.
as ordered. Explain the procedure to SO. Obtain the necessary materials.NURSING RESPONSIBILITIES: BLOOD TRANSFUSION Prior: • • • • During: • • • • • After: • • Adjust the rate of fluids appropriate to needs of pt. Verify doctor’s order. Monitor patients vital sign Observe for signs of a reaction to the transfusion Practice aseptic technique. Observe for signs of a reaction to the transfusion Check for patency of tubing. Check if the patient is compatible with her position. • Record all procedure done . Check the blood if it is compatible to the patient.
2008 Date Ordered Date Taken or Given Date Changed or Discontinue Date Ordered: January 5. 2008 Route of Administration Dosage and Frequency of Administration 7. Generic Name Brand Name Generic Name: Dyphenhydramin e Date Taken or Brand Name: banophen. 2008 Histamine is released by the body during several types of allergic reactions and––to a lesser extent––during some viral infections.5 mg 30 minutes prior to BT block the effect of histamine at H1 receptor sites General Action Functional Classification Mechanism of Action Antihistamine. Drugs Name of the Drug.b. Anticholinergic Indications or Purposes Client Response to the Medication with Actual Side Effects Clients fever was healed AEB the lowering down the temperature of the client from normal level The client may manifested the following side effects: -dizziness and drowsiness -constipation temporarily relieves these symptoms of the common cold: • • • • • • • sneezing runny nose headache minor aches and pains cough sore throat nasal congestion temporarily reduces fever . such as the common cold. benadryl Date Changed or Discontinued: January 6. When Given: January 5.
and increased mucus production. itching. when they bind to the receptors they do not stimulate the cells. however. it stimulates changes within the cells that lead to sneezing. In addition. they prevent histamine from binding and .histamine binds to its receptors on cells. Antihistamines compete with histamine for cell receptors.
Diphenhydramine also blocks the action of acetylcholine (anticholinergic effect) and is used as a sedative because it causes drowsiness. . Assess fever.stimulating the cells. note for presence of associated sign. Nursing Responsibilities Prior to Drug Administration: • • Get the temperature of the client.
Check if your giving the right dosage. Generic Name Brand Name Date Ordered Date Taken or Given Date Changed Route of Administration Dosage and Frequency of General Action Functional Classification Mechanism of Indications or Purposes Client Response to the Medication with Actual . Nursing Responsibilities During Drug Administration: Nursing Responsibilities After Drug Administration: Name of the Drug. Check the patency of the IV tube. Provide opportunities for rest. Instruct client or significant others to increase fluid and fiber-rich foods intake. Maintain a quiet environment.• • • • • • Make sure that the 10 rights are applied.
2008 Date Changed or Discontinued: January 6. 2008 Date Taken or Given: January 5. Check the patency of the IV tube. treatment of excessive bleeding resulting from systemic or local hyperfibrinolysi s • prophylaxis in patients with coagulopathy undergoing surgical procedures • Side Effects Clients nose bleeding was been cured.Generic Name: Tranexamic acid Brand Name: Cyklokapron. cardiovascular or cerebrovascular disease Make sure that the 10 rights are applied. Transamin or Discontinue Date Ordered: January 5. Nursing Responsibilities During Drug Administration: . Nursing Responsibilities Prior to Drug Administration: • • • Assess patients for renal insufficiency. a molecule responsible for the degradation of fibrin. 2008 Administration 8 mg IV now Action Antifibrinolytic Inhibitors inhibits the activation of plasminogen to plasmin. Fibrin is the basic framework for the formation of a blood clot in hemostasis.
Maintain a quiet environment. Generic Name Brand Name Generic Name: Ampicillin Date Ordered Date Taken or Given Date Changed or Discontinue Date Ordered: January 5. ophthalmic exam is recommended before and during therapy if patient is treated beyond several days Check if your giving the right dosage. Instruct client or significant others to increase fluid intake. 2008 Route of Administration Dosage and Frequency of Administration IV 150 mg every 6 gour (-) ANST General Action Functional Classification Mechanism of Action Antiinffectives Indications or Purposes Client Response to the Medication with Actual Side Effects Clients presence of infection was Treat many different types of . Provide opportunities for rest. Nursing Responsibilities After Drug Administration: Name of the Drug.• • • • • tranexamic acid should be avoided in patients with acquired disturbances in colour vision.
gonorrhea. Principen. The amino group helps the drug penetrate the outer membrane of gram-negative bacteria. pneumonia. bronchitis. and infections of the intestines such as salmonella been lessen and had been prevented the other complication that may occur because of infection . 2008 Belonging to the penicillin group of beta-lactam antibiotics. Ampicillin acts as a competitive infections. such as tonsillitis. Omnipen. ampicillin is able to penetrate Gram-positive and some Gramnegative bacteria. It differs from penicillin only by the presence of an amino group. urinary tract infections.Brand Name: Ampicin. Totacillin Not Changed or Discontinued Date Taken or Given: January 5.
Check the patency of the IV tube.V. It inhibits the third and final stage of bacterial cell wall synthesis. Nursing Responsibilities Prior to Drug Administration: • • • • • • Provide patients after negative skin test Make sure that the 10 rights are applied. which ultimately leads to cell lysis. Provide opportunities for rest.inhibitor of the enzyme transpeptidase. Transpeptidase is needed by bacteria to make their cell walls. Ampicillin and gentamicin should not be mixed in the same I. tubing or administered concurrently Check if your giving the right dosage. Nursing Responsibilities During Drug Administration: Nursing Responsibilities After Drug Administration: .
2008 • Cebid Vitamin C is required for the growth and repair of tissues in all parts of your body. Generic Name Brand Name Generic Name: Vitamin C Brand Name: Date Ordered Date Taken or Given Date Changed or Discontinue Date Ordered: January 5. Instruct client or significant others to increase fluid intake. 2008 Date Taken or Route of Administration Dosage and Frequency of Administration PO 1 ml once a day General Action Functional Classification Mechanism of Action Vitamin Suplements Ascorbate is an antioxidant. It is necessary to form collagen. as it protects the body Indications or Purposes Client Response to the Medication with Actual Side Effects Clients get well faster because one action of vitamin c is to promote stronger immune system • Ascorbicap Given: January 5.• • Maintain a quiet environment. Name of the Drug. an important protein .
tendons. used to make skin. 2008 stress. and is a cofactor in several vital enzymatic reactions. ligaments. Vitamin C is essential for the healing of wounds. . and for the repair and maintenance of cartilage. and teeth. to fight for the other diseases may occur Nursing Responsibilities Prior to Drug Administration: • Make sure that the 10 rights are applied. bones. scar tissue.against oxidative Timecelles • Cecon • Cecore 500 • Cee-500 • Cemill • Cenolate • Cetane • Cevi-Bid • Flavorcee • Mega-C/A Plus • Ortho/CS • Sunkist Date Changed or Discontinued: January 6. and blood vessels.
and adequate intake of fluids. 2008 Not discotinue The pt can eat foods rich in CHO.C. CHON.Nursing Responsibilities During Drug Administration • • • • Check if your giving the right dosage.O complied with the diet regimen . Nursing Responsibilities After Drug Administration: c. VIt.C. and drink fluids as tolerated Since the pt. Diet Date Type of diet ordered Date started Date change DAT (Diet as tolerated) DO: January 5. Instruct client or significant others to increase fluid intake. CHON Vit C. General description Indication (s) Or Purpose (s) Specific food taken Client’s response and/ or reaction to diet The patient S. Maintain a quiet environment. Provide opportunities for rest. Vit. she needs to eat food rich in CHO. Fe. taken NPO and soft diet. CHO. and adequate intake of fluids to increase energy and to prevent infection and for Foods rich in CHON.
During to/ in giving the diet: Be sure that the patient is taking or eating foods she can tolerate. S. Try to give fruits and vegetables. Nursing Responsibilities (Diet) Prior to/ in giving the diet: Monitor the client and assess for signs of weakness. Explain to the pt. Assess patient’s condition and how she responded on the foods she is taking.O. After to/ in giving the diet: .tissue repair for immediate healing and damaged cells. the purpose of the dietary recommendation to her current condition.
C. Encourage the patient to have a regular eating habit. NURSING MANAGEMENT 1. Observe patient’s satisfaction on the food she ate. Assess patient for signs of allergy. Nursing Care Plan PROBLEM NO. 1 ASSESSMEN T S: ø O: The patient NURSING DIAGNOSIS Hyperthermi a SCIENTIFIC EXPLANATION The condition of dengue hemorrhagic fever indicates the presence of After 3 hours of nursing intervention OBJECTIVE S Short Term: NURSING INTERVENTION S > establish rapport > to gain the trust and coo-peration of the SO After 3 hours of nursing RATIONALE EXPECTED OUTCOME Short Term: . contentment and other factors after eating.
temperature will be decreased from 37. shall be free from infection AEB V/S within normal limits and WBC count Long Term: The pt. specifically the s. Once recognized by the thermore- . Pt. > assess V/S > to gain base-line data for the care and management to the patient. These WBCs. temp shall decreased from 37.manifests: > skin warm to touch > body temp. will be free from infection AEB V/S within normal limits and WBC count within normal range.7oC to 37oC. > determine precipitating fx and underlying cause >identificatio n and management of the underlying cause are essential to recovery > monitor Lab results (WBC count. Long Term: After 5 days of nursing intervention s. serum electrolyte. Pt’s.7oC > increased HR of 135 bpm > increased RR of 40 bpm infection into an individuals body. pt. The infection triggers an inflammatory response of an increase in WBC and plasma proteins in the blood. may manifest: > diaphoresis > irritability > dehydration > fluid or electrolyte leukocytes and macrophages releases a fever causing chemical known as pyrogens. intervention s. pt’s.6oC to 37oC. serum sodium) > WBC and other lab results show the body’s coping After 5 days of nursing intervention s. of 37.
which could then lead to the killing of the infection (microorganism ). . will prevent the client from experiencing chills > these decreases warmth and increases evaporation cooling > provide ample fluids by mouth or intravenously >to maintain fluid balance within normal range. > remove or loosen excess clothing and cover > control environmental temperature mechanisms > controlling the environment al temp.imbalance > convulsions gulatory center of the brain triggers an increase in the body’s core temperature.
> provide TSB (do not use alcohol) > alcohol cools the skin too rapidly. or in situations with infections > discuss precipitating fx and preventive measures including maintenance of > for faster healing and recovery . > this is specifically necessary for pt. causing shivering > provide information regarding normal V/S and control if there is deviations.
protective skin products. change in env’t. It is used to treat the client’s disease condition.adequate fluid intake. >administer medications per doctor’s order > for faster recovery. and taking meds as prescribed. .
The pt and SO shall demonstrate behaviors to monitor deficit as indicated EXPECTED OUTCOME Short Term: DIAGNOSIS EXPLANATION Risk for fluid Our body volume deficit related to maintains fluid balance through balance patient restriction of maintaining the interventions. Long Term: nursing interventions. However. diet disease condition secondary to between I and pt manifests vomiting but was kept on NPO.PROBLEM NO. So. the able to may manifest: . 2 ASSESSMEN T S: ø O: The NURSING SCIENTIFIC NURSING OBJECTIVES Short Term: After 3 hours of nursing The pt and SO will be demonstrate behaviors to monitor deficit as >assess pt’s > assess V/S INTERVENTION S > establish rapport RATIONALE > to gain the trust and cooperation of After 3 hours of the SO > to gain base-line data for the care and management of the patient. the manifests: >appears weak >dry skin the patient O.
will volume at a functional level AEB individually adequate urinary output and stable V/S. > determine and underlying cause and management of the underlying cause are essential to recovery >administer medications per doctor’s order > for faster recovery. indicated Long Term: After 5 days of nursing interventions. and determine interventions. pt. maintain fluid precipitating fx .> oliguria >decrease >venous filling >hypotension >increased >pulse rate >change skin turgor >change in mental status >increased in body temperature in tendency is that. moist mucus membranes and good skin turgor. pt. general condition >to indicate presence of complications appropriate management to the pt. It is used to treat the client’s disease After 5 days of nursing shall maintain fluid volume at a functional level AEB individually >identification adequate urinary output and stable V/S. moist mucus membranes and good skin turgor. there is an increase in output while there is a decreased in pt’s input resulting to the patient’s being at risk in fluid deficit.
condition. . >monitor bp and note presence of >to monitor physical signs hydration status.
In the contribute to pt’s case. she is possibility of experiencing injury and take steps to correct situations management contribute to the >(+) patient Dengue hemorrhagic fever.PROBLEM NO. >assess pt’s >to indicate complication o DIAGNOSIS EXPLANATION risk for injury (bleeding) r/t altered Platelets are the clotting factors of the blood. 3 ASSESSMEN T S: ø O: The NURSING SCIENTIFIC NURSING OBJECTIVES Short Term: after 4 of NI the pt’s SO will verbalize understandin g of individual factors that > assess V/S > to gain base-line data for the care and of the patient. They should be maintained ranges in order to prevent INTERVENTION S > establish rapport RATIONALE EXPECTED OUTCOME > to gain the Short Term: trust and cooperation of the SO after 4o of NI the pt’s SO shall verbalize understandin g of individual factors that possibility of injury and take steps to correct situations patient clotting factor disease condition manifests: >petichiae >decreased platelet count of 140x109 secondary to within normal bleeding. wherein there is faulty may manifest: tourniquet test general condition presence of .
will be free from injury > provide information regarding s and determine appropriate of the pt. shall be free from injury management of nursing disease condition correct . putting her at risk of bleeding. >to assist the SO to reduce or individual risk factors >identify safety devices >to promote safe physical environment and individual safety Long Term: After 5 days interventions. Long Term: After 5 days of nursing interventions. pt.>fever >hematemesi s >melena >ecchymoses maturation of the megakaryocyte s which results in the diminished production of platelets even though there is excessive consumption of platelets due to generalized intravascular clotting. pt.
The urge to defecate stimulated normally by interventions. Long Term: RATIONALE > to gain the trust and cooperation of after 4o of NI the SO the pt and SO will demonstrate behaviors to prevent constipation EXPECTED OUTCOME Short Term: DIAGNOSIS EXPLANATION risk for injury (bleeding) r/t altered The three major Short Term: functions of the colon: mucosal transport. myoelectrical activity and the processes of defecation. and SO . After 3 days of nursing interventions. 4 ASSESSMENT S: ø O: The NURSING SCIENTIFIC NURSING OBJECTIVES INTERVENTION S > establish rapport after 4o of NI the pt and SO will demonstrate behaviors to prevent constipation Long Term: >assess pt’s general condition >to indicate presence of complications appropriate management of the pt. Any interference with the previously identified functions of the After 3 days colon could lead of nursing to constipation. shall maintain usual pattern of bowel > assess V/S > to gain base-line data for the care and management of the patient. pt.PROBLEM NO. and SO will be able to maintain usual pattern patient clotting factor 2 disease condition manifests: >no bowel movement for 3 days >Irregular defacation habits >Insufficient physical activity >Recent environmental changes and determine pt.
distention. relaxation of the external sphincter muscle and muscles in the pelvic region. patient hard. Interference with any of these processes can lead to may manifest: formed stool >straining with defacation >distended abdomen >hypoactive bowel sounds >anorexia of bowel functioning >palpate abdomen > to assess presence of abdominal distension >promote adequate fluid intake >to promote moist/ soft stool functioning . which initiates a series of four actions: stimulation of the internal sphincter muscles. and increased intraabdominal pressure.rectal the >dry.
it could lead to constipation PROBLEM NO. 5 ASSESSMEN T NURSING SCIENTIFIC OBJECTIVES NURSING INTERVENTION RATIONALE EXPECTED OUTCOME DIAGNOSIS EXPLANATION .constipation. Physical activity could lead to stimulation of contractions of the intestines. but if physical activity is insufficient.
S: ø O: The >non productive cough slight colds patient Ineffective airway retained secretions Due to the presence of Short Term: after 5 hours of nursing interventions the pt will be able to demonstrate maintain airway patency. and the nursing SO > assess V/S > to gain base-line data for the care and management of the patient. and SO shall . S > establish rapport > to gain the trust and Short Term: clearance r/t allergens. maintain airway patency interventions the pt shall demonstrate behaviors to maintain airway patency manifests: production. and SO will be able to maintain airway Long Term: may manifest: >dyspnea >abnormal breath sounds >changes respiratory rate rhythm >difficulty and in and determine pt. the bronchial wall tries to wash them of by increasing mucus mucus when not expectorated cooperation of after 5 hours of the pt. pt. >promote adequate fluid >to liquefy Long Term: After 3 days of nursing interventions. The behaviors to the patient will be retained blocks the air passage causing an ineffective airway clearance After 3 days of nursing interventions. >assess pt’s general condition >to indicate presence of complications appropriate management of the pt.
CLIENTS DAILY PROGRESS IN THE HOSPITAL 1.vocalizing >restlessness >orthopnea >vocalizing patency intake. Clients Daily Progress Chart . and encourage warm versus cold liquids >position heads midline with flexion secretions > to open or maintain airway in at rest or compromised individual >to assess condition of the respiratory tract >auscultate breath sounds VI.
Ineffective airway clearance r/t retained secretions Temp VS PR RR X X X X 37. Risk for injury (bleeding) r/t altered clotting factor secondary to disease condition X 5. Risk for fluid volume deficit related to restriction of diet secondary to disease condition X 3.8°C 110bpm 62cpm 36. Risk for injury (bleeding) r/t altered clotting factor secondary to disease condition X 4. Hyperthermia X X 2.2°C 100bpm 32cpm 36°C 118bpm 48cpm .DAYS Admission 01-05-08 06 07 08 Discharge 01-09-08 Nursing Problems: 1.9°C 120bpm 30cpm 37.
her aunt asked the student-nurses to touch baby Deng’s back or as they call in Kapampangan. DISCHARGE PLANNING a. Before leaving the hospital. “apisan”. the student-nurses assessed her general condition for the last time. This act serves as a precautionary measure or a counter against their belief of “asug”. General Condition of Client upon Discharge Last January 9. b. Before leaving the ward. baby Deng was discharge after being admitted in the hospital for almost four consecutive days. The petechiae she manifested in her extremity were all gone. Baby Deng appears to be in a much better condition as she was before. She is more responsive than before and does not appear lethargic. METHOD M: The take-home medicines of the patient includes • • Cefalexin (antibiotic. She was also actively interacting with the studentnurses as they assess her. 2008.2. antibacterial) Pedialyte (oral electrolyte solution) E: ø T: Emphasized to SO the importance of compliance to medical regimen especially to medication intake H: Health teachings given to the patient includes • Instructed SO to provide patient with adequate rest periods .
We should always keep ourselves protected and keep our surroundings clean. CONCLUSION AND RECOMMENDATION Conclusion Dengue hemorrhagic fever (DHF) is a severe. DHF is something that could be prevented and controlled. To be able raise the awareness of the public regarding this disease in order to lessen the possible occurrence of this condition Recommendation .com) Although potentially deadly.about. replace fluid loss and maintain fluid balance O: To be back after one week (January 16. through the use of appropriate information and techniques in eradicating the spread of the disease.• • Instructed So to observe for any signs of bleeding and refer immediately to a health care provider Instruct SO to increase patient’s fluid intake or as tolerated to prevent dehydration. A number of these develop into dengue hemorrhagic fever. (http://adam. potentially deadly infection spread by certain mosquitoes world wide. More than 100 million cases of dengue fever occur every year. Moreover it is up to our own initiative to become aware and do something about this. Our role as future nurses as health teachers we should make sure we provide the public with information that is applicable for them and encourage them to apply it in their day to day activities. 2008) D: Instructed mother to continue breast feeding VII.
Health care providers are to give appropriate information.The mortality or death rate with dengue hemorrhagic fever is significant. At the same time giving out health teachings is very essential so that he/she will be cautious the next time and minimize the risk of him/her acquiring the disease again. VII. Most death occurs in children. Vector control is implemented using environmental management and chemical method. Through the use of these technique and intervention. It ranges from 6% . they should give the patient information about her/his disease so he/she will know her condition. BIBLIOGRAPHY . including covering containers to prevent access of mosquitoes are among the methods that are being encouraged. Infants under a year of age are especially at risk of dying from DHF. we are surely capable of decreasing the occurrence of dengue in our communities. As for all nurses. eliminating and reducing the vectors.30%. Primary prevention of namely resides in mosquito control. care and treatment to a person who is sick. Proper solid waste disposal and improved water storage practices.
Internet source: • http://www. we are expected to care for the sick and in addition to that.wikipedia. we should be equipped with the appropriate ..a.who. et al.htm • • • http://www.org/wiki/Dengue_fever http://en.wikipedia.int/mediacentre/factsheets/fs117/ http://en.who.int/en/Section10/Section332/Section522_2 515. Book Source: • Seeley. Essentials of Anatomy and Physiology b.searo.org/wiki/Blood Learning Derived As future health care providers.
We should be able to utilize these knowledge and skills to provide others with health teachings. Through the course of our case study. to make prevention and cure as possible. I was also able to enhance my ability to interact and communicate with our client. While learning.knowledge and skills to be able to handle any unexpected situation that could arise in any setting. . At the end of our duty in ONA. establishing rapport more efficiently. I was able to gain new knowledge and insights which I could apply the next time I encounter a patient diagnosed with DHF.
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