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Reviseddhf 160315100344 PDF
Reviseddhf 160315100344 PDF
Reviseddhf 160315100344 PDF
INTRODUCTION
A. OVERVIEW
Page | 1
Mode of Transmission
Incubation Period
Period of Communicability
1. Patients are usually infective to the mosquito from a day before the febrile period
to the end of it.
2. The mosquito becomes infective from day 8 to 12 after the blood meal and
remains infective throughout its life.
Sources of Infection
1. Infected persons- the virus is present in the blood of patients during the acute
phase of the disease and will become a reservoir of the virus, sucked by
mosquitoes, which may then transmit the disease.
2. Standing water- any stagnant water in the household and its premises are usual
breeding places of these mosquitoes.
Page | 2
Dengue Hemorrhagic Fever (DHF)
Grade 1
There is fever accompanied with non-specific constitutional symptoms and the
only hemorrhagic manifestations is positive (+) in the tourniquet test.
Grade 2
All signs of Grade 1, plus spontaneous bleeding from the nose, gums,, and GIT,
are present.
Grade 3
There is the presence of circulatory failure, as manifested by a weak pulse, narrow
pulse pressure, hypotension, cold, clammy skin, and restlessness.
Grade 4
There is profound shock, and undetectable blood pressure and pulse.
Page | 3
Complications
1. Dengue Fever
a. Epistaxis; menorrhagia
b. Gastrointestinal bleeding
c. Concomitant gastrointestinal disorder (peptic ulcer)
2. DHF
a. Metabolic acidosis
b. Hyperkalemia
c. Tissue anoxia
d. Hemorrhage into the CNS or adrenal glands
e. Uterine bleeding may occur
f. Myocarditis
3. Severe manifestations
Dengue encephalopathy is manifested by increasing restlessness, apprehension or
anxiety, disturbed sensorium, convulsions, spacity, and hyporeflexia.
Reference: Handbook of Common Communicable and Infectious Disease, 3 rd edition;Dionesia Mondejar-NavalesRN. Maed, p. 71-73
Vaccine
Dengvaxia, world’s first dengue vaccine was approved in Mexico. The Federal
Commission for the Protection against Sanitary Risks (COFEPRIS) has approved
Dengvaxia®, tetravalent dengue vaccine, for the prevention of disease caused by all four
dengue virus serotypes in preadolescents, adolescents and adults, 9 to 45 years of age
living in endemic areas.
Page | 4
It took the multinational pharmaceutical company Sanofi Pasteur more than 20
years to develop the vaccine with clinical trials in five Asian and five Latin American
countries where dengue is endemic.
The vaccine was launched in the Philippines since it was the only country where
all three phases of the clinical development were conducted.
Health authorities said the vaccine will have side effects, including fever,
headache, muscle pain, weakness, redness and swelling.
The DOH also said that the medical breakthrough is no excuse to stop the fight
against dengue. Communities should work towards prevention by cleaning possible
mosquito breeding sites.
Health Secretary Janette Garin said the agency would get a discounted price for
the vaccine that would be used in the vaccination program starting March.
The DOH will begin vaccinating Grade 4 students in public schools in Metro
Manila, and in Southern and Central Luzon. The vaccine will be given in three doses,
with six-month intervals.
It will give the vaccine to over a million students this year but the health
department is planning to hold a nationwide vaccination on 2017.
Reference: http://www.sanofipasteur.com/en/articles/dengvaxia-world-s-first-dengue-vaccine-approved-in-mexico.aspx; Lyon, France
- December 9, 2015
B. STATISTICS
Local
The number of dengue cases in the country spiked from around 120,000 in 2014
to over 200,000 in 2015.
Despite the sharp increase in dengue cases, the Department of Health (DOH) said
there was no corresponding increase in the number of deaths--with 598 in 2015 compared
to 465 in 2014.
The DOH estimated that some 220 Filipinos a day may be infected by the disease.
Page | 5
Reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222740/ Lulu Bravo ,* Vito G. Roque, Jeremy Brett , Ruby
Dizon, and Maïna L'Azou, 2014 Nov 6
International
The incidence of dengue has grown dramatically around the world in recent
decades. The actual numbers of dengue cases are underreported and many cases are
misclassified. One recent estimate indicates 390 million dengue infections per year (95%
credible interval 284–528 million), of which 96 million (67–136 million) manifest
clinically (with any severity of disease). Another study, of the prevalence of dengue,
estimates that 3900 million people, in 128 countries, are at risk of infection with dengue
viruses.
Member States in 3 WHO regions regularly report the annual number of cases. In
2010, nearly 2.4 million cases were reported. Although the full global burden of the
disease is uncertain, the initiation of activities to record all dengue cases partly explains
the sharp increase in the number of cases reported in recent years.
Other features of the disease include its epidemiological patterns, including
hyper-endemicity of multiple dengue virus serotypes in many countries and the alarming
impact on both human health and the global and national economies.
Page | 6
Cases across the Americas, South-East Asia and Western Pacific exceeded 1.2
million in 2008 and over 3 million in 2013 (based on official data submitted by Member
States). Recently the number of reported cases has continued to increase. In 2013, 2.35
million cases of dengue were reported in the Americas alone, of which 37 687 cases
were of severe dengue.
Reference: http://www.who.int/mediacentre/factsheets/fs117/en/ May, 2015
We handled our patient last January 30, 2016 on our 6am to 2pm shift, bed #15,
Female-Ward at Laguna Medical Center under the supervision of Gloria Ramos,
Ph.D,MAN, RN.
We received the patient lying on bed with IVF Sodium Chloride 0.9 1 L on right
metacarpal vein. The exposure of our duty comprised Nurse-Patient-Interaction, Head-
to-Toe Assessment, IV regulation, vital signs monitoring and recording, drug
administration via oral route, IV drug medication study and charting.
To have further assessment, our group conducted a home visit on February 25,
2015 in the residence of Patient DLB in Lumban, Laguna. First and foremost, we asked
consent and stated the purpose of the home visit. As we gathered data and information
about the patient and his progress, the patient as well as the family members participated
and cooperated hospitably.
D. OBJECTIVES
General Objective:
At the end of the case study, the Level III nursing students will be able to
expound and incorporate all the ideas and knowledge gained to the nursing approach in
providing valid and outmost care connected with the patient diagnosed of Dengue
Hemorrhagic Fever.
Page | 7
Specific Objectives:
As supported by our main objective, the level 3 student nurses will be able to:
1. Familiarize with the background of what Dengue Hemorrhagic Fever is all about;
2. Recognize predisposing and precipitating factors that may increase the development
of Dengue Hemorrhagic Fever;
3. Review and understand the Anatomy and Physiology of the Circulatory system and
Lymphatic system.
5. Determine what specific laboratory results that may lead to Dengue Hemorrhagic
Fever;
Page | 8
II. PATIENT’S PROFILE
Page | 9
III. PATIENT’S HISTORY
A. Past History
B. Present History
5 days prior to admission, the patient experienced on and off fever. The
patient drinks tawa-tawa extract and antipyretic medications like biogesic and
tempra to relieve fever.
After a day, when the patient is still with fever, the patient decided to seek
medical attention in a small Clinic in Unson. They checked the platelet count
which is 187 X10/L and blood pressure of 100/80mmHg. Then he was given a
prescribed medication of Biogesic 500mg for his fever.
Two days prior to hospitalization, the patient is still with fever. He consults to
his paediatrician, Dra. Aquino and checked again for the platelet count that
has a result of 24 x10/L so he was advised to go to the hospital.
One day prior to admission, the patient was experiencing fever, loss of
appetite and epistaxis so the family decided to take him to Laguna Medical
Center, Sta. Cruz, Laguna.
January 29, 2016, at 6:30am he was admitted with a diagnosis of Severe
Dengue by attending physician Dra. Abadier with a blood pressure of
100/78mmHg.
Page | 10
C. Psychological
D. Family History
E. Spiritual
F. Sociocultural
The patient consults to hilot as one of their health care provider. Prior to
admission, patient DLB sipped tawa-tawa extract and had self-medication of advil,
biogesic, and tempra as a relieved for fever. He also consults in health care clinic
in their town.
G. Exercise
Patient is usually staying in their bedroom after school and during weekends.
But at times he used to walk in going to school that is about 1km away from their
residence.
H. Nutritional
The patient eats vegetables like radish, cabbage and mongo beans more
often than not. He said that he just consumes what is served by his mother and
Page | 11
does not usually fond of eating junkfoods or processed foods. He drinks 6-8
glasses of water a day.
I. Developmental
Page | 12
J. Hygiene
Patient takes a bath every The patient is unable to go The patient takes a bath
day before going to school to the bathroom by himself once a day and brushes his
and brushes his teeth twice due to muscle weakness so teeth every morning and
a day. He performs hand the family members prefer before going to bed. He
washing before meal and to perform sponge bath demonstrates hand
he usually eat with the use when he was in the washing with soap and
of spoon and fork instead hospital. He brushed his running water.
of the use of his bare teeth once a day and does
hands. not wash his hands during
hospitalization.
K. Elimination
Page | 13
L. Sleep and Rest
Page | 14
IV. NUTRITIONAL ASSESSMENT
1. What time did you go to “I slept as early as 7pm but Patient stated that he sleeps
bed the night before? not continuous, sometimes I at 9pm in the evening.
woke up when I feel
uncomfortable.”
3. When did you eat again? “The next meal was my “I ate my snack at 10am.”
dinner.”
What and how much? “I drink a half glass of “I had 3 pieces of bread and
water and one spoonful of one glass of ice tea.”
rice with egg pugo.”
What did you eat and “A piece of tasty.” “1 ½ cup of rice and
how much? sinigang.”
6. Did you eat or drink “I had a glass of water and “Yes. I ate at 6:30 in the
anything else? half bottle of gatorade.” evening.”
Page | 15
meal to 2nd meal? about 150ml.”
If so, why? “It depends on what food is “It depends on what food is
available in our house.” available in our house.”
Page | 16
V. PHYSICAL ASSESSMENT
Page | 17
Palpation Warm to touch With moist skin Warm to touch because of the
and with good body’s compensation to the
skin turgor virus.
The patient’s body temperature
was 38.2 °c.
Reference: W. Lloyd. (2013). Retrieved from:
http://www.healthgrades.com/symptoms/clamm
y-skin
Nails Inspection Nail surface is Nail surface is Normal
slightly curved slightly curved
No clubbed No clubbed
finger finger
Palpation Capillary refill Capillary refill Damage to an artery or vein
of more than 3 of less than 3 sec allows blood to escape the
sec With pinkish nail circulatory system. Thus, a low
beds hemoglobin count cause
With pale nail alteration in blood flow.
beds
Eyes Inspection With pale With moist and Damage to an artery or vein
conjunctiva pinkish allows blood to escape the
conjunctiva circulatory system. Thus, a low
Pupil Equally Pupil Equally hemoglobin count cause
Round Reactive Round Reactive alteration in blood flow.
to Light and to Light and
Accommodatio Accommodation
n With equally
With equally distributed eye
distributed eye lid and eye
lid and eye lashes
lashes
Palpation No signs No signs Normal
tenderness tenderness when
when palpating palpating
Ears Inspection Symmetrical, Symmetrical, no Normal
no presence of presence of
discharge or discharge or
redness redness
Can react to Can react to
sound sound
No presence of No presence of
cerumen cerumen
Palpation No tenderness No tenderness Normal
and nodules and nodules
Nose Inspection No nasal No nasal Normal
and discharge discharge
Sinuses No redness and No redness and
Page | 18
inflammation inflammation
No nasal No nasal
deviation deviation
Palpation No tenderness No tenderness Normal
upon palpation upon palpation
Mouth Inspection Dry lips Moist and If the amount of fluid in the
pinkish mucus intravascular space is decreased,
membrane the body compensates. (fluid
Can able to depletion)
move the tongue
With pale in all direction Damage to an artery or vein
palate Uvula is at the allows blood to escape the
midline circulatory system. Low
Can able to hemoglobin count cause
move the alteration in blood flow.
tongue in all
direction
Uvula is at the
midline
No presence of
inflammation in
oral mucosa
Palpation No tenderness No presence of Normal
when palpating inflammation in
for the soft and oral mucosa
hard palate No tenderness
With intact gag when palpating
reflex for the soft and
hard palate
With intact gag
reflex
Neck Inspection No swelling and No swelling and Normal
no venous no venous
distention distention
Palpation No masses No masses Normal
lymph nodes lymph nodes and
and thyroid thyroid gland
gland enlargement
enlargement
Page | 19
With no With no signs of Normal
difficulty of difficulty of
breathing breathing
Percussion Resonance in Resonance in Normal
sound sound
Auscultation With clear With clear Normal
breath sounds breath sounds
With Systolic of With systolic of Normal
100 mmHg and 120 mmHg and
Diastolic of Diastolic of 80
60mmHg mmHg
Abdom Inspection No abdominal No abdominal Normal
en distention with distention with
no signs of no signs of
tenderness or tenderness or
masses masses
Auscultation Bowel sound Bowel sounds Normal
heard heard
RLQ= 7 RLQ= 5
RUQ= 6 RUQ= 7
LUQ= 9 LUQ= 5
LLQ= 8 LLQ= 9
Percussion With tympanic With tympanic Normal
Palpation Abdomen is Abdomen is soft Normal
soft With no signs of
With no signs tenderness or
of tenderness or masses
masses
Muscle Inspection Able to obey Able to obey The dengue virus causes of
command command measurable muscle weakness.
and Palpation
muscle strength The muscle can move the joint
muscle of 5/5 it crosses through a full range of
strength of 4/5 motion against gravity moderate
resistance.
Extremi Inspection Presence of Has no signs of It caused by capillary fragility.
petechiae in lesions The blood vessels start to leak
ties
upper and and cause bleeding. Petechiae
lower
(small skin hemorrhages).
extremities
Page | 20
VI. ANATOMY AND PHYSIOLOGY
Blood
Blood is made up of liquid (called plasma) and solid cells. Blood cells are made in
the bone marrow. Bone marrow is the soft, spongy substance in the centre of bones.
Structure
In adults, the most active bone marrow is found in the pelvic bone, shoulder
bones, back bones (vertebra), ribs, breast bone and skull. Immature blood cells in the
bone marrow are called stem cells. Stem cells can also be found in smaller amounts in the
bloodstream. These are called peripheral blood stem cells.
All of our blood cells develop from stem cells. The process of blood cell
development is called hematopoiesis. In the earliest stage of blood cell development,
stem cells begin to develop either along the lymphoid cell line or the myeloid cell line. In
both cell lines, the stem cells become blasts, which are still immature cells.
Page | 21
Myeloid cell line
Myeloid stem cells develop into red blood cells, platelets and some types of white
blood cells. Red blood cells carry oxygen to all tissues of the body. Platelets form clots in
damaged blood vessels to stop bleeding.
Myeloid stem cells develop into 2 different types of white blood cells, called
granulocytes and monocytes. These white blood cells destroy bacteria and other foreign
invaders and help to fight infection.
Functions
The main function of blood is to carry nutrients, gases, waste products, cells and
hormones. Each type of blood cell has a specific job.
Red blood cells carry oxygen from the lungs to the rest of the body. They also
carry carbon dioxide from the body to the lungs so it can be breathed out.
Platelets form blood clots in damaged vessels to stop bleeding.
White blood cells help prevent and fight infection by destroying bacteria, viruses
and other foreign cells or substances.
Page | 22
Types of white blood cells
White blood cells are the cells that help the body fight infection. There are a
number of different types and sub-types of white blood cells which each have different
roles to play.
The three major types of white blood cells are:
Granulocytes
Monocytes
Lymphocytes
Granulocytes
There are three different forms of granulocytes:
Neutrophils
Eosinophils
Basophils
Granulocytes are phagocytes, that is they are able to ingest foreign cells such as
bacteria, viruses and other parasites.
Granulocytes are so called because these cells have granules of enzymes which help to
digest the invading microbes. Granulocytes account for about 60% of our white blood
cells.
Neutrophils are by far the most prevalent of these cells. Each neutrophil cell can
ingest up to between around 5 and 20 bacteria in its lifetime.
Eosinophils are involved in allergic reactions and can attack multicellular
parasites such as worms.
Basophils are also involved in allergic reactions and are able to release histamine,
which helps to trigger inflammation, and heparin, which prevents blood from clotting.
Monocytes
Monocytes can develop into two types of cell:
Dendritic cells are antigen-presenting cells which are able to mark out cells that are
antigens (foreign bodies) that need to be destroyed by lymphocytes.
Macrophages are phagocyte cells which are larger and live longer than neutrophils.
Macrophages are also able to act as antigen-presenting cells.
Page | 23
Lymphocytes
Lymphocytes are cells which help to regulate the body's immune system.
B lymphocytes (B cells)
T lymphocytes (T cells)
Natural Killer Cells
Page | 24
VII. PATHOPHYSIOLOGY
Precipitating Factors
Predisposing Factors
Environmental conditions (open
Geographical area-tropical island
spaces with water)
in the Pacific (Philippines) Presence of 2 Dengue cases in
the community
Aedes Mosquito
(Carrier of Dengue Virus)
Production of immune
mediators Release of cytokines
Page | 25
Muscle
weakness
4/5
Hemoglobin=86
Epistaxis g/L
RBC=2.69x 1012 /L
Hematocrit=23.9 %
GI
Bleeding
↑ Capilliary
Release of Histamine Melena
permeability
↑ Glomerular
Permeabilty
Plasma leakage
↑ Amount of
plasma protein
DENGUE HEMORRHGIC
FEVER
Urinalysis Result:
(+) 4 protein
2-4 hpf RBC
Few Bacteria
Page | 26
VIII. MEDICAL MANAGEMENT
Laboratories:
Complete blood CBC is done to the patient to test if there is
count with PC, blood loss. To look for low platelet count
typing typical of the later stages of the illness and
to detect the decrease in hemoglobin,
hematocrit, and red blood cell (RBC) count
(evidence of anemia) that would occur with
blood loss associated with severe dengue
fever. (references: cell medicine, 24th edition by
Golman and Schater page 345)
Page | 28
Medications:
Ascorbic acid 500 Supplemental therapy in some GI diseases,
mg 1 tab BID during long term parenteral nutrition.
Increases protection
mechanism of the immune system thus,
resistance to infection. (Reference: Davis’s Drug
Guide for Nurses fifth edition 2010 (ascorbic acid, page
105)
Page | 29
Godex 1 cap 300 To prevent damage to liver, one of the
mg PO BID complication of DHF. Godex acts by
transporting excess, long-chain fatty acids
into the mitochondria to produce high
amounts of energy to produce high
amounts of energy to provide cell
protection and fast treatment of liver
disease.(http://www.mergersdrugfil.com.ph/index.php
/godex-ds )
Page | 30
Vital sign every 1 The vital signs are body temperature,
hour and record pulse, respirations and blood pressure,
which should be looked at in total, are
checked to monitor the function of the
body which may alter the normal function
of the body.(Reference: Fundamentals of Nursing 8th
Edition of 2008 Volume 1 by Berman, Snyder, Kozier
and Erb Chapter 29 Vital signs page. 527)
Page | 31
histamine for 𝐻1 –receptor site; decreases
BP 100/70 allergic response by blocking histamine.
PR 86 (Reference : Jones and Bartlett Nurse’s Drug Handbook
2015 ( diphenhydramine page 325)
RR 21
(-) PC Hydrocortisone Management for Dengue shock syndrome.
10:00 am 100 mg TIV now
(+) black stool Corticosteroids are potent anti-
2:00 pm epistaxis inflammatory agents that have a wide
range of effects on immunological
4:00 pm processes and have found use in a broad
Severe dengue spectrum of diseases (Reference : Jones and
Bartlett Nurse’s Drug Handbook 2015( hydrocortisone
Restless page 256)
(+) epistaxis
(+) petechia
(+) hematoma Secure and Platelet transfusions are used to prevent
right forearm transfuse 5 units spontaneous bleeding or to stop established
Poor pulse platelet properly bleeding in patients with a deficiency in
(+) epigastric typed platelet number or function. In Dengue
tenderness patients, transfusion is done when platelet
Clear breath count is 10000-20000/ul and
sounds thrombocytopenic bleeding is present. All
the patients of Dengue Shock syndrome
6:00 pm require platelet support. Doctors use blood
BP 126/79 typing to make sure that the patient
O2sat 99% receiving a blood transfusion is getting the
Full pulses correct type of blood.
(reference:http://ijtm.in/view_article.php?id=21)
Page | 32
Facilitate Paracetamol is an antipyretics use to
paracetamol IV decreases fever by inhibiting the effects of
150mg/ml PRN pyrogens on the hypothalamus heat
fever regulating centers & by a hypothalamic
action leading to sweating &
vasodilatation. (reference: retrieved from
https://www.scribd.com/doc/36795690/Drug-Study-
Paracetamol)
Page | 33
IVF to follow D5LR is an hypertonic solution that is
D5LR 1L x 70gtts given to prevent dehydration. Dengue is a
2 cycles disease of DEHYDRATION. Much like a
Diarrhea except that the body fluids don’t
come out with the patient’s stool but
through PLASMA LEAKAGE. Imagine
that the arteries and veins of a patient have
thousands of pinpoint holes due to the
body's reaction to the Dengue virus,
causing the fluids inside the blood vessels
to sip out. (reference: Fundamentals of Nursing 8th
edition of 2008 Volume 2 by Snyder, Berman, Kozier
and Erb Chapter 52 Fluid, Electrolyte and Acid – Base
Balance page 1456)
Tranexamic acid
Inhibits activation of plasminogen thereby
500g IV run q 8
preventing the conversion of plasminogen
to plasmin.
Treatment for bleeding. Patient
experienced epistaxis and melena.
(Reference: Davis’s Drug Guide for Nurses fifth edition
2010(tranexamic acid, page 1179)
Page | 34
antihemorrhagic actor that promotes
hepatic formation of active prothrombin.
(Reference: Davis’s Drug Guide for Nurses fifth edition 2010
(vitamin K, page 970)
Page | 35
vital sign blood pulse, respirations and blood pressure,
pressure every 1 which should be looked at in total, are
hour and record checked to monitor the function of the
body which may alter the normal function
of the body.(Reference: Fundamentals of Nursing 8th
Refer Edition of 2008 Volume 1 by Berman, Snyder, Kozier
and Erb Chapter 29 Vital signs page. 527)
Page | 36
Glutamic Dengue Hemorrhagic Fever.(reference:
Oxaloacetic retrieved from http://www.med-health.net/Sgot-Sgpt.html)
Transaminase) on
next CBC
extraction
Day 3 IVF line 1 PNSS Used because it has little to no effect on the
January 31, 2016 tissues and make the person feel hydrated
at 25gtts/min x
12:29 am preventing hypovolemic shock
(2) x 4 hours
or hypotension. (reference:
BP 113/62 https://www.scribd.com/doc/109761163/PNSS-drug-
PR 98 study)
T 37.4
O2sat 99%
Line 2 D5LR at D5LR is an hypertonic solution that is
Page | 37
(+) mild headache 25gtts/min (2) x 4 given to prevent dehydration. Dengue is a
6:00 am hours disease of DEHYDRATION. Much like a
BP 114/67 Diarrhea except that the body fluids don’t
(-) Bleeding come out with the patient’s stool but
8:00 am
through PLASMA LEAKAGE. Imagine
(-) melena
(-) epistaxis that the arteries and veins of a patient have
Awake thousands of pinpoint holes due to the
Confused body's reaction to the Dengue virus,
No epigastric causing the fluids inside the blood vessels
tenderness Refer to sip out. (reference: Fundamentals of Nursing 8th
Full pulse edition of 2008 Volume 2 by Snyder, Berman, Kozier
and Erb Chapter 52 Fluid, Electrolyte and Acid – Base
Clear breath sounds Balance page 1456)
10:00 pm
Coherent
Full pulse Paracetamol 1 Paracetamol is an antipyretics use to
No epistaxis amp 150mg/ml decreases fever by inhibiting the effects of
IV every 4 hours pyrogens on the hypothalamus heat
regulating centers & by a hypothalamic
action leading to sweating &
vasodilatation. (reference: retrieved from
https://www.scribd.com/doc/36795690/Drug-Study-
Paracetamol)
Continue present For supportive Drug; supports body
function until other treatments or the
management
body’s treatments or body’s response can
take over; because medication is a
substance administered for the diagnosis,
cure treatment or relief of symptoms of for
prevention of disease. (Reference: Fundamentals
of Nursing 8th Edition of 2008 by Berman, Synder,
Kozier and Erb Chapter 35 M edications page 830
Page | 38
recommended in patients with active
bleeding. The patient experienced nose
bleeding. FFP does not need to be cross-
matched but should be ABO compatible.
(reference:
http://www.aafp.org/afp/2011/0315/p719.html)
Home Meds:
Godex 1 cap To prevent damage to liver, one of the
300mg BID x 5 complication of DHF. Godex acts by
days transporting excess, long-chain fatty acids
into the mitochondria to produce high
amounts of energy to produce high
amounts of energy to provide cell
protection and fast treatment of liver
disease.(http://www.mergersdrugfil.com.ph/index.php
/godex-ds )
Page | 39
Cefixime 200mg Cefixime is a cephalosporin antibiotic used
cap BID x 7 days to treat infections such as urinary tract
infections, because the patient’s urinalysis
revealed presence of few bacteria in
urine.(reference: retrieved from
https://www.nlm.nih.gov/medlineplus/druginfo/meds/a69
0007.html)
Omeprazole 20
Treatment and prevention of
mg cap OD
hypersecretions of stomach acid.
Omeprazole is used to prevent upper
gastrointestinal tract bleeding. (retrieve from
:http://www.mayoclinic.org/drugs-
supplements/omeprazole-oral-route/description/drg-
2006683)
Page | 40
VIX. LABORATORY TEST
Urinalysis
Provides important clinical information about kidney formation and help diagnose other
diseases.
( Brunner and Suddarth’s T extbook of Medical Surgical Nursing 13 th Edition by Smeltzer, Bare, Hinkle and Cheever chapter 53
Assessment of Kidney and Urinary Function page 1518 )
Pus Cells (WBC) Negative 2– 4/hpf Occurrence of pus cells in urine Page
may| 41
be
taken to be an indicator of an infection,
either on the upper or the lower urinary
tract.
( Retrieved from: http://www.newhealthguide.org/Pus-Cells-in-
Urine.html )
Mucus threads Few If they are present in large amounts then this
means there is some underlying infection in
any part of the urinary tract. If the mucus
threads in urine are associated with red
blood cells (blood), bacteria or yeast then
this indicates to some sort of infection,
irritation or other problems.
(Retrieved from: http://bestwebhealth.org/Mucus-T hreads-In-
Urine--What-Does-It-Mean-And-How-T o-T reat.html )
Amorphous - -
Phosphates
Bacteria Negative Few Bacteria in urine can suggest infection due
to vascular permeability.
Page | 42
Complete Blood Count
Date: 01-29-2016
Page | 43
red blood cells vary very little
in size.
Red cell distribution width
(abbreviated as RDW) and
Standard Variation
(abbreviated as SD) is a
measurement of the amount
that red blood cells vary in
size. Red blood cells help
carry oxygen in the blood.
Reference:
http://www.medfriendly.com/red-cell-
distribution-width.html
PLT 11 170-400 Low Dengue virus induces bone
marrow suppression. Since
bone marrow is the
manufacturing center of blood
cells its suppression causes
deficiency of blood cells
leading to low platelet count.
Reference:
K. Kafeel (2011). Retrieved from:
http://www.onlymyhealth.com/cause-low-
platelet-count-in-dengue-fever-1301653922
MPV 6.2 6.5-12.0 Low Mean platelet volume
(MPV) reflects the average
size of platelets present in a
person's sample of blood.
MPV is low with low platelet
count due to dengue virus
affecting production by the
bone marrow.
Reference:
https://labtestsonline.org/understanding/analy
tes/platelet/tab/faq/
PDW 18.8 9.0-17.0 High Platelet Distribution Width
(PDW) PDW is the variability
in the size of platelets.
Normally PDW increases
with MPV. The patient shows
a low MPV but a high PDW.
Due to the bone marrow
suppression.
Reference:
https://allaboutblood.com/tag/pdw/
PCT 0.007 0.108- Low Low PCT (procalcitonin)
0.282 values (<0.25 µg/L) in
patients with clinical signs of
infection (CAP, UTI) indicate
a low probability for blood
Page | 44
culture proof of bacterial
infection. One major
advantage of PCT compared
to other parameters is its early
and highly specific increase in
response to bacterial
infections and sepsis.
Reference:
http://www.procalcitonin.com/default.aspx?tr
ee=_2_2
P-LCR 7.6 11.0-45.0 Low P-LCR means Platelet large
cell ratio. It provides
information about the
underlying conditions of
thrombocytopenia .
Reference:
http://www.ehj.eg.net/article.asp?issn=1110-
1067;year=2014;volume=39;issue=3;spage=
134;epage=138;aulast=Elsewefy
Date: 01-30-2016
Page | 45
result in neutropenia. The
dengue virus induces bone
marrow suppression.
Reference:
http://www.mayoclinic.org/symptoms/neutrope
nia/basics/causes/sym-20050854
Lym 44.0 20.0-40.0 High It is high because of the
bacteria presence in the urine
of the patient. Lymphocytes
provide a means for immunity
against antigens.
Reference:
http://biology.about.com/od/cellbiology/ss/lym
phocytes.htm
Mon 21.6 3.0-12.0 High Monocytes play important
roles in the immune defense,
inflammation and tissue
remodelling and it do so by
phagocytosis, antigen
processing and presentation
and by cytokine production. It
is high because of the bacteria
presence in the urine of the
patient.
Reference:
http://www.monocytes.de
Eos 0.4 0.5-5.0 Low A low eosinophil level is
usually not a cause for concern
and is actually quite
common. They are very helpful
in defending the body
against parasites. Eosinophils
can be too low due to
administration of steroids.
Steroids are any of a large
number of hormone substances
with a similar and basic
chemical structure. Hormones
are natural chemicals produced
by the body and
released into the blood that
have a specific effect on tissues
in the body.
The patient is administered by
Hydrocortisone.
Reference:
http://www.medfriendly.com/eosinophil.html
Bas 0.1 0.0-1.0 Normal
RBC 2.22 4.00-5.50 Low Red blood cells circulate in the
blood and carry oxygen
Page | 46
throughout the body. They are
produced in the bone
marrow and then released into
the bloodstream as they
mature. Dengue virus damage
the bone marrow that results to
low RBC production.
Reference:
https://labtestsonline.org/understanding/analyte
s/rbc/tab/test/
HGB 69 120-160 Low RBCs contain hemoglobin,
which carries oxygen
throughout your body. It is low
because the patient
experienced epistaxis and
melena. It is low because the
patient experienced epistaxis
and melena. Moreover, the
dengue virus induces bone
marrow suppression
HCT 20.0 40.0-54.0 Low The hematocrit is routinely
ordered as a part of
the complete blood count
(CBC). It may also be ordered
by itself or with a hemoglobin
level as part of a general health
examination. It results from
decrease production of
hemoglobin and damage to
bone marrow.
Reference:
https://labtestsonline.org/understanding/analyte
s/hematocrit/tab/test/
MCV 90.0 80.0-100.0 Normal
MCH 31.1 27.0-34.0 Normal
MCHC 345 320-360 Normal
RDW-CV 10.6 11.0-16.0 Low A low RDW means that the red
blood cells vary very little in
size.
Red cell distribution width
(abbreviated as RDW) and
Coefficient Variation
(abbreviated as CV) is a
measurement of the amount
that red blood cells vary in
size. Red blood cells help carry
oxygen in the blood.
Reference: http://www.medfriendly.com/red-
cell-distribution-width.html
Page | 47
RDW-SD 34.8 35.0-56.0 Low A low RDW means that the red
blood cells vary very little in
size.
Red cell distribution width
(abbreviated as RDW) and
Standard Variation
(abbreviated as SD) is a
measurement of the amount
that red blood cells vary in
size. Red blood cells help carry
oxygen in the blood.
Reference: http://www.medfriendly.com/red-
cell-distribution-width.html
PLT 38 170-400 Low Dengue virus induces bone
marrow suppression. Since
bone marrow is the
manufacturing center of blood
cells its suppression causes
deficiency of blood cells
leading to low platelet count.
Reference:
K. Kafeel (2011). Retrieved from:
http://www.onlymyhealth.com/cause-low-
platelet-count-in-dengue-fever-1301653922
MPV 9.2 6.5-12.0 Normal
PDW 18.9 9.0-17.0 High Platelet Distribution Width
(PDW) PDW is the variability
in the size of platelets.
Normally PDW increases with
MPV. The patient shows a low
MPV but a high PDW. Due to
the bone marrow suppression.
Reference:
https://allaboutblood.com/tag/pdw/
PCT 0.035 0.108- Low Low PCT (procalcitonin)
0.282 values (<0.25 µg/L) in patients
with clinical signs of infection
(CAP, UTI) indicate a low
probability for blood culture
proof of bacterial infection.
One major advantage of PCT
compared to other parameters
is its early and highly specific
increase in response to
bacterial infections and sepsis.
Reference:
http://www.procalcitonin.com/default.aspx?tre
e=_2_2
P-LCR 34.2 11.0-45.0 Normal
Page | 48
Date: 01-31-2016
Page | 49
against parasites. Eosinophils
can be too low due to
administration of steroids.
Steroids are any of a large
number of hormone
substances
with a similar and basic
chemical structure. Hormones
are natural chemicals
produced by the body and
released into the blood that
have a specific effect on
tissues in the body.
The patient is administered by
Hydrocortisone.
Reference:
http://www.medfriendly.com/eosinophil.html
Bas 0.1 0.0-1.0 Normal
RBC 2.69 4.00-5.50 Low Red blood cells circulate in
the blood and carry oxygen
throughout the body. They are
produced in the bone
marrow and then released into
the bloodstream as they
mature. Dengue virus damage
the bone marrow that results
to low RBC production.
Reference:
https://labtestsonline.org/understanding/analy
tes/rbc/tab/test/
HGB 86 120-160 Low RBCs contain hemoglobin,
which carries oxygen
throughout your body. It is
low because the patient
experienced epistaxis and
melena. It is low because the
patient experienced epistaxis
and melena. Moreover, the
dengue virus induces bone
marrow suppression.
HCT 23.9 40.0-54.0 Low The hematocrit is routinely
ordered as a part of
the complete blood count
(CBC). It may also be ordered
by itself or with a hemoglobin
level as part of a general
health examination. It results
from decrease production of
Page | 50
hemoglobin and damage to
bone marrow.
Reference:
https://labtestsonline.org/understanding/analy
tes/hematocrit/tab/test/
MCV 88.9 80.0-100.0 Normal
MCH 32.0 27.0-34.0 Normal
MCHC 360 320-360 Normal
RDW-CV 10.7 11.0-16.0 Low A low RDW means that the
red blood cells vary very little
in size.
Red cell distribution width
(abbreviated as RDW) and
Coefficient Variation
(abbreviated as CV) is a
measurement of the amount
that red blood cells vary in
size. Red blood cells help
carry oxygen in the blood.
Reference:
http://www.medfriendly.com/red-cell-
distribution-width.html
RDW-SD 35.0 35.0-56.0 Normal
PLT 51 170-400 Low Dengue virus induces bone
marrow suppression. Since
bone marrow is the
manufacturing center of blood
cells its suppression causes
deficiency of blood cells
leading to low platelet count.
Reference:
K. Kafeel (2011). Retrieved from:
http://www.onlymyhealth.com/cause-low-
platelet-count-in-dengue-fever-1301653922
MPV 9.1 6.5-12.0 Normal
PDW 18.0 9.0-17.0 High Platelet Distribution Width
(PDW) PDW is the variability
in the size of platelets. Due to
the bone marrow suppression.
Reference:
https://allaboutblood.com/tag/pdw/
PCT 0.046 0.108- Low Low PCT (procalcitonin)
0.282 values (<0.25 µg/L) in
patients with clinical signs of
infection (CAP, UTI) indicate
a low probability for blood
culture proof of bacterial
infection. One major
advantage of PCT compared
to other parameters is its early
Page | 51
and highly specific increase in
response to bacterial
infections and sepsis.
Reference:
http://www.procalcitonin.com/default.aspx?tr
ee=_2_2
P-LCR 34.7 11.0-45.0 Normal
Date: 01-31-2016
Page | 52
throughout the body. They are
produced in the bone
marrow and then released into
the bloodstream as they
mature. Dengue virus damage
the bone marrow that results
to low RBC production.
Reference:
https://labtestsonline.org/understanding/analy
tes/rbc/tab/test/
HGB 102 120-160 Low RBCs contain hemoglobin,
which carries oxygen
throughout your body. It is
low because the patient
experienced epistaxis and
melena. It is low because the
patient experienced epistaxis
and melena. Moreover, the
dengue virus induces bone
marrow suppression
HCT 28.7 40.0-54.0 Low The hematocrit is routinely
ordered as a part of
the complete blood count
(CBC). It may also be ordered
by itself or with a hemoglobin
level as part of a general
health examination. It results
from decrease production of
hemoglobin and damage to
bone marrow.
Reference:
https://labtestsonline.org/understanding/analy
tes/hematocrit/tab/test/
MCV 86.8 80.0-100.0 Normal
MCH 30.8 27.0-34.0 Normal
MCHC 355 320-360 Normal
RDW-CV 10.9 11.0-16.0 Low A low RDW means that the
red blood cells vary very little
in size.
Red cell distribution width
(abbreviated as RDW) and
Coefficient Variation
(abbreviated as CV) is a
measurement of the amount
that red blood cells vary in
size. Red blood cells help
carry oxygen in the blood.
Reference: http://www.medfriendly.com/red-
cell-distribution-width.html
Page | 53
RDW-SD 35.3 35.0-56.0 Normal
PLT 74 170-400 Low Dengue virus induces bone
marrow suppression. Since
bone marrow is the
manufacturing center of blood
cells its suppression causes
deficiency of blood cells
leading to low platelet count.
Reference:
K. Kafeel (2011). Retrieved from:
http://www.onlymyhealth.com/cause-low-
platelet-count-in-dengue-fever-1301653922
MPV 9.6 6.5-12.0 Normal
PDW 18.7 9.0-17.0 High Platelet Distribution Width
(PDW) PDW is the variability
in the size of platelets.
Normally PDW increases
with MPV. Due to the bone
marrow suppression.
Reference:
https://allaboutblood.com/tag/pdw/
PCT 0.071 0.108- Low Low PCT (procalcitonin)
0.282 values (<0.25 µg/L) in
patients with clinical signs of
infection (CAP, UTI) indicate
a low probability for blood
culture proof of bacterial
infection. One major
advantage of PCT compared
to other parameters is its early
and highly specific increase in
response to bacterial
infections and sepsis.
Reference:
http://www.procalcitonin.com/default.aspx?tr
ee=_2_2
P-LCR 35.4 11.0-45.0 Normal
Page | 54
Hematology
Date: 01-28-2016
Page | 55
of monocytes in the blood
(monocytopenia) can be
caused by anything that
decreases the overall white
blood cell count
(see Neutropenia and see
also Lymphocytopenia), such
as a bloodstream infection or
a bone marrow disorder.
Reference:
https://www.merckmanuals.com/home/blood-
disorders/white-blood-cell-
disorders/monocyte-disorders
Platelet count 24000 130-500000 Low Dengue virus induces bone
marrow suppression. Since
bone marrow is the
manufacturing center of blood
cells its suppression causes
deficiency of blood cells
leading to low platelet count.
Reference:
K. Kafeel (2011). Retrieved from:
http://www.onlymyhealth.com/cause-low-
platelet-count-in-dengue-fever-1301653922
Bleeding time - - -
Clotting time - - -
MCV 92.2 80-96FL Normal
MCH 30.1 27-33PG Normal
MCHC 32.7 32-36% Normal
Date: 01-29-16
Page | 56
510x10/L marrow suppression. Since
bone marrow is the
manufacturing center of
blood cells its suppression
causes deficiency of blood
cells leading to low platelet
count.
Reference:
K. Kafeel (2011). Retrieved from:
http://www.onlymyhealth.com/cause-low-
platelet-count-in-dengue-fever-1301653922
Date: 01-29-16
Date: 01-30-16
Date: 01-30-16
Page | 58
Date: 01-30-16
Date: 02-01-2016
Page | 59
the complete blood count
(CBC). It may also be
ordered by itself or with a
hemoglobin level as part of
a general health
examination. It results from
decrease production of
hemoglobin and damage to
bone marrow.
Reference:
https://labtestsonline.org/understanding/an
alytes/hematocrit/tab/test/
RBC 3.35 38-54 Low RBCs contain hemoglobin,
which carries oxygen
throughout your body. It is
low because the patient
experienced epistaxis and
melena. Moreover, the
dengue virus induces bone
marrow suppression.
Platelet 88 250-510 Low Dengue virus induces bone
marrow suppression. Since
bone marrow is the
manufacturing center of
blood cells its suppression
causes deficiency of blood
cells leading to low platelet
count.
Reference:
K. Kafeel (2011). Retrieved from:
http://www.onlymyhealth.com/cause-low-
platelet-count-in-dengue-fever-
1301653922
WBC 7-9 4-11 Normal
Segmented 52 45-55 Normal
neutrophils
Lymphocytes 40.3 38-45 Normal
Monocytes 7-5 3-6 High Monocytes perform their
functions by surrounding
and engulfing bacteria (a
process known as
phagocytosis). Monocytes
can engage in phagocytosis
by coating the foreign
material with complement
or antibodies.
Page | 60
stress, inflammation, a fever
from a virus, severe
infection (because more
macrophages are needed to
fight it), premature cell
death in living tissue,
diseases that result from
abnormal activity of the
immune system, and
regeneration of red blood
cells.
Reference:
http://www.medfriendly.com/monocyte.ht
ml
Date: 02-02-2016
Page | 61
Date: 02-03-16
Date: 02-03-16
TyphiDOT
Date: 01-29-16
Test Result
The patient TyphiDOT test is negative to Salmonella IgG and salmonella IgM.
The Typhidot test gave a sensitivity of 100 per cent and specificity of 80 per cent
when bacteraemic patients were analysed.
The TyphiDot is a DOT enzyme immunoassay that detects either IgM or IgG
antibodies against a specific antigen on the outer membrane protein of serotype Typhi.
Reference:
https://www.researchgate.net/publication/10894775_T yphidot_test_to_detect_IgG_IgM_antibodies_in_t yphoid_fever
Page | 63
DENGUE NS1 IgA/IgG/IgM
Date: 01-29-2016
Test Result
The patient’s antibody test revealed positive in Dengue NS1 and Dengue IgG.
The non-structural protein 1 (NS1) of the dengue viral genome has been shown to
be useful as a tool for the diagnosis of acute dengue infections. Dengue NS1 antigen has
been detected in the serum of DENV infected patients as early as 1 day post onset of
symptoms (DPO), and up to 18 DPO.
Antibody tests, IgM and IgG- detect antibodies produced by the immune system
when a person has been exposed to the virus; these tests are most effective when
performed at least 7-10 days after exposure.
Reference:
http://www.cdc.gov/dengue/clinicalLab/laboratory.html
https://labtestsonline.org/understanding/analytes/dengue/tab/sample/
ABO Rhesus D
O (+)
Page | 64
X. PROBLEM PRIORITIZATION
2. Hyperthermia
3. Imbalance Nutrition
Page | 65
XI. NURSING CARE PLAN
Page | 66
Assessment Nursing Planning Intervention Rationale Expected Outcome
Diagnosis
O: Ineffective After 8 hours of nursing Monitor vital Serve as basis for After 8 hours of nursing
Hemoglobin tissue intervention, the client signs. any alteration in intervention, the
perfusion will be able to: system functions. client was be able to:
results related to Elevate head
revealed 69 decreased Demonstrate of bed to about To promote Demonstrate different
hemoglobin different ways to 10 degrees. circulation and ways to improve
mg/dl as of
concentration improve blood venous drainage. blood oxygenation
01-30-16 in the blood. oxygenation and and circulation.
BP: 100/60
circulation. Discourage
strenuous To avoid increasing Verbalize
mmHg Verbalize activities. oxygen demand. understanding
understanding of of condition and
RR: 20 cpm
condition and Provide health importance
PR: 98 bpm importance teaching To help client of treatment
of treatment regarding DHF. understand his regimen.
Headache regimen. health condition.
Generalized Provide health Demonstrate
Demonstrate teaching on To maintain increased tissue
pallor increased tissue perfusion.
drugs being compliance to
Capillary perfusion. taken. meds.
refill of Collaborative:
more than 3
Administer To control
sec Tranexamic bleeding.
With pale nail Acid 50mg IV
q8 as ordered.
beds
Page | 67
With pale Administer and Maintain hydration
regulate IVF as and help wash
conjunctiva
ordered. away toxins.
and palate
Administer Packed RBC’s are
Muscle
packed RBC’s adequate for stable
strength : as ordered. patients with
subacute/chronic
4/5
bleeding to
increase oxygen
carrying capability
Page | 68
Assessment Nursing Diagnosis Planning Intervention Rationale Expected Outcome
Encourage To promote
adequate fluid heat loss and
intake. hydration.
Page | 69
Encourage To reduce
adequate metabolic
bedrest. consumption
and oxygen
demands.
Collaborative:
To relieve high
Administer
temperature by
Paracetamol 1
amp IV, as inhibiting the
ordered. synthesis of
prostaglandin
Page | 70
Assessment Nursing Planning Intervention Rationale Expected Outcome
Diagnosis
S: “Wala akong Imbalanced ST: within 4 hours of Assess and To determine daily After giving
ganang kumain“ as nutrition less than giving nursing document nutrition needs. effective nursing
verbalized by the body intervention patient patient’s dietary interventions patient
patient. requirements will be able to history, patters will be able to
related to loss of experience an of ingestion, partially demonstrate
O: appetite. increase in the intolerance to behavior, lifestyle
Lethargic amount or type of foods. changes to regain
nutrients ingested. appropriate weight.
Easy
Auscultate bowel Hypermotility of
fatigability LT: within 8 hours of sounds. intestinal tract is
giving nursing common and is
Weak in intervention and associated with
appearance medical management vomiting and
patient will be able to diarrhea, which
Had 2 experience adequate may affect choice
crackers in nutrition through oral of diet/route.
intake.
shift
Instruct To promote god
Pale pt. on good oral appetite.
hygiene before
24 hours and after
dietary recall feedings.
Page | 71
nutrition. eating habit.
Collaborative:
Page | 72
Assessment Nursing Diagnosis Planning Intervention Rationale Expected Outcome
Page | 73
Identify Suggest treatment
underlying options, desire/
condition ability to protect
involves in self and potential
tissue injury. self and potential
to recurrence of
tissue damage.
Monitor To changes
laboratory indicative of
studies. healing or
infection
complications.
Page | 74
Assessment Nursing Planning Intervention Rationale Expected Outcome
Diagnosis
O: Risk for After 4 hours of Establish rapport. To gain patient’s After 4 hours of
injury related nursing trust and nursing management
Weak in to abnormal management, the cooperation. the patient will
blood profile patient will demonstrate
appearance
as evidenced demonstrate Monitor and record For baseline data. behaviors to reduce
Capillary refill by decreased behaviors to vital signs. risk factors and
platelet count. reduce risk factors protect self from
of more than 3 and protect self Assess mood, coping Aggressive and injury.
sec. from injury. abilities, and impulsive
personality styles behavior indicates
Easy fatigability
(aggression and self harm to the
Hematoma at impulse behavior). patient.
the right upper
Observe for presence Observing those
arm of petechiae, signs will help to
ecchymosis, bleeding reduce the risk for
Delirium from one more sites. injury to the other
Platelet count parts of the body.
results revealed 8 Maintain bed in a Ensuring the
9
x10 /L as of 01- lowest position with patient’s safety.
wheels locked.
30-16
Advise SO that those To prevent further
self inflicting injury to the
materials such as patient.
Page | 75
(utensils, knife and
syringes) should be
keep.
Page | 76
XII. DRUGS
Page | 77
Name of Drug Dosage and Indications and Side Effects Mode of Classification Nursing Responsibilities
Frequency Contraindications Action
Page | 78
Name of Drug Dosage and Indications and Side Effects Mode of Action Classification Nursing Responsibilities
Frequency Contraindication
s
Generic Name: 200 mg Indication: Chills Interferes with Antibiotic Be aware that an
Cefixime PO Treatment for fever bacterial cell allergic reaction may
BID infection. headache wall synthesis occur a few days after
Brand Name: seizures by inhibiting the therapy starts.
Suprax Peak: rapid The patient’s Abdominal final step in the Assess bowel pattern
Onset: 2-6 hr urinalysis revealed cramps crosslinking daily.
diarrhea
Date ordered: Duration: 24 hr a presence of few
elevated
of peptidoglycan Assess for signs of
02- 02- 2016 bacteria in urine as strands.
liver function superinfection, such as
of Jan. 31, 2016. test results Peptidoglycan perineal itching, fever,
hepatic failure makes cell malaise, redness, pain,
Contraindication hepatitis membranes rigid swelling, drainage,
s: hepatomegaly and protective. rash, diarrhea, and
Hypersensitivity to jaundice Without it, cough or sputum
cephalosporin or nausea bacterial cells changes.
their rupture and die. Instruct patient and
Components. significant other to
complete the prescribed
course of therapy.
Tell patient and S.O. to
report severe diarrhea
to prescriber
immediately.
Reference : Jones and Bartlett Nurse’s Drug Handbook 2015 (cefixime page 205)
Page | 79
Name of Drug Dosage and Indications and Side Effects Mode of Classificatio Nursing
Frequency Contraindications Action n Responsibilities
Reference : Jones and Bartlett Nurse’s Drug Handbook 2015 (ceftriaxone page 223)
Page | 80
Name of Dosage and Indications and Side effects Mode of Action Classification Nursing
Drug Frequency Contraindications Responsibilities
Reference: Davis’s Drug Guide for Nurses fifth edition 2010 (vitamin K, page 970)
Page | 81
Name of Dosage and Indications and Side effects Mode of Action Classification Nursing
Drug Frequency Contraindicatio Responsibilities
ns
Generic 40 mg Indication: Weakness Suppresses gastric Anti-ulcer, Inform the patient
Name: IV Treatment and Dizziness secretion by proton pump and significant other
Omeprazole OD prevention of Headache inhibiting inhibitor about the reason why
hypersecretions Fatigue hydrogen; drug is given and how it
Peak: unknown of stomach acid. Abdominal characterized as is process inside the
Brand Onset: 10-90 pain gastric pump patient's body.
Name: min Due to patient’s Acid inhibitor Monitor for diarrhea
Losec lost appetite with regurgitatio and abdominal pain.
Duration:
unknown
DHF it will n Take the drug before
Ordered at: cause abdominal Constipatio meals.
pain. n Report severe
01-29-16
Diarrhea headache, worsening
6:30 am Contraindicatio
Flatulence of symptoms, fever,
ns: chills. Swallow the
01-30-16 Hypersensitivity Nausea
Vomiting capsules whole; do not
10:00 am chew, open, or crush
Rash
them.
02-01-16 Itching
Inform patient and
6:00 am S.O. that he/she may
experience these side
effects: Dizziness;
headache; nausea,
vomiting, diarrhea;
symptoms of URI,
cough.
Reference: Davis’s Drug Guide for Nurses fifth edition 2010 (omeprazole, page 878)
Page | 82
Name of Dosage and Indications and Side effects Mode of Classification Nursing
Drug Frequency Contraindications Action Responsibilities
Generic 500 mg Indication: Dizziness Inhibits Anti-
Name: IV Treatment for Hypotension activation of fibrinolytic Assess for
Tranexamic every 8 hours bleeding. Nausea plasminogen agent allergic reaction.
Acid Patient experienced Vomiting thereby Instruct patient
Peak: 2-15 epistaxis and Diarrhea preventing the and S.O. to
Brand minutes melena. conversion of report untoward
Name: Onset: plasminogen to side effects.
Cyklokapron intermittent plasmin Change the
Contraindication: position of the
Ordered at: Duration: 3 Contraindicated to
hrs. patient slowly to
patients who are prevent
01-29-16 allegic to orthostatic
6:30am Tranexamic Acid. hypotension.
01-30-16
2:48pm
02-02-16
6:00am
Reference: Davis’s Drug Guide for Nurses fifth edition 2010 (tranexamic acid, page 1179)
Page | 83
Name of Dosage Indications and Side effects Mode of Classification Nursing Responsibilities
Drug and Contraindications Action
Frequency
Generic 500 mg Indication: Fatigue Increases Vitamin Assess for signs
name: 1 tab Dietary supplement Headache protection (water- of vitamin C
Ascorbic OD Drowsiness mechanism of soluble) deficiency
acid Contraindication: Nausea the immune (gingivitis and
Peak: Hypersensitivity to Vomiting system thus, bleeding gums.
Brand unknown tartrazine Diarrhea resistance to Medication may
name: Onset: Flushing infection. cause drowsiness.
Cecon
unknown Advise patient to
Duration: take this
Date medication as
ordered: unknown
directed and not
to exceed dose
01-29-16 prescribed.
6:30 am
02-02-16
6:00 am
Reference: Davis’s Drug Guide for Nurses fifth edition 2010 (ascorbic acid, page 105)
Page | 84
Name of Drug Dosage Indications and Side Effects Mode of Action Classification Nursing
and Contraindications Responsibilities
Frequency
Page | 85
Reference:
Guidelines for the
management of dengue fever
& dengue haemorrhagic fever
in adults. (2012).
http://www.cochranelibrary.c
om/enhanced/doi/10.1002/14
651858.CD003488.pub2
Contraindications:
Allergy to any
component of
the drug.
Antibiotic-
resistant
infections.
Reference : Jones and Bartlett Nurse’s Drug Handbook 2015( hydrocortisone page 256)
Page | 86
Name of Drug Dosage and Indications and Side effects Mode of Classification Nursing
Frequency Contraindications Action Responsibilities
Generic name: 1 amp Indication: Skin rashes Inhibits the Antipyretic Assess patient for
Paracetamol 150mg/ml Fever Urticaria synthesis of fever, note
IV every Hypoglycemi prostaglandins presence of
Brand name: 4 hours Contraindication: a that may serve associated signs
Acetaminophen PRN Hypersensitivity Leukopenia as mediators (diaphoresis,
of pain and tachycardia, ands
Date ordered: Peak: 15 fever. malaise.
01-30-16 mins. Be aware that long
6:00 am Onset: term use can cause
unknown liver damage.
01-31-16 Assess for allergic
12:29 am Duration: reactions.
4-6 hrs.
02-02-16
6:00 am
Reference: Davis’s Drug Guide for Nurses fifth edition 2010 (acetaminophen, page 5)
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Name of Dosage and Indications and Side effects Mode of Classification Nursing Responsibilities
Drug Frequency Contraindications Action
Generic 20 mg Indication: Dizziness Inhibits the Loop Monitor BP before
name: IV To prevent fluid Headache reabsorption diuretics and after
Furosemide every after overload that may Tinnitus of sodium and administering the drug
blood be imposed by the Hypotension chloride from Monitor for S&S of
Brand transfusion additional blood Nausea the loop of hypokalemia report
name: volume delivered Vomiting Henle and muscle cramps on
Lasix Peak: 30-60 during transfusion. Diarrhea distal renal weakness to
minute tubule. physician.
Constipation
Date Onset: 1-2 hr Contraindication:
Dry mouth Make position
ordered: Hypersensitivity to changes slowly
01-30-16
Duration: 6-
medication Rashes
8 hr because high doses of
4:00 pm antihypertensive
drugs taken
concurrently may
produce episodes of
dizziness or
imbalance.
Instruct the patient
and S.O. to report
adverse reaction
promptly, nausea,
vomiting, diarrhea,
appetite loss and
visual disturbances
may be indicators for
drug toxicity.
Reference: Davis’s Drug Guide for Nurses fifth edition 2010 (Diuretics (Loop), page 392)
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Name of Dosage Indications and Side effects Mode of Action Classification Nursing
Drug and Contraindications Responsibilities
Frequency
Generic 1 cap 300 Indication: Nausea Chalagogues Hepatic Maintain
name: mg To prevent damage to Vomiting promotes the Protector adequate
Godex BID liver, one of the Restlessness discharge of bile hydration.
x 5 days complication of DHF. Anorexia from the system,
Brand Dysphagia purging it
name: Peak: Dengue viral antigens Tachycardia downward.
Cecon unknown have been found within
Onset: hepatocytes, and Chalagogues-
Date the virus appears to be action that has the
unknown
ordered: able to replicate in both specific effect
02-02-16 Duration: hepatocytes and kupffer of stimulating the
unknown cells, and dysregulated flow of bile from
host immune responses the liver.
may play an important
causative role in liver
damage.
Source:
HealthTap, https://www.healthtap.co
m/user_questions/532959-how-does-
dengue-fever-leads-to-hepatomegaly
Contraindications:
Hypersensitivity to
medication
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XIII. DISCHARGE PLAN
Medications:
Present to the significant other all the take home medicines. Give emphasis to
the brand and generic name, therapeutic and side effects as well as its daily
dose and proper route.
Over the counter drugs may interfere with the effectiveness of the prescribed
drugs. It can also harm the patient if the drug is contraindicated.
Inform the family to seek medical help immediately if adverse reactions to
allergies occur.
Exercise:
Treatment:
Remind to take the prescribed medicine, having a written reminder of the correct
medication, time to take, and the right frequency of the medicine on the way home to
establish assurance of medication compliance.
Health Teaching:
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3. Explain the action and side effects of the drugs to the patient.
4. Instruct on proper intake of home medicines
5. Inform the patient about the new discovered Dengue vaccine (Dengvaxia).
Instruct the patient and the guardian to have a check up or to consult physician
once a while to monitor patient’s condition and for detection of recurrences
and other complications that may rise on to it.
Diet:
Advise the patient to eat foods rich in iron such as green leafy vegetables
and animal organs like liver.
Instruct the family members to give the patient protein rich foods such as
meat, fish, eggs and nuts, vitamin K rich foods such as green leafy
vegetables, vit. C rich foods(guava and tomatoes and other citrus fruits),
carbohydrates rich food (breads and rice).
Advise to increase fluid intake to replace fluid loss.
Spiritual:
Encourage the patient to maintain his spiritual needs and advise to never
lose hope in any obstacle that he may encounter.
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XIV. RECOMMENDATION
This study will help you to fully understand how dengue hemorrhagic fever
occurs, what are the symptoms and management to be given to patient with this type of
disease. You will also learn how risk factors such as people living or travelling to tropical
areas. This will serve as your guide in presenting case presentations in your future career.
To faculty members
This study will help you to recall all your knowledge and refreshes your idea
about dengue hemorrhagic fever. This may be helpful in teaching lessons of the faculty
members especially those who handle third year nursing students. We hope that this
would be a great help to all of you!
To our beloved readers who are curious about dengue hemorrhagic fever. This
will be very helpful to you because all the contents of this study were focused on the said
disease. Diet modifications and other health management to prevent occurrence of the
disease are also included.
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XV. BIBLIOGRAPHY
Dengue Cases. Lulu Bravo ,* Vito G. Roque, Jeremy Brett Ruby Dizon, and Maï L'Azou,
2014 Nov 6. Retrieved by:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222740/
Page | 93
Neutropenia. Retrieved from:
http://www.mayoclinic.org/symptoms/neutropenia/basics/causes/sym-20050854
Page | 94