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I.

Personal Data

Name: Mr. M.L


Address: Barangay Quezon, Solano, Nueva Vizcaya
Age: 13
Sex: male
Birth date: 09/18/92
Marital Status: Single
Occupation: Student
Religious Affiliation: Iglesia ni Cristo
Nationality: Filipino
Parents’ Name:
Father’s Name:Mr. J.L
Occupation: unknonwn
Mother’s Name: Mrs. A.L.
Occupation: Midwifery
Date/Time of Admission: O0-04-06 @ 2:30 pm
Date of Discharge: 01-06-06
Attending Physicians: Dr. Respicio/Dr. Bunuan
Admission Diagnosis: Dengue Fever Syndrome
Principal Diagnosis: Dengue Fever Syndrome
Chief Compliant: 5 days PTA On and off fever, rashes

II. HISTORY OF PRESENT ILLNESS


Five days prior to admission patient experiences on and off fever. No consult done but given
paracetamol and FeSO4+Vitamin C by his mother.
Few hours prior to admission the patient was positive of rashes and have (-) fever.
III. HISTORY OF PAST ILLNESS

The patient suffered from minor illness like colds. She was immunized with BCG, Hepa B (3 dose),
DPT, poliomyelitis and anti-measles at RHU Solano. No allergies on foods and drugs as the mother
stated.

IV.BRIEF DESCRIPTION OF THE DISEASE

IV. BRIEF DESCRIPTION OF THE DISEASE

Dengue Hemorrhagic Fever is an acute infectious viral disease, caused by all four serotypes (DEN-
1, DEN-2, DEN-3, DEN-4) of a virus from genus Flavivirus, called dengue virus. It’s the most
prevalent flavivirus infection of humans, with a worldwide distribution in the tropics and warm
areas of the temperature zone corresponding to that of the principal vector, Aedes aegypti. When
simultaneous or sequential introduction of two or more serotypes occurs in the same area, there
may be an increased number of cases with worst clinical presentation – dengue hemorrhagic fever.
The term ‘hemorrhagic’ is imprecise, because what characterizes this form of the disease is not the
presence of hemorrhagic manifestations, but the abrupt increase of capillary permeability, with
diffuse capillary leakage of plasma, hemoconcentration and, in some cases, non-hemorrhagic
hypovolemic shock (dengue shock syndrome). Transmission occurs by bite of Aedes aegypti female
mosquitoes – the same vector of urban yellow fever – a day-active species with low fly-autonomy
that is abundant in and around human habitations.

Clinical Manifestations

Three Stages:
1. Febrile or invasive stage – stars abruptly as high fever, abdominal pain and headache; later
flushing which my be accompanied by vomiting, conjunctival infection and epistaxis.
2. Toxic or hemorrhagic stage – lowering of temperature, severe abdominal pain, vomiting and
frequent bleeding from gastrointestinal tract in the form hematemesis or melena. Unstable blood
pressure, narrow pulse pressure and shock. Death may occur. Tourniquet test, which may be
positive on 3rd day, may become negative due to low or vasomotor collapse.
3.Convalescent or recovery stage – generalized flushing with intervening areas of blanching
appetite regained and blood pressure already stable.

Classification:
Grade I – thrombocytopenia + hemoconcentration. Absence of spontaneous bleeding.
Grade II – thrombocytopenia + hemoconcentrarion. Presence of spontaneous bleeding.
Grade III – thrombocytopenia + hemoconcentration. Hemodynamic instability: filiform pulse,
narrowing of the pulse pressure (<20 mmHg), cold extremities, mental confusion.
Grade IV – thrombocytopenia + hemoconcentration. Declared shock, patient pulseless and with
arterial blood pressure = 0 mmHg (dengue shock syndrome-DSS)

Diagnostic Test
Tourniquet test (Rumpel Leads Test)
• Inflate the blood pressure cuff on the upper arm to a point midway between the systolic and
diastolic pressure for 5 minutes.
• Release cff and make an imaginary 2.5 cm square or 1 inch square just below the cuff, at
the antecubital fossa.
• Count the number of petechiae inside the box.

*A test is positive when 20 or more petechiae per 2.5 cm square or 1 inch square are observed.

V. ANATOMY AND PHYSIOLOGY OF THE AFFECTED SYSTEM

THE BLOOD

Blood is the only fluid tissue. Although blood appears to be appears to be thick homogenous
liquid the microscope reveals it has both liquid and solid components. Essentially blood is a
complex connective tissue in w/c living blood cells, the formed elements are suspended in a
nonliving fluid matrix called plasma.

Although it’s not visible there is a thin whitish layer called Buffy coat at the junction
between the formed elements and the plasma. This layer contains the leukocytes the white blood
cells that act in various ways to protect the body and platelets cell fragments that function in the
blood clothing process. Erythrocytes normally account to about 45 percent of the total volume of
blood samples a percentage known as the hematocrit. White blood cells and platelets contribute less
than 1 percent and plasma makes up most of the remaining 55 percent of whole blood.

Blood is a sticky opaque fluid w/ a characteristics metallic taste. Blood is heavier than water
and about five times thicker or more viscous largely because of its formed elements.

Blood is slightly alkaline with a ph between 7.35 and 7.45. Temperature 38 C or 100.4 F w/c
is always slightly higher than the normal body temperature. Blood accounts approximately 8
percent of body weight and its volume in healthy males is 5-6 letters or approximately 6 quarts.

ERYTROCYTES

Red Blood Cells function primarily to ferry oxygen in the blood to all cells in the body. They
are superb example of the fit between cell structure and function. RBC differ from other blood cells
because c they are anucleate that is they lack nucleus. They also contain very few organelles. In fact
mature RBC circulating in the blood literally sacs of hemoglobin molecules. HEMOGLOBIN is
iron containing proteins that transport the bulks of oxygen that is carried in the blood. More over
because the RBC lack mitochondria and make by ATP by anaerobic mechanism they do not use up
the oxygen they are transporting, making them very efficient oxygen transporter. Erythrocytes are
small cells shape like biconcave disks, flattened disks w/ depressed centers. Because of their thinned
centers they looked miniature doughnuts when vied in the microscope. Their small sizes and
peculiar shape provide large surface area relative to their volume, making them very idea suited for
gas exchange. RBC s outnumbers white blood cells by about 1000 to 1 and are the major factors
contributing to blood viscosity. RBC normally counts about 5 million cells per cubic millimeter of
the blood. The more hemoglobin molecule in the RBC the more oxygen they carry. A single red
blood cell contains about 250 million hemoglobin molecule, each capable of binding 4 molecules pf
the oxygen, each of his tiny cells can carry 1 million of oxygen molecule. Clinicaly normal blood
contains 12-18 g hemoglobin per 100 ml blood. Hemoglobin content is slightly higher in men 13-18
g, than in women 12-16 g. An excessive or abnormal increase in the erethrocytes is
POLCYTHEMIA. This may result from the bone marrow cancer, it may also be a normal
physiological response to high altitudes where the air is thinner and less oxygen is available.

The major problems that result in the excessive number of RBCs is increase in blood
viscosity w/c causes it flow sluggishly in the body and impairs in the circulation.

LEUKOCYTES or white blood cells are far less numerous than red blood cells they are
crucial to body defense against disease. There is 4000 to 11000 WBC s per cubic millimeter and
they account 1 percent of total blood volume. White blood cells are the only complete in the blood
that is they contain nuclei and the usual organelles.

Leukocytes form a protective movable army that helps defend the body against damage the
bacteria, virus’s parasites and tumors cells. Red blood cells ar5e confined to the blood streams and
carry out their function in the blood. WBC by contrast are able to slip into and out of blood vessels-
a process called diapedesis .The circulatory system are simply their means of transportation to
areas of he body where their services are needed in the inflammatory and immune response.

In addition WBCs can locate areas in the tissue damage and infection of the body by
responding to certain chemicals that diffuse from the damage cells, this capability is called positive
chemotaxis. Once they have “caught the scent” the WBC move through the tissue space by ameboid
motion. By fallowing the diffusion gradient they pinpoint areas of tissue damage and rally round in
large numbers and destroy foreign substances and dead cells.

WBCs are classified into two major groups:

GRANULOCYTES are granule containing WBCs. They have lobed nuclei w/ typically consist of
several rounded nuclear areas connected by thin strands of nuclear material. The granules in their
cytoplasm stain specifically w/ Wright stain. The granulocytes include the nuetroplis, eosinophils,
and basophils.
a. Viscosity - blood is more viscous than water. Changing the % of cells, cellular fragments,
plasma proteins or other dissolved substances changes the viscosity. Viscosity is increased if
either the plasma (fluid) is decreased (ex. during dehydration) or if the substances within
the blood are increased (ex. polycythemia)

b. Concentration the cells (red blood cells and white blood cells) that are dissolved within the
plasma are dependent on the concentration of the plasma because water is free to move into
or out of the cell by osmosis. Normally, the plasma is isotonic to the cells. If however, the
plasma becomes hypertonic, the cells will lose water and shrink. A process called crenation.
If the plasma becomes hypotonic, the cells will take on water and swell. If they take on too
much water, they could burst. A process called hemolysis. Maintaining plasma
concentration is essential for the integrity of these cells.

c. Volume - A typical female has 4-5 liters of blood and a typical male has 5-6 liters of blood.
Maintaining blood volume is essential in maintaining blood pressure. If blood pressure
drops below a critical level, blood delivery throughout the body is impaired and death is
probable.

d. pH - plasma proteins, like all proteins of the body, have a 3-dimensional shape that is
dependent on the correct amount of hydrogen (and hydroxyl) ions being present. If the pH
is altered from the normal value of 7.35-7.45, the plasma proteins lose their 3-D shape and
are denatured and unable to carry out their functions.
e. Temperature - the enzymes of the body are responsible for all of the chemical changes that
occur. The function of enzymes to work properly is dependent on temperature. Enzymes
work efficiently at body temperature. Below body temperature, the enzymes work more
slowly. They can slow down enough to not be able to meet the needs of the body. If the
temperature rises, the enzymes will work more efficiently but, if the temperature is raised
too high (106 or so) they are denatured, resulting in brain damage and perhaps death. The
function of the blood is to pass through the hypothalamus of the brain to be monitored for
temperature. If blood temperature is too high or too low, homeostatic mechanisms are
initiated to reestablish normal body temperature

Plasma proteins are mainly produced by the liver. These include:

Albumin - the main function of albumin is to increase the osmotic force in the blood. This osmotic
force is responsible for drawing fluids into the bloodstream in order to maintain blood volume (and
thus blood pressure). If albumin levels increase, more fluid is drawn into the blood and normal
blood volumes are increased (and thus blood pressure is increased). If albumin levels are decreased
(say due to liver damage and the liver is not producing enough or there is kidney damage and
albumin is being lost from the body), less fluid is drawn into the blood and normal blood volume is
decreased (and thus blood pressure is decreased).

Clotting proteins - the liver is responsible for making the many proteins associated with blood
clotting including fibrinogen, plasminogen, clotting factors etc). These must be maintained at
proper levels for properly functioning coagulation.

Alpha and beta globulin - proteins responsible for carrying non-soluble lipids in the blood.

Gamma globulins - These proteins, also called antibodies, are NOT made by the liver.

There are three formed elements in blood: red blood cells, white blood cells and platelets.
Red blood cells constitute the vast majority of these formed elements.

The RBC is a biconcave cell, flexible, no nucleus, lacks mitochondria, contains few
organelles and contains the protein hemoglobin. It is essentially a A bag of hemoglobin@.y white
blood cells in response to a specific antigen (foreign substance). RBC are produced in myeloid tissue
(red bone marrow) located in cranium, vertebrae, y the adrenal cortex in males and females and in
the testes in males. Testosterone, in addition to its many other functions, stimulates the kidney to
produce more erythropoietin. More erythropoietin, more RBC, more oxygen delivered. Because
males have higher levels of testosterone, they also have more RBC and are able to deliver more
oxygen. The reason for the high level of red blood cell production is due to the high rate of
destruction. Know the average lifespan of a red blood cell and understand why and how red blood
cell destruction occurs.

The most important and the most complex component of hemostasis is coagulation (blood
clotting) this process and is initiated, the formation of thrombin, the formation of fibrin. The final clo:
Blood coagulation is a much more complex process that requires numerous substances including
calcium, clotting factors, platelets, vitamin K (needed to make clotting factors II, VII, IX and X). If
any of these are not in the correct amounts, the possibility of too much clotting (formation of
thrombus or embolism) or too little clotting (hemophilia) is the result. The initiation of blood
clotting can occur by two separate mechanisms: the intrinsic pathway and the extrinsic pathway.
The most notable difference between these two pathways is the intrinsic pathway is initiated by
damaged to the inside of the vessel and is started by platelets (damaged occurred from inside). The
extrinsic pathway is initiated by damage the tissue that surrounds the vessel (damage occurring
from outside - generally) in either case, through a series of complicated steps, an activation factor is
produced.
Body Defenses

Every second of every day, an army of hostile bacteria, viruses, and fungi swarms on our
skin and invades our inner passages- yet we stay amazingly healthy most of the time. The body
seems to have developed a single-minded approach toward such foes- if you’re not with us, then
you’re against us!

The body’s defenders against these tiny but mighty enemies are two systems, simply called
the nonspecific and the specific defense systems.

The nonspecific defense system responds immediately to protect the body from all foreign
substances, whatever they are. The nonspecific defenses are provided by intact skin and mucous
membranes, the inflammatory response, and a umber of proteins produced by body cells. This
system reduces the workload of the second protective arm, the specific defense, by preventing entry
and spread of microorganisms throughout the body.

The specific defense system, more commonly called the immune system, mounts the attack
against particular foreign substances. Although certain body organs (lymphatic organs and blood
vessels) are intimately involved with the immune response, the immune system is a functional
system rather than an organ system in an anatomical sense. Its “structures” are a variety of
molecules and trillions of immune cells, which inhabit lymphatic tissues and circulate in body
fluids. The most important of the immune cells are lymphocytes and macrophages.

When our immune system is operating effectively, it protects us from most bacteria, viruses,
transplanted organs or grafts, and even our own cells that have turned against us. The immune
system does this both directly, by cell attack, and indirectly, by releasing mobilizing chemicals and
protective antibody molecules. The resulting highly specific resistance to disease is called immunity
(immune= free).

Unlike the nonspecific defenses which are always prepared to defend the body, the immune
system must first “meet” or be primed by an initial exposure to a foreign substance (antigen) before
it can protect the body against it. Nonetheless, what it lacks in speed it makes up for in the precision
of its counterattacks. Although we will consider them separately, keep in mind that specific and
nonspecific defenses always hand-in-hand to protect the body.

Specific Body Defenses

Some nonspecific resistance to disease is inherited. For instance, there are certain that
humans never get, such as some forms of tuberculosis that affect birds. Most often, however, the
term nonspecific body defense refers to the mechanical barriers that cover body surfaces and to cells
and chemicals that act on the initial battlefronts to protect the body from invading pathogens
(harmful or disease-causing microorganisms).

Phagocytes

Pathogens that make it through the mechanical barriers are confronted by phagocytes
(fa’go-sitz”; phago = eat ) in nearly every body organ. A phagocyte, such as a macrophage or
neutrophil, engulfs a foreign particle much the way an amoeba ingests a food particle. Flowing
cytoplasmic extensions bind in a vacuole. The vacuole is then fused with a lysosome, and its
contents are broken down or digested.
Functions of the blood
Blood performs two major functions:
• transport through the body of

o oxygen and carbon dioxide

o food molecules (glucose, lipids, amino acids)

o ions (e.g., Na+, Ca2+, HCO3−)

o wastes (e.g., urea)

o hormones

o heat
• defense of the body against infections and other foreign materials. All the WBCs participate
in these defenses.

VII. Laboratory and Diagnostic Examination

HEMATOLOGY REPORT (01-04-06)

COMPLETE RESULTS NORMAL VALES SIGNIFICANCE


BLOOD COUNT
138g/L 120-150 g/L Within normal range
Hemoglobin
Hematocrit 40% 31-43% Within normal range
Leucocytes 5.4 x 10 g/dL 4.4-11.3 x 10 g/dL Within normal range
Neutrophils 54% 47-63% Within normal range
Lymphocytes 33 % 20-40% Within normal range
Thrombocytes No. 123 x 10 g/L 150-350 x 10 g/L
Concentration
HEMATOLOGY REPORT (01-05-06)

COMPLETE RESULTS NORMAL VALES SIGNIFICANCE


BLOOD COUNT
139 g/L 120-150 g/L Decreased; possible
Hemoglobin of being anemic
Hematocrit 42% 31-43% Within normal range
Thrombocytes No. 102% 150-350 x 10 g/L
Concentration
HEMATOLOGY REPORT (01-06-06)

COMPLETE RESULTS NORMAL VALES SIGNIFICANCE


BLOOD COUNT
144 g/L 120-150 g/L Within normal range
Hemoglobin
Hematocrit 43 % 31-43% Within normal range
Leucocytes 4.8 x 10 g/dL 4.4-11.3 x 10 g/dL Within normal
range
Neutrophils 48% 47-63% Within normal range
Lymphocytes 32 % 20-40% Within normal range
Thrombocytes No. 144 x 10 g/L 150-350 x 10 g/L
Concentration

VIII. Physical Assessment with Pathophysiologic Basis


Date assessed: January 05-06, 2006

PSYCHOSOCIAL
TYPE OF FAMILY: Nuclear family
SIGNIFICANT OTHERS: Mother and Father
COPING MECHANISM: Comfort and security from parents
PRIMARY DIALECT: Tagalog
SOURCE OF HEALTH CARE: Public health care
GENERAL APPEARANCE: pale looking
MEMORY: Intact
SPEECH: Normal and clear
NON-VERBAL BEHAVIOR: Grimace
SOURCE OF INCOME: Mother working as a public health personnel
IN TIMES OF FINANCIAL CRISIS: Depends on family and relatives
ELIMINATION
URINATION:
• URINE PATTERN: 3 times a day
• COLOR: Yellow
• TRANSPARENCY: Clear
TOILETING ABILITY: Independent
STOOL PATTERN: Once a day
CONSISTENCY: loose with solid particles
COLOR: brown

REST AND ACTIVITY


SLEEP PATTERN: sleeps well, 6-8 hours every night
CURRENT ACTIVITY LEVEL:
ADL: able to do activities without assistance
BODY FRAME: mesomorph
RANGE OF MOTION: able to extend and flex both upper and lower extremities
MOTOR FUNCTION:
FINE: Can able to grasp
GROSS: Can able to kick and push
PAIN RELIEF MEASURE: Medication and bed rest

SAFETY AND ENVIRONMENT


ALLERGIES: No known allergies on food and drugs
EYES/VISION: Intact and able to respond to light
HEARING: Intact and able to respond on sounds
SKIN INTEGRITY: impaired, presence of rashes and petechiae @ both lower and upper
extremities
EXTREMITIES: no deformities
MUCOUS MEMBRANES: dry oral mucous membrane
TEMPERATURE: Afebrile
Location: axilla

OXYGENATION
ACTIVITY INTOLERANCE: Can able to do activity with minimum movement
AIRWAY CLEARANCE:
NOSE: No obstruction
MOUTH: No obstruction
RESPIRATION RATE: 19 bpm
RHYTHM: Regular
POSTURE ASSUME: Sitting position
COLOR:
SKIN: Pinkish
NAILS: Pinkish
LIPS: Pale and dry
CAPILLARY REFILL: 1-2 seconds
PERIPHERAL PULSES;
LOCATION: Radial
RATE: 80 cpm
BLOOD PRESSURE: 110/90 mmHg

NUTRITION
HOSPITAL DIET: On DAT except dark foods
IV’s:
SOLUTION: D5LR
SITE: Left hand
FLUID INTAKE: MORE THAN 600 ml/day combination of water and IV’s
ABILITY TO:
CHEW: Able to chew
SWALLOW: Able to swallow
TOLERATE FOODS: able to tolerate foods
FEED HERSELF: Yes

IX. DRUG STUDY

1.PARACETAMOL

GENERIC NAME: Acetaminophen


TRADE NAME: Tempra
CLASSIFICATION: antipyretics, non-opioid analgesics
DOCTOR’s ORDER: Paracetamol 500 mg/ 1 tablet every 4 hours( for fever)
DATE STARTED: 01-04-06

ACTIONS:
Inhibits the synthesis of prostaglandin that may serve as mediator of pain and fever,
primarily in the CNS. Have no significant anti – inflammatory properties of GI toxicity.

INDICATION:
Fever reduction. Temporary relief of mild to moderate pain. Generally a substitute for
aspirin when the latter is not tolerated or is contraindicated.

CONTRAINDICATION:
Contraindicated in previous hypersensitivity. Products containing alcohol, aspartame,
saccharin, sugar, or tartrazine should be avoided in patient who has hypersentivity or intolerance
to this compound. Use cautiously in malnutrition.

ADVERSE EFFECTS:
GI: hepatic future, hepatotoxicity (overdose)
GU: renal failure
Dermatology: rash, urticaria

NURSING IMPLICATIONS:
• Monitor for s/s of: hepatotoxicity, even with moderate acetaminophen doses,
especially in individuals with poor nutrition.
• Do not take other medications (e.g. cold preparation) containing acetaminophen
without medical advice; overdosing and chronic use ca cause liver damage and
other toxic effects.
• Do not self medicate adults for pain more than 10d (5d for children) without
consulting a physician.
• Do not se this medication without medical direction for: fever persisting longer
than 3d, fever over 39.5 °C, or recurrent fever.
• Do not give children more than 5 doses in 24 h unless prescribe by the physician.
1. 2. VITAMIN A

GENERIC NAME: VITAMIN A


TRADE NAME: (generic name was used)
CLASSIFICATION: Vitamin
DOCTOR’s ORDER: Vitamin A 5000 #4 S.O.
DATE STARTED: 01-04-06

ACTIONS:
Essential for normal growth and development of bones and teeth, for integrity of epithelial
and mucosal surfaces, and for synthesis of visual purple necessary for visual adaptation to the dark.

INDICATION:
Vitamin A deficiency and as a dietary supplement during periods of increased requirements
such as infection.

CONTRAINDICATION:
History of sensitivity to vitamin A or to any ingredient in formulation, hypervitaminosis A,
oral administration to patients with malabsorption syndrome.

ADVERSE EFFECTS:
Body as a whole: Anaphylaxis, death (after IV use)
CNS: Irritability, headache, increased intracranial pressure
GI: Hepatosplenomegaly, jaundice
Hematologic: Leukopenia, hypoplastic anemias, vitamin A plasma levels <1200 IU/dL,elevations of
sedementation rate and prothrombin time
Musculoskeletal: Slow growth; deep, tender, hard lumps over radius, tibia, occiput; retarded
growth.
Urogenital: Hypomenorrhea

NURSING IMPLICATIONS:
• Evaluate dosage with consideration of patient’s average daily intake of vitamin.
• Monitor therapeutic effectiveness. Vitamin deficiency is often associated with
protein malnutrition as well as other vitamin deficiencies. It may manifest as
night blindness, restriction of growth and development , epithelial alterations,
susceptibility of infections, abnormal dryness of skin, mouth and eyes, and
urinary tract calculi.

3.CETIRIZINE

GENERIC NAME: CETIRIZINE


TRADE NAME: VERLIX
CLASSIFICATION: Antihistamine; H1-receptor antagonist; Non-sedating
DOCTOR’s ORDER: Cetirizine 10 g/tab. OD
DATE STARTED: 01-05-06
ACTIONS:
Cetirizine is a H1-receptor antagonist and thus antihistamine without significant
anticholinergic or CNS activity. Low lipophilicity combined with its Hi-receptor selectivity
probably accounts for its relative lack of anticholinergic and sedative properties.

INDICATION:
Seasonal and perennial allergic rhinitis and chronic idiopathic urticaria.

CONTRAINDICATION:
Hypersensitivity to H1-receptor antihistamines; children <2 y/o.

ADVERSE EFFECTS:
GI: Constipation, diarrhea., dry mouth.
CNS: Drowsiness, sedation, headache.

NURSING IMPLICATIONS:
• Monitor of drug interactions. As the drug is highly protein bound, the potential
for interactions with other ptotein-bound drugs exists.
X. SUMMARY OF COURSE IN THE WARD

Last January 04, 2006 @ 2:30 pm, the patient, a 13 yr./old boy was received
@ ER cuddled by his mother with the patient clinical history of on and off
fever(5 days PTA), with IVF of D5LR one liter regulated @ 68mggts/min. @ 400
cc level on his left arm. 5 days PTA, the patient was positive of on and off fever
and few days PTA the patient was positive of rashes, thereby, the patient was
admitted to the pedia ward and was cuddled with the same IVF with the consent
for admission signed by the mother of the patient and was signed by Dr.
Respicio/ Dr. Bunuan. The Doctor ordered for repeat Hgb,Hct,APC due @6:00
pm. The patient was given a paracetamol 5oo mg/ 1 tablet but for fever only and
also Vitamin A 5000 #4 OD. The patient was on DAT and for BP monitored.

On his second day of Hospitalilzation, January 05, 2006, that’s the time when
I handle the patient. The patient was still with the same IVF and continues with
his medications including for BP monitored and still on DAT. The patient
experienced non-productive cough but he looks good and easy to cope up with
his every activity. He has still rashes so the Doctors order him to take Cetirizine
10g/ 1 tablet OD.The Doctor order him for repeat Hgb,Hct and APC.Then
endorsed patient with latest BP of 110/80mmHg.

On his last day of hospitalization, January 06,2006.The patient look good and
comfortable now but with some kind of anxiety because he is on MGH but with
still rashes(some).The doctor again order him for repeat Hgb ,Hct, and
APC.Home medication is Ceritizine. So I endorsed patient with BP of 110/90
mmHg.
SAINT MARY’S UNIVERSITY
BAYOMBONG NUEVA VIZCAYA
SCHOOL OF HEALTH SCIENCES

CASE STUDY
ON
DENGUE FEVER

SUBMITTED TO:

Mr. Patrick Lannu, RN>

SUBMITTED BY:

Alfie Mae Pe Benito


BSN III-H
GROUP 18
XI. COMPREHENSIVE NURSING CARE PLANS

NURSING CARE PLAN


ASSESSMENT NURSING SCIENTIFIC PLANNING NURSING RATIONALE EVALUATION
DIAGNOSIS EXPLANATION INTERVENTION
“S”>”paubo- Ineffective > Primary functions After 3 days of >observe respiratory >shallow breathing After 3 days of
ubo siya ng airway of the respiratory nursing rate/depth with respiration, nursing
minsan kaya clearance system are to remove intervention holding breath may intervention
medyo may related to CO2 and provide patient will result in patient
paghi2rap obstruction O2. Normal tidal establish effective hypoventilation established
siyang huminga on volume is about breathing >auscultate breath >areas of absence of effective
AVB the respiratory 500mL, and normal pattern aeb: sounds breath sound suggests breathing pattern
mother airways frequency is 15 >no sings of atelectasis, where as aeb:
“O” secondary to breaths per minute respiratory adventitious sounds >no signs
>dyspnea non- for a total ventilation compromise/ reflect congestion respiratory
>still have non- productive of 7.5 L/ min. complaints >instruct and assist promote\s ventilations compromise/
productive cough Because of dead effective breathing of all lung segments complaints
cough space, alveolar techniques and mobilization and
>rashes ventilation is 5 This expectoration of
is to supply the secretions
person adequate
supply of oxgen to >facilitate more
inhale. Aids the >administer effective coughing,
body to compensate analgesics before deep breathing and
to the low oxygen breathing pattern activity
supplyL/min. treatments
>Partial pressure of
co2 in arterial blood
is directly
proportional to
amount of co2
produced each
minute and inversely
proportional to
alveolar ventilation.
>gas exchange is
critically dependent
on proper matching
of ventilation and
perfusion.
>presence of
secretions in the
respiratory
passageway can
result to obstruction
thus altering
patients breathing
pattern
NURSING CARE PLAN FOR ALTERED COMFORT

ASSESSMENT NURSING SCIENTIFIC PLANNING NURSING RATIONALE EVALUATION


DIAGNOSIS EXPLANATION INTERVENTION
S Altered >Pain producing After 3 days of >encourage bed rest >minimizes After 3 days of
>”hindi aki comfort sensory stimuli in rendering during acute phase stimulation/ promotes rendering nursing
mapakali kasi related to skin and viscera nursing relaxation intervention the
medyo makati itchiness activate peripheral intervention the >provide/recommend >measure reduce of goal was partially
yung mga secondary to nerve endings of patient will be nonpharmacological cerebral vascular met aeb:
rashes ko AVB rashes AEB primary afferent able to: measures for relief of pressure and that > with still slightly
the patient’ the objectives neurons, witch > have (-) headache slow/block of itchiness
O” cues synapse on second- itchiness sympathetic response > with still some
> itchiness order neurons in >comfortable are effective in rashes on upper
>restlessness cord or medulla. >(-) petecheal relieving headache and and lower
>irritable These second-order rashes associated extremities
>grimace neurons form (-) grimace complications. >(-) restlessness
> petecheal crossed ascending >eliminate >activities that >(-) grimace
rashes pathways that reach vasoconstriction increase
the thalamus and are activities that vasoconstriction
projected to aggravate headache accentuate the
somatosensory headache in the
cortex. Parallel presence of increased
ascending neurons cerebral vascular
connect with pressure
brainstem nuclei and >provide liquids, soft >promoted general
ventrocaudal and foods mouth care if comfort.
medial thalamic nosebleeds occur or
nuclei. These parallel nasal packing has been
pathways project to done to stop bleeding
the limbic systems >administer analgesic >reduce/control pain
and underlie the as ordered and decrease
emotional aspect of stimulation of the
pain. Pain sympathetic nervous
transmission is system
regulated at the
dorsal horn level by
descending
bulbospinal
pathways that
contain serotonin,
norepinephrine , and
several
neuropeptides.
IV. Pathophysiology

Etiologic Factors Risk/Predisposing Factors


- 4 serotype of dengue virus (I, II, III, IV) -water stored in household or brought by the vector
brought by the vector standing water in premises, high human density
- Aedes Aegypti mosquito -Poor waste management, living in rural areas
- Mosquito bites on the integumentary system of a specific subj.
- Weak immune system

Enter the bloodstream

↑ no. of viruses (4-6) day of incubation

decompensatory compensatory

Liver Bloodstream vascular permeability immune response

Destroys Platelet (adhesion) leakage of plasma fever redness muscle pain


Hepathocytes
platelet destruction hemoconcentration

Coagulation defect Hepatomegly thrombocytopenia hypovolemia dehydration

DIC Abdominal pain n/v


When Palpated shock
Nose bleeding petechiae hemoptysis

Death