DHF CASE SCENARIO: ACTIVITY #3

Date Doctor’s Order Interpretation

January 25, 2021,  Please admit to medicine ward  Medicine Ward is a hospital
6:30 am ward in which patients are
 Epistaxis being treated by drugs
 Dengue rather than surgery.
 Hemorrhagic  Secure consent  Informed consent is defined
fever as the patient's choice to
 Typhoid have a treatment or
fever procedure which is based on
their full understanding of
the treatment or procedure,
its benefits, its risks, and any
alternatives to the particular
treatment or procedure. All
clients have the legal right to
autonomy and self-
determination to accept or
reject all treatments and
interventions.
 TPR every shift  These measurements are
taken to help assess the
general physical health of a
person, give clues to
possible diseases, and show
progress toward recovery.
 DAT except dark colored food  Diagnosis of dengue fever or
probably presuming that
patient have it, this will be
 the diet that will be
prescribed to the patient.
The same for any disease
that may give doctors
reason to trace if there is
any bleeding that will pass
through patient’s stools.
Dark colored foods cause
the stool to become dark in
color.
 IVF: D5LR 1L × 60gtts/min × 2  For fluid and electrolyte
cycles replenishment and caloric
supply.
4:00 pm Laboratories:
 (+) epistaxis  Complete blood count with PC,  A CBC determines if there
typing are any increases or
decreases in patient’s blood
cell counts. The CBC can
evaluate patient’s overall
health and detect a variety
of diseases and conditions.
For PC typing, blood tests
must be done to find a
donated blood component
that closely matches the
patient.

 Urine analysis  Urinalysis is the physical,

chemical, and microscopic
 examination of urine. It
involves a number of tests to
detect and measure various
compounds that pass
through the urine. A
urinalysis may be done as
part of a routine medical
exam to screen for early
signs of disease and to check
for blood in the urine.
 Hematocrit monitoring every 6  By determining what
hours percentage of patient’s
blood consists of red blood
cells, an HCT test can be an
early indicator of whether
patient have a condition
related to too few or too
many RBCs.
 Intake and output every shift  To maintain an accurate
record of the patient's fluid
balance. Give valuable
information about your
patient's condition
 Vital sign every 1 hour and  To closely monitor the
record patient. Measuring and
recording a patient's vital
signs accurately is important
as this gives an indication of

 For close monitoring, then notify
Pediatrician, Refer
the patient's physiological
state.
 A pediatrician is medical
doctor who manages the
physical, behavioral, and
mental care for children
from birth until age 18. A
pediatrician is trained to
diagnose and treat a broad
range of childhood illnesses,
from minor health problems
to serious diseases.

 IVF to follow: D5LR 1L x  For fluid and electrolyte

70gtts/min x 2 cycles replenishment and caloric
supply.
January 26, 2021,
3:00 am  Secure and transfuse 5 units  Platelets are commonly
 BP 100/70 platelet properly typed transfused to patients with
 PR 86 low platelet counts or
 RR 21 patients with platelet
 (-) PC dysfunction who are
bleeding or at high risk of
bleeding.
 Secure and transfuse either 5  Platelet transfusion, also
units Platelet Concentrate or 5 known as platelet
units Fresh Frozen Plasma concentrate, is used to
(whichever is available) properly prevent or treat bleeding in
typed and cross matched) people with either a low
 platelet counts or poor
platelet function. Fresh
frozen plasma infusion can
be used for reversal of
anticoagulant effects.
The goal of blood typing and
cross matching is to find a
compatible blood type for
transfusion.
 Regulate accurately present  To ensure that the patient
10:00 am hydration rate has proper intake of fluid
 (+) black stool and other nutrients.
 Tepid sponge bath care (please  Tepid sponge bath is a
facilitate) therapeutic bath by washing
all-around of the body with
warm water to decrease
body temperature, to clean
the client’s body, to
stimulate the circulation and
to make client comfortable
and help to induce sleep.
 Hook to O2 support via nasal  Nasal cannulas are used to
cannula x 3 lpm deliver oxygen when a low
flow, low or medium
concentration is required,
and the patient is in a stable
2:00 pm state.
 Epistaxis  Transfer to ICU please  An ICU is an organized
system for the provision of
 care to critically ill patients
that provides intensive and
specialized medical and
nursing care, an enhanced
capacity for monitoring, and
multiple modalities of
physiologic organ support to
sustain life during a period
of life-threatening organ
system insufficiency.
 Appraised mother  To provide comfort and
guide the patient’s mother
regarding the patient’s
status.
 IVF to follow: D5LR 1L x 70gtts 2  For fluid and electrolyte
4:00 pm cycles replenishment and caloric
 Severe dengue supply.
Restless
 (+) epistaxis  Fecalysis with occult  The fecal occult blood test
 (+) petechia (FOBT) looks for the
 (+) hematoma presence of microscopic
right forearm blood in the feces.
 Poor pulse  Line no 1L PNSS 500cc then  For fluid and electrolyte
 (+) epigastric maintain at 55gtts/min (5 cycles) replenishment for
tenderness intravenous administration.

 Clear breath  Line no 2 D5LR 1L x 55gtts/min  For fluid and electrolyte

sounds (5) replenishment and caloric
supply.
  Refer for next IVF  For continuous of care.
 For Fresh Whole Blood  Blood transfusions are a key
transfusion properly typed and therapeutic component to
crossmatched x 5 hrs 2 doses. treating those with
excessive blood loss. Whole
blood refers to blood drawn
directly from the body from
which none of the
components, such as plasma
or platelets, have been
removed.
 Please monitor vital sign blood  To closely monitor the
pressure every 1 hour and patient. Measuring and
record. recording a patient's vital
signs accurately is important
as this gives an indication of
the patient's physiological
state.
6:00 pm  Refer  For continuous of care.
 BP 126/79  Intake and output every shift  To maintain an accurate
 O2sat 99% record of the patient's fluid
 Full pulses balance. Give valuable
information about your
patient's condition.
 Complete blood count every 8  To closely monitor the
hours patient. A CBC determines if
there are any increases or
decreases in patient’s blood
cell counts. The CBC can
 evaluate patient’s overall
health and detect a variety
of diseases and conditions.

 Please include SGPT/SGOT  SGPT/SGOT, an enzyme that

(Serum Glutamic Pyruvic is normally present in liver
Transaminase), SGOT (Serum and heart cells.
Glutamic Oxaloacetic
Transaminase) on next CBC
extraction.
 O2 at 6 lpm via face mask  To increase the oxygen
concentration delivered,
often a mask reservoir is
utilized.
 IVF line no. 1 PNSS at 55gtts/min  For fluid and electrolyte
(5) x 2 replenishment for
intravenous administration.
 Fused no. 2 D5LR at 25gtts/min  For fluid and electrolyte
(2) x 2 hours replenishment and caloric
supply.
 Refer  For continuous of care.

January 27, 2021,

12:29 am
 BP 113/62  IVF line 1 PNSS at 25gtts/min x  For fluid and electrolyte
 PR 98 (2) x 4 hours replenishment for
 T 37.4 intravenous administration.
 O2sat 99%
  (+) mild  Line 2 D5LR at 25gtts/min (2) x 4  For fluid and electrolyte
headache hours replenishment and caloric
supply.
6:00 am  Refer  For continuous of care.
 BP 114/67  Continue present management  To continue care for the
 (-) Bleeding patient.
 Facilitate Fresh Whole Blood  Blood transfusions are a key
8:00 am transfuse 2nd dose therapeutic component to
 (-) melena treating those with
 (-) epistaxis excessive blood loss. Whole
 Awake blood refers to blood drawn

 Confused directly from the body from

 No which none of the

epigastric components, such as plasma

tenderness or platelets, have been

 Full pulse removed.

 Clear breath
sounds

10:00 pm
 Coherent
 Full pulse No
epistaxis

January 28, 2021,

8:30 am
 Coherent  PNSS 1L x 15 gtts/min (1)  For fluid and electrolyte
replenishment for
 BP 100/60
intravenous administration.
 PR 99
  T 37.0  D5LR 1L x 15 gtts/min (1)  For fluid and electrolyte
 (-) Epistaxis replenishment and caloric
supply.
9:30 pm
 (-) bleeding

January 25, 2021,

6:00 am
 (-) bleeding  May go home  Hospital discharge is when

 Platelet 198 the patient is allowed to

leave a hospital after
treatment.