Republic of the Philippines

TARLAC STATE UNIVERSITY

COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
Lucinda Campus, Brgy. Binauganan, Tarlac City Philippines 2300
Awarded Level 3 Status by the Accrediting Agency of Chartered Colleges and Universities in the Philippines Inc. (AACCUP)

A Clinical Case Study Presented to the Faculty of the

Department of Nursing
In Partial Fulfillment
of the Requirement of the Subject
NCM 119 Lab – RLE (Pedia Ward)

Submitted by:
Ordinario, Maelyn Joy U. Ursua,Jannah Nicole T.
Parazo, Queen Ida C. Valdez, Mike Vhincent P.
Salas, Aidene S. Vergara Amygail V.
Tacliad. Ma. Cristina G. Vergara, Valerie G.
Tomagan, Tricialyn A. Vicente, Cindy Y.
Ursua,Jannah Nichole

BSN 4-2 Group 5

Submitted to:
Ron Mar C. Ramos RN, MAN
Clinical Instructor

October 2022

1
 TABLE OF CONTENTS

INTRODUCTION............................................................................................................. 1
I. NURSING PROCESS .................................................................................... 9
A. ASSESSMENT .............................................................................................. 9
1. Personal Data ........................................................................................... 9
2. Family History of Health and Illness ....................................................... 12
3. History of Past Illness ............................................................................. 12
4. History of Present Illness ........................................................................ 12
5. Physical Assessment.............................................................................. 13
a. 13 Areas of Assessment .................................................................. 13
6. Laboratory and Diagnostic Procedures .................................................. 22
7. Anatomy and Physiology ........................................................................ 29
8. Pathophysiology ..................................................................................... 31
a. Book-based....................................................................................... 31
b. Patient-based.................................................................................... 32
B. PLANNING .................................................................................................. 33
C. IMPLEMENTATION..................................................................................... 41
1. Drugs ...................................................................................................... 41
2. Medical Management ............................................................................. 51
3. Surgical Management............................................................................. 51
4. Diet .......................................................................................................... 52
5. Activity/Exercise...................................................................................... 53
6. Nursing Management ............................................................................. 54
D. EVALUATION .............................................................................................. 57
II. CONCLUSION.............................................................................................. 58
III. RECOMMENDATION .................................................................................. 59
IV. REVIEW OF RELATED LITERATURE AND STUDIES ............................. 60
VI.BIBLIOGRAPHY……………………………………………………………… 61
I. INTRODUCTION

Summer is a beloved time for relaxation and family vacations. But there are some all-to-
familiar annoyances about summers that aren’t so popular – at the top of the list mosquitoes.
If not careful, mosquitoes can expose you to diseases. Mosquitoes are widely known as one
of the most dangerous animals. They are insects that feed off of human blood. When a
mosquito bites you, it injects saliva into the bloodstream that causes an allergic reaction for
many humans. These pests tend to flock to warm climates and are prevalent near sitting
water. (Maxwell, 2019)
Dengue is an acute viral illness caused by RNA virus of the family Flaviviridae and spread
by Aedes mosquitoes. Presenting features may range from asymptomatic fever to dreaded
complications such as hemorrhagic fever and shock (Hansan et.al., 2016). Dengue is a
mosquito- borne disease caused by any one of four closely related dengue viruses (DENV-
1, -2, -3, and -4). Infection with one serotype of DENV provides immunity to that serotype for
life but provides no long-term immunity to other serotypes. Thus, a person can be infected as
many as four times, once with each serotype. Dengue viruses are transmitted from person to
person by Aedes mosquitoes (most often Aedes aegypti) in the domestic environment. The
World Health Organization (WHO) consider dengue as a major global public health challenge
in the tropic and subtropic nations. Dengue has seen a 30-fold upsurge worldwide between
1960 and 2010, due to increased population growth rate, global warming, unplanned
urbanization, inefficient mosquito control, frequent air travel, and lack of health care facilities
(Gubler, 1998). In the past 30 years, dengue transmission and the frequency of dengue
epidemics have increased greatly in most tropical countries such as the Philippines.
Aedes aegypti is the principal mosquito vector of dengue. Adult mosquitoes shelter indoors
and bite during the daytime. They are adapted to breed around human dwellings, in water
containers, vases, cans, old tyres and other discarded objects. The secondary vector for
dengue virus is Ae albopictus, which contributes significantly to transmission in Asia and
whose presence is spreading in Latin American countries. Dengue outbreaks have also been
attributed to Ae polynesiensis and Ae scutellaris, but to a lesser extent. (Centers for Disease
Control and Prevention, 2022)
Uninfected mosquitoes acquire the virus when they feed on a viraemic individual. The virus
develops in the mosquito for 1 to 2 weeks and once it reaches the salivary glands, it can be
transmitted to humans during feeding attempts, which may occur several times a day over
the rest of the mosquito’s lifetime of 1 to 4 weeks (total). The virus can have a significant
transmission potential (Ro) in certain areas. After an infectious mosquito bite, the virus
replicates in local lymph nodes and within 2 to 3 days disseminates via the blood to various
tissues. The virus circulates in the blood typically for 4 to 5 days during the febrile phase and
is cleared within a day of defervescence. (Medscpae, 2021)

STATISTICS/TRENDS
WORLDWIDE

An estimated 500,000 cases of severe dengue require hospitalization each year, of which
a very large proportion is in children. At least 2.5% of cases die, although case fatality could
be twice as high (18). The figure below shows the rise in the annual number of dengue
cases worldwide reported to WHO. (WHO, 2019)

Figure 1: Annual number of Dengue Fever/Dengue Hemorrhagic Fever Cases and Deaths
reported to WHO, 1969-2003
Although mild dengue infections have been recognized for years, the first epidemic of
severe dengue was reported in the Philippines in 1953. This rapidly spread to Thailand, Viet
Nam,
Indonesia, and other Asian countries, becoming endemic and epidemic in several of them.
Before 1970 only nine countries had experienced severe dengue epidemics, a number that
had increased more than four-fold by 1995. The burden of disease is greatest in Asia, where
in many countries dengue is a leading cause of pediatric hospitalisation. The figure below
shows the global distribution of dengue.

Figure 2: Worldwide distribution of Dengue Fever/Dengue Hemorrhagic Fever Cases

LOCAL (PHILIPPINES)

Figure 3: Trends of reported Dengue cases and deaths in the last five years (2015-2019)
 The Philippines is facing a surge in dengue cases, with over 100,000 dengue cases
reported by the Department of Health (DOH) from 1 January to 29 June 2019, an 85 percent
increase in cases from the same period last year, with more than 450 deaths reported. On 15
July, the Department of Health declared a National Dengue Alert, urging regional DOH offices
to step up surveillance, case management and outbreak response in health facilities and
hospitals, as well community and school-based health education campaigns, clean-up drives,
and logistics support for dengue control. While there are many reasons for the increase in the
Philippines, WHO cites that drought and water shortages related to the onset of El Niño has
led people to collect water in containers and an increase in mosquito breeding places (OCA,
2019).

Figure 4: Confirmed Dengue Cases by Age Group and Sex, Philippines, January 1-August
31, 2019.

Figure 5: Reported dengue cases and deaths in Tarlac, 2000-2011

 Figure 5 shows that from year 2000-2011, the reported dengue cases and deaths
fluctuates. As shown from the graph above, the number of dengue cases were at its peak
around year 2006. However, after 8 years, dengue cases in the province of Tarlac from
January to July 6, 2019 declined to 1,629 or 46 percent lower compared to 2,989 for the
same period last year, records from the Provincial Epidemiology and Surveillance Unit
(PESU) showed. PESU Enhanced Dengue Surveillance Report accounted the cases for
the first half of this year from different reporting units in the province, with six deaths
coming from the towns of Paniqui with three and one each from Gerona, Concepcion and
Mayantoc. (Hernandex, 2019)
This case study was chosen by the Student Nurse because this is globally
common, yearly problem of most of the country in Asia. By this, she will be able to discover
its process, how it is being acquired, the pathophysiology and clinical manifestations which
are being experienced by the patient. By doing so, she will be able to fructify her
knowledge, enabling her to know the appropriate nursing care to be rendered to the
patient. This study will help the student nurse to comprehend not only the disease
mentioned but also for the commonalities and differences among other diseases for the
betterment of this study. Through this, the student nurse will be able to improvement her
nursing skills such as performing appropriate assessment upon gathering the data
needed, identifying problems through nursing diagnoses, setting a plan to solve problems,
application of accurate and appropriate nursing interventions, and determining the
outcome of the interventions performed through evaluation. The result of the study will
serve as a guide to the student nurse as she performed standard nursing care soon as
she will be exposed to the clinical areas with the same condition/case.

General Objectives

At the end of the semester, we will be able to understand the condition of the

patient and through that we will be able to formulate appropriate nursing care plan and

implement effective nursing interventions that will help to solve the condition of the patient.

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Specific Objectives

As supported by the general objectives, the student nurse aims the following:

As supported by the general objectives, the researchers aim the following:

1. To assess current condition of the patient and familiarize background of

Dengue;

2. To diagnose proper nursing problems;

3. To plan appropriate strategies in solving the identified problems;

4. To implement the planned nursing interventions for the identified health

problems;

5. To evaluate the effectiveness of the planned interventions in improving the

health status of the patient.

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II. NURSING PROCESS

A. ASSESSMENT

1. Personal Data

Name: Patient A

Age: 17 years old

Sex: Female

Civil Status: Single

Occupational: N/A

Role/ Position In The Family: N/A

Address: Brgy. Binauganan, Tarlac City

Date Of Birth: July 26, 2005

Nationality: Filipino

Chief Of Complaint: Intermittent fever

Admitting Diagnosis: T/C Dengue fever, Urinary Tract Infection

Final Diagnosis: Dengue fever, Urinary Tract Infection (UTI)

Admission Date: September 23, 2022 11:50 pm

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B. Environmental Status

Patient A is from Binauganan, Tarlac, and they were almost at the open drainage.

According to the data gathered, one possible cause of dengue fever is an open-drainage

system that is not inspected on a regular basis by the family. The stagnant water in the

drainage system could have served as a breeding ground for mosquitos, particularly

Aedes species.

C. Lifestyle

Patient Allysa is 17 years old, so she can eat independently; Patient A consumes
fruits and vegetables at least once a week. She eats meat and chicken four times a week
on average. She eats four times per day and drinks eight to nine glasses of water per day.
She usually has a large breakfast. Patient A typically urinates six times per day and
defecates at least once a day, usually in the morning before going to school. Patient A has
completed puberty or menstruation and has a regular menstrual cycle. During her
menstrual cycle, she occasionally experienced dysmenorrhea.

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2.Family history of health and illness FAMILY GENOGRAM

Grandfather Grandmother Grandfather Grandmother

Father Mother

Legends:

Female
Male

Patient Allysa 17y/o

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3. History of Past Illness

The patient has no prior hospitalizations and no allergies or asthma.

4. History of Present Illness

On September 23, 2020, the patient was rushed to the ER with the chief complaint
of intermittent fever of 38 degrees Celsius for the previous five days, her skin is warm to
the touch and flushed. She described five days prior to admission her gradual symptoms
of loss of appetite, vomiting, and rashes. Her last fever was on Thursday, and her last
menstrual period was on September 23rd. PTA consults with a pediatrician after a positive
dengue test. PTA for a few hours, urinalysis, Cefixine, Stimund Cap, and ascorbic acid +
zinc with the diagnosis of Dengue fever and UTI. The patient is awake, comfortable, and
not in distress, according to the general survey. On the neurological examination, GCS 15
indicated a fully awake patient.

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5. 13 Areas of Assessment

A. Social Status
Patient A’s parents are both busy with their professionnwho have only time at night and

during Sundays to visit church with their daughter. The patient spends most of her time

doing homework and playing She also spends some time with her friends during

Saturdays and when there are no classes.

Standard: Social status includes family relationships that state the patient’s support

system in time of stress and in time of need. It meets a fundamental need for social ties,

making life stressful and social support buffers the negative effects of stress, thus

indicating indirectly contributing to good health outcomes. (Kozier, 2016)

Analysis: The gathered data states that the lack of time of the parents may have caused

the child to spend more time on computer games and with her playmates, which is

however, harmonious.

B. Mental Status Level of Consciousness

The patient was conscious but has difficulty answering as evidenced by the guardian being

the one who supplemented the needed information.

Standard: The level of consciousness and orientation determine whether a person is

aware of things that are happening. The patient should be oriented to time and place,

can identify past and recent memories, and should be able to verbalize concrete

messages. (Estez Health Assessment and Physical Examination, 3rd edition)

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Analysis: Using the Pediatric Glasgow Coma Scale, it was observed that the child has a

total of 12/15, which is around average.

Appearance and Movement

The patient looks pale, with flushed skin and looks in pain. She has difficulty talking and

moving; she preferred in the bed. When she needs to void, her mother accompanies her

to the toilet.

Standard: Dress must be appropriate for occasion and weather, client must be cleaned

and groomed, and posture is erect and comfortable for age. Client must be cooperative

and purposeful in interaction with others. (Health and Assessment in Nursing 3rd edition

by Janet Weber and Jane Kelly)

Analysis: Based on the gathered data, the patient has difficulty with her movement as

evidence by facial grimace.

Orientation

Though she had difficulty talking, she still had tried telling her name and age, she is aware

of whom she is with and where she is.

Standard: The client’s ability to recognize other people (person), awareness of when and where

they presently are (time and place), and who they, themselves, are (self).

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Analysis: The patient’s orientation is normal.

Speech

She talked very slow, with deep breath in between sentences; her speech is not that

clearly understood.

Standard: Patient’s speech is understandable, in moderate pace and in clear tone.

Thoughts are logical

Analysis: Her speech is abnormal; this may be associated with pain and headache.

Intellectual Functioning

Though she talked very slowly and unclear; she still managed what was being asked to

her.

Standard: A person should respond normally and appropriately to topics discussed.

Express full and free-flowing thought during the interview, listen, and responds with full

thought (Estes, 2014)

Analysis: Patient has considerable intellectual functioning; she had responded properly

to what being asked, but was not able to express full thought.

C. Emotional Status

While she was asked, he face shows facial grimace and irritability.

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Standard: Normally, the patient should have the ability to manage the stress and to express

emotion appropriately. It also involves the ability to recognize, accept, and express feelings and

limitations. (Fundamentals of Nursing: Concepts, Practice, and Process, 7 th edition)

Analysis: The patient’s emotional status is understandable; her feelings are expressed

through facial features and crying.

D. Sensory Perception Sense of Sight

With the use of penlight, the pupils of the patient were observed and were black in color.

Pupils were also equally round and are reactive to light; sclera was reddish in color. Eyes

were symmetrically moving. The patient stated blurring.

Standard: The client who has a visual acuity of 20/20 is considered to have normal visual

acuity. The eyes must be symmetrical during the six cardinal gazes test. The sclera should

be white with some small blood vessels. Papillary constriction should occur when struck

by light. (Health Assessment and Physical Examination, Marysleep Ellen Zalor Estez)

Analysis: The eyes were observed normal, but the condition of the sclera was found to

be abnormal. The patient also stated blurring, which is probably caused by congestion in

the eyes.

Sense of Smell

Using the test of olfactory nerve, the patient tried to identify coffee and juice by smelling

through one nostril while the other nostril is compressed. She had difficulty identifying the
16
substance.

Standard: The Nose must be symmetrical and along with the face. Each nostril must be

patent and recognize the smell of an object. (Health Assessment and Physical

Examination, Mary Ellen Zalor Estez).

Analysis: The data gathered shows that the patient has difficulty identifying odors may

be due to nasal congestion due to mucus build up.

Sense of Hearing

Whisper test was used to test the patient’s sense of hearing. Patient G was able to identify

the word correctly that was whispered in low pitch about two feet away with both ears, but

had quite a hard time relating the word.

Standard: For the auditory acuity, the patient should be able to hear the tick of the watch

2 inches away from the ear. (Health Assessment and Physical Examination, Mary Ellen

Zalor Estez)

Analysis: The patient still has normal sense of hearing.

Sense of Taste

The patient stated that the food she eats tastes bitter, although they were Not.

Standard: Taste is intact in the posterior one-third of the tongue. (Health Assessment and

Physical Examination, Mary Ellen Zalor Estez)

Analysis: The data shows that the patient taste buds taste bitter; this may be an indication

that her fever has not yet subsided.

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Sense of Touch

A simple test was done using the top of the thermometer pressed in different areas of the

body of the patient. She verbalized pain on some areas, but felt numb on the lower limbs.

Standard: The skin contains receptors for pain, pressure, temperature. Sensory signals

are transmitted along rapid sensory pathways, and less distinct signals such as pressure

of localized touch are sent via slower sensory pathways. (Estes, 2016)

Analysis: Data shows normal sense of touch as evidenced by active pain receptors,

except for the lower limb.

E. Motor Stability

Though having difficulty, during confinement, she was able to color books with minimal

error and cut paper into smaller shapes.

Standard: The normal range is that patient has a good posture, easy to walk, transfer

from bed to chair and walk fast not just slowly. In a standing position, the torso and head

are upright. The head is midline and perpendicular to the horizontal line of the shoulder

and the pelvis. The shoulders and hips are level, symmetry of the scapulae and Iliac

crests. The arms are freely from the shoulders. The feet are aligned, and the toes point

forward. Walking initiated in one smooth rhythmic fashion. (Health Assessment and

Physical examination by Estes)

Analysis: It can be stated based on the findings that the patient has unwell- coordinated

movements, but her upper extremities are working fine.

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 F. Body Temperature

Date Time Temperature Status

September 23, 2022 1:00 PM 38.0°C abnormal
September 23, 2022 5:00 PM 38.0°C abnormal
September 23, 2022 10:00 AM 36.5°C normal

Standard: Normal axillary temperature is within 36.4 to 37.4 centigrade. (Health

assessment and physical examination 3rd edition by Mary Ellen Zator Estes)
Analysis: Based on the data gathered, from her admission to September 24, she had an
abnormal status of body temperature. However, as compared from admission, her
temperature is gradually improving.

G. Respiratory Status
DATE RESPIRATORY STATUS

September 23, 2022 21 bpm Normal

Upon admission, patient A has a respiratory rate of 21 breaths per minute which is patient
was able to breathe normally.
Norms: Normal respiratory rate for school-aged child is 20-30 bpm. In terms of pattern,
normal respirations must be in a fairly steady state, inspiratory volume and depth of chest
movement is maintained, with equal expansion and symmetry. (Kim et al., 2019)
Analysis: Findings show that during her admission, patient A can breathe normally.

H. Circulatory Status
Date Cardiac Rate Status

September 23, 2022 87 bpm Normal

DATE Blood Pressure STATUS

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 September 23, 2022 100/70 mmHg Normal

Upon admission, patient A blood pressure was taken; 100/70 mmHg, which is
considered normal; Cardiac rate was also taken of 87 beats per minute which is
considered normal.
Norms: The normal pulse rate for a school-aged child is 70 to 120 beats per minute. The
normal blood pressure on the other hand is 90-110/55-75 mm/Hg (Kim, et al., 2019)
Analysis: Data above shows that patient A has a normal range of cardiac rate and blood
pressure.

I. Nutritional Status
Patient A can eat through her mouth independently. She usually eats four times a day and
drinks 8-9 glasses a day. Patient A eats fruit and vegetables at least once a week. She
usually eats meats and chicken four times a week and having a heavy meal in the morning.
Patient A eats three times a day.
Norms: Normal eating pattern is considered to be at least three times a day depending
on the metabolic demands and needs of the patient. Fluid intake should be 8-10 glasses
per day. (Roigk, 2018)
Analysis: Based on the above-mentioned data, patient A has a lifestyle that can affect
her immune system.

J. Elimination Status
Patient A usually urinates six times a day and defecates at least once a day, usually in the
morning before going to school.
Norms: There is no generally accepted number of times a person should poop. As a broad
rule, pooping anywhere from three times a day to three times a week is normal (Biggers
and Nall, 2018). A healthy person may urinate anywhere from four to ten times in a day.
The average amount, however, is usually between six and seven times in a 24-hour period
(Marcin and Brusie, 2018).
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Analysis: As compared to the norms, finding show that she has a normal fecal elimination
status and normal urine output.

K. Reproductive Status
Patient A had her puberty or menstruation and has a regular menstruation cycle. She
sometimes experienced dysmenorrhea during her menstruation period.
Norms: The child learns to realize the difference between males and female; children
view the same sex parent as rivals; she is more attached to her father (Electra Complex).
(Legg and Longhurst, 2018)
Analysis: Based on above data, patient A has a regular menstruation cycle.
L. Sleep-Rest Pattern
During her school days, she sleeps usually at 9 in the evening and wakes up at 5:30 in
the morning to prepare for school. During weekends, she sleeps at 11 in the evening and
wakes up at 7 in the morning.
Norms: An individual sleep for about 7-9 hours a day and takes a rest using some of
activities that will help you to relax including reading, watching television and others. Sleep
refers to altered consciousness with generation general showing of physiologic process
while rest refers to relaxation and calmness, both mental and physical (Estes, 2014)
Analysis: Findings show that patient A has a normal sleep-rest pattern.

M. State of Skin Appendages

Her skin is brown in color, has a flushed skin and warm to touch due to her elevated
temperature and a capillary refill of 2-3 seconds. She has a black hair, distributed evenly.
Nails are well trimmed.
Norms: Skin, hair, and nail changes are evident in aging person, the skin become drier
and lose its elasticity, there will be a hair loss and change of color. The nail grows more
slowly and thicken, it also tends to split. (Kozier’s & Erb’s, 2015).
Analysis: Based on the findings, patient A has normal capillary refill. Her skin was warm
due to her elevated temperature
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6. Laboratory and Diagnostic Procedures
Diagnostic Date Purpose/Indicat Reference Actual Interpretation/ Nursing
/ ion Values Results Analysis Responsibilitie
laboratory s
procedure
CBC or September To look for low Hemoglobin WBC: 12.7 WBC: Decrease Before:
Complete 24, 2022 platelet count : 11.2-13.6 RBC: 4.72 due to -Confirm the
Blood typical of the g/dL HCT: 0.39 inadequate patient’s identity
Count later stages of Hematocrit: Hgb: 12.7 inflammatory using two patient
the illness and to 0.34-41% Platelet: response identifiers
detect the WBC: 4.80- 126 defense to according to
decrease in 10.109/L WBC: 4.05 suppress facility policy.
hemoglobin, RBC: 4.00- Neutrophil: infection and
hematocrit, and 5.00x1012/L 0.40 anti-body -Explain test
red blood cell Neutrophil: Lymphocyt mediate procedure.
(RBC) count 0.50-0.70% e: 0.47 immunity takes
(evidence of Lymphocyte Monocyte: place. -Explain that
anemia) that : 0.20-0.40% 0.11 RBC: Normal slight discomfort
would occur with Monocyte: Eosinophil: Hg: Decreased may be felt when
blood loss 0.03-0.08% 0.02 hemoglobin the skin is
associated with Eosinophil: Basophil: results in RBC punctured.
severe dengue 0.005-0.05% 0.00 destruction or
fever. Basophil: MCV: 82.2 infiltration of -Encourage to
0.00-0.01% MCH: 26.9 bone marrow avoid stress if
MCV: 87- MCHC: 32.7 with the possible
102.2 FC infectious cell. because altered
MCH: 25.6- Hct: Normal -physiologic
30.8 pg Neutrophil: status influences
MCHC: 28.2- Decreased that and changes
22
31.1 g/dL immune normal
Platelet: response hematologic
150- leading to values.
450x109/L destruction of
microorganisms During:
. -help the patient
Lymphocyte: to relax.
Increase -Monitor if there
immune some pain
response experience from
fighting the client during
Monocyte: the procedure.
increased -Proper insertion
Eosinophil: of the needle.
decreased - Clean the
Basophil: diaphragm tops
Normal of the culture
MCV: Normal bottles with
MCH: Normal alcohol or iodine
MCHC: Normal (or other
antiseptic agent
per facility
policy) and
change the
needle on the
syringe.
After:
-Apply manual
pressure and
dressings over
puncture site on
removal of
dinner.
23
 -Monitor the
puncture site for
oozing or
hematoma
formation.

-Instruct to
resume normal
activities and
diet.

Diagnosti Date Purpose/Indicati Reference Actual Interpretation/Analy Nursing

c/ on Values Results sis Responsibiliti
laboratory es
procedure
Urinalysis Septe To detect and Color: Color: Yellow Color: Normal Before:
m ber manage a wide Yellow Transparenc findings -Inform the
24, range of disorders Appearance y: Slightly Transparency: patient
2022 such as: : clear to Turbid Normal findings regarding the
slightly hazy Specific Specific gravity: importance of
-General health Specific Gravity: Normal findings urinalysis.
screening to gravity: 1.010 pH: Acidic pH helps in -Educate her
detect renal and 1.005 to pH: 6.5 Acidic preventing bacterial with regards to
metabolic 1.025 with a WBC: 6- growth the preparation
diseases normal fluid 8/HPF WBC: Presence of needed for
intake RBC: 1- infection that may urinalysis.
-Diagnosis of pH: 4.5 to 8 3/HPF lead to UTI -Instruct the
24
diseases or Glucose: Bacteria: RBC: Maybe due to patient to void
disorders of the negative Few bladder problem directly into a
kidneys or urinary Ketones: Epithelial Bacteria: Presence clean, dry
tract negative cells: Few of infection container.
Leukocyte Epithelial cells: Sterile,
Albumin: esterase: +1 Possible disposable
Negative contamination of the containers
Sugar: Erythrocyte: specimen. recommended.
Negative +3 Urobilinogen: During:
Ketone: RBC: Normal -Observe
Negative 7,100/Hpf standard
Leukocyte WBC: 4- precautions
esterase: 5/HPf when handling
+1 urine
Erythrocyte: specimens.
3-5 -Instruct to use
Nitrate: the second
Negative drop of the
Urobilinoge urine.
n: 0.1-1.8 After:
mg/dl -Collect
RBC: 0 – 1/ specimens form
hpf. infants and
WBC: 2- young children
5/hpf. into a
Epithelial disposable
cells: Few collection
apparatus
consisting of a
plastic bag with
an adhesive
backing around
the opening
25
 that can be
fastened to the
perineal area or
around the
penis to permit
voiding directly
to the bag.

-Cover all
specimens
tightly, label
properly and
send
immediately to
the laboratory.

-If a urine
sample is
obtained from
an indwelling
catheter, it may
be necessary to
clamp the
catheter for
about 15-30
minutes before
obtaining the
sample. Clean
the specimen
port with
Antiseptic.
before
aspirating the
26
 urine sample
with a needle
and a syringe.

-If the specimen

cannot be
delivered to the
laboratory or
tested within an
hour, it should
be refrigerated
or have an
appropriate
preservative
added.

Diagnostic Date Purpose/Indicatio Referenc Actual Interpretation/Analysi Nursing

/ n e Values Result s Responsibilitie
laboratory s s
procedure
NS1 Septembe -used to detect the Negative Positive There's a presence of Before:
antigen test r 24, 2022 non-structural (<0.9) (+) detectable dengue NS1 -Inform the
protein NS1 of No antigen in the blood of patient regarding
dengue virus. detectable the patient. the procedure.
dengue -Explain the
-It allows rapid NS1 necessity of the
detection on the antigen. procedure.
first day of fever, The result - Instruct the
before antibodies does not client to
27
appear some 5 or rule out cooperate in the
more days later. dengue procedure
infection. - Provide
An appropriate
additional clothing
sample
should be During:
tested for -Ensure the
IgG & IgM patient comfort.
serology -Provide calm
in 7- 14 and relaxed
days. environment for
the patient
Equivocal After:
(0.9-1.1) -Assist the
Repeat patient to his/her
sample room and
after 1 provide comfort.
week
Positive -Inform the
(>1.1) guardian of the
Presence patient the result
of of the x-ray.
detectable
dengue

28
7. Anatomy and Physiology

IMMUNE SYSTEM

The immune system is a large network of organs, white

blood cells, proteins (antibodies) and chemicals. This

system works together to protect you from foreign

invaders (bacteria, viruses, parasites, and fungi) that

cause infection, illness, and disease.

The immune system is made of up a complex collection

of cells and organs. They all work together to protect

you from germs and help you get better when you’re

sick. The main parts of the immune system are white blood cells, lymph nodes, spleen,

tonsils and adenoids, thymus, bone marrow, skin, mucous membranes and other first-line

defenses, and stomach and bowel.

SKIN

Skin is the first line of defense in preventing and destroying germs before they

enter your body. Skin produces oils and secretes other protective immune system cells.

Langerhans cells (LCs) reside in the epidermis as a dense network of immune system

sentinels and members of the dendritic cell or macrophage family. These cells determine

the appropriate adaptive immune response (inflammation or tolerance) by interpreting the

29
 microenvironmental context in which

they encounter foreign substances.

Langerhans cells are uniquely

specialized at “sensing” the environment,

extending dendritic processes through

intercellular tight junctions to sample the

outermost layers of the skin (stratum

corneum). Langerhans cells detect invading pathogens and display molecules from the

pathogens, called antigens, on their surface. The Langerhans cells then travel to the

lymph nodes and alert the immune system to trigger the immune response because a

pathogen is in the body. Lymph nodes are small organs located throughout the body

connected by vessels that form a network called the lymphatic system. The lymph nodes

are stations in the body for immune cells that help fight against infections.

30
8. PATHOPHYSIOLOGY A. Book-based

31
B. Patient – Based

32
B. Planning

Nursing Care Plan no. 1

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Hyperthermia Within 30 Independent: After 45 mins
" Ang init init ng related to the mins to 1 1. Promote a 1. To promote clear of rendering
pakiramdam ko process of hour of well- flow of air in the appropriate
tapos giniginaw dengue virus rendering ventilated client’s area. nursing
ako" as verbalized infection appropriate area to One way of interventions
by the patient nursing client. promoting heat client’s
SCIENTIFIC interventions loss. temperature
Objective: RATIONALE client’s 2. Provide 2. TSB helps in was
• The skin is Fever, also temperature tepid lowering the decreased
warm to known as will decrease sponge bath body from 38.2°c to
touch hyperthermia or from 38.2c to and temperature and within normal
• Chills are pyrexia, is a the normal do not use alcohol. alcohol cools the range of 36.9c
noted medical range skin too rapidly,
• Pale looking condition when causing Goal met
• Irritable there is an shivering.
• Muscle uncontrolled rise Shivering
Weakness in the body increases
temperature, metabolic rate
Vital Signs are as measured as and body
follows: above 37.5 temperature.
• BP= 100/70 degrees Celsius. 3. These decrease
mmHg It results form 3. Remove warmth and
• PR= 87bpm the failure of the excess increase
• RR= 21bpm body’s clothing and evaporative
• Temp= 38.2 thermoregulatory covers. cooling.
• 02saturation center, the
100% hypothalamus to 4. Additional fluids
33
control the body 4. Encourage help prevent
temperature client to elevated
between the increase temperature
normal range of fluid associated with
36 to 37.5 intakes. dehydration.
degrees Celsius. 5. Reduce
5. Maintain metabolic
bed rest. demands/oxygen
consumption and
allowing client to
relax and have
adequate rest.
6. To know the
effectiveness of
6. Recheck nursing
vital signs. interventions
done and to
know the
progress of
client’s condition.

7. These drugs
inhibit the
Dependent: prostaglandin
7. Administer that serve as
antipyretic mediators of
medication pain and fever.
such as
Paracetamol
500 mg
tablet every
4 hours.

34
 Nursing Care Plan no. 2

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Deficient fluid Short-term Independent Short-term goal

volume goal: Interventions: met:
“Ilang araw na related to loss
po akong of fluids as After 1 hour of 1. Closely 1. Serve as the After 1 hour of
nagsusuka”, as evidenced by rendering monitor and baseline to rendering
verbalized by vomiting, poor nursing record monitor the nursing
the patient. skin turgor intervention, patient’s input balance of intervention,
and dry skin the patient will and output. fluid in the the patient
as well as maintain good body. maintained
Objective: mucous skin turgor good skin
-Dry skin and membrane. and no dry 2. Monitor 2. To facilitate turgor and no
mucous skin and patient’s skin the dry skin as well
membranes mucous turgor and identification as mucous
-Poor skin turgor membrane. signs of dry of the membrane.
mucous dehydration.
Long-term membrane. Long-term goal
Vital signs goal: met:
taken: After 8 hours 3. Weigh the 3. To assess
BP- 100/70 of rendering patient daily or for possible After 8 hours of
mmHg nursing as indicated. fluid volume rendering
T-36.5 C intervention imbalance. nursing
RR- 21 bpm the patient will 4. Provide 4. To restore intervention the
PR- 87 bpm be able to adequate fluid loss in patient was
O2 Sat.- 98% understand hydration order to able to
the risk for according to maintain the understand the
fluid volume the needs of body to risk for fluid
deficit and its the body function well volume deficit
dangers and and to and its dangers
the prevent and the
35
interventions dehydration. interventions to
to prevent it. 5. Provide clear 5. To reduce prevent it.
liquids in small risk of
amounts when gastric
oral intake is irritation and
resumed, and vomiting to
progress diet minimize
as tolerated. fluid loss.
6. Emphasize
importance of 6. To prevent
oral hygiene to peeling and
the patient as to prmote
well as to the interest in
relatives drinking.
present.

7. Educate the 7. Patient

patient needs to
including understand
relatives about the value of
the drinking
interventions extra fluid
on how to during bouts
prevent or of vomiting,
minimize fever, and
future episode other
of dehydration. conditions
causing fluid
deficits to
prevent
dehydration.
8. Educate 8. To involve
patient about the patient to
36
 possible cause take part in
and effect of his or her
fluid losses or plan of care.
decreased
fluid intake.

Dependent
Interventions:

1. Administer IV 1. To increase
Fluids, as the amount
ordered. of body fluid
to replace
fluid and
electrolytes
loss.
2. Administer 2. To reduce
Antiemetics, vomiting.
as ordered.

Collaborative
interventions: To proper
management of the
1. Refer to patient’s condition.
physician if
associated
complications
occur.

37
 Nursing Care Plan No. 3

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: Acute Pain Within 3 hours Assess the Pain After 3 hours of
“Masakit ang pag Related to of nursing client’s description associated with nursing
ihi ko” As Inflammation intervention the of pain, such as UTI is described intervention the
verbalized by the and infection of patient’s pain quality, nature, as burning on patient’s pain will
patient the urinary tract will report and severity of urination, flank be Relieved and
as evidence by satisfactory pain. pain, lower Controlled.
OBJECTIVE: burning pain control. abdominal or
Urination. supra pubic
⚫ Facial Grimace pain.
⚫ Restlessness
Assess for signs Common
VS AS FOLLOWS: and symptoms of signs and
BP: 100/70 urinary tract symptoms of
PR: 87 infection. UTI include
RR: 21 dysuria (painful,
Temp: 36.5 burning
Weight: 60 kg sensation, or
O2 Sat.: 98% difficult
urination),
urinary
frequency &
urgency, and
nocturia.

Assess for risk history of

factors for UTI. sexually
transmitted
infections,
catheter use,
38
 and previous
surgeries of the
genitourinary
tract are at risk
of developing
UTI.

Monitor Maintain
laboratory and baseline data
diagnostic studies,
as indicated

Apply a heating The

pad to the supra application of
pubic area or heat to the
lower back. perineum help
relieve pain and
spasm.

Encourage the Increasing

patient to fluid intake to 2
increased oral fluid to 3 liters per
intake unless day helps
contraindicated. facilitate urine
production,
dilutes urine,
. reduces
irritation of the
inflamed
bladder,
promotes renal
blood flow, and
flushes bacteria
39
 from the urinary
tract.

40
C. Implementation

1. Drugs

Name of Route of Mechanis Indication/Purp Contraindicati Adverse Nursing

drugs administrati m of ose ons effects responsibilities
(generic and on, dosage action prior to, during,
brand name and and after
with frequency of administration
classification) administrati
on
Generic 500mg PO q The central Purpose: caloric an allergic Prior:
name: 4 hrs analgesic Paracetamol is a malnutrition reaction ✓ Check any
Paracetamol (maximum of effect of commonly used liver failure that can medication
4 doses /day) paracetam medicine that occurs result in a order to
Brand name: ol is can help treat suddenly. rash and ensure it is
Dymadon, mediated pain and lower a problems with swelling complete.
Panadol by the fever (fever). It's the liver shock Flushing, The drug
activation commonly used is a condition in low blood name,
Drug of to treat mild to which the body pressure, dosage,
classification: descendin moderate pain, is unable to and a frequency,
Analgesic and g such as maintain rapid and route of
Anti pyretic serotonergi headaches, adequate blood heartbeat administratio
drugs c toothaches, or flow. can occur n should all
pathways. sprains, as well when be included
There is as fevers caused paracetam in the order.
some by illnesses like ol is Check with
disagreem colds and flu. administer the
ent about ed in the practitioner if
its primary hospital any of the
mode of into a vein elements are
action, in your missing.
which arm
41
could be ✓ Examine the
inhibition of patient's
prostaglan medical
din (PG) history for
synthesis any allergies
or an active or
metabolite contraindicati
influencing ons to the
cannabinoi medication
d prescribed. If
receptors. there is an
Paracetam allergy or
ol appears contraindicati
to work by on to the
inhibiting medication,
chemical do not
messenger administer it
s in the and notify the
brain that practitioner.
alert us to
pain. During:
Paracetam ✓ Acetaminoph
ol also en should be
reduces infused
fever by intravenously
affecting over a 15-
chemical minute
messenger period.
s in the
brain's After:
temperatur ✓ Assess the
e- effectiveness
regulating of
42
area. acetaminoph
en on a
regular basis
by assessing
pain levels
and fever
reduction.

43
Name of Route of Mechani Indication/Purp Contraindications Adverse Nursing
drugs administrati sm of ose effects responsibiliti
(generic and on, dosage action es prior to,
brand name and during, and
with frequency after
classification) of administratio
administrati n
on
Generic 400mg once Cefixime, Indication: Cefixime is not Rash, Prior:
name: a day/ q like all Cefixime treats recommended for itching, ✓ If the
Cefixime 200mg q 12 beta- bacterial patients who are hoarsene expected
hrs lactam infections such allergic to ss, response
Brand name: antibiotic as bronchitis cephalosporins or difficulty is not
Suprax s, binds (infection of the cephamycin. breathing seen,
to airway tubes Cefixime has been , difficulty culture the
Drug specific leading to the linked to swallowin infection
classification: penicillin- lungs), anaphylactic/anaphyl g, or any and
Cephalosporin binding gonorrhea (a actoid reactions swelling arrange
s, 3rd proteins sexually (including shock and of your for
generation (PBPs) transmitted death). Cefixime hands, sensitivity
found disease), and should be used with face, or tests
inside the infections of the caution in patients mouth before and
bacterial ears, throat, who are allergic to while during
cell wall, tonsils, and penicillin. using this therapy.
inhibiting urinary tract. medicatio ✓ If a
the third Cefixime n. hypersens
and final belongs to a itive
stage of class of reaction
bacterial antibiotics occurs,
cell wall known as discontinu
synthesis cephalosporins. e use.
44
.
During:
Purpose: ✓ This
Cefixime is medicatio
used to treat n is only
bacterial for this
infections infection
throughout the and
body. It belongs should not
to the be used to
cephalosporin treat other
antibiotics class problems.
of medications. ✓ Do not
It works by crush the
either killing or tablets;
preventing the instead,
growth of swallow
bacteria. This them
medication, whole.
however, will Take the
not treat colds, medicatio
flu, or other n with
virus infections. food.
✓ Take full
course of
therapy
even if
you are
feeling
better.

After:
45
 ✓ Monitor
signs of
allergic
reactions
and
anaphylaxi
s,
including
pulmonary
symptoms
(tightness
in the
throat and
chest,
wheezing,
cough
dyspnea)
or skin
reactions
(rash,
pruritus,
urticaria).
Notify
physician
or nursing
staff
immediate
ly if these
reactions
occur.
✓ Avoid
alcohol
while
46
 taking
this
medica
tion
and for
three
days
afterwa
rd
becaus
e
severe
reactio
ns are
commo
n.

47
Name of Route of Mechanism Indication/Purpo Contraindicatio Adverse Nursing
drugs administratio of action se ns effects responsibiliti
(generic and n, dosage es prior to,
brand name and during, and
with frequency of after
classificatio administratio administratio
n) n n
Generic 8000 mg, Ascorbic acid Vitamin C diarrhea. Monitor for
name: thrice a day serves as a Indication: supplementation nausea. signs and
Ascorbic acid with food and cofactor, Vitamin C is used is not symptoms of
+ zinc 50 mg of zinc enzyme to prevent and recommended if heartbur acute
complement, treat scurvy. you have n. hemolytic
q bed time
Brand co-substrate, Scurvy appears thalassemia, fatigue. anemia
name: and powerful one to three G6PD flushing. (Yellowish
Dayzinc antioxidant in months after deficiency, sickle skin, eyes,
a variety of beginning a cell disease, or headach and mouth
reactions and vitamin C- hemochromatosi e. (jaundice)
Drug metabolic deficient diet. s. Avoid taking difficulty Dark-colored
classificatio processes. It Lethargy, fatigue, supplements falling urine.
n: also helps to malaise, right before or asleep or Fever.
Organic keep vitamin emotional lability, after angioplasty. staying ) Sickle cell
compound E and folic arthralgias, Diabetic patients asleep. crisis (pain
acid stable weight loss, should exercise gas. anywhere in
and improves anorexia, and caution when your body and
iron diarrhea are all taking vitamin C nausea, in more than
absorption. possible supplements vomiting, one place)
symptoms. because it raises diarrhea,
Zinc has the blood sugar metallic
ability to treat Zinc is commonly levels. taste,
both acute used to treat zinc kidney
and chronic deficiency, There are no and
48
diarrhea by diarrhea, and known stomach
inhibiting Wilson disease. contraindications damage
three of the Zinc is also used . Zinc
four major to treat acne, accumulation
intracellular diabetes, may occur in
pathways of anorexia, burns, cases of renal
intestinal ion and a variety of failure.
secretion, other ailments. Overdosing on
including Some scientific zinc can result in
cyclic evidence backs toxicity.
adenosine up its use for Excessive zinc
monophospha some of these consumption
te (cAMP), conditions. (100 mg to 300
calcium, and mg per day) can
nitric oxide. Purpose: be toxic
It acts as an
antioxidant,
protecting your
cells from free
radicals, which
can cause heart
disease, cancer,
and other
diseases.It is
required by the
body to aid in
wound healing, to
improve iron
absorption from
plant foods, and
to support the
immune system.

49
Zinc is a trace
mineral, which
means that the
body only
requires trace
amounts, but it is
required for
nearly 100
enzymes to carry
out vital chemical
reactions. It plays
an important role
in the formation of
DNA, cell growth,
protein synthesis,
the healing of
damaged tissue,
and the
maintenance of a
healthy immune
system. Zinc, a
nutrient found
throughout your
body, aids in the
function of your
immune system
and metabolism.

50
2. Medical Management

Medical Date Performed General Indication/Purpose Client’s Response

Management Description to treatment
Dextrose 5% in September 23, 2022 Useful for daily It is a sterile, There were no
Lactated Ringer’s maintenance of body nonpyrogenic verbalized patient’s
Solution (D5LRS) fluids and nutrition, solution for fluid and response during her
and for rehydration. electrolyte admission.
replenishment and
caloric supply in a
single dose container
for intravenous
administration.

3. Surgical Management

Name of Date Brief Indication/ Client’s Nursing

procedure performed description purposes response to responsibilities,
operation prior
to, during, and
actual
surgical
procedure
(actual)
N/A

51
4. Diet
TYPE OF DIET Date Indication/s
Increase intake foods Eating an iron-rich diet
rich inIRON can increase your body's
production of RBCs.
Without a sufficient
amount of iron, your
body can't produce
enough hemoglobin, a
substance in red blood
cells that makes it
possible to carry oxygen
to the body's tissues. If
you do not have enough
oxygen in your body, it
will cause you to
become tired and groggy
Increase fluid intake • Increase fluid intake
(stay hydrated) during the 24 hours
was statistically
associated with
decreased risk for
hospitalization of
dengue fever patients.
• It is very important
to not let your body
get dehydrated.
52
Nursing Responsibility
-Explain to the patient the
facts about increased
intake of iron rich foods.
-Instruct the patient to eat
foods such as fruits and
vegetables, whole grains,
beans, peas, nuts, tofu,
and seeds
-Encourage client to have
diet rich in vitamin C to
enhance absorption of iron
in iron-rich foods.
-Educate patient and
caregivers about IDA by
explaining importance of
diagnostic procedures and
iron supplementation.
-Educate the patient that
she should consume more
plain water and refrain
eating spicy foods.
-Provide extra fluid with
meals, including juice,
soup, ice cream and
sherbet, gelatin, water on
trays.
 -Emphasize the relevance
of maintaining proper
nutrition and hydration.

5. Activity/Exercises
TYPE OF GENERAL INDICATION/
EXERCISE DESCRIPTION PURPOSE
Walking It is walking with -In this recovery phase it is
determination, moving necessary to include
forward with purpose and exercise in your daily
control as if you had regime which could include
someplace to go. Improves walking or lightweight
strength and efficiency. exercise or also free hand
Walking is an aerobic exercises. Start with
activity that helps condition walking at a slow pace, the
your heart. slower you start the better it
goes for the body.

-During this disease, the

bodies hemoglobin goes
down because of which the
body would frequently get
tired or breathless but
nothing to worry it is just a
part of recovery, in this
situation all you need to
give your body is
rest or breather.

53
6. Nursing management
SOAPIE CHARTING NO. 1
Patient Name: Patient
Case: T/C Dengue fever & Urinary tract infection
Date: 09/24/22 1500H

S " Ang init init ng pakiramdam ko tapos giniginaw ako" as verbalized by the patient.

O • The skin is warm to touch

• Chills are noted
• Pale looking
• Irritable
• Muscle Weakness

Vital Signs are as follows:

• BP= 160/80 mmHg
• PR= 80bpm
• RR= 16bpm
• Temp= 38.2
• 02saturation at 100%
A Hyperthermia related to the process of dengue virus infection

P Within 1 hour of rendering appropriate nursing interventions client’s temperature will

decrease from 38.2 to the normal range
I • Promoted a well-ventilated area to the client
• Provided Tepid Sponge bath with consent
• Instruct the client to removed excess clothing and covers
• Encouraged the client to increased fluid intake
• Maintain bed rest
• Administered antipyretic medication Paracetamol 500mg tablet every 4 hour
• Recheck vital sign
E After 1 hour of rendering appropriate nursing intervention client’s temperature was
decreased from 38.2 to within normal range

54
 SOAPIE CHARTING NO. 2
Name of the Patient: AC
Name of the Nurse: Ma. Cristina Tacliad
Shift: 8:00 am – 5:30 pm
Room No: 018
Date and Time: September 24, 2022 (8:00 am)
“Ilang araw na po akong nagsusuka”, as verbalized by the patient.
S
• Dry skin and mucous membranes
O • Poor skin turgor
Deficient fluid volume related to loss of fluids as evidenced by vomiting, poor
A skin turgor and dry skin as well as mucous membrane.

P After 1 hour of rendering nursing intervention, the patient will maintain good
skin turgor and no dry skin and mucous membrane.

1. Closely monitored and recorded patient’s input and output.

2. Monitored patient’s skin turgor and signs of dry mucous membrane.
I 3. Weighted the patient.
4. Provided adequate hydration according to the needs of the patient’s
body.
5. Provided clear liquids in small amounts and progressed diet as
tolerated.
6. Emphasized importance of oral hygiene to the patient as well as to the
relatives present.
7. Educated the patient including relatives about the interventions on how
to prevent or minimize future episode of dehydration.
8. Educated patient about possible cause and effect of fluid losses or
decreased fluid intake.
9. Administered IV Fluids, as ordered.
10. Administered-NC Antiemetics, as ordered.

• After 1 hour of rendering nursing intervention, the patient maintained

E good skin turgor and no dry skin as well as mucous membrane.
• For continuous monitoring

55
 MA. CRISTINA G. TACLIAD, SN

SOAPIE CHARTING NO. 3

Patient Name: Patient AC

Case: T/C Dengue fever & Urinary tract infection
Date: 09/24/22 1pm

Date/Time Details
9/24/2022
“Hindi na masakit kapag umiihi ako”
S
⚫ Facial Grimace
⚫ Restlessness

VS AS FOLLOWS:
BP: 100/70
O PR: 87
RR: 21
Temp: 36.5
Weight: 60 kg
O2 Sat.: 98%

Acute Pain Related to Inflammation and infection of

A
the urinary tract.
Within 3 hours of nursing intervention the patient’s
P
pain will report satisfactory pain control.
⚫ Assess the client’s description of pain, such as
quality, nature, and severity of pain.
⚫ Assess for signs and symptoms of urinary tract
infection.
⚫ Assess for risk factors for UTI.
⚫ Monitor laboratory and diagnostic studies, as
I
indicated
⚫ Apply a heating pad to the supra pubic area or
lower back.
⚫ Encourage the patient to increased oral fluid
intake unless contraindicated.

After 3 hours of nursing intervention the patient’s pain

E
will be Relieved and Controlled.

56
D. Evaluation

Discharge Planning

One of the important duty of a nurse to ensure continuity of health and quality care as the patient

leaves the hospital premises by teaching the patient and her significant others about her condition,

medications, on how to prevent acquiring such condition again, self-care strategies and

importance of follow-up care and check- ups.

• General Condition upon discharge

• Methods of Approach

Medicine

• Advice the relatives to continue the prescribed home medications to ensure optimum

recovery.

Exercise

• Advice the patient to do walking or jogging for her exercise.

Treatment

• Instruct patient or parents to increase fluid intake.

• Instruct patient or parents to have complete bed rest.

Health Education

• Advise the parents to use insect repellants.

• Also use insecticides in the house once in a month.

• Provide a clean environment.

• Do not stock water without cover to avoid mosquito breeding.

• Maintain good hygiene by taking a daily bath.

Outpatient Department (Check-up)

57
 • Instruct patient to continue follow-up check up to the doctor.

Diet

• Eat healthy foods such as fruits, vegetables, and meat.

• Drink a lot of water at least 8-10 glasses of water a day.

Spirituality

• Advise patient to maintain good and safe environment.

III. Conclusion

Dengue is a mosquito-borne disease cause by any one of four closely related dengue

viruses (DENV -1, -2, -3 and -4). Infection with one serotype of DENV provides immunity to that

serotype for life but provides no long-term immunity to other serotypes. Thus, a person can be

infected as many as four times once with each serotype.

The aim of this study is to improve the student nurse’s knowledge and abilities in regards to

dengue fever cases, particularly in children between the ages of 5 and 10 who are known to be

susceptible to the illness. By including the patient interview, 13 areas of Assessment, laboratory

data analysis, and the creation of an acceptable nursing diagnosis related to the difficulties

associated with dengue fever, it will aid the student nurse. The WHO advises implementing self-

strategies to avoid or prevent development of such condition due to high rates of unacceptable

mortality rates of dengue fever cases. As a result, it’s crucial to have in-depth knowledge, abilities,

and understanding of dengue fever through gathering patient assessment data in order to make the

right diagnoses and develop nursing care plans that result in proper nursing process management.

By setting priorities, creating short- and long-term goals, and implementing the appropriate nursing

interventions on the patient to achieve the desired outcome for the evaluation of the nursing

interventions, it also helped the student nurse develop the ability to formulate appropriate and

accurate nursing care plans. We implemented the planned nursing interventions for the identified

health problems to be able to improve the patient’s health.

58
 Through assessment to patient by checking her vital signs and it came out normal. The

medication continued after discharge. Follow up-care was advised at least annually or as needed

especially if symptoms come back. Proper diet and exercise were properly addressed to the patient

especially her medication.

IV. Recommendation

In view of the following conclusions determined from the study, the following

recommendations should be undertaken:

For Student Nurses

The researchers advised our fellow students to read and explore this case study, as it will

provide necessary and useful information regarding Dengue with Urinary Tract Infection, which will

be useful for future reference. This case will be worth for knowledge exertion as it will improve and

develop clinical skills for this kind of diseases and others that relates to it, in which will help in

delivering care not only with our clients but also in collaboration with other primary healthcare

professionals and colleagues.

For Patients and Significant Other

This study proved the importance of strict compliance with the treatment regimen, the

information that will be gathered in this study will be useful in discovering benefits of following

necessary management and consequences resulted from arise risk factors. The importance of

healthy lifestyle must be properly practiced, to prevent complications. Thus, recommendations

regarding the essential management should be followed, and the involvement of patient’s initiative

and significant other’s contribution in caring with the patient will be highly encouraged.

For Health Care Providers

Infection control procedures and exploration of more independent and collaborative

intervention for this kind of disease is recommended, as this type of condition arises from

59
complications of underlying diseases. Furthermore, due to the patient's current state, meticulous

care and observation should be used to prevent further complications.

V. REVIEW OF RELATED LITERATURE AND STUDIES

The dengue viruses are positive stranded RNA viruses in the genus Flavivirus, family

Flaviviridae. DENV-1, DENV-2, DENV-3, and DENV-4 are the four distinct virus serotypes that

shares antigenic relationship. If an individual was infected with one of this serotype, it convenes to

a lifelong protection against that certain serotype. (Maxwell, 2019)

In most cases asymptomatic or relatively mild disease follows infection with dengue virus. Taking

into account the continuous increase in number of clinical dengue cases, World Health Organization

(WHO) produced guidelines in which they identified the clinical pictures resulting from infection with

dengue virus. The first one is known as dengue fever (DF) which is characterized by the rapid onset

of fever, convoyed headache and retroorbtal pain, followed by various possible signs and symptoms

such weakness, vomiting, arthralgia, and myalgia. (WHO, 2020)

The second clinical picture they presented was dengue hemorrhagic fever (DHF), which is

a more severe form of the disease compared to dengue fever (DF). There's an occurrence of

hemorrhagic manifestations in early 24 hrs and the crucial period in DHF starts at the defervescence

stage. Unlike with DF, DHF is manifested by high fever, thrombocytopenia, hemoconcentration,

hemorrhagic manifestations, petechiaie, gum bleeding, haematemesis and epistaxis. However,

during the critical period, it is necessary to look and observe for any warning signs of worse cases

such as hypotension, persistent vomiting, weak pulse, and tenderness. (Centers for Disease Control

and Prevention, 2021)

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