80464738 dengue fever case study

8/13/2019 80464738 Dengue Fever Case Study

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Acknowledgement

We sincerely express our gratitude to the people behind the completion of this

presentation.

We would like to express our heartfelt gratitude to the friends and classmates for the

support and encouragements you have given us. To our clinical instructors who supervised us

during our clinical exposures at Caraga Regional Hospital and Surigao edical Center and for

the guidance and encouragement throughout this case presentation! to ma"am #ecel $upe%a for

approving our chosen case! to our ever supportive parents and family for their moral and

financial support and motivation. &nd for the most of all to our &lmighty 'od from whom all the

graces flow for the needed guidance and wisdom.

Introduction

(ur patient r. C# is a ) years old preschooler in Cuyago #abonga! &gusan del *orte. He

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was admitted at Caraga Regional Hospital last arch +! +,-,! related to engue /ever with

some H*! acute gastritis.

This prompts the group of choose this case study for us to fully understand the nature of

the said disease and the risk involve it0 hoping that we can contribute something to lessen its

occurrence through educating the community people about its etiology! treatment and

preventions.

This case is both beneficial to the nursing students as the care providers and to the

community people as recipients of care. 1n one way or another both parties involved in the said

case so that both of them need to work hand in hand for its eradication. 1t is indispensible for our

local health care delivery system to continue disseminating information in our community and its

neighboring places for the disease prevention. &s they always say 2an ounce of prevention is

better than a pound of cure3.

Review of RelatedLiterature

Dengue Fever

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engue fever is an infectious disease carried by mos4uitoes and caused by any of

four related dengue viruses. This disease used to be called break5bone fever because it

sometimes causes severe 6oint and muscle pain.engue /ever is a flu5like illness spread

by the bite of an infected mos4uito and an acute febrile viral disease characteri7ed by

sudden onset! fever of 859 days! intense headache! myalgia! anthralgic retro5orbital pain!

anorexia! '1 disturbances and rash.The viruses are transmitted to man by the bite ofinfective mos4uitoes! mainlyAedes aegypti. The incubation period is :5; days ain upon moving the eyes ?ow backache

>ainful aching in the legs and 6oints /ever


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serotype of $*. The virus has a genome of about --,,, bases that codes for three structural

proteins! C! pr! $0 seven nonstructural proteins! *S-! *S+a! *S+b! *S8! *S:a! *S:b! *S90

and short non5coding regions on both the 9" and 8" ends.

"reatment of Dengue FeverThere is no specific treatment for dengue fever! because dengue is caused by a

virusand most people recover completely within + weeks. To help with recovery! healthcare experts recommend.

'etting plenty of bed rest. rinking lots of fluids to prevent dehydration. Taking medicine to reduce fever. >latelet transfusions if the platelet level drops significantly


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ost people who develop dengue fever recover completely within two weeks. Some!

however! may go through several weeks of feeling tired andBor depressed.

!co$epidemiological analysis of dengue infection

during an out%reak of dengue fever& India'ackground

engue infection


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states. elhi experienced an outbreak of / this year! after ) years of silence. Studies conductedin the countries like Ara7il! 1ndonesia and ene7uela! where 1 is present either in epidemic orendemic form have suggested a correlation between weather and pattern of 1. Rain! temperatureand relative humidity are suggested as important factors attributing towards the growth anddispersion of this vector and potential of dengue outbreaks .Since limited data is available on theassociation of climatic conditions and the pattern of 1 from this geographical region! this studywas conducted to find out the relationship of dengue infection with climatic factors such as therainfall! temperature and relative humidity during the dengue outbreak in the year +,,8.

Distri%ution %y age

(ut of G8 serologically positive cases! ); cases belonged to the adultIs age group


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remained almost constant during the months of #uly and &ugust rimary breeding foci served as mother foci during the premonsoon period.A. aegypti larvae spread to secondary foci like discarded tyres! desert coolersetc.! which collect fresh water during the monsoon period .This study supported the proposal thatall the three climatic factors studied could be playing an important role in creating the conducivecondition re4uired for breeding and propagation of this vector! the basal level of which is presentall round the year. This prospective study therefore highlighted the ma6or important factors!which could alone or collectively be responsible for an outbreak.

1n our study! the largest proportion of serologically positive cases was recorded in the postmonsoon period! which is in agreement with our previous study .(ur findings were incoordination with study by other groups from this geographical .The seasonal occurrence ofpositive cases has shown that post monsoon period is the most affected period in Aangladesh aswell .However! a retrospective study from yanmar during -GG)D+,,- reported the maximumcases of dengue during the monsoon period M.Study by group of Rebelo from Ara7il has alsoemphasi7ed the importance of season. They have observed that dengue cases were higher duringrainy season showing the importance of rain in forming prime breeding sites for A. aegypti thusspread of 1 .Study of eco5epidemiological factors by Aarrera et al .showed that / has apositive correlation with the relative humidity and negative relation with evaporation rate. >eaksof dengue cases were observed to be near concurrent with rain peaks in this study fromene7uela showing a significant correlation of intensity of 1 with the amount of rain .1n this

study we have observed that temperature tends to decrease towards the end of monsoon period!specially remains moreover constant during the later months of rainy season. 1ndia andAangladesh fall in the deciduous! dry and wet climatic 7one. The temperature remains highduring the pre monsoon period. 1t is continuous rain pour for a couple of days that brings downthe temperature during the monsoon period! which may also be responsible for an increase in therelative humidity and decrease in the evaporation rate thus maintaining secondary reservoirscontaining rain water. ore studies are needed to establish the relationship between the climaticchanges and dengue outbreaks! which would help in formulating the strategies and plans toforecast any outbreak in future! well in advance.

ery little dengue is found in adults in Thailand! presumably because people ac4uire completeprotective immunity after multiple 1 as children !as 1 is highly endemic in Thailand .(n the

other hand! 1 especially H/ is an emerging disease in 1ndia0 probably this may be the reasonthat people of all the age are found to be sensitive to infection in our study. $ven though moreadults were reported of having anti dengue antibodies! the difference in the number of positivecases was not significant as compared to pediatric age group.The severity of this outbreak waslesser as compared to the H/ epidemic that occurred in year -GG) caused by the serotype en5+ .Serotype en5+ is reported to be the one mainly associated with H/! the more severe form of

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the disease .ore studies in this regard can further elucidate correlation of serotypes withseverity of disease from this geographical region.

(onclusion

This prospective study highlighted rain! temperature and relative humidity as the ma6or andimportant climatic factors! which could alone or collectively be responsible for an outbreak.ore studies in this regard could further reveal the correlation between the climatic changes anddengue outbreaks! which would help in making the strategies and plans to forecast any outbreakin future well in advance.

#atient Healt History

A) 'I*+RA#HI( DA"A,

*ameN r.C#

&geN ) years oldSexN ChildCivil StatusN ChildAirth ayN September ,+! +,,8Home &ddressN Cuyago! #abonga! &gusan del *orteReligion, Roman Catholic

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*ationalityN /ilipino(ccupationN Child

') AD-ISSI*. DA"A

HospitalN Caraga Regional HospitalWard serviceN >edia wardate admissionBtimeN arch 8! +,-,ode of &dmissionN wheelchairate of dischargeN arch G!+,-,

/ital signs upon admission,

WeightN - kgHeightN :",""

TemperatureN 8.9O C>ulse RateN bpmRespiratory RateN +9 cpmAlood pressureN --,B;, mmHg

Chief ComplainN 8 days fever >T& D onset of fever of on and off &ttending >hysicianN r. otor &dmitting >hysicianN ra. a. ?ourdes T. Cubillan&dmitting iagnosisN RBt engue fever with acute gastritis/inal diagnosisN engue fever

>rimary source of dataN >atientSecondary source of dataN S( and >atient"s chart

.0RSI.+ H!AL"H HIS"*R1

ate of &ssessmentN arch 8! +,-,5 arch 9! +,-,

Source of 1nformationN patient! S( and chart

() HIS"*R1 *F #R!S!." ILL.!SS

Aefore admission to the hospital the patient experience nausea and vomiting and fever. So!last arch 8! +,-, at -,N8, am! patient was rushed to the hospital due to on and off fever and

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sudden stomachache to seek medical assurance as verbali7ed by the grandmother. He was thenadmitted at Caraga Regional Hospital and referred to the physician.

D) #AS" H!AL"H HIS"*R1

r. C# experienced childhood illness such as mumps and measles but was not able recallthe exact date it occurred. He did not have any poliomyelitis and rubella as claimed by hisgrandmother. r. C# completed his immuni7ations in Health Center like AC'! >T! (>! HepaA and easles.

He also experienced cough and fever as verbali7ed by the S(.

Vaccine MinimumAge at 1st

Dose

Numberof

Doses

Minimum

Interval

Between Doses

Reason

BCG Birth oranytime

after birth

1 BCG given at earliest possibleage protects the possibility of Bmeningitis ! B infectio"s in#hich infants are prone$

%& 6 #ee's 3 4 #ee's (n early start #ith %& re)"cesthe chance of severe pert"ssis

*&+ 6 #ee's 3 4 #ee's he e,tent protection against

polio is increase) the earlier the*&+ is given

-eeps the &hilippine polio free

.ep B (t birth 3 6 #ee'sintervalfrom 1st

)ose to2n))ose/an) 0 8#ee's

intervalfrom 2n)

)ose to3r))ose$

(n early start of .ep B re)"cesthe chance of being infecte) an)becoming a carrier$

&revent liver cirrhosis an) livercancer$

(bo"t 9 )ie of compilationsof .B$

1 of ilipinos have chronic .Binfection$$

liminate .B before 212 $

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'randm

other/athe

r

>other'randfatherherSIBLI

NGS

easles 9 months (t least 85 of measles can beprevente) by imm"niation atthis age$

&revents )eaths 2 )ie/maln"trition/ pne"monia/

)iarrhea at least 2 get thesecompilations from measles etc$

liminate measles by 28$

History of Hospitali2ationN

*o past history of hospitali7ation.

Family ealt istory,

r. C# was the youngest among the three siblings. The patient"s mother was diagnoseddue to hypertension and his grandfather diagnosed due to diabtes.

+enogram

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#!RS*.AL A.D S*(IAL HIS"*R1

LIF!S"1L!,>ersonal habitsN The patient doesn"t smoke and drink alcoholic beverages. He likes playing withhis friend.

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DI!",

#re Hospitali2ation,

r. C#! His like to eat fruits and 6unk foods. >atient usually consumed one cuprice! two hotdogs or one egg and one glass of milk for his breakfast. uring lunch timeone cup of rice! fried chicken and two glasses of water. uring dinner time one cup ofrice! one to two slice of 2adobong baboy3 and two glasses of water will do. He canconsume five to six glasses of water a day.

0pon Hospitali2ation,

When patient was hospitali7ed! his physician ordered diet as tolerated with nocolored foods like chocolate! milo and chuckie.

SL!!# 3 R!S" #A""!R.

#re$ Hospitali2ation,

>atient usually sleeps at N,, pm and wake up ;N,, am. He also takesan afternoon nap after lunch for + hours with a total of -8 hours of sleep.

0pon 4 Hospitali2ation,

His sleeping pattern in the hospital is 4uite different to his usual routine of sleep.He has difficulty in sleeping since he is always disturbed by itching. *ow he u suallysleep at N,,pm! then he will be awaken by --N,,pm and goes back to sleep around-N,,am until 9N,,am. 1n the day time! he sleeps at GN,,am to --N,, am! +N,, pm to8N,,pm with a total number of ten hours of sleep.

!limination #attern,


The fre4uency of his urination was 9 times a day0 8 times in the morning and +times at night. He defecates every morning and has no difficulty in voiding anddefecating.

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0pon$ Hospitali2ation,

uring hospitali7ation the patient has bathroom privileges.

Activity of Daily Living,


The patient will go to the school and at the recess time the patient were eatingwith his friends and having playing after. &fter the class he goes home to watch television.

0pon$ Hospitali2ation,

>atient has always been on bed most of the time.

Recrea tion 5 Ho%%ies,

The patient is a preschooler in Cuyago! #abonga! &gusan el *orte. He wasspending his time in canteen and playing with his classmates.

S*(IAL DA"A,

Family Relationsip5 Friendsip

With regards to their family relationship! >atient has strong family ties and theirparents are very supportive with regards to their studies. He has many friends to play with.

!ducational Attainment 5 Socio$economic Data

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1n his education! the patient is still a preschooler at Cuyago! #abonga! &gusan del*orte.

Home and .eig%orood (onditions

>atient resides in Cuyago! #abonga! &gusan del *orte. He lives in a semi concretehouse with : bedrooms and a comfort room and has a backyard with plants. &t the neighborhoodhouse! lot of hanging clothes! some tire that have water in the inside and some cans that full ofwater. Their environment has lot of trees.

D!/!L*#-!."AL "AS6

+rowt and Development,

The school age! from ) to -+ years old! in the psychosocial development of $rik

$rikson"s the 1ndustry vs. 1nferiority. /rom age six years to puberty! children begin to develop asense of pride in their accomplishments. They initiate pro6ects! see them through to completion!and feel good about what they have achieved. uring this time! teachers play an increased role inthe child"s development. 1f children are encouraged and reinforced for their initiative! they beginto feel industrious and feel confident in their ability to achieve goals. 1f this initiative is notencouraged! if it is restricted by parents or teacher! then the child begins to feel inferior! doubtinghis own abilities and therefore may not reach his potential.

&ccording to /reud"s Stages of >sychosexual evelopment! age six to puberty is in

?atency stage. uring this stage that sexual urges remain repressed and children interact and

play mostly with same sex peers.

/ital Signs

arch 8! +,-,

;am58pm Shift 8pm5--pm Shift --pm5;am Shift

am -+ pm :pm pm -+am :am

Temp 8.9OC 8OC 8GOC 8;.-OC 8.9C 8;.+OC

>R bpm G bpm G, bpm G, bpm ; bpm G9 bpmRR +9 cpm +: cpm ++ cpm +: cpm +9 cpm +8 cpm

A> --,B;, mmHg -,,B;,mmHg

--,B),mmHg

--,B;,mmHg

G,B), -,,B),

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#H1SI(AL ASS!SS-!."

+!.!RAL S0R/!1,Received patient lying on bed with an 1/ ?*SS -?= attached at the right arm! awake

and conscious. >atient facial expression reflects tardiness! he appeared weak and fatigue. uringour assessment! he wears clean clothes.

S6I.,>ectichial rash noted

Warm to touch*o skin lesion*ormal skin turgor

Tourni4uet Test R bpm G+ bpm G9 bpm G bmp G) bpm G: bpm

RR +9 cpm ++ cpm +- cpm ++ cpm +8 cpm +8 cpm

A> --,B;, mmHg --,B),mmHg

-,,B),mmHg

--,B), -,,B),mmHg

--,B;,mmHg

arch 9! +,-,

;am58pm Shift 8pm5--pm Shift --pm5;am Shift

am -+ pm :pm pm -+am :am

Temp 8.9OC 8;.9OC 8OC 8.8OC 8.+OC 8.+OC

>R bpm G, bpm G bpm G+ bpm G9 bpm G9 bpmRR +9 cpm +9 cpm +8 cpm ++ cpm +: cpm +: cpm

A> --,B;, mmHg --,B),mmHg

-,,B;,mmHg

-,,B),mmHg

--,B;,mmHg

-,,B;,mmHg


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1nflate the blood pressure cuff on the upper arm to a point midway between the systolic

and diastolic pressure for minutes

Release cuff and make an imaginary +.9 cm. s4uare or - inch s4uare 6ust below the cuff!at the antecubital fossa.

Count the number of petechiae inside the box.(r a test is $RR?& observedSymmetric in shapeCoordinated eye notedBblink reflex intact

!ARS A.D H!ARI.+,*o discharge noted*o pain palpation&uricles same color as facial skin*o difficulty in hearing spoken words>inna recoils after it is foldedSymmetric in shape

.*S! A.D SI.0S!S,Colds noted*o pain upon palpationSymmetrical and straightEniform in color as facial skin

-*0"H& LI#S A.D "HR*A",

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Slightly >ink lips notedTongue in central positionTeeth is yellowish in color>ink gums


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/II) /acial5 patient can able to identify various test! and can open his eyes

spontaneously

/III) &uditoryN

a= estibular branch5 the patient is cooperative

b= Cochlear branch5 patient can hear clearly

I7)'lossopharyngeal5 patient has no problem on swallowing

7) agus5 patient has no problem in swallowing

7I)&ccessory5 patient has full range of motion and can turn head left and right side.

7II) Hypoglossal5 able to protrude his tongue and move it is side to sides.

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2

(ranial .erve Assessment

.erve .ame Function "est

I (lfactory Smell Have athlete smell a familiar odor

II (ptic isual &cuity

isual /ield

Have athlete identify fingers

Check peripheral vision

III (culomotor >upillary Reaction Shine ?ight in the eye

I/ Troculear $ye ovement /ollow finger without moving the head

/ Trigeminal /acial Sensation

otor /unction

Touch the face

Have athlete hold mouth open

/I &bducens otor /unction ?ateral $ye movements

/II /acial otor /unction

Sensory

Smile! wrinkle face! puff cheeks

Tastes

/III &coustic Hearing

Aalance

Snap fingers by the ear

RhombergIs Test

I7 'lossopharyngeal Swallowing andoice

Swallow and say &H

7 agus 'ag Reflex Ese tongue depressor

7I Spinal &ccessory *eck otion Shoulder shrugging

7II Hypoglossal Tongue ovementand Strength

Stick out tongue apply resistance with a tonguedepressor


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Anatomy and #ysiology

'lood

Humanblood smearNa Derythrocytes0 b D neutrophil0c Deosinophil0 d D lymphocyte.

'loodis a speciali7edbodily fluidthat delivers necessary substances to the bodyIs cellsDsuch as nutrients and oxygenD and transports wasteproducts away from those same cells.

Blood is comosed of!

Red cells orerytrocytes ?arge microscopic cells without nuclei. >roduced continuously in our bone marrow from stem cells at

a rate of about +58 million cells per second.

ake up :,59,F of the total blood volume. Transport oxygen from the lungs to all of the living tissues of

the body and carry away carbon dioxide. Have about +;,!,,,!,,, iron5rich hemoglobin molecules. Red color of blood is primarily due to oxygenated red cells.

"#ite cells or leu$oc%tes

,ist in variable n"mbers an) types b"t ma'e "pa very small part of bloo):s vol"me;;normallyonly abo"t 1$

They occur elsewhere in the body as well! most notably in thespleen! liver! and lymph glands.

ost are produced in our bone marrow from the same kind ofstem cells that produce red blood cells.

(thers are produced in the thymus gland! which is at the baseof the neck.

21
http://en.wikipedia.org/wiki/Blood_smearhttp://en.wikipedia.org/wiki/Blood_smearhttp://en.wikipedia.org/wiki/Erythrocyteshttp://en.wikipedia.org/wiki/Erythrocyteshttp://en.wikipedia.org/wiki/Neutrophilhttp://en.wikipedia.org/wiki/Eosinophilhttp://en.wikipedia.org/wiki/Eosinophilhttp://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/Body_fluidhttp://en.wikipedia.org/wiki/Body_fluidhttp://en.wikipedia.org/wiki/Cell_(biology)http://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Wastehttp://en.wikipedia.org/wiki/File:SEM_blood_cells.jpghttp://en.wikipedia.org/wiki/Blood_smearhttp://en.wikipedia.org/wiki/Erythrocyteshttp://en.wikipedia.org/wiki/Neutrophilhttp://en.wikipedia.org/wiki/Eosinophilhttp://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/Body_fluidhttp://en.wikipedia.org/wiki/Cell_(biology)http://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Waste


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(onstituent of Human 'lood

Structure Functions

23

8)

9)-aintains 'ody "emperature

:)

;)


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#lasma *ormal blood plasma is G,5G+ Fwater.This is the straw5coloured fluid inwhich the blood cells are suspended!and consists ofN

The medium in which the bloodcells are transported around thebody


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pigments bilinubin and bilviridin!and iron. These components arethen transported by the blood tothe liver where the iron is re5cycled for use by new

erythrocytes! and the bloodpigments form bile salts.


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Have many granules but nonucleus0

Have a longevity of approx. 95Gdays.

There are approx. -9,!,,, 5:,,!,,, platelets per micro5litre ofblood.

"e *=ygenation of 'lood

The oxygenation of blood is the function of the erythrocytes


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R!/I!W *F "H! S1S"!-

I."!+0-!."AR1 S1S" !-,

>atient has no history of skin disease*o skin allergies in foodsSkin is flush or pale pink rash all over the bodySkin is slightly hot to touch during the +ndassessment0

R!S#IRA"*R1 S1S"!-,>atient has no difficulties in breathing

*o history of tonsillitis and sore throat

(ARDI*/AS(0LAR S1S"!-,*o history of hypertension>ulse Rate is with in normal range

>atient has no history of heart problem

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+!.!"*0RI.AR1 S1S"!-,>atient urinates : times a day>atient has no history of renal disease

+AS"R*I."!S"I.AL S1S"!-,&bdominal pain

-0S(0L*S6!L!"AL S1S"!-,>atient appeared weak and fatigue*o history of any surgery

!.D*(RI.! S1S"!-,>atient has no history of thyroid problems

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.!0R*L*+I( S1S"!-,He is able to say what he feels and understandwhat his significant others say to him.*o history of paralysis

H!-A"*L*+I(,>atient"s blood types is 2(3 antigenHematocritN as of arch 8! +,-, is :-.;F0ach :! +,-, is 8; F! 8; F at )N,,pm! 8: F0arch 9 ! +,-, is 89F at -+ midnight.>lateletN as of arch 8! +,-, is 99 x-,GB?0arch :! +,-, is :; x-,GB?! 8G x-,GB? at)N,, pm! 98 x-,GB?! arch 9! +,-, at -+

midnight is 9; x-,G

B?.

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LA'*RA"*R1 R!S0L"S

H!-A"*L*+1

arch 8! +,-,

"!S" R!S0L" 0.I" R!F!R!.(!

Hematocrit :-.; F :,59+

>latelet count 99 x-,GB? -9,5:,,

arch :! +,-,

"!S" R!S0L" 0.I" R!F!R!.(!

Hematocrit 8; F :,59+

>latelet count :; x-,GB? -9,5:,,

arch :! +,-, D )N,,pm

"!S" R!S0L" 0.I" R!F!R!.(!

Hematocrit 8; F :,59+

>latelet count 8G x-,GB? -9,5:,,

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arch :! +,-,

"!S" R!S0L" 0.I" R!F!R!.(!

Hematocrit 8: F :,59+

>latelet count 98 x-,GB? -9,5:,,

arch 9! +,-,5 -+N,, midnight

"!S" R!S0L" 0.I" R!F!R!.(!Hematocrit 89 F :,59+

>latelet count 9; x-,GB? -9,5:,,

0rinalysis

Chemical reactionain scale of ) over -,

'uarded position noted

DIA+.*SIS, &cute pain related to abdominal irritation secondary to dengue fever.

#LA..I.+, Within : hours of rendering nursing intervention to our care patient Qsignificant others will be able toN

erbali7e relieve of pain from pain scale of )B-, t, :B-, /ollow prescribe pharmacological regiment Q non

pharmacological regiment emonstrate use of diversion activity relaxation scales such as

deep breathing exercise.

I-#L!-!."A"I*.S,

Independent Rationale

-. $stablish rapport To gain trust Q cooperation

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+. &ssess for pain scale To have a baseline data

8. >rovide comfort measure Q guideenvironment

To promote non5pharmacological painmanagement

:. $ncourage use of relaxation techni4ue such as deep breathing exercise

To destruct attention Q reduce tension

9. $ncourage verbali7ation of feeling To asses the intensity of painDependent nursing Intervention

'ive medication as prescribe by the attending physician! Ranitidine.

!/AL0A"I*.,'oal met after our nursing intervention! patient and significant others wasable toN

erbali7ed relieve of pain as evidence by pain scale of:B-,.

/ollow prescribed pharmacological regiment and non5pharmacological.

emonstrate use of diversional activities or relaxation scalesuch as deep breathing exercise

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.o) :Date, arch :! +,-,"ime, ;am58pm shift

ASS!SS-!.",

Su%@ective cues,2dili ako katuyog kay dukag ako lawas3 as verbali7ed by the client

*%@ect cues, Sunkin eyes noted

Restlessness noted 1rritability noted Aody weakness noted awning noted

DIA+.*SIS, Sleep retardation related to prolong discomfort rovide calm! 4uit environment Q managecontrollable sleep disrupting factors.

To assess client to establish optimal sleeppattern

:. $ncourage client to verbali7e feelingregarding discomfort.

To assess its intensity

9. $ncourage to increase (/1. To lessen or reduce coughing

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Dependent .ursing Intervention&dminister >( meds. &s prescribe by the attending physician.

!/AL0A"I*.,'oal partially met after the span of our care the patient and significantothers was be able toN

1dentify appropriate intervention to promote sleep. Report improvement in sleep pattern as evidence by patient

verbali7ation of 2ok naman akong katolog3

.o) ;Date, arch :! +,-,"ime, ;am58pm shift

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ASS!SS-!.",

Su%@ective cues,

2 Uasokahon ako kay lood man gud3 as verbali7ed by the patient.

*%@ective cues, 'agging noted omited 8x with a normal amount /re4uent swallowing noted Aody weakness noted Restlessness noted

DIA+.*SIS,*ausea related to pharmaceutical side effect secondary to dengue fever.

#LA..I.+, Within the span our care the patient Q significant others will be able to reduceN Reduce Q prevent the tendency to vomit Relieve Q prevent the feeling of nausea >rovide rest Q comfort.

I-#LI-!."A"I*.S,


-. $stablish rapport To gain trust and cooperation

+. &ssess for the tendency to vomit To be able to assess the fre4uency of nausea8. >rovide clean peaceful environment They maybe able to reduce the stimulation or

worsen nausea

:. >rovide fre4uent oral care To cleanse mouth Q minimi7e bad taste

9. $ncourage deep Q slow breathing To limit dwelling on unpleasant sensation

Dependent .ursing Intervention,&dministration of >( meds as attending physician order! ranitidine.

!/AL0A"I*.,'oal partially met after the span of our care patient Q significant otherswas able toN

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Reduce and prevent the engue to commit Relieve and prevent the feeling of nausea as evidence by

watcher verbali7ation 2ni arang arang na cya! dli parehaadtong kagainah.3

>rovide rest and comfort

.o) articipate prevention measures Q treatment program. erbali7e feelings Q ability to manage situation.

I-#LI-!."A"I*.S,



+. $ncourage to verbali7e skin discomfort To assess the intensity8. keep the area clean Q dry To assess bodies natural process of repair:. >rovide comfort measures To promote non5pharmacological managements9. 1nspect skin rashes To assess client with correcting or minimi7e the

condition

!/AL0A"I*.,'oal partially met after the span of our care the patient Q significantothers was able toN

>articipate in prevention measures Q treatment program. erbali7ed feelings Q ability to manage situation as

evidence by patient verbali7ation of 2 katol c6a pero dilinako kayoton kay bac masamad cya3.

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.o) Date, arch 9! +,-,"ime, ;am58pm shift

ASS!SS-!.",

*%@ective cues, With pale Q dry lips noted! restlessness noted. Aody reflex noted 1rritability noted Warm to touch BS monitoring

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DIA+.*SIS, Risk for deficient fluid volume related to excessive losses to normal routesecondary to dengue fever.

#LA..I.+, Within the span of our care the patient Q significant others will be able toN

1dentify risk factors appropriate intervention 1llustrate behavior or lifestyle changes to prevent development of fluid

deficit

I-#LI-!."A"I*.S,

Intervention Rationale


+. onitor 1 To have a baseline data8. $valuate nutritional status! noting currentintake Q problems

This can negatively effect fluid intake

:. onitor 1 Q ( balance To insure accurate picture of fluid status

9. Weight client Q compare To determine trends). $ncourage to increase (/1 To promote hydration process

;. Render health teaching regarding theimportance of hydration

/or the proper understanding of the treatmentor procedure treatment

!/AL0A"I*.,'oal met after the span of our care the patient Q significant others wasable toN

1dentify individual risk factors Q appropriate intervention. emonstrate behavior or lifestyle changes to prevent development of

fluid volume deficient as evidence by 2painomon na nako ug daghannga tubig3 as verbali7ed by the watcher.

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DIS(HAR+! #LA.

Epon the discharge from Caraga Regional Hospital! the patient as well as the significant

others will be given a written home care instruction which contains the ffN

I.DI(A"I*.S

!./IR*.-!."AL (*.(!R.S

&dvise patient and significant others to keep all hanging clothes and alwaysreplace the water in the vase. 1nstruct patient and S.( to wear pa6ama and sweat shirt and to put on mos4uito

net when sleeping or apply off lotion. Screen the door! windows! and spray insect repellant. $ncourage patient and S.( to clean their surrounding.

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"R!A"-!."

$ncourage patient and S.( to take medications and vitamins daily as prescribed. 1nstruct patient to eat

H!AL"H "!A(HI.+S

&dvice patient to have enough rest and sleep. 1nstruct patient and S.( to conserve energy by balancing activities with rest

periods. Teach S.( to take the medications on time as so to achieve the maximum

therapeutic effect of drugs. &dvise patient and S.( to have a healthy lifestyle. &dvise the significant others to assist patient in coping with his illness.

*0" #A"I!." >F*LL*W 0# (H!(6$ 0#

Remind the S( of the patient to have follow5up check5up on the date scheduledby his physician! one week following his discharge.

&dvise the patient and remind the S.( to take rest upon his discharge and long

exhausting travel going back to Cuyago! #abonga! &*.&dvised the S.( to seek medical help immediately the followingN

-. sudden blurring of vision+. sudden nausea and vomiting8. skin rashes:. dry lips

DI!"

Teach patient and S.( how to become wise consumer by means of examining

nutrition labels < like=. &dvise patient and remind S.( to eat on more nutritious foods like green leafy

vegetables! fruits! meat! and fish.

S#IRI"0AL

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$ncourage patient and S.( to put his trust and faith in 'od alone. Teach patient and S.( to count his blessings and thank 'od despite the

circumstances. &lways remember and pray to 'od! ask guidance and guardian to guide in daily

living.

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80464738 dengue fever case study

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