81923435 dengue-breakbone-fever-case-study
TRANSCRIPT
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Christ the King CollegeNursing Program
Gingoog City
“Dengue (break-bone fever)”
A Case Study on the Concept of Infectious Diseases:In partial fulfillment for the midterm requirement of NCM 107
(Related Learning Experience)
Submitted toMrs. Emily C. Albacete, RN
Clinical Instructor
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Submitted byLeilani Rodriguez-Ampo
Bachelor of Science in Nursing – IV
DateJanuary 27, 2012
Table of Content
I. Objectives &Introduction
II. Personal Information Data
III. Developmental Data
IV. Assessment
V. Anatomy and Physiology
VI. Pathophysiology
VII. Nursing Care Plans
VIII. Drug Analysis/Study
IX. Discharge Planning
X. Diet Analysis
XI. Prognosis
XII. Evaluation
XIII. Recommendation
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XIV. References
XV. Appendices
General Objective
This case presentation aims to identify and determine the general health
problems and needs of the patient with an admitting diagnosis ofSystemic Viral
Illness R/I Dengue Fever. This presentation also intends to help patient promote
health and medical understanding of such condition through the application of the
nursing skills.
Specific Objectives
To raise the level of awareness of patient on health problems that he may
encounter.
To facilitate patient in taking necessary actions, to solve and prevent the
identified problems on his own.
To help patient in motivating him to continue the health care provided by
the health workers.
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To render nursing care and information to patient through the application
of nursing skills.
Dengue fever is an infectious disease carried by mosquitoes and caused by any of four related dengue viruses. This disease used to be called “break-bone” fever because it sometimes causes severe joint and muscle pain that feels like bones are breaking, hence the name. Health experts have known about dengue fever for more than 200 years.
Introduction
This epidemic disease, which occurs in tropical areas, is caused by a virus
that is usually transmitted by a mosquito (aedesaegypti). It is rarely seen in the
United States. After an incubation period of five to seven days, symptoms appear
suddenly with high fever up to 106*F (41*C), flushed face, headache, painful
eyeballs, sorethroat, nervousness, disturbed sleep, and severe pain in the head,
back, and joints (hence the term breakbone). Prostration may be great.
About the third or fourth day the temperature usually drops to normal, only
to recur after about three days. The second wave of illness is usually less severe
and shorter in duration, and is accompanied with a rash on the hands and feet
that spreads to arms, legs, and body. The acute symptoms soon end. Usually the
disease is self-limited, but convalescence is slow.
There is no specific treatment, and deaths from the disease are almost
unknown. Good nursing is important. Bed rest and drinking an abundance of
water are essential. Cool enemas and tepid baths will lower the temperature
should it rise above 104*F (40*C). An ice bag to the head usually feels good.
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Personal Information Data
Name: Charlemagne B. Dime
Age: 14 years old
Sex: Male Child
Nationality: Filipino
Religion: Roman Catholic
Parents: Mr. and Mrs. Gregorio Dime
Address: Purok 3 North Poblacion, Medina, Misamis Oriental
Date admitted: January 01, 2012
Time admitted: 10:15 AM
Chief complaints: Fever x 2 Days
Admission Impressions: Systemic Viral Illness R/I Dengue Fever
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Attending Physician: Dr. Harold R.Cagang
Vital signs:
Temperature: 38.8 C
Heart Rate: 90bpm
Respiration Rate: 24cpm
Weight: 57 kgs.
Developmental Data
Freud’s Psychosexual Stage :Genital stage: Adolescent
develops sexual maturity and learns to establish satisfactory
relationships with the opposite sex.
Nursing Implications:The client said he is a typical teenager
who loves to explore opposite sex relationship, fond of going out after school and
have fun at the recreational areas with friends of the same age.
Erikson’s Developmental Task:Erikson believed the new
interpersonal dimension that emerges during adolescence is a
sense of identity versus role confusion.
Nursing Implication: According to the client he is well
provided with love and care by his parents. He is being
supported and praised for any decision making he does or any feelings he
discussed about events important to him which makes him sure of himself as a
person.
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Piaget’s Cognitive Development:Piaget saw adolescence
as the time when cognition achieves its final form, that of
formal operational thought.
Nursing Implication: The client expresses worry of his
illness because he is aware of the possibility of fatality with
this disease if left untreated and unattended.
Assessment
Family History:
Client was born second to the oldest among three siblings. The family has
no health problems, except the mother is currently being monitored with her
“Hypertension” which is induced due to her fourth pregnancy. However,
Charlemagne is the first in the family being brought to hospital for such illness.
Disease History:
One day prior to his admission, the client said he was gallivanting at the
neighbor’s place last December 31, 2011 (Saturday), and was caught by the rain.
When he reached home he was having chills and hyperthermia. His parents
decided to bring him to hospital since he was vomitus and having chills and
fever.
Physical Assessment Tool:
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Neurologic System
The patient was lethargic during admission as observed by NOD.
Digestive System
The abdomen was not distended, soft and there was no palpable mass
upon palpation. Hyperactive bowel sound heard upon auscultation. The patient
vomited once prior to admission.
Respiratory system
His respiratory pattern is not in regular range for his age as evidenced by
his respiratory rate of 25cpm. His breath is having tachypnea because it is faster
than 20 breaths per minute.
Cardiovascular system
His apical pulse is 90bpmand his radial pulse is 88 bpm. His heart sounds
are normal. There are no murmurs heard in the apical pulse upon inhalation and
exhalation.
Musculoskeletal System
The patient manifested good posture and moved voluntarily; he had
symmetrical musculature on both sides of the body. Weakness was noted and
client is complaining of muscle pains and joint pains.
Genito-Urinary System
Patient voided 60-250 cc per shift as monitored through I&O, and yellow in
color as verbalized by the client.
Integumentary System
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Thick and curly distributed hair was noted. His nails were convex shape,
smooth in texture, capillary refill of 2 seconds of an untrimmed finger nails with
sweaty palms. His skin was flushy red, warm to touch and fare complexion.
HEENT
The size of the head was in proportion with the body. The eyes were
symmetrical with ears; with painful red eyes (Conjunctival suffusion). When the
eyes were tested papillary reaction to light, the pupil constricted to 2mm. Ear had
no discharges noted. Patient’s throat was functioning well and in normal
condition.
Activity
The patient canmove his extremities but with joint pains and muscle pains.
Hecan move and walkwithout assistance and was given comfort room privileges.
He misses watching TV as his only means of recreation at home. He is bored in
the hospital confinement.
Sleep and rest
He usually sleeps at 8:00 pm and rise at 6:00 am. Sometimes his sleeping
pattern is only disturbed when he is not feeling well. The patient feels different
about himself since his hospitalization because of many restrictions imposed by
thehealth care team plus the uncomfortable condition of the IV fluids attached to
his arm and the muscle and jointpains that is disturbing his comfort to sleep.
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Values and Beliefs
The client’s family goes to Catholicchurch every Sunday and believes in
every celebration of Christmas Eve, New Year’s Day, Lenten season and Easter
Sunday.
Physical Examination
DATE
1-01-12
Vital sign
7-3 3-11 11-7
Temperature 38.8C 38.7C 38.2C
Pulse rate 90bpm 98bpm 100bpm
Respiratory rate 24cpm 25cpm 22cpm
A. Skin- warm, flushed red, fair in complexion, with sweaty palmsB. Nails- pallor nail bed, dirty with fine capillary refill (approximately within 2
seconds)C. Head/ face -no mass palpated, flushed faceD. Scalp- thick curly hair evenly distributed with no dandruff or lesions
observedE. Eyes- with red sore conjunctival suffusion, no discharges noted, pupils
are equally round and reactive to light and accommodationF. Ears- symmetrical with cerumen, no discharges notedG. Nose-no flaring of nostrils, no discharges notedH. Mouth-dry mucous membranes and pale lips
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I. Neck- no mass palpated, without lesions, no enlargement of lymph nodes and pain
J. Chest and Lungs- without crackles and ronchiK. Abdomen- soft, not distendedL. Extremities- weak extremities, muscle and joint painsM. GIT- loss of appetiteN. Renal and Urologic changes-decrease urine output(<30ml/hr)O. Cardiovascular changes- noneP. Hematopoietic changes – none
DATE
1-02-12
Vital sign
7-3 3-11 11-7
Temperature 37.8 C 37.2C 38.1 C
Pulse rate 100bpm 110bpm 92bpm
Respiratory rate 29cpm 30cpm 24cpm
A. Skin- warm, flushed red, fair in complexion, with sweaty palmsB. Nails- pallor nail bed, dirty with fine capillary refill (approximately within 2
seconds)C. Head/ face -no mass palpated, flushed faceD. Scalp- thick curly hair evenly distributed with no dandruff or lesions
observedE. Eyes- with red sore conjunctiva suffusion, no discharges noted, pupils are
equally round and reactive to light and accommodationF. Ears- symmetrical with cerumen, no discharges notedG. Nose-no flaring of nostrils, no discharges notedH. Mouth-dry mucous membranes and pale lipsI. Neck- no mass palpated, without lesions, no enlargement of lymph nodes
and painJ. Chest and Lungs- without crackles and ronchiK. Abdomen- soft, not distendedL. Extremities- weak extremities, muscle and joint painsM. GIT- loss of appetiteN. Renal and Urologic changes-decrease urine output(<30ml/hr)
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Interpretation:
Platelets is lower than normal range which would risk for bleeding tendency and
coagulation problems or hemolysis.
Lymphocytes is lower than normal range which might need help in fighting against
infection. Indicates decrease immune system.
Segmenters indicates high glucose level in the blood.
O. Cardiovascular changes- noneP. Hematopoietic changes – none
Diagnostic and Laboratory Results
Date: January 01, 2012 Time: 10am
Complete Blood Count
Result Normal Value
White Blood Cell 5,900 4.5 – 11.0 X 10/mm
Hemoglobin 14.4 Fem- 11.7 – 14.5 g/dl
Male-13.7- 16.7 g/dl
Hematocrit 42.0 Fem-34.1-44.3 vol %
Male-39.3-48.0 vol %
Platelet 115,000 175,000-350,000/mm
Segmenters 86 45-70%
Lymphocytes 11 18-45%
Monocytes 03 3-8%
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Diagnostic and Laboratory Results
Date: January 02, 2012 Time: 10am
Complete Blood Count
Result Normal Value
White Blood Cell 3,200 4.5 – 11.0 X 10/mm
Hemoglobin 15.9 Fem- 11.7 – 14.5 g/dl
Male-13.7- 16.7 g/dl
Hematocrit 47.9 Fem-34.1-44.3 vol %
Male-39.3-48.0 vol %
Platelet 106,000 175,000-350,000/mm
Segmenters 84 45-70%
Lymphocytes 14 18-45%
Monocytes 02 3-8%
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Interpretation:
Platelets rapidly drops more lower than normal range which would risk for bleeding
tendency and coagulation problems or hemolysis.
Lymphocytes is lower than normal range which might need help in fighting against
infection. . Indicates decrease immune system
Segmenters indicates high glucose level in the blood.
WBC a decrease value indicates inadequate inflammatory defenses to suppress
infection and humoral immunity takes place.
I. Anatomy and Physiology of the Blood
ANATOMY AND PHYSIOLOGY
The Immune System A second line of defense is
housed within the body: a finely
tuned immune system that
recognizes and destroys foreign
substances and organisms that
enter the body. The immune
system can distinguish between
the body's own tissues and
outside substances called
antigens. This allows cells of the
immune army to identify and
destroy only those enemy
antigens. The ability to identify an
antigen also permits the immune
system to "remember" antigens
the body has been exposed to in
the past; so that the body can
mount a better and faster immune
response the next time any of
these antigens appear.
The immune system also includes
other proteins and chemicals that
assist antibodies and T cells in their work. Among them are chemicals that alert
phagocytes to the site of the infection. The complement system, a group of
proteins that normally float freely in the blood, move toward infections, where
they combine to help destroy microorganisms and foreign particles. They do this
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by changing the surface of bacteria or other microorganisms, causing them to
die.
Enzyme(EN-zime) is a protein that helps speed up a chemical reaction In
the body.
Antigens(AN-tih-jens) are substances that are recognized as a threat by
the body's immune system, which triggers the formation of specific
antibodies against the substance.
Bone marrow is the soft tissue inside bones where blood cells are made.
Lymphatic(lim-FAH-tik) system is a system that contains lymph nodes
and a network of channels that carry fluid and cells of the immune system
through the body.
Immunity(ih-MYOON-uh-tee) is the condition of being protected against
an infectious disease. Immunity often develops after a germ is introduced
to the body. One type of immunity occurs when the body makes special
protein molecules called antibodies to fight the disease-causing germ. The
next time that germ enters the body, the antibodies quickly attack it,
usually preventing the germ from causing disease.
Primarily, the immune system classifies a substance as:
a. Self-non-foreign – they are normally ignored and tolerance and is
exhibited towards these substances. They are not deemed harmful.
b. Non-self – termed as an “antigen”; a specific response is developed to a
specific antigen. The response is then stored in the immune system’s
memory cells for future reference.
Components of the Immune System:
1. Lymphoid Structures Spleen
- Composed of red and white pulp, acts somewhat like a filter.
- The red pulp is the site where old and injured red blood cells are
destroyed.
- The white pulp contains concentrations of lymphocytes.
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Lymph Nodes- Are distributed throughout the body
- Are connected by lymph channels and capillaries, which remove
foreign material from the lymph before it enters the bloodstream.
2. Immune Cells – Lymphocytes
a. B lymphocytes (or B cells) - produce immunoglobulins.
b. T lymphocytes (or T cells) - help control the immune response and
destroy foreign antigens directly.
c. Plasma Cells - are white blood cells that produce large volumes of
antibodies.
3. Tissues – The remaining lymphoid tissues, such as the tonsils and
adenoids and other.
Mucoid Lymphatic Tissue – contain immune cells that defend the
body’s mucosal surfaces against microorganisms.
Types of Immune Defense:a. Innate or Nonspecific Immunity
- Also termed as the person’s natural resistance, and are the most
basic and primary of all defenses in the body. (skin, mucus
membranes, phagocytic activity)
4. Immune Cells – Lymphocytes
d. B lymphocytes (or B cells) - produce immunoglobulins.
e. T lymphocytes (or T cells) - help control the immune response and
destroy foreign antigens directly.
f. Plasma Cells - are white blood cells that produce large volumes of
antibodies.
5. Tissues – The remaining lymphoid tissues, such as the tonsils and
adenoids and other.
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Mucoid Lymphatic Tissue – contain immune cells that defend the
body’s mucosal surfaces against microorganisms.
2 Types of Immunity Active – acquired through previous exposure of the disease or through
immunization wherein the body “actively” participates in formation of
antibodies for future reference.
Passive – refers to whole, “ready made” immunity acquired from another,
the body is just “passive” in the process of developing antibodies, as it is
already made and given readily.
4 Types of Active Immunitya. Humoral Immunity
b. Mucosal Immunity
c. Cell-mediated Immunity
d. Delayed HypersensitivityReaction
Antibodies or Immunoglobulins – developed from B-cells through the stimulation
of cytokines produced by helper T-cells in the presence of an antigen. They
attach to specific determinant sites on antigens, and carries out phagocytosis
and initiating inflammation.
IgG 75% Crosses placental barrier; present in circulation and tissue
spaces; antiviral, antitoxic and anti-bacterial properties;
activates complement
IgA 15% Found in body secretions and breast milk; protects mucous
membranes from microorganisms
IgM 10% Forms natural ABO antibodies; present in early immune
responses; activates complement
IgE .2% Hypersensitivity reaction mediator; Involved in parasitic
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infectious
IgD .004% Necessary for maturation of B lymphocytes
Hematologic SystemTwo types of blood vessels carry blood throughout our bodies:
1. Arteries carry oxygenated blood (blood that has received oxygen from the
lungs) from the heart to the rest of the body.
2. Blood then travels through veins back to the heart and lungs, where it
receives more oxygen.
The blood that flows through this network of veins and arteries is whole blood,
which contains three types of blood cells:
1. Red blood cells (RBCs) - (also called erythrocytes) are shaped like slightly
indented, flattened disks. RBCs contain the iron-rich
protein hemoglobin. Blood gets its bright red color when
hemoglobin picks up oxygen in the lungs. As the blood
travels through the body, the hemoglobin releases
oxygen to the tissues.
- The body contains more RBCs than any other type of cell, and each has a
life span of about 4 months. Each day, the body produces new RBCs to
replace those that die or are lost from the body.
2. White blood cells (WBCs) - (also called leukocytes) are a key part of the body's
system for defending itself against infection. They can
move in and out of the bloodstream to reach affected
tissues. Blood contains far fewer WBCs than red blood
cells, although the body can increase WBC production
to fight infection. There are several types of WBCs, and their life spans
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vary from a few days to months. New cells are constantly being formed in
the bone marrow.
- Certain types of WBCs produce antibodies, special proteins that recognize
foreign materials and help the body destroy or neutralize them. The white
cell count (the number of cells in a given amount of blood) in someone
with an infection often is higher than usual because more WBCs are being
produced or are entering the bloodstream to battle the infection.
3. Platelets- (also called thrombocytes) are tiny oval-shaped
cells made in the bone marrow. They help in the
clotting process. When a blood vessel breaks,
platelets gather in the area and help seal off the
leak. Platelets survive only about 9 days in the
bloodstream and are constantly being replaced
by new cells.
- Platelets and clotting factors work together to form solid lumps to seal
leaks, wounds, cuts, and scratches and to prevent bleeding inside and on
the surfaces of our bodies. The process of clotting is like a puzzle with
interlocking parts. When the last part is in place, the clot happens — but if
even one piece is missing, the final pieces can't come together.
Pathophysiology of Dengue Fever
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Predisposing PrecipitatingGeographical area-Tropical islands Environmental conditionsIn the Philippines (Asia Pacific)Immuno-compromise
Mosquito carrying dengue virus Soldier, Students
Sweaty skin
AedesAegypti (dengue virus carrier) 8-12 days of viral replication on mosquitoes salivary glands.
Bite from mosquito (portal entry in the skin)Redness & itchiness
Allowing dengue virus to be inoculated towardsthecirculation/blood(Incubation Period: 3-14 days)
Virus disseminated rapidly into the bloodand stimulatesWBCs including B-lymphocytes that produces and
secretesimmunoglobulins (antibodies), andmonocytes, macrophages, neutrophils
Diagnostic Hematology:WBC 12,900/cumm (5,000-10,000)Lymphocytes 49% (20-40%)
Antibodies attach to the viral antigens, and thenmonocytes/macrophages perform phagocytosis through Fc receptor w/in the cells
and dengue virus replicates in the cells.Entryto Spleen
Diagnostic hem: Monocytes:42%Neutrophils 49%
Entry to Bone
Recognition of dengue antigen on infected monocyte
Release of cytokines w/c consist of vasoactive agents such as interleukins, tumor necrosis factor, urokinase and platelet activating factors w/c stimulates WBCs and pyrogen release
Signs/Symptoms:Febrile:38.6*CDiaphoresis,warm skin,flushed,Headache of 3/10pain scaleDengue
Narrative PathophysiologyofDengue Fever
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Dengue fever is a severe potentially deadly infection spread by
AedesAegypti mosquitoes through salivary glands that enters human skin portals
(biten). Dengue virus inoculates in blood circulation and incubates within 3-14
days.Virus disseminated rapidly into the blood and stimulatesWBCs including B-
lymphocytes that produces andsecretes immunoglobulins (antibodies),
monocytes, macrophages, and neutrophils. At this stage, there will be an
increase of WBCs and Lymphocytes. Antibodies attach to the viral antigens, and
thenmonocytes/macrophagesperform phagocytosis through Fc receptor within
the cellsand dengue virus replicates in the cells. Replicated virus cells will then
enter the Spleen and Bone Marrow. Within this period the monocytes and
neutrophils will decrease. Dengue viral antigen will be recognized on the infected
monocyte. Release of cytokines will stimulate WBCs and the release of
pyrogensA manifestation of hyperthermia, diaphoresis, warm skin, flushed face,
and headache is usually shown. Virus attacks liver and spleen and causes cell
death and other complications such as intense bleeding, pulmonary edema,
shock, liver cirrhosis or death.
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NURSING CARE PLANNursing Diagnosis:
Hyperthermia related to illness, exposure to viral/bacterial environment.Cause Analysis:
Pyrexia is common if inflammation is extensive. If fever infection has caused inflammation, fever can be severe depending on particular microorganism. Fever results from the release of pyrogens.
CUES OBJECTIVES NURSING INTERVENTIONS RATIONALE EVALUATION
Subjective:“Gitakiganko, ugtaasakohilanat, nagsakitakoulogikangahapon”, as verbalized by the patient.
Objective:Flushed skinFever: 38.8*CDiaphoresisRed EyesInc. Resp. RateChillsHeadacheDec. platelet count
LTO:
At the end of 2 days intervention the patient will be able:
torecover from decreasing platelet count.
STO:
At the end of 8 hours intervention the patient will be able to:
Maintain body temperature below 37.8*C
Independent:
1. Determine precipitating factors.
2. Assess vital signs especially tympanic or rectal temps.
3. Provide fluids by mouth.
4. Provide cold packs and tepid sponge bath.
Collaborative:
1. Identification and management of underlying cause are essential to recovery.
2. To provide accurate core temperature.
3. to decrease warmth and increases evaporative cooling.
4. topromote cooling & lowering temp.
1.To prevent cellular damage, delirium, and convulsions.
After series of intervention the patient:
Was not yet relieved of fever thoroughly.
Platelets rapidly decreases and patient was transferred for a tertiary care.But patient is relieved w/ fever after immediate interventions given.
-Goals are met partially-
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1. Provide antipyretic medications PRN
NURSING CARE PLANNursing Diagnosis:
Acute Pain related to biological factors such as activity of disease process.
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Cause Analysis: Fever infection has caused inflammation, fever can be severe depending on particular microorganism. Fever results from the release of pyrogens. And causes cell destruction, pain in the body parts and other complications.
CUES OBJECTIVES NURSING INTERVENTIONS RATIONALE EVALUATIONSubjective:“Sakit kayo ulo,akomata, mgabukogug muscles”, verbalized by the client.
Objective:Flushed skinFever: 38.8*CDiaphoresisRed EyesInc. Resp. RateChillsHeadacheDec. platelet countBody malaiseJoint painsMuscle pains
LTO:
At the end of 3days intervention the patient will be able:
torecover from muscle and joint pains.
STO:
At the end of 8 hours intervention the patient will be able to:
verbalize adequate relief of pain or ability to cope with incompletely relieved pain in the muscle & joints& head.
Independent:
1. Assess pain noting location, duration, intensity.
2. Encourage increase fluid intake.
3. Provide comfort measure such as use of heat/cold packs, repositioning, quiet environment .
4. Investigate results of platelet count.
Collaborative:1. Administer
antipyretic medications PRN/ antibacterials/antivi
1.To provide information and determine interventions.
2.To flush bacteria and toxins and regulate body temperature.3.To provide relaxation and refocuses attention from pain and enhance coping mechanism.4. indication of Dengue fever infection at risk.
1. Reduces pain, fever, and infections that is affecting body system of the patient.
After series of intervention the patient:
Was not yet relieved of on and off 3 days fever. Platelets rapidly decreases and patient was transferred for a tertiary care.However patient is relieved w/ headache through cold packs.
-Goals are met
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rals if prescribed.
NURSING CARE PLANNursing Diagnosis:
Imbalanced Nutrition: less than body requirements related to inability to ingest food.Cause Analysis:
Intake of nutrients insufficient to meet metabolic needs.CUES OBJECTIVES NURSING RATIONALE EVALUATION
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INTERVENTIONSSubjective:“Dilinako kaya magtulonpagkaon, busogpermeakotiyan,makasukako”, as verbalized by the client.
Objective:AnorexiaFever: 38.8*CVomitusChillsBody malaise/weaknessFatigue
LTO:
At the end of 3days intervention the patient will be able:
todemonstrate progressive weight gain and strength.
STO:
At the end of 8 hours intervention the patient will be able to:
verbalize relief from Anorexia.
Independent:
1. Assess Causative factor for malnutrition.
2. Determine client’s ability to chew, swallow, and taste food. Evaluate teeth and gums for poor oral health, note gum bleedings.
3. Prevent unpleasant odors/sights.
4. Promote pleasant relaxing environment including oral care before and
1.To determine how to meet metabolic needs of patient.
2.All factors can affect ingestion and or digestion of nutrients.
3.This may have a negative effect on appetite/eating.
4. To enhance food intake.
1. To reduce possibility of early satiety.
2. To stimulate
After series of intervention the patient:
Was able to improved his nutrition intake by taking fruit juices and slowly taking hot soups brought to him.-Goals are met
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after meals.
Collaborative:1. Promote
adequate/ timely fluid intake. Limit fluids 1 hour prior to meal.
2. Encourage use of lozenges.
salivation when dryness is a factor.
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DRUG STUDYDate Ordered: January 01, 2012
Name of Drug Classification
Why Given to Patient in Relation to the Mechanism of Action
Contraindication Side Effect Nursing Consideration
Generic (Brand)Apap,paracetamol Acetaminophen
Dose/Frequency Prescribed500mg 1tab q 4 for PRN T>38.8*C.
Recommended Dose and FrequencyUsual starting dosage based on patient response. Maximum dose, 640 mg/day PO q 4* to 6* PRN.
Therapeutic:Nonopioid Analgesics and Antipyretics
Pharmacologic:Para-aminophenol derivatives
Stability of the Drug:Stored in a room temperature
Unknown. Thought to produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in the CNS. The drug may relieve fever through central action in the hypothalamic heat regulating center.
Hypersensitivity to drugs.
IndicationTreatment of mild pain or fever.
Stimulation, drowsiness, nausea, vomiting, abdominal pain, hepatotoxicity, seizure, renal failure, hemolytic anemia, CNS stimulation, delirium, vascular collapse, convulsions, coma, death.
Assess patient’s type of pain, location, intensity, duration, temp., diaphoresis.Assess allergic reactions: rash,urticariaAssess for chronic poisoning: rapid pulse, weak pulse, dyspnea,coldclummy skin, report immediately.
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Discharge Planning
Medication
Intake of appropriate vitamin supplement and diuretics to increase protection mechanism of the immune system and decreases renal vascular resistance and may increase renal blood flow, respectively.
Economic
The use of nonpharmaco therapy such as drinking plenty of water will promote increase plasma in blood to increase immunity and proper hygiene and promotion of cleanliness at home and work area.
Treatment
Management of such condition would be through hydration and doing control measures to eliminate vector by promoting cleanliness in the environment through proper disposal of rubber tires, changing of water of lower vases once a week, destruction of breeding places of mosquito and residual spraying with insecticides.
Hygiene
Advise to follow proper body hygiene and to maintain cleanliness on surroundings. This would prevent additional cases of DHF.
Out Patient/ Follow-up
Any odd signs such as fever, petechiae, recurrence of fever, must be immediately reported to the physician.
Diet
Instruct to eat no dark colored foods or hemoglobin free diet that can interfere test for stools.
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Diet Analysis
Patient having dengue fever must have to follow a normal diet or diet as
tolerated to foster wasting of nutrient which the patient has loss during the
sickness.
The importance of why the patient ordered to have a “No dark colored
food or hemoglobin free diet” is to prevent interference during stool exam results.
It is safe to serve Cheese, milk, eggs, non-leafy vegetables, refined
vegetables, fruits and fruit juices.
Avoid alcoholic and acidic beverages that may irritate the GIT and
stimulate vomiting. Instruct patient to eat foods that are low fat, low fiber, non-
irritating and non-carbonated.
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Sample Diet for One Day
Breakfast: 6:00 – 7:00
Papaya
Fried vegetarian tocino
Boiled camote
Unpolished rice
Warm milk
Lunch: 11:45 – 12:15
Low salt boiled camote tops
Unpolished rice
3 ounces sliced turkey
1 lettuce leaf
1/2 cup cucumber salad
1 medium apple
Evening Meal: 6:30 – 7:00
3 ounces broiled fish
1/2 cup rice
1/2 cup green beans
1 cup lettuce salad
2 teaspoons margarine
1 cup lemon water
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Prognosis
Typical dengue is fatal in less than 1% of cases. The acute phase of the
illness with fever and myalgias lasts about one to two weeks. Convalescence is
accompanied by a feeling of weakness (asthenia), and full recovery often takes
several weeks.
The prognosis is good as long as the client complies to proper
medications, proper nutrition, adequate hydration and proper hygiene. The
parents can financially support their son for a tertiary care if any complication
arises.
CRITERIA FOR PROGNOSIS BASING FROM THE FOLLOWING
A. Age Good
B. Onset of Illness Poor
C. Duration of Illness Poor
D. Nature of Illness Moderate
E. Support System Good
F. Financial Support Good
G. Compliance of Treatment Good
Evaluation
32
The patient in this study had undergone supportive and symptomatic
management. He was admitted last January 01, 2012 at MOPH-Gingoog Cityand
was eventually transferred to Cagayan de Oro City last January 03, 2012 for a
tertiary care due to rapidly dropping platelets caused by Dengue Fever Virus.
Proper nursing care such as water therapy and administration of prescribed
drugs were done to promote comfort and repression of symptoms. Hygiene was
also strictly implemented to avoid risk for further infection. Nursing assistance
was also given to help him in his activities of daily living.
Health teaching is a very important role on the part of the nurses. This is of
great significance to the knowledge deficit of patients regarding health and
illness.
Recommendation
33
Strict compliance to the medical treatment, health teachings and medical
check-up is advised. With proper nutrition and conformity to the medications &
therapy, recovery would be easier and faster.
There is no specific treatment for classic dengue fever, and like most people
you will recover completely within 2 weeks. To help with recovery, health care
experts recommend:
Getting plenty of bed rest
Drinking lots of fluids
Taking medicine to reduce fever
Often health care provider advises people with dengue fever not to take
aspirin. Acetaminophen or other over-the-counter pain-reducing medicines are
safe for most people. For severe dengue symptoms, including shock and coma,
early and aggressive emergency treatment with fluid and electrolyte replacement
can be lifesaving.
The best way to prevent dengue fever is to take special precautions to avoid
contact with mosquitoes. Several dengue vaccines are being developed, but
none is likely to be licensed by the Food and Drug Administration in the next few
years.
34
When outdoors in an area where dengue fever has been found
Use a mosquito repellant containing DEET, picaridin, or oil of lemon eucalyptus
Dress in protective clothing-long-sleeved shirts, long pants, socks, and shoes
Because Aedes mosquitoes usually bite during the day, be sure to use
precautions especially during early morning hours before daybreak and in the
late afternoon before dark.
Other precautions include:
Keeping unscreened windows and doors closed
Keeping window and door screens repaired
Getting rid of areas where mosquitoes breed, such as standing water in
flower pots, containers, birdbaths, discarded tires, etc.
References
35
Meg Gulanick, Nursing Cared Plans, 6th edition, copyright 2007
Jean ForetGiddenset. al., Mosby PDQ for RN, 2nd edition, copyright 2008
Joyce M. Black et. al., Medical Surgical Nursing, 8th edition, copyright
2009
Barbara E. Gould, Pathophysiology for the Health Profession, 3rd edition,
copyright 2006
Judith A. Schilling McCann et. al., Nursing 2007 Drug Handbook,
copyright 2006
Sue E. Huether, Understanding Pathophysiology, 4th Edition, copyright
2008
Barbara C. Long, Medical Surgical Nursing, 3rd Edition, copyright 1993
Saul Kassin, Psychology, 2nd edition, copyright 1998
Camille B. Wortmanet. al., Psychology, 3rd Edition, copyright 1988
Amy M. Karch, Focus on Nursing Pharmacology, 4th Edition, copyright
2008
AppendicesAnnex -A
36
Christ the King CollegeNursing Program
Gingoog CityKardex
Name of Student: Leilani R. Ampo Year Level: 4 th year BSN Date of Duty: January 3, 2012
Last name: First name: Middle name:Dime, Charlemagne BalisryAge:14 year old
Sex:Male
NationalityFilipino
Religion:Roman Catholic
Civil Status Child
Room/Bed #:207(annex)
Address: Purok 3 North Poblacion, Medina, Misamis OrientalContact Number:
Chief Complaints: Fever X 2 days
Date admittedJan. 01, 2012
Time admitted:10:15 AM
Attending Physician:Dr. Harold R. Cagang
Hospital #27-70-58
Medical record # #5
Admission Impressions:Systemic Viral Illness R/I Dengue FeverPrognosis: Good prognosis as long as client complies with medication, have proper nutrition, maintains proper hygiene and oral fluid intake. Andfamily can afford for a tertiary care hospitalization if complication arises.
Area of Duty:MOPH-Gingoog (Annex Bldg. Medical Ward)
Date Medication Remarks Date Ordered
Time I.V. Fluids RemarksTime on
Time Consumed
1-1-12 Paracetamol 500 mg 1-1-12 Dƽ 0.3 Nacl @
37
20 gtts/min1 tab q 4º PRN if Dƽ NM іL @
SRT ≥ 37.8º C Dƽ NM іL @
SR
Date Ordered
Diet Remarks Date Ordered Laboratory Exams
Remarks
1-1-12 DAT 1-1-12 CBC č plt, u/a Result inNo dark colored Food 1-2-12 Rpt CBC č plt Result in
3PM1-3-12
Rpt CBC č pltRpt CBC č plt
Result in
Treatment:1-1-12 Vomited
Consent to care signedI&O q shiftRefer accordingly
1-2-12 Continue medsStill for labs
1-3-12 For tertiary referral
Vital Sign’s and I & ODate 1-1-12 1-2-12 1-3-12
Temperature: 38.8ºC 37.8ºC 38.1ºCBlood Pressure: 90/60mmHG 120/70mmHG 120/80mmHg
Heart Rate: 90bpm 88bpm 92bpmRespiration Rate: 24cpm 25cpm 24cpm
Reference: MOPH-GC card
38
Annex-B
Christ the King CollegeGingoog City
Nursing ProgramClient Data Form
Name of Student: Leilani R. Ampo Date: January 3, 2012
Year Level:4th YR BSN Group:_________ Area:MOPH-Gingoog (Annex Bldg. medical Ward)
Client’s InformationLast name: First name: Middle name:Dime, Charlemagne BalisryAge:14 year old
Sex: Male
Nationality Filipino
Religion: Roman Catholic
Civil Status Child
Room/Bed #:207(annex)
Address: Purok 3 North Poblacion, Medina, Misamis OrientalContact Number:
Occupation: Date admittedJan. 01, 2012
Time admitted:10:15 AM
Attending Physician: Dr. Harold R. Cagang
Reason for Hospitalization (client quote)Fever X 2 days
Admission Impressions:Systemic Viral Illness R/I Dengue FeverPrognosis: Good prognosis as long as client complies with medication, have proper nutrition, maintains proper hygiene and oral fluid intake. And family can afford for a tertiary care hospitalization if complication arises.
Family History (narrative)Client was born second to the oldest among three siblings. The family has
no health problems, except the mother is currently being monitored with her
“Hypertension” which is induced due to her fourth pregnancy. However,
Charlemagne is the first in the family being brought to hospital for such illness.
Personal History: (narrative)
One day prior to his admission, the client said he was gallivanting at the
neighbor’s place last December 31, 2011 (Saturday), and was caught by the rain.
39
When he reached home he was having chills and hyperthermia. His parents
decided to bring him to hospital since he was vomitus and having chills and with
fever.
Admission DataClient is from :
Home: __√_ Doctor’s Clinic; ___ School: ___ Work: ___ Other Hospital:___ Others: ___
____________________________________________________________ ______________________________
Mode of Admission: Ambulatory; _√__ Wheelchair: ___ Stretcher: ___ Others: ___
____________________________________________________________________________________________________________________________________
Accompanied by: Parents Valuables: None: _√__ With Client: ___ Given to relatives: ___
List:_____________________________________________________________________________________________________________________________________________________________________________________
Laboratory results from outside:Lipunan Hospital Inc., Jan.1, 2012, 10:00 AM
Person to notify in case of emergency :Name: Gregorio Dime (Father)Address: Medina, Misamis orientalContact #: _______________________________
40
Assessment Tool
Vital Signs Temperature: ___37.8 ° C ____________ Axilla/Oral
Pulse: _______88bpm______________ Radial/Brachial
Apical Pulse: _____90bpm__________
Respiration: ____25cpm___________
Blood Pressure: 120/70mmHg__ Standing/Sitting/Lying Time BP taken: 3:50 PM
Height: __5’2”Measured/Estimated
Weight: __57 kgs Measured/Estimated
Allergies/Sensitive to:Any Allergy to Food/Medicine/Latex/others? ___yes _√ _ no
If yes, Please specify: ________________________________
Have used Blood Products? ___yes _√ _ _no Reactions? ___yes __√ _ no
Cranial Nerve Assessment1. Cranial nerve IClient has no difficulty identifying scents and aromas.
2. Cranial nerve II Client has no visual problems.
3. Cranial nerve III Client’s pupils in both eyes have equal size and capable of following moving objects.
4. Cranial nerve IV Client can normally follow moving objects w/ both eyes.
5. Cranial nerve V Facial muscles can move, can chew normally.
6. Cranial nerve VI Eyes can move actively and roll eyes laterally.
7. Cranial nerve VII Can close eyes normally and tongue has good sense of taste.
8. Cranial nerve VIII Has good hearing sensation in both ears.
9. Cranial nerve IX No problem or difficulty of swallowing.
10. Cranial nerve X Strong muscle strength in the head, shoulders,
11. Cranial nerve XI neck, and back….
12. Cranial nerve XII Capable of controlling tongue movement.
41
SkinSkin Integrity/Condition
√intact
Rash
Lesion
Ulcer
Bruising
Scars
Burns
Describe: Petechiae seen after tourniquet test done 1-3-12________________________________________________________
IV Access
√Peripheral Left Arm
Central____________________
Color
Normal
Pale
Cyanotic
√Flushed
Mottled
Jaundiced
Temperature
√Warm
Hot
Cool
Cold
Note: 37.8 ° C 1-2-12
38.9 ° C 1-3-12
Moisture
√Normal
Dry
□ Diaphoretic
Mouth
√Pink/moist
Ulcers
Lesions
Bleeding
Lips
√Dry
Cracked
Intact
Lesions
Head Hair Describe: Client has clean hair and well kept. No infestations of lice.
Lice Dandruff Lesions Bald
Face Client face is clean, no scars, no acne found but face is flushed. Acne Scars Wounds/lesions
Eyes: Vision √No Impairment R/L Impaired R/L Blind Glass/Contact Lenses
Color Describe: Clear Yellow √Red R/L Both eyesDrainage R/L N/A
Ear
Hearing √No Impairment R/L Impaired R/L hearing Aide Others________________________________________________________________________________
Teeth
Dentures Yes√No
Caries Yes√No
Brace Yes√No
42
Cardiovascular Neck
√Flat Distended
Apical Pulse√Regular Irregular Pacemaker Type: _____________
Rate: 90 bpmHeart Sound
√Normal Abnormal
Note:____________________________________________________________________Radial Pulse
√Strong R/L Faint R/L Doppler R/L (If Applicable)Note:______________________________
Brachial Pulse Strong R/L Faint R/L Doppler R/L (If Applicable)
Pedal Pulse Strong R/L Faint R/L Doppler R/L (If Applicable)
Edema√No YesSite: ____________________________
Numbness√No YesSite: Muscle & Joint Pains
RespiratoryRetractions
√N/A Supra Clavicular Intercostal Diaphragmatic
Cough Describe:√N/A Non-productive Productive Ability to clear secretions
Yes No
Breath Sounds √Clear Adventitious: Equal
Tracheostomy Yes√NoDate inserted:_________________Date tube change: _____________
Chest tube Yes√NoLocation;__________________________
Oxygen√Room Air Nasal cannula Face Mask Trach Mask Endotracheal tube BIPAP CPAP
GastrointestinalAbdominal
√Soft Firm Rigid Distended
Tenderness√N/A YesLocation:_____________________
Constipation Yes√No
Diarrhea Yes√NoDate of last BM:___________
Appetite
43
Bowel Sounds√Present ___________Sounds/min. Absent
Feed Independently √Yes No
Nasogastric tube/gastrostomy tube Yes√NoNGT date change:_________________
Good Fair√Poor Nausea Vomiting
Chewing/ Swallowing Difficulties Yes Describe:
_________________√No _________________________
ExtremitiesUpper Lower
Fingers√Complete ______________________ Arthritis
______________________ Callus
_____________________Nails
Cyanotic Club√Dirt Cut
Arms Lesions Scars Arthritis Others Muscle pain & Joint Pain in
the arms.
Toes√Complete ______________________ Arthritis
______________________ Callus
_____________________Nails
Cyanotic Club√Dirt Cut
Legs Lesions Scars Arthritis Others Muscle pain& Joint Pain in
the legs.
Genital and Anal Male Female
Lice STI Not Applicable Catheter Hernia Others
Anus
Lice STI Not Applicable Catheter Hernia Menstruation Date started: Not Applicable
Date ended:
Others
44
Hemorrhoids STI Not Applicable
______________________________________________________________
Anus Hemorrhoids STI Not Applicable
45
Descriptive: Indicate all Observed in the diagram
46
FebrileTemperature 38.8ºC
Headache/Nausea
Red Eyes and Orbital Pain (Conjunctival Suffusion)
Poor appetite
IncreaseBreathingRate: 25 cpm
Flushed face
Sweaty Palms IVF @ Left ArmD5 NM 1L @ 20gtts/min
Long Finger Nails/Dirty
VomitusFeeling
BodyWeakness
MusclePains
Warm Skin
JointPains
PetechiaeAfter TourniquetTest
Annex-CCHRIST THE KING COLLEGE
Nursing ProgramGingoog City
Nurses Health Teaching ToolDisease Process (Pathology of the disease)Dengue fever is a potentially deadly infection spread by AedesAegypti Mosquitoes through salivary glands that enters human skin portals (biten). Dengue Virus inoculates in blood circulation and inoculates w/in 3 -14 days. Virus attacks Liver and Spleen and causes cell death and other complications such as Intense bleeding, Pulmonary Edema, Shock, Liver Cirrhosis and Death eventually.
Medication (12 R’s of medication)No medications available that can provide a cure. Treatment addresses the symptoms and it also attempts to avoid potential complications.
Non narcotic analgesic and antipyretics to decrease temperature or regulate pain.
Antibacterial/Antiviral to prevent/treat infections. Antiemetics to treat vomiting. IVF for electrolytes loss (D5LR) Avoid Aspirin because of gastritis and bleeding tendencies.
Diet Normal diet or Diet as tolerated to foster wasting of nutrient
which patient unconsciously losses during sickness. NDCF (No dark colored food) or hemoglobin free diet that can
interfere results for stools. Safe to serve: Cheese, milk, eggs, non-leafy vegetables, refined
vegetables, fruits and fruit juices.
Daily Plan of activity Rehydration w/ IVF to correct dehydration Administration of meds order Normal diet Keep sanitary environment to prevent infections & promote
healing Bath daily to prevent invasion of microorganisms Clean body & change to clean clothes daily Maintain good oral and body hygiene Exercise Increase fluids intake Regular bowel movement Clean surroundings and spray insecticides
47
Close containers when they collect water Proper garbage disposal
Follow upsHave a follow up consultation & regular check upsProper way to take body temperature at homeHave enough rest and avoid heavy strenuous activityAvoid alcoholic beverages while taking medsEmphasize importance of fluid intakeDiscuss use of antipyretics/antibiotics (overdoses can cause liver damage)Compliance to home medicationsWatch for signs and symptoms that require immediate medical attention
48
Submitted by:
Leilani Rodriguez-AmpoBSN IV
Thank You!
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