case final load

8/14/2019 Case Final Load

1/26

OBJECTIVES

General

This case presentation aims to identify and determine the general health problems

and needs of the patient with an admitting diagnosis of DengueHemorrhagic Fever, Type 1. This presentation also intends to help patient promote

health and medical understanding of such condition through the application of thenursing skills.

Specific

To raise the level of awareness of patient on health problems that she may

encounter.

To facilitate patient in taking necessary actions to solve and prevent theidentified problems on her own.

To help patient in motivating her to continue the health care provided by the

health workers.

To render nursing care and information to patient through the application of

the nursing skills.

Dengue fever is an infectious disease carried by mosquitoes andcaused 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 thatfeels like bones are breaking, hence the name. Health experts have known about

dengue fever for more than 200 years.

INTRODUCTION

Dengue fever is found mostly during and shortly after the rainy season

in tropical and subtropical areas of

Africa

Southeast Asia and China

India

Middle East

Caribbean and Central and South America

Australia and the South and Central Pacific

An epidemic in Hawaii in 2008 is a reminder that many states in the United Statesare susceptible to dengue epidemics because they harbor the particular types ofmosquitoes that transmit it. Worldwide, more than 100 million cases of dengue

infection occur each year. This includes 100 to 200 cases reported annually to theCenters for Disease Control and Prevention (CDC), mostly in people who have


2/26


3/26

General signs and symptoms

>Sudden onset of high fever which may last 2 to 7 days.>Joint & muscle pain and pain behind the eyes.

>Weakness>Skin rashes - maculopapular rash or red tiny spots on the skin called

>Petechiae>Nose bleeding when fever starts to subside

>Abdominal pain>Vomiting of coffee-colored matter

>Dark-colored stools

Theoretical Frame work

Orems Self Care TheoryThe focus of Orem's model of nursing is to enhance the patient's ability for self-care and extend

this ability to care for their dependents (Orem, 2005). A person's self-care deficits are a result of

their environment. Three systems exist within the professional nursing model: the compensatory

system, in which the nurse provides total care; the partial compensatory system, in which the

nurse and the patients share responsibilities for care; and the educative-development system, in

which the patient has the primary responsibility for personal health, with the nurse acting as a

consultant (Central, 2005; Orem, 2005). The basic premise of Orem's model is that individuals

can take responsibility for their health and the health of others, and in a general sense,individuals have the capacity to care for themselves and their dependents.

AIR: Educative/Supportive - Provide education on the good benefits of

having a well ventilated space for living.

WATER: Educative/Supportive - Ensure access to adequate hydration

FOOD: Partial Compensation - Education and provision of a diet that is

suitable for her diagnosis of dengue.

ELIMINATION: Educative/Supportive - May require monitoring of

intake and output

ACTIVITY AND REST: Educative/Supportive - Educate patient as to the

benefits of having enough rest and sleep for the promotion of health

SOLITUDE AND SOCIAL INTERACTION: Partial Compensation - Nurses

may provide social interaction with the patient to establish rapport


4/26

HAZARD PREVENTION: Partial Compensation - Nurses will need to

educate regarding the medication that he may be taking, and administer this

medication initially.

Patient Profile

I. PATIENTS PROFILE

PATIENTS DATA

1. Name: Mr. V.

2. Age: 6 years old3. Address: Blk 50 Lt 11 Lico St.

4. Sex: Male

5. Race: Filipino

6. Birthday: September 1, 2003

7. Place of Origin: Barbaza, Antique

8. Marital Status: Married

9. Religion: Roman Catholic

10. Occupation: N/A

NURSING HISTORY


5/26


6/26

Physical Assessment

BODY PART

HEAD

Skull

Scalp/ Hair

Face

TECHNIQUE USED

palpation

inspection

palpation

inspection

FINDINGS

proportional to

the size of the body,

round, with

prominences in the

frontal area

anteriorly & the

occipital area

posteriorly,

symmetrical in all

planes, gently

curved

scalp is white,

clean, free from

masses, lumps, nits,

dandruff & lesions,

with no areas of

tenderness upon

palpation; hair is

black, evenly

distributed & covers

the whole scalp,

thick & shiny

INTERPRETATION

Normal

Normal

Normal


7/26

Eyes/ Vision

Ears/ Hearing

inspection

palpation

inspection

palpation

oblong shaped,

symmetrical, smooth

& no involuntary

muscle movements

eyes are parallel

& evenly placed,

symmetrical,nonprotruding,

with

scant amount of

secretions, both

eyes black & clear;

sclera is white &

clear; eyebrows

are black,

symmetrical, thick,

can raise both

symmetrically &

without difficulty,

evenly distributed &

parallel with each

other; eyelashes

are evenly

distributed & turned

Normal

Normal


8/26

Nose

Mouth/ Lips

inspection

palpation

inspection

palpation

outward;

ears are parallel,

symmetrical,

proportional to the

size of the head,

bean-shaped, helix

is in line with the

outer canthus of the

eye, skin is the

same color as the

surrounding area &

clean; ear canal is

pinkish, clean, with

scant amount of

cerumen & a few

cilia; able to hear

whisper spoken 2

feet away; 2

piercing are found in

left ear and 1

piercing in right ear

nose is in midline,

symmetrical, patent;

Normal

Normal


9/26

NECK

THORAX &

LUNGS

HEART

inspection

palpation

inspection

palpation

percussion

auscultation

inspection

internal nares are

clean, dark pink with

few cilia

lips are pinkish,

symmetrical, lip

margin is

welldefined,

smooth &

moist; gums are

pinkish, smooth,

moist, no swelling,

no retraction, no

discharge; 32 teeth

are present, aligned,

with no dental

caries; tongue is

pinkish, slightly

rough on top,

smooth along the

lateral margins,

moist, shiny & freely

movable;

cheeks are pinkish,

moist & smooth;

frenulum is in

midline, straight &

Normal

Normal

Normal


10/26


11/26

Anatomy and Physiology

Blood

Whole blood has two components: (1) blood plasma, a watery liquid matrix

that contains dissolved substances, and (2) formed elements, which are cells andcell fragments. Blood is about 45% formed elements and 55% plasma. Normallymore than 99% of the formed elements are red-colored red blood cells. Palecolorless white blood cells and platelets occupy less than 1% of total blood volume.

Substances in Blood Plasma

Constituent Description

Water (91.5%) Liquid portion of blood. Acts as

solvent and

suspending medium for components

of blood;

absorbs, transports and releases

heat.

Proteins (7.0%) Exert colloid osmotic pressure, which

helps

maintain water balance between

blood and

tissues and regulates blood volume.

Albumins Smallest and most numerous plasma

proteins;

produced by liver. Function as

transport

proteins for several steoid hormones

and for


12/26

fatthy acids.

Globulins Produced by liver and by plasma

cells, which

develop from B lymphocytes.

Antibodies help

attack viruses and bacteria. Alpha

and beta

globulins transport iron, lipids and

fat-soluble

vitamins.

Fibrinogen Produced by liver. Plays essential role

in blood

clotting.

Formed Elements in Blood

Name Number Characteristics Functions

Red Blood Cells 4.8million/2L (F)

5.4million/2L (M)

7-82m diameter;

biconcave discs,

without a nucleus;

live for about 120

days

Hemoglobin within

RBCs transports

most

of the oxygen and

part of the carbon

dioxide in the

blood


13/26

White Blood

Cells

5000 10,000/2L Most live for a few

hours to a few days

Combat pathogens

and other foreign

substances that

enter

the body

Neutrophils 60-70% of all

WBCs

10-122m diameter;

nucleus has 2-5

lobes connected by

thin strands of

chromatin;

cytoplasm has very

fine, pale lilac

granules

Phagocytosis.

Destruction of

bacteria with

lysozyme, defensis,

and strong

oxidants,

such as superoxide

anion, hydrogen

peroxide, and

hypochlorite anion

Eosinophils 2-4% of all WBCs 10-122m diameter;

nucleus has 2-3

lobes; large

redorange

granules fill

the cytoplasm

Combat the effects

of

histamine in

allergic

reactions,

phagocytize

antigenantibody

complexes,

and destroy certain

parasitic worms


14/26

Basophils 0.5-1% of all

WBCs

8-102m diameter;

nucleus has 2

lobes; large

cytoplasmic

granules appear

deep blue-purple

Liberate heparin,

histamine and

serotonin in

allergic

reactions that

intensify the

overall

inflammatory

response

Lymphocytes 20-25% of all

WBCs

Small lymphocytes

are 6-92m in

diameter; large

lymphocytes are

10-14 2m in

diameter; nucleus

is round or slightlyindented;

cytoplasm forms a

rim around the

nucleus that looks

sky blue; the larger

the cell, the more

cytoplasm is visible

Mediate immune

responses,

including

antigen-antibody

reactions. B cells

develop into

plasma

cells, which secrete

antibodies. T cells

attach invading

viruses, cancer

cells

and transplanted

tissue cells. Natural

killer cells attack a

wide variety of

infectious microbes

and certain


15/26

spontaneously

arising

tumor cells

Monocytes 3-8% of all WBCs 12-202m diameter;

nucleus is

kidneyshaped or

horseshoe shaped;

cytoplasm is

bluegray

and has foamy

appearance

Phagocytosis (after

transforming into

fixed or wandering

macrophages).

Platelets 150,000-

400,000/2L

2-42m diameter

cell

fragments that live

for 5-9 days;

contain many

vesicles but no

nucleus

Form platelet plug

in

hemostasis;

release

chemicals that

promote vascular

spasm and blood

clotting


16/26

Pathophysiology

Aedes Aegypti

Dengue Virus Type I(Chikungunya Virus)

IgG adheres to the platelet(initiates destruction of the platelet)

thrombocytopenia(50,000/mm3 or less)

increased potentialfor hemorrhage

stimulates intenseinflammatory response

petechial rash, high fever, headache(epistaxis, vomiting, conjunctival infection,

abdominal pain, shock, death)


17/26

sment Diagnosis Planning Intervention Rationale Ev

gnat siya

rbalized by

touch

nd

kin

at both

tic nail

ss

looking

ial V/S of:

C taken

y

g taken at

cal area

pm,

f respi-

tory

0/70 mm

Hyperthermia r/t

to underlyingdisease process

After 8 hours of

nursinginterventions the

body temp. of thepatient will be

reduced from38.9 C tonormal range

Assess for signs and

symptoms of feverand its causative

factors.Inform and instruct

the significant otherabout the shift ofdiet from soft dietto

NPO temporarily.

Provide acomfortable

environment.

Instruct the SO todo TSB

Instruct the SO toreport convulsions

and chilling ifpresent

Administer meds,

as orderedMonitor V/S and

record

To address the

problem

In order for them

to be aware

To ensure clientscomfort.

To at least

reduced theelevated body

temp.For early

prevention ofcomplication

To treatunderlying cause

To note changes

After 8

nursininterve

body tpatien

reduce38.9


18/26


19/26


20/26

eneric

Name

Brand

Name

Classification Action Indication Dosage

Re

acetamol Aldep Analgesic Decreases

fever by

inhibiting the

effects of

pyrogen on

thehypothalamic

heat

regulating

centers and

relieves pain

by inhibiting

prostaglandin

synthesis

Relief of mild

to moderate

pain

Treatment offever

165mg T

r

ot

ad

avo

th

pa

Ad

a

Te

rec

chr

ble

Tel

notfor

last

tha


21/26


22/26

Laboratory Diagnosis

HematologyFor a Complete Blood Count (CBC), specimens of venous blood are taken, itincludes hemoglobin and hematocrit measurements, erythrocyte (RBC) count,leukocyte

(WBC) count, red blood cell (RBC) indices, and a differential white cell count. TheCBC is


23/26

a basic screening test and one of the mostfrequently ordered blood tests.

Possible Causes of

Normal Findings

Increased Decreased

Infection

Inflammation

Trauma

Autoimmune

disease

Drug toxicity

Bone marrow

failure

stress

acute

infection

aplastic anemia

dietary deficiency

Chronic

infection

Viral

Infection

Mononucleosi

s

Leukemia

Sepsis

Immunodeficiency

\

diseases

Parasitic

infections

Allergic

reactions

Leukemia

Increased

Adrenosteroid

production


24/26


25/26

O ut Patient/ Follow-up

Any odd signs such as fever, petechiae, recurrence of fever,etc. must be

immediately reported to the physician.

D iet

Instruct to eat foods that are low fat, low fiber, non-irritating and non-carbonated.

ADAMSON UNIVERSITY

CASE STUDY ON DENGUEHEMMORHAGIC FEVER


26/26

Submitted By: Jerome R. dela Cruz

Submitted to: Ms. Villaluna

Sept 11. 2009

case final load

Documents