I. Personal Data

Name: Mr. M.LAddress: Barangay Quezon, Solano, Nueva VizcayaAge: 13Sex: maleBirth date: 09/18/92Marital Status: SingleOccupation: StudentReligious Affiliation: Iglesia ni CristoNationality: FilipinoParents’ Name:

Father’s Name:Mr. J.LOccupation: unknonwnMother’s Name: Mrs. A.L.Occupation: Midwifery

Date/Time of Admission: O0-04-06 @ 2:30 pmDate of Discharge: 01-06-06Attending Physicians: Dr. Respicio/Dr. BunuanAdmission Diagnosis: Dengue Fever SyndromePrincipal Diagnosis: Dengue Fever SyndromeChief Compliant: 5 days PTA On and off fever, rashes

II. HISTORY OF PRESENT ILLNESSFive days prior to admission patient experiences on and off fever. No consult done but given

paracetamol and FeSO4+Vitamin C by his mother. Few hours prior to admission the patient was positive of rashes and have (-) fever.

III. HISTORY OF PAST ILLNESS

The patient suffered from minor illness like colds. She was immunized with BCG, Hepa B (3 dose), DPT, poliomyelitis and anti-measles at RHU Solano. No allergies on foods and drugs as the mother stated.

IV.BRIEF DESCRIPTION OF THE DISEASE

IV. BRIEF DESCRIPTION OF THE DISEASE

Dengue Hemorrhagic Fever is an acute infectious viral disease, caused by all four serotypes (DEN-1, DEN-2, DEN-3, DEN-4) of a virus from genus Flavivirus, called dengue virus. It’s the most prevalent flavivirus infection of humans, with a worldwide distribution in the tropics and warm areas of the temperature zone corresponding to that of the principal vector, Aedes aegypti. When simultaneous or sequential introduction of two or more serotypes occurs in the same area, there may be an increased number of cases with worst clinical presentation – dengue hemorrhagic fever. The term ‘hemorrhagic’ is imprecise, because what characterizes this form of the disease is not the presence of hemorrhagic manifestations, but the abrupt increase of capillary permeability, with diffuse capillary leakage of plasma, hemoconcentration and, in some cases, non-hemorrhagic hypovolemic shock (dengue shock syndrome). Transmission occurs by bite of Aedes aegypti female mosquitoes – the same vector of urban yellow fever – a day-active species with low fly-autonomy that is abundant in and around human habitations.

Clinical Manifestations

Three Stages:1. Febrile or invasive stage – stars abruptly as high fever, abdominal pain and headache; later

flushing which my be accompanied by vomiting, conjunctival infection and epistaxis.

2.Toxic or hemorrhagic stage – lowering of temperature, severe abdominal pain, vomiting and frequent bleeding from gastrointestinal tract in the form hematemesis or melena. Unstable blood pressure, narrow pulse pressure and shock. Death may occur. Tourniquet test, which may be positive on 3rd day, may become negative due to low or vasomotor collapse.

3.Convalescent or recovery stage – generalized flushing with intervening areas of blanching appetite regained and blood pressure already stable.

Classification:Grade I – thrombocytopenia + hemoconcentration. Absence of spontaneous bleeding.Grade II – thrombocytopenia + hemoconcentrarion. Presence of spontaneous bleeding.Grade III – thrombocytopenia + hemoconcentration. Hemodynamic instability: filiform pulse, narrowing of the pulse pressure (<20 mmHg), cold extremities, mental confusion.Grade IV – thrombocytopenia + hemoconcentration. Declared shock, patient pulseless and with arterial blood pressure = 0 mmHg (dengue shock syndrome-DSS)

Diagnostic TestTourniquet test (Rumpel Leads Test)

Inflate the blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressure for 5 minutes.

Release cff and make an imaginary 2.5 cm square or 1 inch square just below the cuff, at the antecubital fossa.

Count the number of petechiae inside the box.

*A test is positive when 20 or more petechiae per 2.5 cm square or 1 inch square are observed.

V. ANATOMY AND PHYSIOLOGY OF THE AFFECTED SYSTEM

THE BLOOD

Blood is the only fluid tissue. Although blood appears to be appears to be thick homogenous liquid the microscope reveals it has both liquid and solid components. Essentially blood is a complex connective tissue in w/c living blood cells, the formed elements are suspended in a nonliving fluid matrix called plasma.

Although it’s not visible there is a thin whitish layer called Buffy coat at the junction between the formed elements and the plasma. This layer contains the leukocytes the white blood cells that act in various ways to protect the body and platelets cell fragments that function in the blood clothing process. Erythrocytes normally account to about 45 percent of the total volume of blood samples a percentage known as the hematocrit. White blood cells and platelets contribute less than 1 percent and plasma makes up most of the remaining 55 percent of whole blood.

Blood is a sticky opaque fluid w/ a characteristics metallic taste. Blood is heavier than water and about five times thicker or more viscous largely because of its formed elements.

Blood is slightly alkaline with a ph between 7.35 and 7.45. Temperature 38 C or 100.4 F w/c is always slightly higher than the normal body temperature. Blood accounts approximately 8 percent of body weight and its volume in healthy males is 5-6 letters or approximately 6 quarts.

ERYTROCYTES

Red Blood Cells function primarily to ferry oxygen in the blood to all cells in the body. They are superb example of the fit between cell structure and function. RBC differ from other blood cells because c they are anucleate that is they lack nucleus. They also contain very few organelles. In fact mature RBC circulating in the blood literally sacs of hemoglobin molecules. HEMOGLOBIN is

iron containing proteins that transport the bulks of oxygen that is carried in the blood. More over because the RBC lack mitochondria and make by ATP by anaerobic mechanism they do not use up the oxygen they are transporting, making them very efficient oxygen transporter. Erythrocytes are small cells shape like biconcave disks, flattened disks w/ depressed centers. Because of their thinned centers they looked miniature doughnuts when vied in the microscope. Their small sizes and peculiar shape provide large surface area relative to their volume, making them very idea suited for gas exchange. RBC s outnumbers white blood cells by about 1000 to 1 and are the major factors contributing to blood viscosity. RBC normally counts about 5 million cells per cubic millimeter of the blood. The more hemoglobin molecule in the RBC the more oxygen they carry. A single red blood cell contains about 250 million hemoglobin molecule, each capable of binding 4 molecules pf the oxygen, each of his tiny cells can carry 1 million of oxygen molecule. Clinicaly normal blood contains 12-18 g hemoglobin per 100 ml blood. Hemoglobin content is slightly higher in men 13-18 g, than in women 12-16 g. An excessive or abnormal increase in the erethrocytes is POLCYTHEMIA. This may result from the bone marrow cancer, it may also be a normal physiological response to high altitudes where the air is thinner and less oxygen is available.

The major problems that result in the excessive number of RBCs is increase in blood viscosity w/c causes it flow sluggishly in the body and impairs in the circulation.

LEUKOCYTES or white blood cells are far less numerous than red blood cells they are crucial to body defense against disease. There is 4000 to 11000 WBC s per cubic millimeter and they account 1 percent of total blood volume. White blood cells are the only complete in the blood that is they contain nuclei and the usual organelles.

Leukocytes form a protective movable army that helps defend the body against damage the bacteria, virus’s parasites and tumors cells. Red blood cells ar5e confined to the blood streams and carry out their function in the blood. WBC by contrast are able to slip into and out of blood vessels-a process called diapedesis .The circulatory system are simply their means of transportation to areas of he body where their services are needed in the inflammatory and immune response.

In addition WBCs can locate areas in the tissue damage and infection of the body by responding to certain chemicals that diffuse from the damage cells, this capability is called positive chemotaxis. Once they have “caught the scent” the WBC move through the tissue space by ameboid motion. By fallowing the diffusion gradient they pinpoint areas of tissue damage and rally round in large numbers and destroy foreign substances and dead cells.

WBCs are classified into two major groups:

GRANULOCYTES are granule containing WBCs. They have lobed nuclei w/ typically consist of several rounded nuclear areas connected by thin strands of nuclear material. The granules in their cytoplasm stain specifically w/ Wright stain. The granulocytes include the nuetroplis, eosinophils, and basophils.

a. Viscosity - blood is more viscous than water. Changing the % of cells, cellular fragments, plasma proteins or other dissolved substances changes the viscosity. Viscosity is increased if either the plasma (fluid) is decreased (ex. during dehydration) or if the substances within the blood are increased (ex. polycythemia)

b. Concentration the cells (red blood cells and white blood cells) that are dissolved within the plasma are dependent on the concentration of the plasma because water is free to move into or out of the cell by osmosis. Normally, the plasma is isotonic to the cells. If however, the plasma becomes hypertonic, the cells will lose water and shrink. A process called crenation. If the plasma becomes hypotonic, the cells will take on water and swell. If they take on too much water, they could burst. A process called hemolysis. Maintaining plasma concentration is essential for the integrity of these cells.

c. Volume - A typical female has 4-5 liters of blood and a typical male has 5-6 liters of blood. Maintaining blood volume is essential in maintaining blood pressure. If blood pressure drops below a critical level, blood delivery throughout the body is impaired and death is probable.

d. pH - plasma proteins, like all proteins of the body, have a 3-dimensional shape that is dependent on the correct amount of hydrogen (and hydroxyl) ions being present. If the pH

is altered from the normal value of 7.35-7.45, the plasma proteins lose their 3-D shape and are denatured and unable to carry out their functions.

e. Temperature - the enzymes of the body are responsible for all of the chemical changes that occur. The function of enzymes to work properly is dependent on temperature. Enzymes work efficiently at body temperature. Below body temperature, the enzymes work more slowly. They can slow down enough to not be able to meet the needs of the body. If the temperature rises, the enzymes will work more efficiently but, if the temperature is raised too high (106 or so) they are denatured, resulting in brain damage and perhaps death. The function of the blood is to pass through the hypothalamus of the brain to be monitored for temperature. If blood temperature is too high or too low, homeostatic mechanisms are initiated to reestablish normal body temperature

Plasma proteins are mainly produced by the liver. These include:

Albumin - the main function of albumin is to increase the osmotic force in the blood. This osmotic force is responsible for drawing fluids into the bloodstream in order to maintain blood volume (and thus blood pressure). If albumin levels increase, more fluid is drawn into the blood and normal blood volumes are increased (and thus blood pressure is increased). If albumin levels are decreased (say due to liver damage and the liver is not producing enough or there is kidney damage and albumin is being lost from the body), less fluid is drawn into the blood and normal blood volume is decreased (and thus blood pressure is decreased).

Clotting proteins - the liver is responsible for making the many proteins associated with blood clotting including fibrinogen, plasminogen, clotting factors etc). These must be maintained at proper levels for properly functioning coagulation.

Alpha and beta globulin - proteins responsible for carrying non-soluble lipids in the blood.

Gamma globulins - These proteins, also called antibodies, are NOT made by the liver.

There are three formed elements in blood: red blood cells, white blood cells and platelets. Red blood cells constitute the vast majority of these formed elements.

The RBC is a biconcave cell, flexible, no nucleus, lacks mitochondria, contains few organelles and contains the protein hemoglobin. It is essentially a A bag of hemoglobin@.y white blood cells in response to a specific antigen (foreign substance). RBC are produced in myeloid tissue (red bone marrow) located in cranium, vertebrae, y the adrenal cortex in males and females and in the testes in males. Testosterone, in addition to its many other functions, stimulates the kidney to produce more erythropoietin. More erythropoietin, more RBC, more oxygen delivered. Because males have higher levels of testosterone, they also have more RBC and are able to deliver more oxygen. The reason for the high level of red blood cell production is due to the high rate of destruction. Know the average lifespan of a red blood cell and understand why and how red blood cell destruction occurs.

  The most important and the most complex component of hemostasis is coagulation (blood clotting) this process and is initiated, the formation of thrombin, the formation of fibrin. The final clo: Blood coagulation is a much more complex process that requires numerous substances including calcium, clotting factors, platelets, vitamin K (needed to make clotting factors II, VII, IX and X). If any of these are not in the correct amounts, the possibility of too much clotting (formation of thrombus or embolism) or too little clotting (hemophilia) is the result. The initiation of blood clotting can occur by two separate mechanisms: the intrinsic pathway and the extrinsic pathway. The most notable difference between these two pathways is the intrinsic pathway is initiated by damaged to the inside of the vessel and is started by platelets (damaged occurred from inside). The extrinsic pathway is initiated by damage the tissue that surrounds the vessel (damage occurring from outside - generally) in either case, through a series of complicated steps, an activation factor is produced.Body Defenses

Every second of every day, an army of hostile bacteria, viruses, and fungi swarms on our skin and invades our inner passages- yet we stay amazingly healthy most of the time. The body

seems to have developed a single-minded approach toward such foes- if you’re not with us, then you’re against us!

The body’s defenders against these tiny but mighty enemies are two systems, simply called the nonspecific and the specific defense systems.

The nonspecific defense system responds immediately to protect the body from all foreign substances, whatever they are. The nonspecific defenses are provided by intact skin and mucous membranes, the inflammatory response, and a umber of proteins produced by body cells. This system reduces the workload of the second protective arm, the specific defense, by preventing entry and spread of microorganisms throughout the body.

The specific defense system, more commonly called the immune system, mounts the attack against particular foreign substances. Although certain body organs (lymphatic organs and blood vessels) are intimately involved with the immune response, the immune system is a functional system rather than an organ system in an anatomical sense. Its “structures” are a variety of molecules and trillions of immune cells, which inhabit lymphatic tissues and circulate in body fluids. The most important of the immune cells are lymphocytes and macrophages.

When our immune system is operating effectively, it protects us from most bacteria, viruses, transplanted organs or grafts, and even our own cells that have turned against us. The immune system does this both directly, by cell attack, and indirectly, by releasing mobilizing chemicals and protective antibody molecules. The resulting highly specific resistance to disease is called immunity (immune= free).

Unlike the nonspecific defenses which are always prepared to defend the body, the immune system must first “meet” or be primed by an initial exposure to a foreign substance (antigen) before it can protect the body against it. Nonetheless, what it lacks in speed it makes up for in the precision of its counterattacks. Although we will consider them separately, keep in mind that specific and nonspecific defenses always hand-in-hand to protect the body.

Specific Body Defenses

Some nonspecific resistance to disease is inherited. For instance, there are certain that humans never get, such as some forms of tuberculosis that affect birds. Most often, however, the term nonspecific body defense refers to the mechanical barriers that cover body surfaces and to cells and chemicals that act on the initial battlefronts to protect the body from invading pathogens (harmful or disease-causing microorganisms).

Phagocytes

Pathogens that make it through the mechanical barriers are confronted by phagocytes (fa’go-sitz”; phago = eat ) in nearly every body organ. A phagocyte, such as a macrophage or neutrophil, engulfs a foreign particle much the way an amoeba ingests a food particle. Flowing cytoplasmic extensions bind in a vacuole. The vacuole is then fused with a lysosome, and its contents are broken down or digested. Functions of the bloodBlood performs two major functions:

transport through the body of

o oxygen and carbon dioxide

o food molecules (glucose, lipids, amino acids)

o ions (e.g., Na+, Ca2+, HCO3−)

o wastes (e.g., urea)

o hormones

o heat

defense of the body against infections and other foreign materials. All the WBCs participate in these defenses.

VII. Laboratory and Diagnostic Examination

HEMATOLOGY REPORT (01-04-06)

COMPLETE BLOOD COUNT

RESULTS NORMAL VALES SIGNIFICANCE

Hemoglobin138g/L 120-150 g/L Within normal range

Hematocrit 40% 31-43% Within normal rangeLeucocytes 5.4 x 10 g/dL 4.4-11.3 x 10 g/dL Within normal rangeNeutrophils 54% 47-63% Within normal range

Lymphocytes 33 % 20-40% Within normal rangeThrombocytes No.

Concentration123 x 10 g/L 150-350 x 10 g/L

HEMATOLOGY REPORT (01-05-06)

COMPLETE BLOOD COUNT

RESULTS NORMAL VALES SIGNIFICANCE

Hemoglobin139 g/L 120-150 g/L Decreased; possible

of being anemicHematocrit 42% 31-43% Within normal range

Thrombocytes No. Concentration

102% 150-350 x 10 g/L

HEMATOLOGY REPORT (01-06-06)

COMPLETE BLOOD COUNT

RESULTS NORMAL VALES SIGNIFICANCE

Hemoglobin144 g/L 120-150 g/L Within normal range

Hematocrit 43 % 31-43% Within normal rangeLeucocytes 4.8 x 10 g/dL 4.4-11.3 x 10 g/dL Within normal

rangeNeutrophils 48% 47-63% Within normal range

Lymphocytes 32 % 20-40% Within normal rangeThrombocytes No.

Concentration144 x 10 g/L 150-350 x 10 g/L

VIII. Physical Assessment with Pathophysiologic BasisDate assessed: January 05-06, 2006

PSYCHOSOCIALTYPE OF FAMILY: Nuclear familySIGNIFICANT OTHERS: Mother and FatherCOPING MECHANISM: Comfort and security from parentsPRIMARY DIALECT: TagalogSOURCE OF HEALTH CARE: Public health careGENERAL APPEARANCE: pale lookingMEMORY: IntactSPEECH: Normal and clearNON-VERBAL BEHAVIOR: Grimace SOURCE OF INCOME: Mother working as a public health personnel IN TIMES OF FINANCIAL CRISIS: Depends on family and relatives

ELIMINATIONURINATION: URINE PATTERN: 3 times a day COLOR: Yellow TRANSPARENCY: Clear

TOILETING ABILITY: IndependentSTOOL PATTERN: Once a dayCONSISTENCY: loose with solid particles COLOR: brown

REST AND ACTIVITYSLEEP PATTERN: sleeps well, 6-8 hours every nightCURRENT ACTIVITY LEVEL: ADL: able to do activities without assistanceBODY FRAME: mesomorphRANGE OF MOTION: able to extend and flex both upper and lower extremitiesMOTOR FUNCTION: FINE: Can able to grasp GROSS: Can able to kick and pushPAIN RELIEF MEASURE: Medication and bed rest

SAFETY AND ENVIRONMENTALLERGIES: No known allergies on food and drugsEYES/VISION: Intact and able to respond to lightHEARING: Intact and able to respond on soundsSKIN INTEGRITY: impaired, presence of rashes and petechiae @ both lower and upper extremitiesEXTREMITIES: no deformitiesMUCOUS MEMBRANES: dry oral mucous membraneTEMPERATURE: AfebrileLocation: axilla

OXYGENATIONACTIVITY INTOLERANCE: Can able to do activity with minimum movementAIRWAY CLEARANCE: NOSE: No obstruction MOUTH: No obstruction

RESPIRATION RATE: 19 bpmRHYTHM: RegularPOSTURE ASSUME: Sitting positionCOLOR: SKIN: Pinkish NAILS: Pinkish LIPS: Pale and dry

CAPILLARY REFILL: 1-2 secondsPERIPHERAL PULSES; LOCATION: Radial RATE: 80 cpm

BLOOD PRESSURE: 110/90 mmHg

NUTRITIONHOSPITAL DIET: On DAT except dark foodsIV’s: SOLUTION: D5LR SITE: Left hand

FLUID INTAKE: MORE THAN 600 ml/day combination of water and IV’sABILITY TO: CHEW: Able to chew

SWALLOW: Able to swallow TOLERATE FOODS: able to tolerate foods

FEED HERSELF: Yes

IX. DRUG STUDY

1.PARACETAMOL

GENERIC NAME: AcetaminophenTRADE NAME: TempraCLASSIFICATION: antipyretics, non-opioid analgesics DOCTOR’s ORDER: Paracetamol 500 mg/ 1 tablet every 4 hours( for fever)DATE STARTED: 01-04-06

ACTIONS:Inhibits the synthesis of prostaglandin that may serve as mediator of pain and fever,

primarily in the CNS. Have no significant anti – inflammatory properties of GI toxicity.

INDICATION:Fever reduction. Temporary relief of mild to moderate pain. Generally a substitute for

aspirin when the latter is not tolerated or is contraindicated.

CONTRAINDICATION:Contraindicated in previous hypersensitivity. Products containing alcohol, aspartame,

saccharin, sugar, or tartrazine should be avoided in patient who has hypersentivity or intolerance to this compound. Use cautiously in malnutrition.

ADVERSE EFFECTS:GI: hepatic future, hepatotoxicity (overdose)GU: renal failureDermatology: rash, urticaria

NURSING IMPLICATIONS: Monitor for s/s of: hepatotoxicity, even with moderate acetaminophen doses,

especially in individuals with poor nutrition. Do not take other medications (e.g. cold preparation) containing acetaminophen

without medical advice; overdosing and chronic use ca cause liver damage and other toxic effects.

Do not self medicate adults for pain more than 10d (5d for children) without consulting a physician.

Do not se this medication without medical direction for: fever persisting longer than 3d, fever over 39.5 °C, or recurrent fever.

Do not give children more than 5 doses in 24 h unless prescribe by the physician.1.2. VITAMIN A

GENERIC NAME: VITAMIN ATRADE NAME: (generic name was used)CLASSIFICATION: VitaminDOCTOR’s ORDER: Vitamin A 5000 #4 S.O.DATE STARTED: 01-04-06

ACTIONS:Essential for normal growth and development of bones and teeth, for integrity of epithelial

and mucosal surfaces, and for synthesis of visual purple necessary for visual adaptation to the dark.

INDICATION:Vitamin A deficiency and as a dietary supplement during periods of increased requirements

such as infection.

CONTRAINDICATION:History of sensitivity to vitamin A or to any ingredient in formulation, hypervitaminosis A,

oral administration to patients with malabsorption syndrome.

ADVERSE EFFECTS:Body as a whole: Anaphylaxis, death (after IV use)CNS: Irritability, headache, increased intracranial pressureGI: Hepatosplenomegaly, jaundiceHematologic: Leukopenia, hypoplastic anemias, vitamin A plasma levels <1200 IU/dL,elevations of sedementation rate and prothrombin timeMusculoskeletal: Slow growth; deep, tender, hard lumps over radius, tibia, occiput; retarded growth.Urogenital: Hypomenorrhea

NURSING IMPLICATIONS: Evaluate dosage with consideration of patient’s average daily intake of vitamin. Monitor therapeutic effectiveness. Vitamin deficiency is often associated with

protein malnutrition as well as other vitamin deficiencies. It may manifest as night blindness, restriction of growth and development , epithelial alterations, susceptibility of infections, abnormal dryness of skin, mouth and eyes, and urinary tract calculi.

3.CETIRIZINE

GENERIC NAME: CETIRIZINETRADE NAME: VERLIXCLASSIFICATION: Antihistamine; H1-receptor antagonist; Non-sedatingDOCTOR’s ORDER: Cetirizine 10 g/tab. ODDATE STARTED: 01-05-06ACTIONS:

Cetirizine is a H1-receptor antagonist and thus antihistamine without significant anticholinergic or CNS activity. Low lipophilicity combined with its Hi-receptor selectivity probably accounts for its relative lack of anticholinergic and sedative properties.

INDICATION:Seasonal and perennial allergic rhinitis and chronic idiopathic urticaria.

CONTRAINDICATION:Hypersensitivity to H1-receptor antihistamines; children <2 y/o.

ADVERSE EFFECTS:GI: Constipation, diarrhea., dry mouth. CNS: Drowsiness, sedation, headache.

NURSING IMPLICATIONS: Monitor of drug interactions. As the drug is highly protein bound, the potential

for interactions with other ptotein-bound drugs exists.

X. SUMMARY OF COURSE IN THE WARD

Last January 04, 2006 @ 2:30 pm, the patient, a 13 yr./old boy was received @ ER cuddled by his mother with the patient clinical history of on and off fever(5 days PTA), with IVF of D5LR one liter regulated @ 68mggts/min. @ 400 cc level on his left arm. 5 days PTA, the patient was positive of on and off fever and few days PTA the patient was positive of rashes, thereby, the patient was admitted to the pedia ward and was cuddled with the same IVF with the consent for admission signed by the mother of the patient and was signed by Dr. Respicio/ Dr. Bunuan. The Doctor ordered for repeat Hgb,Hct,APC due @6:00 pm. The patient was given a paracetamol 5oo mg/ 1 tablet but for fever only and also Vitamin A 5000 #4 OD. The patient was on DAT and for BP monitored.

On his second day of Hospitalilzation, January 05, 2006, that’s the time when I handle the patient. The patient was still with the same IVF and continues with his medications including for BP monitored and still on DAT. The patient experienced non-productive cough but he looks good and easy to cope up with his every activity. He has still rashes so the Doctors order him to take Cetirizine 10g/ 1 tablet OD.The Doctor order him for repeat Hgb,Hct and APC.Then endorsed patient with latest BP of 110/80mmHg.

On his last day of hospitalization, January 06,2006.The patient look good and comfortable now but with some kind of anxiety because he is on MGH but with still rashes(some).The doctor again order him for repeat Hgb ,Hct, and APC.Home medication is Ceritizine. So I endorsed patient with BP of 110/90 mmHg.

SAINT MARY’S UNIVERSITY BAYOMBONG NUEVA VIZCAYA

SCHOOL OF HEALTH SCIENCES

CASE STUDY ON

DENGUE FEVER

SUBMITTED TO:

Mr. Patrick Lannu, RN>

SUBMITTED BY:

Alfie Mae Pe BenitoBSN III-HGROUP 18

XI. COMPREHENSIVE NURSING CARE PLANS

NURSING CARE PLAN ASSESSMENT NURSING

DIAGNOSISSCIENTIFIC EXPLANATION

PLANNING NURSING INTERVENTION

RATIONALE EVALUATION

“S”>”paubo-ubo siya ng minsan kaya medyo may paghi2rap siyang huminga AVB the mother“O”>dyspnea>still have non-productive cough>rashes

Ineffective airway clearance related to obstruction on respiratory airways secondary to non-productive cough

> Primary functions of the respiratory system are to remove CO2 and provide O2. Normal tidal volume is about 500mL, and normal frequency is 15 breaths per minute for a total ventilation of 7.5 L/ min. Because of dead space, alveolar ventilation is 5 This is to supply the person adequate supply of oxgen to inhale. Aids the body to compensate to the low oxygen supplyL/min. >Partial pressure of co2 in arterial blood is directly proportional to

After 3 days of nursing intervention patient will establish effective breathing pattern aeb:>no sings of respiratory compromise/ complaints

>observe respiratory rate/depth

>auscultate breath sounds

>instruct and assist effective breathing techniques

>administer analgesics before breathing pattern treatments

>shallow breathing with respiration, holding breath may result in hypoventilation>areas of absence of breath sound suggests atelectasis, where as adventitious sounds reflect congestionpromote\s ventilations of all lung segments and mobilization and expectoration of secretions

>facilitate more effective coughing, deep breathing and activity

After 3 days of nursing intervention patient established effective breathing pattern aeb:>no signs respiratory compromise/ complaints

amount of co2 produced each minute and inversely proportional to alveolar ventilation.>gas exchange is critically dependent on proper matching of ventilation and perfusion. >presence of secretions in the respiratory passageway can result to obstruction thus altering patients breathing pattern

NURSING CARE PLAN FOR ALTERED COMFORT

ASSESSMENT NURSING DIAGNOSIS

SCIENTIFIC EXPLANATION

PLANNING NURSING INTERVENTION

RATIONALE EVALUATION

S>”hindi aki mapakali kasi medyo makati yung mga rashes ko AVB the patient’O”> itchiness>restlessness>irritable >grimace> petecheal rashes

Altered comfort related to itchiness secondary to rashes AEB the objectives cues

>Pain producing sensory stimuli in skin and viscera activate peripheral nerve endings of primary afferent neurons, witch synapse on second-order neurons in cord or medulla. These second-order neurons form crossed ascending pathways that reach the thalamus and are projected to somatosensory cortex. Parallel ascending neurons connect with brainstem nuclei and ventrocaudal and medial thalamic nuclei. These parallel pathways project to the limbic systems and underlie the

After 3 days of rendering nursing intervention the patient will be able to:> have (-) itchiness>comfortable>(-) petecheal rashes(-) grimace

>encourage bed rest during acute phase

>provide/recommend nonpharmacological measures for relief of headache

>eliminate vasoconstriction activities that aggravate headache

>provide liquids, soft foods mouth care if nosebleeds occur or nasal packing has been done to stop bleeding>administer analgesic as ordered

>minimizes stimulation/ promotes relaxation>measure reduce of cerebral vascular pressure and that slow/block sympathetic response are effective in relieving headache and associated complications.>activities that increase vasoconstriction accentuate the headache in the presence of increased cerebral vascular pressure>promoted general comfort.

>reduce/control pain and decrease

After 3 days of rendering nursing intervention the goal was partially met aeb:> with still slightly of itchiness> with still some rashes on upper and lower extremities>(-) restlessness>(-) grimace

emotional aspect of pain. Pain transmission is regulated at the dorsal horn level by descending bulbospinal pathways that contain serotonin, norepinephrine , and several neuropeptides.

stimulation of the sympathetic nervous system

IV. Pathophysiology

Etiologic Factors Risk/Predisposing Factors- 4 serotype of dengue virus (I, II, III, IV) -water stored in household or brought by the vector

brought by the vector standing water in premises, high human density - Aedes Aegypti mosquito -Poor waste management, living in rural areas

- Mosquito bites on the integumentary system of a specific subj. - Weak immune system

Enter the bloodstream

↑ no. of viruses (4-6) day of incubation

decompensatory compensatory

Liver Bloodstream vascular permeability immune response

Destroys Platelet (adhesion) leakage of plasma fever redness muscle pain Hepathocytes

platelet destruction hemoconcentration

Coagulation defect Hepatomegly thrombocytopenia hypovolemia dehydration

DIC Abdominal pain n/v When Palpated shock

Nose bleeding petechiae hemoptysis

Death