28086570 Final Dengue

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COLEGIO DE SAN JUAN DE LETRAN – CALAMBASchool of Nursing

Calamba City, Laguna

DENGUE HEMORRHAGIC FEVER: ACASE STUDY

Submitted by:BIÑAS, MAYET O.

BONIFACIO, CYRIL S.BUGUIS, JOHARA A.BURGOS, MYRILL L.

CAASI, HECTOR ANTHONY A.CABALFIN, APRIL RHOSE E.

CALDERON, APRIL EVISON A.CALUPIG, LOURINE A.

CAMO, RACHEL ANNE D.

CANICON, HAZELLE G.CAPIO, RENE C.

CAPURIHAN, CRIZZA JOY T.CARIÑO, JENNIFER

CARMONA, MARICEL M.4BSN1/GROUP III

Introduction

Background of the Study

Dengue hemorrhagic fever is an acute febrile diseases found in tropics.It is a

complication of Dengue fever with hemorrhages. It is characterized by abnormal

vascular permeability, hypovolemia and abnormal blood clotting mechanism.

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The Dengue virus type 1,2,3,4, along with other arboviruse which are

chikungunya, O’ nyong-nyong, west nile and flavi virus are classified as the

causative agents. The vector responsible for the transmission of the virus is the

domestic, day- biting mosquito known as the Aedes aegypti.The vector

responsible for the transmission of the virus is the domestic, day-biting mosquitoknown as the Aedes aegypti.

Rationale for choosing the case

The researchers decided to choose this case because they wanted to acquire more

knowledge about Dengue Hemorrhagic Fever II. They wanted to use the

knowledge they have acquired in promoting awareness to the people especially

the underprivileged that they should seek for medical care in order to prevent the

development and progression of Dengue Hemorrhagic Fever. The researchers also

wanted to focus on preventive measures.

Significance of the Study

This study will help the nursing profession by providing information about the

proper management and care for patients who have Dengue Hemorrhagic Fever. Itwill also educate the people, especially those who have Dengue Hemorrhagic

Fever and vulnerable individuals to seek medical care in order to prevent dengue

Hemorrhagic Fever. It will increase awareness about the importance of having a

healthy lifestyle.

This study will elaborate the interrelatedness of lifestyle habits and developing

Dengue Hemorrhagic Fever.

Scope and Limitation of the Study

This study is focused on the nursing aspect of care to those patients who had,

currently have and are at risk for Dengue Hemorrhagic Fever. This study will only

be used in the nursing profession. The researcher will only be focused their

attention on the medications, diagnostics, care plan, pathophysiology and

discharge planning. This study is not limited to patients who have Dengue

Hemorrhagic Fever only, but it is also for all the people who are interested in the

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disease. We are more focused on the primary prevention through health education

because primary prevention is the true prevention.

Patient’s PROFILE

Biographic Data:

Name: Patient XL Case No: 05-992216

Age/Sex: 9/Female Civil status: Child

Birthdate: December 22, 2000 Religion: Roman Catholic

Birthplace: Makati Medical Center

Occupation: grade three student

Present address: Parian, Calamba City, Laguna

Date of Admission: July 18, 2009

Attending Physician: Dr. Moran, LBDH

Admitting Diagnosis: DHF IIChief complaint: abdominal pain; episodes of vomiting

HISTORY OF PRESENT ILLNESS

The patient is a 9 year-old female, a grade three student who was diagnosed with Dengue

Hemorrhagic Fever II.

Five days prior to admission the client suffers from having a high fever with a

temperature of 39. 4 degrees celcius, Paracetamol was given for relief. After three days the fever subsides and abdominal pain and vomiting of brownish colored vomitus takes place. Due to persistence of the said signs and symptoms, the patient seek consultation and hence admitted at

Los Baños Doctors’ Hospital Medical Center with Dr. Moran as her attending physician.

Upon admission the child has experienced gum bleeding with presence of petechiae over the face and lower extremities accompanied by loss of appetite. Hematology examination shows

low platelet count with a value of 100 mm3.

During the interview session she has a fever and experiences no gum bleeding at all. Her

abdominal pain becomes intermittent.

PAST MEDICAL HISTORY

According to the patient’s mother, she experienced having urinary tract infection when

she was five years old. The patient only experiences having common cough and colds

occasionally. She also experiences fever before and it was relieved by over the counter drugs and

rest. Their family does not seek consultation for regular health check up. She has not been

hospitalized and only seeks consultation to their Baranggay Health Center whenever any health

problem arises. She did not receive an immunization vaccine for measles. She also denies having

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allergies to food and drugs. She says that she is allergic to dust and particles.

FAMILY HISTORY

The patient has a family history of hypertension. Her mother and father are both

hypertensive. Her eldest sister is 23 years old, alive and healthy. Followed by a 21 year old male,

20 year old female, 15 year old female which are alive and healthy also and the last is the patient,

the youngest.

Activities of Daily Living

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Gordon’s FunctionalHealth Patterns

Before During Hospitalization

Health Perception andHealth Management

Pattern

The patient sees her pattern

of health as normal as she

suffered from no seriousillnesses before. She manages

her health by following her mother’s instructions such as

sleeping early and eating

foods on regular basis. Shealso follows proper personal

hygiene for her to become

healthy.

She believes that wellness

will be attained if doctor’s

orders are to be strictlyfollowed.

Nutritional and Metabolic

Pattern

The patient usually eats

vegetables because they havemany of it planted in their

backyard. She said that her favorite food is junk foods

especially chips and salty

foods. She is also fond of eating sweets such as

chocolates and candies. She

usually drinks up to 6 glasses

of water a day includingother beverages. She is not

taking any vitaminsupplements.

The patient is forbidden to eat

dark-colored foods,carbonated drinks and junk

foods.

Elimination Her elimination pattern has

somehow deviated from her

usual urine and stool

elimination. Before her confinement, she usually

urinates for 7 times a day and

defecates at least 2 times per day.

During her confinement, she

now urinates 5 times a day

and defecates 3 times a day.

According to her the variationfrom her elimination pattern

is due to change in appetite

and setting.

Rest and Activity A typical day to her would be

waking up at around 6:00 am

to attend her school. She goeshome at 4:00 in the

afternoon. She does her home

works before eating dinner.

She goes to sleep at 9:00 p.m.

She plays board games with

her other siblings during

confinement. She usuallywakes up at 8 o’clock in the

morning, takes nap after

lunch and goes to sleep at 10

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During her spare time, she

plays hide and seek, patintero and piko with her

classmates.

o’clock in the evening.

Sleep-Rest Pattern The client doesn’t have anydifficulty in sleeping pattern.

She sleeps at around 8 in theevening and wake up early.

She doesn’t have the habit of

sleeping at daytime. Sheusually drinks Milk before

she goes to Sleep and she

usually sleeps at about 10

hours daily.

She usually wakes up at 8o’clock in the morning, takes

nap after lunch and goes tosleep at 10 o’clock in the

evening.

Cognitive-PerceptualPattern The patient is able to readand write. She is currently in

grade three in elementaryeducation and portrays a

sharp memory when asked

about past experiences andsignificant others. She also

has good eyesight and has a

normal functioning for her

senses and perception.

Patient’s mother brings withthem her books to refresh her

of the missed lessons inschool.

Self-Perception and Self Concept Pattern

She views herself as astudent. A student who needs

to fulfill her dreams through

studying hard. She also stated

that she is a jolly, smart andcaring individual.

She has good body posture

and was able to maintain eye

contact upon interview.

Role-Relationships Pattern She is the youngest among

her siblings. She helps theother family members by

doing and following little

tasks whenever they ask her to do so. The patient has a

good family relationship. She

states that she is happy withthem and they care and love

Relationship with the family

members is intact, it isevidenced by their presence

during their youngest

sibling’s confinement. They play board games, and give

their youngest sibling

pasalubong like fruits.

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her so much.

Sexuality-Reproductive

Pattern

Patient denies having

secondary characteristics like pubic hair and axillary hair.

But she confirms that her

breasts are becoming bigger

than usual.

Coping-Stress Pattern As a child she also deals with

some of stressful events

everyday. When she was inschool her teacher helps her

with

her study and school works.

She manages her problems

with the help of the

significant others.

Her status now of being sick

is one of the greatest stressor

for the client and she was

able to cope up because of the

help of the significant others

Values-Belief Pattern The client is a catholic and

she usually goes to church

every Sunday with her family. She state that being

polite to them and

Following elderly them is an

important value for her. She

uses “po” and “opo” when

talking to her elder siblings.

V. Physical Assessment

BP: 100/90 mmhg

PR: 78 bpm

Temperature: 38.6 degrees celcius

RR: 18 bpm

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Area Assessed Method Used Normal

Findings

Actual Findings Rationale

SKIN

Color and

pigmentation

Lesions

Texture

Moisture

Temperature

NAILS

Nail bed color

Shape

Lesions

Thickness

Capillary refill

Inspection

Inspection

Inspection

Inspection

Inspection

Inspection

Inspection

Inspection

Palpation

Palpation

Light to deep

brown

No lesions, scars

or inflammation

Smooth

Moist

Warm

Pink

Convex

No inflammation

of

the skin around

the nail

General flushing,

rashes

No lesions, but

presence of scars

Smooth

Dry

Warm

Pale

Convex

No inflammation

of the skin

around the nail

Firm

Normal capillary

refill less than 2

sec.

Indicative of

bleeding

Normal

Normal

Due to imbalance

fluid in the body

Normal

Imbalance

between

hemoiglobin and

hematocrit results

Normal

Normal

Normal

Normal

(less than 2secs)

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Firm

HEAD

Size

Symmetry

HAIR

Color

Texture

Other findings

SCALP

Distribution of

hair

Lesions

FACE

Inspection

Inspection

Inspection

Inspection

Inspection

Inspection

Inspection

Proportion to the

body

and the skull is

rounded and

smooth

Symmetrical

Black

Curly hair,

straight

No nits/lice

present

Evenly

distributed

Proportion to the

body

and the skull is

rounded

and smooth

Symmetrical

Black

Straight and

smooth

No nits/lice

present

Evenlydistributed

No inflammation,

lumps or masses

Normal

Normal

Normal

Normal

Normal

Normal

Normal

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Skin color

Texture

Facial movement

EYES

External structure

Eyebrows

Eyelashes

Eyelids

EARS

Color

Symmetry

Shape and size

Inspection

Inspection

Inspection

Inspection

Inspection

Inspection

Inspection

Inspection

Inspection

Inspection

No inflammation,

lumps or masses

Light to deep

brown

Smooth

Symmetric facial

movement

Evenly

distributed

Evenly

distributed,

Evenly

distributed,

curved outward

Same as facial

color

Symmetrical at

Pinkish

Symmetric facial

Symmetric facial

movement

Pink conjunctiva

Evenly

distributed

Evenly

distributed

Pinkish

Symmetric at the

level of the eyes

corner

No discharges

and

inflammation

Due to fever

Normal

Normal

Normal

Normal

Normal

Due to fever

Normal

Normal

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NOSE

Color

Shape

Discharges

MOUTH

Lips

Moisture

TONGUE

Position

Color

Texture

Mobility

Lesions

NECK

Inspection

Inspection

Inspection

Inspection

Inspection

Inspection

Inspection

Inspection

Inspection

Inspection

the

level of the eyes

corner

Symmetric to

head

No discharges

and

inflammation

Same with facial

color

Symmetric

No discharges

Pink

Moist

Positioned at the

center can move

freely

Same with facial

color

Symmetric

No discharges

Pink

Dry

Central position

Dull red

Smooth

Can move freely

No lesions or

inflammation

Normal

Normal

Normal

Normal

Due to fever and

decrease fluid in

the body

Normal

Normal

Normal

Normal

Normal

Normal

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Position

Symmetry

Range of

movements

UPPER AND

LOWER

EXTREMITIES

Size

Symmetry

Skin color

Lesions

Inspection

Inspection

Inspection

Palpation

Inspection

Inspection

Inspection

Inspection

Dull red

Smooth

Can move freely

No lesions or

inflammation

Head centered

Symmetrical

Smooth

movements

without

discomfort

Symmetric and at

midline position

Equal size

Symmetrical

Light to deep

brown

No lesions,

Head centered

Symmetrical

Smooth

movements

without

discomfort

Symmetric and at

midline position

Equal size

Symmetrical

Pinkish with

rashes on bothextremities

No lesions,

deformities or

inflammation

Normal

Normal

Normal

Normal

Normal

Due to fever and

disease condition

Normal

Due to

disease

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deformities or

inflammation

THEORETICAL FRAMEWORK

Florence Nightingale's core nursing theory has an environmental focus: It was her belief that the

environment is an alterable medium that can be used to improve the conditions of Nature andencourage healing. Ventilation, clean air, clean water, control of noise, provision for light, and

Adequate waste management are just a some of the elements She believed could be Monitored

and improved when necessary.

Nightingale’s theory addresses the prevention of occurrences of Dengue Hemorrhagic Fever. In

facilitating proper environmental sanitation we can achieve a surroundings with no presence of any vector that cause its transmission as they can no longer exist if the environment is not suited

for their survival hence decreasing the morbidity rate of Dengue in our country. We should be

knowledgeable on how to keep our surroundings free from any breeding sites that could serve asa reservoir for the mosquito. As a nurse we should teach our clients how to do proper water

storage and environmental sanitation so as to prevent disease occurrence and recurrence

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ANATOMY AND PHYSIOLOGY

Blood- a connective tissue

composed of a liquid

extracellular matrix called

blood plasma that dissolves

and suspends various cells and

cell fragments.

1 - HYPERLINK "http://www.psbc.org/education/hematology/blood/blood.htm" Formed

elements:

Red blood cells (or erythrocytes)

White blood cells (or leucocytes)

Platelets (or thrombocytes)

2 - HYPERLINK "http://www.psbc.org/education/hematology/blood/plasma.htm" Plasma =

water + dissolved solutes

Characteristics of Blood

bright red

dark red/purplish

much more dense than pure water

pH range from 7.35 to 7.45

slightly warmer than body temperature

typical volume in an adult is 5 liters

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very small, 2-4 microns in diameter

approximately 250-500,000 per cubic millimeter

essential for clotting of damaged vasculature

Thrombopoietin stimulates the production

Platelet Plug Formation

PATHOPHYSIOLOGY

Precipitating Factors:

Predisposing Factors:Presence of drainage nearby Age

Not using mosquito nets, repellants

Live plants at home

Aedes Aegypti

↓Virus goes into circulation

↓

Dengue Virus Type II

↓IgG adheres to the platelet

↓thrombocytopenia

↓

increased potential for hemorrhage

↓stimulates intense inflammatory response

↓

petechial rash, high fever, headache,vomiting, abdominal pain, (+) torniquet test

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LABORATORY RESULT

Date: July 18, 2009

9:15 Fecalysis Report

Result Normal Findings Analysis

Color

Consistency

Yellow

Semi-formed

Yellow

Semi-formed

Normal

Normal

Blood: NegativeRemarks: No ova/intestinal parasite seen

Drug StudyGeneric/Brand

Name

Classification Indication

(r/t presentillness)

Contraindicati

on(r/t present

illness)

Side effects

(r/t presentillness)

Nursing

Intervention(r/t present

illness)

Ranitidine Histamine H-2

receptor

blocking drug

Prevent gastric

damage from

NSAIDS.

Impaired renal

or hepatic

function

Nausea

Vomiting

Abdominal pain

Fatigue

DizzinessMalaise

Obtain CBC;

assess for

infections,renal or liver

disease.

Report any

evidence of

yellowdiscoloration

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July 19, 2009

8:15

BP: 100/80Temp: 38.00C

Continue meds

TF: D5LRS 1L X 6hrs @ 40gtts/min

BP and Temp q 2hrsHCT am

If the hematocrit levels fall dangerously then a blood transfusion should be considered. If the

hematocrit values rise the patient should be given fluids intravenously and the fluids carefully

monitored to ensure that the patient does not get excess fluids. A rise of more than 20 % as

compared to previous levels may be an indication for IV fluids. The doctor should decide based

on best judgment of patient's condition.

Continuation of medications to prevent diseases and maintain wellness.

LABORATORY RESULT

Date: July 18, 20099:15

Urinalysis Report

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Color

Transparency

pH

Sp.gravity

Sugar

Protein

Squamous epithelial

cell

RBC

Pus Cells

Amorph.

Urates/Phosphates

Yellow

Clear

6.5

1.020

Negative

Negative

Occasional

0-2

0-2

Occasional

Yellow amber

Clear to sl. Turbid

4.5-8

1.005-1.030

Negative

Negative

Few

Few

Few

Few

Normal

Normal

Normal

Normal

Normal

Normal

Normal

Normal

Normal

Normal

LABORATORY RESULT

Date: July 18, 2009

Hematology Report


White blood cell

Hemoglobin

Hematocrit

12 x 10^g/L

10.2 g/dL

31 %

5-10 x 10^g/L

F: 13.0-18.0 g/dL

39-54 %

Increased due to

presence of infection

Decreased due to

bleeding or hemorrhage

Decreased due to bleeding or

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Segmenters

Lymphocytes

Platelet count

0.73

0.27

100 x 10^g/dL

0.60-0.70

0.20-0.30

150-450 x 10^g/L

hemorrhage

Increased due to high

glucose level in the blood

Normal

Due to presence of

bleeding

Date: July 19, 2009, AM

Hematology Report


White Blood Cells

Hemoglobin

Hematocrit

Segmenters

Lymphocytes

Platelet Count

11.9 x 10^g/L

8.5 g/dL

29 %

0.65

0.35

110 x 10^g/dL

5-10 x 10^g/L

F: 13.0-18.0 g/dL

39-54 %

0.60-0.70

0.20-0.30

150-450 x 10^g/L

Increased due to

presence of infection


hemorrhage

Decreased due to

bleeding or

hemorrhage

Normal

Increased due to viralinfection

Due to presence of

bleeding

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Date: July 19, 2009, PM

Hematology Report


White Blood Cells

Hemoglobin

Hematocrit

Segmenters

Lymphocytes

Platelet Count

10 x 10^g/L

9.5 g/dL

29 %

0.68

0.32

113 x 10^g/dL

5-10 x 10^g/L

F: 13.0-18.0 g/dL

39-54 %

0.60-0.70

0.20-0.30

150-450 x 10^g/L

Normal

Decreased due to


Decreased due to

bleeding or

hemorrhage

Normal

Increased due to viral

infection

Due to presence of

bleeding


Hematology Report


White Blood Cells 9.8 x 10^g/L 5-10 x 10^g/L Normal

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Hemoglobin

Hematocrit

Segmenters

Lymphocytes

Platelet Count

9.7 g/dL

29 %

0.69

0.36

126 x 10^g/dL

F: 13.0-18.0 g/dL

39-54 %

0.60-0.70

0.20-0.30

150-450 x 10^g/L

Decreased due to

bleeding or

hemorrhage

Decreased due to bleeding or hemorrhage

Normal


infection

Due to presence of

bleeding


Hematology Report


White Blood Cells

Hemoglobin

Hematocrit

Segmenters

Lymphocytes

9.8 x 10^g/L

10.3 g/dL

31 %

0.57

0.43

5-10 x 10^g/L

F: 13.0-18.0 g/dL

39-54 %

0.60-0.70

0.20-0.30

Normal

Decreased due to


Decreased due to


Decreased due to low

glucose level in the

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Platelet Count 133 x 10^g/dL 150-450 x 10^g/L blood


infection

Due to presence of bleeding


Hematology Report


White Blood Cells

Hemoglobin

Hematocrit

Segmenters

Lymphocytes

Platelet Count

8 x 10^g/L

10 g/dL

30 %

0.68

0.32

85 x 10^g/dL

5-10 x 10^g/L

F: 13.0-18.0 g/dL

39-54 %

0.60-0.70

0.20-0.30

150-450 x 10^g/L

Normal


hemorrhage


hemorrhage

Normal


infection


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Hematology Report


White Blood Cells

Hemoglobin

Hematocrit

Segmenters

Lymphocytes

Platelet Count

10 x 10^g/L

11.4 g/dL

35 %

0.53

0.47

101 x 10^g/dL

5-10 x 10^g/L

F: 13.0-18.0 g/dL

39-54 %

0.60-0.70

0.20-0.30

150-450 x 10^g/L

Normal


hemorrhage

Decreased due to


Decreased due to low

glucose level in the

blood


infection


DISCHARGE TEACHING

Medication

Remind to take the prescribed medicine, having a written reminder of the correct medication,

time to take, and the right frequency of the medicine on the way home to establish assurance of

medication compliance.

Don’t give aspirin and NSAID’s, they increase the risk of bleeding. Any medicines that decrease

platelet count should be avoided.

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Exercise

Instruct to avoid excessive activities that may result to stress.

Just advised to perform range of motions and repetitive body movements for promotion of optimum health.

Remind about the need for health promotion activities such as reading, watching T.V, etc.

Treatment

Bed rest is advisable during the re-occurrence of fever phase.

Instruct to drink plenty of water or fluids that are available at home and eat nutritious diet.

Advised to look for re-occurrence of danger signs and symptoms and report immediately.

Hygiene

Encourage to continue the routinely hygienic care of the patient

Out-Patient Follow-Up Care

Instruct the family members to have a check-up or to consult physician once a while tomonitor patient’s condition and for detection of recurrences and other complications that

may arise on to it.

Diet

Instruct the family members to give the client protein rich foods such as meat, fish, eggs

and nuts, vitamin K rich foods such as green leafy vegetables, vit C rich foods(guava and

tomatoes and other citrus fruits), carbohydrates rich food (breads and rice)

Long Term Objectives:

To promote holistic wellness through rendering quality nursing care and health education.

Short Term Objectives:

For Hyperthermia:

1.Within 2 hours of nursing care, the patient temperature will decrease from 38.6°C to 37-37.5°C

For Abdominal Pain:

2. Within 2-4 hours of nursing care the patient will be able to reduced pain felt from 7/10 to 5/10.

For Moderate Dehydration:

3. Within 8 hours of nursing care client will be able to minimize occurrence of fluid deficit as

evidenced by normal skin turgor

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NURSING CARE PLAN

ASSESSMENT

NURSINGDIAGNOSI

S

BACKGR OUND

KNOWLEDGE

PLANNING

INTERVENTION

RATIONALE

EVALUATION

Subjective:

“ Taas baba po yung

lagnat ko,”

as

verbalized

by the patient.

Objective:

Skinwar

m to

touc

hFlus

hed

skinTem

perat

ure:38.6

°C

Drylips

note

d

Elevated body

temperature

related toinflammator

y response

as evidenced by Temp=

38.6,

flushed andwarm to

touch skin.

Entry of pathogens in

the systemic

circulation

Regulationof toxins in

the body

Release of

pyrogens

Stimulation

of hypothalam

us

Increase or

alteration of

thermoregulation

Within 2hours of

nursing

care, the patient

temperature

willdecrease

from 38.6°C

to 37-37.5°C

Independen

t:

Renderedtepid sponge

bath

Encouraged

to increase

fluid intake

Promoted

surfacecooling,

loosen

clothing,and cool

environment

Encouraged

to have

adequate bed rest

To promote

surfacecooling

To replacefluid loss

due to body

heat

Heat is loss

by

evaporationand

conduction

To

reducemetabolic

demands

To decrease

Within 2hours of

nursing care,

the patienttemperature

will

decreasefrom 38.6°C

to 37.4°C,

skin is cooland flushing

is absent.

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WBC=

12,0

00 asseen

inlabor atory

resul

t

Increase in body

temperature

Dependent:

Administered

Paracetamolas ordered

Administere

d IVF as

ordered

temperature

To support

circulatingvolume and

tissue perfusion

ASSESSMENT

NURSINGDIAGNOSI

S

BACKGR OUND

KNOWLEDGE

PLANNING

INTERVENTION

RATIONALE

EVALUATION

Subjective:

“Masakit po

yung tyanko,” asverbalized

by the

patient.

Objective:

ĉ pain

scale

of 7/10

grim

Acute painrelated to

inflammator

y responseas evidenced

by

verbalizatio

n of patientof “masakit po yung

tyan ko”,

pain scale of

7/10,

grimace andirritability.

Entry of pathogens in

the systemic

circulation

Regulation

of toxins inthe body

Release of

anti-

inflammator y mediators

Within 2-4hours of

nursing care

the patientwill be able

to reduced

pain felt

from 7/10 to5/10.

Independen

t:

Monitoredvital signs

Instructeddeep

breathing

exercise

Encouraged

to havediversional

activites like

To

determinealteration

Helps in

relieving pain

To divertattention of

patient from

pain

Helps

After 2-4hours of

nursing care

the patientwas able to

reduced pain

felt from

7/10 to 5/10.

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acenote

d

irrita ble

weak nessnote

dCharacteris

tic:

stabbing,

shooting

pain

Onset:

“pasumpon g-sumpong

po”

Location: no exact

location“basta sa

buong tyan

po masakit”

Duration: 2-3 minutes

Exacerbatio

n:

Gets worsewhen

pressure is

applied inthe stomach

Radiation:

Radiates in

whole

abdomen

Relief:

“Kapag

Vascular

response

Increasedcapillary

permeability

HyperemiaCellular

exudation

Sw

elling

Pai

n

watchingt.v.

Placed

patient oncomfortable

position

Encouragedto have

adequate

bed rest

Providedtherapeutic

touch

Dependent:

Administere

d Ranitidine

as ordered.

reduce painfelt

For

relaxationand to

prevent

stress

To providecomfort

Helps in

relieving pain

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iniipit ko

po”

Associated

signs and

symptoms:

Bodyweak

ness,

fever

ASSESSMENT

NURSINGDIAGNOSI

S

BACKGR OUND

KNOWLEDGE

PLANNING

INTERVENTION

RATIONALE

EVALUATION

Subjective:

“Tatlong

beses poakong

nagsuka simula

kanina,” asverbalized

by the

patient.

Objective:

3

episodes

of

vomiting

wate

ryand

Fluid

VolumeDeficitrelated to

frequent loss

of fluid inthe

gastrointesti

nal tract asevidenced

by frequent

vomiting.

Insufficient

fluid intake,fluid lossfrom

vomiting

Imbalanced

in fluidvolume

Decreasedvolume in

intravascula

r compartmen

t

Within 8

hours of nursing careclient will

be able to

minimizeoccurrence

of fluid

deficit asevidenced

by normal

skin turgor.

Independen

t:

MonitoredIntake and

Output

Withhold

foods and

fluids for

about 3hours.

Instructed to

sip small

amounts of fluids after

Ensureaccurate picture of

fluid status

To prevent

irritation instomach.

Todetermine if

the stomach

can alreadytolerate

fluids

After 8

hours of nursing car the client

was able

minimizeoccurrence

of deficit as

evidenced by normal

skin turgor

and

verbalizationof patient

“hindi na po

ako

nagsuka.”

Intake(parenteral):

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8/9/2019 28086570 Final Dengue


Monocytes are the precursors of macrophages. They are larger blood cells, which after attaining maturity in the

bone marrow, enter the blood circulation where they stay for 24-36 hours.

1st child

23 yrs. old female

5th child

9 yrs old female (patient)

4th child

15yrs. old female

3rd child

20 yrs. old female

2nd child

21yrs. old male

Father

46 yrs. old w/ hypertension

Mother

48 yrs. old w/ hypertension

8/9/2019 28086570 Final Dengue


28086570 Final Dengue

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