Case study- Dengue Fver
-
Upload
mj-hernandez -
Category
Education
-
view
3.218 -
download
4
Transcript of Case study- Dengue Fver
Pamantasan ng Lungsod ng Marikina
J.P. Rizal St. Concepcion Uno, Marikina City
__________________________
DENGUE FEVER
__________________________
An Individual Case Study
In Partial Fulfillment
of the Requirement for the Course
NCM 101
RLE
St. Victoria Hospital
Submitted by:
TABLE OF CONTENTS
I. Introduction………………………………………
……….………………… 1
II. Objectives with specific
objectives……………………….…………….
3
• General Objective
• Specific Objective
III. Theoretical Foundation (Nursing theory)
……………………………… 4
IV. Nursing History……………………………………………….…………… 5
a. Biographical Data
b. Reason for seeking health care
c. History of present illness
d. Past health History
e. Family genogram…………………………………………………………… 6
f. Social History
V. Immunization/Exposure to communicable
disease………………… 7
VI. Allergies
VII. Home Medication/ Alternative medicine
VIII. Developmental Level
IX. Pediatric
History……………………………………………
…………… 8
a. Developmental Milestone
X. Anatomy and
Physiology………………………………………
….….. 9
XI. Pathophysiology (client based)
………………….…………………….
11
XII. Gordon’s functional
pattern……………………………………………
12
XIII. Physical
Assessment………………………………………
…………… 14
XIV. Diagnostic/Laboratory
Examinations………………………………...
17
XV. Medical
Diagnosis…………………………………………
…………… 23
XVI. Drug
Study………………………………………………
………………. 24
XVII. Nursing care
plan………………………………………………
……… 27
XVIII. Discharge
plan………………………………………………
…………. 31
XIX. References………………………………………
……………………… 32
I. Introduction
Dengue is one of the most common mosquito-borne viral diseases. The first and
second epidemics of Dengue hemorrhagic fever occurred in Manila in 1954 and 1956,
followed by the third in Bangkok in 1958. Since then, Dengue has spread throughout
tropical Asian countries and has expanded globally. Dengue virus belongs to the
flavivirus genus of the Flaviviridae family. They are transmitted among humans by
Aedes mosquitoes bite such as Aedes aegypti. There are four serotypes, namely
Dengue type 1, Dengue type 2, Dengue type 3 and Dengue type 4. Infection with any of
the four serotypes causes clinical symptoms that may vary in virus virulence, and host
response. And recovery from one infection provides life- long immunity against that
particular serotype. Dengue has its progression from Dengue fever, which is a simple
form of dengue it may lead to dengue hemorrhagic fever, a condition which involves
sensitive stomach, petechial, weak pulse, and internal bleeding that can lead to black
vomit or feces. If dengue hemorrhagic fever is untreated it may progress to dengue
shock syndrome, a worst form of dengue which can also result to death.
According to World Health Organization (WHO), each year an estimated 100
million cases of dengue occur worldwide, about 2.5 billion people living in tropical and
subtropical areas are at risk. The National Epidemiology Center of the Philippines'
Department of Health reports a total of 132,046 dengue cases from January to 13
October 2012. This is 24.92% higher compared to the same time period in 2011. Region
III and Region IV-A registered the highest number of cases, about 30% of these cases,
may progress to dengue hemorrhagic fever or dengue shock syndrome and an
estimated 10% will eventually lead to death. The global prevalence of dengue has
grown dramatically in recent decades. The disease is now endemic in 100 countries of
Africa, the Americas, the Eastern Mediterranean, Southeast Asia and the Western
Pacific.
There is no specific treatment for dengue fever, dengue hemorrhagic fever, and
dengue shock syndrome but this can be treated by timely supportive therapy to
undertake circulatory shock due to hemoconcentration (plasma leakage) and bleeding. 1
Close observation of vital signs by the attending physician and nurses with frequent
clinical and laboratory monitoring especially in critical point. Adequate fluid replacement
is also necessary to overcome the plasma leakage. Intravenous infusion is also helpful
to rehydrate especially if the patient is not able to maintain oral intake. For reducing
fever, frequent tepid sponge bath and paracetamol are provided. Aspirin and non-
steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are contraindicated
because these may worsen the bleeding tendency and might cause some infections.
Acetaminophen and paracetamol can be taken under the prescription of the doctor.
I chose these case because I was motivated to study this globally common,
yearly problem of most of the country in Asia. By this, I will be able to discover its
process, how it is being acquired, the pathophysiology and clinical manifestations which
are being experienced by my patient. By doing so, I am able to fructify my knowledge,
enabling me to know the appropriate nursing care for my patient. This study would help
me as a student nurse to comprehend not only the disease mentioned but also for the
commonalities and differences among other diseases for the betterment of this study.
2
II. Objectives with specific objectives
General Objective:
At the end of the study, the student will be able to improve not only the knowledge
in the disease process and clinical manifestations but also on how to give necessary
intervention indicated to the patient. By this, we will be able to hasten our knowledge,
skills, and attitude in giving appropriate nursing care for the patient. Through thorough
research and interview, we can acquire concrete and necessary information about
Dengue Fever.
Specific Objectives:
1. To establish rapport with my client and her significant others to gain good
working relationship for the success of this case study.
2. Present reasonable introduction that will provide an overview of the disease and
can be an eye-opener of information for the readers.
3. Conduct thorough physical assessment of the patient in cephalocaudal manner
to note other problems of the patient to be managed.
4. Discuss the anatomy and physiology of the affected system to have a
background regarding the organ affected by the disease.
5. Provide necessary nursing care plan to prioritize the immediate problem of the
patient.
6. Provide comprehensive discharge plan of the patient to ensure the continuation
of the management of the disease even after discharge.
3
44
III. Theoretical Foundation (1) Nursing theory
According to Florence Nightingale’s Environmental theory, ventilation is
important because a person who breathes his own air repeatedly would become
sick. She also said that we should maintain cleanliness because it is important in
quick recovery of the patient. Effective drainage is also necessary because this
will help in preventing the breeding of the epidemic diseases. And pure water is
also important because when epidemic disease shows itself, safe water is
needed to avoid infection and to ensure your health safety. The case of DG can
be associated with Florence Nightingale theory, wherein, clean environment
plays an important role in rejuvenating the patient’s optimum level of health.
According to the mother, they have uncovered stocked water outside their house
and due to continuous raining they’ve suspected that it is one of the reasons why
her daughter got the disease. Having a clean, quiet, and well- ventilated
environment, also an effective drainage and pure water will help the body to
restore more quickly.
5
IV. Nursing History
A. Biographical Data
This is a case study of DG, a 6 years old girl who lives in Guitnang Bayan,
San Mateo Rizal. Her mother is a Grade 4 teacher in San Mateo Elementary
School. She was born in Quezon City on the date of August 30, 2007. Her parents
are the ones who supported her in hospital bills. Her mother is the one who
brought her to the hospital last September 2, 2013 @6pm under the supervision of
Dra.Ordonez.
B. Reason for seeking Health Care
She was experiencing intermittent fever of 390C for the past 3 days so her
mother decided to take her to the hospital for check-up.
C. History of Present Illness
According to the mother, three days prior to admission, her daughter had a
positive intermittent fever of 390C. What she did was to self-medicate her daughter
with paracetamol for three consecutive days, but the patient was still having fever
which led them to the hospital for check- up with Dra. Ordonez who had also
advised them to have patient admitted.
D. Past Health History (PHH)
My patient had pneumonia when she was two years old and had been
admitted and stayed to the hospital for 1 and a half month. As far as the mother
recalled, her daughter took medicine like amoxicillin.
Patient DG
E. Family Genogram
Lolo (63) Lola (60) Lolo (62) Lola (59)
HPN HPN DM DM
A&W A&W A&W A&W A&W A&W A&W A&W
34 y/o 33y/o 32y/o 31y/o 30y/o 29y/o 33y/o 35y/o
F. Social History
Patient DG is the only Child of Ms.AG. She is in her school age. Patient
DG loves to play computer games at home; she does her homework first before
playing games. According to her mother she sometimes plays outside their
house with her friends.
6
Legend:
Female Male
Alive and well Female Alive and well Male
Unhealthy Female Unhealthy Male
MOTHER SIDEMOTHER SIDE FATHER SIDEFATHER SIDE
V. Immunization/ Exposure to communicable Disease
Patient DG had completed her immunization when she was a child. She
received DPT, OPV, Hepatitis vaccine, Anti-measles vaccine and BCG from the
Barangay health center. She did have pneumonia when she was 2 years old.
VI. Allergies
Patient DG doesn’t have any allergies to any food, dust, drugs or
anything according to the mother.
VII. Home Medications/Alternative Medicine
According to the mother when her daughter catches up cold and cough
she usually gave her herbal medicine like oregano juice with calamansi extract,
and it is effective to her. For fever, she usually gave paracetamol.
VIII.Developmental Level
Patient DG is in her School-age level (6-12 y/o). According to Erik
Erickson (Psychosocial theory), patient DG’s developmental task is to form a
sense of industry vs. inferiority. Child learns to do things well. Patient DG was
able to write her name correctly, she can also read paragraphs. According to her
mother she allows patient DG to do her homework on her own, and when patient
DG is done with it, she allows her to play computer games for her reward.
7
IX. Pediatric History
a. Developmental Milestone
According to Maternal and child nursing care book, Lippincott
William and Wilkins, volume two, pp 915, a school- age person treats her
teacher as the authority; adjustment to all-day school may be difficult and
lead to nervous manifestations of fingernail biting. Also, a six years old
child can walk on a straight line because they have enough coordination.
Patient DG was able to show industry instead of inferiority especially in
doing school works. She can easily tie her shoelaces, read, and write.
According to her mother, she can also shade coloring books with minimal
error, can fold and cut paper into simple shapes.
8
XII. Gordon’s Functional Pattern
PATTERN
BEFORE
HOSPITALIZATION
DURING
HOSPITALIZATION ANALYSIS
Health Perception
Dati po masigla ako,
pumapasok sa school
at naglalaro ng
computer games
Di na po ako
makapasok sa school
kasi may sakit ako
Due to her illness
Nutritional
Metabolic
She eats 3x a day,
loves to eat processed
foods such as tocino,
meatloft, hotdog. She
seldom eats
vegetables and drinks
6-8 glasses of water.
Mostly eat bread and
fruits. She drinks 6-8
glasses of water a day.
The doctor ordered
diet as tolerated
(DAT) to the patient
and except dark
colored food (EDCF)
Elimination
She is able to urinate
(3x a day) and
defecate (1x a day)
normally every day.
She usually defecate
early in the morning
before going to school
without any problem
She is able to urinate
(3x a day) and defecate
(1x a day) normally
every day.
Her condition doesn’t
affect her elimination
pattern.
Activity/Exercise
Her daily routine is
going to school, doing
home works then
playing computer
games
She interacts with her
auntie, mother and
visitors.
She only focuses on
simple things.
Sleep/Rest Matagal po ang tulog
ko, minsan 8-9 hours
Nagigising po ako
minsan.
This may be due to
giving of medication.Cognitive/
Perceptual
There is no problem in
her senses.
She can comprehend
well. Responses to
physical and verbal
There is no problem in
her senses. She is
responsive but shy
when asked.
Adjusting to
environment
12
stimuliRole-Relationship She is the only child
and source of joy and
strength of her parents.
She is the only child
and source of joy and
strength of her parents.
But also stress because
she is sick.
Due to her condition
she can’t perform her
role in her parents.
Sexuality-
Reproductive
She doesn’t fully
understand about
having a
boyfriend/married
Same Due to her youthful
mind, it is still not her
priority in life.
Coping/Stress
Tolerance
She doesn’t fully
identify stressors
Same She is still in a playful
mind and doesn’t
mind stressors of life.Values/Beliefs She is a Born-Again
Christian. She goes to
church every Sunday
Due to parents
influence
13
XIII. Physical Assessment
Name: DG
Age: 6y/o
Date of assessment: Sept. 6, 2013
BODY PARTS NORMAL FINDINGS ACTUAL FINDINGS ANALYSISSkin Uniform color, except
in the areas exposed
to the sun, no edema
present and no other
lesions
Equal distribution of color,
no lesions, (-) turgor, rash
present in in right foot.
Rash may be due to
increase of blood
pressure in the
vessel.
Hair Evenly distributed hair,
thick hair, no infection,
and no presence of
dandruff, silky and
resilient hair.
Hair is black in color, no
evidence of alopecia,
evenly distributed hair, (-)
pediculosis and dandruff
Normal findings
Head/Scalp Rounded, smooth skull
contour, absences of
nodules and masses;
has systematic facial
features and
movements.
There is no
lumps/masses, no lesions,
smooth skull contour
Normal findings
Eyes Eyebrows and
Eyelashes are evenly
distributed, the eyelids
has no discharge and
no discoloration; pupils
are black in color;
round, equal in size
normally 3-7 mm in
diameter; conjunctiva
pink in color, the sclera
are white in color.
Eye brows and eye lashes
are evenly distributed,
eyes are dark brown in
color, Sclera is white in
color, (+) light
accommodation, pupils
are black in color and
equal in size, no lesions or
discharge in conjunctiva
and is pink in color
Normal findings
Ears Color same as facial Color same as facial skin, Normal findings14
skin, symmetrical,
auricle aligned with
outer cantus of eyes
about 10º from vertical,
not tender; pinna
recoils after it is folded
able to hear sound in
both ears.
symmetrical auricle
alignment with outer
cantus of eyes. (+) ear
wax, pinna recoils after it
is folded and able to hear
sound in both ears.
Nose Symmetric and straight
no discharge or flaring,
uniform color. No
tenderness and no
lesions.
No discharge, symmetrical
and straight alignment,
uniform in color. No
tenderness and lesions
Normal findings
Lips/Mouth Lips pink in color, soft,
moist, smooth texture,
ability to purse lips; the
teeth are smooth,
white, firm texture to
the gums. Tongue is in
central position, pink in
color moist.
(-) dryness, teeth are
intact, no inflammation in
uvula and tonsil, tongue is
in central position
Normal findings
Neck Muscle equal in size;
head centered; head
movement is
coordinated and in
smooth movement. No
enlarge lymph node.
Uniform in color, no
lumps/masses, no pain
when swallowing, head
centered
Normal findings
Chest Quiet, rhythmic
respiration, normal
breathing rate, no
retraction when
breathing
No retractions when
breathing, no use of
accessory muscle used
when breathing,
symmetrical chest
movement
Normal findings
15
Abdomen Uniform color, no
evidence of enlarged
liver or spleen. Audible
bowel sounds,
absence at arterial
bruits, and absence at
friction rubs, no
tenderness.
Uniform in color, skin
intact, soft, no tenderness,
(+) borborygmi sound.
Normal findings
Extremities Convex curvature,
angle of nail plate
160º, smooth texture,
when performing the
blanch test of capillary
refill it is prompt return
of usual color. (2-3
sec)
Uniform in color, no
fractures, symmetrical in
movement, has some rash
in right foot, nail beds are
pink in color, capillary
refills at 2-3 seconds
Rash may be due to
increase of blood
pressure in the
vessel.
16
XIV. Diagnostic/Laboratory Examination
Physician: Dr. Chanyungco Date: Sept. 2, 2013
Examination Normal
Values
Actual
Findings
Significance
Hematology
ReportWBC 5.0-10.0x109/L 3.0 Decrease due to inadequate
inflammatory response defense to
suppress infection and anti-body
mediated immunity takes place.RBC 4.2-5.6x1012/L 4.8 Normal
Hemoglobin 140-180g/L 130 Decreased hemoglobin results in RBC
destruction or infiltration of bone marrow
with the infectious cell.Hematocrit 0.37-0.47 0.41 Normal
Platelet 150-400x109/L 167 Normal
WBC Differential
CountSegmenters 0.40-0.60 0.85 Increased due to infection, it attack and
kill infectionsLymphocytes 0.20-0.40 0.13 Decreased due to debilitating illness,
humoral immune response to take place.Monocytes 0.02-0.05 0.02 Normal
CBC with Platelet
Hemoglobin 125-160g/dl 120 Decreased hemoglobin results in RBC
destruction or infiltration of bone marrow
with the infectious cell.Hematocrit 0.38-0.54 0.37 Decreased results in RBC destruction or
infiltration of bone marrow with the
infectious cell.WBC 4.5-10.0x109/L 1.70 Decrease due to inadequate inflammatory
response defense to suppress infection
and anti-body mediated immunity takes
17
place.RBC 4.2-6.2x1012/L 4.20 NormalWBC Differential
CountSegmenters 0.46-0.66 0.33 Decreased due to inadequate protection to
an ongoing infection because it acts as
phagocytes and first to arrive in infected
site.
Lymphocytes 0.20-0.40 0.70 Decreased due to debilitating illness,
humoral immune response to take place.Platelet 150-400x109/L 229 Normal
Leah Tolentino Alsol, Mennen
Med. Tech Pathologist
Lab Result
Examination: Dengue NS1 Significance
Specimen: Blood Dengue NS1 an antigen tests (NS1 stands for
nonstructural protein 1), full name is Platelia Dengue
NS1 Ag assay, is a test for dengue. It allows rapid
detection on the first day of fever, before antibodies
appear some 5 or more days later.
Dengue NS1: Positive (+)
Clinical Result
Date: Sept. 3, 2013
Urinalysis Normal findings Actual findings AnalysisColor Normal urine is a transparent
solution ranging from colorless
to amber but is usually a pale
yellow.
YellowNormal findings
Transparency The turbidity of the urine sample
is clear, slightly cloud, cloudy,
opaque. Normally, fresh urine is
slightly cloudy.
Slightly turbid Normal findings18
Specific Gravity Normal urine density or values
vary between 1.003–1.035
(g·cm−3)
1.030 Normal findings
pH The pH of urine can vary
between 4.6 and 8, with neutral
(7) being norm
(6) Acidic Acidic pH helps in
preventing bacterial
growth
WBC 0.2/hpf 6-8/HPF Presence of
infectionRBC 0.2/hpf 1-3/HPF May be due to
bladder problem
Bacteria Absent Moderate Presence of
infection
Epithelial Cells Absent few Possible
contamination of the
specimen
E Examination Normal
Values
Actual
Findings
Significance
CBC with Platelet
Hemoglobin 125-160g/dl 130 NormalHematocrit 0.38-0.54 0.40 NormalWBC 4.5-10.0x109/L 2.5 Decrease due to inadequate
inflammatory response defense to
suppress infection and anti-body
mediated immunity takes place.RBC 4.2-6.2x1012/L 4.55 NormalWBC Differential
Count
Normal
Values
Actual
Findings
Significance
Segmenters 0.46-0.66 0.38 Decreased due to inadequate
protection to an ongoing infection
because it acts as phagocytes and
first to arrive in infected site.
Lymphocytes 0.20-0.40 0.62 Increase immune response fighting
infection
19
Platelet 150-400x109/L 175 Normal
Date: Sept. 4, 2013
E Examination Normal
Values
Actual
Findings
Significance
CBC with Platelet
Hemoglobin 125-160g/dl 130 NormalHematocrit 0.38-0.54 0.40 NormalWBC 4.5-10.0x109/L 1.80 Decrease due to inadequate
inflammatory response defense to
suppress infection and anti-body
mediated immunity takes place.RBC 4.2-6.2x1012/L 4.55 NormalWBC Differential
CountSegmenters 0.46-0.66 0.42 NormalLymphocytes 0.20-0.40 0.58 Increase immune response fighting
infectionPlatelet 150-400x109/L 178 Normal
Clinical Result Date: Sept. 5, 2013
Urinalysis
Urinalysis Normal findings Actual Findings AnalysisColor Normal urine is a transparent
solution ranging from
colorless to amber but is
usually a pale yellow.
Yellow Normal findings
Transparency The turbidity of the urine
sample is clear, slightly cloud,
cloudy, opaque. Normally,
fresh urine is slightly cloudy.
Clear Normal findings
Specific
Gravity
Normal urine density or values
vary between 1.003–1.035
(g·cm−3)
1.005 Normal findings
pH The pH of urine can vary (6)Acidic Acidic pH helps in
20
between 4.6 and 8, with
neutral (7) being norm
preventing bacterial
growth
WBC 0.2/hpf 1-2/HPF Presence of infection
RBC 0.2/hpf 0-3/HPF May be due to
bladder problem
Bacteria Absent Few Presence of infection
Epithelial Cells Absent Few Possible contamination of the specimen
E Examination Normal
Values
Actual
Findings
Significance
CBC with Platelet
Hemoglobin 125-160g/dl 116 Decreased hemoglobin results in RBC destruction or infiltration of bone marrow with the infectious cell.
Hematocrit 0.38-0.54 0.36 Decreased results in RBC destruction or infiltration of bone marrow with the infectious cell.
WBC 4.5-10.0x109/L 1.1 Decrease due to inadequate inflammatory
response defense to suppress infection
and anti-body mediated immunity takes
place.RBC 4.2-6.2x1012/L 4.06 Decreased due to destruction of RBC or
infiltration of bone marrow with infectious
cellWBC Differential
CountSegmenters 0.46-0.66 0.37 Decreased due to inadequate protection
to an ongoing infection because it acts as
phagocytes and first to arrive in infected
site.
Lymphocytes 0.20-0.40 0.63 Increase immune response fighting
21
infectionPlatelet 150-400x109/L 211 Normal
Clinical Result
Serology for typhidot
IgM (-) IgG(-)
Clinical Interpretation
Results Clinical InterpretationIgM (+) Acute typhoid feverIgM &IgG (+) Acute typhoid fever (in the middle stage of infection)IgG (+) Implication for the presence of IgG antibodies infection (in which case
current fever may not be due to typhoid)IgM & IgG (-) Probably not typhoid
Date: Sept. 6, 2013 @9am
E Examination Normal
Values
Actual
Findings
Significance
CBC with Platelet
Hemoglobin 125-160g/dl 120 Decreased hemoglobin results in RBC destruction or infiltration of bone marrow with the infectious cell.
Hematocrit 0.38-0.54 0.37 Decreased results in RBC destruction or infiltration of bone marrow with the infectious cell.
WBC 4.5-10.0x109/L 2.10 Decrease due to inadequate inflammatory
response defense to suppress infection and
anti-body mediated immunity takes place.RBC 4.2-6.2x1012/L 4.20 NormalWBC
Differential CountSegmenters 0.46-0.66 0.40 Decreased due to inadequate protection to
an ongoing infection because it acts as
phagocytes and first to arrive in infected
site.
Lymphocytes 0.20-0.40 0.60 increase due to increase immune response
fighting infectionPlatelet 150-400x109/L 250 Normal
XV. Medical Diagnosis: Dengue Fever
23
XVIII. Discharge Plan (use METHODS format)
M-edicine • Advise the relatives to continue the prescribed
home medications to ensure optimum recovery.
E-xercise • Provide a clean environment
• Use screens or mosquito nets when sleeping
• Do not stock water without cover to avoid
mosquito breeding. T-reatment • Instruct patient or parents to increase fluid intake
• Instruct patient or parents to have complete bed
restH-ealth Education • Advise the parents to use insect repellants
• Use also insecticides in the house once in a
month
• Maintain good hygiene by taking a daily bathO-ut patient Dep’t
(Check-up)
• Instruct patient to continue follow-up check up to
the doctor.D-iet • Eat healthy foods such as fruits, vegetables, and
meat
• Drink a lot of water, at least 8-10 glasses of water
a dayS-pirituality
• Advise patient to maintain good and safe
environment
31