Southville International School and Colleges

Luxembourg St., BF Homes International, Las Pias City 1740

College of Nursing



Patient-Centered Care Report

Dengue Fever





Paolo R. Gonzales
BSN-4
September 4, 2014

1. Introduction
Patient M.L. a 9 year old pediatric patient living in Las Pinas City was admitted by his mother on
August 11, 2014 at LPDH ER due to chief complaint of a high-grade fever with nausea and
vomiting and loss in his appetite. Patient did not yet experience serious health problems other
than fever, colds, and cough. Patient had no past hospitalization.
Admitting Diagnosis: Dengue Fever

2. Nursing Physical Assessment
Patient M.L. is a 9 year old male. His vital signs upon the admission show as follows:
BP: 90/60, PR: 68, RR: 22, T: 37.9
During my rotation upon assessment received patient awake on bed semi fowlers,
incontinent with IVF inserted on left metacarpal vein, ongoing PNSS 1L X6. Patients vital signs
taken and recorded as follows: T: 37.9 PR: 68 RR: 20 BP: 90/60 O2Sat: 99%.

INSPECTION: His hair is well distributed, dry, dental carries present.
PALPATION: His skin is warm to touch, Capillary refill of 2 seconds, relaxed abdomen, distended
bladder. Temporal pulse (normal) Radial pulse (normal) Brachial pulse (normal)
PERCUSSION: Respiratory (Resonant) Gastrointestinal (Tympany, Dull)
AUSCULTATION: Respiratory (Clear) Gastrointestinal (N/A) Cardiovascular (N/A)







LABORATORY DATA: HEMATOLOGY REPORT
TEST NORMAL VALUE ACTUAL RESULTS FINDINGS
Hemoglobin

Hematocrit

WBC

Segmenters

Lymphocytes

Platelet Count


(M) 130-180 g/L

(M) 37-39 vol%

5-10 x 10 9/L

0.60-0.70

0.20-0.30

150-450x10^g/dL
102

0.26

3.9

0.73

0.73

163 x 10^g/dL
Decreased

Decreased

Decreased

Increased

Increased

Normal



TEST NORMAL VALUE ACTUAL RESULTS FINDINGS
Color

Transparency

Reaction

Specific Gravity

Sugar

Protein

RBC

Pus cells
Yellow Amber

Clear to slightly
turbid
4.5-8

1.005-1.030

Negative

Negative

Few

Few
Yellow

Clear

6.5

1.020

Negative

Negative

0-2

0-2
Normal

Normal

Normal

Normal

Normal

Normal

Normal

Normal



3. Pathophysiology






Aedes aegypti viral replication

Bite from dengue mosquito

Allowing dengue virus to be inoculated in the blood stream


Virus disseminated rapidly and stimulates WBCs including
B lymphocytes that produces and secretes immunoglobulins,
and monocytes/macrophages, neutrophils







Risk Factors
Environment
Hx of dengue

Etiology
Aedes aegypti

Clinical Manifestations
High-grade fever
Nausea and vomiting
Loss of appetite
Flu-like symptoms
Dehydration

4. Actual Managements and Related Treatments
Actual Management:
IV PNSS 1L X 6
CBC
Urinalysis
Maintenance /Due medications
CBC monitoring
TPR monitoring
Ideal Management:
IVF
Antibiotics
Analgesics
Appetite stimulants
CBC monitoring
TPR monitoring
Strict I&O monitoring
Increase fluid intake
TSB

Medications:
Paracetamol 250mg/5ml q4
Amoxicillin 375md TID







5. Nursing Care

1. Hyperthermia
2. Imbalanced nutrition, less than body requirements
3.

Nursing Problem Short-Term Goal Medium-Term Goal Long-Term Goal
1. Hyperthermia

- Patient will show
normal signs of body
temperature
- Patient will display
no further increase in
temperature
- Patient will maintain
improved normal
temperature
1. Fluid volume
deficit

- Patient will be in a
normal hydration
State.
-When assessed the
patient will be show
no signs of
dehydration
-Patient will maintain
his normal oral input
of fluids

2. Imbalanced
nutrition, less
than body
requirements


-The patient will
show signs of
Patient will show
normal caloric intake
-Patients laboratory
status results would
meet the normal
values.
-Patient will maintain
an adequate overall
nutritional status.











6. Prioritization

Achieving the priorities of my patient starts with:
1. Hyperthermia- Lowering down or maintaining a normal temperature is important.
Excessive heat buildup can do a massive damage to the patient and, in extreme cases,
can be fatal. Fever is one of the most common symptoms of illness. A patient is said to
be having fever if his body temperature rises above the normal range which is between
36 - 37oC. Since each individual's temperature range varies, generally, a reading above
37.2oC measured in the mouth is considered febrile. In adults, fever is usually not
dangerous unless it measures 39oC or higher. Most fevers are self-limiting and usually
go away in a relatively short time, usually within a few days. In fact, moderate fever (not
higher than 38oC) has beneficial effects as the body adapts itself through normal
physiological mechanism which strengthen the immune system. Hence, aggressively
treating all fevers can actually interferes with the body's immune response. (n.d.).)

2. Fluid volume deficit - It shows that the patients input and output should be balanced to
identify any fluctuations in intravascular fluid. Fluids must be given for replacement and
maintenance purposes. In the febrile stage of DHF, fluid loss should be replaced with oral
rehydrating salt solution. As much as 75 ml/kg body weight can be given in 4 hours.
Intravenous fluid therapy is recommended when danger signs are present, especially
during defervescence. Intravenous fluid therapy is recommended when danger signs are
present, especially during defervescence. Meanwhile, look for other causes of shock such
as bleeding, which may or may not be obvious. (n.d.).)



3. Imbalanced nutrition, less than body requirements- As client begins to increase in
weight, laboratory results improve to within normal range, and monitoring is needed
less frequently. Vital signs at least until stable, then daily. Repeat electrocardiogram
(ECG) and laboratory tests (electrolytes, acid-base balance, liver enzymes, albumin, and
others) until stable( Ulrich, S. P., Ulrich, S. P., Canale, S. W., & Wendell, S. A. (1994).
Medical-surgical nursing care planning guides. Philadelphia: W.B. Saunders.)









References:

Ulrich, S. P., Ulrich, S. P., Canale, S. W., & Wendell, S. A. (1994). Medical-
surgical nursing care planning guides. Philadelphia: W.B. Saunders.

http://www.healthypinoy.com/health/guidelines/dengue/dengue-
recommendations.html

http://www.nlm.nih.gov/medlineplus/ency/article/001373.htm


Grossman, S.C. & Porth, C.M. (2014). Porth's Pathophysiology: Concepts
of Altered Health States (9th ed.). Philadelphia: Lippincott Williams &
Wilkins.

Ignatavicius, D.D. & Workman, M.L. (2013). Medical-Surgical Nursing:
Patient-Centered Collaborative Care (7th ed.). Philadelphia:
Elsevier/Saunders.

LeMone, P., Burke, K.M., & Bauldoff, G. (2011). Medical-Surgical Nursing:
Critical Thinking in Client Care (5th ed.). Upper Saddle River, NJ:
Pearson/Prentice Hall.

Lewis, S.M., Dirksen, S.R., Heitkemper, M.M., & Bucher, L. (2014).
Medical-Surgical Nursing: Assessment and Management of Clinical
Problems (9th ed.). St. Louis: Mosby.