Case Study in Dengue Compile

DENGUE
PERPETUAL HELP COLLEGE OF MANILA
SECTION A4A1
NOVEMBER 17, 2010
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INTRODUCTION
Dengue hemorrhagic fever is a severe, potentially deadly infection spread by certain species of
mosquitoes (Aedes aegypti). Globally, 2.5 billion people live in areas where dengue viruses can be
transmitted. In the Philippines, Hemorrhagic fever was first reported in 1953. In 1958, it became a notifiable
disease in the country and was later reclassified as Dengue hemorrhagic fever.
Dengue is a primary disease in the tropical and subtropical region. It is caused by one of four
different but related viruses. It is spread by the bite of mosquitoes, most commonly the mosquito Aedes
aegypti.
It is characterized by increased vascular permeability, hypovolemia and abnormal blood clotting me
chanisms. WHO case definition for DHF: 1) fever or history of recent fever, 2) thrombocytopenia (platelet co
unt equal to or less than 100 x 10 /cu mm),
3) hemorrhagic manifestations such as petechiae or overt bleeding phenomena, and
4) evidence of plasma leakage due to increase vascular permeability.
Illness is biphasic; it begins abruptly with fever, and in children, with mild upper
respiratory complaints often anorexia, facial flush and mild GI disturbances. Coincident with defervescence
and decreasing platelet count, the patients condition suddenly worsens, with marked weakness, severe res
tlessness, facial pallor and often diaphoresis, severe abdominal pain and circumoral cyanosis. GI hemorrha
ge is an ominous prognostic sign that usually follows a prolonged period of shock.
Dengue occurrence is sporadic throughout the year. Epidemic usually occurs during the rainy seas
ons June November. Peak months are September and October. It occurs wherever vector mosquito exists.
Currently vector control is the available method for the dengue and DHF prevention and control but
research on dengue vaccines for public health use is in process.
SAN LAZARO HOSPITAL
DENGUE
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NOVEMBER 17, 2010
OBJECTIVES
General objectives
This case presentation aims to identify and determine the general health problems and
needs of the patient with a final diagnosis of dengue hemorrhagic fever with warning signs. This will further
expand our knowledge on this particular disease. We may be able to extend to our client a holistic
approach of care and services that would somehow contribute to the improvement of the client's current
status. It also aims to develop in us, student nurses the proper nursing care needed in order to provide an
effective nursing management in a hospital set-up until the client is ready for discharge.
Specific objectives
PATIENT BASED:
a. Educate the client for somehow that will contribute to the progress of his condition.
b. Promote an environment conducive for optimal health.
c. Emphasize the importance of maintaining a balance diet.
NURSE CENTERED:
Collects related facts regarding the clients personal data and family illness, past and present
medical history and to examine client thoroughly in order to come up with an accurate physical
assessment.
To review the Anatomy and Physiology and to understand better pathophysiology of the problem,
for us to know the risk factors of this case.
To know the drug properties as well as the diagnostic procedure in order to know the effects of the
drug to be administered. And also to be able to select the appropriate nursing intervention.
To enhance our knowledge about proper nursing management as well as its rationale that we take
into great considerations.
SAN LAZARO HOSPITAL
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
To help motivating the patient to continue the health care provided by health workers.
PATIENTS PROFILE
DEMOGRAPHIC HISTORY:
Patients Name:
Age:
Gender:
Address:
Educational Attainment:
Boy XX
9 years old
Male
Tanauan, Batangas
Elementary Level (Out of School)
Religion:
Nationality:
Dialect:
Date of Admission:
Chief Complaint:
Admitting Diagnosis:
Principal Diagnosis:
Admitting Hospital:
Catholic
Filipino
Tagalog
November 8, 2010
High Grade Fever
Dengue with Warning Signs
Dengue
San Lazaro Hospital
HEALTH HISTORY:
History of Present Illness
Early in the morning (Nov. 7, 2010), the child played outside their house and returned home at
lunch time. The afternoon on that day, the eldest brother noticed something strange and different and as
quoted by the eldest brother nanghihina na siya noong dumating ng bahay, nanibago kami kasi malikot
siya. Hinawakan ko siya, napansin ko mainit ang katawan nya at para bang na dengue sya! Afraid that
this is fatal,the brother immediately rushed the child on the hospital. They traveled from Batangas to Manila
SAN LAZARO HOSPITAL
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
( cannot afford Batangas hospital) he was admitted to San Lazaro Hospital (Nov.8, 2010) Patient X initial
temperature was 38degrees Celsius with petechial rash during tourniquet test. He was diagnosed Dengue
fever with warning sign. They got a sample blood from the patient and ordered an IVF and was referred to
Pavillion 4-Extension of Pediatric Ward.
Past Medical and Surgical History

No previous hospital confinement. The usual colds, minor cough and slight fever that a normal
child gets at his age. The treatment is usually rest, hot soup, and sometimes over the counter drugs.
The patient was fully immunized child
Vaccine
Minimum Age at 1st No. of doses
Age received
Interpretation and
BCG
dose
Birth or anytime 1
After birth
analysis
BCG was given at
after birth
earliest
possible
age to protect the

possibility of TB
meningitis
and
other TB infectious
in which infants are
DPT
6 weeks
prone.
1 month and 2 An early start of
weeks
DPT reduces the

chance of severe
pertussis
OPV
6 weeks
1 month and 2 The

weeks
extent
of
protection against
polio is increase
the earlier the OPV
Hep B
SAN LAZARO HOSPITAL
At birth
At birth
is given
An early start of
DENGUE
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NOVEMBER 17, 2010
Hep B reduces the

chance of the child
to be infected and
become a carrier.
This vaccine also
prevents
liver
cirrhosis and liver

Measles
9 months
9 months
cancer.
This
vaccine
prevents
death,
malnutrition,
pneumonia
and
diarrhea.
Family Health History
(+) Heart Disease
(+) Hypertension
(-) Diabetes
(-) Asthma
Social Health History
The patient has 7 siblings, a deceased father and a jobless mother. The eldest sister is the only working
individual in the family and she is the breadwinner. They lived in a small upcoming city in Batangas. The
family belongs to the lower bracket of the society. As for the patient lifestyle, as soon as he wakes he is out
of the house. He comes home before dawn. The patient is undernourished , out of school all because of
financial difficulties .
They are loved by their neighbors and the patient has lots of friends his age
SAN LAZARO HOSPITAL
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
PERSONS REVIEW OF SYSTEM
PERSONS
REVIEW
OF PRIOR
SYSTEM
HOSPITALIZATION
1.) PSYCHOLOGICAL
Self
TO DURING
Perception-Self-
Concept Pattern
INTERPRETATION AND ANALYSIS
HOSPITALIZATION
As a child, he was not During hospitalization, the It is not usual to child to confine him in the
giving priority to his own patient
under hospital because all he wants to do is to play with
was
health; he just wants to observation. The relatives his friends so her emotional and psychological
play
with
his
friends. noticed that the child is status was disturbed.
According to the child, he sometimes
unresponsive Self-concept involves all perceptions. A positive

feels weak after playing and sad. He said that he self-concept is essential to persons mental and
which is not usually happen missed her mother who was physical health. Individuals with positive selfto him. His brother rushed not there for him because concept are better able to cope up in problems
him to San Lazaro Hospital her mother was 9 months and resist psychological and physical illnesses.
even though it was far from pregnant.
Harold Shryock, MD (Modern Medical Guide)
Batangas.
He has a happy family with

7 siblings, his father died
SAN LAZARO HOSPITAL
When
he
was
in
the Having a family beside him makes him stronger.
hospital, his brother and Because family is the one responsible in the
childs care.
6
DENGUE
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NOVEMBER 17, 2010
Role Relationship Pattern
last June2010 and her relatives
supported
him
mother was pregnant. He emotionally and financially.

was contented to their life They are the one beside
but when his father died him everyday. The family
because of heart attack, can buy medications and
their life changed. Before, IVF appropriate for the
Based on the Eriksons theory of psychosocial

development states that all families have certain
tasks and survival and continuity and specific
tasks related to the sequential stage of
development throughout the life of the family.
his father was the one patients treatment.
Taylor, Lilis and Le Mone ( Fundamentals of
supporting
Nursing 5th Edition pg 30)
their
family
needs.
In Tanauan, Batangas they
are near to the hospital but
because
it
was
too
expensive they traveled to

Manila and confined the
chills
to
San
Lazaro
Hospital.
There are no changes to his

sexuality and reproductive
and experiences maleness or femaleness in

physically, emotionally and mentally. Sexuality is
pattern.
The child was unaware to
defined not only by a persons genitalia but also
his
the attitudes and feelings about it.
reproductive
and
sexuality pattern. He was

not
yet
Harold Shryock, MD (Modern Medical Guide)
circumcised
Sexuality and Reproductive
SAN LAZARO HOSPITAL
Sexuality is the degree to which a person exhibits
DENGUE
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NOVEMBER 17, 2010
Pattern
because of young age.
The child verbalized that

masakit ang tiyan ko, with
pain scale of 6/10. There
The child has no problem in

hearing and vision. He has
a
good
communication
skills and awareness.
are no management done

yet except for diversional
activities for the client. The
aunt said that the child
behavior was changed.
Cognitive
Perceptual
Cognitive- Concrete operations (ages 7 to 11). As

physical experience accumulates, accomodation
is increased. The child begins to think abstractly
and conceptualize, creating logical structures that
explain his or her physical experiences.
Barbara Kozier (Fundamentals of Nursing)
Psychosocial Stage 4 - Industry vs. InferiorityThrough social interactions, children begin to
Pattern
develop a sense of pride in their accomplishments

and abilities.
Psychosexual-During the phallic stage, the
primary focus of the libido is on the genitals.
Children also discover the differences between
When
he
was
in
the males and females.
hospital, the child become

He
has
good quiet.
His
became
inferior
developmental stage.
Pyschosoial development- because of his disease. He
the client is in stage of doesnt
SAN LAZARO HOSPITAL
want
to
Stress is a condition in which person responds to
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
Industry vs. Inferiority. He communicate and interact.
changes in the normal balanced state. It can
can
affect
compete
playmates.
Pyshosexual-
to
his
is
socially
and
in
Barbara Kozier (Fundamentals of Nursing pg
1013-1014)
knows male and female.

CognitiveConcrete
Pattern
emotionally,
spiritually.
he
phallic stage where he
Coping Stress Tolerance
physically,
Operations
During hospitalization, he
Major life changes in his
does not pray.
life- when his father died
last june 2010.
He is a Roman Catholic, he
attended
mass
Spiritual beliefs and practices are associated with
every
all aspects of persons life, including health and
Sundays.
illness.
Carol Taylor (Fundamentals of Nursing 5 th edition
pg 977)
SAN LAZARO HOSPITAL
DENGUE
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NOVEMBER 17, 2010
Value Belief Pattern
2.) ELIMINATION
Bowel Elimination: once a Bowel Elimination: not yet The amount of urine expelled from the bladder
day at night
Urinary Elimination:
defecating duting our shift

depends on how much fluid has been taken into
3-4 Urinary Elimination: 3times
the body and how much of this has been
times a day every morning, during 7-3 shift.
eliminated. Same as in stool expulsion, this
He doesnt feel any
afternoon and evening.
depends on how much food and kind of food you
He doesnt feel any discomfort during urination
eat.
discomfort during urination and defecation. And his
and defecation.
urine color is clear.
Harold Shryock, MD (Modern Medical Guide pg

199 and 244)
3.)REST AND ACTIVITY

Activity- Exercise Pattern
He was a playful child so it During hospitalization, the Because of his disease his activity was limited.
was his daily activity. Since patient usually lying in bed. And he preferred to sleep than to interact with his
he was stop to his study, he He walks only when going relative.
just help her mother to to the bathroom. And he sits
household chores, he knew on his bed when he will eat
how to clean their house.
SAN LAZARO HOSPITAL
meals
and
10
take
his
Exercise
plays
major
role
in
health
maintenance. It boasts body strength as well as
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
In terms of:
medications. The doctor
Feeding- he can eat on his
ordered him to have an
own.
enough bed rest to avoid
Hygiene- he can take a
fatigue. But in terms of:
bath without assistance of
Feeding- his brother assist
others, can wear and
him.
remove clothing.
Hygiene- he cannot take a
Toileting- he can recognize
bath, so only wiping his
urging in defecating and
body.
urinating.
Toileting- no changes.
mind ability. It promotes a feeling of zest and well

being and provides greater vigor for the days
activities.
45)
Because of the symptoms he experienced, he
The child sleeps early in During hospitalization, the preferred to sleep so that he will feel comfortable.
the evening from 7pm to child is always sleeping.
Sleep in some way restores the bodys normal
5am. He woke up early to

Sleep-Rest Pattern
level of activity and balance. Sleep can also be a
play with his friends. He

does
not
take
form of comfort and relaxation.
any
Barbara Kozier (Fundamentals of Nursing pg
supportive aids to sleep.

4.) SAFE ENVIRONMENT
He does not have any There were no changes.
1115-1124)
According to Maslows Hierarchy of Needs-
allergic reactions to food
Security needs are important for survival, but they
and medications. He has a

good
skin
turgor.
Sometimes he has many

wounds
SAN LAZARO HOSPITAL
because
of
According to his brother,

hindi naming alam kung
saan
siya
nakagat
ng
lamok, kasi kung saan-saan

siya pumupunta.
11
are not as demanding as the physiological needs.

Examples of security needs include a desire for
safe neighborhoods and shelter from the
environment.
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
playing. They live in city

like town.
5.) OXYGENATION
He
doesnt
have
any During hospitalization, his Respiration includes ventilation and breathing
problem in oxygenation, he nails are pale. But he doe which is the movement of air into and out of the
does
not
experience not
dyspnea while walking.
use
his
accessory lungs.
muscles while breathing.
Essentials of Anatomy and Physiology 6 th Edition

(pg. 417)
6.) NUTRITION
He has a good appetite in When
he
was
in
the It is very important to a person to eat nutritious
all kinds of foods. Her hospital, the doctor ordered foods because it is one of the factors that will
mother and sister was the a diet as tolerated except affect the health. The ideal state of health comes
one preparing their foods. dark colored foods. He partly from sufficient protein and carbohydrates in
According to the brother of recalled his past 24 hours the diet, adequate supply of minerals and vitamins
the patient, kinakain niya foods:
lahat ng pagkain kasi kung
to be well nourished person.
Breakfast Pandesal
ano lang ang nakahain sa

bahay, kahit na gulay at
isda. . And he was not
taking
a piece of fried fish and

veggies.
supplements. The patient
Dinner- 1 cup of rice
he can able to swallow and
and fried fish.
chew foods.
SAN LAZARO HOSPITAL
vitamins
Lunch 1 cup rice with
He has a fair appetite.

12

46)
DENGUE
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NOVEMBER 17, 2010
SAN LAZARO HOSPITAL
13
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PHYSICAL ASSESSMENT
DATE OF ASSESSMENT: November 9,, 2010 11:00am
General Survey:
Client was conscious and coherent, lying in bed with an IV line regulated to 80 gtts per min. hooked at the right side of his arm. His hair is
well-groomed and no body odor being noted during assessment. Patient was cooperative and responds to questions appropriately. He exhibits
moderate lower tone of voice but enough to understand during conversation assisted by his elder brother and he has a proper thought association
and has a sense of reality.
Vital Signs:
Vital signs
Normal
Actual Findings
Interpretation/Analysis
Blood pressure
100/60
100/80
On the disease process any condition affects the cardiac output, blood
volume, blood viscosity has direct effect on the bold pressure. The patient
was not in distress during the assessment
Temperature
36.5-37.5
37.8
(Kozier, B. (2004). Fundamentals of Nursing p. 510).

Febrile due to increase of inflammation as evidenced by an increase in the
number of WBC from the normal value of 4.8 - 10.8 to 2.33.
Inflammation is a local, nonspecific defensive response of the tissues to an
injurious or infectious agent. It is an adaptive mechanism that destroys or
dilutes the injurious agent, prevents further spread of the injury, and
promotes the repair of damaged tissue.
SAN LAZARO HOSPITAL
14
DENGUE
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NOVEMBER 17, 2010
(Kozier, B. (2004). Fundamentals of Nursing p. 634)
Pulse rate
55-90
102
The pulse rate increases as a response to the lowered blood pressure that
results from peripheral vasodilation associated with elevated
body
temperature and because of the increase metabolic rate.

Respiratory rate
12-25
26
(Kozier, B. . Fundamentals of Nursing, 7th edition p. 496).

Several factors influence the respiratory rate. Those that increase the rate
include increases in metabolism, stress (readies the body for fight or flight),
increased environmental temperature, and lowered oxygen concentration
at increased altitudes.
In the case of our patient it is increased because of stress and increased
environmental temperature.
(Kozier, B. (2004). Fundamentals of Nursing p. 506).
PARTS
Skin
METHOD
SAN LAZARO HOSPITAL
NORMAL FINDINGS
ACTUAL FINDINGS
15
INTERPRETATION / ANALYSIS
DENGUE
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NOVEMBER 17, 2010
Skin
Inspection
Skin color varies from light to deep Dark brown with excessive moisture in
Excessive moisture indicates
Observation
brown; from ruddy pink to light pink, from the upper extremities and petechial
hyperthermia as evidenced by
yellow overtimes to olive. Generally rashes.
an
uniform except in areas exposed to sun;
temperature from the normal
areas of lighter pigmentation (palms, lips
range of 35.5-37.5 to 37.8.
nail beds) in dark skin people. Moisture Generally uniform except in areas
While petechial rashes indicates
in the skin folds and the axillae (varies exposed to sun; areas of lighter
the
with environmental temperature, and pigmentation (palms, lips nail beds) in
pathognomonic sign of dengue.
activity).
No
Palpation
edema,
increase
in
the
Hermans
sign,
body
the
dark skin people.

abrasions,
lesion.
The skin is warm to touch
Temperature is uniform and w/in normal No

range
edema,
abrasions,
lesion.
because
of
the
localized
Temperature is not w/in the normal
hyperthermia
range, the skin is moist and warm to
inflammation as evidenced by
touch.
an increase in the WBC count

( Fundamentals of Nursing by
due
to
Kozier, pp.535,540,1071)
Nails
Inspection
Convex curvature; angle of nail plate Convex, smooth in texture, color is

about 160o
pinkish and is highly vascular.
- with smooth texture
SAN LAZARO HOSPITAL
Normal findings accdg. To Kozier

page 543
16
DENGUE
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NOVEMBER 17, 2010
- color is highly vascular& pink in light Blanch test: Prompt return of usual
skinned clients; dark skinned clients may color (after 3 sec.)
have brown or black pigmentation in
longitudinal streaks
with
intact
epidermis
on
tissue
surroundings
- blanch test- prompt return of pink or
usual color 3-5 sec. Kozier, 2008
Head
PARTS
Hair
METHOD
Inspection
NORMAL FINDINGS
ACTUAL FINDINGS
Evenly distributed hair over Hair is evenly distributed to different The mother of the patient attend to his need
Palpation
the scalp with thickness, parts of the body and it is thick. No during hospitalization, it results to good
variable amount of body hair. infection or infestation noted.
hygiene, the condition of the patient limits
No infection or infestation.
his activities but despite of that relatives are

there for him to assist his needs.
Scalp
Inspection
White,
clean,
free
from White, clean, free from masses,
Palpation
masses, lumps scars, lice, lumps scars, lice, nits, dandruff,

nits, dandruff, and lesions no and lesions no area of tenderness
Skull
SAN LAZARO HOSPITAL
Inspection
(Fundamental of Nursing by Kozier, p541)

area of tenderness
Rounded( normocephalic & Round (normocephalic), smooth Normal findings according to
Palpation
symmetrical,
with
frontal, skull contour.

17
Kozier page 544.
DENGUE
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NOVEMBER 17, 2010
parietal,
occipital, Smooth, absence of nodules or
prominences)
masses.
smooth, uniform, absence of

modules or masses
Eyes
PARTS
Eyebrows
METHOD
Inspection
NORMAL FINDINGS
Symmetrically aligned.
ACTUAL FINDINGS
Hair is evenly distributed skin Normal findings.
Equally distributed, curled intact

slightly outward
Eyelashes
Inspection
Symmetrically
Inspection
aligned. With age, eyebrows become bristly and coarse.

aligned
and (Kozier, B. Fundamentals of Nursing, 7 th
equal movement.
Equally distributed, Curled
Eyelashes are equally
slightly outward
Eyelids
and
The
skin
is
discharge
distributed, it is thick and is
intact,
and
no Lids
edition, p. 548).
Normal findings.
Eyelashes should be curled outward to sweep
curled outward.
foreign particles away from the eyes.
closes symmetrically,
no bilateral blinking and no visible Normal findings according to Kozier page 548.
discoloration. The lids close sclera above corneas, and

symmetrically
blinks upper and lower borders of
involuntary and with bilateral cornea are slightly covered

Sclera and
Conjunctiva
SAN LAZARO HOSPITAL
Inspection
blinking.
when lids are open.
Shiny, smooth & pink or red Both sclerae are shiny and
in color
Extremely red color of both conjunctivae
smooth.
indicates inflammation as evidenced by the
Palpebral conjunctivae are
body temperature of 37.8 and an increase in
18
DENGUE
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NOVEMBER 17, 2010
extremely red.
the WBC count.
(Kozier, B. Fundamentals of Nursing, 7 th

edition, p.548).
Cornea
Inspection
transparent, shiny & smooth, Transparent shiny and smooth.
Normal findings
(Kozier, B. Fundamentals of Nursing 7th edition,
details of the iris are visible
p. 550).
Pupils and iris
Inspection
Black in color, equal in size, Iris brown in color, equal in size Normal findings.
normally 3-7 mm in diameter, and round in shape. Iris is flat
sound- smooth border iris flat and round. Pupil diameter is Pupils
& sound. Pupils constrict 4mm.
equally
reactive
to
light
and
accommodates symmetrically.
when looking at near object Patients pupils constrict when

and dilate when looking at far looking at near objects and (Kozier, B.
Extraocular
Inspection
muscle tests
objects.
dilate when looking at far edition, p. 550).
Both eyes coordinated, move
objects.
Within normal findings.
Inspection
(Kozier, B. (2004). Fundamentals of Nursing p.
554).
Able to read newsprint with The patient can read writings Normal findings.
20/20 vision on snellen chart. that
was given to him for (Kozier, B. Fundamentals of Nursing, 7 th
visualization .
Ears
SAN LAZARO HOSPITAL
Normal findings.
in unison with parallel

alignment.
Visual Acuity
Fundamentals of Nursing, 7 th
19
edition, p. 552).
DENGUE
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PARTS
Auricles
METHOD
Inspection
NORMAL FINDINGS
ACTUAL FINDINGS
The color is same as facial The color is same as facial Normal Findings
skin,
symmetrical,
the skin, symmetrical, the auricles
auricles aligned with outer aligned with outer cantus of

cantus of the eye.
Palpate
the eye.
Mobile, firm and not tender, Mobile, firm and not tender,
pinna recoils after it is folded. pinna recoils after it is folded. Kozier, B Fundamentals of Nursing 7 th edition,
Ear Canal
Inspection
Distal third contains hair Distal
third
follicles and glands. Dry follicles
and
contains
glands.
p. 556
hair Normal Findings
Dry
cerumen, grayish-tan color or cerumen, grayish-tan color or

sticky,
Hearing Acuity
Inspection
wet
cerumen
in sticky, wet cerumen in various Kozier, B. Fundamentals of Nursing, 7 th edition,
various shades of brown.

shades of brown.
p. 556
Normal voice tones audible. Normal voice tones audible. Normal Findings
Sound is heard in both ears Sound is heard in both ears or
or localized at the center of localized at the center of the
the head (Weber Negative). head.
Air conducted hearing is
greater than bone conducted
according to Kozier page 558
hearing (positive Rinne)
Nose
PARTS
SAN LAZARO HOSPITAL
METHOD
NORMAL FINDINGS
ACTUAL FINDINGS
20
ANALYSIS
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
Nose
Inspection
Symmetric and straight
Symmetric
No discharge in flaring
discharge or flaring, uniform in and no discharges. He can also identify
Uniform in color
color.
Not tender, no lesion
lesions.
(-)
in
shape.
tenderness
No Patient can breathe normally through nose

and common odors like alcohol.
Normal findings according to Kozier page
560-561
Facial Sinuses
Septum
Palpation
No tenderness
No tenderness noted.
Inspection
560-561
Air moves freely as the client Nasal septum intact and in Normal findings according to Kozier page
breathes through the nares. midline.
Normal findings according to Kozier page
560-561
Nasal septum intact & in

midline
Mouth
PARTS
Lips
Buccal mucosa
METHOD
Inspection
NORMAL FINDINGS
Uniform pink color
Palpation
Soft, moist, smooth texture Soft, moist, smooth texture
Inspection
ACTUAL FINDINGS
Uniform pink color
Symmetry of contour
Symmetry of contour
Ability to purse lips
Ability to purse lips
Uniform pink color
Uniform pink color
Soft, moist, smooth texture Soft, moist, smooth in texture.
SAN LAZARO HOSPITAL
21
Normal findings accdg. to Kozier, p.563
Normal findings accdg. to Kozier, p.563
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
Gums
Tongue
Inspection
Pink gums, moist, firm Pinkish gums, no retraction, Gums are pinkish in color.
texture to gums.
moist and firm.
Inspection
Central position
(Fundamentals of Nursing by Kozier, p564)

Central position, pink in color, Normal
Palpation
Pink color, moist, slightly moist, moves freely, no lesions, (Fundamentals of Nursing by Kozier, p564)
rough;
then,
Normal findings
whitish tenderness and nodules.
coating
Smooth; lateral margins;
no lesions
Raised papillae
Moves
freely,
no
tenderness
Smooth tongue base with
Teeth
Inspection
prominent veins.
24 pediatric teeth
Missing tooth, with 22
Normal Findings
smooth, white, shiny tooth smooth, yellow, shiny tooth
Uvula
Tonsils
SAN LAZARO HOSPITAL
enamel
enamel
pink gums moist.
pink gums moist.
Inspection

Soft, moist, smooth texture Soft, moist, smooth texture Pink Normal Findings
Inspection
Pink and smooth.

and smooth.
No discharge. Tonsils of No discharge. Tonsils of normal Normal Findings
22
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
normal size.
size.
Pink and smooth posterior Pink and smooth posterior wall.

wall.
Neck
SAN LAZARO HOSPITAL
23
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
Upper extremities
PARTS
Shoulders
METHOD
Inspection
NORM AL FINDINGS
ACTUAL FINDINGS
Able to tolerate wide range Able to do ROM.
Palpable
of motion. No difficulty
upon
bending
Normal Findings
and
stretching. . No lesions, no
Arms and forearms
Inspection
scars and no deformity.

Able to tolerate wide range Able to do ROM exercises Both arms have equal strength, patient can move
Palpable
of motion. No difficulty without difficulty in doing.

upon
bending
and Have some scars but no
stretching. No lesions, no deformity.

Elbows
arms against gravity and against full resistance.

(Fundamentals of Nursing by Kozier p1068)
Inspection

Able to tolerate wide range Able to do ROM exercises Normal findings according to Kozier page 1061
Palpable

upon
bending
and
Wrist
Inspection
Palpable

upon
bending
and
SAN LAZARO HOSPITAL
24
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
Hands and Fingers
Inspection
Palpable
of motion. No difficulty without difficulty in doing in the

upon
bending
and left hand.
stretching. . No lesions, no With the presence of IV line in

the right hand it makes difficult

to move.
Thorax
PARTS
Chest size and
METHOD
Inspection
shape
Breath sounds
Posterior
NORMAL FINDINGS
ACTUAL FINDINGS
Anteroposterior
to Anteroposterior to transverse Normal
transverse
Auscultation
Palpation
chest
symmetrical.
Bronchovesicular
is chest symmetrical.
breathe Patient
has
sound.
bronchovesicular breath sound. (Fundamentals of nursing by Kozier p573)
Full and symmetric chest Vocal nor tactile fremitus, Normal findings according to Kozier page 578expansion. Fremitus tactile Bronchovesicular
most clearly at the apex of sound.
the lungs
Quiet,
rhythmic
and
effortless respiration.
Vesicular and
bronchovesicular
breath
sound.
SAN LAZARO HOSPITAL
(Fundamentals of nursing by Kozier p573)

clear, Normal.
25
breathe 579
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
Percussion
Notes
resonate,
except Notes resonate, except over
over scapula, the lowest scapula, the lowest point of

point of resonance is at the resonance is at the diaphragm
diaphragm.
Anterior
Inspection
Quiet,
rhythmic
and Quiet rhythmic and effortless.
effortless respiration.
579
Full and symmetric chest Full

Palpation
expansion.
Same
is
normally
decreased over heart and

breast tissue.
Notes resonate down to the
6th rib at the level of the
diaphragm but are flat over
areas of heavy muscle and
Percussion
bone, dull on areas the

heart and the liver, and
tympanic
SAN LAZARO HOSPITAL
over
and
as expansion.
posterior vocal fremitus,

fremitus
Normal findings according to Kozier page 578-
the
26
symmetric
chest
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
underlying stomach.
Breast
PARTS
Breast
METHOD
Inspection
NORNAL FINDINGS
No masses and lumps
Areola
Palpation
Inspection
(Kozier, 2008)
Dark in color in contrast to Dark in color in contrast to Normal Findings
Palpation
surrounding
masses,
skin.
lumps
ACTUAL FINDINGS
No masses and lumps
ANALYSIS
Normal findings
No surrounding skin. No masses,

and lumps and lesions.
lesions.
Nipples
Inspection
Size is proportional. No Size is proportional.
Palpation
discharged or secretions.
(Kozier, 2008)
Normal findings.
(Kozier, 2008)
Abdomen
PARTS
Skin integrity
Contour and
METHOD
Inspection
Inspection
symmetry
Movement
SAN LAZARO HOSPITAL
NORMAL FINDINGS
Unblemished skin, uniform in color.
ACTUAL FINDINGS
Unblemished skin, uniform Normal findings Kozier page 592-598
Flat, rounded.
in color
Flat, symmetric contour.
Normal findings Kozier page 592-598
Symmetric contour.
Inspection
Symmetric
movements
caused
27
by Symmetric
movementNormal findings Kozier page 592-598
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
respiration.
caused by respiration, no
Audible bowel sounds
visible vascular pattern.

Audible bowel sounds

Bowel sounds
Auscultation
Umbilicus
Inspection
Clean
Clean
Bladder
Liver
Palpation
Palpation
Not palpable
May not be palpable.
Not palpable
No
enlargement.
Border feels smooth
palpable

Not Normal findings Kozier page 592-598
Genitalia
Patient refuses to be assessed but according to the patient he was not circumcise yet.
Lower Extremities
PARTS
Hip
METHOD
Inspection
NORMAL FINDINGS
ACTUAL FINDINGS
Able to perform wide Able to perform minimal range of motion exercise Normal findings
range of motion. No no masses and deformities.
masses,
Leg
scars
and
(Fundamentals of Nursing by Kozier
Inspection
deformity.
Able to perform wide Able to perform wide range of motion.
Palpation
range of motion. No Has flakes and scars but has no deformity.

masses,
scars
and
deformity.
SAN LAZARO HOSPITAL
p1068)
Normal findings
pg. 495)
28
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
Knee
Inspection
Able to perform wide Able to perform wide range of motion.
Palpation
range of motion. No No masses and deformity but have some round

masses,
Foot and toes
scars
and and oval shape of scars of about 1cm in size.
Normal findings
Inspection
deformity.
Able to perform wide Comfortable to perform wide range of motion.
(2004) p. 497)
Normal
Palpation
range of motion. No
(Fundamentals
masses,
Kozier,(2004) p.496)
scars
and No masses and deformity .
of
Nursing
deformity.
Peripheral
pulse
SAN LAZARO HOSPITAL
Palpation
Symmetric
full Symmetric full pulsation
pulsation
Normal findings
(by Kozier, (2004) p496)
29
by
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
. ANATOMY AND PHYSIOLOGY

Blood Basics
Blood is a collection of specialized cells
suspended in straw-colored liquid called plasma.
Blood delivers oxygen and nutrients in the body
cells, collect waste, distribute hormones, spread
heat around the body to control the temperature
and play part in fighting infection and healing
injuries.
Blood forms about one-twelfth of the body
weighing of an adult, amounting to about 11 pints
(5 liters) in volume. Roughly 50-55 percent of the
blood is plasma, the liquid only-portion in which cellular components are distributed. Plasma is 90%
containing dissolve substances such as glucose(blood sugar), hormones, enzymes, and also waste
products such as urea and lactic acid.
Plasma also contains proteins such as
albumins, fibrinogen(important clotting factor) and
globular proteins or globulins help transport lipids,
which are fatty substance such as cholesterol.
Gamma globulins are mostly disease-fighting
substances that are known as antibodies. The
remaining 45-50% of blood is made up of 3 types
of specialized cells. Red cells or erythrocytes carry
oxygen; various white cells known as leukocytes
are part of defense system and cellular fragment
(platelets or thrombocytes) involved in the process
of clotting.
SAN LAZARO HOSPITAL
30
DENGUE
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NOVEMBER 17, 2010
Two types of blood vessels carry blood throughout our bodies:

1. Arteries carry oxygenated blood (blood that has received oxygen from the lungs) from the heart to
the rest of the body.
2. Blood then travels through veins back to the heart and lungs, where it receives more oxygen.
As the heart beats, you can feel blood traveling through the body at pulse points like the neck and the
wrist where large, blood-filled arteries run close to the surface of the skin.
The blood that flows through this network of veins and arteries is whole blood, which contains three types
of blood cells:
1. red blood cells (RBCs)
2. white blood cells (WBCs)
3. platelets
In babies and young kids, blood cells are made within the bone marrow (the soft tissue inside of bones) of
many bones throughout the body. But, as kids get older, blood cells are made mostly in the bone marrow of
the vertebrae (the bones of the spine), ribs, pelvis, skull, sternum (the breastbone), and parts of the
humerus (the upper arm bone) and femur (the thigh bone).
The cells travel through the circulatory system suspended in a yellowish fluid called plasma, which is 90%
water and contains nutrients, proteins, hormones, and waste products. Whole blood is a mixture of blood
cells and plasma.
Red Blood Cells
Red blood cells (also called erythrocytes) are shaped like slightly indented, flattened disks. RBCs contain
the iron-rich protein hemoglobin. Blood gets its bright red color when hemoglobin picks up oxygen in the
lungs. As the blood travels through the body, the hemoglobin releases oxygen to the tissues.
The body contains more RBCs than any other type of cell, and each has a life span of about 4 months.
Each day, the body produces new RBCs to replace those that die or are lost from the body.
SAN LAZARO HOSPITAL
31
DENGUE
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White Blood Cells

White blood cells (also called leukocytes) are a key part of the body's system for defending itself against
infection. They can move in and out of the bloodstream to reach affected tissues. Blood contains far fewer
WBCs than red blood cells, although the body can increase WBC production to fight infection. There are
several types of WBCs, and their life spans vary from a few days to months. New cells are constantly being
formed in the bone marrow.
Several different parts of blood are involved in fighting infection. White blood cells called granulocytes and
lymphocytes travel along the walls of blood vessels. They fight germs such as bacteria and viruses and
may also attempt to destroy cells that have become infected or have changed into cancer cells.
Certain types of WBCs produce antibodies, special proteins that recognize foreign materials and help the
body destroy or neutralize them. The white cell count (the number of cells in a given amount of blood) in
someone with an infection often is higher than usual because more WBCs are being produced or are
entering the bloodstream to battle the infection.
After the body has been challenged by some infections, lymphocytes "remember" how to make the specific
antibodies that will quickly attack the same germ if it enters the body again.
Platelets
Platelets (also called thrombocytes) are tiny oval-shaped cells made in the bone marrow. They help in the
clotting process. When a blood vessel breaks, platelets gather in the area and help seal off the leak.
Platelets survive only about 9 days in the bloodstream and are constantly being replaced by new cells.
Important proteins called clotting factors are critical to the clotting process. Although platelets alone can
plug small blood vessel leaks and temporarily stop or slow bleeding, the action of clotting factors is needed
to produce a strong, stable clot.
Platelets and clotting factors work together to form solid lumps to seal leaks, wounds, cuts, and scratches
and to prevent bleeding inside and on the surfaces of our bodies. The process of clotting is like a puzzle
SAN LAZARO HOSPITAL
32
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
with interlocking parts. When the last part is in place, the clot happens but if even one piece is missing,
the final pieces can't come together.
When large blood vessels are severed (or cut), the body may not be able to repair itself through clotting
alone. In these cases, dressings or stitches are used to help control bleeding.
Nutrients in the Blood
Blood contains other important substances, such as nutrients from food that has been processed by the
digestive system. Blood also carries hormones released by the endocrine glands and carries them to the
body parts that need them.
Blood is essential for good health because the body depends on a steady supply of fuel and oxygen to
reach its billions of cells. Even the heart couldn't survive without blood flowing through the vessels that
bring nourishment to its muscular walls.
Blood also carries carbon dioxide and other waste materials to the lungs, kidneys, and digestive system to
be removed from the body.
Blood cells and some of the special proteins blood contains can be replaced or supplemented by giving a
person blood from someone else via a transfusion. In addition to receiving whole-blood transfusions,
people can also receive transfusions of a particular component of blood, such as platelets, RBCs, or a
clotting factor. When someone donates blood, the whole blood can be separated into its different parts to
be used in this way.
SAN LAZARO HOSPITAL
33
DENGUE
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NOVEMBER 17, 2010
BOOK BASED PATHOPHYSIOLOGY:

MODIFIABLE
NON MODIFIABLE
Environmental conditions
Geographical
Rainy season
Age
Aedes aegypti acquires

virus from a host
8-12 days of viral

replication on mosquitos
salivary glands
The virus is transferred

into the susceptible host
via bite of the mosquito
Itchiness/
redness in the
area
Dengue virus is inoculated

into humans within 3-14
days
Dengue virus circulates in

the blood
Virus disseminate rapidly

into the blood
Stimulates leukocytes
especially B lymphocytes
SAN LAZARO HOSPITAL
34
Production and
secretion of Igs &
monocytes/
macrophages,
neutrophils
Leukocytosis
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
Antibodies bind to the viral

antigens
Monocytes/macrophages
perform phagocytosis through
Fc receptor within the cells.
Dengue virus replicates in the
cells of monocytes/
macrophages
Recognition of dengue viral

antigen on infected monocyte
by cytotoxic T cells
Release of cytokines w/c

consists of vasoactive agents
such as IL, TNF, UK, platelet
activating factors
Stimulates leukocytes and

pyrogen release
Direct cellular destruction

& infection of bone marrow
& immunological shortened
platelet survival
Fever
Diaphoresis
Warm
flushed skin
Malaise
Headache
Leukopeni
a
Causes depressed platelet

synthesis
Thrombocytopeni
a
SAN LAZARO HOSPITAL
Dengue
35
hemorrhagic
fever
Epistaxis
Gum
bleeding
Melena
Hematochezi
a
Abdominal
pain
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
MODIFIABLE
NON MODIFIABLE
Environmental conditions
Geographical
Rainy season
Age
Capillary
permeability
Pleural
effusion
Aedes
aegypti acquires virus
from a host
Edema
8-12 days of viral replication

on mosquitos salivary glands
The virus is transferred into

the susceptible host via bite of
the mosquito
Itchiness/
redness in the
area
Dengue virus is inoculated

into humans within 3-14 days
Dengue virus circulates in the

blood
Virus disseminate rapidly into

the blood
CLIENT BASED PATHOPHYSIOLOGY

Stimulates leukocytes
especially B lymphocytes
SAN LAZARO HOSPITAL
36
Production and
secretion of Igs &
monocytes/
macrophages,
neutrophils
Leukocytosis
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
Antibodies bind to the viral

antigens
Monocytes/macrophages
perform phagocytosis through
Fc receptor within the cells.
Dengue virus replicates in the
cells of monocytes/
macrophages
Recognition of dengue viral

antigen on infected monocyte
by cytotoxic T cells
Release of cytokines w/c

consists of vasoactive agents
such as IL, TNF, UK, platelet
activating factors
Stimulates leukocytes and

pyrogen release
Direct cellular destruction &

infection of bone marrow &
immunological shortened
platelet survival
Causes depressed platelet

synthesis
SAN LAZARO HOSPITAL
37
Thrombocytopeni
a
Fever
Diaphoresis
Warm
flushed skin
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
Leukopeni
a
Dengue
hemorrhagic fever
SAN LAZARO HOSPITAL
38
Abdominal
pain
Melena
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
LABORATORY REPORTS
Diagnostic Procedures
HEMATOLOGY
Hematology is the branch of internal medicine, physiology, pathology, clinical laboratory work, and pediatrics that is concerned with the study
of blood, the blood-forming organs, and blood diseases.
Name: Indepenso, Ryan
Age: 9 Sex: Male
Patient I.D. 020238

Hospital Number: 0134623
COMPONENTS
WBC
RESULT
2.33
Unit
10^9/L
Normal
4.8-10.8
Interpretation and Analysis

Virus attacks WBC and this is a normal finding In a patient with
RBC
Hemoglobin
Hematocrit
MCV
4.79
13.04
40.78
85.15
10^9/L
g/L
%
Hq
4.7-6.1
13-17
40-52
87-98
dengue.
Normal
Normal
Normal
Mean corpuscular volume (MCV) is a measurement of the average size
of your RBCs. When the MCV is decreased, your RBCs are smaller
MCH
27.23
Pq
28-33
than normal (microcytic) as is seen in iron deficiency

Mean corpuscular hemoglobin (MCH) is a calculation of the average
amount of oxygen-carrying hemoglobin inside a red blood cell.
Macrocytic RBCs are large so tend to have a higher MCH, while
MCHC
31.98
g/L
33-36
microcytic red cells would have a lower value.

Decreased MCHC values (hypochromia) are seen in conditions where
the hemoglobin is abnormally diluted inside the red cells, such as in iron
deficiency anemia and in thalassemia.
SAN LAZARO HOSPITAL
39
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
Platelet
RDW
Neutrophil
Lymphocytes
Eosinophil
Monocytes
Basophils
90
13.09
60.3
32.3
0.7
5.5
1.2
SAN LAZARO HOSPITAL
10^9/L
%
%
%
%
%
%
150-400
11.4-19.0
40-70
19-48
2-8
3-9
0-2
Destroys the bodys capacity to produce new platelets

Normal
Normal
Normal
Refer to Wbc
Normal
Normal
40
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
DRUG STUDY:
Drug Name
Dosage,
Action
Indication
Adverse Effect
Contraindication
Nursing Responsibilties
Frequency,
Route
Generic:
Dosage: 20 mg
Omeprazole
Brand:
Frequency: OD
Inhibits activity of GERD,
CNS:
acid
dizziness,
patients
pump and binds hypersecretory
asthenia.
hypersensitivity
to
GI:
(proton) pathologic
hydrogen- conditions,
headache, Contraindicate in
diarrhea, with the drug.
Losec, Prilosec,
potassium
duodenal ulcer, abdominal
Zegerid
adenosine
helicobcter
Route: IV
with
Dosage adjustments
may be necessary in
Asians and patients with
hepatic impairment.
pain,
Drug increases its
nausea, vomiting,
own bioavailability with
triphosphatase at pylori infection, constipation,
repeated doses. Drug is
Pharmacologic
secretory surface frequent
flatulence.
unstable in gastric acid;
Class:
of gastric parietal heartburn
Musculoskeletal:
less drug is lost to
cells
back pain.
hydrolysis because drug
Respiratory:
increases gastric pH.
proton
pump inhibitor
Pregnancy
to
block
formation
of
gastric acid.
cough,
Category: C
SAN LAZARO HOSPITAL
respiratory
41
upper
tract
Caution patient to
infection.
avoid
Skin: rash.
activities if he gets dizzy.
hazardous
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
Drug Name
Dosage,
Action
Indication
Adverse Effect
Contraindication
Nursing Responsibilties
Frequency,
Route
Generic Name:
Dosage:250 g
Acetaminophen
Brand Name:
produce
olytic
to
Fraquency:
analgesia
Q4, prn
blocking
Paracetamol
Classification:
to To relieve mild Hematologic:haem
Thought
by moderate
Route:
inhibiting
Per Orem
synthesis
neutropenia
as
of headache,
Category:
pain receptors to is
stimulation. The also
moderate
acetaminophen
Skin:
nutrition.
rash,
doses,
in
with
poor
Patient & Family Education
and
sensitize period pains. It
Do not take other

medications (e.g., cold
used
to
drug may relieve bring

through down
even
with
individuals
the CNS or of and joint pain, urticaria

that
hepatotoxicity,
Hyperglycema
derivative
Pregnany
Monitor for S&S of:
especially
prostagalandin in muscle
other substances backache
Assessment & Drug Effects
Metabolic:
Paraminophenol
SAN LAZARO HOSPITAL
acetaminophen.
by to things such Hepatic: Jaundice
impulses
fever
anmia, to
pain leukopeia,
pain due
Hypersensitivity
preparations)
containing
high
42
acetaminophen
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
central action in temperature.
without
medical
the hypothalamic For
advice;
overdosing
heat-regulating
this
reason,
center.
paracetamol
can
be
given to children
after
cause
liver
and
other
damage
toxic
effects.
Tell patients to consult
vaccinations
prescriber before giving
to prevent post-
drug to children younger
immunisation
than 2.
pyrexia
(high
temperature).
SAN LAZARO HOSPITAL
and chronic use can
Do not use for fever
Paracetamol is
persisting longer than
often included in
3 days, fever over 39.5
cough, cold and
flu
recurrent fever unless
remedies
directed by prescriber.
43
(103
F),
or
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
URSING CARE PLAN

1. Hyperthermia
CUES
NURSING
SUBJECTIVE:
DIAGNOSIS
Hyperthermia
Mainit po ang
pakiramdam ko.
INFERENCE
Exogenous
OUTCOMES
After 30 minutes
related to illness
pyrogens (Dengue
of nursing
as evidenced by
virus)
interventions, the
temperature of
OBJECTIVE:
37.7C
Host cells
RATIONALE
INDEPENDENT:
-provide tepid sponge
bath
-promotes heat
loss by
nursing
interventions, the
evaporation and goal was not met
client will be
conduction
as evidenced by
the increase in
Endogenous
37.5C or within
-promote surface
-promotes heat
temperature of the
pyrogens
normal range of
cooling by means of
loss by means
client rose to
undressing
of radiation and
37.8C.
37C
as follows:
Hypothalamus
T: 37.7C
change in set
PR: 102 bpm
point
conduction
RR: 26 cpm
-provide cool
-promotes heat
environment
loss by means
Fever (increase in
of convection
core temperature
to new set point)
SAN LAZARO HOSPITAL
EVALUATION
After 30 minutes of
lowered to at least
Vital signs taken
BP: 100/80 mmHg
INTERVENTIONS
temperature of the
-Flushed skin
-Warm to touch
EXPECTED
44
-instruct client to
-to reduce
minimize movement
metabolic
or maintain bed rest
demands of
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
-discuss importance of
-to prevent
adequate oral fluid
dehydration
intake particularly to
the parents
DEPENDENT:
-to prevent
-administer IV fluids
dehydration
as ordered
SAN LAZARO HOSPITAL
45
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
2.
ACUTE PAIN
Cues
Nursing
diagnosis
Acute pain related
Subjective:
to
I
have
Inference
upper
GI
Bite of infected
mosquito
severe bleeding
abdominal pain
secondary
Nursing
outcome
Short term:
to
hemorrhagic fever
Rationale
Short term:
After one hour of
After
1.Assess
intervention,
Severity
~
Verbalize 2.
Encourage 2.
Exhibited
facial
gradual relief or verbalization
grimace
upon
reduction of pain
Pain
feelings of pain
only
experienced
blood
gradual
is relief or reduction of
be absent of facial grimace
and upon body movement.
Long term:
expressed by the
After two days of
patient
nursing
Verbalize
of subjective and can pain as evidenced by
body movement
Virus attacks the
intervention,
the patient was able to:
Virus entered into

~
one hour of
pain 1.To identify extent nursing
the characteristics and of pain
patient will:
the blood
Pain scale of 8/10
Evaluation
interventions
Independent
nursing
dengue
Objectives:
Expected
Goal was met
3. Provide comfort 3. To provide a
Vital signs taken
intervention,
as follows:
patient will:
the measures
Plasma leakage
and non pharmacologic Long term:
encourage relative pain management
After
to perform touch
nursing
days
of
intervention,
Temp: 37.8 c
PR: 102 bpm
adequate relief of
RR: 26 cpm
pain or ability to 4. Encourage and 4 For relaxation ~ Verbalize adequate
SAN LAZARO HOSPITAL
Verbalize therapy
two
46
the patient was able to:
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
BP: 100/80mmHg
Bleeding
cope
with assist to do deep and can contribute relief
incompletely
breathing exercise
to pain relief
evidenced
Demonstrate
pain
and their opportunities ~ Demonstrate
non
the 5. To maximize
client
non pharmacologic
significant
ways
others
to
lessen
pain
for
self
control pharmacologic ways to
about over
lessen pain
non
manifestations of
pharmacologic
pain
Goal was met.
ways to lesson
pain
6. Notify physician 6. To meet pain
if
regimen
inadequate
is control goal.
.
Collaborative:
1.
Administer 1.To
medications
prescribed.
47
relief
or
as maintain
acceptable level of
pain
SAN LAZARO HOSPITAL
as
scale of 4/10
5. Teach
pain
by
relieved pain.
pain
of
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
2.
Assist
laboratory
with 2. To determine
and changes
diagnostic studies indications
of
as indicated.
or
healing
complications and
to
identify
precipitating
factors
SAN LAZARO HOSPITAL
48
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
DIAGNOSTIC EXAMINATIONS
Tourniquet Test
It is a test to determine the vascular resistance and platelet function. It an ancillary test but not
considered as a confirmatory test.
Place the cuff of a sphygmomanometer around the arm in the usual manner and inflate to a
pressure halfway between systolic and diastolic levels. Maintain compression for five minutes and
wait two minutes or more before observation. Describe an area 1-square inch on the volar surface
of the forearm 1-1/2 inches distal from the antecubital fossa. Count the petechiae within this
prescribed area. A positive tourniquet test is > 20 petechiae.
Total White Blood Cells Count
In case of dengue, this test will reveal leukopenia. The presence of leukocytosis and neutrophilia
excludes the possibility of dengue and bacterial infections (leptospirosis, meningoencephalitis,
septicemy, pielonephritis etc.) must be considered.
Thrombocytopenia (< 100.000 /mm3)
Total platelets count must be obtained in every patient with symptoms suggestive of dengue for
three or more days of presentation. Leptospirosis, measles, rubella, meningococcemia and
septicemy may also course with thrombocytopenia.
Hematocrit (micro-hematocrit)
According to the definition of DHF, it is necessary that there is a presence of hemoconcentration

(hematocrit elevated by > 20%); when its not possible to know the previous value of hematocrit,
we must regard as significantly elevated the results > 45%.
Bleeding Parameters
Bleeding Time = 1-3 minutes

Clotting Time = 3-5 minutes
Prothrombin Time = 12-15 seconds
Activated Partial Thromboplastin Time = 30-40 seconds
SAN LAZARO HOSPITAL
49
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
MEDICAL MANAGEMENT
Supportive and symptomatic treatment should be provided.

For fever, give paracetamol for muscle pains. For headache, give analgesic. Do not give aspirin.
Rapid replacement of body fluid is the most important treatment.
Includes intensive monitoring and follow-up.
Give ORESOL to replace fluid as in moderate dehydration at 75ml.kg in 4-6 hours or up to 2-3L in
adults. Continue ORS intake until patients condition improves.

IVF (PLR)
Intravenous fluid therapy is recommended when danger signs are present, especially during
defervescence. Crystalloids (D5LRS or D5NSS or PLRS or PNSS) can be given at 5-15
ml/kg/hour, with periodic adjustment according to patient's subsequent response. The vital signs
and urine output are important parameters to monitor response to IVF therapy. When the patient is
in shock, IVF must be given at a faster rate and bigger volume, the 20/20 rule, that is, 20ml/kg in
20-30 minutes. After adequately replacing the fluid losses, maintenance IVF therapy should be
instituted. D5LRS or D5IMB if < 2 yrs old may be used and should be given at 3 ml/kg/hr up to 2-3
liters per day in adults. Patients usually require IVF therapy for 24-48 hours
H2-antagonists anti-ulcer (proton pump, antacids)
Plasma Expanders Dextran
Blood Transfusion:
1. Platelet Concentration
2. PRBC
3. Fresh Whole Blood
4. Fresh Frozen Plasma
5. Cryoprecipitate
Monitor platelet count and hematocrit level
Baseline platelet count should be available at any stage of dengue hemorrhagic fever. Serial
determinations may be required during the defervescence stage to anticipate the onset of shock or
to detect occult bleeding. After recovery with fluid replacement, platelet count and hematocrit may
be repeated just before discharge.
NURSING MANAGEMENT
Provide a comfortable, dim and quiet room for rest.

Advise to increase oral fluid intake.
SAN LAZARO HOSPITAL
50
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
Watch out for bleeding manifestations.

For hemorrhage keep the patient at rest during bleeding episodes. For nose bleeding, maintain
an elevated position of trunk and promote vasoconstriction in nasal mucosa membrane through an
ice bag over the forehead. For melena, ice bag over the abdomen. Avoid unnecessary movement.
Observe signs of shock such as low pulse, cold clammy perspiration, prostration. Dorsal
recumbent position facilitates circulation.

Diet DAT EDCF and drinks.
SAN LAZARO HOSPITAL
51
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
DISCHARGE PLANNING (METHODS)
Instruct the patients mother the importance of compliance to medicines to achieve appropriate
therapeutic effects. Take Paracetamol for fever, if the patients temperature is 38 degrees Celsius and
above and Vitamin C to increase immune system.
E Tell the patient that he may have to decrease his activities and may not be allowed to do any hard
exercises for faster recovery.
Emphasized the proper treatment if the signs and symptoms of DHF reoccur. Proper TSB (Tepid
sponge bath) if there is a fever, increasing the fluid intake except for colored drinks and seek the
professional health team.
H Advice the patients mother to guide and follow the balance diet and to have adequate rest and sleep
of his son. Instructed the patients mother to provide insect repellants (natural or synthetic) for him and
emphasized the environmental cleanliness is a must. Advise patient to seek medical help if the sign and
symptoms
occur:
Shortness of breath
Symptoms of underlying disorders (wheezing, coughing)
Swelling of the feet or ankles
Intolerance
Chest discomfort
- For some complications of DHF
O Instructed patient to have follow-up checked-up @ OPD 2 weeks

after discharge from the hospital.
D-
Suggest the patient to eat healthy foods from all of the 5 food
groups:
Eating
fruits,
healthy
vegetables,
foods
may
breads,
help
dairy
her
feel
products,
better
She may be told to eat foods that are low in fat and salt.
S - Advise patient to always pray to our lord and never lose hope in
any obstacle that we may encounter.
SAN LAZARO HOSPITAL
52
and
meat
have
and
more
fish.
energy.
DENGUE
SECTION A4A1
NOVEMBER 17, 2010
EVALUATION
We met the objective we post at the beginning of this case study. We gained knowledge
about the related factor hinged in Communicable Disease like Dengue, through our clients we are able to
apply the nursing intervention needed for their situation. With this, as our fundamental foundation, we can
provide the expected care management and health teaching for our clients with this kind of condition. In
addition to this the case study, it also identify and determine the general problems and needs of the patient
with Dengue. The proper evaluation concerning the nursing management of client has also been aptly
accomplished. This presentation was able to help the patient promote health, prevention of disease and
medical understanding of such condition through the application of nursing skills.
RECOMMENDATION
The absence of danger signs allows the treatment of dengue hemorrhagic fever at home. Hospitalized
patients may be sent home if they have remained afebrile for at least 72 hours or if the danger signs have
resolved. However Primary prevention of dengue mainly resides in mosquito control. We can eliminate
vector by changing water and scrubbing sides of lower vases once a week, destroying the breeding places
of mosquito by cleaning surroundings, having a proper disposal of rubber tires, empty bottles and cans and
cleaning all stagnant water and water containers and make sure to cover these. The Department of Health
has a new program called the 4S: (a) Search and destroy (b) Self-protection measure (c) Seek early
consultation (d)Say yes to defogging during an outbreak.
For the Nursing student who will be assigned to San Lazaro wherein they will encounter
communicable diseases such as Dengue can gain knowledge by reading this case study we prepared. This
case presentation is an appropriate tool that will meet the current information needs of individuals, and
guide to promote health. They must be first equipped with the proper basic knowledge about the Anatomy
and Physiology of the system involved in this case. This case presentation also recommended to nursing
students who have patients with Dengue to use this presentation as an instrument or a source of
background knowledge about the said problem.
SAN LAZARO HOSPITAL
53
DENGUE
SECTION A4A1
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NOVEMBER 17, 2010

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DENGUE

PERPETUAL HELP COLLEGE OF MANILA

NOVEMBER 17, 2010

SAN LAZARO HOSPITAL

NOVEMBER 17, 2010

SAN LAZARO HOSPITAL

NOVEMBER 17, 2010

SAN LAZARO HOSPITAL

NOVEMBER 17, 2010

Past Medical and Surgical History

Minimum Age at 1st No. of doses

age to protect the

DPT reduces the

1 month and 2 The

SAN LAZARO HOSPITAL

NOVEMBER 17, 2010

Hep B reduces the

cirrhosis and liver

Social Health History

SAN LAZARO HOSPITAL

NOVEMBER 17, 2010

PERSONS REVIEW OF SYSTEM

INTERPRETATION AND ANALYSIS

under hospital because all he wants to do is to play with

friends. noticed that the child is status was disturbed.

According to the child, he sometimes

unresponsive Self-concept involves all perceptions. A positive

Harold Shryock, MD (Modern Medical Guide)

He has a happy family with

SAN LAZARO HOSPITAL

the Having a family beside him makes him stronger.

NOVEMBER 17, 2010

Role Relationship Pattern

last June2010 and her relatives

mother was pregnant. He emotionally and financially.

Based on the Eriksons theory of psychosocial

his father was the one patients treatment.

Taylor, Lilis and Le Mone ( Fundamentals of

Nursing 5th Edition pg 30)

expensive they traveled to

There are no changes to his

and experiences maleness or femaleness in

defined not only by a persons genitalia but also

the attitudes and feelings about it.

sexuality pattern. He was

Harold Shryock, MD (Modern Medical Guide)

Sexuality and Reproductive

SAN LAZARO HOSPITAL

Sexuality is the degree to which a person exhibits

NOVEMBER 17, 2010

because of young age.

The child verbalized that

The child has no problem in

skills and awareness.

are no management done

Cognitive- Concrete operations (ages 7 to 11). As

develop a sense of pride in their accomplishments

the males and females.

hospital, the child become

Barbara Kozier (Fundamentals of Nursing)

SAN LAZARO HOSPITAL

Stress is a condition in which person responds to