Tagum Doctors College Inc.

Tagum City
College of Nursing

A CASE STUDY
On
SYSTEMIC VIRAL INFECTION

Presented to
Jay Balan, RN
KAMO NA BAHALA SA INYO PART, IF NAA PMU NA.REMEMBER NGA ADDITIONAL
CORRECTION PKI.ADD NALANG OK? TNX.
ESPECIALLY SA PATHO UG SA ASSESSMENT NI BRYAN, DAPAT TUGMA SA
NURSING CARE PLAN ANG RESPIRATORY ASSESSMENTS.
-dada : )

In Partial fulfillment of the requirements

In
Related Learning Experience

By
Alba, Fedelyn
Baruiz, Cindy
Placido, Norlan
Carmona, Bryan
Calinga, Jaymark
Bohol, Levly Ann
Calabucal, Darlene
Bartolome, Resheyl
 Albarico, Mike Quim
Quesada, Shiela Mae
Castillo, Richelle Anne
BSN 3

TABLE OF CONTENTS

I. INTRODUCTION

A. Objective

a. General Objective

b. Specific Objective

II. ASSESSMENT

A. Biographical Data

B. Chief Complaint

C. History of Present Illness

D. Past Medical History

E. Personal and Family History

F. Developmental Task According to Erik

Erikson, Freud and Jean Piaget

G. Physical Assessment

a. General Survey

b. Vital Signs

III. LABORATORY AND DIAGNOSTIC EXAMINATION

 IV. REVIEW OF ANATOMY AND PHYSIOLOGY

V. SYMPTOMATOLOGY

VI. ETIOLOGY

VII. PATHOPHYSIOLOGY

a. Written

b. Diagram

VIII. PLANNING

A. Nursing Care Plan

B. Discharge Plan

IX. PHARMACOLOGICAL MANAGEMENT

X. COURSE IN THE WARD

XI. SYNTHESIS OF CLIENT’S CONDITION

A. Conclusion

B. Patient’s Prognosis

C. Recommendation

XII. EVALUATION OF THE OBJECTIVES OF STUDY

XIII. REFERENCES

XIV. BIBLIOGRAPHY

I. Introduction

(LAST)As a third year nursing students, we had our duties in different areas in

the hospital. We are assigned to care for our different patients. Giving holistic care to

them and attending their different needs. As we go on in our duties we had encountered

so many different diseases that affect the different lives of our patients. In choosing our

case, we did not see it as a requirement, but also we choose it as a chance to gain

more knowledge about the disease.(LAST)

We met our client at Tagum Doctors Hospital. His diagnosis was dengue

hemorrhagic fever grade 1, acute tonsilopharyngitis. What is the disease all about?

Dengue is a mosquito-borne infection that in recent decades has become a

major international public health concern. Dengue is found in tropical and sub-tropical

regions around the world, predominantly in urban and semi-urban areas. It is

transmitted by the main vector, Aedes aegytpi mosquito. Dengue hemorrhagic fever

(DHF), a potentially lethal complication, was first recognized in the 1950s during dengue

epidemics in the Philippines and Thailand. Today DHF affects most Asian countries and

has become a leading cause of hospitalization and death among children in the

region .The incidence of dengue hemorrhagic fever has grown dramatically around the

world in recent decades. Some 2.5 billion people two fifths of the world's population are

now at risk from dengue. WHO currently estimates there may be 50 million dengue
infections worldwide every year. The worldwide incidence is estimated to be 50 to 100

million cases of dengue fever (DF) and estimated 500,000 thousand cases of dengue

hemorrhagic fever (DHF) per year. In 2007 alone, there were more than 890 000

reported cases of dengue in the America, of which 26 000 cases were DHF (who.int

http://www.who.int/). The Philippine Department of Health (DOH) today reported that a

total of 2,332 dengue cases have been admitted to sentinel hospitals nationwide from

January 1 to May 15 this year. There were sixteen deaths recorded. The NEC (National

Epidemiology Center) report also revealed that the regions with the highest number of

cases were the National Capital region (732 cases), Region 3 (307), Region 5 (268),

and Region 7 (231). The ages of cases ranged from 1 month to 75 years old, with forty-

six percent (535) of the cases belonging to the 1-9 years age group (news-medical.net.

http://www.news-medical.net). Davao City: With nearly three dozen deaths since

January 2010 in at least two areas in Southern Mindanao alone, including this city,

officials have rallied residents a new to seriously help in combating dengue, the

Department of Health in Southern Mindanao had said.

In this city alone, 20 persons mostly children have died of dengue fever since

January 2010. In Tagum City, one patient died of dengue fever since the start of 2010

and 24 others had been hospitalized, said by Dr. Arnel Florendo of the city health office.

(washington.edu. http://depts.washington.edu).(JUMP STATEMENT)

What is acute tonsillopharyngitis?. Acute tonsillopharyngitis (sore throat) is an

inflammatory process of the oropharynx. It can become a particularly nasty throat

infection involving Mycoplasma pneumoniae and Chlamydia pneumoniae organisms

that often occurs in children. It can also occur in patients who are given antibiotics for
simpler infections and fail to take the prescribed regimen (dose and time)

(http://answers.yahoo.com). in the UK there are 100 per 1000 population a year

affected by acute tonsillopharyngitis. Acute tonsillitis is more common in childhood

(http://clinicalevidence.bmj.com). In metro Manila there were 1300 individuals reported

having acute tonsillopharyngitis as of year 2008.(manila times). In Tagum city,

according to City health there were 200 cases has been reported in their office having

acute tonsillopharyngitis.

Objectives

General:

After apprehensive case study, the students will be able to comprehend about the

cause and effect of the certain disease experienced by the client. this will enable us to

apply our knowledge from our class lectures on how to give appropriate nursing

interventions in the actual setting.

Specific:

In this case study we are task to:

• Gather complete personal data and pertinent information that will serve as our

main source of reliable facts and baseline data for completion of our study,

• be able to identify its signs and symptoms,

 • trace the anatomy and physiology of the affected organs and systems,

• trace and analyze the pathophysiology of the infirmity,

• consider laboratory results and relate it to the condition of our client,

• learn its medications and treatments,

• construct nursing care plans for the patient,

• identify the prognosis of the patient.

II. ASSSESSMENT

A. Biographical Data

Name: Patron, John Louie F.

Room and Bed Number: 314/1

Ward: 3B

Birthdate: Oct. 30, 2001

Birthplace: Trento, Agusan Del Sur

Age: 8 years old

Sex: Male

Religion: Roman Catholic

 Civil status: Single

Citizenship: Filipino

City Address: Trento, Agusan del Sur

Mother: Jocelyn Fuentes

Father: Leo Patron

Number of siblings: 3

MEDICAL DATA

Date Admitted: August 13, 2010

Time: 10:10 pm

Complaint: Fever, nasal cluffiver (cluffering)

Physician: Dr. Cecil Dy (Attending Physician)

Diagnosis: SVI R/O UTI

Final Diagnosis: Dengue Hemorrhagic Fever Grade 1, Acute Tonsilopharyngitis

Date Discharged: August 18, 2010

B. CHIEF COMPLAINT

The patient is 8 years old with a complaint of fever and nasal cluffering. He was

admitted to the hospital and was diagnosed to have severe(systemic) viral infection.
 C. SOCIO-ECONOMIC

Patient Patron is the son of Mr. And Mrs. Leo Patron and he was the youngest

among their 4 children. They own a small business like general merchandise that selling

all types of dry goods. According to the patient’s mother, their gross income for a day is

almost 20,000 pesos but their net income would be only 3000. They are in middle class

in the society and they are able to provide their simple needs. They are also member of

health insurance like Phil. Health and SSS- medicare. They live in a peaceful village

where the patient enjoys mingling with the other children inside the village. They go to

church to together with his brother, sister, mother and father every Sunday where they

consider it as their family day.

D. PAST HEALTH HISTORY

According to our interview with the mother and father of our patient, it has been

stated that John had experienced chickenpox as a sort of childhood illness and a

previous tonsillitis. Other than this, significant illness was mentioned during his

childhood years except for some cough, runny nose and fever. Regarding with his

immunization, our patient was confirmed of having a complete immunization during his

childhood years and got sick after every immunization.

With regards to the diet of our patient, it was said that our patient loves to eat junk

foods and didn’t like to eat fruits and vegetables. Our patient was said to have taken

regular meals of 3 times a day and 2 times for snacks mostly are junk foods, but he will

just eat if the mother would please him to do so when the mother is at home. It was

mentioned also that our patient ate rice for about half cup per meal and is accompanied
with soup and a juice. It was also mentioned that John drinks a little amount of water

everyday.

Concerning with the sleeping pattern of our patient, it was said that 9-10 hours of

sleep was regular for John. He sleeps at around 8-9 pm after dinner and wakes up

every morning at around 6-7 am. Our patient has an exercise pattern. Concerning about

his check up, they had a nearby health center and but preferred to have it at the

polyclinic, where they have their own family doctor.

August 12 in the afternoon when the patient arrived from school; he is having a

fever so the mother gave him a paracetamol to relief the fever. The next day, the patient

is still having a fever so the mother gave his son a glass of boiled “tawa-tawa” for they

are suspecting that the patient has a dengue fever and also he is vomiting. Around 9

pm, the patient is still having a high grade fever so the mother decided to admit the

patient to the Tagum Doctors Hospital around 10:15 pm.

E. PRESENT HEALTH HISTORY

Our patient, 8 years old was admitted at 3B ward at Tagum Doctors Hospital last

August 13, 2010 with chief complaints of fever and nasal claffering.

1 day prior to admission, the patient was said to have taken “tawa-tawa” , and

still with high grade fever but negative with occurrence of vomiting, and loose bowel

movement, they still haven’t consulted for further management of the patient’s

discomfort until the patient felt worse.

 1 hour prior to admission, the patient was noted for onset of fever, vomiting and

dizziness accompanied with difficulty of breathing. As a result, they prompted to

consult for a health care service, by this time; the patient was afebrile upon

assessment, hence subsequently admitted at Tagum Doctors Hospital on August

13, 2010. As a result, the following days proceeds further management and

evaluation.

F. PHYSICAL ASSESSMENTS

System Normal findings Actual findings Remarks

General  Appears as its  Appears as its The general

appearance age age appearance of the

 mesomorph  mesomorph patient is

 In good hygiene  Good hygiene appropriate to his

age and found to

 Appearance is  Appears
be normal.
appropriate for appropriate for

age age

 Alert and active  Alert & active

 Appears happy  Appears happy

 Cooperative  Cooperative

 Appears well-  Appears well-

nourished nourished
  Can speak and  He can speak and

can express can express what

what he he wanted.

wanted.  Hair is evenly

 Body hair is fine distributed

and thinly throughout the

distributed body.

Vital signs  RR: 20 - 30  RR:23 cpm All of the findings

cpm  heart rate: 96 for the vital signs

 heart rate 80 - bpm are found to be

110 bpm  Temperature: 37. within normal

 temperature: 2 °C range.

36.5 – 37.5 °C

Nutritional  Normal weight  Patient weight is The nutritional

Status of 39 to 79 22 kg, within status is not

pounds (18 to normal weight. normal since the

36kg)  Height of 46 patient doesn’t

 Normal height inches have balance diet

of 40 to 52 Patient eats 3 and loves to eat

inches times a day. He unhealthy foods

 Eat balance diet didn’t like to eat like junk foods.

and exercise vegetable and

 fruits. Mostly he

eats junk foods

during snack time.

Neurologic  Oriented to  Patient is All of the findings

Status people, time oriented to for neurological

and place. people, time and status are found to

With thought place. be appropriate

organization of  With thought except for his

comprehensible organization of varying moods

with the use of comprehensible upon assessment

appropriate with the use of like his

words and clear appropriate uncooperativeness

speech. words and clear when he was

 Calm behavior speech. being asked by

 Attitude of  Calm behavior selected

cooperative as observed, the questions.

 mood patient stays put.

appropriate with  Uncooperative

situation  mood

 insight i intact appropriate with

and appropriate situation

 insight is intact

and appropriate
Skin  Skin color  light brown All of the findings

ranges from  no foul odor for the skin are

pale white with  no lesions / found to be within

pink, yellow, edema normal.

brown, or olive  smooth and

tones to dark even
brown or black.
 slightly moist
No strong odor
 soft
should be
 warm to touch
evident, and the
 returns after
skin should be
pinched: good
lesion free.
turgor
 Skin should be
 skin is intact
soft warm,

slightly moist
 Body hair is fine
with good turgor
and thinly
and without
distributed
lesions and

edema.

 Body hair is fine

and thinly

distributed
Hair  Even distribution  Well distributed All of the findings

 Hair color is throughout the for the hair are

black body, black in found to be within

 No scalp lesions color, fine hair normal.

 No masses covers body

 No lesions
 hair is clean,

neatly arranged  No masses

 Characteristics  Clean and dry

of hair is elastic,

lustrous and  Silky, elastic,

silky lustrous
Nails  Pinkish nail bed  He has pinkish All of the findings

nails for the nails are

found to be
 Concave shape,
 The nails are within normal.
has longitudinal
has concave
ridges
shape
 Nails are clean
 Clean nails and
and well
well trimmed
trimmed

 Color of the nail

 Capillary refill:
bed back to
pink tones return
original color
< 2sec
after 1-2
 seconds

 The angle of

the nail base  160º angle

and skin is 160 between

º nail base and

skin

 Head  Symmetrical,  normocephalic & All of the findings

rounded and symmetric for the head are

normocephalic  head found to be within

 Head circumference is normal.

circumference 51 cm

is 45 – 60 cm  head is steady

 head is steady  No dandruff

 No palpable

lymph nodes  No palpable

 No dandruff lymph nodes

 full range of

motion  full range of

motion: up,

down, sideways
 No tenderness
 No swelling,
 Symmetrical
lacerations,
facial
bruises and no
 expression such tenderness was

as smiling, seen upon

frowning inspection.

 No masses  Symmetrical

facial expression

 No masses
Eyes  eyes are  eyes are both All of the findings

symmetrical symmetric for the eyes are

 eye lashes are  eye lashes is found to be within

evenly thin, curled normal.

distributed, thin outward and

and curled evenly

outward distributed

 Sclera white  sclera is white

 No discharge,  no discharge,

no discoloration lesions,

of eyelids lacerations

 When lids are  when lids are

close, sclera is close, sclera is

not visible not visible

 Pink conjunctiva  pinkish

 No edema or conjunctiva

 no edema or
 tenderness over tenderness in

lacrimal gland the eyes

 equal eye  Equal eye

movement movement

 alignment of  Outer canthus

outer canthus aligns with tip of

with the tip of pinnas

the pinnas  No unusual

 should not have discharges from

unusual the lacrimal

discharges from ducts noted

the eye

 (PERLA

assessment)
Ears  Symmetrical  3cm equal in All of the findings

size bilaterally for the ears are

 Top of ears are found to be within

 Top of ears are
aligned with the normal.
aligned with the
outer canthus of
outer canthus of
the eyes
the eyes
 smooth without
 No lesions
lesions

 the same with

 Color same as the facial color
facial skin
 auricle, tragus
 Firm and not and mastoid
tender process is not
 No masses tender

 No discharges  no discharge,

noted

 He can hear
 Should not have
vibrating sound
difficulty of
by the use of
hearing
tuning fork

Nose and  Symmetrical  midline in face All of the findings

sinuses  No discharges  no discharge for the ears are

 Uniform in color  Same color as found to be within

skin the normal.

 no tenderness,
 Not tender
noted

 lower and middle

turbinate is pink

 Pink mucosa in color with

with adequate adequate nasal

nasal hair hair

 absence of

lesions in the

 Nasal septum nose

intact and in the  septum is

midline straight

 Sinuses are not

tender
 Sinuses are not

tender  No nasal flaring

 He is able to

smell pleasant

and foul odors

 No nasal flaring suggesting good

olfaction.
  Without  Client is able to

difficulty of breathe without

breathing and difficulties when

with good sense one nostril is

of smell occluded

suggesting nares

on both side of

the nose are

patent.
Mouth  Deciduous teeth  14 (28) All of the findings

mixed with deciduous and for the mouth are

permanent mixed with found to be within

teeth must be permanent teeth normal.

present erupted

 pink tone of  pinkish tone of

gums, tongue, gums, tongue

and tonsils and tonsils

 Moist and  Moist

slightly rough  absence of

tongue lesions

 absence of

lesions in oral  smooth tongue

mucosa base with

 Smooth tongue capillaries

 base  pinkish in color

and smooth

 pinkish soft and

 Light pink,
hard palate
smooth soft
 Uvula is
palate
positioned in the
 Light pink hard
midline.
palate

 Uvula is

positioned in

the midline of

soft palate

Throat and neck  No palpable  No palpable All of the findings

lymph nodes lymph nodes for the throat and

 Generally neck are found to

 Uniform in color
uniform in color be within normal.

 No edema

 Neck can move  No edema

freely
 Neck can move
 neck is short
freely
with skin folds
 neck is short
 with no difficulty
with some skin
 on swallowing folds

 Patient can

swallow food

without difficulty

Breast and axilla  Symmetrical  Symmetrical All of the findings

breast and breast and axilla for the breast and

symmetrical axilla are found to

axilla be within normal

 No tenderness
 absence of range.

tenderness
 No secretions
 No secretions

or discharges

 No masses or  No masses or
nodules nodules
Chest and  Respiratory  Normal RR of 23 All of the findings

respiratory Rate: 20 – 30 cpm. for the chest and

system cpm respiratory system

 Symmetrical are found to be

 rounded,
placement of all within normal
symmetric,
structures range.
shoulder and
 Bilaterally equal
scapula are
shoulder height
equal horizontal
 regular
position
 breathing  unlabored,

pattern regular

breathing,

pattern
 No
 skin are free
lesions/masses
from lesions and

masses
 No tenderness
 no tenderness
Cardiovascular  Apical pulse:80-  PR:110 bpm All of the findings

and peripheral 110 bpm for the

 Apical pulse cardiovascular and

 presence of
audible peripheral are
apical pulse
found to be within

normal range.
 No cold
 Absence of cold
extremities and
extremities and
discolored
no discolored
extremities
extremities
 Capillary
 Capillary refill
refill less than 2
less than 2 sec.
sec.
Abdomen and  Uniform skin  Uniform in color All of the findings

gastrointestinal color in the for the abdomen

system abdomen are found to be

 prominent when
 Symmetric within normal
standing and
contour is range.
supine positions
rounded
 Absence of

lesions

 No lesions  no tenderness

 No masses

palpable
 No tenderness
 Presence of
 No masses
flatus
 Presence of
 His bowel
flatus
movement is
 Bowel sound of
once in two days
5–30 clicks per
without difficulty
minute
and color of

brown.

 Bowel sound of

8 click/min.
Musculoskeletal  Uniform color  uniform in color All finding in the

of extremities musculoskeletal

 10 fingers and system are found

 10 fingers and
 toes toes to be within

 Symmetrical  feet & legs are normal.

symmetric

 Absence of
 No fractures,
fractures,
dislocations and
dislocations and
deformities
deformities
 full range of
 full range of
motion
motion without

tenderness
 No tremors and
 Absence of
palpable
tremors and
nodules
nodules
 extremities
 warm to touch
warm to touch
 strong muscle
 strong muscle
strength
strength
Genito-urinary  Symmetrical in  Symmetrical in  The genito-

System color color urinary

 absence of  absence of systems are

tenderness tenderness found to be

 No secretions normal since

or discharges patient doesn’t

 No masses or
 No masses or have problem
 nodules nodules in regards to

 Urine output of  Urine output of his urination.

30 cc/hour 30 cc/hr with

color of yellow

Developmental Task

Theorist Theory Developmental Justifica Result and

Task tion Justification

Robert Activity during He is 8 years old.

Havighu aging He belongs to a

rst middle Childhood

Havighurst
from (6-8 years
identified Six
old). His
Major Stages in
developmental
human life
tasks is to:
covering birth to

old age.
According to the
• Infancy & * Learning physical
patient he is
early skills necessary for
actively
childhood ordinary games.
participating in
 different games
(Birth till 6
such as card
years old)
games, hide
• Middle
and seek,
childhood
running,
(6-13 years
“tumbang
old)
preso”, “Takyan”
• Adolescen
and slipper
ce (13-18
game.
years old)

• Early

Adulthood
*Building
(19-30
wholesome
years old)
attitudes toward
• Middle Age
oneself as a
(30-
growing organism
60years
According to the
old)
patient he
• Later
respected his
maturity
parents and did
(60 years
the usual things
old and
that his parents
over)
told him to do
 like cleaning his
From there,
own shoes,
Havighurst
*Learning to get making his
recognized that
along with age- assignments.
each human has
mates and to care his
three sources for
younger brother.
developmental

tasks. They are:

According to the
• Tasks that
patient, he has
arise from
many friends in
physical
the school, most
maturation:
are male. They
Learning to
get along by
walk, talk, *Learning an
chatting jokes to
control of appropriate
each other and
bowel and masculine or
by playing
urine, feminine social
games. (Patient
behaving in role
will assume the
an
role of being the
acceptable
defender of his
manner to
two sisters,
opposite sex,
heavy works
adjusting to
*Developing should be his
 fundamental skills task at home.)
menopause.
in reading, writing,
• Tasks that
and calculating
arise from

personal
According to
values:
patient mostly of
Choosing an
Developing his friends are
occupation,
conscience, male. He wear
figuring out
morality, and a male clothes
ones
scale of values and did usual
philosophical
boy things like
outlook.
playing playing
• Tasks that
Achieving personal
“takyan” and
have their
independence
chatting to his
source in the
male friends.
pressures of

society:

Learning to
According to the
read, learning
patient he is
to be
good in math
responsible
but bad at
citizen.
English. He

The reads fast and

his writing skill

 was good.
developmental

tasks model that According to the

Havighurst patient he

developed was respected his

age dependent parents and did

and all served right things to

pragmatic other like saying

functions “please” and

depending on “thank you”

their age. (conscience and

(http.wikipedia.or morality: Help

g) his mother

perform tasks at

home).

According to the

patient, he woke

up in the

morning by

himself and his

mother gave

him some

money to spend

food for his

 snack.

Jean Moral Theory Children's moral He knows

Piaget thinking undergoes from what is

other shifts. In right and wrong

Children younger
particular, younger like when he did
than 10 or 11
children base their wrong to his
years think about
moral judgments parents his
moral dilemmas
more on intention is to
one way; older
consequences, acquire
children consider
whereas older attention from
them differently.
children base their his mother so
As we have seen,
judgments on he did the
younger children
intentions. shouting
regard rules as
(concrete afterwards he
fixed and
operational stage)- realize the
absolute. They
wrong attitude
Justify!
believe that rules
he showed and
Determinants for
are handed down
said sorry to his
this stage:???
by adults or by
mother.
God and that one
-transitivity (with
cannot change
logic and common
them. The older
sense.)
 child's view is
-
more relativistic.

He or she

understands that

it is permissible to

change rules if

everyone agrees.

Rules are not

sacred and

absolute but are

devices which

humans use to

get along

cooperatively.

Erik Psychosocial Competence:

Erikson Industry vs.

According to the
Inferiority
patient, when he
All of the stages
(Childhood, 7 to
got a high score
in Erikson's
11 years)
the people
epigenetic theory
around him
are implicitly
praised for his
present at birth The aim to bring a
accomplishment
(at least in latent productive
s.
form), but unfold situation to
according to both completion Rationale:

an innate scheme gradually From that he

and one's up- supersedes the begin to
bringing in a whims and wishes demonstrate
family that of play. The industry by
expresses the fundamentals of being diligent,
values of a technology are persevering at
culture. Each developed. To lose tasks until
stage builds on the hope of such completed, and
the preceding "industrious" putting work
stages, and association may before pleasure.
paves the way for pull the child back If children are
subsequent to the more instead ridiculed
stages. Each isolated, less or punished for
stage is conscious familial their efforts or if
characterized by rivalry of the they find they
a psychosocial oedipal time. are incapable of
crisis, which is
meeting their
based on
teachers' and
(www.learningplac
physiological
parents'
eonline.com)
development, but
expectations,
also on demands
they develop
put on the
feelings of
individual by inferiority about

parents and/or their capabilities.

society. Ideally,

the crisis in each

stage should be

resolved by the

ego in that stage,

in order for

development to

proceed correctly.

The outcome of

one stage is not

permanent, but

can be altered by

later experiences.

Everyone has a

mixture of the

traits attained at

each stage, but

personality

development is

considered

successful if the
 individual has

more of the

"good" traits than

the "bad" traits.

(http.haverford.co

m)

III. Laboratory Test/Diagnostic Test

DATE TEST NORMAL RESULT INTERPRETATIO

FINDINGS/VALUES N
Urinalysis Color Yellow Yellow Our patient has a

normal color of
08-12-2010
urine which is

yellow.
Specific 1.020 -1.030 g/ml 1.010g/m Our client has a

Gravity l normal urine

 specific gravity.
Appearan Clear Clear Our patient has a

ce normal urine

appearance since

it is clear.
Sugar None Negative This is normal

because sugar

should not be

found in the urine.

Albumin None Negative This is normal

because albumin

should not be

found in the urine

Pus cells less than 10 per 2-4/hpf Our clien has an

microliter of urine acute infection like

UTI that can be

treated for a few

days of treatment.
Reaction 7 - 14 alkaline Alkaline Persistent alkaline

urine (pH 7 -

8)indicates:

suggests urinary

tract infection,

vegetarian diet,
 alkalosis ,pyloric

stenosis /

obstruction,

vomiting, alkalizing

drugs.
Hematolog Hemoglo Male: 135-160g/L 106g/L Our client has a

y bin mass decreased

concentr hemoglobin mass

08-12-2010
ation concentration

because of his

disease which is

DHF.
Leukocyt 5-10x10g/L 6.3x10 Our patient has a

e no. g/L normal leukocyte

concentr level.

ation
Segment 0,55-0,65 0,72 Our client has an

ers increased

segmenters it is an

indication that

there is infection

somewhere in the

body.
Lymphoc 0,25-0,40 0,25 Our client has a
 ytes normal lymphocyte

level.
Monocyte 0,02-0,06 0,02 Our client has a

s normal monocyte

level.

Eosinoph 0,01-0,05 0,01 Our client has a

ils normal Eusinophils

level
Thrombo 150-300x10g/L 203.0x10 Our patient has a

cyte g/L normal

Thrombocyte level.
Hematocr 0,34-0,40 0,35 Our patient has a

it normal Hematocrit

level.
Fecalysis Color Yellowish brown Brown The color of the

stool of our patient

08-14-2010
is normal
Consiste soft and bulky, small Soft The consistency of

ncy and dry our patients stool

is normal.
Parasitic None No ova Normal.

ova found

Hematolog Thrombo 150-300x10g/L 218.4x10 Our patient has a

y cyte g/L normal

08-14-2010 Thrombocyte level.
Hematoc 0,34-0,40 0,39 Our patient has a

rit normal Hematocrit

level.
Hematolog Hemoglo Male: 135-160g/L 122g/L Our patient has a

y bin mass decrease AMC

concentr because of DHF.

08-15-2010
ation
@6 AM
Leukocyt 5-10x10g/L 4.6x10g/ Our patient has a

e no. L normal leukocyte

concentr level.

ation
Segment 0,55-0,65 0,63 Our client has a

ers normal segmenters

level.
Lymphoc 0,25-0,40 0,35 Our client has a

ytes normal level of

lymphocyte.
Monocyte 0,02-0,06 0,03 Our client has a

s normal monocyte

level.
Eosinoph 0,01-0,05 0,01 Our patient has a

ils normal Eusinophils

level.
Thrombo 150-300x10g/L 199.8x10 Our patient has a
 cyte g/L normal

Thrombocyte level.
Hematocr 0,34-0,40 0,37 Our patient has a

it normal Hematocrit

level.
Hematolog Thrombo 150-300x10g/L 190x10g/ Our patient has a

y cyte L normal

Thrombocyte level.
08-15-2010
Hematocr 0,34-0,40 0,38 Our patient has a
@ 2PM it normal Hematocrit

level.
Hematolog Thrombo 150-300x10g/L 162.8x10 Our patient has a

y cyte g/L normal

Thrombocyte level.
08-15-2010
Hematocr 0,34-0,40 0,37 Our patient has a
@ 10 PM it normal Hematocrit

level.
Hematolog Thrombo 150-300x10g/L 216.0x10 Our patient has a

y cyte g/L normal

Thrombocyte level.
08-16-2010
Hematocr 0,34-0,40 0,36 Our patient has a
@ 6 AM it normal Hematocrit

level.
Hematolog Thrombo 150-300x10g/L 156.4x10 Our patient has a

y cyte g/L normal

 08-16-2010 Thrombocyte level.
Hematocr 0,34-0,40 0,34 Our patient has a
@ 2 PM
it normal Hematocrit

level.
Hematolog Thrombo 150-300x10g/L 153x10g/ Our patient has a

y cyte L normal

Thrombocyte level.
08-17-2010
Hematocr 0,34-0,40 0,39 Our patient has a

it normal Hematocrit

level.

III. REVIEW OF ANATOMY AND PHYSIOLOGY

ANATOMY AND PHYSIOLOGY OF THE BLOOD

About the blood

• Approximately 8% of an adult's body weight is made up of blood.

• Females have around 4-5 liters, while males have around 5-6 liters. This difference
is mainly due to the differences in body size between men and women.
• Its mean temperature is 38 degrees Celsius.
• It has a pH of 7.35-7.45; making it slightly basic (less than 7 is considered acidic).
• Whole blood is about 4.5-5.5 times as viscous as water, indicating that it is more
resistant to flow than water. This viscosity is vital to the function of blood because if
blood flows too easily or with too much resistance, it can strain the heart and lead to
severe cardiovascular problems.
• Blood in the arteries is a brighter red than blood in the veins because of the higher
levels of oxygen found in the arteries.
• An artificial substitute for human blood has not been found.

Functions of blood
Blood has three main functions: transport, protection and regulation.

Transport
Blood transports the following substances:
• Gases, namely oxygen (O2) and carbon dioxide (CO2), between the lungs and
rest of the body
• Nutrients from the digestive tract and storage sites to the rest of the body
• Waste products to be detoxified or removed by the liver and kidneys
• Hormones from the glands in which they are produced to their target cells
• Heat to the skin so as to help regulate body temperature

Protection
Blood has several roles in inflammation:
• Leukocytes, or white blood cells, destroy invading microorganisms and cancer
cells
• Antibodies and other proteins destroy pathogenic substances
• Platelet factors initiate blood clotting and help minimize blood loss

Regulation
Blood helps regulate:
• pH by interacting with acids and bases
• Water balance by transferring water to and from tissues

Composition of blood
Blood is classified as a connective tissue and consists of two main components:
1. Plasma, which is a clear extracellular fluid
2. Formed elements, which are made up of the blood cells and platelets
The formed elements are so named because they are enclosed in a plasma membrane
and have a definite structure and shape. All formed elements are cells except for the
platelets, which tiny fragments of bone marrow cells.

Formed elements are:

• Erythrocytes, also known as red blood cells (RBCs) - Red blood cells (RBCs),
also known as erythrocytes, have two main functions:
1. To pick up oxygen from the lungs and deliver it to tissues elsewhere
2. To pick up carbon dioxide from other tissues and unload it in the lungs

• Leukocytes, also known as white blood cells (WBCs)- Leukocytes are further
classified into two subcategories called granulocytes which consist of neutrophils,
eosinophils and basophils; and agranulocytes which consist of lymphocytes and
monocytes.
1.) Neutrophils- A type of white blood cell, specifically a form of granulocyte, filled with
neutrally-staining granules, tiny sacs of enzymes that help the cell to kill and digest
microorganisms it has engulfed by phagocytosis. The mature neutrophil has a
segmented nucleus (it is called a seg or poly) while the immature neutrophil has band-
shape nucleus (it is called a band). The neutrophil has a lifespan of about 3 days.
2.) Eosinophils- A type of leukocyte (white blood cell) with coarse round granules of
uniform size within its cytoplasm and typically a bilobate (two-lobed) nucleus.
Eosinophils are so named because their cytoplasmic granules stain red with the dye
eosin. Eosinophils normally constitute 1 to 3% of the peripheral blood leukocytes, at a
count of 350 to 650 per cubic millimeter. Also called an eosinophilic leukocyte.
3.) Basophils- A type of leukocyte (white blood cell) with coarse bluish-black granules of
uniform size within the cytoplasm and typically a bilobate (two-lobed) nucleus. Basophils
are so named because their cytoplasmic granules stain with basic dyes. Basophils
normally constitute 0.5 to 3% of the peripheral blood leukocytes. Basophils contain (and
can release) histamine and serotonin. Also called a basophilic leukocyte.

• Platelets- A minute, nonnucleated, disk like cytoplasmic body found in the blood
plasma of mammals that is derived from a megakaryocyte and functions to
promote blood clotting

Blood plasma
Blood plasma is a mixture of proteins, enzymes, nutrients, wastes, hormones and
gases. The specific composition and function of its components are as follows:
 ANATOMY AND PHYSIOLOGY OF THE VASCULAR SYSTEM

BLOOD VESSELS

1.) Arteries- The walls (outer structure) of arteries contain smooth muscle fibre that
contract and relax under the instructions of the sympathetic nervous system. It
transports blood away from the heart. Transport oxygenated blood only (except in the
case of the pulmonary artery).

2.) Arterioles- Arterioles are tiny branches of arteries that lead to capillaries. These are
also under the control of the sympathetic nervous system, and constrict and dilate, to
regulate blood flow. Transport blood from arteries to capillaries; Arterioles are the main
regulators of blood flow and pressure.
3.) Capillaries- Capillaries are tiny (extremely narrow) blood vessels, of approximately
5-20 micrometers (one micro-meter = 0.000001metre) diameter. There are networks of
capillaries in most of the organs and tissues of the body. These capillaries are supplied
with blood by arterioles and drained by venules. Capillary walls are only one cell thick,
which permits exchanges of material between the contents of the capillary and the
surrounding tissue. Function is to supply tissues with components of, and carried by, the
blood, and also to remove waste from the surrounding cells ... as opposed to simply
moving the blood around the body (in the case of other blood vessels); Exchange of
oxygen, carbon dioxide, water, salts, etc., between the blood and the surrounding body
tissues.

4.) Venules- Venules are minute vessels that drain blood from capillaries and into
veins. Many venules unite to form a vein. Drains blood from capillaries into veins, for
return to the heart.

5.) Veins- The walls (outer structure) of veins consist of three layers of tissues that are
thinner and less elastic than the corresponding layers of aerteries. Veins include valves
that aid the return of blood to the heart by preventing blood from flowing in the reverse
direction. Transport blood towards the heart. Transport deoxygenated blood only
(except in the case of the pulmonary vein).
 ANATOMY AND PHYSIOLOGY OF THE HEART

The essential function of the heart is to pump blood to various parts of the body. The
mammalian heart has four chambers: right and left atria and right and left ventricles.
The two atria act as collecting reservoirs for blood returning to the heart while the two
ventricles act as pumps to eject the blood to the body. As in any pumping system, the
heart comes complete with valves to prevent the back flow of blood. Deoxygenated
blood returns to the heart via the major veins (superior and inferior vena cava), enters
the right atrium, passes into the right ventricle, and from there is ejected to the
pulmonary artery on the way to the lungs. Oxygenated blood returning from the lungs
enters the left atrium via the pulmonary veins, passes into the left ventricle, and is then
ejected to the aorta. In the frontal view of the heart shown below, the right atrium is in
blue, the left atrium in yellow, the right ventricle in purple, and the left ventricle in red.
The chambers are semi-transparent so that the valves, drawn in white, can be seen.

ANATOMY AND PHYSIOLOGY

OF THE ORAL CAVITY

Teeth- are for chewing. This is the process that mechanically breaks food into smaller
pieces and mixes it with saliva. (Essentials of Anatomy and Physiology, 5th Ed., p370)
Tongue- is made up of skeletal muscle that is innervated by the hypoglossal nerves
(12th cranial). On the upper surface of the tongue are small projections of papillae, many
of which contain taste buds. (Essentials of Anatomy and Physiology, 5th Ed., p372)

Salivary Glands- the digestive secretion in the oral cavity is saliva, produced by three
pairs of salivary glands. The parotid glands in front of the ears. The submandibular
glands are at the posterior corners of the mandible, and sublingual glands are below the
floor of the mouth. Saliva is mostly water, which is important to dissolve food for tasting
and to moisten food for swallowing. (Essentials of Anatomy and Physiology, 5th Ed.,
p372)

Pharynx- the oropharynx and laryngopharynx are food passageways connecting the
oral cavity to the esophagus. No digestion takes place in the pharynx. Its only related
function is swallowing, the mechanical movement of food. (Essentials of Anatomy and
Physiology, 5th Ed., p373)

Esophagus- is a muscular tube that takes food from the pharynx to the stomach; no
digestion takes place here. Peristalsis of the esophagus propels food in one direction
and ensures that food gets to the stomach even if the body is horizontal or upside down.
At the junction with the stomach, the lumen of the esophagus is surrounded by the
lower esophageal sphincter. It relaxes to permit food to enter the stomach, then
contracts to prevent the backup of stomach contents. (Essentials of Anatomy and
Physiology, 5th Ed., p373)

(TONSILS!)
 Symptomatology

Signs and Symptoms Actual Findings Rationale

 Fever Present A fever is one of the body's

immune responses that

attempt to neutralize a

bacterial or viral infection.

 Headache Present The possible causes of a

headache range from a

relatively harmless common

headache or common cold

to life-threatening

emergencies like dengue or

even the unlikely

occurrence of a brain
 tumor.

 Sore throat Present A sore throat is a symptom

of a wide variety of mild to

serious diseases, disorders

and conditions. A sore

throat can result from

infection, allergy,

inflammation, trauma,

malignancy, airway

obstruction and other

abnormal processes.

(rationale)

 Abdominal pain Present Abdominal pain often

occurs in conjunction with

other symptoms, which vary

depending on the

underlying disease,

disorder or condition. The

underlying disorder,

disease or condition that is

causing abdominal pain can

cause complications, some

 of which can be serious,

even life-threatening. With

(rationale)

 Vomiting Present Vomiting can be due to a

mild condition, such as

indigestion or a moderate

condition, disorder or

disease, such as

gallstones, or a side effect

of medication. Vomiting can

also occur in serious, even

life-threatening conditions,

including bleeding peptic

ulcer, intestinal, dengue,

obstruction or meningitis.

(rationale)

Absent Symptoms affecting the

 Respiratory symptoms
breathing systems

(abnormal breath sounds)

 Cough Present A cough is a defensive

 reflex of the body that

functions to keep the

airways clear of irritating or

obstructing substances so

that breathing and the

intake of oxygen is

effective.

Breathing difficulty can be a

 Breathing difficulty
Present symptom of a variety of

mild to serious disorders,

diseases or conditions.

Breathing difficulty and can

result from infection,

inflammation, trauma,

malignancy, airway

obstruction and other

abnormal processes.

Absent Bleeding severity can range

 Bleeding easily
from mild local bleeding at

a small injury to massive

hemorrhage
 Under normal

Present circumstances, as viruses

 Acute tosilitis
and bacteria enter the body

through the nose and

mouth, they are filtered in

the tonsils. Within the

tonsils, white blood cells of

the immune system mount

an attack that helps destroy

the viruses or bacteria, and

also causes inflammation

and fever.

VI. ETIOLOGY

Etiology Actual Findings Implications

Predisposing

Sex Women and young females tend to develop

severe forms of dengue fever at higher rates
than males.
 It is common in children in Under 15 years of
Age in Asia whereas in South America it is
Age observed in all ages. (How can age be a
predisposing factor?)

Race Dengue Hemorrhagic fever, highest incidence

was seen in Malay males more than 12 years
of age. Also incidence of DHF is much greater
in Asian countries. (how can the race be a
predisposing factor?)

Precipitating

Aedes is a genus of mosquito originally found

in tropical and subtropical zones, but has

Aedes mosquito
spread by human activity to all continents

excluding Antarctica. Several of the species

transmit important human diseases and one

species, Aedes albopictus, is the most

invasive mosquito in the world.

(Combine with the Being in tropical and subtropical areas around

“race”, e.g. (Race/ the world — especially in high-risk areas, such

geographical as tropical Asia, Central and South America,

location) and the Caribbean — increases your risk of

Living or traveling exposure to the virus that causes dengue

in tropical areas fever. Dengue virus transmission occurs year-

round, although the risk is highest during a

recognized dengue fever outbreak.

VIII. PLANNING

Nursing Care Plan

DATE CUES NEEDS NSG. OBJECTIVE OF INTERVENTION EVALUATION

/TIME CARE
DIAGNOSIS

08 Subjective V Ineffective At the end of 8 • Assess Goal met as

cues: Breathing hours duty, respiratory rate evidenced by

/ E
Pattern Related patient will be and depth by patient was
“Paspas man
17 N
to enlargement able to maintain listening to lung able to
muginhawa
/ T of the tonsils breathing pattern sounds. maintained
akong anak
secondary to as evidenced by ®Respiratory rate normal
10 maam”, as I
acute eupnea, and and rhythm breathing
verbalize by
L tonsilopharyngiti changes are early pattern as
regular
the patients
7-3 A s respiratory warning signs of evidence by the
mother.
pm rate/pattern. impending respiratory rate
T
respiratory of 25 cpm
Objective I - An difficulties. which is within

cues: infection • Assess for normal range of

O
is the dyspnea and 20-20 cpm
Irritability noted
N
detriment quantify (e.g.,
• Tachypne
al note how many
a noted
colonizati words per breath
• Coughing
on of a patient can say);
noted
host relate dyspnea to
• Nasal
organism precipitating
flaring
by a factors.
noted
foreign ®Dyspnea that
V/S
species. occurs with
-T: 35.7°C
In an activity may

-P: 83 infection, indicate activity

bpm the intolerance.

infecting • Monitor breathing

-R: 34
organism patterns such as
-BP: 90/60 seeks to Tachypnea

utilize the (increase in

host's respiratory rate) ®

resources Specific breathing

to patterns may

multiply, indicate an

usually at underlying

the disease process

expense or dysfunction.

of the Cheyne-Stokes

host. The respiration

infecting represents

organism, bilateral

or dysfunction in the

pathogen, deep cerebral or

interferes diencephalon

with the associated with

 normal brain injury or

functionin metabolic

g of the abnormalities.

host and Apneusis and

can lead ataxic breathing

to chronic are associated

wounds, with failure of the

gangrene, respiratory

loss of an centers in the

infected pons and

limb, and medulla.

even • Note retractions

death. or flaring of

Source:www. nostrils. ®These

wikipedia.org signify an

increase in work

of breathing
• Assess position

patient assumes

for normal or easy

breathing. As this

may add to

breathing difficulty

• Monitor vital

capacity in

patients with

neuromuscular

weakness and

observe trends.

®Monitoring

detects changes

early.

• Position patient

with proper body

 alignment for

optimal breathing

pattern. ®If not

contraindicated, a

sitting position

allows for good

lung excursion

and chest

expansion.

• Encourage

sustained deep

breaths by: Using

demonstration

(emphasizing

slow inhalation,

holding end

inspiration for a
 few seconds, and

passive

exhalation)

• Asking patient to

yawn ®This

simple technique

promotes deep

inspiration

• Explain effects of

wearing restrictive

clothing.

®Respiratory

excursion is not

compromised.
 Nursing Care Plan

DATE CUES NEEDS NSG. OBJECTIVE INTERVENTION EVALUATION

/TIME OF CARE
DIAGNOSIS

INDEPENDENT:

A Subjective: Activity At the 1. Note clients report Goal met: the

intolerance end of my of weakness, patient was

U “Dali ra mani A
related to present eight hours fatigue, pain, able to
kapoyon akong
G C
condition shift the difficulty participate to
anak kung
U T secondary to patient will be accomplishing the nurse
maglakaw-lakaw
Acute able to tasks, and/or suggested
S mam uy mao nga I
tonsilopharyngitis participate insomnia ® activity
sige nalang siya ug
T V and Dengue willingly in symptoms may willingly.
higda kay kapoy
I Hemorrhagic necessary be result of or
daw.” As verbalize
Fever grade 1. activities as contribute to
1 by the patient’s T
stated by the intolerance of
mother.
7, Y nurse. activity.
 ® viruses are 2. Ascertain ability to

incapable of of stand and move

2 Objective: -
replication about degree of
0 • Muscle
outside of a living assistance
weakness
1 E cell. They must necessary/use of
noted
penetrate a equipment ® to
0 X
• Dizziness
susceptible living determine
noted E cell and use the current status
• Dry cough
@ R biosynthetic and needs
noted.
machinery fo the associated with
C
• Doesn’t have
cell to produce participation in

8:00 an interest to I viral progeny. needed/desired

AM taking a
This cause the activities.
S
walk.
decrease in 3. Plan care to

• V/S: E
decreasing body carefully balance
 Temp: 35. cell function due rest periods with
7°C to an increase activities ® to
  PR: 83 P replication of the reduce fatigue.

cpm viruses in the 4. Plan for

A
 RR: 34 affected progressive
T
bpm individual. increase of

 BP: 90/60 T activity

• With D5 LR level/participation
E
REFERENCE:
1000cc @ in exercise
R training, as
65cc/hour Essentials of

infusing well N Pathophysiology, tolerated by the

@ Left Carol Mattson patient ® both

metacarpal Porth, Second activity

vein. Edition, Page tolerance and

231. health status

may improve

with progressive

training.
 Nursing Care Plan

DAT CUES NEEDS NSG. OBJECTIVE INTERVENTION EVALUATION

E DIAGNOSIS OF CARE

/TIM
E
Subjective:

A .”dili man gud siya Fear related to Within 8hour Goal met: the

U ganahan ma S Hospitalization span of care, 1.)Established rapport patient was

G hospital mam, kay E secondary to the patient will R: To gain trust and able to

U mahadlok man siya L Acute display cooperation. participate to

S ug nurse” as F tonsilopharyng appropriate the nurse

T verbalized by the - itis and range of 2.) Encouraged the patient to suggested

patients mother. P dengue feelings and express concerns and fears activity

1 E hemorrhagic lessened fear. and ask questions as willingly.

7, Objective: R fever grade 1. needed.

• Vital signs: C R: Open communication

2 T:36.3°C E Scientific fosters a trusting

0 RR: 20cpm P basis: relationship, which helps

1 PR:70bpm T reduce fear.

0 BP: 100/60 I Children (and

O most people) 3.) Provided information in

@ • Poor N are afraid of verbal and written form.

eye conact things that Speak in simple sentences

8:00 noted they cannot and concrete terms.

AM • Impair understand or R: Facilitates

ed attention control, and understanmding and

• Irritabi strange or retention of information.

lity noted new situations

• Unres or objects. 4.) Provided opportunity for

ponsive They can be questions and answer

fearful of honestly.

many things, R: Enhances sense of trust

because so and nurse client relationship.

much of the

world is new 5.) Explained procedures

to them. within level of client’s ability

to understand and handle.

R: to prevent
confusion/overload.

6.) Praised the patient when

he makes a step towards

fighting or confronting his

fear.

R: to lessen his fear during

monitorin.
 PHARMACOLOGICAL MANAGEMENT:

Drug Study

Date/ Name of Drug/ Classification Dosage Indication Mechanis Side Effects Nursing

Shift Drawing / Time/ m of Responsibilitie

Route Action s

Ampicillin Antibiotics 500mg/ Treatment Binds to - Diarrhea Assess pt for

q 6 for the the cell - Nausea infection at
Aug.
/IVTT following wall, - Vomiting beginning of
infections: resulting in - Rashes and

17, respiratory cell death. - Urticaria throughout

infections, - Super therapy.
skin and infection
2010 -Report
skin
immediately
structure
any rash;
/ infections,
persistent
soft-tissue
diarrhea;
infections,
swelling of
7³
Otitis
face, tongue,
media,
mouth, or
sinusitis,
throat; or
genitourinar
chest
y infections,
tightness.
and
Report if
meningitis.
condition

being treated

worsens or

does not

improve by the

time

prescription is
 completed.

-Instruct pt to

tell the doctor

if he/she has

allergy to any

drugs.

- tell the pt the

side effects of

the drugs

DRUG STUDY
Dat Name of Drug/ Classification Dosage/ Time/ Indicatio Mechanism Side Effects Nursing

e/ Drawing Route n of Action Responsibili

Shift ties

(hypothalami

c action)???
Aug Generic Name: Antipyretics, 250g/5ml/6.5ml Mild - Rash -Advise the

. nonopioid / q 4 hrs pain. Inhibits the - Urticaria significant

analgesics (PRN)/PO Fever synthesis of - Leukopenia other of pt to

Acetaminophen
prostaglandin - Pancytopenia take
17,
s that may - Renal failure medication

serves as - Neutropenia exactly as

Brand Name:
mediators of directed and
201
pain and not to take
0
Paracetamol fever, more than

primarily in the
(Biogesic)
/ the CNS. recommend

Have no ed amount.

significant Excessive
7³ anti- use of

inflammatory >4g/day

properties of may lead to

GI toxicity. hepatotoxicit

y, renal or

cardiac

damage.

-Advise pt to

consult

health care

professional

s if

discomfort

or fever is

not relived

by routines

doses of this
drug.

-Assess

type,

location,

and intensity

prior to and

30-60 min

following

administrati

on

- Instruct pt

to tell the

doctor if

he/she has

allergy to

any drugs
 - Don’t

exceed 1%

doses for

children

within 24

hours.

- tell the pt

the side

effects of

the drugs.

DRUG STUDY

Date Name of Drug/ Classification Dosage/ Indication Mechanism of Side Effects Nursing

/ Drawing Time/ Action Responsibilities

Shift Route
 PPA Cough and 5ml Nasal • Acts as an • Nervousnes • Instruct the

cold syrup/3x congestion agonist of s significant

Aug. (phenylpropanol
preparation aday/ PO , dopamine • Dizziness other of the
amine)
rhinorrhea, and • Restlessnes patient to the
Brand name:
17, sneezing, norepinephrin s proper use of

(Urilin Syrup) post nasal e. • Insomnia the medicine.

drip; • Suppresses • Instruct the

• Headache
2010 common appetite by patient to
• Drowsiness
cold, depressing report any
• Rebound
sinusitis, CNS appetite adverse
/ congestion
allergic control reactions to
• Chest pain
rhinotic, center. drug.
• Arrhythmias
vasomotor Stimulates • Assess the
7³
• Hypertensio
rhinitis.. alpha nasal mucosa
n
adrenergic it congestion
• Nausea
receptors in is still
• Vomiting
nasal mucosa, persisting.
producing • Assess the

vasoconstriction respiration of

. the patient.

• Checked the

vital signs of

the patient

and also the

BP because

one of the

adverse

reactions to

drug is

hypertension,

note the

increase in Bp

and report it to

the NOD.
X. COURSE IN THE WARD

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6

August 12, 2010- August 13, 2010- August 14, 2010- August 15, 2010- August 16, 2010- August 17, 2010-

An 8 years old 6:40 am- Ivf was 7:55 am- IVF was 8:15 am, 9:30am, Physician 6:30 am- platelet

patient was consumed and followed up with physician\n ordered for repeat and hematocrit

admitted at 10:15 followed up with D5IMB 500 ordered to follow platelet and count repeated.

am under Dr. Dy D5.3 NaCl 500cc @same rate. VS D5LR 500cc @ hematocrit count. Patient was

and the following to run at 65cc/hr. checked and same rate. Due VS checked and encouraged to

orders were ampicillin 500 mg recorded. Due meds given as recorded within increase OFI and

made: on diet as every 6 hrs IVTT meds given. ordered. Watched normal range. to avoid dark

tolerated, VS and PPA 5ml 3x a for episodes of Due meds given colored foods.

every 4 hrs., for day was ordered bleeding. 8:10pm- Advised to rest.

CBC and platelet and started. physician ordered VS monitored and

count.the Patient was to repeat platelet recorded. Due

physician ordered instructed to eat and hematocrit meds given.

D5.3NaCl 500 cc no dark colored counton 10pm.

to run @ 65 cc/hr. food and to IVF was followed

paracetamol 250 increase OFI. up with D5LR 500

mg/ml is given 6:10pm-physician @ same rate.

every 4 hrs PRN., ordered to repeat

platelet and

hematocrit count

and to monitor the

respiration. 11pm-

IVF was

consumed and

followed up with

D5IMB 500cc at

65cc/hr
• Discharge Plan

MEDICATION (What medications?.. e.g bring home meds)

- Explain to the family the importance of the drug therapy and the intended
purpose of the treatment regimen.

® In order to elicit cooperation and gain support from the family members. It
also facilitates maintenance of treatment regimen at home.

- Instruct patient and significant others about the right dosage and frequency
of the medications prescribed

® To avoid complications related to wrong usage of drugs.

- Warn patient and the significant others about adverse reactions of the
prescribed medication

EXERCISE

- Stress to the family the importance of having adequate rest and sleep
periods.

® Rest periods decrease oxygen needs, reducing strain on the heart and
lungs and allowing restoration of homeostasis before further activities.

- Advice patient that she may perform light exercise like performing range of
motion exercises;
®to maintain and elevate the musculoskeletal strength

- Provide a calm and restful environment.

 ®a calm and peaceful environment is very conducive for the faster recovery of
the patient

TREATMENT

- Advise significant others to express care and love for one another.

® Positive family relationship promotes personal growth and development of

each family member and a source of support throughout life despite illness.

- Encourage the patient to verbalized feeling and concerns about treatments

® A supportive environment and a supportive attitude on the nurse part are

crucial in promoting the patient’s adaptation to the changes brought about by
hospitalization and other hospital procedures.

HYGIENE

- Encourage patient to do personal care or self care habits daily.

® Maintains cleanliness and refreshes the body and reduces chances of

infection

- Encourage the family to maintain a clean surrounding at all times.

® It deters the spread of microorganism from the environment.

OUT PATIENT ORDERS

 - Encourage the client and the significant others to comply with follow up
check ups regularly with his physician upon being discharged from the institution

® It enables the physician to evaluate the patient’s condition to monitor the

patient’s progress after medical intervention, and to detect further abnormalities.

- Inform patient or significant others to report any abnormalities noted as soon

as possible

® Prompts early interventions regarding conditions as soon possible

DIET

- encourage to eat nutritious foods

- increased intake of Oral Fluid

- increased intake of foods rich in Iron.

• Patient’s Prognosis

CRITERIA GOOD FAIR POOR JUSTIFICATION

Onset of X The patient was not fully aware of his

Illness condition. Since he is till young and
doesn’t have any idea about the disease.
Duration of X Since the patient is not aware of his
Illness condition, he doesn’t know the degree or
severity of his disease, all he knows is that
he is ill.
Willingness X Our rating for the willingness to take
to take medicines or the compliance of the patient
treatment to the treatment regimen is rated good for
regimen he is willing and is able to comply with the
treatment given to him.
Age X It is common in children in Under 15 years
of Age in Asia whereas in South America it
is observed in all ages.

http://www.docstoc.com/docs/35851083/D
engue-fever
Race X Dengue Hemorrhagic fever, highest
incidence was seen in Malay males more
than 12 years of age. Also incidence of
DHF is much greater in Asian countries

http://www.tm.mahidol.ac.th/seameo/2005
_36_spp4/36sup4_196.pdf

Environ- X The patient’s environment is not a threat

ment to his condition. There are no containers
or any tires where the mosquito can lay
eggs. Also, environment plays a less role
in aggravating the patient’s present
condition.
 Gender X Women and young females tend to
develop severe forms of dengue fever at
higher rates than males.

About the Predisposing Factors of Dengue

| eHow.com
http://www.ehow.com/about_4617430_pre
disposing-factors-
dengue.html#ixzz0xRVwKgRO

Family X The family is very supportive to the patient

Support as they always encourage him to comply
with his medication. They are actually the
ones who push him to have a medical
check-up and they are also financially
capable with regards to the client’s
hospitalization. Parents are very kind and
cares the patient in the best way they can.

Legend:

Good - 3pts. Fair - 2pts. Poor -1pt.

Rating:

Good: 2.4 – 3 Fair: 1.7 – 2.3 Poor: 1 – 1.6

Computation:

Good: 3 x 5 = 15
Fair: 2 x 1 = 2
Poor: 1 x 2= 2

GENERAL PROGNOSIS:
The general prognosis of the patient is good with the score of 2.7. five out of the

seven criteria under the specific/detailed prognosis has showed good forecast and

one is justified as fair and two are justified as poor. Therefore, the client achieved a

state of good care providence by the health care team as well as the advices from

her family. The family assured that they will sustain the client financially and

emotionally.

XI. EVALUATION OF THE OBJECTIVES OF STUDY

We had gathered and completed personal data and pertinent information that

will serve as our main source of reliable facts and baseline data for completion of our

study and identified signs and symptoms of the disease.

We traced the anatomy and physiology of the affected organs and systems

and analyzed the pathophysiology of the infirmity. Considered laboratory results and

related it to the condition of our client. We learned its medications and treatments

and constructed nursing care plans for the patient, identified the prognosis of the

patient.

XII. REFERENCES: (dili ni mao ang format)

 http://depts.washington.edu

http://www.docstoc.com/docs/35851083/Dengue-fever

Nurse’s Pocket Guide, 11th Edition page 70-73.

http://www.hhmi.org/biointeractive/vlabs/cardiology/content/cg/basic.html

docstoc.com

http://www.virtualmedicalcentre.com/anatomy.asp?
sid=30&alpha=&title=Blood-Function-and-Composition

http://www.askmedicaldoctor.com/medical/…

About the Predisposing Factors of Dengue | eHow.com

http://www.ehow.com/about_4617430_predisposing-factors-

dengue.html#ixzz0xRVwKgRO

http://www.tm.mahidol.ac.th/seameo/2005_36_spp4/36sup4_196.pdf

http://www.ivy-rose.co.uk/HumanBody/Blood/Blood_Vessels.php

http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?

p=114&np=141&id=1612#4

XII. BIBLIOGRAPHY
Books:

Black, Hawks, et.al. Medical Surgical Nursing Clinical Management and for Positive

Outcomes. 8th edition. Saunders Elsevier Inc, Singapore. ©2002.

Smeltzer, Suzanne, et. al. Brunner & Suddarth’s Textbook of Medical-Surgical

Nursing. Vol. 1. 12th edition. Lippincott Williams and Wilkins. 530 Walnut Street,

Philadelphia. ©2010. pp. 267, 298, 1183, 1173-1175, 2214,

Chernecky, Cynthia; Berger, Barbara. Laboratory Tests and Diagnostic Procedures.

4th edition. Saunders Elsevier, Inc. 625 Walnut Street, Philadelphia. ©2004. pp.206-

207, 230-232, 359-360, 428-429 735-736, 570-571, 599-601, 835-836

Internet Sources:

Med Help.©2010. http://www.medhelp.org/posts/Gastroenterology/Albumin-Globulin-

Ratio/show/884073

Adam.©2010. http://www.nlm.nih.gov/medlineplus/ency/article/003640.htm

Med Help.©2010. http://www.medhelp.org/posts/Gastroenterology/Albumin-Globulin-

Ratio/show/884073

Wikipedia. Copyright 2010. http://en.wikipedia.org/wiki/Chest_radiograph

Wikipedia. Copyright 2010. http://en.wikipedia.org/wiki/Medical_ultrasonography

ClinicalTrials.gov.©2010 http://clinicaltrials.gov/ct2/show/NCT01047085