PERSONAL DATA:

Name: Tayaban, Krendyle Lesino Age: 8 years old Sex: Female Address: DB 307, Bahong, La Trinidad, Benguet Religion: Jehovas Witness Type of community: semi-urban Admitting physician: Dr. Robles Date Admitted: August 18,2010

CHIEF COMPLAINTS:
Fever accompanied by bleeding gums and rashes

DIAGNOSIS:
Admitting and Final: Dengue Hemorrhagic fever with warning signs

I. FAMILY BACKGROUND
Patient Tayaban is the eldest in the family with one younger sibling. Her mother, Margaret Tayaban is a housewife while her father, James Tayaban is a construction worker. They have a nuclear type of family who are living together in a semi-concrete house at La Trinidad, Benguet. Both parents are involved in the decision making but most of the budgeting is done by the mother. They have a little priority when it comes to health as compared to their other needs when delegating their budget. The mother also admits that there is a problem in sanitation in their backyard that is believed to be the breeding place of the dengue-carrying mosquitoes. Tayaban family is now at a stage where they are categorized as a Family with School Age Children. Their 2 childrens ages range from 6 to 8 years old. The parents are currently adjusting to the activities of their growing children, and the costs of their increasing needs such as school tuition fees and other expenses whether it be a school or a recreational activity for the family. The parents should already start involving their children in their decision making as the children would likely incur a great impact in the process. The parents are also expected to encourage and support their childrens educational attainment. These are needed so as to promote optimum performance of the children and open communication between the family members.

II. DEVELOPMENTAL DATA

Patient Tayaban is under the School Age stage which is the time for Industry and Inferiority according to Sigmund Freud. She tries to develop a sense of self-worth by refining her skills in school. During this stage, often called the Latency, we are capable of learning, creating and accomplishing numerous new skills and knowledge, thus developing a sense of industry. This is also a very social stage of development and if we experience unresolved feelings of inadequacy and inferiority among our peers, we can have serious problems in terms of competence and self-esteem. As the world expands a bit, our most significant relationship is with the school and neighborhood. Parents are no longer the complete authorities they once were, although they are still important. According to Havighurst, for the developmental task for aged 6-18, the patient is expected to learn physical skills necessary for ordinary games, learn to get along with age mates, build wholesome attitudes toward oneself as a growing organism, learn on appropriate masculine or feminine social role, develop concepts necessary for everyday living develop conscience, morality and a scale of values, achieve personal independence, develop attitudes toward social groups and institutions.

III. HEALTH HISTORY

History of Present Illness: The patient is apparently healthy and well until 5 days prior to admission, she had an on and off fever accompanied by chills and vomiting. For this, the mother gave her Tempra as her home medication. The fever subsides but then again fluctuates high over the next 24 hours. It fluctuates from normal to high (37 to 38.5 degree Centigrade taken via the axilla taken by the mother). 2 days PTA, the fever lowered but the mother noticed bleeding gums and small petechial rashes seen on her left arm. 1 day prior to admission the signs and symptoms are still present with already marked weakness thus they decided to sought consultation at this institution, Pines Doctors Hospital with an initial vital signs of 38.4 for Temperature, 25 cycles per minute for the respiratory rate and 87 beats per minute for the pulse rate, he undergone different diagnostic tests like the

Rumpel leads test, Hematologic procedures, fecalysis and urinalysis. With the results, a working diagnosis of Dengue Hemorrhagic Fever with danger signs was made hence was admitted room 307 last August 11, 2010.

History of Past Illness The patient does not have any past hospitalizations nor undergone any surgical procedure prior to admission. According to the mother, she only had the common illnesses like colds, cough, fever and diarrhea but are easily treated at home.

Pathophysiology of Present Illness Presence of stagnant water in the familys backyard

Dengue-carrying mosquitoes are able to breed

Patient does not take any vitamins to boost immune system; does not eat a lot of nutritious foods like vegetables

Female Aedes mosquito is able to bite the patient and transfer/transmit the virus- FlaviVirus

The virus easily entered the circulation of the body and affected easily the host and its different organs
Early s/sx
Decreased appetite Fever Headache Joint aches Malaise Muscle aches Vomiting
Enlarged liver (hepatomegaly)

Patient does not waer pajamas; stays outside the house every afternoon; no screen on their doors and windows

Acute Phase

Low blood pressure

Rash

Red eyes

Red throat

Nursing diagnoses: Hyperthermia related to infectious process secondary to Dengue Hemorrhagic fever Impaired skin integrity related to presence of peticheal rashes secondary to DHF Impaired tissue perfusion related to decreased platelet count secondary to DHF Activity intolerance related generalized weakness secondary to DHF Fluid and electrolyte imbalance related to episodes of vomiting and profused sweating secondary to DHF

This is the case of Tayaban, Krendyle, Lesino: -

Risk for bleeding related to decreased platelet secondary to DHF Risk for impaired nutrition: less than body requirements related to

Inclusive period of hospitalization

She decreased appetite secondary to 2010 with chief process was admitted last August 11, ongoing disease complaints of on and off fever with bleeding gums and rashes On the same day, a diagnosis was made, Dengue Hemorrhagic fever with warning signs On the same day, diagnostics were done- hematologic, fecalysis and urinalysis Throughout the 9 days of hospitalization, he undergone an intensive medical treatment which includes medications (Cetirizine Syrup 5 ml P.O-BID, Probiotic 1 gel PO BID and Cherifer 5ml HS.), fluid and electrolyte replacement No transfusion was made due to the normal findings found on her blood test and there are no signs of massive bleeding seen. The patient became well and adherent to medical and nursing regimens thus was discharged in good and healthy dispositon.

IV. MEDICAL TREATMENT AND MANAGEMENT INCLUDING PROCEDURES AND ITS IMPLICATION TO NURSING
Medical treatment/Manage ment/Diagnostic procedures 1. Medication Regimen: a. Cetirizine b. Probiotic

INDICATION/INTERPRET ATION Medications are given to all kinds of illnesses to stop the pathogenicity or virulence of the causative agent of the

Implication to Nursing

The principle of the 12 Rs in giving medications should be

specific disease. It reliefs the signs and symptoms brought about by the said disease process. DHF is deadly thus drugs are very important. Supplements like multivitamins are also needed to increase the immune system of the patient which is compromised In dengue hemorrhagic 2. Fluid and fever, vomiting is electrolyte present as well as Replacemen profused sweating due t to increase in temperature. There is a tendency that the patient can be dehydrated. Another thing is that, DHF causes decrease in platelet that may cause bleeding that can lead to shock and death if not well compensated. IVFs are then very important in the patients case which are given throughout the hospitalization period. 3. Physical assessment: Rumpel leads test Physical assessment is very important along with the diagnostics to determine the disease process that the patient has. It serves as a basis in knowing its severity. For the Rumpel leads test, it serves as an objective data to rule out DHF.

c. Cherifer (multivita mins)

followed. The nurse should also be knowledgeable on the drug/s that he/she will give

Nurses should be a good observant specially in determining for signs and symptoms of dehydration and shock. Sterile and proper technique in inserting and changing IVF Correct infusion rate must be observed

Nurses should be fast in doing Physical assessment Nurses should also be knowledgeable on the different PA techniques appropriate to the patients disease Proper/correct diagnosis based on the signs and symptoms must be made

4. Hematologic tests a. Hematocr it-normal b. Hemoglo bibnormal c. Dengue titer-(+) d. Platelet

Blood components are very crucial in DHF. This poses a great risk in the life of the patient. Basing it from the result, there is a decreased in the level

Nurses should be reviewing the charts of the patient and should refer any deviation from the normal values

countdecreas ed August 11,2010: platelet113,000 (150450,000 e. Blood typing- O 5. Fecalysis, Occult blood test and urinalysis Results: OBT- (-) Fecalysisnormal Urinalysis : +RBC,WB C

of the platelets that may now cause bleeding then to shock or even death. For blood typing, it is used for emergency transfusion.

Coordination with the other health team is important Following protocol when it comes to blood transfusion

Fecalysis and occult blood test are done to determine if there is already bleeding in the system. Melena may indicate upper GI bleeding. For her urinalysis, there are some traces of RBC and WBC which may indicate slight bleeding or a malfunction in the filtering mechanism of the kidney that may be caused by a problem in its perfusion. Increase WBC may also indicate infection

Nurses should be reviewing the charts of the patient and should refer any deviation from the normal values Coordination with the other health team is important

V. DRUG STUDY- SABI MO KAW NA BAHALA DITO