School of Nursing
Calamba City, Laguna
Submitted by:
BIÑAS, MAYET O.
BONIFACIO, CYRIL S.
BUGUIS, JOHARA A.
BURGOS, MYRILL L.
CAASI, HECTOR ANTHONY A.
CABALFIN, APRIL RHOSE E.
CALDERON, APRIL EVISON A.
CALUPIG, LOURINE A.
CAMO, RACHEL ANNE D.
CANICON, HAZELLE G.
CAPIO, RENE C.
CAPURIHAN, CRIZZA JOY T.
CARIÑO, JENNIFER
CARMONA, MARICEL M.
4BSN1/GROUP III
Introduction
The researchers decided to choose this case because they wanted to acquire more
knowledge about Dengue Hemorrhagic Fever II. They wanted to use the
knowledge they have acquired in promoting awareness to the people especially
the underprivileged that they should seek for medical care in order to prevent the
development and progression of Dengue Hemorrhagic Fever. The researchers also
wanted to focus on preventive measures.
This study will help the nursing profession by providing information about the
proper management and care for patients who have Dengue Hemorrhagic Fever. It
will also educate the people, especially those who have Dengue Hemorrhagic
Fever and vulnerable individuals to seek medical care in order to prevent dengue
Hemorrhagic Fever. It will increase awareness about the importance of having a
healthy lifestyle.
This study will elaborate the interrelatedness of lifestyle habits and developing
Dengue Hemorrhagic Fever.
This study is focused on the nursing aspect of care to those patients who had,
currently have and are at risk for Dengue Hemorrhagic Fever. This study will only
be used in the nursing profession. The researcher will only be focused their
attention on the medications, diagnostics, care plan, pathophysiology and
discharge planning. This study is not limited to patients who have Dengue
Hemorrhagic Fever only, but it is also for all the people who are interested in the
disease. We are more focused on the primary prevention through health education
because primary prevention is the true prevention.
Patient’s PROFILE
Biographic Data:
Name: Patient XL Case No: 05-992216
Age/Sex: 9/Female Civil status: Child
Birthdate: December 22, 2000 Religion: Roman Catholic
Birthplace: Makati Medical Center
Occupation: grade three student
Present address: Parian, Calamba City, Laguna
Date of Admission: July 18, 2009
Attending Physician: Dr. Moran, LBDH
Admitting Diagnosis: DHF II
Chief complaint: abdominal pain; episodes of vomiting
HISTORY OF PRESENT ILLNESS
The patient is a 9 year-old female, a grade three student who was diagnosed with Dengue
Hemorrhagic Fever II.
Five days prior to admission the client suffers from having a high fever with a
temperature of 39. 4 degrees celcius, Paracetamol was given for relief. After three days the fever
subsides and abdominal pain and vomiting of brownish colored vomitus takes place. Due to
persistence of the said signs and symptoms, the patient seek consultation and hence admitted at
Los Baños Doctors’ Hospital Medical Center with Dr. Moran as her attending physician.
Upon admission the child has experienced gum bleeding with presence of petechiae over
the face and lower extremities accompanied by loss of appetite. Hematology examination shows
low platelet count with a value of 100 mm3.
During the interview session she has a fever and experiences no gum bleeding at all. Her
abdominal pain becomes intermittent.
PAST MEDICAL HISTORY
According to the patient’s mother, she experienced having urinary tract infection when
she was five years old. The patient only experiences having common cough and colds
occasionally. She also experiences fever before and it was relieved by over the counter drugs and
rest. Their family does not seek consultation for regular health check up. She has not been
hospitalized and only seeks consultation to their Baranggay Health Center whenever any health
problem arises. She did not receive an immunization vaccine for measles. She also denies having
allergies to food and drugs. She says that she is allergic to dust and particles.
FAMILY HISTORY
The patient has a family history of hypertension. Her mother and father are both
hypertensive. Her eldest sister is 23 years old, alive and healthy. Followed by a 21 year old male,
20 year old female, 15 year old female which are alive and healthy also and the last is the patient,
the youngest.
Health Perception and The patient sees her pattern She believes that wellness
Health Management of health as normal as she will be attained if doctor’s
Pattern suffered from no serious orders are to be strictly
illnesses before. She manages followed.
her health by following her
mother’s instructions such as
sleeping early and eating
foods on regular basis. She
also follows proper personal
hygiene for her to become
healthy.
Nutritional and Metabolic The patient usually eats The patient is forbidden to eat
Pattern vegetables because they have dark-colored foods,
many of it planted in their carbonated drinks and junk
backyard. She said that her foods.
favorite food is junk foods
especially chips and salty
foods. She is also fond of
eating sweets such as
chocolates and candies. She
usually drinks up to 6 glasses
of water a day including
other beverages. She is not
taking any vitamin
supplements.
Rest and Activity A typical day to her would be She plays board games with
waking up at around 6:00 am her other siblings during
to attend her school. She goes confinement. She usually
home at 4:00 in the wakes up at 8 o’clock in the
afternoon. She does her home morning, takes nap after
works before eating dinner. lunch and goes to sleep at 10
She goes to sleep at 9:00 p.m.
During her spare time, she o’clock in the evening.
plays hide and seek,
patintero and piko with her
classmates.
Sleep-Rest Pattern The client doesn’t have any She usually wakes up at 8
difficulty in sleeping pattern. o’clock in the morning, takes
She sleeps at around 8 in the nap after lunch and goes to
evening and wake up early. sleep at 10 o’clock in the
She doesn’t have the habit of evening.
sleeping at daytime. She
usually drinks Milk before
she goes to Sleep and she
usually sleeps at about 10
hours daily.
Self-Perception and Self She views herself as a She has good body posture
Concept Pattern student. A student who needs and was able to maintain eye
to fulfill her dreams through contact upon interview.
studying hard. She also stated
that she is a jolly, smart and
caring individual.
Role-Relationships Pattern She is the youngest among Relationship with the family
her siblings. She helps the members is intact, it is
other family members by evidenced by their presence
doing and following little during their youngest
tasks whenever they ask her sibling’s confinement. They
to do so. The patient has a play board games, and give
good family relationship. She their youngest sibling
states that she is happy with pasalubong like fruits.
them and they care and love
her so much.
Coping-Stress Pattern As a child she also deals with Her status now of being sick
some of stressful events is one of the greatest stressor
everyday. When she was in for the client and she was
school her teacher helps her
able to cope up because of the
with
help of the significant others
her study and school works.
She manages her problems
with the help of the
significant others.
V. Physical Assessment
SKIN
Pale
NAILS Imbalance
Inspection
between
Nail bed color
Convex hemoiglobin and
Pink
hematocrit results
Inspection No inflammation
Shape of the skin Normal
Inspection
Convex around the nail Normal
Lesions
Palpation
No inflammation Firm
Normal
of
Normal capillary
Palpation the skin around refill less than 2
Thickness the nail sec. Normal
HEAD
Symmetrical Symmetrical
Symmetry Inspection Normal
HAIR
Black
Color Inspection Normal
Straight and
Texture Inspection smooth Normal
Black
Other findings Inspection No nits/lice Normal
Curly hair,
present
straight
No nits/lice
present
SCALP
Smooth
Symmetric facial
EYES
movement
External structure Inspection
Evenly
EARS distributed,
Symmetric at the
level of the eyes
corner
Shape and size Inspection Normal
No discharges
Same as facial and
color
inflammation
Symmetrical at
NOSE the
inflammation
MOUTH
Normal
Color Inspection
Normal
Dull red
Texture Inspection
Normal
Smooth
Mobility Inspection Pink
Normal
Can move freely
Lesions Inspection Moist
No lesions or
inflammation
Positioned at the
Symmetric and at
midline position
Head centered
UPPER AND
Symmetrical Normal
LOWER
Inspection Smooth Normal
EXTREMITIES
movements
Inspection Due to fever and
Size Equal size
without disease condition
Inspection
Symmetry discomfort Symmetrical
Normal
Inspection
Skin color Symmetric and at Pinkish with
Due to
rashes on both
Lesions midline position
extremities disease
No lesions,
deformities or
inflammation
Equal size
Symmetrical
Light to deep
brown
No lesions,
deformities or
inflammation
THEORETICAL FRAMEWORK
Florence Nightingale's core nursing theory has an environmental focus: It was her belief that the
environment is an alterable medium that can be used to improve the conditions of Nature and
encourage healing. Ventilation, clean air, clean water, control of noise, provision for light, and
Adequate waste management are just a some of the elements She believed could be Monitored
and improved when necessary.
Nightingale’s theory addresses the prevention of occurrences of Dengue Hemorrhagic Fever. In
facilitating proper environmental sanitation we can achieve a surroundings with no presence of
any vector that cause its transmission as they can no longer exist if the environment is not suited
for their survival hence decreasing the morbidity rate of Dengue in our country. We should be
knowledgeable on how to keep our surroundings free from any breeding sites that could serve as
a reservoir for the mosquito. As a nurse we should teach our clients how to do proper water
storage and environmental sanitation so as to prevent disease occurrence and recurrence
ANATOMY AND PHYSIOLOGY
composed of a liquid
cell fragments.
Characteristics of Blood
bright red
dark red/purplish
Protection
Formed Elements
RBC
a hemoglobin carrier
anucleate
No mitochondria
120 lifespan
WBC or Leukocytes
amoeboid motion
chemotaxis
leukocytosis
leukopoiesis
Platelets
PATHOPHYSIOLOGY
Precipitating Factors:
Predisposing Factors:
Presence of drainage nearby Age
Not using mosquito nets, repellants
Live plants at home
Aedes Aegypti
↓
Virus goes into circulation
↓
Dengue Virus Type II
↓
IgG adheres to the platelet
↓
thrombocytopenia
↓
increased potential for hemorrhage
↓
stimulates intense inflammatory response
↓
petechial rash, high fever, headache,vomiting, abdominal pain, (+) torniquet test
LABORATORY RESULT
Blood: Negative
Remarks: No ova/intestinal parasite seen
Drug Study
Generic/Brand Classification Indication Contraindicati Side effects Nursing
Name (r/t present on (r/t present Intervention
illness) (r/t present illness) (r/t present
illness) illness)
Ranitidine Histamine H-2 Prevent gastric Impaired renal Nausea Obtain CBC;
receptor damage from or hepatic Vomiting assess for
blocking drug NSAIDS. function Abdominal infections,
pain renal or liver
Fatigue disease.
Dizziness
Malaise Report any
evidence of
yellow
discoloration
of skin and
eyes, or
diarrhea.
Maintain
adequate
hydration.
Advise patient
to report any
confusion or
disorientation.
Continue meds
TF: D5LRS 1L X 6hrs @ 40gtts/min
BP and Temp q 2hrs
HCT am
If the hematocrit levels fall dangerously then a blood transfusion should be considered. If the
hematocrit values rise the patient should be given fluids intravenously and the fluids carefully
monitored to ensure that the patient does not get excess fluids. A rise of more than 20 % as
compared to previous levels may be an indication for IV fluids. The doctor should decide based
on best judgment of patient's condition.
LABORATORY RESULT
LABORATORY RESULT
Hematology Report
Due to presence of
bleeding
Hematology Report
Normal
Lymphocytes 0.35 0.20-0.30
Due to presence of
bleeding
Date: July 19, 2009, PM
Hematology Report
Due to presence of
bleeding
Hematology Report
Due to presence of
bleeding
Hematology Report
Due to presence of
bleeding
Hematology Report
Normal
Lymphocytes 0.32 0.20-0.30
Due to presence of
bleeding
Date: July 21, 2009, PM
Hematology Report
Due to presence of
bleeding
DISCHARGE TEACHING
Medication
Remind to take the prescribed medicine, having a written reminder of the correct medication,
time to take, and the right frequency of the medicine on the way home to establish assurance of
medication compliance.
Don’t give aspirin and NSAID’s, they increase the risk of bleeding. Any medicines that decrease
platelet count should be avoided.
Exercise
Instruct to avoid excessive activities that may result to stress.
Just advised to perform range of motions and repetitive body movements for promotion of
optimum health.
Remind about the need for health promotion activities such as reading, watching T.V, etc.
Treatment
Bed rest is advisable during the re-occurrence of fever phase.
Instruct to drink plenty of water or fluids that are available at home and eat nutritious diet.
Advised to look for re-occurrence of danger signs and symptoms and report immediately.
Hygiene
Encourage to continue the routinely hygienic care of the patient
Out-Patient Follow-Up Care
Instruct the family members to have a check-up or to consult physician once a while to
monitor patient’s condition and for detection of recurrences and other complications that
may arise on to it.
Diet
Instruct the family members to give the client protein rich foods such as meat, fish, eggs
and nuts, vitamin K rich foods such as green leafy vegetables, vit C rich foods(guava and
tomatoes and other citrus fruits), carbohydrates rich food (breads and rice)
To promote holistic wellness through rendering quality nursing care and health education.
For Hyperthermia:
1.Within 2 hours of nursing care, the patient temperature will decrease from 38.6°C to 37-37.5°C
2. Within 2-4 hours of nursing care the patient will be able to reduced pain felt from 7/10 to 5/10.
3. Within 8 hours of nursing care client will be able to minimize occurrence of fluid deficit as
evidenced by normal skin turgor
NURSING CARE PLAN
Onset: Sw
“pasumpon elling Provided
g-sumpong therapeutic
po” touch
Pai Helps in
Location: n relieving
no exact pain
location
“basta sa
buong tyan
po masakit”
Duration:
2-3 minutes Dependent:
Administere
Exacerbatio d Ranitidine
n: as ordered.
Gets worse
when
pressure is
applied in
the stomach
Radiation:
Radiates in
whole
abdomen
Relief:
“Kapag
iniipit ko
po”
Associated
signs and
symptoms:
Bod
y
weak
ness,
fever
Leukocytes, or white cells, are responsible for the defense of the organism.
Round nucleus, produces antibodies, contributes to allergic reactions,tumor control, regulation of the
immune system
Nucleus with 2-4 lobes connected by thin filaments;
Red blood cells are responsible for providing oxygen to tissues and partly for recovering carbon dioxide
produced as waste.
Platelets are important in preventing blood loss, releases chemicals for blood clotting
Nucleus often bilobed; releases chemicals that reduce inflammation; attacks certain worm parasites
Neutrophils are very active in phagocyting bacteria and are present in large amount in the pus of wounds.
Unfortunately, these cells are not able to renew the lysosomes used in digesting microbes and dead after
having phagocyted a few of them
Basophil secrete anti-coagulant and vasodilatory substances as histamines and serotonin. Even if they
have a phagocytory capability, their main function is secreting substances which mediate the
hypersensitivity reaction.
The main function of platelets, or thrombocytes, is to stop the loss of blood from wounds
(hematostasis).
Monocytes are the precursors of macrophages. They are larger blood cells, which after attaining maturity in the
bone marrow, enter the blood circulation where they stay for 24-36 hours.
1st child
5th child
4th child
3rd child
2nd child
Father
Mother