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TRANSCRIPT
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OBJECTIVES
General
This case presentation aims to identify and determine the general health problems
and needs of the patient with an admitting diagnosis of DengueHemorrhagic Fever, Type 1. This presentation also intends to help patient promote
health and medical understanding of such condition through the application of thenursing skills.
Specific
To raise the level of awareness of patient on health problems that she may
encounter.
To facilitate patient in taking necessary actions to solve and prevent theidentified problems on her own.
To help patient in motivating her to continue the health care provided by the
health workers.
To render nursing care and information to patient through the application of
the nursing skills.
Dengue fever is an infectious disease carried by mosquitoes andcaused by any of four related dengue viruses. This disease used to be called
break-bone fever because it sometimes causes severe joint and muscle pain thatfeels like bones are breaking, hence the name. Health experts have known about
dengue fever for more than 200 years.
INTRODUCTION
Dengue fever is found mostly during and shortly after the rainy season
in tropical and subtropical areas of
Africa
Southeast Asia and China
India
Middle East
Caribbean and Central and South America
Australia and the South and Central Pacific
An epidemic in Hawaii in 2008 is a reminder that many states in the United Statesare susceptible to dengue epidemics because they harbor the particular types ofmosquitoes that transmit it. Worldwide, more than 100 million cases of dengue
infection occur each year. This includes 100 to 200 cases reported annually to theCenters for Disease Control and Prevention (CDC), mostly in people who have
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General signs and symptoms
>Sudden onset of high fever which may last 2 to 7 days.>Joint & muscle pain and pain behind the eyes.
>Weakness>Skin rashes - maculopapular rash or red tiny spots on the skin called
>Petechiae>Nose bleeding when fever starts to subside
>Abdominal pain>Vomiting of coffee-colored matter
>Dark-colored stools
Theoretical Frame work
Orems Self Care TheoryThe focus of Orem's model of nursing is to enhance the patient's ability for self-care and extend
this ability to care for their dependents (Orem, 2005). A person's self-care deficits are a result of
their environment. Three systems exist within the professional nursing model: the compensatory
system, in which the nurse provides total care; the partial compensatory system, in which the
nurse and the patients share responsibilities for care; and the educative-development system, in
which the patient has the primary responsibility for personal health, with the nurse acting as a
consultant (Central, 2005; Orem, 2005). The basic premise of Orem's model is that individuals
can take responsibility for their health and the health of others, and in a general sense,individuals have the capacity to care for themselves and their dependents.
AIR: Educative/Supportive - Provide education on the good benefits of
having a well ventilated space for living.
WATER: Educative/Supportive - Ensure access to adequate hydration
FOOD: Partial Compensation - Education and provision of a diet that is
suitable for her diagnosis of dengue.
ELIMINATION: Educative/Supportive - May require monitoring of
intake and output
ACTIVITY AND REST: Educative/Supportive - Educate patient as to the
benefits of having enough rest and sleep for the promotion of health
SOLITUDE AND SOCIAL INTERACTION: Partial Compensation - Nurses
may provide social interaction with the patient to establish rapport
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HAZARD PREVENTION: Partial Compensation - Nurses will need to
educate regarding the medication that he may be taking, and administer this
medication initially.
Patient Profile
I. PATIENTS PROFILE
PATIENTS DATA
1. Name: Mr. V.
2. Age: 6 years old3. Address: Blk 50 Lt 11 Lico St.
4. Sex: Male
5. Race: Filipino
6. Birthday: September 1, 2003
7. Place of Origin: Barbaza, Antique
8. Marital Status: Married
9. Religion: Roman Catholic
10. Occupation: N/A
NURSING HISTORY
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Physical Assessment
BODY PART
HEAD
Skull
Scalp/ Hair
Face
TECHNIQUE USED
palpation
inspection
palpation
inspection
FINDINGS
proportional to
the size of the body,
round, with
prominences in the
frontal area
anteriorly & the
occipital area
posteriorly,
symmetrical in all
planes, gently
curved
scalp is white,
clean, free from
masses, lumps, nits,
dandruff & lesions,
with no areas of
tenderness upon
palpation; hair is
black, evenly
distributed & covers
the whole scalp,
thick & shiny
INTERPRETATION
Normal
Normal
Normal
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Eyes/ Vision
Ears/ Hearing
inspection
palpation
inspection
palpation
oblong shaped,
symmetrical, smooth
& no involuntary
muscle movements
eyes are parallel
& evenly placed,
symmetrical,nonprotruding,
with
scant amount of
secretions, both
eyes black & clear;
sclera is white &
clear; eyebrows
are black,
symmetrical, thick,
can raise both
symmetrically &
without difficulty,
evenly distributed &
parallel with each
other; eyelashes
are evenly
distributed & turned
Normal
Normal
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Nose
Mouth/ Lips
inspection
palpation
inspection
palpation
outward;
ears are parallel,
symmetrical,
proportional to the
size of the head,
bean-shaped, helix
is in line with the
outer canthus of the
eye, skin is the
same color as the
surrounding area &
clean; ear canal is
pinkish, clean, with
scant amount of
cerumen & a few
cilia; able to hear
whisper spoken 2
feet away; 2
piercing are found in
left ear and 1
piercing in right ear
nose is in midline,
symmetrical, patent;
Normal
Normal
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NECK
THORAX &
LUNGS
HEART
inspection
palpation
inspection
palpation
percussion
auscultation
inspection
internal nares are
clean, dark pink with
few cilia
lips are pinkish,
symmetrical, lip
margin is
welldefined,
smooth &
moist; gums are
pinkish, smooth,
moist, no swelling,
no retraction, no
discharge; 32 teeth
are present, aligned,
with no dental
caries; tongue is
pinkish, slightly
rough on top,
smooth along the
lateral margins,
moist, shiny & freely
movable;
cheeks are pinkish,
moist & smooth;
frenulum is in
midline, straight &
Normal
Normal
Normal
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Anatomy and Physiology
Blood
Whole blood has two components: (1) blood plasma, a watery liquid matrix
that contains dissolved substances, and (2) formed elements, which are cells andcell fragments. Blood is about 45% formed elements and 55% plasma. Normallymore than 99% of the formed elements are red-colored red blood cells. Palecolorless white blood cells and platelets occupy less than 1% of total blood volume.
Substances in Blood Plasma
Constituent Description
Water (91.5%) Liquid portion of blood. Acts as
solvent and
suspending medium for components
of blood;
absorbs, transports and releases
heat.
Proteins (7.0%) Exert colloid osmotic pressure, which
helps
maintain water balance between
blood and
tissues and regulates blood volume.
Albumins Smallest and most numerous plasma
proteins;
produced by liver. Function as
transport
proteins for several steoid hormones
and for
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fatthy acids.
Globulins Produced by liver and by plasma
cells, which
develop from B lymphocytes.
Antibodies help
attack viruses and bacteria. Alpha
and beta
globulins transport iron, lipids and
fat-soluble
vitamins.
Fibrinogen Produced by liver. Plays essential role
in blood
clotting.
Formed Elements in Blood
Name Number Characteristics Functions
Red Blood Cells 4.8million/2L (F)
5.4million/2L (M)
7-82m diameter;
biconcave discs,
without a nucleus;
live for about 120
days
Hemoglobin within
RBCs transports
most
of the oxygen and
part of the carbon
dioxide in the
blood
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White Blood
Cells
5000 10,000/2L Most live for a few
hours to a few days
Combat pathogens
and other foreign
substances that
enter
the body
Neutrophils 60-70% of all
WBCs
10-122m diameter;
nucleus has 2-5
lobes connected by
thin strands of
chromatin;
cytoplasm has very
fine, pale lilac
granules
Phagocytosis.
Destruction of
bacteria with
lysozyme, defensis,
and strong
oxidants,
such as superoxide
anion, hydrogen
peroxide, and
hypochlorite anion
Eosinophils 2-4% of all WBCs 10-122m diameter;
nucleus has 2-3
lobes; large
redorange
granules fill
the cytoplasm
Combat the effects
of
histamine in
allergic
reactions,
phagocytize
antigenantibody
complexes,
and destroy certain
parasitic worms
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Basophils 0.5-1% of all
WBCs
8-102m diameter;
nucleus has 2
lobes; large
cytoplasmic
granules appear
deep blue-purple
Liberate heparin,
histamine and
serotonin in
allergic
reactions that
intensify the
overall
inflammatory
response
Lymphocytes 20-25% of all
WBCs
Small lymphocytes
are 6-92m in
diameter; large
lymphocytes are
10-14 2m in
diameter; nucleus
is round or slightlyindented;
cytoplasm forms a
rim around the
nucleus that looks
sky blue; the larger
the cell, the more
cytoplasm is visible
Mediate immune
responses,
including
antigen-antibody
reactions. B cells
develop into
plasma
cells, which secrete
antibodies. T cells
attach invading
viruses, cancer
cells
and transplanted
tissue cells. Natural
killer cells attack a
wide variety of
infectious microbes
and certain
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spontaneously
arising
tumor cells
Monocytes 3-8% of all WBCs 12-202m diameter;
nucleus is
kidneyshaped or
horseshoe shaped;
cytoplasm is
bluegray
and has foamy
appearance
Phagocytosis (after
transforming into
fixed or wandering
macrophages).
Platelets 150,000-
400,000/2L
2-42m diameter
cell
fragments that live
for 5-9 days;
contain many
vesicles but no
nucleus
Form platelet plug
in
hemostasis;
release
chemicals that
promote vascular
spasm and blood
clotting
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Pathophysiology
Aedes Aegypti
Dengue Virus Type I(Chikungunya Virus)
IgG adheres to the platelet(initiates destruction of the platelet)
thrombocytopenia(50,000/mm3 or less)
increased potentialfor hemorrhage
stimulates intenseinflammatory response
petechial rash, high fever, headache(epistaxis, vomiting, conjunctival infection,
abdominal pain, shock, death)
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sment Diagnosis Planning Intervention Rationale Ev
gnat siya
rbalized by
touch
nd
kin
at both
tic nail
ss
looking
ial V/S of:
C taken
y
g taken at
cal area
pm,
f respi-
tory
0/70 mm
Hyperthermia r/t
to underlyingdisease process
After 8 hours of
nursinginterventions the
body temp. of thepatient will be
reduced from38.9 C tonormal range
Assess for signs and
symptoms of feverand its causative
factors.Inform and instruct
the significant otherabout the shift ofdiet from soft dietto
NPO temporarily.
Provide acomfortable
environment.
Instruct the SO todo TSB
Instruct the SO toreport convulsions
and chilling ifpresent
Administer meds,
as orderedMonitor V/S and
record
To address the
problem
In order for them
to be aware
To ensure clientscomfort.
To at least
reduced theelevated body
temp.For early
prevention ofcomplication
To treatunderlying cause
To note changes
After 8
nursininterve
body tpatien
reduce38.9
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eneric
Name
Brand
Name
Classification Action Indication Dosage
Re
acetamol Aldep Analgesic Decreases
fever by
inhibiting the
effects of
pyrogen on
thehypothalamic
heat
regulating
centers and
relieves pain
by inhibiting
prostaglandin
synthesis
Relief of mild
to moderate
pain
Treatment offever
165mg T
r
ot
ad
avo
th
pa
Ad
a
Te
rec
chr
ble
Tel
notfor
last
tha
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Laboratory Diagnosis
HematologyFor a Complete Blood Count (CBC), specimens of venous blood are taken, itincludes hemoglobin and hematocrit measurements, erythrocyte (RBC) count,leukocyte
(WBC) count, red blood cell (RBC) indices, and a differential white cell count. TheCBC is
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a basic screening test and one of the mostfrequently ordered blood tests.
Possible Causes of
Normal Findings
Increased Decreased
Infection
Inflammation
Trauma
Autoimmune
disease
Drug toxicity
Bone marrow
failure
stress
acute
infection
aplastic anemia
dietary deficiency
Chronic
infection
Viral
Infection
Mononucleosi
s
Leukemia
Sepsis
Immunodeficiency
\
diseases
Parasitic
infections
Allergic
reactions
Leukemia
Increased
Adrenosteroid
production
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O ut Patient/ Follow-up
Any odd signs such as fever, petechiae, recurrence of fever,etc. must be
immediately reported to the physician.
D iet
Instruct to eat foods that are low fat, low fiber, non-irritating and non-carbonated.
ADAMSON UNIVERSITY
CASE STUDY ON DENGUEHEMMORHAGIC FEVER
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Submitted By: Jerome R. dela Cruz
Submitted to: Ms. Villaluna
Sept 11. 2009