troy's case study

7/31/2019 Troy's Case Study

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PAMANTASAN NG LUNGSOD NG MARIKINACOLLEGE OF NURSING

Dengue Fever

In Partial Fulfillment in the Requirements ofRLE

Submitted by:

Troy M. Silverio


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Dengue is a mosquito-borne infection found in tropical and sub-tropical regions aroundthe world. In recent years, transmission has increased predominantly in urban and semi-urbanareas and has become a major international public health concern. Severe dengue (previouslyknown as Dengue Hemorrhagic Fever) was first recognized in the 1950s during dengueepidemics in the Philippines and Thailand. There are four distinct, but closely related, serotypes

of the virus that cause dengue (DEN-1, DEN-2, DEN-3 and DEN-4). The incidence of denguehas grown dramatically around the world in recent decades. Over 2.5 billion people over 40%of the world's population are now at risk from dengue. WHO currently estimates there may be50100 million dengue infections worldwide every year.

Transmission

The Aedes aegypti mosquito is the primary vector of dengue. The virus is transmitted tohumans through the bites of infected female mosquitoes. After virus incubation for 410 days, aninfected mosquito is capable of transmitting the virus for the rest of its life. Infected humans arethe main carriers and multipliers of the virus, serving as a source of the virus for uninfected

mosquitoes. Patients who are already infected with the dengue virus can transmit the infection(for 45 days; maximum 12) via Aedes mosquitoes after their first symptoms appear. The Aedesaegypti mosquito lives in urban habitats and breeds mostly in man-made containers. Unlikeother mosquitoes A. aegypti is a daytime feeder; its peak biting periods are early in the morningand in the evening before dusk. Female A. aegypti bites multiple people during each feedingperiod.

Characteristics

Dengue fever is a severe, flu-like illness that affects infants, young children and adults,but seldom causes death. Dengue should be suspected when a high fever (40C/ 104F) isaccompanied by two of the following symptoms: severe headache, pain behind the eyes, muscleand joint pains, nausea, vomiting, swollen glands or rash. Symptoms usually last for 27 days,after an incubation period of 410 days after the bite from an infected mosquito. Severe dengueis a potentially deadly complication due to plasma leaking, fluid accumulation, respiratorydistress, severe bleeding, or organ impairment. Warning signs occur 37 days after the firstsymptoms in conjunction with a decrease in temperature (below 38C/ 100F) and include:severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums, fatigue,restlessness, blood in vomit. The next 2448 hours of the critical stage can be lethal; propermedical care is needed to avoid complications and risk of death.

Treatment

There is no specific treatment for dengue fever.


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Biographical Data:

Name: J.B.MAge: 22Address: Banaba San Mateo Rizal

Date of Birth: August 15, 1990Gender: MaleMarital Status: SingleNationality: FilipinoReligion: Roman CatholicEducational Attainment: Presently in 5th Year CollegeType of Health Plan: No Phil HealthDate and Time of Admission: July 28, 2012 11:25AM

Source and Reliability of Information:

The Client himself who seems reliable because he can verbalize the discomfort thathe feels

The clients mother who seems reliable because she is the one who is taking care ofthe client

Clients chart as a secondary source of information

Chief Complaint:

Fever accompanied by a stabbing pain in the lower extremities

History of Present Illness:

Client experience an intermittent fever for 4 consecutive days 4 days prior to admissionand it is accompanied by a stabbing pain in the lower extremities when the client is athome. Client did self-medicate and took over-the-counter medicines like Bioflu,Biogesic, and Alaxan. The fever and pain can be relieved but sign and symptomsmanifested after several hours.

Past Medical History:

Client does not have any history of serious childhood illnesses and diseases. Client wasnever been hospitalized before (until clients chiefcomplaints occur) and never

undergone any surgical procedure.According to clients mother, her son had completedhis immunization when he was a child because they have a family clinic (private clinic)in SSS.

Family Medical History:

According to clients mother, she is experiencing an increase of blood pressure and herhusband was complaining about joint pain.


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Immunization/Exposure to Communicable Disease:

According to clients mother, her son had completed his immunization when he was achild because they have a family clinic (private clinic) in SSS. Client verbalized that hehas not been expose to any kind of communicable disease.

Allergies:

Client has no known allergies to food and medications.

Home medications/Alternative Medicine:

Most of the time, client do self-medication and take over-the-counter medicines likeBioflu, Biogesic, Alaxan, and Neozep whenever he feels sick.

Psychosocial History:

Client drinks coffee every morning with his breakfast. Client started drinking alcoholwhen he was 17 years old and until now he drinks alcohol, but moderately andoccasionally. Client does not smoke.

Developmental Level:

PsychosocialCrisis

Central Task PositiveOutcome

EgoQuality

Definition

DevelopmentalTask

LaterAdolescence

8-22 Years

IndividualIdentity

vs.IdentityConfusion

Roleexperimentation

Strong moralidentity;

Ready forintimaterelationships

Fidelity Ability tofreely

pledge andsustainvalues andideologies

Autonomy fromparents;

Sex-role identity

Internalizedmorality;

Career choice

EarlyAdulthood

22-34 Years

Intimacyvs.Isolation

Caregiving Form closerelationshipsand sharewith others

Love Capacity formutualitythattranscendschildhooddependency

Stablerelationships;

Child rearing;

Work etc


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Gordons Functional Patterns

Before Hospitalization During Hospitalization Analysis

Health Perception/Health Management Client is confident andsatisfied about his healthand he considered himselfas a healthy person. Hedoes not smoke. He starteddrinking when he was 17years old and e only drinksalcohol occasionally andmoderately. He does nottake any illegal drug. Clientdoes not have any history

of chronic childhoodillnesses and diseases.According to clientsmother, her son hadcompleted hisimmunization when he wasa child because they havea family clinic (privateclinic) in SSS. Client wasnever been hospitalizedbefore (until clients chief

complaints occur) andnever undergone anysurgical procedure. Most ofthe time, client do self-medication and take over-the-counter medicines likeBioflu, Biogesic, Alaxan,and Neozep whenever hefeels sick. His only exerciseis during weekend when heplays basketball because ofbusy schedule in school.

Client consideredhimself as an unhealthyperson due to presentcondition, but he isconfident and hopefulthat he will easily getbetter. The patient andhis family are compliantto all the doctors order,stating that being in ahealthy condition is

necessary because heneeds to come back toschool as a graduatingstudent as soon aspossible.

Nutritional -Metabolic

Client has a strongappetite, he eats whateverhe wants. He eats 4 timesa day including the snacks.His regular diet iscomposed of rice and meat

The client loss hisappetite due touncomfortable feelingand he is not use tohospital settings. Theclient is on DAT diet

An individuals healthstatus greatly affectseating habits andnutritional status


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with vegetables and fruit.He has no known allergiesto food. He does not smokebut drinks alcohol. Heconsumes 5 to 6 glasses of

water per day. He does nothave any problem withnausea and vomiting,swallowing, chewing, orindigestion.

except dark color food.

Elimination The clients averagevoiding pattern is 4 times aday in a moderate amount,light yellow in color, withoutexperiencing discomfort.The client passes out stool

once a day in moderateamount, well-formed andbrownish in color

During hospitalizationthe client voids 3 timesa day in moderateamount, light yellow incolor, withoutexperiencing any

discomfort. Hedefecates once a daybut not every day, inmoderate amount, well-formed and yellowish-brown in color

Activity/Exercise Client is able to perform allactivities of daily livingindependently. Client likesplaying basketball andguitar during weekends and

playing computer gameslike DOTA. His time andenergy during weekdays isfocused on his studies.

The client activitieswere minimizedbecause of hiscondition, neverthelessthe client can perform

ADLs independentlybecause he feels thathe have enough energyto do it and that hebelieves that hes nottoo ill. The only leisureof the client is readinghis books inengineering.

Sleep/Rest He does not have usualtime of sleep stating that

his studies as the reason.The client do not use anyforms of sleeping aids andis not experiencingepisodes of insomnia andany other related disorders.Day time naps are not doneby the client.

Client complainedabout difficulty of

sleeping and sleeps forshort periods of timedue to pain, fever andsometime due to vitalsign taking every hourthat is why sometimeshe doesnt feel rested.

Illness that causes paor physical distress ca

result in sleepproblems. People whoare ill require moresleep than normal andthe normal rhythm andwakefulness is oftendisturbed.There isdisruption of the sleep-


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wake cycle because ofthe patients disease.

Cognitive/Perceptual Client is currently studyingand is in his 5th year takingup Civil Engineering in

T.I.P. He can read andwrite and can speak andunderstand English.

The clients conditiondoesnt affect hisreading and writing. He

can and is understoodby others.

Role/Relationship Client is not in arelationship. He has a goodrelationship with his motherand siblings as well as withhis friends in school.

This hospitalizationcaused a lot of troublefor his studies due tomany absences and lotof lessons missed.

Sexual/Reproductive Client is not in arelationship. He is notengaged to sexual activity

due to personal reasons.

Client doesnt performsexual activities.

Coping/StressTolerance

He hangs out with hispeers to relax and relievestress; they usually go outto play basketball or DOTA.He sometimes plays hisguitar-based for the same-named purpose.

This recenthospitalization was atraumatic experiencefor the client for ithappening the firsttime. There have beenmany changesoccurred that made itdifficult for him toadjust.

Coping is the cognitiveand behavioral effort tmanage specificexternal and/or internademands that areappraised as taxing orexceeding theresources of theperson.

Value/Belief Client is a Roman Catholic.According to him he goesto church rarely becausehis busy schedule inschool.

Client cannot go tomass due tohospitalization.

Physical Assessment:

Body Part Findings Analysis

Upper Extremities:

Left arm

Lower Extremities:Left and Right Legs

Rash

Rash

Muscle pain

Bright red rash: Bright red rashhas measles-like appearance.

The redness may remaindominant in some parts whileothers may remain unaafected.These rashes may disappearafter a few days, only toreappear again.Degradation of skeletal muscleprotein


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Anatomy and Physiology:

Blood The vital fluid that courses through the body'sblood vessels provides the means by which thebodys cells receives vital nutrients and oxygen

and dispose of their metabolic waste. As bloodflows past the tissue cells, exchangescontinually occur between the blood and thetissue cells, so that vital activities can go oncontinuously.

Erythrocytes Also called red blood cells or RBCs. Cells thatcontain hemoglobin, an iron-containing pigmenthat binds oxygen in order to transport it to thecells of the body.

Formed Elements The solid, cellular portion of blood. It consists oerythrocytes, leukocytes, and platelets.

Hematopoiesis The process of forming blood.Leukocytes Also called white blood cells or WBCs. A groupof several different types of cells that provideprotection against the invasion of bacteria andother foreign material. They are able to leavethe blood-stream and search out the foreigninvaders (bacteria, virus, and toxins), wherethey perform phagocytosis.

Plasma The liquid portion of blood containing 90%water. The remaining 10% consists of plasmaproteins (serum albumin, serum globulin,

fibrinogen, and prothrombin), inorganicsubstances (calcium, potassium, and sodium),organic components (glucose, amino acids,cholesterol), and waste products (urea, uricacid, ammonia, and creatinine).

Platelets Cells responsible for the coagulation of blood.These are also called thrombocytes and contano hemoglobin.

Red Blood Cell Also called erythrocytes or RBCs. Cells thatcontain hemoglobin, and iron-containingpigment that binds oxygen in order to transpor

it to the cells of the body.White Blood Cell Blood cell that provides protection against theinvasion of bacteria and other foreign material.

Albumin A protein that is normally found circulating in thbloodstream. It is abnormal for albumin to be inthe urine.

Amino Acids An organic substance found in plasma. It isused by cells to build proteins.


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Calcium An inorganic substance found in plasma. It isimportant for bones, muscles, and nerves.

Creatinine A waste product of muscle metabolism.Fats Lipid molecules transported throughout the

body dissolved in the blood.

Fibrinogen Blood protein that is essential for clotting to takplace.

Gamma Globulin Protein component of blood containingantibodies that help to resist infection.

Globulins One type of protein found dissolved in theplasma.

Glucose The form of sugar used by the cells of the bodyto make energy. It is transported to the cells inthe blood.

Plasma Proteins Proteins that are found in plasma. Includesserum albumin, serum globulin, fibrinogen, and

prothrombin.Potassium An inorganic substance found in plasma. It is

important for bones and muscles.

Sodium An inorganic substance found in plasma.Urea A waste product of protein metabolism. It

diffuses through the tissues in lymph and isreturned to the circulatory system for transportto the kidneys.

Bilirubin Waste product produced from destruction ofworn-out red blood cells; disposed of by theliver.

Enucleated The loss of a cell's nucleus.Hemoglobin (Hg) Iron-containing pigment of red blood cells that

carries oxygen from the lungs to the tissue.

Agranulocyte Nongranular leukocyte. This is one of the twotypes of leukocytes found in plasma that areclassified as either monocytes or lymphocytes.

Granulocyte Granular polymorphonuclear leukocyte. Thereare three types: neutrophil, eosinophil, andbasophil.

Pathogens Disease-bearing organisms.Basophil A granulocyte white blood cell that releases

histamine and heparin in damaged tissues.Eosinophils A granulocyte white blood cell that destroy

parasites and increases during allergicreactions.

Neutrophil A granulocyte white blood cell that is importantfor phagocytosis. It is also the most numerousof the leukocytes.

Monocyte An agranulocyte white blood cell that is


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important for phagocytosis.

Lymphocytes An agranulocyte white blood cell that providesprotection through the immune response.

Agglutinate Clumping together to form small clusters.Platelets agglutinate to start the clotting

process.Fibrin Whitish protein formed by the action of thromb

and fibrinogen, which is the basis for the clottinof blood.

Hemostasis To stop bleeding or the stagnation of thecirculating blood.

Prothrombin Protein element within the blood that interactswith calcium salts to form thrombin.

Thrombin A clotting enzyme that converts fibrinogen tofibrin

Thrombocytes Also called platelets. Platelets play a critical pa

in the blood-clotting process by agglutinatinginto small clusters and releasingthrombokinase.

Thromboplastin Substance released by platelets; reacts withprothrombin to form thrombin.

ABO System The major system of blood typing.Blood Typing The blood of one person is different from

another's due to the presence of antigens onthe surface of the erythrocytes. The majormethod of typing blood is the ABO system andincludes types A, B, O, and AB. The other majo

method of typing blood is the Rh factor,consisting of the two types, Rh+ and Rh-.

Rh Factor An antigen marker found on erythrocytes ofpersons with Rh + blood.

Type A One of the ABO blood types. A person with typA markers on his or her RBCs. Type A bloodwill make anti-B antibodies.

Type AB One of the ABO blood types. A person with botype A and type B markers on his or her RBCsSince it has both markers, it will not makeantibodies against either A or B blood.

Type B One of the ABO blood types. A person with typB markers on his or her RBCs. Type B bloodwill make anti-A antibodies.

Type O One of the ABO blood types. A person with nomarkers on his or her RBCs. Type O blood willnot react with anti-A or anti-B antibodies.Therefore, it is considered the universal donor

Universal Donor Type O blood is considered the universal dono


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Since it has no markers on the RBC surface, itwill not trigger a reaction with anti-A or anti-Bantibodies.

Universal Recipient A person with type AB blood has no antibodiesagainst the other blood types and therefore, in

an emergency, can receive any type of blood.Rh-Negative A person with Rh- blood type. The person'sRBCs do not have the Rh marker and will makantibodies against Rh + blood.

Rh-Positive A person with RH + blood type. The person'sRBCs have the Rh marker.


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Pathophysiology of the Disease:

PredisposingGeographical area tropical islands inthe Pacific (Philippines) and Asia

PrecipitatingEnvironmental conditions (open spaceswith water pots, plants, and riverside)

Mosquito carrying dengue virusSweaty skin

Aedes aegypti (dengue viruscarrier):8-12 days of viralreplication on mosquitoessalivary glands

Bite from mosquito(Portal of Entry in the Skin)

Allowing dengue virus to beinoculated towards thecirculation/blood (Incubation Period:3-14 days

Virus disseminated rapidly into theblood and stimulates WBCs includingB lymphocytes that produces andsecretes immunoglobulins (antibodies),and monocytes/macrophges,neutrophils

Antibodies attach to the viral antigens,

and then monocytes/macrophages will

perform phagocytosis through Fc receptor

(FcR) within the cells and dengue virus

replicates in the cells


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Antibodies attach to the viral antigens,

and then monocytes/macrophages will

perform phagocytosis through Fc

receptor (FcR) within the cells and

dengue virus replicates in the cells

Recognition of dengue viralantigen on infected monocyte

Release of cytokines which consist ofvasoactive agents such as interleukins,tumor necrosis factor, urokinase and plateletactivating factors which stimulates WBCsand pyrogen release

Entry to theSpleen

Entry to theBone marrow

Dengue

Cellular direct destruction and

infection of red bone marrowprecursor cells as well asimmunological shortened

latelet

Thrombocytopenia

Recovery


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DISCHARGE PLAN

MEDICATION

Instruct patient to follow and continue the intake of vitamin B-complex as prescribed by the

doctor.

ENVIRONMENT

Instruct patient to provide clean and peaceful environment.Inform patient to always empty all the stock bottles in their house to eliminate possiblebreeding grounds of the mosquitoes.Educate patient about the importance of the proper ways of cleaning the surroundings.

TREATMENT

Instruct patient to provide adequate bed rest to minimize fatigueAvoid all strenuous activity that can make the patient tired.

HEALTH TEACHINGS

Instruct patients family to prepare foods that are appetizing and nutritious.Educate patient to give emphasis on the importance of proper hygiene.Recommend to patient to wear long comfortable sleeves and long socks to protect against

mosquito bites or to apply mosquito repellants.

OUT-PATIENT

Inform patient to notify the physician if symptoms set in.

DIET

Inform the patient to prepare nutritious food and provide iron supplement vitamins.

SPIRITUALITY

Instruct patient and patients family to continue to believe in GOD and always have faithwith HIM.

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