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Table Of Contents

I. Introduction

II. Nursing History

a. Demographic Profile

b. Admission Data

c. Chief Complaint

d. History of Present Illness

e. Past Medical History

f. Family History

III. Laboratory Exam

IV. Nursing Care Plan

V. Medical Management (Drug Study)

I. Introduction

In the Philippines there are many diseases illness arising because of environmental

changes that may be caused by human activities and geographical conditions. It is

considered as one of the tropical country and so disease can spread throughout the

country.

Dengue Hemorrhagic Fever is an increasing public health problem and it has

been known for more than a century in the tropical areas of the South-East Asia and

Western Pacific Regions. In the Philippines, DHF was first recognized in 1953 while in

Thailand it was in 1958. The mystery concerning the causative agent was solved when

dengue virus types 2, 3 and 4 were isolated in the Philippines in 1956 and dengue virus

type 1 in Thailand in 1958.

Dengue hemorrhagic fever (DHF) can be defined as an acute febrile illness

caused by four serotypes of dengue virus (family Arbovirus, genus Flavivirus) and

characterized clinically by a hemorrhagic diathesis and a tendency to develop a shock

syndrome (dengue shock syndrome-DSS) that may be fatal. Thrombocytopenia with

concurrent hemoconcentration is a constant finding.

II. Nursing History

A. Demographic Data

Client R.C is 6 years old, male, born on September 11, 2007, Roman Catholic, A grade

one student and presently residing at District IV.

B. Admission data

On the 8th day of December 2013, Sunday, at exactly 4pm client was admitted at San

Lazaro Hospital.He was conscious and coherent. Carried and cuddled by his mother.

C. Chief complaint

Fever (39°C) abdominal pain (pain scale of 8)

D. History of present illness

4 days prior to consultation client manifested fever (38.5°C) and took over the counter

drug and self medicated by Paracetamol 125mg/5l every 3 hours. But there was no relief of

symptoms.

Morning before time of admission client was experiencing fever (39°C) and abdominal

pain (pain scale of 8) with episodes of vomiting, and has rashes on his lower extremities.

Client was brought to the near clinic in Tondo for checked-up and Ospital ng Tondo but they

referred to San Lazaro Hospital for further management.

E. Past medical history

According to the mother, the client did not yet experience having serious health

problems other than fever, colds and cough. Client has no previous surgery and no previous

hospitalization. No other known disease; and no allergy to food and drug.

F. Family history

In mother side there is a history of hypertension while in his father side there is a history of

Asthma.

Assesment Diagnosis Planning Implementation Rationale Evaluation

S- None

O-weak looking-pale-warm to touch-Echymosis and rashes on lower extremities-VS: Temp: 36.3RR: 29PR: 100

-Blood count: (50) Decrease Platelet

Risk for bleeding r/t decreasedplatelet count

Short Term:

After 4 hours of nursing interventions:

-Skin will remain intact with no signs of bleeding

-Mucous membrane will remain intact

Long Term:

After 4 days of nursing intervention the client will:

-Normalizes/ Restores RBC count

1. Assess and monitor vital signs every 2 hours.

2. Assess body systems for bleeding:

-Skin, mucous membranes for petechiae, echymosis, and hematoma formation.

-Gums and nasal membranes for bleeding.

-Vomitus, stool and urine for visible occult blood.

- Neurological changes (headache, visual changes)

3. Encourage use of bristle toothbrush,

-Increased heart rate and orthostatic changes accompany bleeding. (NCP 3rd ed., Schroeder & Jones,p 389)

-Early detection of bleeding helps prevent significant blood loss and potential shock. Occult blood shows internal bleeding affects mental status and LOC

-Fragile tissues and altered clotting

Short Term:

After 4 hours of nursing interventions

-Skin and mucous membrane is intact with no signs of bleeding.

Long Term:

After 4 days of nursing interventions the client will:

-Urine and stool are free from blood-Normalized RBC count

sponge or mild mouthwash to clean teeth and gums.

4.Instruct client to avoid forceful blowing, coughing, sneezing and straining to have a bowel movement

5. Monitor platelet count

mechanisms increase the risk of hemorrhage following even minor trauma.

-These activities can damage mucous membrane increasing the risk of bleeding

-Spontaneous bleeding can occur at platelet count <50,000/mm3

IV.Nursing Care Plan

Assessment Diagnosis Planning Implementation Rationale Evaluation

V.Medical Management

Drug Name Classification Action Contraindication/Indication

SideEffects Nursing Consideration

Generic Name:• AcetaminophenParacetamol

Brand Name:•Biogesic

Dosage:

For child: 6-12 years old (10ml-20ml) or 2 to 4 tsps. Paracetamol 250mg/ml.

•Non-narcotic analgesic, Antipyretic

• Inhibits pyrogen effect on the hypothalamic-heat-regulating centers.

• relief of pain and discomfort from headache, cold, flu,minor muscle aches, overexertion, menstrual cramps, toothache, minor arthritic pain.

Side effects of paracetamol are rare.

• Monitor CBC, liver and renal functions.

• Assess for fecal occult blood and nephritis.

• Avoid using OTC drugs with Acetaminophen.

• Take with food or milk to minimize GI upset.

• Report N&V. cyanosis, shortness of breath and abdominal pain as these are signs of toxicity.

• Report paleness, weakness and heart beat skips

• Report abdominal pain, jaundice, dark urine, itchiness or clay-colored stools.

• Report pain that persists for more than 3-5 days

• Avoid alcohol.

Medical Management

Drug Name Classification

Action Contraindication/

Indication

Side Effect:

Health Teaching

Generic Name: Proton Suppresses Hypersensitivi -Headache • Tell patient to

omeprazole/sodium bicarbonate

Brand Name:

• Prilosec

Dosage:

• For ulcers, GERD, erosive esophagitis and eradication of H. pylorithe recommended dose for adults is 20-40 mg daily.

pump inhibitors

gastric acid secretion by specific inhibition of the H+/K+-ATPase in the gastric parietal cell.

ty to drug or its components.

- abdominal pain

-hives

-difficulty breathing

-swelling of face, lips, tongue, or throat. 

take 30 to 60 minutes before a meal, preferably in morning.

• Instruct patient to swallow capsules or tablets whole and not to chew or crush them. If he can't swallow capsule, tell him he may open it, carefully sprinkle and mix entire contents into 1 tbsp of cool applesauce, and swallow immediately with glass of water.

• Inform patient taking OTC delayed-release tablets for heartburn that full effect may take 1 to 4 days. Advise him not to take tablets for more than 14 days without consulting healthcare

professional.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

III. LABORATORY EXAM

Description Purpose Normal Values Result Implication

Complete blood count>A complete blood count (CBC), also known as full blood count (FBC) or full blood exam (FBE)

The CBC provides valuable information about the blood and to some extent the bone marrow, which is the blood-forming tissue. The CBC is used for the following

or blood panel, is a test panel requested by a doctor or other medical professional that gives information about the cells in a patient's blood. A scientist or lab technician performs the requested testing and provides the requesting medical professional with the results of the CBC.

purposes:

-as a preoperative test to ensure both adequate oxygen carrying capacity and hemostasis

-to identify persons who may have an infection

-to diagnose anemia

-to identify acute and chronic illness, bleeding tendencies, and white blood cell disorders such as leukemia

-to monitor treatment for anemia and other blood diseases

-to determine the effects of chemotherapy and radiation therapy on blood cell production

Hemoglobin>is an iron-containing protein that transport

the bulk of the oxygen carried in the blood.

Measures the amount of the oxygen-carrying protein in the blood.

140-175 115.7

(decreased)

A low hemoglobin isn’t considered significant and causes no symptoms. It referred to as ANEMIA

Hematocrit>This is the fraction of whole blood volume that consists of red

Measures the percentage of a person's blood that consists of red blood cells.

37.0-47.0 normal

blood cells.RBC Count>7-8um diameter; biconcave discs, without a nucleus; live for about 12 days.

carries hemoglobin to provide oxygen to tissues; average lifespan is 12 days

4.5-5.9 3.88

(decreased)

WBC Count>Evaluation of white blood cells, the cells that are part of the body's defense system against infections and cancer and also play a role in allergies and inflammation.

Combat pathogens and other

foreign

Substances that enter the body

4.8-10.8 4.10

(decreased)

May indicate  bacterial infection. May also be raised in acute viral infections.

Platelets>Platelets (thrombocytes) are the smallest type of blood cell. They are important in blood clotting.

When bleeding occurs, the platelets swell, clump together, and form a sticky plug that helps stop the bleeding. If there are too few platelets, uncontrolled bleeding may be a problem. If there are too many platelets, there is a chance of a blood clot forming in a blood vessel. Also, platelets may be involved in hardening of the arteries (atherosclerosis).

150-400 50

(decreased)

Decreased duViral infection (mononucleosis, measles, hepatitis, dengue fever)

MCV>is a measurement of

the average size of RBCs.

80.0-90.0 Normal

MCH>is a calculation of the

27.0-31.0 Normal

average amount of oxygen-carrying hemoglobin inside a red blood cell.MCHC>is a calculation of the average percentage of hemoglobin inside a red cell.

32.0-36.0 Normal

Neutrophils>They are commonly referred to as polymorphonuclear (PMN) leukocytes, although, in the technical sense, PMN refers to all granulocytes. They have a multi-lobed nucleus that may appear like multiple nuclei, hence the name polymorphonuclear leukocyte. The cytoplasm may look transparent because of fine granules that are pale lilac.

Neutrophils defend against bacterial or fungal infection and other very small inflammatory processes that are usually first responders to microbial infection; their activity and death in large numbers forms pus.

0.40-0.70 0.27

(decreased)

Lymphocyte>Responsible for immune response

Lymphocytes are much more common in the lymphatic system. Lymphocytes are distinguished by

having a deeply staining nucleus

0.19-0.48 0.56

(Increased)

that may be eccentric in location, and a relatively small amount of cytoplasm.

Monocyte> Monocytes share the "vacuum cleaner" (phagocytosis) function of neutrophils, but are much longer lived as they have an additional role: they present pieces of pathogens to T cells so that the pathogens may be recognized again and killed, or so that an antibody response may be mounted.

Monocytes eventually leave the bloodstream to become tissue macrophages, which remove dead cell debris as well as attacking microorganisms. Neither of these can be dealt with effectively by the neutrophils. Unlike neutrophils, monocytes are able to replace their lysosomal contents and are thought to have a much longer active life. They have the kidney shaped nucleus and are typically agranulated. They also possess abundant cytoplasm.

0-7 Normal

Eosinophil>. In general, their nucleus is bi-lobed. The cytoplasm is full of granules that assume a characteristic pink-orange.

Eosinophils primarily deal with parasitic infections. Eosinophils are also the predominant inflammatory cells in allergic reactions. The most important causes of eosinophilia include allergies such as asthma, hay fever, and hives; and also parasitic infections color with eosin stain.

0.02-0.08 0.01

(Increased)

Red Cell Distribution Width>is a parameter that measures variation in

11.4-14.0% 15.60%

(Increased)

High RDW levels may be an indication of several conditions. One is that a high red blood cell

red blood cell size or red blood cell volume

distribution width (RDW) may indicate vitamin B12 deficiency. It may also be a manifestation of iron deficiency.