dengue hemorrhagic fever dfs
TRANSCRIPT
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Dengue fever syndrome (DFS) and dengue hemorrhagic fever(DHF) are acute febrile diseases which occur in the tropics, can be life-threatening, and are caused by four closely related virus serotypesof thegenus Flavivirus, family Flaviviridae.It is also known as breakbone fever,since it can be extremely painful. Unlike malaria, dengue is just asprevalent in the urban districts of its range as in rural areas. Eachserotype is sufficiently different that there is no cross-protection andepidemics caused by multiple serotypes (hyperendemicity) can occur.Dengue is transmitted to humans by the Aedes aegypti mosquito ormore rarely the Aedes albopictus mosquito. The mosquitoes that spreaddengue usually bite at dusk and dawn but may bite at any time duringthe day, especially indoors, in shady areas, or when the weather iscloudy.
The WHO says some 2.5 billion people, two fifths of the world'spopulation, are now at risk from dengue and estimates that there maybe 50 million cases of dengue infection worldwide every year. Thedisease is now endemic in more than 100 countries.
As of August 2010, there where 70,000 cases reported in thePhilippines by the Department of Health and 501 reported deaths.
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This case presentation aims to identifyand determine the problems and needs
of the patient with admitting diagnosis ofdengue. We also intends to help patientto promote health and understand suchconditions through the application of
nursing skills.
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We relate this case to FlorenceNightingales Environmental Theory
because proper management of storedwater and clean environment avoidinsects and mosquitoes to lived at. It alsoprevents acquiring diseases especially
dengue cases.
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Biographical DataName: Lyssa Melandru Barrinuevo RosarioAge: 2 years old
Address: B 841-A Chrysanthemum St. Camella HomesClassic Don Bosco, Paraaque CityDate of Birth: February 02, 2008Gender: FemaleStatus: Single
Occupation: NONEDate of Admission: September 09, 2010 at 8:53pm.Attending Physician: Dr. Rodel FontanillaEmergency Contact Person: Her Father, Daniel IanDel Rosario
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Chief ComplaintUpon Admission, the client complained of fever
and cough. History of Present Illness
Four days prior to admission, the client is having afever and also an unproductive cough.
Past Health History
The client has no any history of surgicalprocedures. Her past illnesses are just fever, coughand colds.
Family Health HistoryThe clients mother has an asthma.
Social Health HistoryThe client is the only child of Mr. Daniel Ian DelRosario and Mrs. Mary Carla Del Rosario. The patientis a Roman Catholic.
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The client completed all the vaccineslike BCG given at birth, DPT 1, 2 and 3,
OPV 1, 2 and 3, Hep B 1, 2 and 3 andMMR given at 11th month.
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When the client has a fever, her fathergave her Tempra. When she has cough,
she was given Lagundi.
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Blood
Whole blood has two components: (1)blood plasma, a watery liquid matrix thatcontains dissolved substances, and (2)formed elements, which are cells and cellfragments. Blood is about 45% formedelements and 55% plasma. Normally more
than 99% of the formed elements are red-colored red blood cells. Pale colorless whiteblood cells and platelets occupy less than1% of total blood volume.
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Substances in Blood Plasma
Constituent Distribution
Water (91.5%) Liquid portion of blood. Acts as solvent andsuspending medium for components ofblood;absorbs, transports and releases heat.
Proteins (7.0%) Exert colloid osmotic pressure, which helpsmaintain water balance between blood andtissues and regulates blood volume.
Albumins Smallest and most numerous plasma proteins;produced by liver. Function as transportproteins for several steroid hormones and forfatty acids.
Globulins Produced by liver and by plasma cells, which
develop from B lymphocytes. Antibodies helpattack viruses and bacteria. Alpha and betaglobulins transport iron, lipids and fat-solublevitamins.
Fibrinogen Produced by liver. Plays essential role inblood
clotting.
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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 about120 days
Hemoglobin within RBCstransports most of the
oxygen and part of thecarbon dioxide in theblood
White Blood Cellds 500010,000/2L Most live for a few hoursto a few days
Combat pathogens andother foreign substancesthat enter the body
Neutrophils 60-70% of all WBCs 10 122m diameter;nucleus has 2-5 Lobes
connected by thinstrands of chromatin;cytoplasm has very fine,pale lilac.
Phagocytosis.Destruction of bacteria
with lysozyme, defenses,and strong oxidants,such as super oxideanion, hydrogenperoxide, andhypochlorite anion
Eosinophils 2-4% of all WBCs 10-122m diameter;nucleus has 2-3lobes;
large red- orangegranules fill thecytoplasm
Combat the effects ofhistamine in allergic
reactions, phagocytesantigen antibodycomplexes, and destroycertain parasitic worms
Basophils 0.5-1% of all WBCs 8-102m diameter;nucleus has 2 lobes;large cytoplasm granulesappeardeep blue-purple
Liberate heparin,histamine and serotoninin allergicreactions that intensifythe overall inflammatory
response
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Lymphocytes 20-25% of allWBCs
Small lymphocytesare 6-92m indiameter; largelymphocytes are
10-14 2m indiameter; nucleusis round or slightlyindented;cytoplasm forms arim around thenucleus that lookssky blue; the largerthe cell, the more
cytoplasm is visible
Mediate immuneresponses, includingantigen-antibodyreactions. B cells
develop into plasmacells, which secreteantibodies. T cellsattach invadingviruses, cancer cellsand transplantedtissue cells. Naturalkiller cells attack awide variety of
infectious microbesand certainspontaneously arisingtumor cells.
Monocytes 3-8% of all WBCs 12-202m diameter;nucleus iskidney shaped orhorseshoe shaped;cytoplasm is blue-grayand has foamyAppearance
Phagocytosis (aftertransforming intofixed or wanderingmacrophages)
Platelets 150,000-400,000/2L
2-42m diameter cellfragments that livefor 5-9 days;contain manyvesicles but noNucleus
Form platelet plug inhomeostasis; releasechemicals thatpromote vascularspasm and bloodclotting
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Bite of a aedes mosquitocarrying a flavivirus
Mosquito inject the virus
to the victims skin
Virus enters the bloodstream
Infects cells andgenerate cellular
response
Initiate immuneresponse (stimulates
release of cytokines)
Cytokines destroycell membrane and
cell wall
When treated early with doctorprescribed medication and
manage to prevent theappearance of the other symptoms
IVFs and electrolyte replacementsand precaution
Patient recovers
When illness becamesevere
Damage cells due toboth cytokines and virus
Fluid shift from ICF - ECF
Bloody vomitus, urineand stool
Circulatorycollapsed and Shock
DEATH
Manifest evanescent rashes Rashes in several
areas of the body
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Pattern Before During Analysis
Health Perception andHealth Management
Perceives that she ishealthy
Perceives that she is notthat healthy for having adengue
Clients problem at herhealth status
Nutirtion and Metabolism Preferred rice and fish She preffered more riceand fish
Client may have anutritional imbalancedue to inconsistent foodintake
Elimination Client have a regularand routinely bowelmovement
Experienced diarrhea atfirst day of herhospitalization and now,she is constipated
Client have a probelmon her elimination
Cognitive and Sensory Client has no claims ofdifficulty in learning andpercepting differentsensations and have noany vision of hearing
problem
Client has no claims ofdifficulty in learning andpercepting differentsensations and have noany vision of hearing
problem
Clients level of cognitionand perception arenormal
Sleep and Rest Sleeps normally andcontinuously for about 8to 10 hours
Sleeps normally andcontinuously for about 8to 10 hours
There is no anydeprivation on hersleeping pattern
Self Perception and SelfConcept
Client perceived heremotions according toher feelings andattitudes about herself
Client perceived heremotions according toher feelings andattitudes about herself
Client has no anydeprivation in thispattern
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Role and Relationship Has a strong bondingwith his family andhas no disturbances
in her roles andrelationship
Has a strong bondingwith his family andhas no disturbances
in her roles andrelationship
Good family ties willpromote support forrecovery and gives
comfort and feelingof belongingness
Sexuality andReproductive
The patient identifyherself according toher orientation andher knowledge abouther sexuality
The patient identifyherself according toher orientation andher knowledge abouther sexuality
The client knows howcould she identifywhich group hersexual belong
Coping and Stress Client has no anyfactor to be stressed
The client is stressedbecause of herhospitalization
The client is notcomfortable on herhealth status thattrigger stress to her
Vakues and Belief Client is a RomanCatholic and go tochurch every
sundays. Her fatheroriented heraccording to theirbeliefs
Client is a RomanCatholic and go tochurch every
sundays. Her fatheroriented heraccording to theirbeliefs
Good Spiritual tiesthat help her to havea faster recovery and
spiritually growingthat improve tiesbetween her ansGod
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Parts Normal Findings Analysis
Head and Skull proportional tothe size of the body,round, withprominences in thefrontal areaanteriorly & theoccipital areaposteriorly,
symmetrical in allplanes, gentlyCurved
proportional tothe size of the body,round, withprominences in thefrontal areaanteriorly & theoccipital areaposteriorly,
symmetrical in allplanes, gentlycurved
NORMAL
Scalp and Hair scalp is white,clean, free frommasses, lumps, nits,dandruff & lesions,with no areas oftenderness uponpalpation; hair isblack, evenlydistributed & coversthe whole scalp,thick & shiny
scalp is white,presence of wound,nomasses, lumps, nits &dandruff,with no areas oftenderness uponpalpation; hair isblack, evenlydistributed & coversthe whole scalp,thick & shiny
Due to itching of scalp
Face oblong shaped,symmetrical, smooth& no involuntary
muscle movements
oblong shaped,symmetrical, smooth& no involuntary
muscle movements
NORMAL
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Eyes and Vision eyes are parallel & evenly
placed, symmetrical, non
protruding, with scant amount
of secretions, both eyes black
& clear; sclera is white &
clear; eyebrows are black,
symmetrical, thick, can raiseboth symmetrically & without
difficulty, evenly distributed &
parallel with each other;
eyelashes are evenly
distributed & turned outward;
upper eyelids cover a small
portion of the iris, cornea &
the sclera when the eyes are
open, when the eyes are
closed the lids meet
completely, symmetrical &
the color is the same as the
surrounding skin; lid margins
are clear, without scaling or
secretions; lower palpebral
conjunctiva are shiny, moist,
transparent & salmon pink in
color; iris are proportional to
the size of the eye, round &
symmetrical; pupils are from
pinpoint to almost the size ofthe iris, round, symmetrical,
constricts with increasing light
& accommodation; able to
move eyes in full range of
direction
eyes are parallel & evenly
placed, symmetrical, non
protruding, with scant amount
of secretions, both eyes black
& clear; sclera is white &
clear; eyebrows are black,
symmetrical, thick, can raiseboth symmetrically & without
difficulty, evenly distributed &
parallel with each other;
eyelashes are evenly
distributed & turned outward;
upper eyelids cover a small
portion of the iris, cornea &
the sclera when the eyes are
open, when the eyes are
closed the lids meet
completely, symmetrical &
the color is the same as the
surrounding skin; lid margins
are clear, without scaling or
secretions; lower palpebral
conjunctiva are shiny, moist,
transparent & salmon pink in
color; iris are proportional to
the size of the eye, round &
symmetrical; pupils are from
pinpoint to almost the size ofthe iris, round, symmetrical,
constricts with increasing light
& accommodation; able to
move eyes in full range of
direction
NORMAL
Nose nose is in midline,
symmetrical, patent;
internal nares are
clean, dark pink with
few cilia
nose is in midline,
symmetrical, patent;
internal nares are
clean, dark pink with
few cilia
NIRMAL
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Ears and Hearing parallel, symmetrical,proportional to the size ofthe head, bean-shaped,helix is in line with the outercanthus of the eye, skin is
the same color as thesurrounding area & clean;ear canal is pinkish, clean,with scant amount ofcerumen & a few cilia;able to hear whisperspoken 2 feet away
parallel, symmetrical,proportional to the size ofthe head, bean-shaped,helix is in line with the outercanthus of the eye, skin is
the same color as thesurrounding area & clean;ear canal is pinkish, clean,with scant amount ofcerumen & a few cilia;able to hear whisperspoken 2 feet away rightear
NORMAL
Mouth and Lips lips are pinkish,
symmetrical, lip margin iswell defined, smooth &moist; gums are pinkish,smooth, moist, no swelling,no retraction, nodischarge; 32 teeth arepresent, aligned, with nodental caries; tongue ispinkish, slightly rough ontop, smooth along thelateral margins, moist, shiny& freely movable; cheeksare pinkish, moist & smooth;frenulum is in midline,straight & thin; soft palate ispinkish, smooth & moist;hard palate is slightlypinkish; uvula is at thecenter, symmetrical
& freely movable
lips are pinkish,
symmetrical, lip margin iscracked & dry lips;gumsare pinkish, smooth, moist,no swelling, no retraction,no discharge; 32 teethare present, aligned,with no dental caries;tongue is pinkish, slightlyrough on top, smoothalong the lateral margins,moist, shiny & freelymovable; cheeks arepinkish, moist & smooth;frenulum is in midline,straight & thin; soft palate ispinkish, smooth & moist;hard palate is slightlypinkish; uvula is at thecenter, symmetrical
& freely movable
Sign of Dehydration
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Neck proportional to thesize of the body &head, symmetrical &
straight, no palpablelumps, masses orareas of tenderness
proportional to thesize of the body &head, symmetrical &
straight, no palpablelumps, masses orareas of tenderness
NORMAL
Thorax and Lungs chest contour issymmetrical, spine isstraight, no lumps, nomasses, no tenderareas, with clearbreath sounds
chest contour issymmetrical, spine isstraight, no lumps, nomasses, no tenderareas, with clearbreath sounds
NORMAL
Abdomen abdominal skin isunblemished, noscars, color is uniformwith thebody color,abdomen is roundedwith symmetricmovements causedby respiration;umbilicus is concave
abdominal skin isunblemished, noscars, color is uniformwith thebody color,abdomen is roundedwith symmetricmovements causedby respiration;umbilicus is concave
NORMAL
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Upper Extremities symmetrical, with visibleveins, fine hair evenlydistributed, warm, dry &elastic upon palpation,with area of tenderness onthe left arm; palms arepinkish, warm, soft &elastic; nails aretransparent, smooth &convex with light pink nailbeds & white translucenttips; 5 fingers in each hand;both shoulders, arms,elbows, hands & wrists can
be moved in differentrange of motion withrelative ease
symmetrical, with visibleveins, fine hair evenlydistributed, warm, dry &elastic upon palpation,with area of tenderness onthe left arm; palms arepinkish, warm, soft &elastic; nails aretransparent, smooth &convex with light pink nailbeds & white translucenttips; 5 fingers in each hand;both shoulders, arms,elbows, hands & wrists can
be moved in differentrange of motion withrelative ease
NORMAL
Lower Extremities skin is smooth, fine hair isevenly distributed, absenceof varicose veins, musclessymmetrical, lengthsymmetrical, 5 toes in eachfoot, sole & dorsal surface is
smooth with pink nail beds& white translucent tips;both legs, knees, ankles, &toes can be moved indifferent range of motionwith relative ease; scar onboth patellar
skin is smooth, fine hair isevenly distributed, absenceof varicose veins, musclessymmetrical, lengthsymmetrical, 5 toes in eachfoot, sole & dorsal surface is
smooth with pink nail beds& white translucent tips;both legs, knees, ankles, &toes can be moved indifferent range of motionwith relative ease; scar onboth patellar
NORMAL
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TEST NORMAL FINDINGS ANALYSIS
Red Blood Cells 3.95.3 4.21 NORMAL
Hemoglobin 110160 110 NORMAL
Hematocrit 0.310.43 0.37 NORMAL
White Blood Cells 515.5 4.4 Infection of the bodyby the DFS strain
causes in stimulationof the immunesystem to combatthe disease causingdecreased levels ofWBC count in theblood
Platelet Count 200400 152 DFS can causethrombocytopeniaby direct infection ofbone marrowmegakaryocytes aswell asimmunologicalshortened platelet
survival..
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Name of theDrug
Dosage Mechanismof actions
Indications Contraindications
AdverseEffect
Nursing Alert
Paracetamol
Syrup
120mg/5ml
5ml every 4hours PRN fortemp >37.8C
Inhibition of
cyclooxygenase (COX),While it hasanalgesicandantipyreticpropertiescomparableto those ofaspirin orother NSAIDs
relief of
fevers, achesand painsand relievepain in mildarthritis buthas no effecton theunderlyinginflammation, redness,and swellingof the joint
Should not
be used inhypersensitivity to thepreparationand insevere liverdiseases
gastrointestin
al problems,allergic skinreactions,Blooddyscrasia,nephropathy, like drugcombinations containingphenacetin,acute liverfailure,hepatotoxicity
Use liquid
form forchildren andpatients withdifficulty inswallowing
In children,dontexceed fivedoses in 24hours
Mupirocin(Bactroban
Ointment)
Apply 3x aday
Prevent skinlesions
Indicated forthe topical
treatment ofimpetigodue to:Staphylococcus aureusandStreptococcus pyogenes.
Contraindicated in
individualswith a historyof sensitivityreactions toany of itscomponents.
Burning,stinging or
painRash,nausea,erythema,dry skin,tendernessand swelling.
Check forany
reactions ofthe skintoward theappliedointment
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Augmentin 312mg/5ml
4ml every 8hours
To reducethedevelopment of drug-resistantbacteria andmaintain theeffectivenessofantibacterialdrugs, shouldbe used onlyto treat or
preventinfectionsthat areproven orstronglysuspected tobe causedby bacteria
Indicated inthetreatment ofinfectionscaused bysusceptiblestrains of thedesignatedorganisms intheconditions(UTI, LRTI,Otitis Media,
Sinusitis, andskininfections)
Contraindicated inpatients witha history ofallergicreactions toanypenicillin.
Contraindicated inpatients witha previous
history ofcholestaticjaundice/hepaticdysfunction.
Diarrhea orloose stools,nausea andvomiting, skinrashes,urticaria,and vaginitis.
Assess theclient if she isallergic inPenicillin andpreparemedicationsfor resultingany adversereaction dueto allergyoccur.
DulcolaxPediatricSuppository
Once a day To Stimulatethe bowelMovement
For thetreatment ofoccasionalconstipation.
In patientswith ileus,intestinalobstruction,acutesurgicalabdominalconditions
Rarely,abdominaldiscomfortand diarrheahave beenreported.
Check foranyabdominaldiscomfort orreport ofdiarrheal
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Cues Diagnosis ExpectedOutcome
NursingIntervention
Rationale Evaluation
Subjective:Ang anak ko
ilang araw nahindidumudumi. Asverbalized by theclients father.
Objective:Abdominal pain,urgency, andcramping.
Altered bowelsounds
Constipationrelated to
decreaseddietary intake
STG:After 8 hours of
nursinginterventions, thepatient willestablish or returnto normalpatterns ofbowelfunctioning.
LTG:After 1-2 days ofnursingintervention, theclients motherwill verbalizeways to avoidconstipation ofher child.
Independent:- Determine stool
color,consistency,frequency, andamount.
- Auscultatebowel sounds.
- Encourage fluidintake of 2500-3000 ml/daywithincardiactolerance.
- Recommendavoiding gasforming foods.
- Assist in perinialskin conditionfrequently,noting changesor beginning
breakdown.
-Assists in
identifyingcausative orcontributingfactors andappropriateinterventions.
- Bowel soundsare generallydecreased inconstipation.
- Assists inimproving stoolconsistency.
- Decreasegastric distressand abdominaldistension.
- Prevents skinexcoriation andbreakdown.
Fully Met-the patients
bowelmovement returnto its normalpattern.
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- Discuss use ofstool softeners,mild stimulants,bulk-forminglaxatives, orenemas asindicated.Monitoreffectiveness.
- Encourage toeat high-fiber richfoods.
Collaborative:
- Consult withdietitian toprovide well-balanceddiet high in fiberand bulk.
Dependent:- Administrationof laxatives.
- Facilitatesdefecation whenconstipation ispresent.
- To enhanceeasydefecation.
- Fiber resistsenzymaticdigestion andabsorbs liquids inits passage alongthe intestinaltractand therebyproduces bulk,which acts as a
stimulant todefecation.
-It helps instimulation orincrease thefrequency ofbowel
evacuation
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Cues Diagnosis ExpectedOutcome
NursingIntervention
Rationale Evaluation
Objective:Dry and crackedlips.
RR: 38
Temp: 38.6CPR: 130
Fluid VolumeDeficit related tofailure ofregulatorymechanisms
STG:Within 8 hours,patient willmaintainadequate fluid
volume.
LTG:After 1-2 days ofnursingintervention theclient will notshow any signs ofdehydration
Independent:-Monitored vitalsigns; notedchanges in bodytemperature.
-Monitored I/Oqh; obtaineddaily weightsand compared
with 24-hr I/O.
-Encouraged
increase in fluidintake andconsumption offoods high in fluidcontent.
-Turned patientq2h andprovided support
for bodyprominences.
-Increased HRalong withdecreased BPand elevatedtemperature,
is present inconditions withfluid volumedeficit.
-Fluidreplacementneeds are basedon correction of
current deficitsand ongoinglosses.Decreasedurinary outputmay requireaggressive fluidreplacement.
-Relieves thirst
and aids in bodyfluidreplacement.
-Patients withfluid volumedeficit are more
at risk for skinbreakdown.
Fully met:The Clientmaintains theadequate fluidvolume
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-Provided skinand mouth care,massaged skin,and appliedemollients as
necessary.
-Monitored IVflow ratesregularly;observed formarkedelevations in BP,restlessness, moistcough, dyspnea,basilar crackles,
and frothysputum.
Dependent:-Administered IVfluids as ordered.
-Regular skin andmouth carerelieves drynessand discomfort.Light massage
promotescirculation. Useof emollients andmild soapspromotes goodhygiene andcomfort withoutexcessive dryingof the skin.
-Patients on IVfluid therapymay be at risk forcardiopulmonarycompromise.
-Aggressive fluidreplacementmay be requiredto correct fluidvolume deficit.
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Cues Diagnosis ExpectedOutcome
NursingIntevention
Rationale Evaluation
Subjective:Apat na arawna maiinit anganak ko. As
verbalized by theclients father
Objective:Temp.- 38.6CFlushed skinwarm to touch
Hyperthermiarelated todisease processas evidence by
increase bodytemperaturegreater than thenormal range
After 4 hoursof effectivenursingintervention, the
patientstemperature willdecrease from38.6C to itsnormal range.
After 1-2 days ofnursingintervention theclients mother
will know how toprevent theoccurrence ofhyperthermia
INDEPENDENT*monitor coretemperatureeveryhour
*note presence ofsweating as bodyattempts toincrease heat lossby evaporation.
*increase oralfluid intake
*promote bedrest, encouragerelaxation skillsand diversionalactivities.
*temperature of38.9-41.1 Csuggest acuteinfectious diseaseprocess.
*Evaporation isdecreasedby environmentalfactors ofhigh humidity andhighambient
temperature aswell as bodyfactorsproducing loss ofability tosweat.
*to supportcirculatingvolume and tissue
perfusion.
*to reducemetabolicdemands/oxygenconsumption.
Fully Met:The clienttemperaturedecrease to 36.5
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*provide TSB asneeded
*promote surfacecooling, loosenclothing andcoolenvironment
*Review specificriskfactors/causes,signs and
symptoms withthe interventionsrequired
DEPENDENT*Administermedications asindicated totreatunderlying
cause,such as:-Paracetamol
COLLABORATIVE*administerreplacementfluidsand electrolytes
*heat is loss byevaporationand conduction.
*heat is loss byconvection,radiation andconduction.
*to promotewellness.
*to decrease thebodytemperature
*to treatunderlyingCondition
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Medications: Instruct the patient to take her
medicines as prescribed. Exercise: teach the patient to make or to conduct
exercises everyday like walking.
Treatment: Follow the ordered treatment of the
doctor Health Teaching: Teach the client to maintain a
clean environment to avoid viral infections
OPD Follow-up: Instruct the client to come back for
her follow-up check up. Diet: DAT and increase fluid intake