Pamantasan ng Lungsod ng Marikina J.P. Rizal St. Concepcion Uno, Marikina City __________________________ DENGUE HEMORRHAGIC FEVER __________________________ A Group Case Study Submitted to: Mr. Ryan E. Aliwalas, RN In Partial Fulfillment of the Requirement for the Course NCM 101 RLE H-Vill Hospital Submitted by: Gomez, Richerylle C. Gutierrez, Floren Angelie V. Hernandez, Richelle Joy T. Hussin, Johanna Fariza T. Ison, Sheila May H. Javier, Jayson R. Jayme, Carolyn Eleanor F. Labide, Prima Encar T. Ladjahasan, Irish Princess A. Lagumbay Joanne B. Lardillo, Catherine A. Lomocso, Jamielyn Kate B.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Pamantasan ng Lungsod ng MarikinaJ.P. Rizal St. Concepcion Uno, Marikina City
Gomez, Richerylle C.Gutierrez, Floren Angelie V.Hernandez, Richelle Joy T.Hussin, Johanna Fariza T.
Ison, Sheila May H.Javier, Jayson R.
Jayme, Carolyn Eleanor F.Labide, Prima Encar T.
Ladjahasan, Irish Princess A.Lagumbay Joanne B.Lardillo, Catherine A.
Lomocso, Jamielyn Kate B.
GROUP 7AUGUST 2009
INTRODUCTION
We live in our world today where everything seems to be in a fast face.
As it is, we cannot deny that things change over or in a certain period of
time. New technologies were being invented, clothes for fashion, jewelries,
luxuries mode of entertainment, etc. It’s just like having a new mode of
socialization, cultures, beliefs, perceptions, adaptation to life and environment.
With all of these, one aspect of human being which are greatly affected and the
one which we have to be most concern of would be in the side of our heath and
well being.
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 through out the country.
One example of these is disease is what we called Dengue Fever and
dengue Hemorrhagic Fever (DHF). It is considered as one of the acute febrile
diseases caused by one of the four closely related virus serotype of the genus
flavivirus. It can be transmitted by Aedes Aegypti mosquito to humans usually
attacking during the day. One will experience onset of fever, severe headaches,
muscle and joint pains which will give name to Breakbone Fever or Bonecrusher.
There are also rashes characterized by bright red petechaie commonly seen on
the lowers limbs and on the chest. There may also be gastritis associated to
abdominal pain, nausea, vomiting, or diarrhea. Proper attention of health care
provider should be given including good assessment, early detection or diagnosis
and medications which are essential for total interference of prevention.
GOAL
General Goal:
To be knowledgeable about the nature of Dengue Fever Syndrome,
management and treatment to be able to render effective nursing
care to the client.
Specific Goal:
To be familiar with the etiology of the disease
To know the pathophysiology of the disease
To be aware of the signs and symptoms
To know its complications
To be knowledgeable on how to prevent the disease
To know the treatment and how to apply it
To know the diagnostic exam
PATIENT’S PROFILE
Name: CJS
Age: 13 years old
Gender: Male
Address: # 32 Natividad St. Malanday San Mateo, Rizal
Date of Birth: October 24, 1995
Place of Birth: Marikina
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Single
Occupation: N/A
Date of Admission: August 24, 2009
Time of admission: 9:00 pm
Physician: Dra. Del Valle
Place of Admission: H-Vill Hospital
Admitting Diagnosis: Dengue Fever Syndrome
a.1 CHIEF COMPLAIN
The patient complains of abdominal pain, headache, fever and general
flushing of skin with on and off vomiting.
a.2 PRESENT ILLNESS
Four days prior to admission, the patient had an intermittent fever
associated with abdominal pain, headache, and general flushing of the
skin with on and off vomiting. A few hours prior to admission still the above
sign and symptoms remain but already have (-) vomiting with
accompanying chills and was diagnosed with Dengue fever Syndrome.
a.3 PAST MEDICAL YEARS
It was according to the patient that he wasn't been hospitalized yet not
until when he was diagnosed with Dengue Fever Syndrome. Before that
diagnosis, he was already experiencing fever and his mom gives him a
Paracetamol for remedy.
a.4 FAMILY HISTORY
According to his grandmother the only disease that the family has
genetically is Diabetes Mellitus and no other diseases noted.
a.5 SOCIAL HISTORY
CJS is the son of Mr. and Mrs. SJ. CJS is currently on the secondary level
of education at Roosevelt College at Malanday, Marikina City, near their
place.
His father works as a seaman while his mother is a housewife; his
grandmother is also living with them. Hence, his grandmother and his
mother were the ones responsible in all the household chores.
According to CJS, he eats vegetables and fish instead he prefers
eating hotdogs. Furthermore he has no other vices except for computer
games. After school hours, he goes directly to the computer shop together
with his brother and friends.
a.6 ENVIRONMENTAL HISTORY
According to the patient the environment that the family have has an open
drainage, wherein big rats and cockroaches can be seen. The house is
cleaned by his mother and grandmother. It was described by the patient
that there are parts of their house that is deprived from light.
C. HISTORY OF ILLNESS
During the mid of August, CJS, started experiencing fever that persist only
at night. As a remedy his mom gave him Paracetamol to lower his body
temperature. Except from fever he’s also experiencing abdominal pain,
headache and general flushing of the skin with on and off vomiting.
As the above signs and symptoms persists, his parent decided to bring
him to the hospital.
Upon the physical assessment and after several diagnostic procedures
that the patient had undergone, he was diagnosed with Dengue Fever
Syndrome (DFS) and was admitted under the service of Dra. Del Valle.
THEORETICAL FRAMEWORK
CJS, is at the stage of puberty, was diagnosed of having Dengue Fever
Syndrome (DFS).At the clinical check-up, the physician was able to identify some
clinical signs of it and was referred to Dra. Del Valle. The case of CJS can be
correlated with the theory of Florence Nightingale
Application Theory:
The case of CJS can be correlated with the theory of Nightingale wherein,
the environment of the patient is a factor leading to recovery. Having a clean,
well ventilated and quite environment is important in. With a nurturing
environment, the body could repair itself.
PHYSICAL EXAMINATION
PHYSICAL ASSESSMENT
1. Received Patient on bed awake conscious and coherent 2. With IVF D5LR 1000ml at 450 cc level and regulated at 25gtts/min.
I. LINEAR MEASUREMENT
1. Height: 5’4’’2. Weight : 51kgs.
PHYSICAL ASSESSMENTNAME: CJSDATE OF ASSESSMENT: August 24, 2009VITAL SIGNS:BP: 10070 mmHg PR: 76bpmRR: 22bpm Temp: 36.5˚C
General Appearance: Received lying on bed, conscious and coherent. Pale and has general flushing with rashesArea assessed TechniqueUsedNormal Findings Actual Findings Rationale
Area Assessed Method Used Normal Findings Actual Findings RationaleSKINColor and pigmentation
LesionsTextureMoistureTemperatureMobility and turgor
NAILSNail bed colorShapeLesionsThicknesscapillary refill
Inspection
InspectionPalpationPalpationPalpationPalpation
InspectionInspectionInspectionPalpationPalpation
Light to deep brown
No lesions, scars or inflammationSmoothMoistThe skin springs back to its previous state after being pinched
PinkConvexNo inflammation ofthe skin around the nailFirm
General flushing
No lesions, but presence of scars SmoothMoistThe skin springs backto its previous stateafter being pinched
PaleConvexNo inflammation of theskin around the nail
Decrease WBCin the body
NormalNormalNormalNormalNormal
Decrease RBCin the bodyNormalNormalNormal
FirmNormal capillary refill
Normal (less than 3secs)
HEADSizeSymmetry
HAIRColorTextureOther findings
SCALPDistribution of hairLesionsOther findings
FACESkin colorTextureFacial movement
EYES
InspectionInspection
InspectionInspectionInspection
InspectionInspectionInspection
InspectionInspectionInspection
Proportion to the bodyand the skull isrounded and smoothSymmetrical
BlackCurly hair, straightNo nits/lice present
Evenly distributedNo inflammation,lumps or masses
Light to deep brownSmoothSymmetric facialmovement
Proportion to the bodyand the skull is roundedand smoothSymmetricalNo nits/lice present
Head centeredSymmetricalSmooth movementswithout discomfortSymmetric and atmidline position
Equal sizeSymmetricalEvenly distributedLight to deep brownNo lesions,deformities orinflammation
Normal
SmoothCan move freelyNo lesions orinflammation
Head centeredSymmetricalSmooth movementswithout discomfortSymmetric and atmidline position
Equal sizeSymmetricalEvenly distributedLight to deep brownNo lesions,deformities orinflammation
Normal
NormalNormalNormalNormal
NormalNormalNormalNormal
NormalNormalNormalNormalDue todisease
Normal
GORDON’S 11 FUNCTIONAL HEALTH PATTERN
FUNCTION BEFORE
HOSPITALIZATIONDURING
HOSPITALIZATIONINTERPRETATION
Nutrition Eats 3x a day He loves to
eat bread & processed foods such as hotdog, tocino, longanisa, and others.
He doesn’t eat vegetables and fish
Seldom drinks water
Mostly eat bread
This time he frequently
drinks water
The Doctor ordered DAT diet to the patient except dark colored food
To replace fluid loss
Elimination He is able to urinate & defecate normally everyday by himself
He doesn’t have any problem on his elimination
Defecates usually early in the morning before going to school
He can still urinate & defecate by himself even without an assistance
His condition doesn’t affected his elimination pattern
Sleeping Has a regular sleeping pattern
Normal sleep is 6-8 hrs. per day but he naps for 1-2 hrs in the afternoon
Disturbed sleeping pattern
Due to adherence to time of medication & vital signs monitoring
Cognitive-Perceptual
Pattern
Has a normal cognitive perception
He is responsive & can
Portraying cooperativeness
Can comprehend well
He responds appropriately to verbal & physical stimuli
communicate well
Self- Perception-Self concept
Perceived himself as a good friend, brother & son.
This time he perceives himself as an approachable person
Due to his ability to establish good rapport to other people
Role Relationship Pattern
He was able to do his responsibilities as a son & brother
This time his role as a patient is not fully met
Due to his condition, he is not aware of performing his real role in this field.
Sexuality-Reproductive
Pattern
He doesn’t think of the things like having a girlfriend & getting married.
Same Due to his youthful mind, it is still not his priority in life
Coping Stress & Tolerance Pattern
He doesn’t fully identifies his stressors.
Same At his age, he still has a playful mind & he doesn’t mind the stressors in life.
Activity-Exercise Pattern
His daily routine on playing computer. His daily activities were limited in waking up in the morning to attend his class & after that going to computer shop.
He interacts with his grandmother & other people around him
Cooperates well to the doctor & nurses.
He only focuses on simple things.
Value-Belief Pattern
He is a Catholic
Due to their culture preferences & parent’s influence
Health Perception – Health Management
Pattern
He perceived his health in the state of good condition
He thinks that he is not healthy
Due to his illness
HEMATOLOGY
EXAMINATION REFERENCE VALUE
EXAM RESULTS
INTERPRETATION
Aug. 24,2009 Aug. 26, 2009RBC COUNT 4-6X1012/ L 5.1 4.7 Within normal rangeWBC COUNT 5-10X10g/L 3.0 2.4HEMOGLOBIN Male: 140-
170gms/ L155 138 Within normal range
Female: 120-140gms/L
HEMATOCRIT Male:0.43-0.54
0.47 0.42 Within normal range
Female: 0.37-0.45
DIFFERENTIAL COUNTSEGMENTERS 0.55-0.65 0.57 0.40LYMPHOCYTES 0.25-0.35 0.43 0.60MONOCYTES 0.02-0.06 -----------EOSINOPHIL 0.01-0.03 -----------BASOPHIL 0.01-1.0 -----------CLOTTING TIME ----------- -----------BLEEDING TIME ----------- -----------BLOOD TYPE ----------- -----------ESR ----------- -----------STAB ----------- -----------PLATELETS 150-400x103
Produce analgesia by blocking pain impulses by inhibitinfg synthesis of prostaglandin in the CNS or of other substances that sensitize pain receptors to stimulation.
Symptomatic relief of pain and fever. Relief of headache, toothachge, back pain, dysmenorrheal,myalgias,neuralgias, etc. Analgesics and anti pyretic for patients hypersensitive to aspirin
-Provide information to the client about the importance of regular observation & effective skin care
- Serves as baseline data to determine any discrepancies -To maintain skin integrity at optimal level.
-To avoid lesions, scratching of skin & harboring of microorganism.
- To assess extent of involvement of skin impairment.
-To prevent friction that may cause irritation of the skin
- To promote wellness by gaining knowledge on treatment/ therapy
After 8 hours of rendering effective nursing intervention the goal was completely met as evidenced by patient’s demonstration of behavior in preventing skin impairment.-patient verbalizes comfortability, decrease feeling of itchiness and gradual disappearance of rashes.-patient’s skin color(pigmentation) becomes normal (absence of redness)
Subjective:“Masakit ang tiyan ko” as verbalized by the patient.
Objective:V/S taken: Aug 24,2009 as of 4pm
BP – 110/70mmHgTemp. – 35.5˚CRR – 30bpmPR – 67bpm
- Guarding of stomach- Facial grimace- Pain scale of 8
Acute pain related to clinical manifestations of dengue hemorrhagic fever
Short Term Goal:
Within 8 hours of effective nursing intervention patient will be able to feel less pain on his abdomen.
Long Term Goal:
After period of hospitalization, the patient will be able to maintain a relax and calm abdomen.
Independent Nursing Action:-Perform a comprehensive assessment of pain
- Provide nonpharmacologic management like change of position & applying warm compress- Encourage divers ional activities - Encourage rest period
Dependent nursing intervention:- Administer medications as order by physicians such s gastroflora
- To improve quality, frequency & location of pain. -To alleviate pain.
-To divert his attentions to the pain - To prevent fatigue
- To alleviate pain.
After 8 hours of rendering effective nursing intervention the goal was partially met as evidenced by less guarding of stomach and patient’s verbalize partial relieve of pain.
Subjective:“Mainit po ang katawan ko”as verbalized by the patient.
Objective:V/S taken: Aug 25,2009 as of 6pm
BP – 110/70mmHgTemp. – 38.6˚CRR – 30bpmPR – 67bpm
- Flushing of skin- Skin warm to touch
Elevated body temperature related to
Short Term Goal:
Within 8 hours of effective nursing intervention patient body temperature will be decrease from 38.6- 37.5˚C
Long Term Goal:
After period of hospitalization, the patient will be able to know the proper management of hyperthermia
Independent Nursing Action:-Monitor vital sign
- Monitor intake and output
- Perform TSB
-Increase oral fluid intake
- Provide safe & quite environment
-Inform the patient about proper management of fever
Dependent nursing intervention:- Administer medications as order by physicians such as
- Serves at baseline data. -To know the fluid balance of the body
- To reduce body temperature through the process of conduction- To prevent dehydration and support circulating volume.- To provide conducive place to rest .Inform the patient about proper management of fever- To be able for the patient to know the proper management.
-To elevate the patient’s body
After 8 hours of rendering effective nursing intervention the goal was completely met as evidenced by patient’s body temperature decreases from 38.6-37.5˚C. Patient’s skin not warm to touch. Normal complexion of the skin.
Paracetamol or any anti –pyretic drugs.
temperature.
PATHOPHYSIOLOGY
↓
Bite of a aedes aegypti mosquito carrying a virus↓
Virus goes into the circulation↓
Infects cells & generate cellular response↓
Initiates destruction of the platelet↓
↑ Potential for hemorrhage↓
Stimulates intense inflammatory response ▼ ▼Release of exogenous pyrogens The body releases anti- ↓ inflammatory mediators↑ WBC (Neutrophils & Macrophages) (Histatin, Kinins) ↓ ↓Release of endogenous pyrogens Vascular response ↓ ↓ Reset of hypothalamic thermostat Redness & Heat ↓ ↓ Fever Headache, Vomiting ▼ ▼ Epistaxis, Abdominal pain Muscle contract Blood vessels Circulatory Collapse Shock To produce construct to ↓ Additional heat prevent loss of body heat DEATH ↓ ↓SHIVERING CHILLS
A. Patient's Name:> C.J.S a thirteen year-old male patient, who was diagnosed with Dengue Hemorrhagic Fever.
B. Diet:> Encourage nutritious foods like vegetables, meat and fruits.
C. Medications:> Give acetaminophen in case the temperatures increases.> Give oresol to replace fluid in the body.
D. Treatment:> Increased oral fluid intake.
E. Health Teaching:> D- discuss the possible source of infection of the disease.> E- educate the family/patient on how to eliminate those vectors.> N- Never stocked water in a container without cover.> G- Gallon, container and tires must have proper way of disposal.> U- Use insecticides at home to kill or reduce mosquito.> E- Encourage the family of the patient to clean the surroundings to destroy the