pedia_case analysis_dengue. sakin 2docx

8/7/2019 pedia_case analysis_dengue. sakin 2docx

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Southeast Asian College, Inc.

College of Nursing

S.Y. 2010 2011

Submitted by:

Chester C. Lozano

CON 423 Group 11

Submitted to:

Mrs Elizabeth M Abanto


2/22

I. BACKGROUNDOF THE STUDY

II. PATIENTS PROFILE

III. NURSING HISTORY

a. CHIEFCOMPLAINT

b. HISTORYOFPRESENT ILLNESS

c. HISTORYOFPAST ILLNESS

d. FAMILY HISTORY

IV. PHYSICAL ASSESSMENT

V. PATHOPHYSIOLOGY

VI. CLINICAL REPORT

VII. DRUG STUDY

VIII. NURSINGCARE PLAN


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I. Background of the Study

Dengue Fever (DF) is caused by one of four closely related, but antigenically

distinct, virus serotypes DEN-1, DEN-2, DEN-3 and DEN-4 of the genus flavivirus.

Infection with one of these serotypes provides immunity to only that serotypes of life, so

persons living in a dengue-endemic area can have more than one dengue infection

during their lifetime. Dengue Fever through the four different dengue serotypes are

maintained in a cycle involves humans and the Aedes mosquito through the

transmission of viruses to humans by the bite of an infected mosquito. The mosquito

becomes infected with dengue virus when it bites a person who has dengue and after

about a week can transmit the virus while biting a healthy person. Dengue cannot be

transmitted or directly spread from person to person. Aedes Aegypti is the most

common aedes species which is a domestic, day-biting mosquito that prefers to feed on

humans.

The principal symptoms of dengue are high fever, headache, backache, joint

pains, nausea and vomiting, eye pain and skin rash. Fever in symptomatic dengue fever

may be as high as 410C. The fever typically begins on the 3rd day and lasts 5-7 days,

abating the cessation of viremia. Fever is often preceded by chills, erythematous

mottling of the skin, and facial flushing. Occasionally, the fever abates for a day and

then returns, a pattern that has been called saddleback fever.


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All persons are susceptible in acquiring DF. Both sexes are equally affected. Age

groups predominantly affected are pre school age and school age. Adults and infants

are not exempted. Peak age affected 5 9 years.

DF is sporadic throughout the year. Epidemic usually occurs during rainy

seasons (June November). Peak months are September October. Occurs wherever

vector mosquito exists.

Patients Profile

Name: E.S.C

Address:414 T. Anzures St. Sampaloc Manila

Birthday: September24, 2004

Age: 6 years Old

Birthplace:Manila

Gender:Female

Height: 117cm

Weight: 18.5 kg

Civil Status: Single

Religion: Roman Catholic


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Case No.:

Final Diagnosis: Dengue Fever Syndrome

II. Nursing History

1. Chief Complain- FEVER

2. History of Present Illness

The patient condition started 5 days, PTA when patient had

undocumented fever.

No other symptoms noted such as cough, cold, vomiting, and no

consultation was done.

3 days PTA, still with fever, following sign and symptoms was noted

similar to headache, joint pain and 1 episode of epistaxis on the Left nostril CBC

was done.

3. Past Medical History

According to the father this was her daughters first hospitalization, no


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There are no histories of drug maintenance and accident, only common

illness that the patient had encountered. Their family also doesnt love traveling

to much.

4. Family Health History

According to the father, both sides of the family have history of diabetes

mellitus, no other history of illness in their family have been noted. It was their

first time to handle this kind of illness.

5. Socio Economic and Environmental History

According to the father, their environment is clean, there is no stagnant

water in their house, but he doesnt have an idea if its the same in her daughters

school. They provide mosquito repellant in their house. What their problem is

they have no idea about the sanitation of his daughters school.


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III. Physical Assessment

General appearance:

o Conscious, coherent, awake, oriented to place and people

Vital Signs:

o BT:38.4oC increased; due to increase cellular metabolism; increase circulating

pyrogens

o RR: 29 bpm normal

o

PR: 113 cpm normal

Body Part Inspection Palpation Percussion Auscultation


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Scalp

Forehead

Face

Eyes

Brows

Lashes

Sclera

Conjunctiva

Cornea

Iris

W/ slight

dandruff butno woundspresent

No scars, notoily, w/outwrinkles

Symmetrical,no presenceof scar, w/outwrinkles andpimples

Symmetrical,slightly

round, alignw/ the ears

Hair evenlydistributed,skin is intact,black in color

Short, black,turn outward

?

Pink in color

Shiny,transparent &smooth

Black incolor, round

Free fromany lesions

Notenderness, no lesions

Smooth, norashes, notenderness


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Vision

Nose

Mouth

Lips

Gums

Teeth

Tongue

Sublingualarea

slowly as itfollows my

sign

20/20 vision

Septum isaligned in themidline, nodischarge, no

obstruction,air flowsfreely

Open & closesymmetrically

Reddish incolor & dry

Intact,pinkish incolor, noswelling norbleeding

?

Positioncentrally,moist, slightlypinkish, no

lesions

Pinkish,visible veins

Whitish, bony

Nodeformities

nor lesions

No edema


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Tonsils

Ears

Neck

Lymph Nodes

Thyroid

Skin

Chest

Heart

small, alignwith the

eyes, pinnais inline withthe outercanthus ofthe ear, nosweeling

Good flexion,

extension &rotation

Not enlarged

No bulges

Faircomplexion,w/outwrinkles, nodryness

Equal chestexpansion,rise & fallduringrespiration isvisible

Soft & flat

No abnormal

Palpablecarotidpulse

Notpalpable

Moves up& down asthe patientswallows

Slightlycold, goodskin turgor

No nodules

Palpableapical

Clear lungsounds, norales orwheezes

PR = 61bpm


11/22

Upper

Lower

MuscleStrength

T 36.5rC

symmetrical

Able toperformROMexercises

radialpulse, no

tenderness, slightlycold

Dry totouch

VI. Pathophysiology

PREDISPOSING FACTOR PRE DISPOSING FACTOR

Factor:

- Age:6 y/o

- female

Immunocompromised

host

Environment


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Infects cells & generate cellular response

Initiates destruction of the platelet

Potential for hemorrhage

Stimulates intense inflammatory response

WBC (Neutrophils & Macrophages) (Histatin,Kinins)

Release of endogenous pyrogens vascular response

Reset of hypothalamic thermostat Redness & Heat

The body releases anti-Release of exogenous

pyrogens


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Muscle contract Blood vessels

To produce construct to

Additional heat prevent loss of body heat

DEATH

SHIVERING CHILLS

V. Diagnostic Studies

I. Clinical ReportDate of examination: Dec 13, 2010

Type of examination:

Test Result Unit Reference

Hemoglobin 127 g/LMALE: 133177

FEMALE: 117157

CHILD (12y/o): 96156

NEWBORN: 180220

Hematocrit .37

g/L MALE: 0.400.52

FEMALE: 0.350.47

CHILD (12y/o): 0.340.48

NEWBORN: 0.480.68


14/22

WBC

Neutrophil

Lymphocyte

Monocyte

Eosinophils

Basophils

Band

4.6

0.28

0.58

0.02

0.01

0.00

0.02

10^3uL 6y/o: 4.5012.00

1y/o: 6.0014.00

NEWBORN: 9.0030.00

ADULT: 0.400.70

CHILD: 0.300.60

ADULT: 0.200.40

CHILD: 0.300.60

0.020.10

0.010.04

0.00-0.01

0.050.10

Platelet Count 143 10^3uL 150100

MCV 78 fl

ADULT: 80100

CHILD (12y/o): 7692

NEWBORN:95125

MCH 26.80 Pg ADULT: 2734

CHILD (1y/o): 2331

MCHC 0.34 g/dL

ADULT: .31.36

CHILD (12y/o): .32.36

NEWBORN: .30.42

RDW 13.80 % 11.514.5


15/22

IV. Clinical Report

Date of examination: December10, 2010

Type of examination:

Test Result Unit Reference

Hemoglobin 132 g/LMALE: 133177

FEMALE: 117157

CHILD (12y/o): 96156

NEWBORN: 180220

Hematocrit .39

g/L MALE: 0.400.52

FEMALE: 0.350.47

CHILD (12y/o): 0.340.48

NEWBORN: 0.480.68

RBC 4.99 10^6uL

MALE: 4.405.90

FEMALE: 3.805.20

CHILD (12y/o): 3.505.20

NEWBORN: 4.706.10

WBC

Neutrophil

3.1

0.46

10^3uL

ADULT: 4.5011.00

6y/o: 4.5012.00

1y/o: 6.0014.00

NEWBORN: 9.0030.00

ADULT: 0.400.70


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Monocyte

Band

0.19

0.020.10

0.010.04

0.050.10

Platelet Count 239 10^3uL 150100

MCV 79.00 fl

ADULT: 80100

CHILD (12y/o): 7692

NEWBORN:95125

MCH 26.50 Pg ADULT: 2734

CHILD (1y/o): 2331

MCHC .34 g/dL

ADULT: .31.36

CHILD (12y/o): .32.36

NEWBORN: .30.42

RDW 14.40 % 11.514.5

MPV 7.20 fl MALE: 7.39

FEMALE: 810


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V. Clinical Report

Date of examination: December13, 2010

Type of examination: Immunology and Serology Section

Assay Patients Result

Dengue Rapid Test IgM= POSITIVEIgG= POSITIVE


18/22

VI. Drug Study

Name of Drug Action Indication Contraindication Adverse Effect NursingConsideration

Generic:

paracetamol

Brand:

Biogesic

Classification:antipyretics

Dosage:

~ Children

12yr should not

receive >5

doses/24 hrwithout

notifying the

physician or

other health

care

professional.

~ PO (Adultsand Children

>12yr): 325-

650mg q 4-6 hr

or1g 3-4 times

daily or

Inhibits the

synthesis of

prostaglandins

that may serve as

mediators of painand fever,

primarily in the

CNS. Has no a

significant and

anti-inflammatory

property or GI

toxicity.

Therapeutic

effects:

Analgesia.

Antipyresis.

Mild pain. Fever. Contraindicated

in: Previous

hypersensitivity;

Products containing

alcohol, aspartame,saccharine, sugar

or tartrazine should

be avoided in

patients who have

hypersensitivity or

tolerance to these

compounds.

Use cautiously in:

Hepatic

disease/renal

disease: Chronic

alcohol use/abuse:

Malnutrition.

GI: HEPATIC

FAILURE,

HEPATOXICITY

(overdose).

GU: renal failure

(high

doses/chronic

use).

Hemat:

neutropenia,pancytopenia,

leucopenia.

Derm: rash,

urticaria.

Pedi: Advise

parents or

caregivers to check

concentration of

liquid preparations.Errors have

resulted in serious

liver damage. Have

parents or

caregivers

determine the

correct formulationand dose foe their

child and

demonstrate how to

measure it using an

appropriate

measuring device.


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1300mg q 8 hr.

~ PO (Children

1-12yr):10-15mg/kg/

dose q 4-6 hr

as needed.

~ PO (Infants):

10-15mg/kg/

dose q 4-6 hr

as needed.


20/22

VII. Nursing Care Plan

Assessment Diagnosis Planning Intervention Evaluation

Subjective:

Nilalamig ako, as

verbalized by the

patient.

Objective:

warm to touch

pale skin color

restlessness

increased bodytemperature

tachycardia

VS as follows:

T 38rCP 103bpmR 20cpmBP 110/80mmHg

Hyperthermia related

to illness secondary to

dengue as manifested

by increased in body

temperature (38rC)

After 2 hours of

nursing intervention,

the patient will

maintain core

temperature within

normal range.

Monitor VS

Perform TSB Note

presence/absenc

e of sweating asbody attempts toincrease heatloss

Instruct toincrease fluidintake

Administer

medication asprescribe by thephysician

Goal Met.

After 2 hours of

nursing intervention,

the patient was able

to maintain core

temperature within

normal range as

evidenced by T

37.2rC, pulse rate of

81bpm, able to sleepwell.


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Nursing Care Plan

AssessmentDiagnosis Planning Intervention Rationale Evaluation

SUBJECTIVE :

Lagi ako

nauuhaw as

verbalized by the

patient

OBJECTIVE :

- Dry lips and

mouth

- Poor skin

turgor

> Fluid Volume

Deficit

Related to

decreased

motivation to

drink liquids

secondary to

fatigue

After 2 days of

nursing

intervention,

Patient will

maintain fluid

volume at anamount optimum

for normal

functioning as

evidenced by a

normal urine

output with

normalspecific gravity,

stable vital signs,

moist mucosa

Vital signs taken

Monitor I and O

Anticipate fluid

replacement by

preparing

peripheral

route for IV

transfusion.

Encourage fluid

intake by placing

a

glass of juice or

water

to have good

baseline data

to have good

baseline data

Provide route

for IV fluid

replacement to

save time and

decrease risk for

complications.

Best way to

encourage fluid

intake. DHF

patient are always

thirsty prior to thedefervescence

stage.

Monitoring for

trends for 2 to 3

days gives a more

Aftet 2 Days

after a series of

nursing care, the

patient

manifested a

normal urineoutput of 30ml

per hour with a

specific gravity

of1.011. Stable

Vital signs were

monitored andrecorded. CRT

was recorded

normal. Physical

assessment

revealed no sign

of fluid deficit


22/22

within the

patients

reach.

Monitor total fluid

intake and output

every 2 hours

valid picture of

the client's

hydration statusthan monitoring

for a shorter

period.

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