21244742 Dengue Fever Case Study

Pamantasan ng Lungsod ng MarikinaJ.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 CourseNCM 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.

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



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

No inflammation, lumpsor masses

PinkishSymmetric facialSymmetric facialmovement

NormalNormal

NormalNormalNormal

NormalNormalNormal

Due to feverNormalNormal

External structureEyebrowsEyelashesEyelids

EARSColorSymmetryShape and size

NOSEColorShapeDischarges

MOUTH LipsSymmetryMoisture

TONGUEPositionColor

InspectionInspectionInspectionInspection




InspectionInspection

Evenly distributedEvenly distributed,Evenly distributed, curved outward

Same as facial colorSymmetrical at thelevel of the eyescornerSymmetric to headNo discharges andinflammationSame as facial color

Same with facial colorSymmetricNo discharges

SymmetricPinkMoist

Positioned at thecenter can movefreely

Pink conjunctivaEvenly distributedEvenly distributed

Symmetric to headNo discharges andinflammationNormal

Same with facial colorSymmetricNo discharges

SymmetricPinkDry

Central positionDull red

NormalNormalNormal

NormalNormalNormal

NormalNormalNormal

NormalNormalD/t poornutrition

Normal

TextureMobilityLesions

NECKPositionSymmetryRange of movements

UPPER AND LOWEREXTREMITIESSizeSymmetryDistribution of hairSkin colorLesions

Temperature


InspectionInspectionInspectionPalpation

InspectionInspectionInspectionInspectionInspection

Inspection

Dull redSmoothCan move freelyNo lesions orinflammation

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

g/L172 166 Within normal range

Brand name/ Generic name

Classification Action Indication Adverse Effect Contraindication Nursing consideration

Acetaminophen(Paracetamol)

Nonopoiod analgesics and anti pyretics

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

Rash, nausea, vomiting, blood dyscrasias , anemia, analgesic nephropathy , nephrotoxicity , hypersensitivity reactions

Hypersensitivity. Patients

Patients with alcoholic liver disease. Impaired liver or kidney function

Assessment Nursing Diagnosis Planning Nursing Intervention

Rationale Evaluation

Subjective:“Nangangati ako” as verbalized by the patient

Objective:V/S taken: Aug 24,2009 as of 4pm

BP – 100/70mmHgTemp. – 36.5˚CRR – 22 bpmPR – 76bpm

- Redness of the skin- Skin rashes

Risk for impaired skin integrity related to

Short Term Goal:

Within 2hours of nursing intervention, patient will demonstrate behavior in preventing skin impairment.

Long Term Goal:

After period of hospitalization, the patient will be able to understand and apply treatment/ or therapy, regimen to the skin impairment.

Independent Nursing Action:-Monitor vital signs

- Provide skin hygiene through sponge bathing & changing regularly

- Keep bed clothes dry, use non- irritating materials, & keep bed wrinkled free

- Palpate skin lesions for size, shape, consistency, texture & hydration

- Encourage reposition schedule for client

-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.


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.


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

Non- predisposing Factor:- Age:13 y/o- Male

Predisposing Factor:-Immuno compromised - Environment

Discharge Planning

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

breeding places of mosquito.

Documents

21244742 Dengue Fever Case Study