I. INTRODUCTION

Our client Mr. JM 8 years old, living in Norzagaray, Bulacan, was diagnosed with DHF II (Dengue Hemorrhagic Fever stage 2). His primary

complaints are abdominal pain, headache and fever. He is a grade three student and studying at FVR elementary school. His parents are Mrs. A 33 years

old and Mr. M 42 years old. Our patient was born in Korean because his parents are working on that country.

Dengue Fever is caused by one of the four closely related, but antigenically distinct, virus serotypes Dengue type 1, Dengue type 2, Dengue type 3,

and Dengue type 4 of the genus Flavivirus and Chikungunya virus. Infection with one of this serotype provides immunity to only that serotype of life, to a

person 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 the cycle which involves humans and Aedes aegypti or Aedes albopictus mosquito through the transmission of the viruses to

humans by the bite of an infected mosquito. The mosquito becomes infected with the Dengue virus when it bites a person who has Dengue and after a week

it 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 specie which is a domestic, day-biting mosquito that prefers to feed on humans.

.The biggest increase of Dengue cases in the country was seen in Metro Manila, where there was an almost 200 percent increase. According to

government figures 15,061 cases of the disease in the Philippines were reported in the first six months of the year. The increase in the number of dengue

cases may be attributed to the constantly changing climate brought by global warming as well as congestion in urban areas. Deaths due to dengue rose to 172

compared with 115 for the first half of 2007. Metro Manila had the highest number of cases, an increase of 191 percent over the same period in 2007.World

Health Organization officials earlier this year warned climate change was increasing the incidence of dengue fever and other infectious diseases in the

country. There is no known cure or vaccine for dengue fever, which is transmitted by the white-spotted mosquito. The Philippines Department of Health

(DOH) today reported that a total of 2,332 dengue cases has been admitted to sentinel hospitals nationwide from January 1 to May 15 this year. There were

sixteen deaths recorded. Partial reports from the DOH National Epidemiology Center (NEC) indicate a 58% decrease in the number of cases this year

compared with the same period last year. The NEC report also revealed that the regions with the highest number of cases were the National Capital region

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(732 cases), Region 3 (307), Region 5 (268), and Region 7 (231). The ages of cases ranged from 1 month to 75 years old, with forty-six percent (535) of the

cases belonging to the 1-9 years age group.

OBJECTIVES:

• Knowledge Objectives:

- To acquire knowledge about DHF.

- To know the effects of DHF to our patient and the right intervention specified for him.

- To know the essentiality of the case that would assist us student-nurses to build a holistic knowledge, skills and attitude approach to learning .

• Skill Objective:

1. Identify the risk factors that occur in the disease and make a pathophysiology about the disease.

2. Formulate significant diagnosis that is related to Nursing Care Plan and make a nursing care plan.

3. Identify the medications administered to the client and the drugs indication, contraindication, side effects, and nurse’s responsibility.

• Attitude Objective:

1. To build trust and rapport to the patient.

2. To gain cooperation and trust from the patient.

3. To gain trust and cooperation from the relatives of the patient.

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II. NURSING ASSESSMENT

A. PERSONAL DATA

NAME: Mr. JMAGE: 8 years old SEX: MaleADDRESS: Friendship Village Resour, Norzagaray BulacanMARITAL STATUS: SingleBIRTHDATE: February 16, 2002NATIONALITY: FilipinoBIRTHPLACE: KoreaEDUCATIONAL ATTAINMENT: Grade 3 studentPOSITION IN THE FAMILY: SonRELIGION: Roman CatholicHEALTH CARE FINANACING AND USUAL SOURCES OF MEDICAL CARE: MotherDATE ADMISSION: September 6, 2010TIME: 1:20 pm

B. CHIEF COMPLAINT

Mr. JM was admitted to Bulacan Medical Center with a chief complaint of abdominal pain and headache.

C. HISTORY OF THE PRESENT ILLNESS

The client experienced having abdominal pain every time his stomach is full. He was just lying on bed when the abdominal pain started. He was brought by his mother to Roquero hospital because of having fever, abdominal pain and headache and after 2 days he was transferred to BMC because his family observes having no improvement on their son’s situation. He was given Ampicillin and Augmentin at the Roquero hospital. He was given Ranitidine at the BMC hospital for treatment of the abdominal pain.

D. HISTORY OF THE PAST ILLNESS

The client doesn’t have any allergies and haven’t encountered any accident or injuries. He has completed his immunization according to his aunt. It was his second hospitalization because he was just transferred to BMC. He just had taken Paracetamol every time he experience having fever and headache.

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E. FAMILY HEALTH ILLNESS HISTORY

GENOGRAM

The client is the only child of Mr. M.M and Mrs. A.M. He was born in Korea where his parents are working; when he was around 26 days old that’s the time he was brought here in the Philippines. It was the first incidence of having Dengue in their family. His grandfather has arthritis and hypertension while his grandmother has asthma and the rest of the families are healthy.

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MALE

FEMALE

PATIENT

† DECEASED

Δ ASTHMA

HPN Hypertension

Ω Arthritis

AC30 Y/O

JM8 Y/O

KM44 Y/O

MM42 Y/O

OM47 Y/O

EM73 Y/O

†

HM84 Y/OHPN †

KC76 Y/O

Δ†

AM33 Y/O

YC89 Y/O

Ω

F. FUNCTIONAL HEALTH PATTERN

A. HEALTH PERCEPTION AND HEALTH MANAGEMENT PATTERN

The client’s health has been better. Prior to hospitalization he has no colds but if it happens their first aid is to drink herbal medicines and if it doesn’t work they will seek for a doctor’s consultation. They think that the illness is caused by the poor sanitation of the place where they stayed at Tondo, Manila and when they went to Norzagaray, Bulacan that’s when the symptoms started. He was rushed to the hospital after experiencing abdominal pain, headache and high fever.

B. NUTRITIONAL AND METABOLIC PATTERN

The client loves to eat fried chicken and he always eats fruits every breakfast and drinks milk twice a day. He also has a good appetite prior to hospitalization, while during hospitalization he has poor appetite because of the feeling of weakness and he doesn’t like the food. During his hospitalization, he is restricted by his doctor to eat dark colored foods. He doesn’t have any skin problems or any dental problems.

C. ELIMINATION PATTERN

The client urinates 4x a day during his hospitalization with a yellowish color about 100 ml per voiding. He defecate once a day everyday with a formed color brown stool.

AMOUNT FREQUENCY COLOR ODORURINE 100 ml 4 times a day Yellow PungentSTOOL Once a day Brown Foul

D. ACTIVITY-EXERCISE PATTERN

Mr. JM has sufficient energy for completing his desired activities, like during playing and doing activities at school. During his spare time he would play outdoor activities with his neighbors.

0-Feeding 0-Bathing 0-Toileting 0-Bed Mobility0-Dressing 0-Grooming 0-General Mobility IV-CookingIV- Home maintenance II-Shopping

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Level 0- full self careLevel I- requires use of equipment or deviceLevel II- requires assistance or supervision from another personLevel III- requires assistance or supervision from another person or deviceLevel IV- is dependent and does not participate

E. SLEEP-REST PATTERNThe client has a regular sleeping pattern because of having 10 hrs. of sleep starting from 8pm-5am. He has a continuous sleep and often takes nap in

the afternoon after school. He doesn’t have any problem falling asleep.

F. COGNITIVE PERCEPTUAL PATTERN

The client has no difficulty in hearing and on vision. He learned through school and family. Prior to hospitalization, he experienced abdominal pain and headache and he took Paracetamol to lessen the pain that he is experiencing,

G. SELF-PERCEPTION AND SELF-CONCEPT PATTERN

He felt good about himself. Since the illness started he missed some of his classes in school. He felt angry every time he wouldn’t get what he wanted and being tearful every time he was forced to do something he wouldn’t like to do.

H. ROLE-RELATIONSHIP PATTERN

He belongs to an extended family. Every time they have a problem they will just communicate with each other to solve the issue. His parents are really affected with his hospitalization because they are not here to take care of him. His relatives were the one taking good care of him while he in the hospital.

I. SEXUALITY-REPRODUCTIVE PATTERN

Not applicable

J. COPING STRESS TOLERANCE PATTERN

He had no big problem in his life, sometimes he experience having fight with his playmates but still they where able to solve it by themselves.

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K. VALUE-BELIEF PATTERN

The client is a catholic and they believe in God. For their family it is really important to have a connection to God. It really helps every time they are facing a problem and during his stay in the hospital his family is praying for his wellness.

G. GROWTH AND DEVELOPMENT

PSYCHOSOCIAL PSYCHOSEXUAL COGNITIVE MORAL

STAGESchool AgeIndustry vs. Inferiority

Latency (Genital Stage) Concrete Operations Phase Conventional (Interpersonal Concordance Orientation Stage)

DEFINITION At this stage, the children begin to create and develop a sense of competence and perseverance. They are motivated by activities that provide a sense of worth. They concentrate on mastering skills that will help the, function in the adult world. Although children of this age work hard to succeed, they are always faced with the possibility of failure, which can lead to a sense of inferiority. If children have been successful in previous stages, they are motivated to be industrious and to cooperate with others toward a common goal

The stage begins around the time that children enter into school and become more concerned with peer relationships, hobbies, and other interests. The latent period is a time of exploration in which the sexual energy is still present, but it is directed into other areas such as intellectual pursuits and social interactions. This stage is important in the development of social and communication skills and self-confidence.

Cognitive development refers to the manner in which people learn to think, reason, and use language. It involves a person’s intelligence, perceptual ability, and ability to process information. At concrete operations phase it solves concrete problems. The child begins to understand relationships such as size. They understand right and left. The child has cognizant of viewpoints. In this stage (characterized by 7 types of conservation: number, length, liquid, mass, weight, area, volume), intelligence is demonstrated through logical and systematic manipulation of

At Conventional level, person is concerned with maintaining expectations and rules of the family, group, nation, or society. A sense of guilt has developed and affects behavior. The person values conformity, loyalty, and active maintenance of social order and control. Conformity means good behavior or what pleases or helps another and is approved Societal focus. In interpersonal concordance orientation he decisions and behavior are based on concerns about other’s reaction; the person wants others approval or a reward.

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symbols related to concrete objects. Operational thinking develops (mental actions that are reversible). Egocentric thought diminishes.

ANALYSIS Our client has reached this stage. He is a grade 3 student; through social interactions to his classmates and friends he developed a sense of pride in his accomplishments and abilities. According to our patient, he is always encouraged and commended by his parents and teachers when he did something good. By encouraging and commending a child, our client developed a feeling of competence and belief in his skills. He also stated, that his parents always letting him to do what he wants to do but within the scope of his age.

Mr. JM developed a strong sexual interest in his opposite sex like his friends. According to him, during his earlier age (around 5 to 7 years old) he was solely focus on his individual needs and interests in the welfare of others. He also stated that he is always socialized to his friends and classmates during their spare time in school.

Our client thinks logically about concrete events, but has difficulty understanding abstracts or hypothetical concepts. He also understands the awareness that actions can be reversed because he is able to reverse the order of relationships between categories.

Our client stated that his parents always calling him as a “good-boy” because according to him he is always following the saying and rules of his parents.

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III. ANATOMY AND PHYSIOLOGY

Circulatory System

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THE SYSTEMIC CIRCULATION

Major arteries (in bright red) and veins (dark red) of the system

Blood from the aorta passes into a branching system of arteries that lead to all parts of the body. It then flows into a system of capillaries where its exchange

functions take place.

Function only: to supply materials to — and remove materials from — the capillaries. Blood from the capillaries flows into venules which are drained by

veins.

• Veins draining the upper portion of the body lead to the superior vena cava.

• Veins draining the lower part of the body lead to the inferior vena cava.

• Both empty into the right atrium.

BLOOD

Blood is a liquid tissue. Suspended in the watery plasma are seven types of cells and cell fragments.

• red blood cells (RBCs) or erythrocytes

• platelets or thrombocytes

• kinds of white blood cells (WBCs) or leukocytes

• Three kinds of granulocytes

• neutrophils

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• eosinophils

• basophils

Two kinds of leukocytes without granules in their cytoplasm

• lymphocytes

• monocytes

FUNCTIONS OF THE BLOOD

Blood performs two major functions:

• transport through the body of

• oxygen and carbon dioxide

• food molecules (glucose, lipids, amino acids)

• ions (e.g., Na+, Ca2+, HCO3−)

• wastes (e.g., urea)

• hormones

• heat

• Defense of the body against infections and other foreign materials. All the WBCs participate in these defenses

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All the various types of blood cells

• Are produced in the bone marrow (some 1011 of them each day in an adult human!).

• Arise from a single type of cell called a multipotent stem cell.

These stem cells

• are very rare (only about one in 10,000 bone marrow cells);

• are attached (probably by adherens junctions) to osteoblasts lining the inner surface of bone cavities;

• produce, by mitosis, two kinds of progeny:

• More stem cells (A mouse that has had all its blood stem cells killed by a lethal dose of radiation can be saved by the injection of a single

living stem cell!).

• Cells that begin to differentiate along the paths leading to the various kinds of blood cells.

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IV. THE PATIENT AND HIS ILLNESS

A. PATHOPHYSIOLOGY (Schematic Diagram)

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Non Modifiable Factors;-age

Modifiable Factors;-environment (sanitation)

Bite of aedes mosquito

Immune system recognizes the viral invasion; triggers immune

response

Dengue flavi virus mix in the blood circulation

↑ WBC

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Hemorrhage in the micro circulation of the gums (that could cause bleeding

gums)

↓ Platelet count would now decrease the clothing capability ↑ hemorrhage

Megakaryocytes desentigrate as core body temp. continue to rise which would result to ↓ platelet

count.

Macrophages will release pyrogens that would stimulate the thalamus to ↑ body

temp.

PHYSICAL ASSESSMENT

Name: Mr. JM Vital signs:Birthday: February 16, 2002 Temperature: 38.4°CAge: 8 y/o Pulse rate: 90 bpmDate of Assessment: Sept. 08, 2010 Respiratory rate: 35 cpmWeight: 27 kg. Blood pressure: 100/70mmHgHeight: 4’11 BMI: 12.0

Parts to be Examined Technique Normal Findings Actual Findings Interpretation1. GENERAL SURVEY

Body built, height & weight in relation to client’s age, lifestyle and health

Inspection Proportionate, varies with lifestyle

He has a proportionate body built which is appropriate with his

lifestyle

Normal

Client’s posture and gait, standing, sitting and walking

Inspection Relaxed, erect posture; coordinated

movement

He is slightly unrelaxed and has

minimal movements

Deviation from Normal due to discomfort and

illness.Client’s overall hygiene and grooming

Inspection Clean, neat He dresses cleanly, neatly and

appropriately.

Normal

Body and breath odorInspection No body odor or

minor body odor relative to work or exercise; no breath

odor

He has no body & breath odor. Normal

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Clinical MeasurementsHeightWeight

InspectionUnderweight = <18.5

Normal weight = 18.5-24.9

Overweight = 25-29.9

Obesity = BMI of 30 or greater

Inches 4’1127 kg.

BMI =12.0

The client is underweight based on the

result of BMI.

Vital SignsTemperaturePulse rateRespiratory RateBlood Pressure

InspectionPalpation Inspection

Auscultation and Palpation

36.5-37.5 C60-100bpm12-21cpm

120/80mmhg

38.4 C 90bpm 35cpm 100/70mmhg

Temperature are elevated due to increased WBC

BEHAVIORSigns of distress, in posture or facial expression Inspection No distress noted On stress

Deviation from Normal due to

hospitalization.

Signs of health or illness Inspection Healthy appearance He has an unhealthy appearance

Deviation from Normal due to

illness.

Client’s attitude InspectionCooperative, able to follow instructions

He is very cooperative and able to follow my instructions

Normal

Client’s affect/mood; appropriateness of client’s response

InspectionAppropriate to

situationHe responds appropriately Normal

Quantity of speech, qualityInspection

Understandable, moderate pace; clear tone and inflection;

He speech is slightly understandable,clear and has association of

Normal

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exhibit thought association

thoughts

Relevance and organization of thoughts

Inspection Logical sequence; makes sense; has sense of reality

He has relevance of thoughts that makes sense and has a sense of reality

Normal

2. INTEGUMENTARYA. SKIN

Color and uniformity of color Inspection Varies from light to deep brown; ruddy pink to light pink;

from yellow overtones to oliveGenerally uniform

except in areas exposed to the sun;

areas of lighter pigmentation in dark-

skinned people

Pale in color, Herman signs are present

Deviation from Normal d/t

decreased tissue perfusion & peripheral

vasoconstriction.

Presence of edema Inspection No edema He has edema on the IV site

Deviation from normal d/t IV

infusion Presence of lesion according to location, distribution, color, configuration, size, shape, type or structure

Inspection Freckles, some birthmarks, some flat and raised nevi; no abrasions or other

lesions

He has no lesion; no abrasions or other

lesions Normal

Skin moisture Inspection Moisture in skin folds and axillae (varies with environmental

temperature and humidity and activity)

He has warm and silky skin moisture.

Deviation from Normal d/t

uncomfortable environment.

Skin temperature Palpation Uniform; within His skin temperature Deviation from

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normal range is warm normal due to increase body temperature

Skin turgor Palpation Skin springs back to previous state; has a

good skin turgor

With redness when pinched

Deviation from Normal d/t blood

circulationB. NAILS

Fingernail’s shape, curvature and angle

Inspection Convex curvature; angle of nail plate

about 160 °

His nail has a convex curvature

approximately 160°Normal

Fingernail and toenail texture Palpation No visible lines and cracks Smooth texture

He has a smooth nails without any damages

Normal

Fingernail and toenail bed color Inspection Highly vascular and pink in light-skinned people; dark-skinned may have brown or

black pigmentation in longitudinal streaks

Pallor

Deviation from Normal d/t poor

arterial circulation.

Tissues surrounding nails InspectionIntact epidermis

He has an intact epidermis with no

hangnailsNormal

Blanch test of capillary refill Palpation Prompt return of pink or usual color;

Delayed 1-2 sec

There is a prompt return of blood

resulting to the usual color, delayed for 4

sec.

Deviation from Normal d/t poor

arterial circulation.

3. HEADA. SKULL

Size, shape and symmetry Inspection Rounded (normocephalic);

smooth skull contour

His skull is rounded and has a smooth skull

contourNormal

Presence of nodules, masses and depressions

Palpation Smooth, uniform consistency; absence

He has no nodules and masses

Normal

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of nodules and massesB. SCALP

Color and appearance Inspection Usually white but it also depends on dark-

skinned people

His scalp is white and has a smooth surface Normal

Areas of tenderness Palpation No tenderness There are no areas of tenderness

Normal

C. HAIREvenness of growth, thickness and thinness

Inspection Evenly distributed thick hair

He has a thick hair and it is evenly distributed

Normal

Texture, oiliness over the scalp Palpation Smooth texture; no oiliness

He has a smooth scalp and oily and brittle

hair.

Deviation from normal due to

hospitalization.Color Inspection Black Black with short hair. Normal

D. FACEFacial features, symmetry of facial movements

Inspection Symmetrical facial features and movements

He has asymmetrical facial features which

has asymmetrical movements

Deviation from Normal d/t illness

and hospitalization.

4. EYES

Inspect the eyes for edemas and hallowness

Inspection No edemaNo edema Normal

A. EYEBROWSEvenness of distribution and direction of curl

Inspection Hair evenly distributed and the

curl is outward

He has an evenly distributed hair in her eyebrow and they are

aligned with equal movement

Normal

B. EYELASHESEvenness of distribution and direction of curl

Inspection Equally distributed; curls slightly outward

His eyelashes are equally distributed and

curled outward

Normal

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C. EYELIDSSurface characteristics, position in relation to the cornea, ability to blink and frequency of blinking

Inspection Skin intact; no discharge or

discoloration; Lids closed symmetrically approximately 15-20 involuntary blinks per

minute

He has a smooth eyelids with no

discharge; lids closed symmetrically and has

15-20 blinks per minute

Normal

D. CONJUNCTIVABulbar Conjunctiva for color, texture and presence of lesions

Inspection Transparent capillaries sometimes

evident

His Bulbar Conjunctiva is

transparent and has some visible small

capillaries

Normal

Palpebral Conjunctiva for color, texture and presence of lesions

Inspection Shiny, smooth and pink or red

He has shiny, smooth and reddish palpebral

conjunctiva

Deviation from Normal d/t blood

circulation.E. SCLERA

Color and clarity Inspection Sclera appears white He has white sclera NormalF. CORNEA

Clarity and texture Inspection Transparent, shiny and smooth; the details of iris are

visible

He has a transparent, shiny and smooth

cornea

Normal

G. IRISShape and color Inspection Rounded shape which

are the same in each eye; color varies

depending on the race and the color is

evenly distributed

He has a dark brown iris which is uniform

and they are both rounded

Normal

H. PUPILSColor, shape and symmetry of size Inspection Black in color, equal His pupils are black, Normal

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in size and smooth border

equal in size and has smooth borders

I. VISUAL ACUITYNear Vision Inspection Able to read

newsprintsHe has been able to

read newsprints with the use of eye glasses

Normal

Distant Vision Inspection When looking straight ahead, client can see

objects in the periphery

N/A(no equipment)

N/A

J. PUPILS

Light reaction and accommodationInspection Illuminated pupils

constrictsPupils also constricts when looking at near objects, dilate when looking at far objects and converge when

near object is moved toward the nose

His pupils constrict when light passes and it also converge when near object is moved

toward his nose

Normal

5. LACRIMAL GLAND / SAC & NASOLACRIMAL DUCTLacrimal Gland Inspection and

palpationNo edema, tenderness

or tearingThere are no edema,

tenderness and tearing noted from the client

Normal

A. EXTRAOCULAR MUSCLESAlignment and coordination Inspection Both eyes

coordinated, move in unison, with parallel

alignment

His both eyes are coordinated, move in unison with parallel

alignment

Normal

B. VISUAL FIELDPeripheral visual fields Inspection When looking straight

ahead, client can see He can see objects in

the peripheryNormal

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objects in the periphery

6. EARSA. AURICLES

Color, symmetry of size and position

Inspection Color same as facial skin; symmetrical;

auricle aligned with outer canthus of eye about 10 ° vertical

His ears’ skin color is same as the

surrounding skin and both are symmetrical;

the auricles are aligned in the outer canthus of each eye

Normal

Texture, elasticity and areas of tenderness

Palpation Mobile, firm and not tender; pinna recoils

after being folded

His auricles are mobile, firm and not

tender; his pinna recoils when folded

Normal

B. EXTERNAL EAR CANALCerumen, skin lesions, pus and blood

Inspection Dry cerumen, grayish-tan color,

sticky or wet cerumen in various shades of

brown

He had no visible cerumen, has a grayish

color

Normal

C. HEARING ACUITY TESTSClient’s response to normal voice tone

Inspection Normal voice tones audible

His voice tones is audible Normal

Watch tick test Inspection Able to hear ticking sound in both ears

He can hear ticking sound in both ears

Normal

Weber’s test Inspection Sound is heard at both ears or at the center (Weber’s negative)

He heard at both ears or at the center (Weber’s negative)

Normal

Rinne test Inspection Air conduction is greater than the bone conduction (Rinne

Positive)

Air conduction is greater than the bone conduction (Rinne Positive)

Normal

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7. NOSEDeviations in shape, size or color and flaring or discharge

Inspection Symmetric and straight; no discharge

or flaring; uniform color

His nose are uniform in color same as with the surrounding skin; there are no discharge and flaring

Normal

Nasal cavities for presence of redness, swelling, growths and discharge

Inspection Mucosa pink; clear watery discharge; no

lesions

He has a clear watery discharge and has no apparent lesions

Normal

Nasal septum between the nasal chambers

Inspection Nasal septum intact and in midline

His nasal septum is in the middle

Normal

Patency of both nasal cavities Inspection Air moves freely as the client breathes through the nares

He usually breathes freely through his nares

Normal

Tenderness, masses and displacement of bones and cartilage

Palpation Not tender There are no tenderness, masses or displacement of bones

and cartilage

Normal

SINUSESTenderness Palpation Not tender His sinuses are not

tenderNormal

8. MOUTHA. LIPS

Symmetry of contour, color and texture

Inspection Uniform pink color, soft, moist, smooth

texture, symmetry of contour, ability to

purse lips

He has a pale in color lips, slightly dry and

smooth; it has symmetry of contour and has the ability to

purse his lips

Deviation from Normal d/t

illness.

B. BUCCAL MUCOSAColor, moisture, texture and presence of lesions

Inspection Moist, smooth, soft, glistening and elastic

texture

He has a moist, soft, glistening and elastic texture of his buccal

mucosa

Normal

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C. TEETHColor, number, condition and presence of dentures

Inspection Pre-schooler teeth; smooth, white and shiny tooth enamel

He has a shiny tooth enamel without any

dental problemsNormal

D. GUMSColor and condition Inspection Pink gums; moist and

firm texture to gums; no retractions

His gums are pinkish to reddish in color

Deviation from normal due to

bleedingE. TONGUE/ FLOOR OF MOUTH

Color and texture of the mouth and frenulum

Inspection Central position; Pink color, moist, slightly rough; thin whitish

coating, lateral margins; no lesions;

raised papillae

His tongue is in the center, pink in color, it is moist, slightly rough without lesions; it has a thin whitish coating and lateral margins

Normal

Position, color and texture, movement and base of tongue

Inspection and palpation

Moves freely; no tenderness; smooth tongue base with prominent veins

His tongue moves freely with weak

tendernessNormal

Presence of nodules, lumps or excoriated areas

Palpation Smooth with no palpable nodules

It has no nodules Normal

F. PALATES AND UVULAColor, shape, texture, and presence of bony preminences

Inspection Light pink, smooth, soft palate

Lighter pink hard palate, more irregular

He has pale in color and smooth soft palate

while pale and irregular hard palate

Deviation from Normal d/t

decrease blood circulation

Position of uvula and mobility while examining the palates.

Inspection Positioned in midline of soft palate

The uvula is in the middle

Normal

G. OROPHARYNX AND TONSILSColor and texture Inspection Pink and smooth

posterior wallsHe has a smooth and pinker posterior walls

Normal

Size of tonsils, color and discharge Inspection Pink and smooth; no discharge; of normal

His tonsils are pink and smooth without

Normal

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size discharge and of normal size

Presence of Gag reflex Inspection Gag reflex is present He has a positive gag/cough reflex

Normal

9. NECK A. LYMPH NODESLymph Nodes and tenderness Inspection and

palpationNot palpable His nodes are not

palpableNormal

B. TRACHEAPlacement Inspection and

palpationCentral placement in

midline of neck; spaces are equal in

both sides

His trachea is in the middle with equal

spaces on both sides

Normal

C. THYROID GLANDSymmetry and visible masses Inspection Not visible on

inspectionIt is not visible Normal

Smoothness, enlargement and nodules

Palpation Glands ascends during swallowing; painless, centrally

located and smooth

His thyroid glands rise when swallowing; it is smooth and painless

Normal

10. THORAXA. POSTERIOR

Shape, symmetry, compare the diameter of anteroposterior to transverse diameter

Inspection Chest symmetric; anteroposterior to

transverse diameter in ratio of 1:2

His chest are symmetric;

anteroposterior to transverse has a

diameter ratio of 1:2

Normal

Spinal alignment Inspection Spine vertically aligned

His spine is vertically aligned

Normal

Temperature, tenderness and masses

Palpation Skin intact; uniform temperature

His skin is intact and has uniform warm

temperature

Normal

Respiratory excursion Inspection and Full and symmetric He has a full and Normal

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palpation expansion; as the client breathes, thumbs usually separates 3-5cm

symmetric expansion and as she breathes,

thumbs usually separate for 3-5 cm.

Vocal fremitus Palpation Bilateral symmetry of vocal fremitus; it is heard mostly at the

apex of lungs

He has a bilateral symmetry of vocal fremitus; it is heard clearly at the apex

Normal

Percuss the thorax Percussion Percussion notes resonance except over

scapulaLowest point of

resonance is at the diaphragm

His percussion notes resonance sound except over the

scapula and the lowest resonance heard is at

the diaphragm

Normal

Auscultate the thorax Auscultation Vesicular and bronchovesicular

sounds

There are vesicular and bronchovesicular

sounds heard

Normal

B. ANTERIORBreathing patterns Inspection Quiet, rhythmic and

effortless respirationHe has a quiet, rhythmic and

effortless respiration

Normal

Temperature, tenderness and masses

Palpation Skin intact; uniform temperature

His skin is intact and has uniform warm

temperature

Normal

Respiratory excursion Inspection and palpation

Full and symmetric expansion; as the client breathes, thumbs usually separates 3-5cm

He has a full and symmetric expansion and as he breathes,

thumbs usually separate for 3-5 cm.

Normal

Vocal fremitus Palpation Bilateral symmetry of vocal fremitus; it is heard mostly at the

apex of lungs

He has a bilateral symmetry of vocal fremitus; it is heard clearly at the apex

Normal

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Percuss the anterios thorax Percussion Percussion notes resonance except over

ribsLowest point of

resonance is at the diaphragm

His percussion notes resonance sound

except over the ribs and the lowest

resonance heard is at the diaphragm

Normal

Auscultate the trachea Auscultation Bronchial or tubular breath sounds

There are bronchial or tubular sounds heard

Normal

Auscultate the thorax Auscultation Vesicular and bronchovesicular

sounds

There are vesicular and bronchovesicular

sounds heard

Normal

11. CARDIOVASCULARAortic and pulmonic areas Inspection and

palpationNo pulsation No pulsations felt Normal

Tricuspid area Inspection and palpation

No pulsation; no lift or heave

No pulsations or lift and heave

Normal

Apical area Inspection and palpation

Some pulsations visible; no lift or

heave

There are some pulsations felt but there are no lift or

heave

Normal

Epigastric area Inspection and palpation

Aortic pulsations There are aortic pulsations

Normal

Auscultate aortic, pulmonic, apical, tricuspid and epigastric area

Auscultation S1-usually heard at all sites but louder at the

apical areaS2-usually heard at all sites but louder at the

base of heart

There are heart sounds heard in all sites

Normal

12. CAROTID ARTERIESPalpate with extreme caution Palpation Symmetric pulse

volumes; full pulsations

His carotid artery has a full symmetric pulse

volumes and pulsations

Normal

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Auscultate the carotid arteries Auscultation No sounds heard There are no sounds heard

Normal

13. JUGULAR VEINSPresence of veins Inspection Veins not visible There are no visible

veinsNormal

14. ABDOMENSkin integrity Inspection Unblemished skin,

uniform colorHe has unblemished skin, uniform color

Normal

Abdominal contour Inspection Flat, rounded or scaphoid

He has symmetric contour

Normal

Enlarged liver or spleen Inspection No evidence of enlarged liver and

spleen

There are no evidence of enlarged liver and

spleen

Normal

Symmetry of contour Inspection Symmetric contour He has a symmetric contour

Normal

Abdominal movements Inspection Symmetric movements caused by

respiration

He has symmetric movements because of

respiration

Normal

Vascular patterns Inspection No visible vascular patterns

There are no vascular patterns seen

Normal

Bowel sounds, vascular sounds and peritoneal friction rubs

Auscultation Audible bowel sounds usually occur every 5-20seconds; absence of

arterial bruits and friction rub

There are audible bowel sounds heard every 30 seconds but no arterial bruits and

friction rub

Normal

Percuss in each quadrants Percussion Tympany over stomach and gas-

filled bowels; dullness over the liver and

spleen or full bladder

There is tymphany over stomach and gas

filled bowels

Normal

Light palpation of quadrants Palpation No tenderness, relaxed abdomen with

smooth, consistent

There is no tenderness, his abdomen is relaxed with smooth consistent

Normal

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tension tension15. MUSCULOSKELETALA. MUSCLES

Size, comparison on one side to other side

Inspection Equal size on both sides of the body

He has equal muscle size on both sides of the body

Normal

Contractures Inspection No contractures He has no contractures NormalFasciculation and tremors Inspection No tremors He has no tremors NormalMuscle tonicity Palpation Normally firm He has firm muscles NormalMuscle strength Inspection and

PalpationSmooth coordinated

movementsHe has a weak and

slight un-coordinated movements

Deviation from Normal d/t

illness.B. BONES

Normal structure and deformities Inspection No deformities He has no deformities NormalEdema and tenderness Palpation No tenderness or

swellingHe has no edema,

tenderness and swelling

Normal

C. JOINTSSwelling Inspection No swelling Positive swelling Deviation from

Normal d/t uncomfortable environment.

Tenderness, smoothness of movements, crepitation and nodules

Palpation No swelling, tenderness, crepitation

or nodules

There are no tenderness, swelling,

crepitation or nodules;

Normal

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Joint range of motion Inspection Varies to some degree in accordinance with

person’s genetic makeup and degree of

physical ability.

He has a good joint ROM.

Normal

30

DIAGNOSTIC PROCEDURE/ LABORATORY

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Diagnostic Laboratory Procedure

Date Ordered

`Indication or Purpose Result Normal Values Analysis and Interpretation of Result

Nursing Responsibilities

Complete Blood Count

Sept. 07, 2010

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 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.

Components Actual FindingsWBC 2.2 L 109/LRBC 6.20 H 1012/LHGB 100 g/LHCT 0.330PLT 69 L 109/LPCT 0.046 L 10-2/LMCV 72 L flMCH 25.5 L pgMCHC 356 H g/LRDW 16.7 H%MPJ 6.6 flPDW 10.1 %%Lymphocytes 39.3 %#Lymphocytes 0.8 L 109 L%Monocytes 13.3 H%#Monocytes 0.2 L 109L%Granulocytes 47.4 %#Granulocytes 1.2 L 109L

Normal Findings3.5 – 10.03.80 – 5.80110 – 1650.350 – 0.500150 – 3900.100 – 0.50080 – 9726.5 – 33.5315 – 35010.0 – 15.06.5 – 11.010.0 – 18.017.0-481.2-3.24.0-10.00.3-0.843.0-76.01.2-6.8

Analysis/InterpretationAbnormal/DecreasedAbnormal/ElevatedNormalNormalAbnormal/DecreasedAbnormal/DecreasedAbnormal/DecreasedNormalAbnormal/ElevatedAbnormal/ElevatedNormalNormalNormalAbnormal/DecreasedAbnormal/ElevatedAbnormal/DecreasedNormalNormal

Before:-Identify the patient-explain the procedure to the patient-Inform the patient that there are no foods, fluids, or medications restrictions, unless by medical directions.During:-Instruct the patient to cooperate fully and to follow directions during the laboratory procedures.After:-Secure the laboratory results of the patient.

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V. THE PATIENT AND HIS CARE

A. MEDICAL MANAGEMENT

a. IVF, BLOOD TRANSFUSION, NEBULIZATION, TOTAL PARENTERAL NUTRITION, NGT, OXYGEN THERAPY ETC.

MEDICAL MANAGEMENT

DATE ORDERED,

DATE RESULT IN

GENERAL DESCRIPTION

INDICATION/PURPOSES

CLIENT’S RESPONSE

NURSING RESPONSIBILITIES

• D5 0.3 NaCl

500 cc @25 gtts/ min

September 6, 2010 HypertonicCrystalloidSterile, non-pyrogenic and contain no bacteriostatic or antimicrobial agents. It contains 77 mEq/L solution and 77 mEq/L chloride.

Hypertonic solution draws fluids from the ICF causing cells to shrink and ECF to expand.Given to patients with hyponatremias (Na deficits) with edema.IVF may also come in a form of nutrient solution, electrolyte solution, alkalyzing solution & acidifying solution.

The patient gets sufficient energy for the body and the brain to function well.

-Frequently check the IVF site for infiltration, dislodge and inflammation

-Explain the purpose of the IVF to the patients’ family.

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• Normal Saline Solution

250 cc as fast Drip

September 06, 2010

Solution of common salt in distilled water, of a strength of 0.9 per cent. It is called normal saline because the percentage of salt resembles that of the crystalloids in the blood plasma.Applied to a wound an isotonic causes no increase in the flow of lymph from the capillary blood vessels.

-Can be use to replace fluids in dehydration, go with blood transfusion, hyponatremia, and burn victims. It is isotonic.-to dilute medications and to clean wounds out and to clean wounds out and other things.-fast drip for low BP in dengue hemorrhagic fever patient.

The patient gets sufficient energy for the body and the brain to function well.

-monitor for urine output, which should be 100ml or more every 4hrs.

-assess IV site carefully to avoid extravasations and tissue necrosis.

-monitor renal function, urinary output, fluid balance and electrolytes level.

b. Drugs

Generic/ Brand name

Date ordered, date taken/Given, date

changed, date discontinued

Route of administration,

dosage, frequency

General action, classification, mechanism of

action

Indication/ purposes

Client’s response Nursing responsibilities(Prior, during,

after)Ranitidine Hydrochloride(Zantac, Gavilast, Apo-ranitidine.RanitilUlzan)

September 6, 2010 • 250mg TIV q 8° • Histamine-receptor antagonist• Anti ulcer drug• Reduces gastric secretion and increases gastric

• Treatment of active duodenal ulcer; maintenance therapy for duodenal ulcer patient after healing of acute

No signs of any adverse reaction.

• Assess vital signs.• Monitor CBC and liver function tests.• Assess patient for epigastric or abdominal pain and

34

mucus and bicarbonate production, creating a protective coating in gastric mucosa.

ulcer; treatment of gastro esophagealReflux disease:short-term treatment of active, benign gastric ulcer; treatment of pathologic GI hypersecretory conditions (e.g., Zollinger-Ellison syndrome, systemic mastocytosis, and postoperative hypersecretion); heartburn.

frank or occult blood in the stool, emesis, or gastric aspirate.• Inform patient that it may cause drowsiness or dizziness.• Inform patient that increased fluid and fiber intake may minimize constipation.• Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health care professional promptly.

c. Diet

Type of diet Date started Date changed/D/C

General description Indications/Purposes Specific Foods taken Client response to the diet

DAT except dark colored food

September 6, 2010• A human being

pattern of eating.

Any food except dark colored foods that he desires nutritious,

All nutritious food except dark colored

The patient obeys and maintained the

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• It simply means "eat anything you want except dark colored foods.”

if this will not lead to any complications and if the client needs further monitoring for lab test

foods such as chocolates, dinuguan, squid, etc.

instructed diet.

d. ACTIVITY/ EXERCISE

TYPE OF EXERCISE DATE ORDERED/ DATE STARTED/ DATE DISCONTINUED

GENERAL DESCRIPTION

INDICATIONS/ PURPOSES

CLIENT’S RESPONSE TO ACTIVITY

NURSING RESPONSIBILITIES

36

Regular physical activity September 6, 2010 important for maintaining physical fitness and can contribute positively to maintaining a healthy weight, building and maintaining healthy bone density, muscle strength, and joint mobility, promoting physiological well-being, reducing surgical risks, and strengthening the immune system.

-improve the range of motion of muscles and joints.

- increasing cardiovascular endurance.

The patient can regain the strength he has lost in the days of his hospitalization

-explain to the patient the importance and benefits of having a regular exercise.

-encouraged the relative or family to join in the activity.

-give some exercises that the patient can do that can’t cause him any stress.

NURSING CARE PLAN

CUES NURSING DIAGNOSIS

SCIENTIFIC KNOWLEDGE

GOALS/ OBJECTIVES

NURSING RATIONALE EVALUATION/ EXPECTED

37

INTERVENTION OUTCOME

Subjective:

“Nahihilo, nanghihina at sumasakit ang tiyan ko” as verbalized by the patient.

Objective:

• Pallor

• Hemoglobin = 100 g/L

• Hematocrit = 0.330 L/L

Ineffective Tissue Perfusion r/t Decreased hemoglobin concentration in blood AEB low hemoglobin concentration, pallor and dizziness, and muscle weakness.

Definition:

Decrease in oxygen resulting in the failure to nourish the tissues at the capillary level [Tissue perfusion problems can exist without decreased cardiac output; however there may be a relationship between cardiac output and tissue perfusion.]

Typhoid Ileitis & DHF

Viral infection

Decreased CBC & platelet count

Decreased level of hemoglobin and

hematocrit

Decreased blood oxygenation

pallor, dizziness, muscle weakness

After 12 hours of nursing intervention, the client will be able to:

1. Demonstrate different ways to improve blood oxygenation and circulation.

2. Verbalize understanding of condition and importance of treatment regimen.

3. Demonstrate increased tissue perfusion.

1.2. 1. a.) Encourage

patient to take iron supplements and eat foods rich in iron.

b.) Elevate head of bed to about 10 degrees.

c.) Discourage strenuous activities.

2. a.) Provide health teaching regarding DHF and Typhoid Ilietis

b.) Provide health teaching on drugs being taken.

3. a.) Monitor vital signs.

1. a.)To help elevate hemoglobin and hematocrit levels

b.) To promote circulation and venous drainage.

c.)To avoid increased oxygen demand.

2. a.) To help client understand his health condition.

b.)To maintain compliance to meds.

3. a.)Serve as basis for any alteration in system functions.

After 32 hours of nursing intervention the client was:

1.Demonstrated different ways to improve blood oxygenation and circulation.

2. Verbalized understanding of condition and importance of treatment regimen.

3. Demonstrated increased tissue perfusion

38

Source:

Nurse’s Pocket Guide Ninth Edition

Ineffective tissue perfusion

b.) Encourage early ambulation when possible.

Collaborative:

• Administer medications as ordered

• Administer and regulate IVF as ordered

• Administer packed RBC’s

Monitor lab studies ( Hb,Hct, RBC count)

b.) Enhances venous return.

• Help control/alleviate symptoms

• Maintain hydration and help wash away toxins

• Packed RBC’s are adequate for stable patients with subacute/chronic bleeding to increase oxygen carrying capability.

• Aids in establishing blood replacement needs & monitoring effectiveness of

39

Source:

Nurse’s Pocket Guide Ninth Edition

therapy.

Source:

Nurse’s Pocket Guide Ninth Edition

CUES NURSING DIAGNOSIS

SCIENTIFIC KNOWLEDGE GOALS/ OBJECTIVES

NURSING

INTERVENTION

RATIONALE EVALUATION/ EXPECTED OUTCOME

Subjective:

Mainit angpakiramdam ko”as verbalized bythe patient.

Objective:

• Flushed skin,warm totouch.

Hyperthermia related to inflammatory response as manifested by body temperature of 38.6 degree Celsius, flushed and warm to touch skin.

Infectious agents (pyrogens)

Monocytes

Pyrogenic cytokines

Anterior hypothalamus

Elevated thermoregulatory set point

After 4 hrs. Ofnursinginterventions,the patient willmaintain coretemperaturewithin normalrange.

Independent:

Rendered tepid sponge bath

Encouraged to increase fluid intake

Promoted surfacecooling, loosenclothing, and coolenvironment

Encouragedto haveadequate

To promote cooling surface

To replace fluid loss due to bodyheat

Heat is loss byevaporation andconduction

To reduce metabolic

After 4 hrs. Of nursing interventions, thepatient was ablemaintain coretemperature withinnormal range. Goal met.

40

• Restlessness

• V/S taken as follows:

T: 38.6 °CP: 78R: 19BP: 110/80

Increased Heat

conservation(Vasoconstriction/behaviour changes) Increased Heat production (involuntary muscular contractions)

F E V E R

bed rest

Dependent:

AdministeredParacetamolas ordered

Administered IVF as ordered

demands

To decrease temperature

To supportcirculatingvolume andtissueperfusion

CUES NURSING DIAGNOSIS

SCIENTIFIC KNOWLEDGE

PLANNING NURSING INTERVENTION

RATIONALE EVALUATION

Subjective:

“Palagi akong

Diagnosis:

Risk for deficient Recognition of

dengue viral antigen

Short Term:After 1 hr. of nursing

Independent:> Note possibleconditions like

>These conditionsmay lead to fluid

Short term:Goal Met.

41

nauuhaw”, as verbalized by the patient

Objective:

> Decreased platelet count= 69L >Thirst>Weakness

fluid volume related to decreased blood volume secondary to altered platelet production

Definition:

The state in which an individual is at risk of experiencing vascular, cellular, or intracellular dehydration

on infected monocyte by

cytotoxic cells↓

Cellular direct destruction

↓Infection of red bone

marrow precursor cells

↓Immunological

platelet survival ↓

Platelet lyses↓

Hemorrhage↓

Increasing the risk for fluid volume

deficit

interventions, theclient will be able todemonstratebehaviors that reducethe risk of decreasedfluid volume asmanifested by:

> Increased oral

fluid intake.

> Enumerate ways

to prevent

bleeding

fluid loss andlimited intake.

> Monitor I&O

> Monitor VS changes.

> Assess the signsand symptoms ofGI bleeding. Check for secretions.Observe color andconsistency ofstools or vomitus.

> Observe forpresence ofpetichiae,ecchymosis,bleeding from one more sites.

> Encourage use of soft toothbrush.Avoid straining instool, and forcefulnose blowing.

deficits

>To ensure accurate picture offluid status

>Water loss candirectly affect thebody system

>The GI tract is themost usual sourceof bleeding of itsmucosal fragility

>Su-acutedisseminatedintravascularcoagulation maydevelop seondary toaltered clottingfactor

>Minimal trauma can cause mucosal bleeding

After 1 hour of nursing interventions, the client was able to demonstrate behaviors that reduce the risk of decreased fluid volume.

.> Increased oralfluid intake.> Enumerate waysto preventbleeding

42

> Monitor labstudies ( Hb,Hct,RBC count,platelet, PTT,APTT)

> Encourage waterfor thirst instead ofjuices or soda..

> Promote intake of high-water content foods (e.g. popsicles, gelatin, eggnog, watermelon)

Collaborative:> Provide/ assist ingivingsupplementalfluids as indicated(e.g. parenteral,enteral)

>Aids in establishing blood replacementneeds & monitoringeffectiveness oftherapy.

>Juices or soda are more concentrated and has lesser water content.

>Adds water in the diet without overwhelming the client with bulk of drinking water.

>To replenish fluid volume for severe dehydration

VI. DISHARGE PLANNING

METHODSMEDICATION:

43

• Continue taking prescribe medication for the patient on exact dosage, time, and frequency making sure that the purpose of the medication is truly discussed by the health care provider.

• Instruct the patient to follow the instruction when administering meds.

• Advice the significant others not to leave the patient during meds.

• Advice the patient not to stop intake of prescribed meds, unless approved by the physician.

• Don’t give aspirin and NSAID’s, they increase the risk of bleeding. Any medicines that decrease platelet count should be avoided.

EXERCISE:

• Instruct to avoid excessive activities that may result to stress. Just advised to perform range of motions and repetitive body movements for promotion of

optimum health. Remind about the need for health promotion activities such as reading, watching T.V, etc.

TREATMENT:

• Bed rest is advisable during the re-occurrence of fever phase.

• Instruct to drink plenty of water or fluids that are available at home and eat nutritious diet.

• Advised to look for re-occurrence of danger signs and symptoms and report immediately.

HYGIENE:

• Encourage to continue the routinely hygienic care of the patient

44

OPD:

• Instruct the family members to have a check-up or to consult physician once a while to monitor patient’s condition and for detection of recurrences and other

complications that may arise on to it.

DIET:

• Instruct the family members to give the client protein rich foods such as meat, fish, eggs and dairy products.

VII. CONCLUSION

As part of our requirement, we had learned so much in handling our client who DHF. We attained and follow certain standards and rules to promote

nurse patient interaction. With this case study, we gain knowledge that we can surely use in the future ahead. All we do to our client is the summary of what

we have learned in lectures in school. We also share some information with our client like the main probable cause and the risk factors of having DHF. We

do manage our time to give sufficient care to our beloved client. We believed that client is our work and we have the responsibility to attend to their needs

and serve them as best as we can. We are able to provide health teaching about the proper health care to our client with DHF. We started having an interview

by building trust to our client because at first, he wasn’t like to share some information to us. But, as time goes by, we were able to let our client share some

information that will be very useful in this case studies.

VIII. BIBLIOGRAPHY• Schull, Dwyer Patricia, Nursing Spectrum DRUG Handbook, The McGraw-Hill Companies, Inc. copyright © 2008 • Wilkinson, Judith M, and Nancy R. Ahern, Nursing Diagnosis Handbook 9th edition, Pearson Education South Asia Pte. Ltd copyright © 2009

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• Kozier, Barbara; Avory Berman; Glenora Erb and Shirlee Snyder, Fundamentals of Nursing 7th Edition, Pearson Education South Asia Pte. Ltd. Copyright © 2004

• Colbert, Bruce J; Jeff Ankney and Karen T. Lee, Principles of Anatomy & Physiology , an interactive journey, Pearson Education South Asia Pte. Ltd. Copyright © 2007

• Walker, Richard Guide to the HUMAN BODY, Octopus Publishing Group Ltd. Copyright © 2003 • Delaune, Sue E. and Patricia K. Ladner, Fundamentals of Nursing, Standards and practice, 3rd edition, Thomson learning Asia,Copyright ©2006 • Nursing 2006 Drug handbook 26th edition , Lippincott Williams and wilkins • Deglin, Judith Hopper and April Hazard Vallerand, Davis’s Drug Guide for Nurses, 9th edition • Nurse’s Pocket Guide: Nursing diagnoses with interventions 4th edition • Brunner & Suddarths, Medical and Surgical Nursing 10 th edition, Lippincott Williams & Wilkins Copyright © 1996

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