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SUBMITTED BY: SUBMITTED TO: BSN 3 GROUP 2 Mrs.MARIBEL MURILLO

JANE MICHELLE CESARIO

A. GENERAL DATA

1. PATIENT NAME: IE.DR

DENGUE

2. ADDRESS: Laoac, Pangasinan

3. AGE: 4 years old

4. SEX:Male

5. BIRTH DATE: April 20, 2009

6. RANK IN THE FAMILY: 2nd child

7. NATIONALITY: Filipino

8: CIVIL STATUS: Single

9 .DATE OF ADMISSION: July 22,2013

10. ORDER OF ADMISSION:

Admit to pedia ward

Secure consent

TPR q4 every shift

Diagnostics: CBC, platelet, urinalysis

11. ATTENDING PHYSICIAN: Dr. Viduya

12. ADMITTING DIAGNOSIS: Fever for 3days

B.CHIEF COMPLAINT

Intermitent fever for 3days

C.HISTORY OF PRESENT ILLNESS

a day prior to admission the patient experienced hyperthermia.

D.PAST HEALTH HISTORY/STATUS

He didn’t have any operations, surgeries or any allergies to food or drugs . He had measles, mumps and common colds. He has been immunized and

completed vaccinations for Bacillus Calmette Guerin (BCG), Oral Polio Virus (OPV), Diphtheria, Pertusis, andTetanus (DPT), Hepatitis B and MMR.

E.FAMILY ASSESSMENT

NAME

RELATION

AGE

SEX

OCCUPATION

EDUCATIONAL

ATTAINMENT

J.DR

Mother

32

Female

OFW

College graduate

J.DR

Sister

7

Female

Student

F.SYSTEM TO REVIEW-Gordon’s 11 Functional Health Patterns Assessment

1.HEALTH PERCEPTION-HEALTH MAINTENANCE PATTERN

-‘’Health is only physical it is a wholeness of a person’’as verbalized by the patient.

2.NUTRITIONAL-METABOLIC PATTERN

BEFORE HOSPITALIZATION:The patient eats 3 times a day and with afternoon snacks. According to the SO of the patient, he eats meat, fish and also

vegetables. He doesn’t have any allergies on foods and drugs. His appetite is moderate and usually depends on the food being served. He didn’t

complain any difficulty in swallowing.

DURING HOSPITALIZATION:The patient has loss his appetite and hasn’t eaten a lot. He is on a DAT (Diet asTolerated) EDCF (Except Dark Colored

Foods).

3.ELIMINATION PATTERN

BEFORE HOSPITALIZATION:The patient does not have any problem on her elimination pattern. He usuallyurinates 4-5 timesa day without any

difficulty. He added that the color of her urine is light yellow. He didn’t feel any pain in urination. The patient defecates once a day usuallyearly in the

morning with yellow to brown color. He verbalizedthat sometimes however, it is hard in consistency with dark color, which generallydepends on what he

eats.

DURING HOSPITALIZATION: The patient urinates 2-3 times a day. The color of his urine is yellow. The patientdefecates once every two days.

4.ACTIVITY EXERCISE PATTERN

BEFORE HOSPITALIZATION:He could perform activities of her daily living.

DURING HOSPITALIZATION: His activity was limited lying on bed but the patient is given her bathroom privileges.

5.SLEEP-REST PATTERN

BEFORE HOSPITALIZATION:He has the normal 6-8 hours of sleep. He also has his nap time for 1-2 hours a day.Sleeping and watching the

television are his form of rest.

DURING HOSPITALIZATION:He doesn’t have the adequate time of sleep since he is disturbed with the nursesthat enter the room every now

and then, and because of the environmental changes of his surroundings. He also has inadequate time to rest since she doesn’t have enough time

to sleep.

6.COGNITIVE-PERCEPTUAL PATTERN

He sees herself as a person with a good personality. She has been a good brother and daughter. He said he has to be a good person in order not to hurt

others.

7.ROLE-RELATIONSHIP PATTERN

BEFORE HOSPITALIZATION:He has a close relationship with her family. They were two siblings in their family. He was the youngest. I was also able to

ask his mother about his being a son andshe confessed that he is a good son but at times he doesn’t obey her.

DURING HOSPITALIZATION:He had more time to bond with her family.

8.SEXUALITY-REPRODUCTIVE PATTERN

-none-

9.COPING STRESS TOLERANCE

He does not fully identify her situations having stress but she always tell her parents when something is wrong.

10.VALUE-BELIEF PATTERN

He is a Roman Catholic devotee. She always goes with her family every Sunday to go tomass. He was taught by his family to believe and have fear to

GOD. They usually believe inquack doctors.

G. HEREDO-FAMILIAL ILLNESS

Maternal PATERNAL

(Deceased)

Asthma

IE.DR

(patient)

dengue

None

H. DEVELOPMENT HISTORY (according to Erickson, Freud, Piaget, Kohlberg, Fowler)

THEORIST

AGE

SEX

PATIENT DESCRIPTION

Erickson

Fidelity: Identity vs. Role Confusion (Adolescence, 13-19

years)

FEMALE

Existential Question: Who Am I and What Can I Be? The adolescent is newly concerned with how they appear to others. Superego identity is the accrued confidence that the outer sameness and

continuity prepared in the future are matched by the sameness and continuity of one's meaning for oneself, as evidenced in the promise of a career. The ability to settle on a school or occupational identity is

pleasant. In later stages of Adolescence, the child develops a sense of sexual identity. As they make the transition from childhood to adulthood, adolescents ponder the roles they will play in the adult world.

Initially, they are apt to experience some role confusion—mixed ideas and feelings about the specific ways in which they will fit into society—and may experiment with a variety of behaviors and activities (e.g. tinkering

with cars, baby-sitting for neighbors, affiliating with certain political or religious groups). Eventually, Erikson proposed, most adolescents achieve a sense of identity regarding who they are and where their lives

are headed.

Piaget’s theory of cognitive

development

Formal operations (beginning at ages 11-

15)

FEMALE

Cognition reaches its final form. By this stage, the person no longer requires concrete objects to make rational judgments. He or she is

capable of deductive and hypothetical reasoning. His or her ability for abstract thinking is very similar to an adult.

FREUD Genital stage

12 – 20 y/o

FEMALE

The genital stage affords the person the ability to confront and resolve his or her remaining psychosexual childhood conflicts. The ego is established

in the latter. The person’ s concern shifts from primary-drive gratification (instinct) to applying secondary process-thinking to gratify desire symbolically and intellectually by means of friendships, a love

relationship, family and adult responsibilities

I.PHYSICAL ASSESSMENT

A. GENERAL SURVEY

Body proportions are normal. Posture is erect but slightly not comfortable when standing straight. Gait is rhythmic and coordinated with arms

swinging at side when walking. Wears ordinary clothes such as shirt and shorts. He weighs 14.5 kilograms. There is slight body odor and breath

odor. Interacts and communicates in an appropriate manner with others. He is alert and oriented with time, place and person. His speech is clear

and can comprehend with instructions when asked.

B. VITAL SIGN

BP: 70/80mmHg

PR: 93 beats per minute

RR: 26 breaths per minute

TEMP: 38 degree Celsius

C. REGIONAL EXAM

1. Hair, head and face:Head is normal cephalic, no lesions, and no complaints of pain when palpated. Can puff out cheeks, and can feel sharp and dull

objects.

2. Eyes are symmetric to each other, eye bags noted due to lack of sleep, no swelling, lesions, and no complaints of eye pain; eyelashes are evenly

distributed, curled outward; skin intact, no discoloration, symmetric eyelids and eyeballs; able to blink involuntarily; bulbar conjunctiva transparent, no

lesions; palpebral conjunctiva, smooth, pink, no edema.

3. Nose: shape and size are symmetric; no lesions; as the client breaths normally; mucosa is pink and no lesions, intact nasal septum between the nasal

chambers.

4. Ears: the color is light which is symmetric to her facial skin; firm, not tender and pinna recoils after it was folded; cerumen is sticky wet, no skin

lesions, pus and blood.

5. Mouth and Throat: There are no lesions and or swelling noted on the mouth. Presence of tartar and cavities are seen on the front teeth. The tongue is

reddish and in normal size. No inflammation of the throat.

6. Neck and Lymph Nodes: No pain when palpated. No swelling or inflammation.

7. Skin: fair complexion, no edema, no birthmark, no lesions, moisture in skin folds and ax illae.

8. Nails: pinkish, intact epidermis improper grooming, no markings and capillary refill 1-3 second.

9. Thorax and Lungs: No signs of distressed when breathing, not using accessory muscle, and no pain when palpated. It is also symmetrical to each

other.

10. Cardiovascular:No distension of Jugular veins. The pulse rate is palpated with 93 beats per minute rate and regular pattern.

11. Breast and Axilla: Breast are symmetrical to each other, there is no visible vein and no retraction and dimpling. No presence of mass and nodules

with foul odor and no lesions. No enlarge lymph nodes.

12. Abdomen: Characterized as rounded, no lesions. No bruit sound.

13. Extremities: Both arms and legs are same with the skin tone of the body. Skin is warm to touch. No lesions and excoriations noted.

14. Genitals: not performed.

15. Rectum and Anus: not performed

II. PERSONAL / SOCIAL HISTORY

a. Habits/ Vices: watching television, playing.

a. Caffeine: not drinking coffee

b. Smoking: not smoking

c. Alcohol: not drinking alcohol

d. Tea: not drinking tea.

E. drugs –none

b. Lifestyle

When staying in house he watches television or playing with toys.

c. Social Affiliation

He doesn’t participate in any affiliations.

d. Rank in the family

He is youngest among two siblings

e. Travel (within 6 months)

He didn’t travel.

f. Educational Attainment

Still not going to school

I. Environment History (Living/ Neighborhood/Circumstances)

Their house is bungalow and made of cement, they have their own comfort room and faucet as their source of water. They sell different kinds of candies

as their source of living. They have their own tricycle as their transportation and they also use it as their service in their rolling store.

V.INTRODUCTION

Dengue Fever is caused by one of the four closely related, but antigenically distinct, virusserotypes Dengue type 1, Dengue t ype 2, Dengue type

3, and Dengue type 4 of the genus Flavivirus and Chikungunya virus. Infection with one of these serotype provides immunity toonly that serotype of life, to

a person living in a Dengue-endemic area can have more than oneDengue infection during their lifetime. Dengue fever through the four different Dengue

serotypesare maintained in the cycle which involves humans and Aedes aegypti or Aedes albopictusmosquito 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 Dengueand after a

week it can transmit the virus while biting a healthy person. Dengue cannot betransmitted or directly spread from person to person. Aedes aegypti is

the most common aedesspecie which is a domestic, day-biting mosquito that prefers to feed on humans.

INTUBATION PERIOD: Uncertain. Probably 6 days to 10 days

PERIOD OF COMMUNICABILITY: Unknown. Presumed to be on the 1st week of illness when virus is still present in the blood

CLINICAL MANIFESTATIONS:

First 4 days:

>febrile or invasive stage --- starts abruptly as high fever, abdominal pain and headache; later flushing which may be accompanied by vomiting,

conjunctival infection and epistaxis

4th to 7th day:

>toxic or hemorrhagic stage --- lowering of temperature, severe abdominal pain, vomiting and frequent bleeding from GIT in the form of melena;

unstable BP, narrow pulse pressure and shock; death may occur; vasomotor collapse

7th to 10th day:

>convalescent or recovery stage --- generalized flushing with intervening areas of blanching appetite regained and blood pressure already

stable

MODE OF TRANSMISSION:

Dengue viruses are transmitted to humans through the infective bites of female Aedesmosquito. Mosquitoes generally acquire vi rus while

feeding on the blood of an infected person. After virus incubation of 8-10 days, an infected mosquito is capable, during probing and blood feeding of

transmitting the virus to susceptible individuals for the rest of its life. Infected female

mosquitoes may also transmit the virus to their offspring by transovarial (via the eggs)transmission.

Humans are the main amplifying host of the virus. The virus circulates in the blood of infected humans for two to seven days, at approximately

the same time as they have fever. Aedesmosquito may have acquired the virus when they fed on an individual during this period. Dengue cannot be

transmitted through person to person mode.

CLASSIFICATION:

1. Severe, frank type

>flushing, sudden high fever, severe hemorrhage, followed by sudden drop of temperature, shock and terminating in recovery or death

2. Moderate

>with high fever but less hemorrhage, no shock present

3. Mild

>with slight fever, with or without petichial hemorrhage but epidemiologically related to typical cases usually discovered in the course of invest or

typical cases

GRADING THE SEVERITY OF DENGUE FEVER:

Grade 1:

>fever

>non-specific constitutional symptoms such as anorexia, vomiting and abdominal pain

>absence of spontaneous bleeding>positive tourniquet test

Grade 2:

>signs and symptoms of Grade 1: plus

>presence of spontaneous bleeding: mucocutaneous, gastrointestinal

Grade 3:

>signs and symptoms of Grade 2 with more severe bleeding: plus>evidence of circulatory failure: cold, clammy skin, irritability,

weak tocompressible pulses, narrowing of pulse pressure to 20 mmhg or less, coldextremities, mental confusion

Grade 4:

>signs and symptoms of Grade 3, declared shock, massive bleeding, pulse lessand arterial blood Pressure = 1 mmhg (Dengue Syndrome/DS)

SUSCEPTABILITY, RESISTANCE, AND OCCURRENCE:

>all persons are susceptible

>both sexes are equally affected>age groups predominantly affected are the pre-school age and school age>adults and infants are not

exempted

>peak age affected: 5-9 years old

DF is sporadic throughout the year. Epidemic usually occurs during rainy seasons (June – November). Peak months are September – October. It occurs

wherever vector mosquito exists.

DIAGNOSTIC TEST:

Tourniquet tes

>Inflate the blood pressure cuff on the upper arm to a point midway between thesystolic and diastolic pressure for 5 minutes.

>Release cuff and make an imaginary 2.5 cm square or 1 inch square just belowthe cuff, at the antecubital fossa.

>Count the number of petechiae inside the box. A test is positive when 20 or more petechiae per suare are observed.

Dengue haemorrhagic fever (DHF), a potentially lethal complication, was firstrecognized in the 1950s during the dengue epidemics in the

Philippines and Thailand, but todayDHF affects most Asian countries and has become a leading cause of hospitalization and deathamong children in

several of them.

VI. ANATOMY AND PHYSIOLOGY

The Immune System

A second line of defense is housedwithin the body: a finely tuned

immunesystem that recognizes and destroysforeign substances and

organisms thatenter the body. The immune system

candistinguish between the body's owntissues and outside substances c

alledantigens. This allows cells of theimmune army to identify and destro

yonly those enemy antigens. The abilityto identify an antigen also permits

theimmune system to "remember" antigensthe body has been exposed

to in thepast; so that the body can mount abetter and faster immune

response thenext time any of these antigens appear.The immune system

also includes

other proteins and chemicals that assistantibodies and T cells in their wor

k.Among them are chemicals that alertphagocytes to the site of the

infection.The complement system, a group of proteins that normally float

freely in the blood, move toward infections, where theycombine

to help destroy microorganisms and foreign

particles. They do this bychanging the surface of bacteria or other

microorganisms, causing them to die.

VII. PATHOPHYSIOLOGY

Medical Diagnosis

T/C Dengue Hemorrhagic Fever/ Pleural Effusion, T/C Liver Pathology

Definition

Dengue Hemorrhagic Fever -

is a severe, potentially deadly infection spread by certain species of mosquitoes (Aedesaegypti).

Pleural Effusion -

is excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs.Excessive amounts of such fluid can impair breathing

by limiting the expansion of the lungs during inhalation.

Liver Pathology –

a condition characterized by any liver diseases or condition

Predisposing

Geographicacl area – tropical islands

in thePacific (Philippines) and Asia

Precipitating

Environmental conditions (open spaces with water pots, and

plants)Immunocompromise Mosquito carrying dengue virus

soldier sweaty skin

Aedesaegypti (dengue virus carrier) 8-

12 days of viral replication on

mosquito’s salivary glands

Bite from mosquito (portal of entry in

the skin)

Allowing dengue virus to be inoculated

towards the circulation/blood

(incubation days 3-14 days)

Antibodies attach to the viralantigens, and

thenmonocytes/macrophages willperform

phagocytosis through Fcreceptor (FcR) within

the cells anddengue virus replicates in the

cells

Virus disseminated rapidly into the blood and stimulates WBCs including B-lymphocytes that produces and secretes immunoglobulin (antibodies), and monocytes, macrophages and neutrophils monocyte.

Redness and itchiness in the area

Entry to the

bone marrow

Entry to the

spleen

Recognition of dengue viral antigen on

infected monocyte.

Release of cytokines which consist of

vasoactive agent such as interleukens, tumor

necrosis factor, urokinase and platelet

activating factor which stimulate WBC and

pyrogen release

Dengue

Cellular direct destruction of red bone

marrow precursor cell as well as

immunological shortened platelet

Virus ultimately targets liver and spleen

parynchemal cells where infection

produces cell death

Hepatosplenomegaly Thrombocytopenia

Dengue Hemorrhagic

VIII. NURSING CARE PLAN

FOCUS: Increased body temperature

ASSESSMENT

DIAGNOSIS

PLANNING

INTERVENTION

RATIONALE

EVALUATION

Subjective:

“ apat na araw na po ako nilalagnat, di pa

po ako guagaling,”as verbalized by

the patient.

Objective: Flushed skin Weak in

appearance Teary eyes Increase in vital

signs PR: 93 bpm T: 38° C

R:26 BP:100/80mmHg

Hyperthermia

related to increased metabolic rate as

evidenced by increase in body temperature

(38°C).

Short term

objective: After 30 minutes of rendering

appropriate nursing intervention, the

patient’s temperature will be decreased

from 38°C to 37.5°C or lower(within

normal range).

Diagnostics: Note presence or

absence of sweating as body attempts to increase heat loss by

evaporation, conduction, and diffusion.

Monitor and record all sources of fluid loss such as urine.

Monitor vital signs especially temperature.

Therapeutics: Dependent: Administer

medications as indicated or ordered by the physician.

Administer

replacement of fluids

and electrolytes. Independent: Perform tepid sponge

bath.

Evaporation is

decreased by environmental factors of high humidity and high

ambient temperature.

Oliguria and/or renal failure may occur due to hypotension,

dehydration, shock, and tissue necrosis.

To evaluate effects or degree of hyperthermia.

To treat underlying

cause.

To support circulating volume and tissue perfusion.

Heat loss by

evaporation and

conduction.

Goal met. Patient’s temperature subsided from

38°C to 37.5°C.

Promote surface

cooling by means of

undressing/reducing clothes and removing excess blankets.

Maintain Bed rest.

Educative:

Discuss importance of adequate fluid intake from 1,500-

2000 ml per day. Instruct to increase

intake of Vitamin C-

rich foods.

To assist with measures to reduce body temperature/restore

normal body/organ function.

To reduce metabolic demands and oxygen consumption.

To prevent dehydration.

To boost the immune

system.

FOCUS: Nose bleeding

ASSESSMENT

DIAGNOSIS

PLANNING

INTERVENTION

RATIONALE

EVALUATION

Subjective: “bigla nalang

pong dumugo itong ilong ko”, verbalized by

the patient. Objective: Irritability

Epistaxis Weak in

appearance

pallor

Risk for injury hemorrhage

related to alter clotting factor.

Short term objective: After an

hour of nursing interventions, the patient will be able

to demonstrate behaviors that reduce the risk for

bleeding.

Diagnostics: Assess vital signs

including BP, pulse, and respiration.

Assess skin color and

moisture, urinary output, level of consciousness or

mentation.

Review laboratory data

(CBC) result Assess for signs and

symptoms of G.I

bleeding. Check for secretions; observe color and consistency

of stools or vomitus. Therapeutics:

Dependent: Assist with treatment

of underlying

conditions causing or contributing to blood loss.

Educative: Need to inform health

care providers when

taking aspirin and other anti-coagulant-type agents.

Instruct at risk patient

and family regarding:

To determine if

intravascular fluid deficit exists.

Changes in these signs maybe indicative of blood loss affecting

systemic circulation or local organ function such as kidneys or

brain.

Note for alterations on

blood. The G.I.

tract(esophagus and

rectum) is the most usual source of bleeding of its mucosal

rigidity.

To prevent

bleeding/correct

potential causes of excessive blood loss.

These agents will most

likely be held for a

period of time prior to elective procedures to reduce potential for

excessive blood loss. To prevent bleeding /

correct potential causes

Goal me. Patient is able to

demonstrate behaviors that reduce risk for bleeding.

- Specific signs of

bleeding requiring health care provider

notification such as prolonged epistaxis.

of excessive blood loss.

IX. DRUG STUDY Generic name: ceftriaxone sodium

Brand name: Rocephin Drug Classification: Antibiotic, Cephalosporin (third generation) Dosage: 1 amp IV q 12 h, ANST (-)

Indication: Urinary tract infection

MECHANISM OF

ACTION

SIDE EFFECT CONTAINDICATIONS ADVERSE REACTION NURSING

CONSIDERATIONS

Bactericidal: Inhibits

synthesis of cell wall

causing cell death

Nausea, vomiting,

diarrhea, anorexia,

abdominal pain,

flatulence

Ranging from rash

to fever

Pain, phlebitis

Super infections,

desulfiram-like

reaction with

alcohol

Contraindicated

with allergy to cephalosporins or penicillins.Use

cautiously with renal failure.

CNS: headache, dizziness, lethargy,

paresthesias

GI: Nausea, vomiting, diarrhea,

anorexia, abdominal pain, flatulence,

pseudomembranous colitis, liver

toxicity

GU: nephrotoxicity

Hematologic: Bone marrow

depression – decreased WBC,

decreased platelets, decreased Hct.

Hypersensitivity: Ranging from rash

to fever to anaphylaxis; serum

sickness reaction

Local: Pain, abscess at injection site;

phlebitis, inflammation at IV site

Other: Super infections, desulfiram-

like reaction with alcohol.

Teaching points:

You may experience

these side effects:

stomach upset or

diarrhea

Report severe

diarrhea, difficulty

breathing, unusual

tiredness or fatigue,

pain at injection site.

Discontinue if

hypersensitivity reaction

occurs.

Generic name: paracetamol Brand name:Flugard

Drug classification: antipyretic, analgesic (non opioid) Dosage: IV 1 amp now then PRN fer fever Indications: for fever

MECHANISM OF ACTION SIDE EFFECT CONTAINDICATIONS ADVERSE REACTION NURSING

CONSIDERATIONS

Antipyretic: reduces fever by acting directly on the hypothalamic

heat-regulating center to cause vasodilation and sweating, which helps

dissipate heat. Analgesic: site and

mechanism action unclear.

none Contraindicated

with allergy to acetaminophen.

Use cautiously with impaired hepatic function, chronic

alcoholism, pregnancy, lactation.

CNS: headache CV: chest pain, dyspnea,

myocardial damage when doses of 5-8 g/day are ingested daily for several

weeks or when doses of 4 g/day are ingested for 1 year.

GI: Hepatic toxicity and failure, jaundice

GU: acute renal failure, renal tubular necrosis.

Hematologic: methemoglobinemia – cyanosis; hemolytic anemia –

hematuria; anuria; neutropenia, leukopenia,thrombocytopenia,

hypoglycemia Hypersensitivity: rash, fever

Assessment:

History: allergy to acetaminophen,

impaired hepatic function.

Physical: skin

color, lesions, T; liver evaluation; CBC, LFT’s, renal

function tests.

X. DIAGNOSTIC TESTS/LABORATORY RESULTS:

TESTS RESULT NORMAL VALUES REMARKS

RBC Count

4.55

M=4.69-6.13x10 12/L F=4.04-5.48x10 12/L

normal

Hemoglobin

103

M=140-180g/L F=120-160g/L

normal

Hematocrit

.30

M=0.40-0.54

F=0.37-0.47

normal

WBC

3.8

5-10x10 9/L

Normal

DIFFERENT COUNT :

Segment

.49

0.50-0.70

Normal

Lymphocytes

.46

0.20-0.40

Monocytes

.5

0.0-0.07

URINALYSIS

RESULTS NORMAL VALUES SIGNIFICANCE

PHYSICAL: Color

Transparency CHEMICAL:

Specific Gravity

Urobilinogen

Red Blood Cells

Protein

pH

Blood cells

MICROSCOPIC: RBC

Epithelial Cells

A Urates/Phosphates

Dark Yellow

Slightly turbid

1.010

Normal

1-2

(-)

6.0

(-)

1-2

Few

Few

Straw yellow to amber

Clear

1.010 – 1.030

0 – 2

(-)

4.8-8

(-)

Normal

Indicates abnormality

Normal

Normal

Normal

Normal

Normal

Normal

XI. ONGOING APPRAISAL

The patient is responding well to both medical and nursing intervention.

XIII. DISCHARGE PLAN (HEALTH TEACHING)

Medication: Instruct IE.DR to take all the necessary medicines that the doctors prescribed.

Treatment: Instruct to follow all prescribed therapeutic regimens.

Clinical follow up: Instruct the patient to come back on scheduled follow up check.

Diet: Advise to eat dark green leafy vegetables, rich in iron and vitamin C diet to regain strength and boost his immune system

Danger Signs: Instruct the patient to seek medical advice if he is experiencing excessive nose bleeding and high-grade fever and appearance of rashes.

I. PATHOPHYSIOLOGY ( in diagram )

Dengue infection

Antibody formation

Reinfection

Augmentation of virus multiplication

Increased vascular permeability Reduce Platelets

Plasma Leakage Coagulopathy

Hypovolemia Disseminated intravascular coagulation

Shock Severe Bleeding

Death