Acknowledgement

We sincerely express our gratitude to the people behind the completion of this
presentation.
We would like to express our heartfelt gratitude to the friends and classmates for the
support and encouragements you have given us. To our clinical instructors who supervised us
during our clinical exposures at Caraga Regional Hospital and Surigao edical Center and for
the guidance and encouragement throughout this case presentation! to ma"am #ecel $upe%a for
approving our chosen case! to our ever supportive parents and family for their moral and
financial support and motivation. &nd for the most of all to our &lmighty 'od from whom all the
graces flow for the needed guidance and wisdom.
Introduction
(ur patient r. C# is a ) years old preschooler in Cuyago #abonga! &gusan del *orte. He
1
was admitted at Caraga Regional Hospital last arch +! +,-,! related to .engue /ever with
some .H*! acute gastritis.
This prompts the group of choose this case study for us to fully understand the nature of
the said disease and the risk involve it0 hoping that we can contribute something to lessen its
occurrence through educating the community people about its etiology! treatment and
preventions.
This case is both beneficial to the nursing students as the care providers and to the
community people as recipients of care. 1n one way or another both parties involved in the said
case so that both of them need to work hand in hand for its eradication. 1t is indispensible for our
local health care delivery system to continue disseminating information in our community and its
neighboring places for the disease prevention. &s they always say 2an ounce of prevention is
better than a pound of cure3.
Review of Related
Literature
Dengue Fever
2
.engue fever is an infectious disease carried by mos4uitoes and caused by any of
four related dengue viruses. This disease used to be called break5bone fever because it
sometimes causes severe 6oint and muscle pain. .engue /ever is a flu5like illness spread
by the bite of an infected mos4uito and an acute febrile viral disease characteri7ed by
sudden onset! fever of 859 days! intense headache! myalgia! anthralgic retro5orbital pain!
anorexia! '1 disturbances and rash.The viruses are transmitted to man by the bite of
infective mos4uitoes! mainly Aedes aegypti. The incubation period is :5; days <range 85
-: days=.
Sign and Symptoms of Dengue Fever
Chills
Headache
>ain upon moving the eyes
?ow backache
>ainful aching in the legs and 6oints
/ever <temperature rises as -,:@ / <:,@ C==with relative low heart rate
<bradycardia= and low blood pressure <hypotension=
The eyes become reddened
& flushing or pale pink rash comes over the face
The glands <lymph nodes= in the neck and groin are often swollen
The palms and soles may be bright red and swollen
How is Dengue Fever diagnosed?
& doctor or other health care worker can diagnose dengue fever by doing a blood test.
The test can show whether the blood sample contains dengue virus or antibodies to the virus. 1n
epidemics! dengue is often clinically diagnosed by typical signs and symptoms.
Wen to go for dengue test
1f one has persistent fever for more than two days then one should go for CAC
<Complete Alood Count= check up. 1f the platelet count and WAC count are below than there
usual range one should go for a dengue antigen test. 1f one has continues fever for more than two
days and B or constant headaches one should go for CAC check up. &nd one should decide
whether to go for dengue test depending on the result of CAC counts.
!tiology
.engue fever is cause by dengue virus <.$*C=! mos4uitoDborne flavivirus.
.$*C nssR*$ positive D strand virus of the family flaviviradae0 genusflavivirus. There are four
3
serotype of .$*C. The virus has a genome of about --,,, bases that codes for three structural
proteins! C! pr! $0 seven nonstructural proteins! *S-! *S+a! *S+b! *S8! *S:a! *S:b! *S90
and short non5coding regions on both the 9" and 8" ends.
"reatment of Dengue Fever
There is no specific treatment for dengue fever! because dengue is caused by a
virus and most people recover completely within + weeks. To help with recovery! health
care experts recommend.
'etting plenty of bed rest.
.rinking lots of fluids to prevent dehydration.
Taking medicine to reduce fever.
>latelet transfusions if the platelet level drops significantly <below +,,,,= or if
there are significant bleeding.
!pidemiology
.engue is transmitted by &edes mos4uitoes! particularly A. aegypti and A.
albopictus. .engue may also be transmitted via infected blood products <blood transfusions!
plasma! and platelet=! but the scale of this problem is unknown.
#revention
ethods of prevention of .engue fever mentioned in various sources include those listed
below. This prevention information is gathered from various sources! and may be inaccurate or
incomplete. *one of these methods guarantee prevention of .engue fever.
&void mos4uito bites
os4uito repellant
>rotective clothing
Window screens
Remove water5filled mos4uito breeding areas
&void heavily populated residential areas.
When indoors! stay in air5conditioned or screened areas. Ese bed nets if sleeping areas
are not screened or air5conditioned.
.engue vaccine 5 not yet available but being researched.
1f you have symptoms of dengue! report your travel history to your doctor
#rognosis
4
ost people who develop dengue fever recover completely within two weeks. Some!
however! may go through several weeks of feeling tired andBor depressed.
!co$epidemiological analysis of dengue infection
during an out%reak of dengue fever& India
'ackground
.engue infection <.1= is amongst the most important emerging viral diseases transmitted by
mos4uitoes to humans! in terms of both illness and death .The worldwide large5scale
reappearance of dengue for the past few decades has turned this disease into a serious public
health problem! especially in the tropical and subtropical countries .1t is estimated that 9+F of
the global population are at the risk of contracting .engue fever <./= or dengue hemorrhagic
fever <.H/= lives in the South $ast &sian Region. &lthough all the four serotypes have been
circulating in this region! ecological and climatic factors are reported to influence the seasonal
prevalence of the dengue vector! &edes aegypti! on the basis of which countries in this region are
divided in to four 7ones with different ./B.H/ transmission potential .1n most of the countries!
dengue epidemics are reported to occur! during the warm! humid and rainy seasons! which favor
abundant mos4uito growth and shorten the extrinsic incubation period as well .
./ has been known to be endemic in 1ndia for over two centuries as a benign and self5limited
disease. 1n recent years! the disease has changed its course manifesting in the severe form as
.H/! with increasing fre4uencies ..elhi City <1ndia= is home to more than -8 million people and
is endemic for .1 .(verpopulation has conse4uently led to poor sanitary conditions and water
logging at various places. & ma6or epidemic of .H/ from .elhi was last reported in the year
-GG) after which .1 became a notifiable disease and a number of policies were formulated to
bring the .1 as well as its vector under control. The retrospective studies! one conducted by us
during the period! -GG;D+,,- and another by *ational 1nstitute of Communicable .iseases
<*1C.=! *ew .elhi during the year -GG;! have observed a decline in the number of cases having
either ./ or .H/ in the following years .&lthough! the vector mainly responsible for the spread
of .1 is present all the year around in .elhi! studies on the relative prevalence and distribution
have shown the highest A. aegypti larval indices during the monsoon and post monsoon period .
1n the year +,,8! 1ndia had experienced one of the wettest monsoons in +9 years! which led to a
spate of mos4uito growth creating an alarming situation of mos4uito borne diseases in many
5
states. .elhi experienced an outbreak of ./ this year! after ) years of silence. Studies conducted
in the countries like Ara7il! 1ndonesia and Cene7uela! where .1 is present either in epidemic or
endemic form have suggested a correlation between weather and pattern of .1. Rain! temperature
and relative humidity are suggested as important factors attributing towards the growth and
dispersion of this vector and potential of dengue outbreaks .Since limited data is available on the
association of climatic conditions and the pattern of .1 from this geographical region! this study
was conducted to find out the relationship of dengue infection with climatic factors such as the
rainfall! temperature and relative humidity during the dengue outbreak in the year +,,8.
Distri%ution %y age
(ut of HG8 serologically positive cases! )H; cases belonged to the adultIs age group <J -+ years=
and +,) cases to pediatric age group <K -+ years= in this study. ?arger proportions of
serologically positive cases were observed among adults! with a positive prevalence of 9).:F
among children and 9HF among adults! distribution was however! not significantly different
when compared with pediatric age group <p J ,.,9=. The difference between numbers of
serologically positive cases among adult and pediatric group in post monsoon period as
compared to the rest of the season was also not significant <p J ,.,9=
Discussion
1n the year +,,8! 1ndia had experienced one of the wettest monsoons in +9 years! which led to a
spate of mos4uito growth creating an alarming situation of mos4uito borne diseases in .elhi and
many other states .&s a conse4uence to this unusually heavy rain! an outbreak of dengue fever
was once again reported from .elhi after a silence of six long years. ost of vector borne
diseases exhibit a distinctive seasonal pattern and climatic factors such as rainfall! temperature
and other weather variables affect in many ways both the vector and the pathogen they transmit
.Worldwide studies have proposed that ecological and climatic factors influence the seasonal
prevalence of both the A. aegypti and dengue virus .The vector mainly responsible for the spread
of .1 is present at the basal level all the year around in .elhi! however! studies on the relative
prevalence and distribution have shown the highest A. aegypti larval indices during the monsoon
and post monsoon period .Since limited data is available on the affect of climatic factors on the
pattern of .1! this study was planned to carry out the month wise detailed analysis of three
important climatic factors such as rainfall! temperature and relative humidity on the pattern of
.1.
(bservations on the seasonality were based on a single yearIs data as the intensity of sampling
was at its maximum during this outbreak period. The outbreak coincided mainly with the post
monsoon period of subnormal rainfall! which was followed! by relatively heavy rainfall during
the monsoon period0 from #une to September +,,8. The difference in the total rainfall and
temperature during three seasonal periods was found to be statistically significant <p L ,.,9=.
onthly weather data showed that temperature variations were more amongst different months
during the pre monsoon and post monsoon period as compared to the monsoon period. $ven
though! the monsoon season began in mid5 #une! there was no respite from the heat as there was
not much difference in the temperature during the last month of pre monsoon0 ay and
beginning of monsoon in the #une. Enusual heavy rainfall subse4uently led to decrease in
temperature during the later part of monsoon period. The temperature showed a decline and
6
remained almost constant during the months of #uly and &ugust <8,.+@C=! continuous heavy
rainfall subse4uently led to further decrease in the temperature during the month of September to
+G@C. Relative humidity increased during the rainy season and remained high for several weeks.
&n in5depth analysis of these three factors thus led to a proposal that optimum temperature with
high relative humidity and abundant stocks of fresh water reservoirs generated due to rain!
developed optimum conditions conducive for mass breeding and propagation of vector and
transmission of the virus.
(ur study was in tune with a previous study by *1C. of seasonal variations and breeding pattern
of A. aegypti in .elhi! which showed that there are two types of breeding foci! namely0 primary
and secondary breeding foci. >rimary breeding foci served as mother foci during the pre
monsoon period. A. aegypti larvae spread to secondary foci like discarded tyres! desert coolers
etc.! which collect fresh water during the monsoon period .This study supported the proposal that
all the three climatic factors studied could be playing an important role in creating the conducive
condition re4uired for breeding and propagation of this vector! the basal level of which is present
all round the year. This prospective study therefore highlighted the ma6or important factors!
which could alone or collectively be responsible for an outbreak.
1n our study! the largest proportion of serologically positive cases was recorded in the post
monsoon period! which is in agreement with our previous study .(ur findings were in
coordination with study by other groups from this geographical .The seasonal occurrence of
positive cases has shown that post monsoon period is the most affected period in Aangladesh as
well .However! a retrospective study from yanmar during -GG)D+,,- reported the maximum
cases of dengue during the monsoon period M.Study by group of Rebelo from Ara7il has also
emphasi7ed the importance of season. They have observed that dengue cases were higher during
rainy season showing the importance of rain in forming prime breeding sites for A. aegypti thus
spread of .1 .Study of eco5epidemiological factors by Aarrera et al .showed that ./ has a
positive correlation with the relative humidity and negative relation with evaporation rate. >eaks
of dengue cases were observed to be near concurrent with rain peaks in this study from
Cene7uela showing a significant correlation of intensity of .1 with the amount of rain .1n this
study we have observed that temperature tends to decrease towards the end of monsoon period!
specially remains moreover constant during the later months of rainy season. 1ndia and
Aangladesh fall in the deciduous! dry and wet climatic 7one. The temperature remains high
during the pre monsoon period. 1t is continuous rain pour for a couple of days that brings down
the temperature during the monsoon period! which may also be responsible for an increase in the
relative humidity and decrease in the evaporation rate thus maintaining secondary reservoirs
containing rain water. ore studies are needed to establish the relationship between the climatic
changes and dengue outbreaks! which would help in formulating the strategies and plans to
forecast any outbreak in future! well in advance.
Cery little dengue is found in adults in Thailand! presumably because people ac4uire complete
protective immunity after multiple .1 as children !as .1 is highly endemic in Thailand .(n the
other hand! .1 especially .H/ is an emerging disease in 1ndia0 probably this may be the reason
that people of all the age are found to be sensitive to infection in our study. $ven though more
adults were reported of having anti dengue antibodies! the difference in the number of positive
cases was not significant as compared to pediatric age group.The severity of this outbreak was
lesser as compared to the .H/ epidemic that occurred in year -GG) caused by the serotype .en5
+ .Serotype .en5+ is reported to be the one mainly associated with .H/! the more severe form of
7
the disease .ore studies in this regard can further elucidate correlation of serotypes with
severity of disease from this geographical region.
(onclusion
This prospective study highlighted rain! temperature and relative humidity as the ma6or and
important climatic factors! which could alone or collectively be responsible for an outbreak.
ore studies in this regard could further reveal the correlation between the climatic changes and
dengue outbreaks! which would help in making the strategies and plans to forecast any outbreak
in future well in advance.
#atient Healt History
A) 'I*+RA#HI( DA"A,
*ameN r.C#
&geN ) years old
SexN Child
Civil StatusN Child
Airth .ayN September ,+! +,,8
Home &ddressN Cuyago! #abonga! &gusan del *orte
Religion, Roman Catholic
8
*ationalityN /ilipino
(ccupationN Child
') AD-ISSI*. DA"A
HospitalN Caraga Regional Hospital
Ward serviceN >edia ward
.ate admissionBtimeN arch 8! +,-,
ode of &dmissionN wheelchair
.ate of dischargeN arch G!+,-,
/ital signs upon admission,
WeightN -H kg
HeightN :",""
TemperatureN 8H.9O C
>ulse RateN HH bpm
Respiratory RateN +9 cpm
Alood pressureN --,B;, mmHg
Chief ComplainN 8 days fever >T& D onset of fever of on and off
&ttending >hysicianN .r. .otor
&dmitting >hysicianN .ra. a. ?ourdes T. Cubillan
&dmitting .iagnosisN RBt .engue fever with acute gastritis
/inal diagnosisN .engue fever
>rimary source of dataN >atient
Secondary source of dataN S( and >atient"s chart
.0RSI.+ H!AL"H HIS"*R1
.ate of &ssessmentN arch 8! +,-,5 arch 9! +,-,
Source of 1nformationN patient! S( and chart
() HIS"*R1 *F #R!S!." ILL.!SS
Aefore admission to the hospital the patient experience nausea and vomiting and fever. So!
last arch 8! +,-, at -,N8, am! patient was rushed to the hospital due to on and off fever and
9
sudden stomachache to seek medical assurance as verbali7ed by the grandmother. He was then
admitted at Caraga Regional Hospital and referred to the physician.
D) #AS" H!AL"H HIS"*R1
r. C# experienced childhood illness such as mumps and measles but was not able recall
the exact date it occurred. He did not have any poliomyelitis and rubella as claimed by his
grandmother. r. C# completed his immuni7ations in Health Center like AC'! .>T! (>C! Hepa
A and easles.
He also experienced cough and fever as verbali7ed by the S(.
Vaccine Minimum
Age at 1st
Dose
Number
of
Doses
Minimu
m
Interval
Betwee
n Doses
Reason
BCG Brth or
anytme
after brth
1 BCG gven at earest possbe
age protects the possbty of TB
menngts & TB nfectous n
whch nfants are prone.
DPT 6 weeks 3 4 weeks An eary start wth DPT reduces
the chance of severe pertusss
OPV 6 weeks 3 4 weeks The extent protecton aganst
poo s ncreased the earer the
OPV s gven
Keeps the Phppne poo free
Hep B At brth 3 6 weeks
nterva
from

1
st
dose to
2
nd
dose,
and ; 8
weeks
nterva
from 2
nd
dose to
3
rd
dose.
An eary start of Hep B reduces
the chance of beng nfected and
becomng a carrer.
Prevent ver crrhoss and ver
cancer.
About 9000 de of compatons
of HB.
10% of Fpnos have chronc HB
nfecton..
Emnate HB before 2012 .
10
'randm
other
/athe
r
> other
'randfatherher
S
I
B
L
I
N
G
S
Meases 9 months At east 85% of meases can be
prevented by mmunzaton at
ths age.
Prevents deaths (2% de),
manutrton, pneumona,
darrhea (at east 20%) get these
compatons from meases) etc.
Emnate meases by 2008.
History of Hospitali2ationN
*o past history of hospitali7ation.
Family ealt istory,
r. C# was the youngest among the three siblings. The patient"s mother was diagnosed
due to hypertension and his grandfather diagnosed due to diabtes.
+enogram
11

#!RS*.AL A.D S*(IAL HIS"*R1
LIF!S"1L!,
>ersonal habitsN The patient doesn"t smoke and drink alcoholic beverages. He likes playing with
his friend.
12

DI!" ,
#re Hospitali2ation,
r. C#! His like to eat fruits and 6unk foods. >atient usually consumed one cup
rice! two hotdogs or one egg and one glass of milk for his breakfast. .uring lunch time
one cup of rice! fried chicken and two glasses of water. .uring dinner time one cup of
rice! one to two slice of 2adobong baboy3 and two glasses of water will do. He can
consume five to six glasses of water a day.
0pon Hospitali2ation,
When patient was hospitali7ed! his physician ordered diet as tolerated with no
colored foods like chocolate! milo and chuckie.
SL!!# 3 R!S" #A""!R.
#re$ Hospitali2ation,
>atient usually sleeps at HN,, pm and wake up ;N,, am. He also takes
an afternoon nap after lunch for + hours with a total of -8 hours of sleep.

0pon 4 Hospitali2ation,
His sleeping pattern in the hospital is 4uite different to his usual routine of sleep.
He has difficulty in sleeping since he is always disturbed by itching. *ow he usually
sleep at HN,,pm! then he will be awaken by --N,,pm and goes back to sleep around
-N,,am until 9N,,am. 1n the day time! he sleeps at GN,,am to --N,, am! +N,, pm to
8N,,pm with a total number of ten hours of sleep.
!limination #attern,
#re$ Hospitali2ation,
The fre4uency of his urination was 9 times a day0 8 times in the morning and +
times at night. He defecates every morning and has no difficulty in voiding and
defecating.
13
0pon$ Hospitali2ation,
.uring hospitali7ation the patient has bathroom privileges.
Activity of Daily Living,
#re$ Hospitali2ation,
The patient will go to the school and at the recess time the patient were eating
with his friends and having playing after. &fter the class he goes home to watch television.
0pon$ Hospitali2ation,
>atient has always been on bed most of the time.
Recrea tion 5 Ho%%ies,
The patient is a preschooler in Cuyago! #abonga! &gusan .el *orte. He was
spending his time in canteen and playing with his classmates.
S*(IAL DA"A,
Family Relationsip5 Friendsip
With regards to their family relationship! >atient has strong family ties and their
parents are very supportive with regards to their studies. He has many friends to play with.
!ducational Attainment 5 Socio$economic Data
14
1n his education! the patient is still a preschooler at Cuyago! #abonga! &gusan del
*orte.
Home and .eig%orood (onditions
>atient resides in Cuyago! #abonga! &gusan del *orte. He lives in a semi concrete
house with : bedrooms and a comfort room and has a backyard with plants. &t the neighborhood
house! lot of hanging clothes! some tire that have water in the inside and some cans that full of
water. Their environment has lot of trees.
D!/!L*#-!."AL "AS6
+rowt and Development,
The school age! from ) to -+ years old! in the psychosocial development of $rik
$rikson"s the 1ndustry vs. 1nferiority. /rom age six years to puberty! children begin to develop a
sense of pride in their accomplishments. They initiate pro6ects! see them through to completion!
and feel good about what they have achieved. .uring this time! teachers play an increased role in
the child"s development. 1f children are encouraged and reinforced for their initiative! they begin
to feel industrious and feel confident in their ability to achieve goals. 1f this initiative is not
encouraged! if it is restricted by parents or teacher! then the child begins to feel inferior! doubting
his own abilities and therefore may not reach his potential.
&ccording to /reud"s Stages of >sychosexual .evelopment! age six to puberty is in
?atency stage. .uring this stage that sexual urges remain repressed and children interact and
play mostly with same sex peers.
/ital Signs
arch 8! +,-,
;am58pm Shift 8pm5--pm Shift --pm5;am Shift
H am -+ pm :pm Hpm -+am :am
Temp 8H.9OC 8HOC 8GOC 8;.-OC 8H.9C 8;.+OC
>R HH bpm HG bpm G, bpm G, bpm H; bpm G9 bpm
RR +9 cpm +: cpm ++ cpm +: cpm +9 cpm +8 cpm
A> --,B;, mmHg -,,B;,
mmHg
--,B),
mmHg
--,B;,
mmHg
G,B), -,,B),
15
#H1SI(AL ASS!SS-!."
+!.!RAL S0R/!1,
Received patient lying on bed with an 1C/ <>?*SS -?= attached at the right arm! awake
and conscious. >atient facial expression reflects tardiness! he appeared weak and fatigue. .uring
our assessment! he wears clean clothes.
S6I.,
>ectichial rash noted
Warm to touch
*o skin lesion
*ormal skin turgor
Tourni4uet Test <Rumpel ?eads Test=
16
arch :! +,-,
;am58pm Shift 8pm5--pm Shift --pm5;am Shift
H am -+ pm :pm Hpm -+am :am
Temp 8H.9OC 8;.+O C 8;.9OC 8H.-OC 8H.9OC 8H.:OC
>R HH bpm G+ bpm G9 bpm GH bmp G) bpm G: bpm
RR +9 cpm ++ cpm +- cpm ++ cpm +8 cpm +8 cpm
A> --,B;, mmHg --,B),
mmHg
-,,B),
mmHg
--,B), -,,B),
mmHg
--,B;,
mmHg
arch 9! +,-,
;am58pm Shift 8pm5--pm Shift --pm5;am Shift
H am -+ pm :pm Hpm -+am :am
Temp 8H.9OC 8;.9OC 8HOC 8H.8OC 8H.+OC 8H.+OC
>R HH bpm G, bpm HG bpm G+ bpm G9 bpm G9 bpm
RR +9 cpm +9 cpm +8 cpm ++ cpm +: cpm +: cpm
A> --,B;, mmHg --,B),
mmHg
-,,B;,
mmHg
-,,B),
mmHg
--,B;,
mmHg
-,,B;,
mmHg
1nflate the blood pressure cuff on the upper arm to a point midway between the systolic
and diastolic pressure for minutes
Release cuff and make an imaginary +.9 cm. s4uare or - inch s4uare 6ust below the cuff!
at the antecubital fossa.
Count the number of petechiae inside the box.
(r a test is <P= when +, or more petechiae per +.9 cm. s4uare or - inch s4uare are
observed.
HAIR,
$venly distributed hair
Short and thick hair
Alack color
*o dandruff on the scalp noted
.AILS,
Short! clean nails of both fingers and toes noted
*ails are convex curvature with an angle at about -), degrees
*o early clubbing noted
*ail texture is smooth
Tissue surrounding nails are intact
!1!S A.D /ISI*.,
*o edema or tenderness! over lacrimal gland
>$RR?& observed
Symmetric in shape
Coordinated eye notedBblink reflex intact
!ARS A.D H!ARI.+,
*o discharge noted
*o pain palpation
&uricles same color as facial skin
*o difficulty in hearing spoken words
>inna recoils after it is folded
Symmetric in shape
.*S! A.D SI.0S!S,
Colds noted
*o pain upon palpation
Symmetrical and straight
Eniform in color as facial skin
-*0"H& LI#S A.D "HR*A",
17
Slightly >ink lips noted
Tongue in central position
Teeth is yellowish in color
>ink gums<bluish or dark patches in dark skin client=
.!(6,
Trachea is central placement in the midline of the neck
uscles e4ual in si7e! head center
+AS"R*I."!S"I.AL,
&bdominal pain upon palpation
&udible bowel sounds noted
-0S(*L*S6!L!"AL,
*o history of fracture
Aody weakness noted
uscle strength e4ual
(ADI*/AS(0LAR A.D #!I#H!RAL S1S"!-,
>ulseN9; bpm
>atient is not cyanotic
*o palpation noted
*o 6ugular vein
+!.I"*0RI.AR1 S1S"!-,
*o pain noted
With yellow urine noted
(RA.IAL .!R/!S,
1. (lfactory5 &ble to identify different aromas
II. (ptic5 >atient has normal visual ac4uity
III. (culomotor5 >upil is constricted upon focusing in the light
IV. Trochlear5 >atient eyeball can able to move downward Q laterally
C. TrigeminalN
a) (pthalmic branch5 blink reflex present
b= axillary branch5 able to fail sensation being introduced to him
c) andibular branch5 able to clench his teeth
/I) &bducens5 able to move his eyeball laterally of both eyes
18
/II) /acial5 patient can able to identify various test! and can open his eyes
spontaneously
/III) &uditoryN
a= Cestibular branch5 the patient is cooperative
b= Cochlear branch5 patient can hear clearly
I7) 'lossopharyngeal5 patient has no problem on swallowing
7) Cagus5 patient has no problem in swallowing
7I) &ccessory5 patient has full range of motion and can turn head left and right side.
7II) Hypoglossal5 able to protrude his tongue and move it is side to sides.
19
20
(ranial .erve Assessment
.erve .ame Function "est
I (lfactory Smell Have athlete smell a familiar odor
II (ptic Cisual &cuity
Cisual /ield
Have athlete identify fingers
Check peripheral vision
III (culomotor >upillary Reaction Shine ?ight in the eye
I/ Troculear $ye ovement /ollow finger without moving the head
/ Trigeminal /acial Sensation
otor /unction
Touch the face
Have athlete hold mouth open
/I &bducens otor /unction ?ateral $ye movements
/II /acial otor /unction
Sensory
Smile! wrinkle face! puff cheeks
Tastes
/III &coustic Hearing
Aalance
Snap fingers by the ear
RhombergIs Test
I7 'lossopharyngeal Swallowing and
Coice
Swallow and say R&HR
7 Cagus 'ag Reflex Ese tongue depressor
7I Spinal &ccessory *eck otion Shoulder shrugging
7II Hypoglossal Tongue ovement
and Strength
Stick out tongue apply resistance with a tongue
depressor
Anatomy and #ysiology
'lood
Human blood smearN
a D erythrocytes0 b D neutrophil0
c D eosinophil0 d D lymphocyte.
'lood is a speciali7ed bodily fluid that delivers necessary substances to the bodyIs cells D
such as nutrients and oxygen D and transports waste products away from those same cells.
Blood is comosed of!
Red cells or erytrocytes
?arge microscopic cells without nuclei.
>roduced continuously in our bone marrow from stem cells at
a rate of about +58 million cells per second.
ake up :,59,F of the total blood volume.
Transport oxygen from the lungs to all of the living tissues of
the body and carry away carbon dioxide.
Have about +;,!,,,!,,, iron5rich hemoglobin molecules.
Red color of blood is primarily due to oxygenated red cells.
"#ite cells or leu$oc%tes
Exst n varabe numbers and types but make up
a very sma part of bood's voume--normay
ony about 1%.
They occur elsewhere in the body as well! most notably in the
spleen! liver! and lymph glands.
ost are produced in our bone marrow from the same kind of
stem cells that produce red blood cells.
(thers are produced in the thymus gland! which is at the base
of the neck.
21
Some white cells <called lymphocytes= are the first responders for our immune system.
Some white cells <called lymphocytes= are the first responders for our immune system.
#latelets or trom%ocytes
cell fragments without nuclei that release blood clotting
chemicals at the site of wounds.
They do this by adhering to the walls of blood vessels!
thereby plugging the rupture in the vascular wall.
They also can release coagulating chemicals which cause
clots to form in the blood that can plug up narrowed blood
vessels.
1ndividual platelets are about -B8 the si7e of red cells.
They have a lifespan of G5-, days.
produced in bone marrow from stem cells.
Hemoglo%in
is the iron5containing oxygen5transport metalloprotein
in the red blood cells of vertebrates!
S
and the tissues of
some invertebrates.
Hemoglobin has an oxygen binding capacity between
-.8) and -.8; ml (
+
per gram of hemoglobin!
M+S
which
increases the total blood oxygen capacity seventyfold.
#lasma
Clear li4uid water <G+PF=! sugar! fat! protein and salt
solution which carries the red cells! white cells! platelets!
and some other chemicals.
*ormally! 99F of our bloodIs volume is made up of
plasma.
&bout G9F of it consists of water.
Contains blood clotting factors! sugars! lipids! vitamins!
minerals! hormones! en7ymes! antibodies and other
proteins. 1t is likely that plasma contains some of every
protein produced by the body55approximately 9,, have
been identified in human plasma so far.
Functions of 'lood
22
(onstituent of Human 'lood
Structure Functions
23

8)
9)
-aintains 'ody "emperature
:)
;)
<)
"r
ans
po
rts
,
.i
sso
lve
d
gas
es
<e.
g.
ox
yg
en!
car
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n
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e=0
W
ast
e
pro
du
cts
of
me
tab
oli
sm
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g.
wa
ter!
ure
a=0
Ho
rm
on
es0
$n
7y
me
s0
*u
trie
nts
<su
ch
as
glu
cos
e!
am
ino
aci
ds!
mi
cro
5
nut
rie
nts
<vi
ta
mi
ns
Q
mi
ner
als
=!
fatt
y
aci
ds!
gly
cer
ol=
0
>la
sm
a
pro
tei
ns
<as
soc
iat
ed
wit
h
def
ens
e!
suc
h
as
blo
od5
clo
ttin
g
an
d
ant
i5
bo
die
s=0
Al
oo
d
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ls
<in
cl.
wh
ite
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ls
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yte
sI!
an
d
red
blo
od
cel
ls
Ier
yth
roc
yte
sI=.
(o
ntr
ols
pH
Th
e
pH
of
blo
od
mu
st
re
ma
in
in
the
ran
ge
).H
to
;.:
!
oth
er
wi
se
it
be
gin
s
to
da
ma
ge
cel
ls.
Re
mo
ves
to=
ins
fro
m
te
%o
dy
Th
e
kid
ne
ys
filt
er
all
of
the
blo
od
in
the
bo
dy
<ap
pro
x.
H
pin
ts=!
8)
tim
es
ev
ery
+:
ho
urs
.
To
xin
s
re
mo
ve
d
fro
m
the
blo
od
by
the
kid
ne
ys
lea
ve
the
bo
dy
in
the
uri
ne.
<T
oxi
Re
gul
ati
on
of
'o
dy
Flu
id
!le
ctr
oly
tes
$x
ces
s
sal
t is
re
mo
ve
d
fro
m
the
bo
dy
in
uri
ne!
wh
ich
ma
y
co
nta
in
aro
un
d
-,
g
sal
t
per
da
y
<su
ch
as
in
the
cas
es
of
pe
opl
e
on
we
ste
rn
die
ts
co
nta
ini
ng
mo
re
sal
t
tha
#lasma
*ormal blood plasma is G,5G+ F
water.
This is the straw5coloured fluid in
which the blood cells are suspended!
and consists ofN
The medium in which the blood
cells are transported around the
body <by the blood vessels= and are
able to operate effectively.
Helps to maintain optimum body
temperature throughout the
organism.
Helps to control the pH of the
blood and the body tissues!
maintaining this within a range at
which the cells can thrive.
Helps to maintain an ideal balance
of electrolytes in the blood and
tissues of the body.

.issolved substances including
electrolytes such as sodium!
chlorine! potassiun! manganese!
and calcium ions0
Alood plasma proteins <albumin!
globulin! fibrinogen=0
Hormones.
!rytrocytes
>Red %lood
cells?
1mmature erythrocytes have a
nucleus but mature erythrocytes
have no nucleus.
Carry oxygen

Haem
$rythrocytes have a Rprosthetic
groupR <meaning Rin addition toR 5
in this case! in addition to the cell=.
The active component of this
prosthetic group is Haem.
Haem relies on the presence of
iron </e=.
Haem combines with oxygen to
form oxyhaemoglobinN
.


$rythrocytes are eventually broken
down by the spleen into the blood

24
pigments bilinubin and bilviridin!
and iron. These components are
then transported by the blood to
the liver where the iron is re5
cycled for use by new
erythrocytes! and the blood
pigments form bile salts. <Aile
breaks down fats.=

Have a longevity of approx. -+,
days.


There are approx. :.9 5 9.H million
erythrocytes per micro5litre of
healthy blood <though there are
variations between racial groups
and menBwomen=.

Leucocytes
>Wite %lood
cells?
There are different types of
leucocytes <described in more
detail 5 below=! classified asN
'ranularN e.g. *eutrophils!
$osinophils! Aasophils.
&granular <do not contain
granules=N e.g. onocytes!
?ymphocytes.
a6or part of the immune system.
Have a longevity of a few hours to
a few days <but some can remain
for many years=.

There are approx. 9!,,, 5 -,!,,,
leucocytes per micro5litre of blood.

"rom%ocytes
>#latelets?
Alood platelets are cell fragments0 To facilitate blood clotting 5 the
purpose of which is to prevent loss of
body fluids.
.isk5shaped0
.iameter +5: um
<- micro5metre T - um T
,.,,,,,-m=0

25
Have many granules but no
nucleus0

Have a longevity of approx. 95G
days.

There are approx. -9,!,,, 5
:,,!,,, platelets per micro5litre of
blood.

"e *=ygenation of 'lood
The oxygenation of blood is the function of the erythrocytes <red blood cells= and takes place in
the lungs. The se4uence of events of the blood becoming oxygenated <in the lungs= then
oxygenating the tissues <in the body= is as followsN

The Right Centricle <of the heart= sends de5oxygenated blood to the lungs.

While in the lungsN
-. Carbon .ioxide diffuses out of the blood into the lungs! and
+. (xygen <breathed into the lungs= combines with haemoglobin in the blood as it passes
through the lung capillaries.

(xyhaemoglobin returns to the heart via the pulmonary vein and then enters the systemic
circulation via the aorta.

There is a low concentration of oxygen in the body tissues. They also contain waste
products of the metabolism <such as carbon dioxide=.

.ue to the high concentration of oxygen in the blood and the low concentration of oxygen
in the tissues!


... the high concentration of carbon dioxide in the tissues diffuses into the blood. <G9F of
this carbon dioxide dissolves in the blood plasma.=

Alood returns from the tissues back to the heart via the superior vena cava <from the upper5
body= and the inferior vena cava <from the lower5body=
26
R!/I!W *F "H! S1S"!-
I."!+0-!."AR1 S1S" !-,
>atient has no history of skin disease
*o skin allergies in foods
Skin is flush or pale pink rash all over the body
Skin is slightly hot to touch during the +
nd
assessment0
R!S#IRA"*R1 S1S"!-,
>atient has no difficulties in breathing
*o history of tonsillitis and sore throat
(ARDI*/AS(0LAR S1S"!-,
*o history of hypertension
>ulse Rate is with in normal range
>atient has no history of heart problem
27
+!.!"*0RI.AR1 S1S"!-,
>atient urinates : times a day
>atient has no history of renal disease
+AS"R*I."!S"I.AL S1S"!-,
&bdominal pain
-0S(0L*S6!L!"AL S1S"!-,
>atient appeared weak and fatigue
*o history of any surgery
!.D*(RI.! S1S"!-,
>atient has no history of thyroid problems
28
.!0R*L*+I( S1S"!-,
He is able to say what he feels and understand
what his significant others say to him.
*o history of paralysis
H!-A"*L*+I(,
>atient"s blood types is 2(3 antigen
HematocritN as of arch 8! +,-, is :-.;F0
ach :! +,-, is 8; F! 8; F at )N,,pm! 8: F0
arch 9 ! +,-, is 89F at -+ midnight.
>lateletN as of arch 8! +,-, is 99 x-,
G
B?0
arch :! +,-, is :; x-,
G
B?! 8G x-,
G
B? at
)N,, pm! 98 x-,
G
B?! arch 9! +,-, at -+
midnight is 9; x-,
G
B?.
29
LA'*RA"*R1 R!S0L"S
H!-A"*L*+1
arch 8! +,-,
"!S" R!S0L" 0.I" R!F!R!.(!
Hematocrit :-.; F :,59+
>latelet count 99 x-,
G
B? -9,5:,,
arch :! +,-,
"!S" R!S0L" 0.I" R!F!R!.(!
Hematocrit 8; F :,59+
>latelet count :; x-,
G
B? -9,5:,,
arch :! +,-, D )N,,pm
"!S" R!S0L" 0.I" R!F!R!.(!
Hematocrit 8; F :,59+
>latelet count 8G x-,
G
B? -9,5:,,
30
arch :! +,-,
"!S" R!S0L" 0.I" R!F!R!.(!
Hematocrit 8: F :,59+
>latelet count 98 x-,
G
B? -9,5:,,
arch 9! +,-,5 -+N,, midnight
"!S" R!S0L" 0.I" R!F!R!.(!
Hematocrit 89 F :,59+
>latelet count 9; x-,
G
B? -9,5:,,
0rinalysis
Chemca reacton:
31
&'S& R'S(L& R')'R'N*' SIGNI)I*AN*
'
Coor yeow yeow- amber Norma
Sugar negatve negatve Norma
Transparency cear cear Norma
Sp gravty 1.005 1.010-1.030 Deuted
Proten negatve negatve Norma
RBC 0-1/hpf 0-1 Norma
E ces negatve negatve Norma
pH 6 6.5-7.5 Acdc
Input and *utput -onitoring Seet
INTAKE OUTPUT
DATE ORAL PARENTERAL TOTAL DATE URINE STOOL OTHERS TOTAL
32
7-3 7-3
3-11 80cc 700cc 780cc 3-11 900cc - - 900cc
11-7 80cc 450cc 530cc 11-7 900cc - - 900cc
&otal!
1+,1-cc
&otal!
1.--cc
&otal!
1.--cc
INTAKE OUTPUT
DATE ORAL PARENTERAL TOTAL DATE URINE STOOL OTHERS TOTAL
7-3 2000
cc
400cc 2400c
c
7-3 1200c
c
1200c
c
3-11 1500
cc
300cc 1800c
c
3-11 1000c
c
1 - 1000c
c
11-7 1000
cc
150cc 1050c
c
11-7 900cc 1 - 900cc
&otal!
/+,/-cc
&otal!
,+1--cc
&otal!
,+1--c
DR0+ S"0D1
DateN arch 8! +,-, <,9N,,pm=
+eneric .ame, &luminum
'rand .ame,
Dosage, +, cc now then -, cc T1.
(lassification,
33
Indications,
-ecanism of Action,
(emical !ffect,
"erapeutic !ffectN
(ontraindications,
AD/!RS! R!A("I*.,
.ursing (onsideration,
Date, arch 8! +,-, <,)N,,pm=
+eneric .ame, Salbutamol P guaifenesin
'rand .ame,
Dosage,
(lassification, expectorant
Indications,
Treatment for respiratory tract infection and for excessive mucus secretions
34
-ecanism of Action,
Reduces viscosity of tenacious secretions by increasing respiratory tract fluid
(ontraindications,
Contraindicated to patients with hypersensitive to the drug and its components
AD/!RS! R!A("I*.N
C*SN di77iness! headache! insomnia! nervousness! tremor
CCN hypertension! palpitations! tachycardia
$$*TN drying and irritation of nose and throat
'1N heartburn! nausea! vomiting
$T&A(?1CN hypokalemia! weight loss
ESCE?(SU$?$T&?N muscle cramps
.ursing (onsideration,
Date, arch 8! +,-, <,)N,,pm=
+eneric .ame, >aracetamol
'rand .ame, Tempra
Dosage, +9mgB9ml ) cc 4 : hrs prn
(lassification, nonopioid analgesic
Indications,
ild pain or fever.
-ecanism of Action,
(emical !ffect, ay produce analgesic effect by blocking pain impulses! by inhibiting
prostaglandin or pain receptor sensiti7ers. ay relieve fever by acting in hypothalamic
heat5regulating center.
"erapeutic !ffect, Relieves pain and reduces fever.
35
(ontraindications,
Contraindicated in patients hypersensitive to drug. >atient undergoing long term therapy
for chronic non congestive angle5closure glaucoma! and patient"s with hyponatremia!
hypokalemia! renal or hepatic impairment adrenal gland failure and hypercloremic
acidosis.
AD/!RS! R!A("I*.,
C*SN .rowsiness! >arathesia
'EN Hematuria
'1N *ausea
HematologicN Hemolytic anemia! neutropenia! leucopenia! pancytopenia!
thrombocytopenia
HepaticN liver damage
etabolicN Hypoglycemia
.ursing (onsideration,
&ssess patient"s pain or temperature before and during therapy.
&ssess patient"s drug history. any (TC products and combination prescription pain
products contain acetaminophen. Calculate daily dosage accordingly.
Ae alert for adverse reaction and drug interactions.
Date, arch 8! +,-, < -+ pm=
+eneric .ame, Ranitidine
'rand .ame, Vantac
Dosage, 89 mg 1CTT 4 H hrs.
(lassification, &nti5ulcerative
Indications,
.uodenal and gastric ulcer
'astroesophangeal reflux disease
-ecanism of Action,
(emical !ffect, Competitively inhibits action if H+ at receptors sites of parietal cells!
decreasing gastric acid secretion.
36
(ontraindications,
Contraindication in patient"s hypersensitive to the drug or any of its components.
Adverse Reaction,
C*SN headache! fatigue
CCN Chest pain
'1N *ausea and vomiting! abdominal pain
.ursing (onsiderations,
&ssess patient"s '1 condition before starting therapy and regularly there after to monitor
the drug"s effectiveness.
Ae alert for adverse reaction and drugs interactions.
&ssess patient"s and family"s knowledge of drug therapy.
1nstruct patient"s not to drink alcohol during therapy.
Date, arch 8! +,-,
+eneric .ame, &mpicillin
'rand .ame, *ovo5&mpicillin
Dosage, 9,,mg 1CTT 4 )hrs
(lassification, antibiotic
Indications,
Respiratory tract or skin structure infection
'astrointestinal infection
ET1
Aacterial meningitis or septicemia
-ecanism of Action,
(emical !ffect, inhibits cell5wall synthesis during microorganism multiplication.
"erapeutic !ffect, kills susceptible bacteria! including non5penicillinase producing
'ram5positive bacteria and many gram5negative organisms.
(ontraindications,
37
#recipitating Factors,
&geN ) years old
SexN child
Aite of a Cirus carrying &edes aegypti mos4uito
os4uito in6ects fluid into victim"s skin
Cirus enters blood stream
1nfects cells and generate cellular response
/ever
Headache
&bdominal pain
*ausea
Comiting
>aracetamol
Contraindicated in patients hypertensive to the drug or other penicillins.
Adverse Reactions,
(.S, sei7ure
(/, vein irritation
+I, nausea! vomiting! diarrhea! glossitis
Hematologic, anemia! thrombocytopenia! leucopenia
*ter, anaphylaxis
.ursing (onsideration,
(btain history of patient"s infection before therapy and observe throughout
therapy to assess improvement.
&sk patient about previous allergic reaction to penicillin. & negative history of
penicillin allergy doesn"t rule out future reaction.
onitor patient"s hydration status if deserve '1 reaction occurs.

#A"H*#H1SI*L*+1
38
#recipitating Factors,
$ndemic area of .engue /ever
1nfected mos4uito &edes aegypti
Hanging clothes inside the house
Rubber tires
$mpty cans
.ehydration
1nitiates immune response
<Stimulates release of cytokines=
Cytokines destroy cell membrane and cell wall
.evelop non5neutrali7ing antibodies
1ncreased activation of kinins
and release vascular
premeability
When treated early with
doctor prescribe
medications and manage to
prevent the appearance of
other symptoms
When illness becomes severe
.amage cells due to both
cytokines and virus
1C/"s and $lectrolyte
replacement and
precautions
Hyperpyrexia
/acial flushing
Convulsions
>etechial rash
1ncreased capillary
permeability
Ranitidine
Ranitidine
39
&mpicillin
>atient recovers Thrombocytopenia
Hemoconcentration
$ffusion
$dema
?ow serum albumin
Circulatory collapse
.ecreased peripheral
perfusion
?owering of temperature
Severe abdominal pain
Aloddy vomitus
Aleeding fom '1T in a form of melena
Circulatory instability
.0RSI.+ (AR! #LA.
.o) 8
Date, arch 8! +,-,
"ime, ;am58pm shift
ASS!SS-!.",
Su%@ective cues, 2Tognaw ako lawas3 as stated by the client
*%@ective cues,
/lushed skin
Warm to touch
With pale and dry lips
1rritability *oted
Aody Weakness *oted
CBS monitoring Temp. 8H.9! >R HH! RR +9! A> --,B;,
DIA+.*SIS, Hyperthermia related to infection process secondary to dengue fever.
#LA..I.+, Within H hours of rendering nursing intervention to our care patient Q
significant others will be able toN
aintain core temperature within normal range! decrease of temperature
from 8H.9O C to normal.
.emonstrate behavior to promote and maintain normothermia.
Ae free from any complication such as sei7ures or convulsion.
I-#L!-!."A"I*.S,
40
Independent Rationale
-.$stablish rapport To gain trust and cooperation
+.Close monitoring of CBS! -Q( To have a baseline data
8.>erform TSA To facilitate heat loss by evaporation Q
conduction.
:.$ncourage to increase (/1 To avoid dehydration
9.>rovide cool environment To facilitate heat loss by conviction
).>romote ade4uate sleep and rest To decrease metabolic demands
;. Watch out for any signs Q symptoms
of complications or unusuality such as
sei7ures.
To be able to detect early signs and symptoms
and provide appropriate nursing intervention
Dependent .ursing Intervention
-. &dminister >( meds. &s ordered by the attending physician! paracetamol.
!/AL0A"I*.,
'oal met after the span of our care the patient Q significant others was
able toN
aintain core temperature with in normal range Q decrease of
temperature as evidence by 8;.9O C temperature.
.emonstrate behaviors to monitor Q promote normothermia.
Ae free from any complications such as sei7ures and convulsion.
41
.o) 9
Date, arch 8! +,-,
"ime, ;am58pm shift
ASS!SS-!.",
Su%@ective cues,
2Sakit ako tiyan3 as verbali7ed by the patient.
*%@ective cues,
'rimace face noted
With pale and dry lips noted
*ot in respiratory distress
1rritability noted
Restlessness noted
Aody weakness noted
>ain scale of ) over -,
'uarded position noted
DIA+.*SIS, &cute pain related to abdominal irritation secondary to dengue fever.
#LA..I.+, Within : hours of rendering nursing intervention to our care patient Q
significant others will be able toN
Cerbali7e relieve of pain from pain scale of )B-, t, :B-,
/ollow prescribe pharmacological regiment Q non
pharmacological regiment
.emonstrate use of diversion activity relaxation scales such as
deep breathing exercise.
I-#L!-!."A"I*.S,
Independent Rationale
-. $stablish rapport To gain trust Q cooperation
42
+. &ssess for pain scale To have a baseline data
8. >rovide comfort measure Q guide
environment
To promote non5pharmacological pain
management
:. $ncourage use of relaxation techni4ue
such as deep breathing exercise
To destruct attention Q reduce tension
9. $ncourage verbali7ation of feeling To asses the intensity of pain

Dependent nursing Intervention
'ive medication as prescribe by the attending physician! Ranitidine.
!/AL0A"I*.,
'oal met after our nursing intervention! patient and significant others was
able toN
Cerbali7ed relieve of pain as evidence by pain scale of
:B-,.
/ollow prescribed pharmacological regiment and non5
pharmacological.
.emonstrate use of diversional activities or relaxation scale
such as deep breathing exercise
43
.o) :
Date, arch :! +,-,
"ime, ;am58pm shift
ASS!SS-!.",
Su%@ective cues,
2dili ako katuyog kay dukag ako lawas3 as verbali7ed by the client
*%@ect cues,
Sunkin eyes noted
Restlessness noted
1rritability noted
Aody weakness noted
Wawning noted
DIA+.*SIS, Sleep retardation related to prolong discomfort <itchiness Q cough= secondary
to dengue fever.
#LA..I.+, Within H hours of rendering nursing intervention to our care patient and
significant others will be able toN
1dentify appropriate intervention to promote sleep
Report in improvement in sleep pattern.
I-#LI-!."A"I*.S,
Independent Rationale
-. $stablish rapport To gain trust Q cooperation
+. Recommend 4uit activities such as listening
to sopping music
To reduce stimulation to client to relax
8. >rovide calm! 4uit environment Q manage
controllable sleep disrupting factors.
To assess client to establish optimal sleep
pattern
:. $ncourage client to verbali7e feeling
regarding discomfort.
To assess its intensity
9. $ncourage to increase (/1. To lessen or reduce coughing
44
Dependent .ursing Intervention
&dminister >( meds. &s prescribe by the attending physician.
!/AL0A"I*.,
'oal partially met after the span of our care the patient and significant
others was be able toN
1dentify appropriate intervention to promote sleep.
Report improvement in sleep pattern as evidence by patient
verbali7ation of 2ok naman akong katolog3
.o) ;
Date, arch :! +,-,
"ime, ;am58pm shift
45
ASS!SS-!.",
Su%@ective cues,
2 Uasokahon ako kay lood man gud3 as verbali7ed by the patient.
*%@ective cues,
'agging noted
Comited 8x with a normal amount
/re4uent swallowing noted
Aody weakness noted
Restlessness noted
DIA+.*SIS, *ausea related to pharmaceutical side effect secondary to dengue fever.
#LA..I.+, Within the span our care the patient Q significant others will be able to reduceN
Reduce Q prevent the tendency to vomit
Relieve Q prevent the feeling of nausea
>rovide rest Q comfort.
I-#LI-!."A"I*.S,
Independent Rationale
-. $stablish rapport To gain trust and cooperation
+. &ssess for the tendency to vomit To be able to assess the fre4uency of nausea
8. >rovide clean peaceful environment
They maybe able to reduce the stimulation or
worsen nausea
:. >rovide fre4uent oral care To cleanse mouth Q minimi7e bad taste
9. $ncourage deep Q slow breathing
To limit dwelling on unpleasant sensation
Dependent .ursing Intervention,
&dministration of >( meds as attending physician order! ranitidine.
!/AL0A"I*.,
'oal partially met after the span of our care patient Q significant others
was able toN
46
Reduce and prevent the .engue to commit
Relieve and prevent the feeling of nausea as evidence by
watcher verbali7ation 2ni arang arang na cya! dli pareha
adtong kagainah.3
>rovide rest and comfort
.o) <
Date, arch :! +,-,
"ime, ;am58pm shift
ASS!SS-!.",
47
Su%@ective cues,
2Uatol lage ako lawas3 as verbali7ed by the patient.
*%@ective cues,
With skin rushes noted
Restlessness noted
1rritability noted
*ot in respiratory distress
Aody weakness noted
/re4uent itching
DIA+.*SIS, 1mpaired skin integrity related to presence of rushes secondary to dengue fever
#LA..I.+, Within the span of our care patient Q significant others will be able toN
>articipate prevention measures Q treatment program.
Cerbali7e feelings Q ability to manage situation.
I-#LI-!."A"I*.S,
Independent Rationale
-. $stablish rapport To gain trust and cooperation
+. $ncourage to verbali7e skin discomfort
To assess the intensity
8. keep the area clean Q dry
To assess bodies natural process of repair
:. >rovide comfort measures
To promote non5pharmacological managements
9. 1nspect skin rashes To assess client with correcting or minimi7e the
condition
!/AL0A"I*.,
'oal partially met after the span of our care the patient Q significant
others was able toN
>articipate in prevention measures Q treatment program.
Cerbali7ed feelings Q ability to manage situation as
evidence by patient verbali7ation of 2 katol c6a pero dili
nako kayoton kay bac masamad cya3.
48
.o) A
Date, arch 9! +,-,
"ime, ;am58pm shift
ASS!SS-!.",
*%@ective cues,
With pale Q dry lips noted! restlessness noted.
Aody reflex noted
1rritability noted
Warm to touch
CBS monitoring
49
DIA+.*SIS, Risk for deficient fluid volume related to excessive losses to normal route
secondary to dengue fever.
#LA..I.+, Within the span of our care the patient Q significant others will be able toN
1dentify risk factors appropriate intervention
1llustrate behavior or lifestyle changes to prevent development of fluid
deficit
I-#LI-!."A"I*.S,
Intervention Rationale
-. $stablish rapport To gain trust and cooperation
+. onitor 1C To have a baseline data
8. $valuate nutritional status! noting current
intake Q problems
This can negatively effect fluid intake
:. onitor 1 Q ( balance To insure accurate picture of fluid status
9. Weight client Q compare To determine trends
). $ncourage to increase (/1 To promote hydration process
;. Render health teaching regarding the
importance of hydration
/or the proper understanding of the treatment
or procedure treatment
!/AL0A"I*.,
'oal met after the span of our care the patient Q significant others was
able toN
1dentify individual risk factors Q appropriate intervention.
.emonstrate behavior or lifestyle changes to prevent development of
fluid volume deficient as evidence by 2painomon na nako ug daghan
nga tubig3 as verbali7ed by the watcher.
50
DIS(HAR+! #LA.
Epon the discharge from Caraga Regional Hospital! the patient as well as the significant
others will be given a written home care instruction which contains the ffN
I.DI(A"I*.S

!./IR*.-!."AL (*.(!R.S
&dvise patient and significant others to keep all hanging clothes and always
replace the water in the vase.
1nstruct patient and S.( to wear pa6ama and sweat shirt and to put on mos4uito
net when sleeping or apply off lotion.
Screen the door! windows! and spray insect repellant.
$ncourage patient and S.( to clean their surrounding.
51
"R!A"-!."
$ncourage patient and S.( to take medications and vitamins daily as prescribed.
1nstruct patient to eat
H!AL"H "!A(HI.+S
&dvice patient to have enough rest and sleep.
1nstruct patient and S.( to conserve energy by balancing activities with rest
periods.
Teach S.( to take the medications on time as so to achieve the maximum
therapeutic effect of drugs.
&dvise patient and S.( to have a healthy lifestyle.
&dvise the significant others to assist patient in coping with his illness.
*0" #A"I!." >F*LL*W 0# (H!(6$ 0#?
Remind the S( of the patient to have follow5up check5up on the date scheduled
by his physician! one week following his discharge.
&dvise the patient and remind the S.( to take rest upon his discharge and long
exhausting travel going back to Cuyago! #abonga! &*..
&dvised the S.( to seek medical help immediately the followingN
-. sudden blurring of vision
+. sudden nausea and vomiting
8. skin rashes
:. dry lips
DI!"
Teach patient and S.( how to become wise consumer by means of examining
nutrition labels < like=.
&dvise patient and remind S.( to eat on more nutritious foods like green leafy
vegetables! fruits! meat! and fish.
S#IRI"0AL
52
$ncourage patient and S.( to put his trust and faith in 'od alone.
Teach patient and S.( to count his blessings and thank 'od despite the
circumstances.
&lways remember and pray to 'od! ask guidance and guardian to guide in daily
living.
53
54
55