Case Study in Dengue Compile

DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010

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INTRODUCTION
Dengue hemorrhagic fever is a severe, potentially deadly infection

spread by certain species of mosquitoes (Aedes aegypti). Globally, 2.5 billion
people live in areas where dengue viruses can be transmitted. In the
Philippines, Hemorrhagic fever was first reported in 1953. In 1958, it became
a notifiable disease in the country and was later reclassified as Dengue
hemorrhagic fever.
Dengue is a primary disease in the tropical and subtropical region. It is

caused by one of four different but related viruses. It is spread by the bite of
mosquitoes, most commonly the mosquito Aedes aegypti.
It is characterized by increased vascular permeability, hypovolemia an

d abnormal blood clotting mechanisms. WHO case definition for DHF: 1) feve
r or history of recent fever, 2) thrombocytopenia (platelet count equal to or l
ess than 100 x 10 /cu mm),
3) hemorrhagic manifestations such as petechiae or overt bleeding phenome
na, and
4) evidence of plasma leakage due to increase vascular permeability.
Illness is biphasic; it begins abruptly with fever, and in children, with mild up
per
respiratory complaints often anorexia, facial flush and mild GI disturbances.
Coincident with defervescence and decreasing platelet count, the patient’s c
ondition suddenly worsens, with marked weakness, severe restlessness, faci
al pallor and often diaphoresis, severe abdominal pain and circumoral cyanos
is. GI hemorrhage is an ominous prognostic sign that
usually follows a prolonged period of shock.
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Dengue occurrence is sporadic throughout the year. Epidemic usually o

ccurs during the rainy seasons June November. Peak months are September
and October. It occurs wherever vector mosquito exists. Currently vector
control is the available method for the dengue and DHF prevention and
control but research on dengue vaccines for public health use is in process.
OBJECTIVES
General objectives
This case presentation aims to identify and determine the

general health problems and needs of the patient with a final diagnosis of
dengue hemorrhagic fever with warning signs. This will further expand our
knowledge on this particular disease. We may be able to extend to our client
a holistic approach of care and services that would somehow contribute to
the improvement of the client's current status. It also aims to develop in us,
student nurses the proper nursing care needed in order to provide an
effective nursing management in a hospital set-up until the client is ready for
discharge.
Specific objectives
PATIENT BASED:
a. Educate the client for somehow that will contribute to the
progress of his condition.
b. Promote an environment conducive for optimal health.
c. Emphasize the importance of maintaining a balance diet.
NURSE CENTERED:
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 Collects related facts regarding the clients personal data and family
illness, past and present medical history and to examine client
thoroughly in order to come up with an accurate physical assessment.
 To review the Anatomy and Physiology and to understand better

pathophysiology of the problem, for us to know the risk factors of this
case.
 To know the drug properties as well as the diagnostic procedure in

order to know the effects of the drug to be administered. And also to
be able to select the appropriate nursing intervention.
 To enhance our knowledge about proper nursing management as well

as its rationale that we take into great considerations.
 To help motivating the patient to continue the health care provided by

health workers.
PATIENT‘S PROFILE
DEMOGRAPHIC HISTORY:
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HEALTH HISTORY:
History of Present Illness
Patient’s Name: Boy XX
Age: 9 years old
Gender: Male
Address: Tanauan, Batangas
Educational Elementary Level (Out of School)
Attainment:
Religion: Catholic
Nationality: Filipino
Dialect: Tagalog
Date of November 8, 2010
Admission:
Chief Complaint: High Grade Fever
Admitting Dengue with Warning Signs
Diagnosis:
Principal Dengue
Diagnosis:
Admitting San Lazaro Hospital
Hospital:
Early in the morning (Nov. 7, 2010), the child played outside their
house and returned home at lunch time. The afternoon on that day, the
eldest brother noticed something strange and different and as quoted by the
eldest brother “nanghihina na siya noong dumating ng bahay, nanibago kami
kasi malikot siya. Hinawakan ko siya, napansin ko mainit ang katawan nya
at para bang na dengue sya!” Afraid that this is fatal,the brother
immediately rushed the child on the hospital. They traveled from Batangas
to Manila ( cannot afford Batangas hospital) he was admitted to San Lazaro
Hospital (Nov.8, 2010) Patient X initial temperature was 38degrees Celsius
with petechial rash during tourniquet test. He was diagnosed Dengue fever
with warning sign. They got a sample blood from the patient and ordered an
IVF and was referred to Pavillion 4-Extension of Pediatric Ward.
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Past Medical and Surgical History

No previous hospital confinement. The usual colds, minor cough and
slight fever that a normal child gets at his age. The treatment is usually rest,
hot soup, and sometimes over the counter drugs.
The patient was fully immunized child

Vaccine Minimum Age No. of doses Age received Interpretation
at 1st dose and analysis
BCG Birth or 1 After birth BCG was
anytime after given at
birth earliest
possible age
to protect the
possibility of
TB meningitis
and other TB
infectious in
which infants
are prone.
DPT 6 weeks 3 1 month and An early start
2 weeks of DPT
reduces the
chance of
severe
pertussis
OPV 6 weeks 3 1 month and The extent of

2 weeks protection
against polio
is increase
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the earlier
the OPV is
given
Hep B At birth 3 At birth An early start
of Hep B
reduces the
chance of the
child to be
infected and
become a
carrier. This
vaccine also
prevents liver
cirrhosis and
liver cancer.
Measles 9 months 1 9 months This vaccine
prevents
death,
malnutrition,
pneumonia
and diarrhea.
Family Health History

(+) Heart Disease
(+) Hypertension
(-) Diabetes
(-) Asthma
Social Health History
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The patient has 7 siblings, a deceased father and a jobless mother. The
eldest sister is the only working individual in the family and she is the
breadwinner. They lived in a small upcoming city in Batangas. The family
belongs to the lower bracket of the society. As for the patient lifestyle, as
soon as he wakes he is out of the house. He comes home before dawn. The
patient is undernourished , out of school all because of financial difficulties .
They are loved by their neighbors and the patient has lots of friends his age
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PERSON’S REVIEW OF SYSTEM
PERSON’S REVIEW OF PRIOR TO DURING INTERPRETATION AND

SYSTEM HOSPITALIZATIO HOSPITALIZATION ANALYSIS
N
1.) PSYCHOLO
GICAL As a child, he was During It is not usual to child to confine
 Self Perception- not giving priority hospitalization, the him in the hospital because all he
Self-Concept to his own health; patient was under wants to do is to play with his
Pattern he just wants to observation. The friends so her emotional and
play with his relatives noticed psychological status was disturbed.
friends. According that the child is
to the child, he sometimes Self-concept involves all
feels weak after unresponsive and perceptions. A positive self-concept
playing which is not sad. He said that he is essential to person’s mental and
usually happen to missed her mother physical health. Individuals with
him. His brother who was not there positive self-concept are better able
rushed him to San for him because her to cope up in problems and resist
Lazaro Hospital mother was 9 psychological and physical
even though it was months pregnant. illnesses.
far from Batangas.
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Harold Shryock, MD (Modern

Medical Guide)
 Role Relationship
Pattern
He has a happy When he was in the
family with 7 hospital, his brother Having a family beside him makes
siblings, his father and relatives him stronger. Because family is the
died last June2010 supported him one responsible in the child’s care.
and her mother was emotionally and
pregnant. He was financially. They are Based on the Erikson’s theory of
contented to their the one beside him psychosocial development “states
life but when his everyday. The that all families have certain tasks
father died because family can buy and survival and continuity and
of heart attack, medications and IVF specific tasks related to the
their life changed. appropriate for the sequential stage of development
Before, his father patient’s treatment. throughout the life of the family”.
was the one
supporting their Taylor, Lilis and Le Mone
family needs. ( Fundamentals of Nursing 5th
In Tanauan, Edition pg 30)
Batangas they are
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near to the hospital

but because it was
too expensive they
 Sexuality and traveled to Manila
Reproductive and confined the
Pattern chills to San Lazaro
Hospital.
There are no
changes to his Sexuality is the degree to which a
sexuality and person exhibits and experiences
The child was reproductive maleness or femaleness in
unaware to his pattern. physically, emotionally and
reproductive and mentally. Sexuality is defined not
 Cognitive sexuality pattern. only by a person’s genitalia but also
Perceptual Pattern He was not yet the attitudes and feelings about it.
circumcised
because of young Harold Shryock, MD (Modern
age. Medical Guide)
The child verbalized
that “masakit ang
Cognitive- Concrete operations
tiyan ko,” with pain
(ages 7 to 11). As physical
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scale of 6/10. There

experience accumulates,
The child has no are no management
accomodation is increased. The
problem in hearing done yet except for
child begins to think abstractly and
and vision. He has diversional activities
conceptualize, creating logical
a good for the client. The
structures that explain his or her
communication aunt said that the
physical experiences.
skills and child behavior was
awareness. changed.
Barbara Kozier (Fundamentals of
Nursing)
Psychosocial Stage 4 - Industry

vs. Inferiority-Through social
 Coping Stress interactions, children begin to
Tolerance Pattern develop a sense of pride in their
accomplishments and abilities.
Psychosexual-During the phallic

stage, the primary focus of the
libido is on the genitals. Children
also discover the differences
between males and females.
When he was in the
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hospital, the child

Barbara Kozier (Fundamentals of
become quiet.
Nursing)
His became inferior
He has a good because of his
developmental disease. He doesn’t
stage. want to Stress is a condition in which
Pyschosoial communicate and person responds to changes in the
 Value Belief development- the interact. normal balanced state. It can affect
Pattern client is in stage of physically, emotionally, socially and
Industry vs. spiritually.
Inferiority. He can
compete to his Barbara Kozier (Fundamentals of
playmates. Nursing pg 1013-1014)
Pyshosexual- he is
in phallic stage
where he knows
male and female.
Cognitive- Concrete During
Operations hospitalization, he
Major life changes does not pray.
in his life- when his
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father died last june

2010. Spiritual beliefs and practices are
associated with all aspects of
He is a Roman person’s life, including health and
Catholic, he illness.
attended mass
Carol Taylor (Fundamentals of
every Sundays.
Nursing 5th edition pg 977)
2.) ELIMINATION Bowel Elimination: Bowel Elimination: The amount of urine expelled from
once a day at night not yet defecating the bladder depends on how much
Urinary Elimination: duting our shift fluid has been taken into the body
3-4 times a day Urinary Elimination: and how much of this has been
every morning, 3times during 7-3 eliminated. Same as in stool
afternoon and shift. expulsion, this depends on how
evening. He doesn’t feel any much food and kind of food you eat.
He doesn’t feel any discomfort during
discomfort during urination and Harold Shryock, MD (Modern
urination and defecation. And his Medical Guide pg 199 and 244)
defecation. urine color is clear.
3.)REST AND
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ACTIVITY He was a playful During Because of his disease his activity

 Activity- Exercise child so it was his hospitalization, the was limited. And he preferred to
Pattern daily activity. Since patient usually lying sleep than to interact with his
he was stop to his in bed. He walks relative.
study, he just help only when going to
her mother to the bathroom. And Exercise plays a major role in health
household chores, he sits on his bed maintenance. It boasts body
he knew how to when he will eat strength as well as mind ability. It
clean their house. meals and take his promotes a feeling of zest and well
In terms of: medications. The being and provides greater vigor for
Feeding- he can eat doctor ordered him the day’s activities.
on his own. to have an enough
Hygiene- he can bed rest to avoid Harold Shryock, MD (Modern
take a bath without fatigue. But in terms Medical Guide pg 45)
assistance of of:
others, can wear Feeding- his brother
and remove assist him.
clothing. Hygiene- he cannot
Toileting- he can take a bath, so only
 Sleep-Rest recognize urging in wiping his body. Because of the symptoms he
Pattern defecating and Toileting- no experienced, he preferred to sleep
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urinating. changes. so that he will feel comfortable.
The child sleeps During Sleep in some way restores the

early in the evening hospitalization, the body’s normal level of activity and
from 7pm to 5am. child is always balance. Sleep can also be a form of
He woke up early to sleeping. comfort and relaxation.
play with his
friends. He does Barbara Kozier (Fundamentals of
not take any Nursing pg 1115-1124)
supportive aids to
sleep.
4.) SAFE He does not have There were no According to Maslow’s Hierarchy of
ENVIRONMENT any allergic changes. Needs-Security needs are important
reactions to food for survival, but they are not as
and medications. According to his demanding as the physiological
He has a good skin brother, “hindi needs. Examples of security needs
turgor. Sometimes naming alam kung include a desire for safe
he has many saan siya nakagat neighborhoods and shelter from the
wounds because of ng lamok, kasi kung environment.
playing. They live in saan-saan siya
city like town. pumupunta.” Barbara Kozier (Fundamentals of
Nursing)
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5.) OXYGENATION He doesn’t have During Respiration includes ventilation and

any problem in hospitalization, his breathing which is the movement of
oxygenation, he nails are pale. But air into and out of the lungs.
does not he doe not use his
experience accessory muscles Essentials of Anatomy and
dyspnea while while breathing. Physiology 6th Edition (pg. 417)
walking.
6.) NUTRITION He has a good When he was in the It is very important to a person to
appetite in all kinds hospital, the doctor eat nutritious foods because it is
of foods. Her ordered a ‘diet as one of the factors that will affect
mother and sister tolerated except the health. The ideal state of health
was the one dark colored foods’. comes partly from sufficient protein
preparing their He recalled his past and carbohydrates in the diet,
foods. According to 24 hours foods: adequate supply of minerals and
the brother of the vitamins to be well nourished
patient, “kinakain Breakfast – person.
niya lahat ng Pandesal
pagkain kasi kung Harold Shryock, MD (Modern
ano lang ang Lunch – 1 cup Medical Guide pg 46)
nakahain sa bahay, rice with a piece
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kahit na gulay at of fried fish and

isda.” . And he was veggies.
not taking vitamins
supplements. The Dinner- 1 cup of
patient he can able rice and fried
to swallow and fish.
chew foods.
He has a fair
appetite.
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PHYSICAL ASSESSMENT
DATE OF ASSESSMENT: November 9,, 2010 11:00am

General Survey:
Client was conscious and coherent, lying in bed with an IV line regulated to 80 gtts per min. hooked
at the right side of his arm. His hair is well-groomed and no body odor being noted during assessment.
Patient was cooperative and responds to questions appropriately. He exhibits moderate lower tone of voice
but enough to understand during conversation assisted by his elder brother and he has a proper thought
association and has a sense of reality.
Vital Signs:
Vital signs Normal Actual Findings Interpretation/Analysis
Blood pressure 100/60 100/80 On the disease process any condition affects the
cardiac output, blood volume, blood viscosity has
direct effect on the bold pressure. The patient was not
in distress during the assessment
(Kozier, B. (2004). Fundamentals of Nursing p. 510).
Temperature 36.5-37.5 37.8 Febrile due to increase of inflammation as evidenced
by an increase in the number of WBC from the normal
value of 4.8 - 10.8 to 2.33.
Inflammation is a local, nonspecific defensive
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response of the tissues to an injurious or infectious

agent. It is an adaptive mechanism that destroys or
dilutes the injurious agent, prevents further spread of
the injury, and promotes the repair of damaged
tissue.
(Kozier, B. (2004). Fundamentals of Nursing p. 634)
Pulse rate 55-90 102 The pulse rate increases as a response to the lowered
blood pressure that results from peripheral
vasodilation associated with elevated body
temperature and because of the increase metabolic
rate.
(Kozier, B. . Fundamentals of Nursing, 7th edition p.
496).
Respiratory rate 12-25 26 Several factors influence the respiratory rate. Those
that increase the rate include increases in
metabolism, stress (readies the body for fight or
flight), increased environmental temperature, and
lowered oxygen concentration at increased altitudes.
In the case of our patient it is increased because of
stress and increased environmental temperature.
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(Kozier, B. (2004). Fundamentals of Nursing p. 506).
• Skin
PARTS METHOD NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION /
ANALYSIS
Skin Inspection Skin color varies from light to Dark brown with excessive Excessive moisture
Observation deep brown; from ruddy pink moisture in the upper indicates hyperthermia
to light pink, from yellow extremities and petechial as evidenced by an
overtimes to olive. Generally rashes. increase in the body
uniform except in areas temperature from the
exposed to sun; areas of normal range of 35.5-
lighter pigmentation (palms, Generally uniform except in 37.5 to 37.8. While
lips nail beds) in dark skin areas exposed to sun; areas petechial rashes
people. Moisture in the skin of lighter pigmentation indicates the Herman’s
folds and the axillae (varies (palms, lips nail beds) in sign, the
with environmental dark skin people. pathognomonic sign of
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Palpation temperature, and activity). dengue.
No edema, abrasions, lesion. No edema, abrasions,

Temperature is uniform and lesion. Temperature is not The skin is warm to
w/in normal range w/in the normal range, the touch because of the
skin is moist and warm to localized hyperthermia
touch. due to inflammation
as evidenced by an
increase in the WBC
count
• ( Fundamentals of
Nursing by Kozier,
pp.535,540,1071)
Nails Inspection Convex curvature; angle of Convex, smooth in texture,
nail plate about 160o color is pinkish and is highly Normal findings accdg. To
- with smooth texture vascular. Kozier page 543’
- color is highly vascular&
pink in light skinned clients; Blanch test: Prompt return
dark skinned clients may of usual color (after 3 sec.)
have brown or black
pigmentation in longitudinal
streaks
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with intact epidermis on

tissue surroundings
- blanch test- prompt return
of pink or usual color 3-5 sec.
Kozier, 2008
• Head
ANALYSIS
Hair Inspection Evenly distributed Hair is evenly distributed The mother of the patient
Palpation hair over the scalp to different parts of the attend to his need during
with thickness, body and it is thick. No hospitalization, it results to
variable amount of infection or infestation good hygiene, the condition of
body hair. No noted. the patient limits his activities
infection or but despite of that relatives are
infestation. there for him to assist his
needs.
Scalp Inspection White, clean, free White, clean, free from

Palpation from masses, lumps masses, lumps scars,
scars, lice, nits, lice, nits, dandruff, and
(Fundamental of Nursing by
dandruff, and lesions lesions no area of
Kozier, p541)
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no area of tenderness
tenderness
Skull Inspection Rounded( normoceph Round (normocephalic), Normal findings according to
Palpation alic & symmetrical, smooth skull contour. Kozier page 544.
with frontal, parietal, Smooth, absence of
occipital, nodules or masses.
prominences)
smooth, uniform,
absence of modules
or masses
• Eyes
PARTS METHOD NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION / ANALYSIS
Eyebrows Inspection Symmetrically Hair is evenly Normal findings.
aligned. distributed skin intact With age, eyebrows become
Equally distributed, and aligned. bristly and coarse.
curled slightly Symmetrically aligned (Kozier, B. Fundamentals of
outward and equal movement. Nursing, 7th edition, p. 548).
Eyelashes Inspection Equally distributed, Eyelashes are equally Normal findings.

Curled slightly distributed, it is thick Eyelashes should be curled
outward and is curled outward. outward to sweep foreign
particles away from the eyes.
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Eyelids Inspection The skin is intact, no Lids closes

discharge and no symmetrically, Normal findings according to
discoloration. The bilateral blinking and Kozier page 548.
lids close no visible sclera above
symmetrically blinks corneas, and upper
involuntary and with and lower borders of
bilateral blinking. cornea are slightly
covered when lids are
open.
Sclera and Inspection Shiny, smooth & Both sclerae are shiny Extremely red color of both
Conjunctiva pink or red in color and smooth. conjunctivae indicates
Palpebral conjunctivae inflammation as evidenced by the
are extremely red. body temperature of 37.8 and an
increase in the WBC count. .
(Kozier, B. Fundamentals of
Nursing, 7th edition, p.548).
Cornea Inspection transparent, shiny & Transparent shiny and Normal findings
smooth, details of smooth. (Kozier, B. Fundamentals of
the iris are visible Nursing 7th edition, p. 550).
Pupils and Inspection Black in color, equal Iris brown in color, Normal findings.
iris in size, normally 3-7 equal in size and
mm in diameter, round in shape. Iris is Pupils equally reactive to light
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sound- smooth flat and round. Pupil and accommodates

border iris flat & diameter is 4mm. symmetrically.
sound. Pupils Patient’s pupils
constrict when constrict when looking (Kozier, B. Fundamentals of
looking at near at near objects and Nursing, 7th edition, p. 550).
object and dilate dilate when looking at
when looking at far far objects.
objects.
Extraocular Inspection Both eyes Within normal findings.Normal findings.
muscle tests coordinated, move in
unison with parallel (Kozier, B. (2004). Fundamentals
alignment. of Nursing p. 554).
Visual Acuity Inspection Able to read The patient can read Normal findings.
newsprint with 20/20 writings that was (Kozier, B. Fundamentals of
vision on snellen given to him for Nursing, 7th edition, p. 552).
chart. visualization .
• Ears
PARTS METHOD NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION / ANALYSIS
Auricles Inspection The color is same as The color is same as Normal Findings
facial skin, facial skin,
symmetrical, the symmetrical, the
auricles aligned with auricles aligned with
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Palpate outer cantus of the outer cantus of the

eye. eye. Kozier, B Fundamentals of
Mobile, firm and not Mobile, firm and not Nursing 7th edition, p. 556
tender, pinna recoils tender, pinna recoils
after it is folded. after it is folded.
Ear Canal Inspection Distal third contains Distal third contains Normal Findings
hair follicles and hair follicles and
glands. Dry cerumen, glands. Dry cerumen,
grayish-tan color or grayish-tan color or Kozier, B. Fundamentals of
sticky, wet cerumen sticky, wet cerumen Nursing, 7th edition, p. 556
in various shades of in various shades of
brown. brown.
Hearing Inspection Normal voice tones Normal voice tones Normal Findings
Acuity audible. Sound is audible. Sound is
heard in both ears or heard in both ears or
localized at the localized at the center
center of the head of the head.
(Weber Negative). according to Kozier page 558
Air conducted
hearing is greater
than bone conducted
hearing (positive
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Rinne)
• Nose
PARTS METHOD NORMAL FINDINGS ACTUAL FINDINGS ANALYSIS
Nose Inspection Symmetric and Symmetric in shape. Patient can breathe normally
straight No discharge or through nose and no discharges.
No discharge in flaring, uniform in He can also identify common
flaring color. (-) tenderness odors like alcohol.
Uniform in color and lesions. Normal findings according to
Not tender, no lesion Kozier page 560-561
Facial Sinuses Palpation No tenderness No tenderness noted. Normal findings according to

Kozier page 560-561
Septum Inspection Air moves freely as Nasal septum intact Normal findings according to
the client breathes and in midline. Kozier page 560-561
through the nares.
Nasal septum intact
& in midline
• Mouth
PARTS METHOD NORMAL ACTUAL FINDINGS INTERPRETATION / ANALYSIS
FINDINGS
Lips Inspection Uniform pink color Uniform pink color
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Palpation Soft, moist, smooth Soft, moist, smooth Normal findings accdg. to Kozier,
texture texture p.563
Symmetry of Symmetry of contour
contour Ability to purse lips
Ability to purse lips
Buccal Inspection Uniform pink color Uniform pink color Normal findings accdg. to Kozier,
mucosa Soft, moist, smooth Soft, moist, smooth in p.563
texture texture.
Gums Inspection Pink gums, moist, Pinkish gums, no Gums are pinkish in color.
firm texture to retraction, moist and Normal findings
gums. firm. (Fundamentals of Nursing by
Kozier, p564)
Tongue Inspection Central position Central position, pink in Normal
Palpation Pink color, moist, color, moist, moves (Fundamentals of Nursing by
slightly rough; freely, no lesions, Kozier, p564)
then, whitish tenderness and
coating nodules.
Smooth; lateral
margins; no lesions
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Raised papillae
Moves freely, no
tenderness
Smooth tongue
base with
prominent veins.
Teeth Inspection 24 pediatric teeth Missing tooth, with 22 Normal Findings
smooth, white, smooth, yellow, shiny
shiny tooth enamel tooth enamel
pink gums moist. pink gums moist.
(Fundamentals of Nursing by
Kozier, p602)
Uvula Inspection Soft, moist, smooth Soft, moist, smooth Normal Findings
texture Pink and texture Pink and (Fundamentals of Nursing by
smooth. smooth. Kozier, p602)
Tonsils Inspection No discharge. No discharge. Tonsils of Normal Findings
Tonsils of normal normal size.
size. Pink and smooth
Pink and smooth posterior wall. (Fundamentals of Nursing by
posterior wall. Kozier, p602)
• Neck
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FINDINGS
Neck Inspection Proportional to size Muscles equal in size, Patient has unlimited ROM.
of the head, head centered, There are no palpable lymph
symmetrical and coordinated smooth nodes. Head can easily flex and
straight. Freely movement, head was rotates. Trachea is in the central
movable without flexed, hyperextend, placement and no indication of
difficulty. laterally flexes, possible neck tumor nor thyroid
laterally rotates, no enlargement
Palpation No palpable lumps noted palpable lymph
or tenderness nodes, trachea in Muscles in the neck like
The trachea is in central placement in sternocleidomastoid and trapezius
the Central midline of neck spaces draw the head to the side and
placement in are equal on both elevate the chin and elevate the
midline of neck, sides, thyroid gland shoulders to shrug them.
spaces are equal moves with
on both sides. deglutition. The trachea, thyroid gland, anterior
cervical nodes and carotid artery
lie within the anterior triangle.
(Fundamentals of nursing by Kozier
p566)
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• Upper extremities
PARTS METHOD NORM AL ACTUAL FINDINGS INTERPRETATION / ANALYSIS
FINDINGS
Shoulders Inspection Able to tolerate Able to do ROM. Normal Findings
Palpable wide range of
motion. No
difficulty upon
bending and
stretching. . No
lesions, no scars
and no deformity.
Arms and Inspection Able to tolerate Able to do ROM Both arms have equal strength,
forearms Palpable wide range of exercises without patient can move arms against
motion. No difficulty in doing. gravity and against full resistance.
difficulty upon Have some scars but
bending and no deformity. (Fundamentals of Nursing by
stretching. No Kozier p1068)
lesions, no scars
and no deformity.
Elbows Inspection Able to tolerate Able to do ROM Normal findings according to Kozier
Palpable wide range of exercises without page 1061
motion. No difficulty in doing.
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difficulty upon
bending and
stretching. . No
lesions, no scars
and no deformity.
Wrist Inspection Able to tolerate Able to do ROM Normal findings according to Kozier
Palpable wide range of exercises without page 1061
motion. No difficulty in doing.
difficulty upon
bending and
stretching. . No
lesions, no scars
and no deformity.
Hands and Inspection Able to tolerate Able to do ROM Normal findings according to Kozier
Fingers Palpable wide range of exercises without page 1061
motion. No difficulty in doing in
difficulty upon the left hand.
bending and With the presence of
stretching. . No IV line in the right
lesions, no scars hand it makes difficult
and no deformity. to move.
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• Thorax
FINDINGS
Chest size Inspection Anteroposterior to Anteroposterior to Normal
and shape transverse chest is transverse chest
symmetrical. symmetrical. (Fundamentals of nursing by
Kozier p573)
Breath Auscultation Bronchovesicular Patient has a clear, Normal.
sounds breathe sound. bronchovesicular (Fundamentals of nursing by
breath sound. Kozier p573)
Posterior Palpation Full and symmetric Vocal nor tactile Normal findings according to
chest expansion. fremitus, Kozier page 578-579
Fremitus tactile Bronchovesicular
most clearly at the breathe sound.
apex of the lungs
Quiet, rhythmic and
effortless
respiration.
Vesicular and
bronchovesicular
Percussion breath sound.
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Notes resonate, except

Notes resonate, over scapula, the
except over lowest point of
scapula, the lowest resonance is at the
point of resonance diaphragm
is at the diaphragm.
Anterior Inspection Quiet, rhythmic and Quiet rhythmic and Normal findings according to
effortless effortless. Kozier page 578-579
respiration.
Palpation Full and symmetric Full and symmetric
chest expansion. chest expansion.
Same as posterior
vocal fremitus,
fremitus is normally
decreased over
heart and breast
tissue.
Notes resonate
Percussion down to the 6th rib
at the level of the
diaphragm but are
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4
flat over areas of

heavy muscle and
bone, dull on areas
the heart and the
liver, and tympanic
over the underlying
stomach.
• Breast
PARTS METHOD NORNAL ACTUAL FINDINGS ANALYSIS
FINDINGS
Breast Inspection No masses and No masses and lumps Normal findings
Palpation lumps (Kozier, 2008)
Areola Inspection Dark in color in Dark in color in contrast Normal Findings
Palpation contrast to to surrounding skin. No
surrounding skin. masses, lumps and
No masses, lumps lesions.
and lesions. (Kozier, 2008)
Nipples Inspection Size is Size is proportional. Normal findings.
Palpation proportional. No
discharged or
secretions. (Kozier, 2008)
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• Abdomen
ANALYSIS
Skin integrity Inspection Unblemished skin, uniform in Unblemished skin, Normal findings Kozier
color. uniform in color page 592-598
Contour and Inspection Flat, rounded. Flat, symmetric Normal findings Kozier
symmetry Symmetric contour. contour. page 592-598
Movement Inspection Symmetric movements Symmetric Normal findings Kozier

caused by respiration. movement caused page 592-598
by respiration, no
visible vascular
pattern.
Bowel Auscultation Audible bowel sounds Audible bowel Normal findings Kozier
sounds sounds page 592-598
Umbilicus Inspection Clean Clean Normal findings Kozier
page 592-598
Bladder Palpation Not palpable Not palpable Normal findings Kozier
page 592-598
Liver Palpation May not be palpable. No enlargement. Normal findings Kozier
Border feels smooth Not palpable page 592-598
• Genitalia
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4
Patient refuses to be assessed but according to the patient he was not circumcise yet.
• Lower Extremities
PARTS METHOD NORMAL ACTUAL FINDINGS INTERPRETATION /
FINDINGS ANALYSIS
Hip Inspection Able to perform Able to perform minimal range of Normal findings
wide range of motion exercise no masses and
motion. No deformities. (Fundamentals of Nursing
masses, scars by Kozier p1068)
and deformity.
Leg Inspection Able to perform Able to perform wide range of Normal findings
Palpation wide range of motion.
motion. No Has flakes and scars but has no (Fundamentals of Nursing
masses, scars deformity. by Kozier pg. 495)
and deformity.
Knee Inspection Able to perform Able to perform wide range of Normal findings
Palpation wide range of motion.
motion. No No masses and deformity but have (Fundamentals of Nursing
masses, scars some round and oval shape of scars by Kozier (2004) p. 497)
and deformity. of about 1cm in size.
Foot and Inspection Able to perform Comfortable to perform wide range Normal
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4
toes Palpation wide range of of motion. (Fundamentals of Nursing

motion. No by Kozier,(2004) p.496)
masses, scars No masses and deformity .
and deformity.
Peripheral Palpation Symmetric full Symmetric full pulsation Normal findings
pulse pulsation (by Kozier, (2004) p496)
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. ANATOMY AND PHYSIOLOGY
Blood Basics
Blood is a collection of
specialized cells suspended in straw-
colored liquid called plasma. Blood
delivers oxygen and nutrients in the
body cells, collect waste, distribute
hormones, spread heat around the
body to control the temperature and
play part in fighting infection and
healing injuries.
Blood forms about one-twelfth

of the body weighing of an adult, amounting to about 11 pints (5 liters) in
volume. Roughly 50-55 percent of the blood is plasma, the liquid only-portion
in which cellular components are distributed. Plasma is 90% containing
dissolve substances such as glucose(blood sugar), hormones, enzymes, and
also waste products such as urea and lactic acid.
Plasma also contains proteins

such as albumins,
fibrinogen(important clotting factor)
and globular proteins or globulins
help transport lipids, which are fatty
substance such as cholesterol.
Gamma globulins are mostly
disease-fighting substances that are
known as antibodies. The remaining
45-50% of blood is made up of 3
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types of specialized cells. Red cells or erythrocytes carry oxygen; various

white cells known as leukocytes are part of defense system and cellular
fragment (platelets or thrombocytes) involved in the process of clotting.
Two types of blood vessels carry blood throughout our bodies:
1. Arteries carry oxygenated blood (blood that has received oxygen from
the lungs) from the heart to the rest of the body.
2. Blood then travels through veins back to the heart and lungs, where it
receives more oxygen.
As the heart beats, you can feel blood traveling through the body at pulse
points — like the neck and the wrist — where large, blood-filled arteries run
close to the surface of the skin.
The blood that flows through this network of veins and arteries is whole
blood, which contains three types of blood cells:
1. red blood cells (RBCs)

2. white blood cells (WBCs)
3. platelets
In babies and young kids, blood cells are made within the bone marrow (the
soft tissue inside of bones) of many bones throughout the body. But, as kids
get older, blood cells are made mostly in the bone marrow of the vertebrae
(the bones of the spine), ribs, pelvis, skull, sternum (the breastbone), and
parts of the humerus (the upper arm bone) and femur (the thigh bone).
The cells travel through the circulatory system suspended in a yellowish fluid
called plasma, which is 90% water and contains nutrients, proteins,
hormones, and waste products. Whole blood is a mixture of blood cells and
plasma.
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Red Blood Cells
Red blood cells (also called erythrocytes) are shaped like slightly indented,
flattened disks. RBCs contain the iron-rich protein hemoglobin. Blood gets its
bright red color when hemoglobin picks up oxygen in the lungs. As the blood
travels through the body, the hemoglobin releases oxygen to the tissues.
The body contains more RBCs than any other type of cell, and each has a life
span of about 4 months. Each day, the body produces new RBCs to replace
those that die or are lost from the body.
White Blood Cells
White blood cells (also called leukocytes) are a key part of the body's system
for defending itself against infection. They can move in and out of the
bloodstream to reach affected tissues. Blood contains far fewer WBCs than
red blood cells, although the body can increase WBC production to fight
infection. There are several types of WBCs, and their life spans vary from a
few days to months. New cells are constantly being formed in the bone
marrow.
Several different parts of blood are involved in fighting infection. White blood
cells called granulocytes and lymphocytes travel along the walls of blood
vessels. They fight germs such as bacteria and viruses and may also attempt
to destroy cells that have become infected or have changed into cancer
cells.
Certain types of WBCs produce antibodies, special proteins that recognize

foreign materials and help the body destroy or neutralize them. The white
cell count (the number of cells in a given amount of blood) in someone with
an infection often is higher than usual because more WBCs are being
produced or are entering the bloodstream to battle the infection.
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After the body has been challenged by some infections, lymphocytes

"remember" how to make the specific antibodies that will quickly attack the
same germ if it enters the body again.
Platelets
Platelets (also called thrombocytes) are tiny oval-shaped cells made in the
bone marrow. They help in the clotting process. When a blood vessel breaks,
platelets gather in the area and help seal off the leak. Platelets survive only
about 9 days in the bloodstream and are constantly being replaced by new
cells.
Important proteins called clotting factors are critical to the clotting process.
Although platelets alone can plug small blood vessel leaks and temporarily
stop or slow bleeding, the action of clotting factors is needed to produce a
strong, stable clot.
Platelets and clotting factors work together to form solid lumps to seal leaks,
wounds, cuts, and scratches and to prevent bleeding inside and on the
surfaces of our bodies. The process of clotting is like a puzzle with
interlocking parts. When the last part is in place, the clot happens — but if
even one piece is missing, the final pieces can't come together.
When large blood vessels are severed (or cut), the body may not be able to
repair itself through clotting alone. In these cases, dressings or stitches are
used to help control bleeding.
Nutrients in the Blood
Blood contains other important substances, such as nutrients from food that
has been processed by the digestive system. Blood also carries hormones
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released by the endocrine glands and carries them to the body parts that
need them.
Blood is essential for good health because the body depends on a steady
supply of fuel and oxygen to reach its billions of cells. Even the heart couldn't
survive without blood flowing through the vessels that bring nourishment to
its muscular walls.
Blood also carries carbon dioxide and other waste materials to the lungs,
kidneys, and digestive system to be removed from the body.
Blood cells and some of the special proteins blood contains can be replaced
or supplemented by giving a person blood from someone else via a
transfusion. In addition to receiving whole-blood transfusions, people can
also receive transfusions of a particular component of blood, such as
platelets, RBCs, or a clotting factor. When someone donates blood, the whole
blood can be separated into its different parts to be used in this way.
43
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BOOK BASED PATHOPHYSIOLOGY:
MODIFIABLE NON MODIFIABLE
Environmental conditions Geographical

Rainy season
Age
Aedes aegypti acquires

virus from a host
8-12 days of viral

replication on mosquito’s
salivary glands
The virus is transferred Itchiness/

into the susceptible host redness in the
via bite of the mosquito area
Dengue virus is inoculated

into humans within 3-14
days
Dengue virus circulates in

the blood
Virus disseminate rapidly

into the blood
Production and
secretion of Ig’s &
Stimulates leukocytes monocytes/
especially B lymphocytes macrophages,
neutrophils
44
SAN LAZARO HOSPITAL
Leukocytosis
DENGUE
4
Antibodies bind to the viral

antigens
Monocytes/macrophages
perform phagocytosis through
Fc receptor within the cells.
Dengue virus replicates in the
cells of monocytes/
macrophages
Recognition of dengue viral

antigen on infected monocyte
by cytotoxic T cells
Release of cytokines w/c

consists of vasoactive agents
such as IL, TNF, UK, platelet
activating factors
Fever
Diaphoresis
Stimulates leukocytes and Warm
pyrogen release flushed skin
Malaise
Headache
Direct cellular destruction
& infection of bone marrow Leukopeni
& immunological shortened a
platelet survival
Causes depressed platelet

synthesis
Thrombocytopeni
Epistaxis
a
Gum
bleeding
Dengue Melena
hemorrhagic
45 Hematochezi
SAN LAZARO HOSPITAL fever a
Hematuria
Abdominal
DENGUE
4
MODIFIABLE NON MODIFIABLE
Environmental conditions Geographical

Capillary Rainy season
permeability Age
Pleural effusion Edema

Aedes aegypti acquires virus
from a host
8-12 days of viral replication

on mosquitos salivary glands
The virus is transferred into Itchiness/

the susceptible host via bite of redness in the
the mosquito area
Dengue virus is inoculated

into humans within 3-14 days
Dengue virus circulates in the

blood
Virus disseminate rapidly into

the blood
CLIENT BASED PATHOPHYSIOLOGY Production and
secretion of Ig’s &
Stimulates leukocytes monocytes/
especially B lymphocytes macrophages,
neutrophils
46
SAN LAZARO HOSPITAL
Leukocytosis
DENGUE
4
Antibodies bind to the viral

antigens
Monocytes/macrophages
perform phagocytosis through
Fc receptor within the cells.
Dengue virus replicates in the
cells of monocytes/
macrophages
Recognition of dengue viral

antigen on infected monocyte
by cytotoxic T cells
Release of cytokines w/c

consists of vasoactive agents
such as IL, TNF, UK, platelet
activating factors
Fever
Stimulates leukocytes and Diaphoresis
pyrogen release Warm
flushed skin
Direct cellular destruction &

infection of bone marrow &
immunological shortened
platelet survival
Causes depressed platelet

synthesis
47
SAN LAZARO HOSPITAL Thrombocytopeni
a
DENGUE
4
Leukopeni
a
Dengue Abdominal
hemorrhagic fever pain
Melena
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4
LABORATORY REPORTS
Diagnostic Procedures
HEMATOLOGY
Hematology is the branch of internal medicine, physiology, pathology, clinical laboratory work, and
pediatrics that is concerned with the study of blood, the blood-forming organs, and blood diseases.
Name: Indepenso, Ryan Patient I.D. 020238
Age: 9 Sex: Male Hospital Number: 0134623
COMPONEN RESUL Unit Normal Interpretation and Analysis

TS T
WBC 2.33 10^9/L 4.8-10.8 Virus attacks WBC and this is a normal finding In a
patient with dengue.
RBC 4.79 10^9/L 4.7-6.1 Normal
Hemoglobi 13.04 g/L 13-17 Normal
n
Hematocrit 40.78 % 40-52 Normal
MCV 85.15 Hq 87-98 Mean corpuscular volume (MCV) is a measurement
of the average size of your RBCs. When the MCV is
decreased, your RBCs are smaller than normal
(microcytic) as is seen in iron deficiency
MCH 27.23 Pq 28-33 Mean corpuscular hemoglobin (MCH) is a
calculation of the average amount of oxygen-
49
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carrying hemoglobin inside a red blood cell.

Macrocytic RBCs are large so tend to have a higher
MCH, while microcytic red cells would have a lower
value.
MCHC 31.98 g/L 33-36 Decreased MCHC values (hypochromia) are seen in
conditions where the hemoglobin is abnormally
diluted inside the red cells, such as in iron
deficiency anemia and in thalassemia.
Platelet 90 10^9/L 150-400 Destroys the body’s capacity to produce new

platelets
RDW 13.09 % 11.4-19.0 Normal
Neutrophil 60.3 % 40-70 Normal
Lymphocyt 32.3 % 19-48 Normal
es
Eosinophil 0.7 % 2-8 Refer to Wbc
Monocytes 5.5 % 3-9 Normal
Basophils 1.2 % 0-2 Normal
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DRUG STUDY:
Drug Name Dosage, Action Indication Adverse Contraindic Nursing

Frequency Effect ation Responsibilties
, Route
Generic: Dosage: Inhibits GERD, CNS: Contraindica  Dosage

Omeprazole 20 mg activity of pathologic headache, te in patients adjustments may
acid (proton) hypersecret dizziness, with be necessary in
Brand: pump and ory asthenia. hypersensiti Asians and
Losec†‡, Frequency binds to conditions, GI: diarrhea, vity with the patients with
Prilosec, : OD hydrogen- duodenal abdominal drug. hepatic
Zegerid potassium ulcer, pain, nausea, impairment.
adenosine helicobcter vomiting,
Pharmacolo Route: IV triphosphata pylori constipation,  Drug increases
gic Class: se at infection, flatulence. its own
proton pump secretory frequent Musculoskele bioavailability
inhibitor surface of heartburn tal: back with repeated
gastric pain. doses. Drug is
Pregnancy parietal cells Respiratory: unstable in
Category: C to block cough, upper gastric acid; less
formation of respiratory drug is lost to
51
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4
gastric acid. tract hydrolysis

infection. because drug
Skin: rash. increases gastric
pH.
 Caution
patient to avoid
hazardous
activities if he
gets dizzy.
Drug Name Dosage, Action Indication Adverse Contraindic Nursing
Frequency Effect ation Responsibilties
, Route
Generic Dosage:25 Thought to To relieve Hematologic: Hypersensiti Assessment &

Name: 0g produce mild to haemolytic vity to Drug Effects
Acetaminoph analgesia by moderate anmia, acetaminoph Monitor for S&S of:
en Fraquency blocking pain due leukopeia, en. hepatotoxicity, even
: pain to things neutropenia with moderate
Brand Q4, prn impulses by such as Hepatic: acetaminophen
Name: inhibiting headache, Jaundice doses,
52
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Paracetamol Route: synthesis of muscle Metabolic: especially in

Per Orem prostagalan and joint Hyperglycem individuals with poor
Classificati din in the pain, a nutrition.
on: CNS or of backache Skin: rash, Patient & Family
Paraminophe other and urticaria Education
nol substances period
derivative that pains. It is  Do not take other
sensitize also used medications (e.g.,
Pregnany pain to bring cold
Category: receptors to down a preparations)
B stimulation. high containing
The drug temperatur acetaminophen
may relieve e. For without medical
fever this reason, advice;
through paracetamo overdosing
central l can be and chronic use
action in the given to can
hypothalami children cause liver
c heat- after damage
regulating vaccination and other toxic
center. s effects.
53
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to prevent  Tell patients to

post- consult prescriber
immunisati before giving
on drug to children
pyrexia younger than 2.
(high
temperatur Do not use for
e). fever
Paracetamo persisting longer
l is than
often 3 days, fever over
included in 39.5°
cough, cold C (103° F), or
and flu recurrent fever
remedies unless directed
by prescriber.
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URSING CARE PLAN

1. Hyperthermia
NURSING EXPECTED INTERVENTIO RATIONAL EVALUATIO
CUES INFERENCE
DIAGNOSIS OUTCOMES NS E N
SUBJECTIVE: Hyperthermi Exogenous After 30 INDEPENDENT: After 30
“Mainit po a related to pyrogens minutes of -provide tepid -promotes minutes of
ang illness as (Dengue nursing sponge bath heat loss nursing
pakiramdam evidenced by virus) interventions by interventions
ko.” temperature , the evaporation , the goal
of 37.7˚C Host cells temperature and was not met
OBJECTIVE: of the client -promote conduction as evidenced
-Flushed skin Endogenous will be surface cooling by the
-Warm to pyrogens lowered to at by means of -promotes increase in
touch least 37.5˚C undressing heat loss temperature
Hypothalamu or within by means of the client
Vital signs s change in normal range of radiation rose to
taken as set point of 37˚C -provide cool and 37.8˚C.
follows: environment conduction
T: 37.7˚C Fever
PR: 102 bpm (increase in -promotes
RR: 26 cpm core -instruct client heat loss
BP: 100/80 temperature to minimize by means
55
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4
of
movement or convection
mmHg maintain bed
rest -to reduce
metabolic
demands of
-discuss
importance of
to new set adequate oral -to prevent
point) fluid intake dehydratio
particularly to n
the parents
DEPENDENT:
-administer IV -to prevent
fluids as dehydratio
ordered n
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2. ACUTE PAIN
Cues Nursing Inference Expected Nursing Rationale Evaluation
diagnosis outcome interventio
ns
Subjective: Acute pain Bite of Short term: Independen Short term:
related to infected After one t After one hour
I have severe upper GI mosquito hour of 1.To identify of nursing
abdominal bleeding nursing 1.Assess pain extent of intervention, the
pain secondary to intervention, characteristic pain patient was able
dengue the patient s and to:
Objectives: hemorrhagic Virus entered will: Severity
fever into the 2. Pain is ~ Verbalize
Exhibited blood ~ Verbalize 2. Encourage subjective gradual relief or
facial gradual relief verbalization and can only reduction of pain
57
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4
grimace upon or reduction of feelings of be as evidenced by

body of pain pain experienced absent of facial
movement Virus attacks and grimace upon
the blood Long term: expressed by body movement.
Pain scale of After two the patient
8/10 days of 3. Provide 3. To provide Goal was met
nursing comfort a non
Vital signs Plasma intervention, measures pharmacologi Long term:
taken as leakage the patient and c pain After two days of
follows: will: encourage management nursing
relative to intervention, the
Temp: 37.8 c ~ Verbalize perform patient was able
PR: 102 Bleeding adequate touch to:
bpm relief of pain therapy 4 For
RR: 26 cpm or ability to relaxation ~ Verbalize
BP: cope with 4. Encourage and can adequate relief
100/80mmHg pain incompletely and assist to contribute to of pain as
relieved pain. do deep pain relief evidenced by
breathing pain scale of
~ exercise 5. To 4/10
Demonstrate maximize
58
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4
non 5. Teach the their ~ Demonstrate

pharmacologi client and opportunities non
c ways to significant for self pharmacologic
lessen pain others control over ways to lessen
about non manifestation pain
pharmacol s of pain
ogic ways Goal was met.
to lesson
pain
6. To meet
6. Notify pain control
physician if goal.
regimen is .
inadequate
Collaborativ 1.To relief or

e: maintain
1. Administer acceptable
medications level of pain
as
prescribed. 2. To
59
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4
determine
changes
2. Assist with indications of
laboratory healing or
and complications
diagnostic and to
studies as identify
indicated. precipitating
factors
60
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DIAGNOSTIC EXAMINATIONS
Tourniquet Test
• It is a test to determine the vascular resistance and platelet function. It

an ancillary test but not considered as a confirmatory test.
• Place the cuff of a sphygmomanometer around the arm in the usual

manner and inflate to a pressure halfway between systolic and
diastolic levels. Maintain compression for five minutes and wait two
minutes or more before observation. Describe an area 1-square inch on
the volar surface of the forearm 1-1/2 inches distal from the
antecubital fossa. Count the petechiae within this prescribed area. A
positive tourniquet test is > 20 petechiae.
Total White Blood Cells Count
• In case of dengue, this test will reveal leukopenia. The presence of

leukocytosis and neutrophilia excludes the possibility of dengue and
bacterial infections (leptospirosis, meningoencephalitis, septicemy,
pielonephritis etc.) must be considered.
Thrombocytopenia (< 100.000 /mm3)
• Total platelets count must be obtained in every patient with symptoms

suggestive of dengue for three or more days of presentation.
Leptospirosis, measles, rubella, meningococcemia and septicemy may
also course with thrombocytopenia.
Hematocrit (micro-hematocrit)
• According to the definition of DHF, it is necessary that there is a

presence of hemoconcentration (hematocrit elevated by > 20%); when
it’s not possible to know the previous value of hematocrit, we must
regard as significantly elevated the results > 45%.
Bleeding Parameters
• Bleeding Time = 1-3 minutes

• Clotting Time = 3-5 minutes
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4
• Prothrombin Time = 12-15 seconds

• Activated Partial Thromboplastin Time = 30-40 seconds
MEDICAL MANAGEMENT
• Supportive and symptomatic treatment should be provided.
• For fever, give paracetamol for muscle pains. For headache, give
analgesic. Do not give aspirin.
• Rapid replacement of body fluid is the most important treatment.
• Includes intensive monitoring and follow-up.
• Give ORESOL to replace fluid as in moderate dehydration at 75ml.kg in

4-6 hours or up to 2-3L in adults. Continue ORS intake until patient’s
condition improves.
• IVF (PLR)
Intravenous fluid therapy is recommended when danger signs are

present, especially during defervescence. Crystalloids (D5LRS or
D5NSS or PLRS or PNSS) can be given at 5-15 ml/kg/hour, with periodic
adjustment according to patient's subsequent response. The vital signs
and urine output are important parameters to monitor response to IVF
therapy. When the patient is in shock, IVF must be given at a faster
rate and bigger volume, the 20/20 rule, that is, 20ml/kg in 20-30
minutes. After adequately replacing the fluid losses, maintenance IVF
therapy should be instituted. D5LRS or D5IMB if < 2 yrs old may be
used and should be given at 3 ml/kg/hr up to 2-3 liters per day in
adults. Patients usually require IVF therapy for 24-48 hours
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4
• H2-antagonists – anti-ulcer (proton pump, antacids)
• Plasma Expanders –Dextran
• Blood Transfusion:
1. Platelet Concentration
2. PRBC
3. Fresh Whole Blood
4. Fresh Frozen Plasma
5. Cryoprecipitate
• Monitor platelet count and hematocrit level
Baseline platelet count should be available at any stage of dengue

hemorrhagic fever. Serial determinations may be required during the
defervescence stage to anticipate the onset of shock or to detect
occult bleeding. After recovery with fluid replacement, platelet count
and hematocrit may be repeated just before discharge.
NURSING MANAGEMENT
• Provide a comfortable, dim and quiet room for rest.
• Advise to increase oral fluid intake.
• Watch out for bleeding manifestations.
• For hemorrhage – keep the patient at rest during bleeding episodes.

For nose bleeding, maintain an elevated position of trunk and promote
vasoconstriction in nasal mucosa membrane through an ice bag over
the forehead. For melena, ice bag over the abdomen. Avoid
unnecessary movement.
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4
• Observe signs of shock such as low pulse, cold clammy perspiration,

prostration. Dorsal recumbent position facilitates circulation.
• Diet – DAT EDCF and drinks.
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DENGUE
4
DISCHARGE PLANNING (METHODS)
M – Instruct the patient’s mother the importance of compliance to

medicines to achieve appropriate therapeutic effects. Take Paracetamol for
fever, if the patient’s temperature is 38 degrees Celsius and above and
Vitamin C to increase immune system.
E – Tell the patient that he may have to decrease his activities and may not
be allowed to do any hard exercises for faster recovery.
T – Emphasized the proper treatment if the signs and symptoms of DHF

reoccur. Proper TSB (Tepid sponge bath) if there is a fever, increasing the
fluid intake except for colored drinks and seek the professional health team.
H – Advice the patient’s mother to guide and follow the balance diet and to
have adequate rest and sleep of his son. Instructed the patient’s mother to
provide insect repellants (natural or synthetic) for him and emphasized the
environmental cleanliness is a must. Advise patient to seek medical help if
the sign and symptoms
occur:
• Shortness of breath ▪Symptoms of underlying
disorders (wheezing, coughing)
• Swelling of the feet or ankles ▪ Intolerance
• Chest discomfort
- For some complications of DHF
O – Instructed patient to have follow-up checked-up @ OPD 2 weeks

after discharge from the hospital.
D- Suggest the patient to eat healthy foods from all of the 5 food
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DENGUE
4
groups: fruits, vegetables, breads, dairy products, meat and fish.

Eating healthy foods may help her feel better and have more energy.
She may be told to eat foods that are low in fat and salt.
S - Advise patient to always pray to our lord and never lose hope in
any obstacle that we may encounter.
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DENGUE
4
EVALUATION
We met the objective we post at the beginning of this case
study. We gained knowledge about the related factor hinged in
Communicable Disease like Dengue, through our clients we are able to apply
the nursing intervention needed for their situation. With this, as our
fundamental foundation, we can provide the expected care management
and health teaching for our clients with this kind of condition. In addition to
this the case study, it also identify and determine the general problems and
needs of the patient with Dengue. The proper evaluation concerning the
nursing management of client has also been aptly accomplished. This
presentation was able to help the patient promote health, prevention of
disease and medical understanding of such condition through the application
of nursing skills.
RECOMMENDATION
The absence of danger signs allows the treatment of dengue hemorrhagic

fever at home. Hospitalized patients may be sent home if they have
remained afebrile for at least 72 hours or if the danger signs have resolved.
However Primary prevention of dengue mainly resides in mosquito control.
We can eliminate vector by changing water and scrubbing sides of lower
vases once a week, destroying the breeding places of mosquito by cleaning
surroundings, having a proper disposal of rubber tires, empty bottles and
cans and cleaning all stagnant water and water containers and make sure to
cover these. The Department of Health has a new program called the 4S: (a)
Search and destroy (b) Self-protection measure (c) Seek early consultation
(d)Say yes to defogging during an outbreak.
For the Nursing student who will be assigned to San Lazaro wherein
they will encounter communicable diseases such as Dengue can gain
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4
knowledge by reading this case study we prepared. This case presentation is

an appropriate tool that will meet the current information needs of
individuals, and guide to promote health. They must be first equipped with
the proper basic knowledge about the Anatomy and Physiology of the system
involved in this case. This case presentation also recommended to nursing
students who have patients with Dengue to use this presentation as an
instrument or a source of background knowledge about the said problem.
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DENGUE
4
69
SAN LAZARO HOSPITAL

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DENGUE

PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010

Dengue hemorrhagic fever is a severe, potentially deadly infection

Dengue is a primary disease in the tropical and subtropical region. It is

It is characterized by increased vascular permeability, hypovolemia an

Dengue occurrence is sporadic throughout the year. Epidemic usually o

This case presentation aims to identify and determine the

 To review the Anatomy and Physiology and to understand better

 To know the drug properties as well as the diagnostic procedure in

 To enhance our knowledge about proper nursing management as well

 To help motivating the patient to continue the health care provided by

Past Medical and Surgical History

The patient was fully immunized child

OPV 6 weeks 3 1 month and The extent of

Family Health History

Social Health History

PERSON’S REVIEW OF SYSTEM

PERSON’S REVIEW OF PRIOR TO DURING INTERPRETATION AND

Harold Shryock, MD (Modern

near to the hospital

scale of 6/10. There

Psychosocial Stage 4 - Industry

Psychosexual-During the phallic

hospital, the child

father died last june

ACTIVITY He was a playful During Because of his disease his activity

urinating. changes. so that he will feel comfortable.

The child sleeps During Sleep in some way restores the

5.) OXYGENATION He doesn’t have During Respiration includes ventilation and

kahit na gulay at of fried fish and

DATE OF ASSESSMENT: November 9,, 2010 11:00am

Inflammation is a local, nonspecific defensive

response of the tissues to an injurious or infectious

(Kozier, B. (2004). Fundamentals of Nursing p. 506).

Palpation temperature, and activity). dengue.

No edema, abrasions, lesion. No edema, abrasions,

with intact epidermis on

Scalp Inspection White, clean, free White, clean, free from

Eyelashes Inspection Equally distributed, Eyelashes are equally Normal findings.

Eyelids Inspection The skin is intact, no Lids closes

sound- smooth flat and round. Pupil and accommodates

Palpate outer cantus of the outer cantus of the

Facial Sinuses Palpation No tenderness No tenderness noted. Normal findings according to

Notes resonate, except

flat over areas of

Movement Inspection Symmetric movements Symmetric Normal findings Kozier

toes Palpation wide range of of motion. (Fundamentals of Nursing

. ANATOMY AND PHYSIOLOGY

Blood forms about one-twelfth

Plasma also contains proteins

types of specialized cells. Red cells or erythrocytes carry oxygen; various

Two types of blood vessels carry blood throughout our bodies:

1. red blood cells (RBCs)

Red Blood Cells

White Blood Cells

Certain types of WBCs produce antibodies, special proteins that recognize

After the body has been challenged by some infections, lymphocytes

Nutrients in the Blood

BOOK BASED PATHOPHYSIOLOGY:

MODIFIABLE NON MODIFIABLE

Environmental conditions Geographical

Aedes aegypti acquires