TABLE OF CONTENTS

I. Introduction ---------------------------------------------------------- 4

II. Patient Profile ------------------------------------------------------- 7

III. Developmental Task----------------------------------------------- 8

IV. Health Assessment

1. Past Health History ----------------------------------------- 9

2. History of Present Illness ---------------------------------- 9

3. Functional Health Patterns -------------------------------- 10

4. Physical Examination --------------------------------------- 14

5. Diagnostic and Laboratory Findings --------------------- 21

V. Anatomy and Pathophysiology

1. Anatomy and Physiology ---------------------------------- 25

2. Pathophysiology -------------------------------------------- 29

3. Signs and Symptoms -------------------------------------- 31

VI. Medical Management --------------------------------------------- 31

VII. Nursing Management -------------------------------------------- 33

1
VII. Appendix

Nursing Care Plan -------------------------------------------- 34

Drug Study ---------------------------------------------------- 45

Health Teaching Plan ---------------------------------------- 55

Discharge Plan ------------------------------------------------ 64

IX. Bibliography ------------------------------------------------------- 66

Introduction

2
 Dengue Fever, seasonal viral infection characterized by fever,

headache, extreme pain in the joints and muscles, and skin rash. A

more serious but less common form of the disease, dengue

hemorrhagic fever (DHF), may cause severe and fatal internal

bleeding. Dengue fever and DHF are caused by any of four different

viruses, and are transmitted from one person to another by the female

mosquito of two species of the genus Aedes. Outbreaks of the disease

usually occur in the summer when the mosquito population is at its

peak. The infection cannot be transmitted directly from person to

person and not all people who are bitten necessarily contract the

disease. Dengue fever and DHF occur in many tropical and sub-tropical

areas in Asia, Africa, Central and South America.

The incubation period (time between infection and onset of

symptoms) of dengue fever is five to eight days. The fever typically

runs its course in six to seven days, but convalescence is usually slow.

Treatment for dengue fever is directed at reducing symptoms.

The incubation period of DHF is two to seven days. In the early

stages the symptoms are very similar to those of dengue fever. The

second stage symptoms include nausea, vomiting, and abdominal

pain. The onset of hemorrhagic symptoms rapidly follows—bleeding

nose and gums, bruising easily, and sometimes internal bleeding. The

amount of blood circulating through the body is reduced, sometimes

3
producing shock, characterized by pale, cold extremities; a rapid, weak

pulse; and falling blood pressure. Treatment for these symptoms is a

standard fluid rehydration therapy in order to maintain blood pressure.

If circulatory failure is not reversed, death may follow. DHF is most

common among children under the age of 15. Ten percent of childhood

cases of DHF are fatal.

The most effective preventive measure is the use of mosquito

repellent. As yet no successful vaccine for dengue fever has been

developed. According to the World Health Organization (WHO), dengue

fever and DHF are among the most rapidly increasing insect-borne

illnesses today. Several factors are believed to contribute to the wide

spread of dengue fever. Inadequate water and waste treatment

facilities, along with insufficient pest control measures, promote the

rapid increase of mosquito populations in certain areas. In addition,

dwindling public health resources cannot keep up with the needs of

growing urban populations that are susceptible to infection.

The student chose this case for this disease is widespread in our

country. Dengue is a highly preventable disease, but still many die

from it due to unsanitary surroundings and the lack of knowledge of

detecting and using precautionary measures to prevent self and others

from acquiring it. This case study is intended to improve the

4
knowledge and the skills of the student-nurse regarding the care and

the health teachings given to a dengue patient.

PATIENT PROFILE:

Name: M. R. P.

Age: 32

Sex: Male

Status: Married

Address: Cebu, City

Name of Hospital:

Date of Admission: 4/13/09

Ward & Bed No.: Male Surgical Ward bed no. 5

Case No.:

Chief Complaint: Fever and cough for 3 months

Medical Diagnosis: Dengue Fever - Dengue Fever, seasonal viral

infection characterized by fever, headache, extreme pain in the joints

and muscles, and skin rash. A more serious but less common form of

the disease, dengue hemorrhagic fever (DHF), may cause severe and

fatal internal bleeding.

5
Developmental Task:

According to Erik Erikson (Psychosocial theory)

“Adulthood”

• 25 y.o. – 65 y.o.

• Generativity vs. Stagnation

- fulfilling life’s goals involving career, family and society

- indicators of positive resolution would show creativity,

productivity, concern for others

- indicators of negative resolution would show self-

indulgence, self-concern, lack of interests and

commitments

According to Robert Havighurst (Developmental Task Theory)

“Middle Age”

• achieving adult civic and social responsibility

• establishing and maintaining an economic standard of living

• assisting teenage children to become responsible and happy

adults

• Developing adult leisure-time activities

• Relating oneself to one’s spouse as a person

6
 • Accepting and adjusting to the physiologic changes of middle

age

• Adjusting to aging parents

HEALTH ASSESSMENT:

1. Past Health History

In 2006, the patient had a surgery in Manila for the excision of

cysts at the abdominal, thoracic and back areas. And in 2007 he was

admitted in Thailand and had an appendectomy surgery performed.

The patient has seafood allergies, non-smoker and drinks once or twice

a week. The patient undergoes regular check-up every prior to

boarding a sea vessel.

History of Present illness

Patient was suffering from a persistent cough for 3 months

without fever and was given Carbocistein for his cough. Four days prior

to admission patient suffered cough with whitish sputum, fever, muscle

pain, severe headache and nausea and vomiting which prompted his

admission. Patient was brought to the hospital and was admitted at

11:00am and had the following vital signs: BP: 90/60 T: 39.1 PR: 86 RR:

24.

7
2. GORDON’S FUCNTIONAL HEALTH PATTERN

(Date Assessed: April 16, 2009)

2.1 Health Perception and Health Maintenance

Before hospitalization, Mr. MP used to take vitamin C and

other brands of multivitamins as daily supplement but has

stopped taking vitamins for a long time already. The patient does

not have drug maintenance and only takes OTC meds in times of

illnesses such as cough, colds, fever and other common illnesses.

The patient lives in an environment where there are breeding

sites of mosquitoes, flies and rodents. The patient does not

smoke but is a second hand smoker through friends that smoke

and through air pollution when travelling; drinks alcoholic

beverages for about once or twice a week. Patient was admitted

in Manila on 2006 for the excision of cyst in the back and

abdominal areas. He was also admitted in Thailand on 2007 for

8
 appendectomy. Before admission, the patient rates his health as

a perfect 10.

During hospitalization, the patient is responsive, alert and

coherent and is currently taking antibiotics, paracetamol and

bronchodilators. And now he rates his health as 8 out of 10

2.2 Nutrition and Metabolism

Before hospitalization, Mr. MP eats 3 meals a day and

sometimes with snacks in between. He usually eats 2-3 cups of

rice and a serving of either vegetables, beef, pork, chicken or

fish. Patient drinks 10-15 glasses of water everyday. He takes

Vitamin C or other brands of multivitamins as a daily

supplement. Mr. MP does not have drug allergies and does not

have difficulty eating, but is allergic to crustaceans.

During hospitalization, the patient reported a decreased in

appetite. He is on DAT and was advised to increase fluid intake.

His current weight is approximately 60 - 65 kg.

2.3 Elimination

Prior to admission, the patient eliminates once a day with

well formed, brown stools. The patient usually urinates 4-6 times

9
 a day with clear, yellowish colored urine. From time to time in

the past, Mr. MP experiences diarrhea and constipation. Other

than that the patient does not have any problem eliminating.

During hospitalization, bowel movement did not change

while urination increased due to increased fluid intake.

2.4 Activity and Exercise

Before hospitalization, a typical day for the patient would

be waking up at around 7am-9am, eat his meals, socialize, watch

TV or spend time with family and friends. But when on board his

schedule changes and he spends most of his waking hours doing

heavy work. When on board, the patient regularly exercises but

when not on board he rarely exercises.

During his confinement, Mr. MP spends most of his time

sleeping. He only stands up and walk when he needs to

eliminate. Patient needs only a little amount of help in

performing ADLs.

2.5 Cognition and Perception

Mr. MP is responsive, alert, coherent and cooperative. He is

a graduate of Bachelor of Science in Marine and Transportation.

10
 He was able to understand and answer questions given to him

without difficulty.

2.6 Sleep and Rest

Before confinement, when the patient is on board a vessel

he rarely gets a proper sleep. The patient usually sleeps an

average of only 5-7 hours every night. But when the patient is at

home he sleeps for an average of 7-9 hours. The patient does not

take any medication to aid sleeping. The patient watches TV

before sleeping.

Upon admission, the patient spends most of his time

sleeping due to lack of activities to do in the hospital.

2.7 Sexuality and Reproduction

Mr. MP is a male, married and has two children. Patient

never had a history of STDs.

2.8 Self-perception and Self-concept

According to Mr. MP, he is contented with the way he is

and with what God has given him.

2.9 Roles and Relationship

11
 Mr. MP is the 3rd of 4 siblings. He is married to Crediana

Pilapil and has two children Karen, 4 and Joshua, 2. He is the

bread winner of his family and still financially supports his

parents.

2.10 Stress Tolerance and Coping

According to patient, he gets stressed when he’s on board

because of heavy work and his way of coping is through

watching TV and socializing.

2.11 Values and Beliefs

The patient is a Roman catholic and does not have

superstitious beliefs.

3. PHYSICAL EXAMINATION

(Date Assessed: April 16, 2009)

3.1 General Survey

Received pt. lying on bed, awake, conscious, alert and

coherent with IVF # 5 D5NM 1L @ 30gtts/min infusing well at

right arm with the following vital signs: BP = 100/70mmHg T =

38.1°C P = 90bpm RR = 21cpm. Frequent coughing and

weakness noted.

12
 3.2 Skin

Upon inspection, skin is pale and white and has a generally

uniform color except for areas exposed to the sun. There are

presences of surgical scars on abdominal, back and thoracic areas.

Upon palpation, skin was dry and warm to touch. Patient has

good skin turgor

Hair

The patient’s hair upon inspection was thin and has an even

distribution. There were no presence of flakes, sores and lice.

Upon palpation, patient has smooth, soft hair.

Nails

Patient has an untrimmed, clear and convex shaped nails. The

nail bed appears pinkish.

Upon palpation, patient’s nails are smooth and the capillary refill

time is less than 1 second.

3.3 Head

Upon inspection, head is round and symmetrical.

Upon palpation, patient has a round head with a uniform

consistency. There is an absence of nodules and masses.

Neck/ Lymph nodes

13
 Neck is symmetrical and muscles are equal in size.

Lymph nodes were non-palpable upon palpation. Trachea is

placed on the center and is properly aligned.

Face

The patient has symmetrical facial features and movements.

Wrinkles were noted on forehead.

Upon palpation, there was an absence of nodules, masses and

edema.

3.4 Eyes

The patient has chinky eyes; pupils are equally rounded, reactive

to light and accommodation; patient has pale conjunctivas. The

corneas are clear and patient could clearly see and read the paper

prints given to him. Both eyes could completely close when instructed

to do so.

There were no lesions, masses and nodules upon palpation.

Ears

Ears have the same color as the face. Auricles are aligned to the

outer canthus of the eyes. There was presence of dry cerumen. Patient

is able to hear normal volume of voice.

14
 3.5 Nose and Sinuses

Patient has well aligned Nose Bridge; has pink mucosa and there

were dried mucus noted upon inspection.

Upon palpation, nose is non-tender, no lesions, masses and

nodules.

Mouth

The lips appear dry and pink in color. Patient was able to purse

the lips when asked to do so; Teeth are yellowish and without

dentures; Oral mucosa appears pinkish and slightly dry; tongue is in

central position and has a presence of white streaks; uvula is placed on

midline.

Upon palpation, the oral mucosa was smooth, intact and without

nodules.

3.6 Thorax and lungs

The chest was equal on its rise and fall and in chest

expansion; presence of surgical scars, spine is vertically aligned;

frequent coughing noted.

Fremitus is heard most clearly at the apex of the lungs and has a

uniform temperature.

15
 Resonant upon percussion but dull over bony areas. Harsh

sounds were heard during auscultation; with 21 breaths per minute.

3.7 Cardiovascular

There are no pulsations, lifts and heaves on chest and epigastric

are; jugular veins are not distended. Capillary refill is less than 1

second and has palpable pulses.

There were no presence of bruits and murmurs upon auscultation

and with 90 bpm.

3.8 Breasts

Breasts are round and flat with no retractions and discharges.

There is no tenderness, masses or nodules upon palpaltion.

3.9 Abdomen

Abdomen is round and has symmetric movements caused by

respiration. There are presence of scars from previous appendectomy

and excision of benign cysts.

Bowel sounds are audible occurring every 15-20 seconds;

tympanic upon percussion.

Abdomen is relaxed and smooth with no presence of tenderness

and masses. Bladder is non-palpable.

16
 3.10 Genito-urinary/Reproductive

There is no pain in urinating and has no of STDs.

3.11 Musculo-skeletal

Muscles have equal strength on both sides of the body with no

contractures, no tremors and has smooth coordinated movements.

Weakness noted and complaints of joint and muscle pain.

3. 12 Neurologic Assesment

Patient is conscious, alert and coherent. Oriented to time, place,

things and persons; does not have difficulty in understanding and can

express self. Patient was able to concentrate and follow instructions.

Patient has well-coordinated movements.

Cranial Nerves

• I – Olfactory: Patient was able to identify the different smells

given

• II – Optic: Has 20/20 vision; able to read reading material; can

see objects in the periphery

• III – Oculomotor: Able to follow six ocular movements; pupil is

reactive to light and accommodation

• IV – Trochlear: Able to follow six ocular movements

17
 • V – Trigeminal: was able to elicit blink reflex; felt deep and light

sensations; was able to clench teeth

• VI – Abducens: Able to move eyes laterally

• VII – Facial: Patient was able to smile, raise the eyebrows,

frown, puff out cheeks and close his eyes tightly;

was able to identify various tastes such as sour,

sweet, bitter and salt

• VIII – Auditory: Has a sense of equilibrium; is able to hear

normal volume of voice

• IX – Glossopharyngeal: Able to move tongue from side to side

and from up to down; able to swallow

• X – Vagus: Able to swallow; client can speak clearly

• XI – Accessory: can turn head and shrug shoulders against

resistance

• XII – Hypoglossal: was able to protrude tongue; able to move

tongue from side to side and from up to down

DIAGNOSTIC AND LABORATORY TESTS

• X-ray result

Lung fields are clear. Pulmonary vascular markings appear

normal. Trachea is in the midline, superior mediastinum is not widened

18
and cardiac shadow is not enlarged. The diaphragmatic leaflets in both

sides are intact.

No significant cardiopulmonary findings.

• CBC Monitoring

NORMA
DATE & PATIENT’
TEST L INTERPRETATION
TIME S RESULT
VALUES
COMPLET 4-13-09

E BLOOD 10:30a

COUNT m
IgG adheres to the

Platelet 150 – platelet

108
450 (initiates destruction of

the platelets)
WBC
5 – 10 5 Normal

Hemoglobi
11.5 –
n 12.20 Normal
17.0

Hematocri
35 – 55 37.30 Normal
t
RBC 3.6 – 5.0 4.10 Normal

19
 DATE & NORMAL PATIENT’
TEST INTERPRETATION
TIME VALUES S RESULT
COMPLET 4-14-

E BLOOD 09

COUNT 6:00am
IgG adheres to the

Platelet 150 – platelet

99
450 (initiates destruction of

the platelets)
WBC
5 – 10 4.43

Hemoglobi
11.5 –
n 11.5 Normal
17.0

Hematocrit 35 – 55 35.40 Normal

20
 DATE & NORMAL PATIENT’
TEST INTERPRETATION
TIME VALUES S RESULT
COMPLET 4-15-

E BLOOD 09

COUNT 6:00am
IgG adheres to the

Platelet 150 – platelet

110
450 (initiates destruction of

the platelets)
WBC
5 – 10 4

Hemoglobi
11.5 –
n 11.90 Normal
17.0

Hematocrit 35 – 55 35.90 Normal

RBC 3.6 – 5.0 3.93 Normal

21
 DATE & NORMAL PATIENT’
TEST INTERPRETATION
TIME VALUES S RESULT
COMPLET 4-16-

E BLOOD 09

COUNT 6:00am
Platelet 150 –
158 Normal
450
WBC
5 – 10 4.60

Hemoglobi
11.5 –
n 12.10 Normal
17.0

Hematocrit 35 – 55 36.30 Normal

RBC 3.6 – 5.0 3.94 Normal

• Blood Glucose Test

DATE & NORMAL PATIENT’ INTERPRETATIO

TEST
TIME VALUES S RESULT N
BLOOD
4-14-09
GLUCOSE
6:00am
LEVEL
70.00 –
Glucose 93.29 Normal
110.00

ANATOMY AND PHYSIOLOGY AND PATHOPHYSIOLOGY

1. ANATOMY AND PHYSIOLOGY

22
 The Cardiovascular System is one of the most important systems

in your body. It is your body's delivery system for the circulation of

blood. It is made up of blood, blood vessels and the heart.

Blood moving away from the heart delivers oxygen and nutrients

to every part of your body through arteries. You can remember the

function of arteries by recalling that "A" stands for "away from the

heart." And your heart has to have enough pressure to get that blood

down to your fingertips and to the tip of your toes.

The arteries will carry blood away from your heart to smaller and

smaller blood vessels called capillaries. So when you go to the doctor

23
and they squeeze your fingertips, they are looking at the rate of your

capillary refill. Or when you have surgery, you may be asked to remove

your fingernail polish or false fingernails. Before, during or after

surgery they may check the rate of your capillary refill. It's a form of

checking your blood pressure. Capillaries connect the ends of the

smallest arteries (arterioles) with the beginnings of the smallest veins

(venules) to send the blood back to your heart through the veins.

Blood moving back to the heart picks up waste products like a

trash truck so that your body can get rid of them. Veins carry the blood

back to the heart and it does this against gravity. That's quite a feat

when you think about it. So again, there has to be enough pressure

generated from the heart in order to get the blood to your fingers and

toes, and then back up to the heart again. That's a lot of pressure. Too

much or too little pressure can be detrimental to your health.

Your Heart is about the size of your clenched fist. And your heart

is indeed a muscle. The muscle fibers in the heart are different than

the muscle fibers on your legs or that line your organs and blood

vessels. This type of muscle fiber is called "cardiac muscle." These

muscle fibers branch out and (anastomose) form a continuous network.

At intervals, there are prominent bands or intercalated disks that cross

the fibers. The special fibers in the heart are called Purkinje fibers. The

Purkinje Fibers form the impulse-conducting system of the heart.

24
 Your heart contracts and relaxes approximately 70 or so times a

minute at rest. And of course it will contract more when you are

exercising. Muscles contract and relax, that's what they do. The heart

muscle squeezes and pumps blood through its four chambers to all

parts of your body. And it pumps blood through an phenomenal

collection of blood vessels. Your blood stream will travel through a

pipeline that is very rubbery in nature. This pipeline has tons of

branches that are both small and large.

When you inhale, you breathe in air and then send it straight

down to your lungs. Blood is pumped from the heart to your lungs. This

is where oxygen from the air that you've breathed in gets mixed with

the blood. The oxygen-rich blood travels back to the heart where it is

pumped through your arteries, to the capillaries and to the rest of the

whole body. This system delivers oxygen to all the cells in your body.

This includes your skin, bones and other organs. Yep! Even your bones

need blood. Your veins will then carry the oxygen-depleted blood back

to the heart for another ride in this huge circulatory system.

The majority of your blood is a colorless liquid called plasma.

Red blood cells [RBC's] make the blood look red and it's the

RBC's that deliver oxygen to the cells in the body and carry back waste

gases in exchange. The RBC's look like tiny little inner tubes or donuts

under a microscope. In the middle is where the oxygen sits.

25
 White blood cells [WBC's] are part of your body's defense against

disease. Some WBC's will attack and kill germs by devouring them and

others will attack and kill by manufacturing and waging chemical

warfare agents against disease.

Platelets are other cells that help your body repair itself after

injury. Platelets play an important role in blood coagulation,

hemostasis and blood thrombus formation. When a small vessel is

injured, platelets adhere to each other and the edges of the injury and

form a plug that covers the area. The plug or blood clot formed soon

retracts and stops the loss of blood.

2. PATHOPHYSIOLOGY

Dengue virus infections often are not apparent. Dengue classical

occurs mainly in nonimmune, non-adults and children. Symptoms

begin after 5 - 10 days the incubation period. DHF / DSS usually occurs

during a second dengue infection in people who either actively or

passively preexisting (mother) has acquired immunity to a dengue

virus serotype heterologous. The disease begins abruptly with a small

step in 2-4 days followed by a rapid deterioration. Increased vascular

permeability, bleeding, and possibly DIC may be mediated by dengue

circulating antigen-antibody complexes, complement activation, and

the release of vasoactive amines. In the process of eliminating infected

26
immune cells, proteases and lymphokines may be released and

activate the coagulation cascade and complete vascular permeability

factor.

Early symptoms of dengue fever include headache, chills,

backache, fever, nausea and joint pain. The initial fever may be as high

as 104 degrees Fahrenheit at the onset of the illness and individuals

may develop severe pain in the legs and behind the eyes. A rash

consisting of patchy bright red spots may develop over the body after

the first few days of illness.

27
 Exposure to an
Lack of sleep
environment
Lack of vitamins
where there are

Immunocompromis breeding sites

ed host for mosquitoes

Bite from an aedes aegypti

mosquito

Dengue Virus Type I

(Chikungunya Virus)

Viral invasion

Increased WBC

Fever

Stimulates intense

inflammatory response

Joint and muscle pains

IgG adheres to the platelet

(Initiates destruction of the

platelet)

Low platelet count

28
3. SIGNS AND SYMPTOMS

TEXTBOOK-BASED PATIENT’S INTERPRETATION

MANIFESTATIONS
1. Fever 1. Fever Infection
2. Severe headache 2. Nausea and

vomiting
3. Nausea and 3. Joint and muscle Inflammatory

vomiting pain response

4. Rash
5. Joint and muscle

pain

MEDICAL MANAGEMENT

The mainstay of treatment is supportive therapy. Increased oral

fluid intake is recommended to prevent dehydration. If the patient is

unable to maintain oral intake, supplementation with intravenous fluids

may be necessary to prevent dehydration and significant

hemoconcentration. A platelet transfusion is rarely indicated if the

platelet level drops significantly (below 20,000) or if there is significant

bleeding.

The presence of melena may indicate internal gastrointestinal

bleeding requiring platelet and/or red blood cell transfusion.

It is very important to avoid Aspirin and non-steroidal anti-

inflammatory medications. These drugs are often used to treat pain

29
and fever, but in this case, they may actually aggravate the bleeding

tendency associated with some of these infections. If dengue is

suspected, patients should receive instead acetaminophen

preparations to deal with these symptoms.

Medical management given to the patient:

• Getting plenty of bed rest

• Drinking lots of fluids

Medicines given:

• Levofloxacin 500mg 1 tab OD

• Omeprazole 20mg 1 cap OD

• Paracetamol 500mg 1 tab q4 for fever

• Ventolin 1 neb q 8

30
NURSING MANAGEMENT:

Dengue Nursing Interventions rely on following doctor's advise of

increase in fluid intake for hydration (water specifically and avoiding

coloured fluids that may mask bleeding), encouraging the patient to

rest more so the body recovers form the pains and aches. Patient even

after discharge from the hospital must still be under bleeding

precautions. Use soft bristled toothbrush (or cotton instead) when

doing oral care, not eating coloured food and fluids that may mask

bleeding, monitoring s/s of bleeding as epistaxis (nosebleeding) , black

stools or hematochezia (GIT bleeding),hematuria (blood in the urine),

bruising and petechia. Avoid from instances where patient will develop

bruises like rough play and jarring of body parts against objects.

31
 1. NURSING CARE PLANS

a.) NURSING DIAGNOSIS:

Increased body temperature related to dengue infection

EXPECTED NURSING ACTUAL

FINDINGS SCIENTIFIC BASIS
OUTCOME INTERVENTIONS EVALUATION
S = no subjective Dengue fever is Within 8 hours of INDEPENDENT: After 8 hours nurse-

cues transmitted only via an nursing • Assessed and patient interaction

O= Received pt. infected mosquito or interventions, the monitored body and interventions,

lying on bed, by contact with the patient will be able temperature the patient was able

awake, conscious, blood of someone who to: = to determine to:

alert and is actively infected • decrease body patient’s • Patient’s

coherent with IVF with one of the four temperature from temperature temperature

# 5 D5NM 1L @ viruses responsible for 38.1 to a normal • Performed TSB decreased from

30gtts/min the fever. range (36.5 – = TSB promotes 38.1 °C to 37.6 °C

infusing well at 37.5) heat loss through

32
 right arm. Source: conduction and

= skin is warm to http://dengue- • demonstrate evaporation

touch feverdisease.blogspot. behaviors to • Removed

= weakness noted com promote excessive clothes

= V/S: normothermia and covers

T: 38.1 °C = promote heat loss

P: 90 through

R: 21 evaporation

BP: 100/70 mmHg • Provided proper

ventilation

= Provide comfort

and access of cool

air

• encouraged to

increase oral fluid

33
 intake

= to prevent

dehydration from

perspiring

profusely and

provides nutrition

• advised to

decrease physical

activity

= to prevent

increase

metabolic rate

COLLABORATIVE:

• Paracetamol

500mg

34
 q4 for fever

= The drug may

relieve fever

through central

action in the

hypothalamic heat-

regulating center.

• Levofloxacin

= Inhibits bacterial

DNA gyrase and

prevents DNA

replication in

susceptible

bacteria

• Provided

35
 supplemental

fluids (IVF # 5

D5NM 1L @

30gtts/min) as

indicated.

= replaces lost fluid

b.) NURSING DIAGNOSIS:

Risk for Fluid volume deficit r/t increased metabolic rate (fever,infection)

FINDINGS SCIENTIFIC BASIS EXPECTED NURSING ACTUAL

OUTCOME INTERVENTIONS EVALUATION

S = no subjective Febrile states Within 8 hours nurse- INDEPENDENT: After 8 hours nurse-

cues decrease body fluids patient interaction & • Assessed patient interaction

O= Received pt. through perspiration interventions, the pt. etiological factors and interventions,

lying on bed, and increase will be able to: = to know the cause the patient was able

awake, conscious, respiration. • Identify which should also to:

alert and coherent appropriate be treated • Increase fluid intake

36
 with IVF # 5 interventions • Assessed skin • Maintain hydration

D5NM 1L @ • Increase fluid turgor and status

30gtts/min intake moisture • Patient’s

infusing well at • Maintain hydration = indicator of temperature

right arm. status dehydration decreased from

= dry skin noted • Monitored 38.1 °C to 37.6 °C

= slightly dry lips temperature

= slightly dry oral = febrile states

mucosa decrease body

= weakness noted fluids through

= V/S: perspiration and

T: 38.1 °C increase

P: 90 respiration

R: 21 • Monitore

BP: 100/70 mmHg d I & O balance

37
 being aware of

insensible loses

= to ensure

accurate picture of

fluid status

• Gave tepid sponge

bath

= TSB promotes

heat loss through

conduction and

evaporation

• Advised patient to

increase oral

intake

= to maintain

38
 hydration status

COLLABORATIVE:

• Provided

supplemental

fluids (IVF # 5

D5NM 1L @

30gtts/min) as

indicated.

= replaces lost fluid

• Paracetamol

500mg

q4 for fever

= The drug may

relieve fever

through central

39
 action in the

hypothalamic

heat-regulating

center.

c.) NURSING DIAGNOSIS:

Ineffective airway clearance related to retained secretions

FINDINGS SCIENTIFIC BASIS EXPECTED NURSING ACTUAL

OUTCOME INTERVENTIONS EVALUATION

S = “gahi kayo ako An airway may be Within 8 hours nurse- INDEPENDENT: After 8 hours of

ubo, di nako partially or patient interaction & • Monitored nursing

40
 mapagawas” completely interventions, the pt. respiratory rate and interventions, the

O = Received pt. obstructed due to will be able to: depth patient was able to:

lying on bed, mucus plug of • Maintain airway = to monitor the • Maintain airway

awake, retained mucus patency progress of patency

conscious, alert secretion .In • Demonstrate treatment • Increase fluid

and coherent Cerebrovascular behaviors to • Advised to increase intake

with IVF # 5 disease there is a improve airway fluid intake • Perform deep

D5NM 1L @ respiratory function patency = to liquefy secretions breathing

30gtts/min in which the patient • Perform • Placed patient in exercises

infusing well at may not be able to techniques that MHBR position. • Reported

right arm. speak or cough will alleviate = To maintain open decrease in throat

= dry cough noted effectively, and this mucus secretions. airway. irritation

= harsh sounds may lead to severe • Kept environment

noted upon respiratory distress. free from allergy

auscultation (dust, smoke, etc.)

41
 = to avoid irritating

Source: the lungs

Medical-Surgical • Teach patient

Nursing “ Concept & about deep

Clinical Practice” breathing exercises

4th edition by: COLLABORATIVE:

Phipps. Et.al • Provided

humidification such

as ventolin 1 neb

q8

= loosens secretions

making it easier to

cough out

Levofloxacin given

= Inhibits bacterial

42
 DNA gyrase and

prevents DNA

replicdatioin in

susceptible

bacteria; indicated

for acute bacterial

worsening of

chronic bronchitis

2. DRUG STUDIES

Mechanis Nursing
Name of Contraindicatio
Classification m of Indication Side Effects Responsibilitie
Drug n
Action s
Generic General Inhibits - acute - patients CNS: H/A, -if patient

43
Name: Classification: bacterial bacterial hypersensitive insomnia, pain, experiences

Levofloxac Anti-infectives DNA gyrase worsenin to drug, its dizziness, seizures symptoms of

in and g of components, or CNS

CV: chest pain,
Time: Functional prevents chronic other stimulation,
palpitations,
OD (8am) Classification: DNA bronchitis fluoroquinolone stop drug and
vasodilation
Route: Fluoroquinolon replicdatioin - communit s notify

Oral es in y - use cautiously GI: nausea, prescriber.

Dose: susceptible acquired in patients with diarrhea, Begin seizure

500mg 1 bacteria pneumoni history of constipation, precautions

tab a seizure vomiting, -watch out for

- nosocomi disorders or abdominal pain, hypersensitivity

al other CNS dyspepsia reactions

pneumoni diseases, such ,flatulence -drug may cause

a as abnormal ECG
GU: vaginitis
-obtain

44
 arteriosclerosis specimen for
Hema: eosinophila,
culture and
- use cautiously haemolytic anemia
sensitivity tests
and with
Meta: before starting
dosage
hypoglycaemia therapy to
adjustments in
determine if
patients with Musculo: back
bacterial
renal pain, tendon
resistance has
impairment rupture
occurred

Respi: allergic -monitor glucose

pneumonitis level and renal,

hepatic and
Skin: rash, pruritis
hematopoietic

Other: studies

hypersensitivity -tell patient to

45
 take drug as

prescribed to

avoid bacterial

drug resistance

-advise patient
reactions
to take drug

with plenty of

fluids

-give drug with

meals
Reference: Williams, Wilkins. Nursing 2007 Drug Handbook, Philadelphia: Lippincott Williams & Wilkins, 2007.

Name of Classificatio Mechanism Indication Contraindicati Side Effects Nursing

Drug n of Action on Responsibiliti

46
 es
Generic General Inhibits - frequent - CNS: - Don’t confuse

Name: Classification: activity of heartburns hypersensitivity headache, Prilosec with

Omeprazole Gastrointestin acid pump - duodenal to drug and its dizziness, Prozac or

Time: al tract drugs and binds to ulcer components asthenia Prilocaine

OD (during hydrogen- GI: diarrhea, - Tell patient to

breakfast) Functional potassium abdominal swallow drug

Route: Classification: adenosine pain, nausea, whole and not

Oral Anti-ulcer triphoshatase vomiting, to open,

Dose: drugs at secretory constipation, crush or chew

20mg 1 cap surface of flatulence them

gastric Musculo: - Instruct

parietal cells back pain patient to

to block Respi: cough, take drug 30

formation of upper mins before

47
 gastric acid respiratory meals

tract infection - Caution

Skin: rash patient to

avoid

hazardous

activities if he

gets dizzy
Reference: Williams, Wilkins. Nursing 2007 Drug Handbook, Philadelphia: Lippincott Williams & Wilkins, 2007.

48
 Nursing
Name of Classificatio Mechanism Contraindicati
Indication Side Effects Responsibiliti
Drug n of Action on
es
Generic General Unknown. - mild pain or - Hema: - be aware in

Name: Classification: Thought to fever hypersensitivit haemolytic calculating

Paracetamol Central produce y to drug anemia, total daily

Time: nervous analgesia by - use cautiously neutropenia, dose

q4 for fever system drugs blocking pain in patients leukopenia, - use liquied

Route: impulses by with long-term pancytopenia form for

Oral Functional inhibiting alcohol use Hepa: patients who

Dose: Classification: synthesis of because jaundice have

500mg 1 tab Non-opioid prostaglandin therapeutic Meta: difficulty

analgesics and in the CNS or doses cause hypoglycaemi swallowing

antipyretics of other hepatoxicity in a - advice

substances these patients Skin: rash, patient that

49
 that sentisize uticaria drug is only

pain receptors for short-

to stimulation. term use

The drug may - warn patient

relieve fever that

through unsupervise

central action d long-term

in the use can

hypothalamic cause liver

heat- damage

regulating

center.
Reference: Williams, Wilkins. Nursing 2007 Drug Handbook, Philadelphia: Lippincott Williams & Wilkins, 2007.

50
 Nursing
Name of Classificatio Mechanism Contraindicatio
Indication Side Effects Responsibilitie
Drug n of Action n
s

51
Generic General Relaxes - to prevent or - hypersensitivity CNS: tremor, - teach patient

Name: Classification: bronchial, treat to drug nervousness, to perform

albuterol Respiratory uterine and bronchospas - use cautiously dizziness, oral inhalation

sulfate tract drugs vascular m in in patients with insomnia, correctly

Trade smooth patients CV disorders, headache, - if prescriber

Name: Functional muscle by with hyperthyroidism hyperactivity orders more

Ventolin Classification: stimulating reversible , or diabetes , weakness, than 1

Time: bronchodilator beta2 obstructive mellitus and in CNS inhalation, tell

q8 s receptors airway those who are stimulation, patient to

Route: disease unusually malaise. wait at least 2

Inhalation responsive to minutes

CV:
Dose: adrenergics before
tachycardia,
1 neb repeating
palpitations,
procedure
hypertension
- warn patient

52
 about risk of
EENT: dry
paradoxical
and irritated
bronchospas
nose and
m and to stop
throat with
drug
inhaled form,
immediately if
nasal
it occurs
congestion,

epistaxis,

hoarseness

Meta:

hypokalemia

Musculo:

muscle

53
 cramps

Respi:

bronchospas

m, cough,

wheezing,

dyspnea,

bronchitis,

increased

sputum

Other:

hypersensitiv

ity reactions
HEALTH TEACHING PLAN

Topic: Preventing dengue

54
General Objectives: Given varied activities and health teaching, the patient will be able to comprehend the clinical

signs of

Dengue, exhibit the value of cooperation interventions in preventing dengue.

Teaching–
Specific Time
Content Learning Resources Evaluation
Objectives Allotment
Activities

Given fifteen • Bondpapers

minutes of • Pen

teaching-learning • Time and

session, the effort of both

patient will be patient and

able to: nurse

Sources of Discussion and 3 mins Question and

• Identify the infection: interaction with Answer

55
 source of • immediate the patient

infection of source is a

dengue; vector

mosquito, the

aedes aegypti

or the common

household

mosquito

• the infected

person

7 mins Question and

• describe the Answer

types of Types of dengue:

56
dengue and 1. Dengue fever

it’s signs (Classic

and dengue)

symptoms Signs and

correctly; symptoms:

• Fever

• Severe

headache

• Nausea and

vomiting

• Rash

• Joint and

muscle pain

57
2. Dengue

Hemorrhagic

Fever

Signs and

symptoms:

• Symptoms of

dengue

hemorrhagic

fever include all

of the

symptoms of

classic dengue,

plus:

• Marked

damage to

58
 blood and

lymph vessels

• Bleeding from

the nose, gums

or under the

skin, causing

purplish bruises

3. Dengue shock

syndrome-the

most severe

form of dengue

disease-

59
 Signs and

symptoms:

• include all

of the

symptoms of

classic dengue

and dengue

hemorrhagic

fever, plus

• fluids
5 mins Question and
leaking outside
Answer
of blood vessels
• practice the

60
ways on • massive

how to bleeding

prevent • shock (very

dengue low BP)

Ways to prevent

dengue:

• Use a

mosquito

repellant

• Dress in

protective

clothing-long-

61
 sleeved shirts,

long pants,

socks, and

shoes

• Keeping

unscreened

windows and

doors closed

• Keeping

window and

door screens

repaired

• Getting rid

of areas where

62
 mosquitoes

breed, such as

standing water

in flower pots,

containers,

birdbaths,

discarded tires,

etc.
Reference:

• Cuevas, Frances Pricilla L. Public Health Nursing in the Philippines. Philippines: Publications

Committee,National League of Phil. Gov. Nurses, Incorporated, 2007.

• scribd.com

63
DISCHARGE PLAN

A case of M.R.P., 32 years old, male, married, a Filipino and a

Roman Catholic. He lives in Pob. Cogon, Lilo-an, Cebu. He was born

on January 6,1977 Patient was admitted for the first time in

AMOSUP-Seamen’s Hospital due to persistent cough and fever of

39.1C.

Medication:

• Advised the patient to have drug compliance as prescribed by

the physician such as

Environment:

• Encouraged patient to clean surroundings

• Advised patient to cover water barrels and other storage for

water

• Instructed patient to avoid dark places

• Told to get rid of areas where mosquitoes breed, such as

standing water in flower pots, containers, birdbaths, discarded

tires, etc.

Treatment:

• Instructed patient to return for follow-up check-up

Health Teachings:

64
 • Advised patient to use off lotion especially when outdoors

• Encouraged patient to use a mosquito net when sleeping

• Advised patient to wear pajamas or long sleeves when

sleeping

• Advised patient to have proper hygiene like taking a bath

everyday using shampoo and soap

Observable Signs and Symptoms:

Instructed patient to report immediately to health care provider if

these symptoms occur:

• High fever, up to 105 degrees Fahrenheit

• Severe headache

• Pain behind the eye

• Severe joint and muscle pain

• Nausea and vomiting

• Rash

Diet:

• Instructed patient to eat foods rich in iron like green leafy

vegetables and organ meats

• Advised to increase oral fluid intake.

Spiritual:

• Encouraged patient to pray to his God to give him good health

and guidance

65
 • Respect patient’s spiritual beliefs.

BIBLIOGRAPHY

• Myers, Ehren. RN Notes ‘Nurse’s Clinical Pocket Guide’ 2nd ed.

Philadelphia: F.A. Davis Company, 2006.

• Cuevas, Frances Pricilla L. Public Health Nursing in the Philippines.

Philippines: Publications Committee,National League of Phil. Gov.

Nurses, Incorporated, 2007.

• Williams, Wilkins. Nursing 2007 Drug Handbook, Philadelphia:

Lippincott Williams & Wilkins, 2007.

• Doenges, Moorhouse & Murr. Nurse’s Pocket Guide 10th ed.

Philadelphia: F.A. Davis Company, 2007

• Kozier, Barbara. Fundamentals of Nursing ‘Concepts, Process

and Practice’ 7th ed. Singapore: Pearson Education South Asia

Pte. Ltd., 2004

• Brunner & Suddarth. Textbook of Medical-Surgical Nursing 11th ed.

Lippincot, Williams & Wilkins, 2008

• nursingcrib.com

• doh.com.ph

• scribd.com

• blogspot.com

66