Far Eastern University Dr. Nicanor Reyes Medical Foundation I.

Biographic Data Name: Maruel Rosalio Aviso Satuito Address: Lira St., North Fairview, Quezon City Age: 6 8/12 Gender: Male Religious Affiliation: Seventh Day Adventist Marital Status: Single Occupation: N/A Room and Bed #: 504-G Chief Complaint: Fever Provisional Diagnosis: Dengue fever syndrome; some dehydration Attending Physician: Dr. C. Micu/Dr. Yang/Dr. Aguinaldo II.Nursing History A. Past Health History The patient has (-) asthma, allergy and pulmonary tuberculosis. He had already given 1 dose of BCG, 3 doses of Hepa B, OPV, and DPT for his immunization. He doesnt have known allergies to foods and medications, only to dust. He didnt encounter any accidents and even foreign travel. The patient was hospitalized before with the same diagnosis, which is Dengue. This was his second time and he is currently taking Loratadine + Phenyephrine HCl, Zinc Sulfate, Rifampicin, Isoniazid and Paracetamol as needed. B. History of Present Illness Three days prior to admission, the patient experienced fever with a temperature o of 38.5 C and dysuria but with good appetite and activity. One day prior to admission, the patient was still febrile, vomits previously ingested food and with cough. His appetite as well as his activity decreased. Few hours prior to admission, the patient is still with above signs and symptoms. They seek consult, hematologic test was taken and revealed abnormal levels of MCV (mean corpuscular volume), MCH (mean corpuscular hemoglobin), and eosinophils. Serologic test was also taken and had a result in Dengue blot of negative IgG and IgM and positive for Dengue NS1 Antigen. After he was checked, he was admitted with a diagnosis of Dengue Fever Syndrome with some Dehydration. C. Family History The patients family has (+) asthma and (-) allergy, pulmonary tuberculosis, hypertension, diabetes mellitus and heart, lung, kidney and liver disease. D. Developmental History According to Erik Eriksons Developmental Theory, the patient who is 6 years old is under the School age stage wherein the ego development outcome is Industry vs. Inferiority. At this stage, the child or the patient is beginning to create, develop, and manipulate. Hence, he develops his sense of competence and perseverance. Upon observation and with the patients father statement, the patient is active and his self-concept is good though he is quite behind in school compared to others. With him at home is his Father, other relatives and their helper, who guides him in what he does and leads him in his development. III. Patterns of Functioning A. Psychological Health 1. Coping Patterns - Before he was admitted to the hospital, he usually engages in activities that involve physical strength like running but since the patient was confined, he needs to adjust to the new environment. He was able to cope up with his condition by spending more time on coloring books and writing. Nevertheless, his father and some relatives

helped him to recovery.

understand the condition and encouraged him to

cooperate

for

his

now

2. Interaction Patterns - According to the fathers statement, they had a recent loss of a family member (mother). The patient was closer to her mother before but since her mother died, he interacts more with his uncle, grandmother and their helper.

3. Cognitive Patterns - The last time his father talked to the clients adviser, the adviser told him that he was quite behind compared to his classmates. There is a slow progress when it comes to his reading and writing skills. 4. Self-concept - He sees himself well and there seems to be no problem with the way he views including his character and personality.

himself

5. Emotional Patterns - Since he tells all his problems to his father, they didnt have problems about feelings that are kept and hidden even when his mother died. They explained to the child clearly what happened and that he should understand their situation. Fortunately, the response of the child was good and he was able to cope up. He is not hard-headed and he behaves well. 6. Sexuality - According to his father, he is joining together with a group of boys and girls. When there are family gatherings, he usually stays and plays with his girl cousin. 7. Family Coping Patterns - The child approaches his father to tell his problems and to ask for guidance. His thinks that his son was able to open up everything.

father

INTERPRETATION: The child generally likes to spend his time in activities that most of the boys do like playing basketball and running but as he stayed in bed for his stay in the hospital, we saw that he also enjoyed drawing and coloring as his past time. His family was supportive enough to take care of him that while his father was still in work, his uncle took care of him and after office hours, his father went straight to the hospital to talk, play and take care of his son. When his mother was still alive, she was the one whos always with the child but now, although there were no problems with his attitude, he wasnt guided as well as his mother did thats why his grades are quite behind his other classmates. His father also concluded that since his child tells his problems and feelings to his father, therefore, there they wont have any problems about feeling that are kept that could affect the childs performance in school or attitude. ANALYSIS: The patient speaks when he is asked and seemed to be happy and fine. He didnt have any problems during his stay in the hospital maybe because he had activities to do and he sees that his relatives take good care of him. And although it is hard to lose a parent, the situation was clearly and well explained thats why the loss didnt give the child problems regarding his attitude. He has friends from both boys and girls and he do not isolate himself from his classmates. B. Socio-Cultural Patterns 1. Cultural Patterns - Every time a family member gets sick, they drink herbal medicines and calamansi with honey as a primary cure to the illness and if the herbals didnt make them feel better, they seek for medical assistance. 2. Significant Relationships

to her

- He is closest to his mother before because she gives all her time and attention child.

3. Recreation Patterns - He plays basketball and likes physical activities like running but during his stay in the hospital, he spends his time coloring books and drawing. He also enjoys playing with his cousin. 4. Environment - According to his father, when her mother was still alive, she usually keeps everything clean and makes sure that her son is safe especially at home but now its already different. In addition to that, their place is also surrounded by a lot of trees. INTERPRETATION: They have their own belief regarding herbal medicines as their primary cure and seek medical assistance if the illness continues. He was closest to his mother before since she was the one whos always with him before and really guided him. His father also said that her wife makes sure that her son is safe especially at home but his relatives cannot maintain it now so their house is a bit messy. He spends his time in doing the things that he enjoys like drawing and coloring. He also enjoys the company of his girl cousin. ANALYSIS: It is fine if they stick to their belief and it is also good to know that they still seek for medical assistance after all. It is also good that his relatives are very caring and supportive thats why he never lacked of care and love that although they cannot give much like the clients mother did, they still make an effort in making things a lot easy for the child. C. Spiritual Patterns 1. Religious Beliefs and Practices - They believe in Holy Scriptures, the great controversy (Christ and Satan), (Life, Death and resurrection of Christ), Baptism, Lords Supper, Sabbath, Stewardship, Second coming of Christ, Millennium and the end of sin and New earth. They dont eat pork and they avoid eating meat and fish. They are vegetarian and they also avoid coffee, tea and alcohol. 2. Values and Valuing - He is very courteous especially when answering questions. Though his mother past away, good manners and right conduct are still what he possesses, with the guidance of his father and relatives. IV. Activities of Daily Living ADL 1. Nutrition Before Hospitalization Appetite is good and usually depends on the food being served. His output is normal and he defecates twice a day. During Hospitalization On diet as tolerated except dark colored foods with good appetite. For the days, he was hospitalized, he didnt defecate but his voiding pattern is still normal. Because of hospitalization, Interpretation and Analysis Even with the slight change on his diet, he didnt complain about it. Before he was experienced dysuria but during hospitalization, theres no problem found. No problems found.

2. Elimination

3. Exercise

He is very active and engages in

exercises running. 4. Hygiene

5. Substance Abuse 6. Sleep and Rest

as coloring book and drawing had been his past time. He takes a bath He still washes daily and washes his hands but his hands. taking a bath regularly is not being done because of fever (but he is now afebrile). N/A N/A He sleeps in the afternoon; goes to sleep at 11 pm and wakes up at 7 am. He still sleeps in the afternoon and because hes no longer watching television shows, he is now sleeping early than his normal sleeping pattern. He plays and he is His uncle is the in a group of boys one taking care and girls at school. of him and his father is going straight to the hospital after work together with his cousin.

such

He still maintain to have a good hygiene despite of his illness.

N/A Though he sleeps at 11 pm, he still maintained 8 hours of sleep needed by a child like him.

7. Sexual Activity

No problems found.

V. Physical Assessment Norms General Appearance 1. Posture/Gait Relaxed, erect posture; Coordinated Actual Findings Standing erect, and in good posture Interpretation and Analysis Normal, since the patient exhibits good posture and coordination in movements. Normal, the patient has no signs of skin abnormalities. The patient is always in good hygiene and good grooming. The patient is on diet appropriate to childs age.

2.

Skin Color

Free from pallor, Cyanosis, jaundice, erythema. Clean, neat.

Normal condition

3. Personal Hygiene & Grooming 4. Nutritional Status

In good hygiene and good grooming Eating wellbalanced diet appropriate to age Balanced diet

5. Age

Appropriateness

Mental age appropriate to physical age Answers quickly.

Acts accordingly to his physical age Courteous

Mental age of patient is appropriate to his physical age The patient is well mannered and is polite than others in his age. No mannerism was seen during the assessment and interview. Normal Normal Normal Normal Normal

6. Verbal Behavior

7. Non-verbal behavior

Answers well with familiar people and shows hesitancy with new faces. 36.5C-37.5C 70 110bpm 20 30cpm 80 120mmHg 20 42kg

None

Measurements 1. Temperature 2. Pulse Rate 3. Respiratory Rate 4. Blood Pressure 5. Weight

37.1C 100bpm 22cpm 100/60 mm HG 24.5 kg

Body Part (Technique Used) Head (Inspection)

Norms Clear and pink palpebral Conjunctiva, White and clear sclera. Nasal turbinate pink in color, pink buccal mucosa. Symmetrical chest expansion, no retraction, clear breath sounds, good air entry Normal rate, regular rhythm, no murmurs. Good peristalsis sound should be heard

Actual Findings Pink palpebral conjuctiva, white sclera, pale nasal turbinate, moist lips, buccal mucosa pink, hyperthropic tonsils. Symmetrical chest expansion, no retraction, clear breath sounds, good air entry. Normal rate, regular rhythm, no murmurs. Flat; Good peristalsis sound heard in all quadrants.

Interpretation and Analysis No problems were found on these parts, except for the tonsils.

Chest (Inspection, Palpation, Auscultation)

No deviations were found at this part.

Heart (Auscultation)

No heart deviations were detected. No problem was assessed in the abdomen

Abdomen (Auscultation)

VI.Course in the Ward 1. Laboratories DATE 6/15/1 0 PROCEDURE HEMATOLOGY NORMS RBC count - 5.56.5x1012/L RESULT RBC count5.52x1012/L INTERPRETATION AND ANALYSIS RBC count is normal. Hemoglobin is

Hemoglobin (Hgb) 14-16g/dl Hematocrit (Hct) 0.42-0.52L/L MCV 82-92 fl

Hemoglobin (Hgb)14.30g/dl Hematocrit (Hct)0.42L/L MCV-76.5 fl

normal. Hematocrit is normal. MCV (mean corpuscular volume) is below the normal range that indicates decreased size in RBC. MCH (mean corpuscular hemoglobin) is below the normal range It indicates disproportionate hemoglobin in each RBC MCHC (mean corpuscular hemoglobin concentration) is normal. Platelet count is normal. WBC count is normal. Segmenters, lymphocytes and monocytes are normal. Eosinophils is below the normal range It indicates that the components responsible for combating certain infections are lowered. Decreased RBC count can be associated with abnormal destruction or abnormal loss of erythrocytes. It indicates lack of needed elements for erythrocyte production. Decreased hemoglobin

MCH 27-33 pg.

MCH-25.9 pg.

MCHC 32-38%

MCHC-33.9%

Platelet count -160380x109/L WBC count 5-10 x109/L DIFFERENTIAL COUNT Segmenters-0.550.65 Lymphocytes-0.250.35 Monocytes-0.02-0.06

Platelet count261x109/L WBC count6.25x109/L DIFFERENTIAL COUNT Segmenters-0.60 Lymphocytes-0.34 Monocytes-0.05

Eosinophils-0.01 Eosinophils-0.03-0.05 6/16/1 0 HEMATOLOGY RBC count - 5.56.5x1012/L RBC count4.51x1012/L

Hemoglobin (Hgb) 14-16g/dl

Hemoglobin (Hgb)-

11.80g/dl

indicates decreased oxygen transportation to cells and removal of carbon dioxide for excretion to the lungs. Decreased hematocrit count indicates decreased RBC volume in proportion to other components of blood. Decreased MCV indicates decreased size in RBC. Decreased MCH It indicates disproportionate hemoglobin in each RBC Increased MCHC but within normal level. Decreased platelet count but still within normal level. Decreased WBC count It indicates risk for viral infection. Decreased segmenters indicate that there is lowered defense against bacterial infection and physiologic stress. Increased lymphocytes indicate a high risk for infection.

Hematocrit (Hct) 0.42-0.52L/L

Hematocrit (Hct)0.32L/L

MCV 82-92 fl

MCV-72.7fl.

MCH 27-33 pg.

MCH-26.2pg.

MCHC 32-38%

MCHC-36.0%

Platelet count -160380x109/L

Platelet count182x109/L

WBC count 5-10 x109/L

WBC count4.25x109/L

DIFFERENTIAL COUNT Segmenters-0.550.65

DIFFERENTIAL COUNT Segmenters-0.39

Lymphocytes-0.250.35

Lymphocytes-0.43

Increased monocytes indicate lowered response to inflammation Decreased eosinophils It indicates that the components

Monocytes-0.17 Monocytes-0.02-0.06

Eosinophils-0.01 Eosinophils-0.03-0.05 6/16/1 0 HEMATOLOGY RBC count - 5.56.5x1012/L RBC count4.48x1012/L

responsible for combating certain infections are lowered.

Decreased RBC count can be associated with abnormal destruction or abnormal loss of erythrocytes. It indicates lack of needed elements for erythrocyte production. Decreased hemoglobin indicates decreased oxygen transportation to cells and removal of carbon dioxide for excretion to the lungs. Decreased hematocrit count indicates decreased RBC volume in proportion to other components of blood. Decreased MCV indicates decreased size in RBC.

Hemoglobin (Hgb) 14-16g/dl

Hemoglobin (Hgb)11.70g/dl

Hematocrit (Hct) 0.42-0.52L/L

Hematocrit (Hct)0.33L/L

MCV 82-92 fl

MCV-73.0fl.

MCH 27-33 pg.

MCH-26.1pg.

Decreased MCH It indicates disproportionate hemoglobin in each RBC Decreased MCHC but within normal level. Increased platelet count but within normal level. Decreased WBC count It continues to fall to abnormal level that may indicate that

MCHC 32-38%

MCHC-35.8%

Platelet count -160380x109/L

Platelet count192x109/L

WBC count 5-10 x109/L

WBC count4.24x109/L

condition is getting worse. Decreased segmenters indicate that there is lowered defense against bacterial infection and physiologic stress. Increased lymphocytes indicate a high risk for infection. Increased monocytes indicate lowered response to inflammation Decreased eosinophils It indicates that the components responsible for combating certain infections are lowered. Decreased RBC count can be associated with abnormal destruction or abnormal loss of erythrocytes. It indicates lack of needed elements for erythrocyte production. Increased hemoglobin but still not within normal level It indicates decreased oxygen transportation to cells and removal of carbon dioxide for excretion to the lungs. Decreased hematocrit count indicates decreased RBC volume in proportion to other components of

DIFFERENTIAL COUNT Segmenters-0.550.65

DIFFERENTIAL COUNT Segmenters-0.29

Lymphocytes-0.56 Lymphocytes-0.250.35

Monocytes-0.13 Monocytes-0.02-0.06

Eosinophils-0.02 Eosinophils-0.03-0.05 6/17/1 0 HEMATOLOGY RBC count - 5.56.5x1012/L RBC count4.44x1012/L

Hemoglobin (Hgb) 14-16g/dl

Hemoglobin (Hgb)11.90g/dl

Hematocrit (Hct) 0.42-0.52L/L

Hematocrit (Hct)0.32L/L

blood. Increased MCV but still not within normal level It indicates decreased size in RBC. Increased MCH but still not within normal level It indicates disproportionate hemoglobin in each RBC. Decreased MCHC but within normal level. Increased platelet count but within normal level. Increased WBC count but still not within normal level It continues to fall to abnormal level that may indicate that condition is getting worse. Decreased segmenters indicate that there is lowered defense against bacterial infection and physiologic stress. Increased lymphocytes indicate a high risk for infection. Lymphocytes-0.57 Lymphocytes-0.250.35 Decreased monocytes but still higher than the normal level It indicates lowered response to inflammation Increased eosinophils but within the normal level

MCV 82-92 fl

MCV-73.2 fl.

MCH 27-33 pg.

MCH-26.8 pg.

MCHC 32-38%

MCHC-35.6%

Platelet count -160380x109/L WBC count 5-10 x109/L

Platelet count177x109/L WBC count4.39x109/L

DIFFERENTIAL COUNT Segmenters-0.550.65

DIFFERENTIAL COUNT Segmenters-0.26

Monocytes-0.12 Monocytes-0.02-0.06

Eosinophils-0.05 Eosinophils-0.03-0.05 6/15/1 0 URINALYSIS MACROSCOPIC Color Straw amber transparent Bilirubin Negative Protein Negative pH 4.5-8 Character Clear Hazy Urobilinogen 0.11.0 EU/Dl Nitrite Negative Blood Negative Glucose Negative Leukocytes Negative Specific gravity 1.010-1.025 MACROSCOPIC Color Yellow Bilirubin Negative Protein Negative pH 6.5 Character Hazy Urobilinogen Normal Nitrite Negative Blood Negative Glucose Negative Leukocytes Negative Specific gravity 1.010 Color of the urine is normal. Bilirubin and protein are not present. pH is normally acidic. Character is normal. Urobilinogen is normal. Nitrite, blood, glucose and leukocytes are not present. Specific gravity is normal. It correlates with urine osmolality and gives important insight into the patient's hydration status. Casts and crystals are not present. Pus cells are in normal range. There is 0-1/hpf present in red blood cells that may be associated with hematuria. The presence of epithelial cells is rare that indicates that there is no possible contamination of the specimen. A.Urates/Phosphate s and bacteria are occasionally found and it indicates that there is presence of contamination.

MICROSCOPIC Casts Negative Crystals Negative Pus cells - 0-5/hpf Red blood cells 0/hpf

MICROSCOPIC Casts None Crystals None Pus cells 0-1/hpf Red blood cells 01/hpf

Epithelial cells Few

Epithelial cells Rare

A.Urates/ Phosphates None Bacteria - None

A.Urates/ Phosphates Occasional

Bacteria Occasional 6/15/1 0 SEROLOGY Dengue blot IgG Negative IgM Negative Dengue blot IgG Negative IgM Negative Remarks: Dengue NS1 Antigen: Positive

IgG is negative It indicates that the patient has long term immunity. IgM is negative It indicates that you've had dengue or not, within 30 days of infection. Dengue NS1 Antigen is positive and it indicates that there is an early diagnosis of dengue.

6/15/1 0

BLOOD BANK

Blood typing ABO O RH - Positive

The patients blood type is O and with a positive RH.

2. Medications Generi Dosag c/ e/ Trade Frequ Name ency Paracet 250 amol mg/ 5mL every 4 hrs for temp > 37.8 C

Classificati on Antipyretic/ Analgesic

Indication

Contraindication - Hypersensitivity Alcoholism; because therapeutic doses can cause hepatotoxicity to these patients - Use cautiously with impaired hepatic function, pregnancy and lactation

Side Effects

Nsg. Responsibilities > In children, do not exceed 5 doses. > Advise patient that the drug is only for short term use and to consult the physician if giving to children for longer than 5 days or adults for longer than 10 days. > Advise patient or caregiver that many over the counter drugs contain acetaminoph

- For relief of fever, headaches and other minor aches and pains; used in combination with NSAIDs and opioid analgesics for managemen t of more severe pain

- Hemolytic anemia - Neutropenia -Leucopenia Pancytopenia - Jaundice Hypoglycemi a - Rash - urticaria

Loratadi ne + Phenylephrine HCl

2.5 mL x 10 doses q 12 hrs

Antihistamin e Decongesta nt

- Temporary relief of stuffy nose, sinus, and ear symptoms caused by the common cold, flu, allergies, or other breathing illnesses (e.g., sinusitis, bronchitis).

-Hypersensitivity - Pregnant and lactating - Alcohol intake

-Mild nasal irritation Hypertension - Drying effect in respiratory and GI mucous membranes - GI upset - Arrhythmia, prolonged QT interval - Dysuria, urinary hesitancy - Skin interruption

Zinc Sulfate

20mg/ 5mL 5mL OD

Supplement

Rifampi cin

200m g/5mL, 6mL

Antimycobacterial

-Dietary supplementa tion; supplement to IV solutions given for TPN - Treatment or prevention of zinc deficiencies. Ophthalmic solution used as mild astringent for relief of eye irritation. - Indicated for the treatment of diarrhea - To treat asymptomati c infection

- Patients with hypersensitivity to Zinc or any component of the product.

- Nausea, - Stomach upset - Heartburn - Vomiting - Headache - Drowsiness - Gastric ulcer Serious side effects occur: - fever - chills - sore throat sores in mouth - unusual tiredness - weakness

en. > Ensure proper administratio n of topical decongestan t. > Monitor blood pressure and cardiac response to drug. > Administer antihistamin e 1 hour before or 2 hours after meals to increase absorption. > Increase fluid intake to reduce thickening on the secretions. > Do not use decongestan t for more than 5 days > Injection must be diluted before use. > Refrigerate suspension.

- Hypersensitivity -Severe

- Cutaneous syndrome - Hepato-

> Assess lung sounds through

30 mins before breakf ast OD

Isoniazi d

200m g/5mL, 5mL 30 mins before breakf ast OD

Antimycobacterial

and for treatment of active clinical tuberculosis and to prevent relapse - It is useful for elimination of Neisseria meningococ ci in carriers and for Gram positive (Staphylococ cus aureus and epidermidis, Streptococcu s pyogenes, viridans and pneumoniae) and gram negative bacteria (Haemophilu s influenzae type B). - Patients who develop severe hypersensitivity reactions including drug -induced hepatitis - Fever, chills, arthritis; and acute liver disease of any etiology.

hepatic damage - Acute gout

toxicity - Thrombocytopenia -Hypersensitivity - It may be - Shock contra- Shortness of indicated in breath pregnancy - Acute except in hemolytic the anemia and presence renal failure of a (nephrodisease toxicity) such as severe tuberculosi s.

course of therapy. > Asses results of periodic laboratory tests and chest x-ray, therapeutic effectiveness and signs of adverse reactions.

- For the treatment of all forms of tuberculosi s in which organisms are susceptible .

- Stomach upset - Heartburn - Nausea - Dizziness - Blurred vision - Darkening of the urine - Skin rash - Yellowing of the eyes or skin - Numbness or tingling of the hands or feet

> Assess laboratory examinations . > Monitor renal/liver function. > Assess visual disturbance that may indicate optical neuritis.

VII. Ecologic Model A. Hypothesis Dengue is transmitted by the bite of an Aedes mosquito infected with any one of the four dengue viruses. It occurs in tropical and sub-tropical areas of the world. Symptoms appear 314 days after the infective bite. Dengue fever is a febrile illness that affects infants, young children and adults. In the case of our patient, the cause of the dengue has rooted from unhealthy environment, as the client is exposed to different areas during outdoor activities. Also, his immune system has weakened, due to stress, because his mother passed

away two months ago. mother was still alive.

Also, the clients home is not well maintained, as it was when his

B. Predisposing Factors 1. Host a. Age and Sex At the age of 6 and as a boy, the client is interested on different activities such as playing outside the house (basketball and running), playing with his cousin and coloring activities. Frequent outdoor activities expose him to unhealthy environment. b. Race and Nationality Dengue occurs commonly in the tropics, like the Philippines. c. Customs The family practices the use of herbal medicines before consulting a health care professional. If the condition is prolonged because of delayed consultation to a health provider, the illness may worsen. 2. Agent a. Mechanical Dengue is transmitted to humans by the Aedes aegypti or more rarely the Aedes albopictus mosquito, both of which feed exclusively during daylight hours. b. Chemical The virus in the blood of the infected individual then infects the mosquito and travels from the mosquito's stomach to its salivary glands were the virus multiplies. The virus is then injected into another person when the mosquito injects anticoagulants that prevent blood clotting when the mosquito is feeding. The mosquito remains able to transmit dengue for its entire life. 3. Environment a. Physical The clients mother, as stated by his father, is very conscious about cleanliness. The physical environment is well-maintained. But since his mothers death, the environment is not maintained as it was before. b. Biologic Since his mother passed away only recently, the clients family is still in a state of grief and may case stress to the client. Also, the client was very close to his late mother. c. Socio-economic The income of his family is fair, only enough to provide for the needs of the client. C. Ecologic Model The Ecologic models are used to show the relationship between the host, agent and the environment and to determine if there is an imbalance between the three (3) predisposing factors that may lead to an occurrence of disease. 1. Lever by The diagram below shows the possible imbalance of the ecologic model caused weakened immune system caused by psychological stress and exposure to unhealthy environment possibly leading to acquiring Dengue.

care

STRESS AEDES AEGYPTI

UNHEALTHY ENVIRONME NT

2. Wheel

3. Web This primarily talks of the multiple causation of the disease. The diagram below shows the possible imbalance of the predisposing factors.

Living or traveling in tropical areas

Increase in the number of breeding sites

Weakened Immune System

Stress

Prior infection with a dengue fever virus

4. Triangle MARUEL

AEDES AEGYPTI

ENVIRONMENT

D. Analysis (with reference) make us like heart with Chronic stress can raise cortisol levels and weaken our immune system and more susceptible to colds and the flu, as well as more serious health problems disease, diabetes and other diseases.

Anyone can be affected by dengue - infants, young children, and adults. People weak immune system are more susceptible to the virus.

In proximity to human settlements, Aedes aegypti mosquitoes breed primarily in artificial water containers, and the mosquitos life-cycle is closely associated with human activities. Larval habitats are increasing rapidly in urban areas. Since there is no curative treatment for dengue, targeted environmental and ecosystem management is

increasingly relevant. In many settings, however, generalized community clean-up campaigns or spacespray application of insecticides, have had only a transient and limited effect or even no measurable effect at all on disease incidence. Dengue is transmitted by the bite of an Aedes mosquito infected with any one of the four dengue viruses. It occurs in tropical and sub-tropical areas of the world. Symptoms appear 3 14 days after the infective bite. Dengue fever is a febrile illness that affects infants, young children and adults. Symptoms range from a mild fever, to incapacitating high fever, with severe headache, pain behind the eyes, muscle and joint pain, and rash. There are no specific antiviral medicines for dengue. It is important to maintain hydration. Use of acetylsalicylic acid (e.g. aspirin) and non-steroidal anti-inflammatory drugs (e.g. Ibuprofen) is not recommended. potentially clinical Dengue haemorrhagic fever (fever, abdominal pain, vomiting, bleeding) is a lethal complication, affecting mainly children. Early clinical diagnosis and careful management by experienced physicians and nurses increase survival of patients.

Sources: http://stress.about.com/od/stresshealth/a/coldsandflu.htm http://www.thepoc.net/thepoc-features/health-and-wellness/health-and-fitnessfeatures/7231-the4s-strategy-dengue-awareness-prevention-philippines.html http://www.who.int/heli/risks/vectors/denguecontrol/en/index.html http://www.who.int/topics/dengue/en/

E. Conclusion and Recommendation Based on the the data gathered, the hypothesis was proven. There is a significant relationship between the predisposing factors and the clients current illness. Due to his involvement to outdoor activities, he was exposed to different environments, possibly an unhealthy environment. Also, since his mothers death, his home was not maintained as before, possibly leading to breeding sites of mosquitoes. In addition, his mothers death may have caused him depression, then stress, then finally, weakening his immune system. From the clients condition, we recommend the following: To maintain the strongest immune system possible, you must have a nutritious diet, get regular exercise, and reduce stress in your life. You must attend to all three of these areas to achieve your optimum health. Because dengue is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue, the treatment is purely concerned with relief of the symptoms (symptomatic). Rest and fluid intake for adequate hydration is important. Aspirin and nonsteroidal anti-inflammatory drugs should be avoided. The prevention of dengue requires control or eradication of the mosquitoes carrying the virus that causes dengue. In nations plagued by dengue fever, people are urged to empty stagnant water from old tires, trash cans, and flower pots. Governmental initiatives to decrease mosquitoes also help to keep the disease in check but have been poorly effective. Wear long pants and long sleeves. For personal protection, use mosquito repellant sprays that contain DEET when visiting places where dengue is endemic. Limiting exposure to mosquitoes by avoiding standing water and staying indoors two hours after sunrise and before sunset will help. The Aedes aegypti mosquito is a daytime biter with peak periods of biting around sunrise and sunset. It may bite at any time of the day and is often hidden inside homes or other dwellings, especially in urban areas. VIII. Pathophysiology (next page)

IX. Problems Identified DATE NURSING PROBLEMS IDENTIFIED Ineffective tissue perfusion related to decreased HgB concentration in the blood secondary to DHF 1 CUES JUSTIFICATION M and F: 5-10 x 109 /L

Decreased WBC:

4.39x109/L
Decreased HgB : M 14-16 g/dl

11.90g/dl
Decreased capillary refill time Lagi kasi akong nasa trabaho kaya naiiwan siya kasama ng Lola, Uncle at Yaya naming sa bahay, as verbalized by father. Normal capillary refill time: less than 3 sec.

Risk for impaired parent attachment r/t physical barriers such as busy work schedule and shift to single parenting.

If the father is always there with the child, he will be able to watch out the health of his son.

-Kamamatay lang kasi ng Mama niya dalawang buwan na ang nakakaraan, reported by the father.

If only the mother is still alive she can be the one to take good care of the child while the father is working. Thus, the mother can provide clean environment for her child to prevent diseases.

X. Nursing Care Plan