Академический Документы
Профессиональный Документы
Культура Документы
INTRODUCTION
1
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
OBJECTIVES
General objectives
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:
2
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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.
PATIENT‘S PROFILE
DEMOGRAPHIC HISTORY:
3
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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.
4
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
5
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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.
(+) Hypertension
(-) Diabetes
(-) Asthma
6
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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
7
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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.
8
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
9
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
10
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
11
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
12
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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
13
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
14
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
15
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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
16
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
17
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
PHYSICAL ASSESSMENT
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.
18
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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.
19
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
• 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
20
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
21
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
• Head
PARTS METHOD NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION /
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.
22
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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).
23
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
24
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
• 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
25
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
26
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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
• Mouth
PARTS METHOD NORMAL ACTUAL FINDINGS INTERPRETATION / ANALYSIS
FINDINGS
Lips Inspection Uniform pink color Uniform pink color
27
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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
28
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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
PARTS METHOD NORMAL ACTUAL FINDINGS INTERPRETATION / ANALYSIS
29
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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)
30
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
• 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.
31
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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.
32
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
• Thorax
PARTS METHOD NORMAL ACTUAL FINDINGS INTERPRETATION / ANALYSIS
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.
33
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
Notes resonate
Percussion down to the 6th rib
at the level of the
diaphragm but are
34
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
• 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)
35
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
• Abdomen
PARTS METHOD NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION /
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
• Genitalia
36
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
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
37
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
38
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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.
39
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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:
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.
40
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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 (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.
41
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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.
Blood contains other important substances, such as nutrients from food that
has been processed by the digestive system. Blood also carries hormones
42
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
Production and
secretion of Ig’s &
Stimulates leukocytes monocytes/
especially B lymphocytes macrophages,
neutrophils
44
SAN LAZARO HOSPITAL
Leukocytosis
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
Monocytes/macrophages
perform phagocytosis through
Fc receptor within the cells.
Dengue virus replicates in the
cells of monocytes/
macrophages
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
Thrombocytopeni
Epistaxis
a
Gum
bleeding
Dengue Melena
hemorrhagic
45 Hematochezi
SAN LAZARO HOSPITAL fever a
Hematuria
Abdominal
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
Leukocytosis
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
Monocytes/macrophages
perform phagocytosis through
Fc receptor within the cells.
Dengue virus replicates in the
cells of monocytes/
macrophages
Fever
Stimulates leukocytes and Diaphoresis
pyrogen release Warm
flushed skin
47
SAN LAZARO HOSPITAL Thrombocytopeni
a
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
Leukopeni
a
Dengue Abdominal
hemorrhagic fever pain
Melena
48
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
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
49
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
50
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
DRUG STUDY:
51
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
Caution
patient to avoid
hazardous
activities if he
gets dizzy.
Drug Name Dosage, Action Indication Adverse Contraindic Nursing
Frequency Effect ation Responsibilties
, Route
52
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
53
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
54
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
55
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
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
56
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
58
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
59
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
determine
changes
2. Assist with indications of
laboratory healing or
and complications
diagnostic and to
studies as identify
indicated. precipitating
factors
60
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
DIAGNOSTIC EXAMINATIONS
Tourniquet Test
Hematocrit (micro-hematocrit)
Bleeding Parameters
61
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
MEDICAL MANAGEMENT
• For fever, give paracetamol for muscle pains. For headache, give
analgesic. Do not give aspirin.
• IVF (PLR)
62
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
• Blood Transfusion:
1. Platelet Concentration
2. PRBC
5. Cryoprecipitate
NURSING MANAGEMENT
63
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
64
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
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.
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
D- Suggest the patient to eat healthy foods from all of the 5 food
65
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
S - Advise patient to always pray to our lord and never lose hope in
any obstacle that we may encounter.
66
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
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
For the Nursing student who will be assigned to San Lazaro wherein
they will encounter communicable diseases such as Dengue can gain
67
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
68
SAN LAZARO HOSPITAL
DENGUE
PERPETUAL HELP COLLEGE OF MANILA SECTION A4A1 NOVEMBER 17, 2010
4
69
SAN LAZARO HOSPITAL