NARRATIVE EVALUATION OF NURSING PROBLEMS

Fluid Volume deficit related to gastroinstestinal bleeding. The problem was

ranked first because loss of fluid in the body can cause alteration in the system of the
body. Fluids are essential in the body. It is the primary component in most cells and
performs many vital functions, including transporting nutrients to cells and removing
waste by-products. Goals met. the client verbalized understanding of need for close
monitoring of BP and blood loss. And participated in therapeutic regimen and monitoring
and had normal blood pressure.

Imbalanced nutrition less than body requirements related to inability to absorb

nutrients necessary for formation of normal red blood cells as evidenced by weight loss.
The problem is ranked third. Good nutrition shows how healthy a person is. Since the
client has poor nutrition, there are susceptibilities of infection and diseases. Thus, this
is most likely the cause of her illness. Some interventions done were instructing the
client to eat iron-rich foods and avoiding junk foods. The goal was partially met. The
client has verbalized importance of good nutrition.

Fatigue related to decrease hemoglobin and hematocrit levels. This is prioritized

thirdly because fatigue is the least focused and it can be treated if the two nursing
problems above will be solved. Proper functioning of the body can be attained Some
interventions done, Instruct the client to have adequate resting periods. Goal was
partially met.

DISCHARGE PLANNING

M edications
The client was prescribed to take Cefuroxime 500 mg/cap to take 1 tablet 3x a
day for 5 days scheduled hours: (8am-1 pm- 6 pm). She was also instructed to take
Metronidazole 300 mg/cap to take 1 capsule 3x a day for 5 days scheduled hours (8am-
1 pm- 6 pm). And lastly, Mefenamic Acid 500 mg/ cap to take 1 capsule twice a day as
needed for PRN.

Exercise
The doctor instructed to do deep breathing exercises. Ambulation was also
advised and active ROM exercise.

Treatment
Take medicines the doctor prescribes exactly as directed. If you feel it is not
helping, call your doctor. Do not quit taking it on your own. Avoid lifting heavy objects.

Health Teaching
Dengue Fever
Dengue fever is an acute mosquito-
borne infection caused by the dengue
viruses. This is found in tropical and
sub-tropical regions around the world.
For instance, dengue fever is an
endemic illness in many countries in
South East Asia. The dengue viruses
encompass two different serotypes,
each of which can lead to dengue fever
and dengue hemorrhagic fever.
Dengue hemorrhagic tever, also called
breakbone fever, a severe case of
dengue caused by a virus found in
tropical and subtropical areas and
transmitted by a mosquito bite.
Incubation is usually 3 to 6 days after
the bite.
Characteristics of an Aedes aegypti
mosquito:
1. Daybiting
2. Low-flying
3. Live in stagnant water
4. In urban area cases, it may progress to circulatory
failure, shock and die.

Dengue fever is transmitted to humans 1. Rapid deterioration (Deterioration

through by the bites of occurs after 2-5 days of the typical
female Aedes mosquitoes which are symptoms of dengue fever)
infected with a dengue virus. It cannot 2. Irritability associated with rapid
be spread directly from human to deterioration
human. 3. Restlessness associated with rapid
deterioration
Incubation period 4. Low blood pressure related to
The incubation period ranges from 3 to hemorrhage
14 days, commonly 4 to 7 days. 5. Weak and rapid pulse Related to
hemorrhage
Stages of Dengue Hemorrhagic Fever 6. Petechial rash Related to hemorrhage
• Grade I: fever + Herman's sign
(flushes and redness of skin with General Measures on Preventing
lighter color at the center of the Mosquito-borne Disease
rash) - Clean all water containers once a
• Grade II: Grade I symptoms + week.
bleeding (epistaxis or - Scrub the sides well to remove eggs
nosebleeding, gingival of mosquitoes sticking to the sides.
bleeding, hematemesis or upper - Clean gutters of leaves and debris
gastrointestinal bleeding; e.g: so that rain water will not collect as
vomiting of blood), and melena or breeding places of mosquitoes.
dark stool. - Old tires used as roof support should
• Grade III: Grade II + Circulatory be punctured or cut to avoid
Collapse (hypotension, cold accumulation of water.
clammy skin and weak pulse).
- Collect and dispose all unusable tin
cans, jars, bottles and other items
that can collect and hold
- water.

- Wear long-sleeved clothing and

trousers, and apply effective
mosquito repellent containing DEET
to exposed parts of the body &
Dengue fever is clinically characterized clothes.
by sudden onset of high fever, severe
headache, pain behind the eyes, muscle
and joint pains, anorexia, nausea and - Use mosquito screens or nets when
rash. Young children may exhibit a the room is not air-conditioned.
milder non-specific febrile illness with
rash.

Dengue hemorrhagic fever is a severe

- Place mosquito coil or electric
and potentially fatal complication of mosquito mat / liquid near possible
dengue fever. Initially, the features entrance, such as window, to
include high fever, which lasts two to prevent mosquito bites.
seven days and can be as high as 40-
41 oC, facial flush and other non-specific
constitutional symptoms of dengue - Prevent the accumulation of
fever. Later, it may be followed by the stagnant water
manifestation of bleeding tendency such
as skin bruises, nose or gum bleeding, - Put all used cans and bottles into
and possibly internal bleeding. In severe covered dustbins.
 - Change water for plants at least
once a week, leaving no water in the
saucers underneath flower pots.
- Cover tightly all water containers,
wells and water storage tanks.
- Keep all drains free from
- blockage.
- Top up all defective ground
surfaces to prevent the accumulation
of stagnant water.
- Drink vitamins and fruits rich in
vitamin C to have a strong immune
system
- Consult your doctor if you feel you
have these signs and symptoms.

Out-patient (Follow-up)
• Check up on Wednesday 8-9 am next week.

Diet
The client was instructed 8-10 glasses/day of water. Eat foods rich in Vitamin C
and advised iron-rich foods especially leafy green vegetables.
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