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I.

OBJECTIVE
 To know accurate information about the clients past history and
illness in relation to clients condition

 To exhibit the anatomy and physiology of the body system


involved in the disease.

 To acquire knowledge about the specific medications of the


patient as well as its action, indication, contraindications and adverse
reaction.

 To utilize all the nursing interventions in abiding to the nursing


process.

 To integrate the appropriate health teachings for proper home


management of the health problem and promotion of self care.

II. PATIENT”S PROFILE:


Name: Karen Joy Cerezo Balolong
Birth date: November 3, 1993
Sex: Female
Age: 14 years old
Address: Lunec, Malasiqui Pangasinan
Civil Status: Single
Nationality: Filipino
Religion: Iglesia ni Cristo
Chief Complaint: chest pain and abdominal pain
Date of Admission: July 23, 2008
Attending Physician: Dr. Reyes

III. HISTIRY OF PAST AND PRESENT ILLNESS:


Patients present condition started 5 days ago PTA as moderate to high
grade fever accompanied by nose bleeding, epigastric pain, no consult
done. One day PTA patient had another episode of nose bleeding still with
fever. Few hours PTA she complained of severe abdominal pain and chest
tightness.

IV. MEDICAL DIAGNOSIS:

 Dengue hemorrhagic Fever

Dengue is a mosquito-borne infection that in recent decades has become


a major international public health concern. Dengue is found in tropical
and sub-tropical regions around the world, predominantly in urban and
semi-urban areas.
Dengue hemorrhagic fever (DHF) is a specific syndrome that tends
to affect children under 10. It causes abdominal pain, hemorrhage
(bleeding), and circulatory collapse (shock). DHF is also called Philippine,
Thai, or Southeast Asian hemorrhagic fever and dengue shock syndrome.

DHF starts abruptly with high continuous fever and headache. There are respiratory
and intestinal symptoms with sore throat, cough, nausea, vomiting, and abdominal
pain. Shock occurs two to six days after the start of symptoms with sudden
collapse, cool, clammy extremities (the trunk is often warm), weak pulse, and
blueness around the mouth (circumoral cyanosis).

In DHF, there is bleeding with easy bruising, blood spots in the skin (petechiae),
spitting up blood (hematemesis), blood in the stool (melena), bleeding gums, and
nosebleeds (epistaxis). Pneumonia is common, and inflammation of the heart
(myocarditis) may be present.

Dengue haemorrhagic fever (DHF), a potentially lethal complication,


was first recognized in the 1950s during dengue epidemics in the
Philippines and Thailand. Today DHF affects most Asian countries and has
become a leading cause of hospitalization and death among children in
the region.

There are four distinct, but closely related, viruses that cause
dengue. Recovery from infection by one provides lifelong immunity
against that virus but confers only partial and transient protection against
subsequent infection by the other three viruses. There is good evidence
that sequential infection increases the risk of developing DHF.

Transmission

Dengue viruses are transmitted to humans through the


bites of infective female Aedes mosquitoes. Mosquitoes
generally acquire the virus while feeding on the blood of
an infected person. After virus incubation for eight to 10
days, an infected mosquito is capable, during probing
and blood feeding, of transmitting the virus for the rest
of its life. Infected female mosquitoes may also transmit
the virus to their offspring by transovarial (via the eggs)
transmission, but the role of this in sustaining WHO/TDR/Stammers
transmission of the virus to humans has not yet been
defined.

Treatment

There is no specific treatment for dengue fever.

For DHF, medical care by physicians and nurses experienced with the effects and
progression of the complicating haemorrhagic fever can frequently save lives -
decreasing mortality rates from more than 20% to less than 1%. Maintenance of the
patient's circulating fluid volume is the central feature of DHF care.

Immunization

There is no vaccine to protect against dengue. Although progress is underway,


developing a vaccine against the disease - in either its mild or severe form - is
challenging.

• With four closely related viruses that can cause the disease, the vaccine must
immunize against all four types to be effective.
• There is limited understanding of how the disease typically behaves and how
the virus interacts with the immune system.
• There is a lack of laboratory animal models available to test immune
responses to potential vaccines.

Despite these challenges, two vaccine candidates have advanced to evaluation in


human subjects in countries with endemic disease, and several potential vaccines
are in earlier stages of development. WHO provides technical advice and guidance
to countries and private partners to support vaccine research and evaluation

V. ANATOMY AND PHYSIOLOGY:

Review of system

The cardiovascular/circulatory system transports food, hormones, metabolic


wastes, and gases (oxygen, carbon dioxide) to and from cells. Components of the
circulatory system include:

• blood: consisting of liquid plasma and cells


• blood vessels (vascular system): the "channels" (arteries, veins, capillaries)
which carry blood to/from all tis
• ues. (Arteries carry blood away from the heart. Veins return blood to the
heart. Capillaries are thin-walled blood vessels in which gas/ nutrient/ waste
exchange occurs.)
• heart: a muscular pump to move the blood

Vascular System - the Blood Vessels


Arteries, veins, and capillaries comprise the vascular system. Arteries and veins
run parallel throughout the body with a web-like network of capillaries connecting
them. Arteries use vessel size, controlled by the sympathetic nervous system, to
move blood by pressure; veins use one-way valves controlled by muscle
contractions.

Arteries
Arteries are strong, elastic vessels adapted for carrying blood away from the
heart at relatively high pumping pressure. Arteries divide into progressively
thinner tubes and eventually become fine branches called arterioles. Blood in
arteries is oxygen-rich, with the exception of the pulmonary artery, which carries
blood to the lungs to be oxygenated.

The aorta is the largest artery in the body, the main artery for systemic circulation.
The major branches of the aorta (aortic arch, ascending aorta, descending aorta)
supply blood to the head, abdomen, and extremities. Of special importance are the
right and left coronary arteries, that supply blood to the heart itself.

Capillaries
The arterioles branch into the microscopic capillaries, or capillary beds, which lie
bathed in interstitial fluid, or lymph, produced by the lymphatic system. Capillaries
are the points of exchange between the blood and surrounding tissues. Materials
cross in and out of the capillaries by passing through or between the cells that line
the capillary. The extensive network of capillaries is estimated at between 50,000
and 60,000 miles long.1
Veins
Blood leaving the capillary beds flows into a series of progressively larger vessels,
called venules, which in turn unite to form veins. Veins are responsible for returning
blood to the heart after the blood and the body cells exchange gases, nutrients,
and wastes. Pressure in veins is low, so veins depend on nearby muscular
contractions to move blood along. Veins have valves that prevent back-flow of
blood.

Blood in veins is oxygen-poor, with the exception of the pulmonary veins, which
carry oxygenated blood from the lungs back to the heart. The major veins, like
their companion arteries, often take the name of the organ served. The exceptions
are the superior vena cava and the inferior vena cava, which collect body from all
parts of the body (except from the lungs) and channel it back to the heart.

Artery/Vein Tissues

Arteries and veins have the same three tissue layers, but the
proportions of these layers differ. The innermost is the intima;
next comes the media; and the outermost is the adventitia.
Arteries have thick media to absorb the pressure waves
created by the heart's pumping. The smooth-muscle media
Blood vessel walls expand when pressure surges, then snap back to push
anatomy the blood forward when the heart rests. Valves in the arteries
prevent back-flow. As blood enters the capillaries, the
pressure falls off. By the time blood reaches the veins, there is little pressure. Thus,
a thick media is no longer needed. Surrounding muscles act to squeeze the blood
along veins. As with arteries, valves are again used to ensure flow in the right
direction.

Anatomy of the Heart

The heart is about the size of a man's fist. Located between the lungs, two-thirds of
it lies left of the chest midline The heart, along with the pulmonary (to and from the
lungs) and systemic (to and from the body) circuits, completely separates
oxygenated from deoxygenated blood.

Internally, the heart is divided into four hollow chambers, two on the left and two on
the right. The upper chambers of the heart, the atria (singular: atrium), receive
blood via veins. Passing through valves (atrioventricular (AV) valves), blood then
enters the lower chambers, the ventricles. Ventricular contraction forces blood into
the arteries.
Oxygen-poor blood empties into the right atrium via the superior and inferior vena
cavae. Blood then passes through the tricuspid valve into the right ventricle which
contracts, propelling the blood into the pulmonary artery. The pulmonary artery is
the only artery that carries oxygen-poor blood. It branches to the right and left
lungs. There, gas exchange occurs -- carbon dioxide diffuses out, oxygen diffuses in.

Pulmonary veins, the only veins that carry oxygen-rich blood, now carry the
oxygenated blood from lungs to the left atrium of the heart. Blood passes through
the bicuspid (mitral) valve into the left ventricle. The ventricle contracts, sending
blood under high pressure through the aorta, the main artery for systemic
circulation. The ascending aorta carries blood to the upper body; the descending
aorta, to the lower body.

VI. LABORATORY RESULTS

Urinalysis
a.) Macroscopic Findings
EXAM NAME RESULT NORMAL VALUES SIGNIFICANCE
The result is NORMAL but if
dark urine: concentrated;
Very pale: yellow dilute
Color Yellow Yellow urine; dark urine: indicate
presence of myglobin; brown
blood urine in urine:
increased urinary bilirubin
level; other colors: may
result it from diet and
medication.
Appearance sl. Turbid Clear
The result is NORMAL but if
present it reflex
Protien (-) 0.8 mg/dL hypoglycemia or a decreased
in the renal threshold to
glucose
The result is NORMAL but if
present it reflex
Glucose (-) 0 hypoglycemia or a decreased
in the renal threshold to
glucose
The result is NORMAL but if
Decreased: indicates renal
insufficiency, diabetes
Specific Gravity 1.005 1.005-1.030 insipidus, lithium toxicity.
Increased: indicates
decrease renal perfusion,
inappropriate antidiuretic
hormone secretion or
congestive heart failure.
pH 7.5 4.6-8 Increased.

b.) Microscopic Findings


EXAM NAME RESULT NORMAL VALUES SIGNIFICANCE
RBC 10-15/hpf 0-2/hpf The result is INCREASED
Pus cells 1-2/hpf 5-10/hpf Increased.
Epithelial cells few 0 It indicates renal damage of
EXAM NAME RESULT NORMAL VALUESa varietySIGNIFICANCE
of types, both acute
WBC 5.2 5.0/10.0 or chronic
Within normal range.
AmorphousLYM Occasional 55.2 0 25.0/50.0 Above Normal range.
Urates: RBC 4.03 4.30/6.20 Below normal range.
Below normal range.
Hemoglobin is the
oxygen-carrying
component of the
HGB 11.9 12.0/18.0 blood. Decreases in
hemoglobin occur in
many anemias, in
autoimmune illnesses
such as lupus and in
hemorrhage.

Hematocrit mirror
the values of the red
blood cells,
HCT 35.3 37.0/55.0 decreased RBCs
occur in anemias, the
patient losses blood
through bleeding.
Chronic infection can
also cause an
abnormally low RBC
result.
MCV 87.5 80.0/100.0 Within normal range.
MCH 29.4 27.0/34.0 Within normal range.
MCHC 33.6 31.0/36.0 Within normal range.
PLT 53 150/400 Below normal range.
MPV 10.1 7.0/11.0 Within normal range.
PDW 10.0 10.0/18.0 Within normal range.

Hematology July 25,2008

Ultrasound July 24, 2008

Whole Abdominal US

There is minimal bilateral effusion noted. Anechoic ascetic fluid is detected in


the hepatorenal fossa, Right iliac fossa, left lower quadrant and pelvic region.
The liver is unenlarged, exhibiting uniform echo texture and smooth contour.
No evident focal lesion or biliary ectasia. The hepatic vessels are undilated.
The gall bladder shows normal size and increased mural thickness of 7mm
devoid of calculi and luminal lesion. Minimal pericholycystic fluid is also seen. Patent
and undilated common bile duct.
No remarkable finding are discerned in the pancreas, kidneys, spleen, and
visualized major abdominal vessels.
Transabdominal sonogram shows an empty and unenlarged uterus. There is
no adnexal or other focal mass detected in the lower abdomen.
The urinary is clear.

IMPRESSION:
Bilated pleural effusion and ascites, as desird thickened gall bladder wall
most likely due to ascites.

Fiel P. Santos, MP

VII. MEDICAL MANAGEMENT AND TREATMENT

According to Doctor’s Order

July 23, 2008

 For ultrasound of lower abdomen


 Cefuroxime 750mg IV q 8
 Ranitidine 1 amp IV q 12
 For CBC, urinalysis

July 24, 2008

 IVF D5LR 1 L x 8hrs.


 For repat Hct and platelet @ 12NN
 Transfusion of 5 “u” of platelet concentration properly typed and cross
matched.
 Cefuroxime 750mg IV q 8
 Ranitidine 1 amp IV q 12

July 25, 2008


 Cefuroxime 750mg IV q 8
 Ranitidine 1 amp IV q 12

VIII. DISCHARGE PLANNING

 Intake of vitamin supplements and diuretics to increase protection


mechanism of the immune system and decreases renal vascular resistance
and may increase renal blood flow.

 The use of nonpharmacotheraphy such as drinking of plenty of water will


promote plasma in blood to increase immunity and proper hygiene and
promotion of cleanliness at home and school area.

 Management of such condition would be through hydration and doing control


measures such as eliminate vector by promoting cleanliness in the
environment through proper disposal of rubber tires, changing of water of
lower vases once a week, destruction of breeding places of mosquito and
residual spraying with insecticide.
 Advice to follow proper body hygiene and to maintain cleanliness on
surroundings.

 Any odd signs such as fever, petechiae, recurrence of fever, must be


immediately reported to the physician.

 Instruct to eat foods that are low fat. Low fiber, non-irritating and non-
carbonated.

UNIVERSITY OF LUZON
COLLEGE OF NURSING

DAGUPAN CITY

DENGUE
HEMORRHAGIC FEVER

In partiel fulfillment of requirements in

Related Learning Exparience (RLE)

Prepared by:

Christy Q. Malong

BSN III-C

Preapred to:

Clinical Instructor Mrs. Amelia Casing


SY: 2008

UNIVERSITY OF LUZON
COLLEGE OF NURSING

DAGUPAN CITY

A CASE READING

In partiel fulfillment of requirements in

Related Learning Exparience (RLE)

Prepared by:

Christy Q. Malong

BSN III-C

Preapred to:

Clinical Instructor Mrs. Amelia Casing

SY: 2008

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