Central Colleges of the Philippines Quezon City College of Nursing A Case Study of Dengue Hemorrhagic Fever II Submitted by:

Ancheta, Albert Bacero, Milagros Paringit Jr., Reynaldo Perez, Eleanor Perez, Jovita Portacio, Bryan Sean Razon, Russel Shawn Robosa, Delia Vallejo, Magnolia Jae Submitted to: Mr. Jordan S. Brosas Clinical Instructor San Juan Medical Center Pediatric Ward

Table of Contents Objectives Introduction Demographic Data Gordons Typology of 11 Functional Health Patterns Physical Assessment Laboratory Exam Pathophysiology Theoretical Framework Nursing Care Plan 1 Nursing Care Plan 2 Drug Study Discharge Planning 1 2 3-4 5-8 9 - 12 13 - 20 21 22 23 - 24 25 - 26 27 - 31 32

I.

Objectives

A. General Objectives After 5 days (total of 40 hours) of exposure in Pediatric Ward at San Juan Medical Center, we as a student nurse are here to present a case study of a 15 years old patient diagnosed of having a Dengue Hemorrhagic Fever II. This is to identify and determine the patients health, problems and needs, and to develop the skills needed to render proper nursing care to the patient. B. Specific Objectives 1. Knowledge/Cognitive To formulate an effective and efficient nursing care plan. To analyze the diagnostic and laboratory exams done to the patient and understand its significance to the disease condition. 2. Skills/Psychomotor To apply the skills learned from our R.L.E. to render nursing care to the client. (e.g. Bedside Care, Positioning the patient, T.S.B. and administered of drugs) 3. Attitude/Affective To establish good rapport with the clients relatives and to the s taff nurses assigned at Pediatric Ward. To cooperate with each member of the group for the success of our case study.

II.

Introduction

Dengue hemorrhagic fever, also called breakbone fever, is 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. Signs and symptoms include fever, severe joint and muscle pain, and rash. Dengue hemorrhagic fever (DHF) is a more severe presentation of dengue fever caused by the same mosquito bite. A strain of Arbovirus caused Dengue Hemorrhagic Fever and transmitted by the Aedes aegypti mosquito. Characteristics of an Aedes aegypti mosquito are day biting, Low-flying, live in stagnant water and in urban area. Additional Signs and Symptoms: 1. Rapid deterioration Deterioration occurs after 25 days of the typical symptoms of dengue fever. 2. Irritability Associated with rapid deterioration. 3. Restlessness Associated with rapid deterioration. 4. Low blood pressure Related to hemorrhage. 5. Weak and rapid pulse Related to hemorrhage. 6. Petechial rash Related to hemorrhage. The Philippines Department of Health (DOH) today reported that a total of 3,332 dengue cases had been admitted to sentinel hospitals nationwide from October to Nov15 this year. There were 32 deaths recorded.

III. Demographic Data A. Patients Profile Name: Patient K.P. Address: San Juan City Age: 15 y/o Sex: Male Civil Status: Single Birthday: December, 1995 Birthplace: San Juan City Nationality: Filipino Religion: Roman Catholic Educational Attainment: 3rd year High School Occupation: N/A Date and time of Admission: December 5, 2011 (3:00 P.M.) Chief Complain: Fever with Epistaxis Admitting Diagnosis: Dengue Hemorrhagic Fever II Final Diagnosis: Dengue Hemorrhagic Fever II B. Past Medical History N/A C. Present Medical History 2 days PTA, the patient was brought by his mother in the E.R. of SJMC with a chief complain of intermittent fever. Laboratory examination was done. 1 day PTA, the patient was brought back by his mother and this time there was a chief complain of body malaise. Laboratory examination was done again. On the 3rd day the patient was brought back again by his mother because there is epistaxis with a decreased fluid intake. That made the mother to admit his son.

D. Heredo-familial History Disease Heart Disease Hypertension Asthma Diabetes Mellitus E. Lifestyle and environment Our patient is a 3rd year H.S. student. Every afternoon after his class, he goes to the internet caf owned by his parents. He spent about 3 hours in their internet caf playing online games. Although they have clean surroundings in their home, there are presence of stagnant water due to rainy season. Paternal + + Maternal -

IV. Gordons Typology of 11 Functional Health Patterns I. Health Perception Health Management Pattern During Hospitalization Hindi ako okay sa ngayon. Palagi akong napapagod, inaantok at masakit ang ulo. Nilalagnat ako at dumugo pa ang ilong ko. Nagsusuka din ako at nagkaroon ako ng rashes kaya dinala ako dito.

Prior To Admission Ok naman ang kalusugan ko. Hindi pa ako na hospital dati at hindi rin ako madaling mahawaan ng sakit. Hindi ko rin naranasan maaksidinte at maoperahan. Wala din akong problema sa sugat at kumpleto din ako sa bakuna.

- Patient stated that he never - Hes not feeling ok. He have a been hospitalize and think that he fever, headache, gingival bleeding and epistaxis. He is not satisfied is physically fit. with his condition. II. Nutritional Metabolic Pattern During Hospitalization Wala akong ganang kumain. Mga tatlong subo ng kutsara lang ang kaya kong kainin at 750 ml. lang ang nainum ko.

Prior To Admission Magana po akong kumain at walang bawal na pagkain sa akin. Apat na beses ako kung kumain sa loob ng 24 oras. Malakas akong uminom ng tubig. Nakaka 3 litro ako sa isang araw. III. Elimination Pattern Prior To Admission Wala naman akong problema sa pag dumi at pag ihi. Isang beses po ako dumumi sa loob ng 24 oras. Kulay po ng dumi ko ay brown at malambot. Ang ihi ko naman po ay light yellow. Hindi ko rin po naranasan umihi at dumumi na may dugo. - Patient doesnt have any problems about his stool and urination.

During Hospitalization Wala naman po akong problema pag ihi at pag dumi. Normal naman ang ihi at dumi ko. Katulad lang din noong wala pa akong sakit. Kulay ihi ko ay yellow at ang dumi ko walang pinagbago.

sa po po ng ay

IV.

Activity and Exercise Pattern During Hospitalization Sa nagyon po, hindi ko po nagagawa ang lahat ng ginagawa ko dati. Kasi po parati akong inaantok at mahina po ang pakiramdam ko. - At this moment, he cannot do anything due to his condition.

Prior To Admission Hindi po ako nag eehersisyo. Hindi rin po ako palaging napapagod at sa umaga po nilalakad ko lang ang school ko kasi malapit lang sa bahay namin. Bahay at school lang po ako. Hindi po ako nagbabarkada sa labas. Pagkatapos po ng school ko ay naglalaro nalang ako ng computer games. - He is not doing any exercise but he feel no problem with his health. V. Sleep-Rest Pattern

Prior To Admission 12 midnight na po ako natutulog at 5 A.M. ako nagigising pag may pasok ako sa school Pag walang pasok, 10 A.M. ako nagigising. Wala naman po akong problema sa pag tulog. VI.

During Hospitalization Sa ngayon po dito sa hospital walang oras ang tulog ko. Tulog lang po ako ng tulog kasi po parati akong inaantok. Pero hindi po tuloy-tuloy ang tulog ko.

Cognitive-Perceptual Pattern During Hospitalization Sa pag dedesisyon po, si mama nalang po ang palagi kong tinatanong kung ano dapat kung gawin.

Prior To Admission Sa pag dedesisyon po, si mama nalang po ang bahala sa mga desisyon ko. Siya po ang tinatanong ko kong ano dapat kong gawin. - He is dependent to his mother.

VII. Self-perception and Self-Concept Pattern Prior To Admission Iniisip ko naman ang kalagayan at kalusugan ko. Wala naman akong problema sa katawan. During Hospitalization Iniisip ko na sana gumaling na ako kaagad. At sa tingin ko may pagbabago sa aking sarili pag gumaling na ako. Magagawa ko na lahat ng ginagawa ko araw-araw at makapag-aral na ulit ako.

VIII. Role-Relationship Pattern Prior To Admission Sa aming mag kakapatid pangtatlo po ako. 5 kami magkakasama sa bahay pati po si mama at papa. Okay naman po ako sa bahay. Nararamadaman ko naman po na mahal ako ng pamilya ko. Very supportive naman po sila sa akin at wala naman po akong problema sa kanila. - He is comfortable with his family. He felt the love and support from them. IX. Sexual-Reproductive Pattern During Hospitalization In active During Hospitalization Sa ngayon po dito sa hospital kasama ko mama at papa ko. Dinadalaw nalang po ako ng mga kapatid ko. Ramdam ko naman po ang pagmamahal nila sa akin.

Prior To Admission In active X.

Copping-Stress Tolerance Pattern During Hospitalization Nalulungkot po ako ngayon kasi po may sakit ako. Pero nandyan naman po si mama at ang pamilya ko. Kaya okay na po ako.

Prior To Admission Hindi ko naman po naranasan na mawalan ng mahal sa buhay. Pag nalulungkot po ako at may problema, sinasabi ko po agad sa mama ko. Nawawala din agad ang problema ko dahil nandyan po si mama na tumutulong sa akin.

XI.

Value-Belief Pattern During Hospitalization Nagdadasal po ako pag gising ko sa umaga at bago matulog. Dinadasal ko po na sana pagalingin na ako ni lord para po maka uwi na ako sa amin.

Prior To Admission Katoliko po ako at ang pamilya ko. Occasional lang po ako nagsisimba. Nagdadasal naman po ako pag gising ko sa umaga at bago matulog.

VI. Laboratory Exam HEMATOLOGY Dec. 4, 2011 Test Hemoglobin Hematocrit RBC WBC Result 144 0.42 5.09 3.5 Normal Value 120-170 g/L Remarks Within normal range Significance

0.37-0.54 g/L Within normal range 4.0-6.0 x10 L 4.5-10 x 10 L Within normal range DECREASE Presence of acute Infection. Increase due to presence of acute infection in the WBC. Decrease in lymphocytes due to sepsis.

Neutrophils

0.80

0.38-0.68

INCREASE

Lymphocytes

0.14

0.22-0.53

DECREASE

Eosinophil Monocytes Basophil Platelet Count

----0.06 ----185

0.01-0.07 0.05-0.12 0.002-0.010 150-400 x 10 L

---Within normal range ---Within normal range

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HEMATOLOGY Dec. 5, 2011 Test Hemoglobin Hematocrit RBC WBC Result 156 0.46 5.57 2.3 Normal Value 120-170 g/L Remarks Within normal range Significance

0.37-0.54 g/L Within normal range 4.0-6.0 x10 L 4.5-10 x 10 L Within normal range DECREASE Presence of acute Infection. Increase due to presence of acute infection in the WBC.

Neutrophils

0.71

0.38-0.68

INCREASE

Lymphocytes

0.24

0.22-0.53

----

Eosinophil Monocytes Basophil Platelet Count

----0.05 ----160

0.01-0.07 0.05-0.12 0.002-0.010 150-400 x 10 L 14

---Within normal range ---Within normal range

HEMATOLOGY Dec. 6, 2011 Test Hemoglobin Hematocrit RBC WBC Result 137 0.40 4.84 2.5 Normal Value 120-170 g/L Remarks Within normal range Significance

0.37-0.54 g/L Within normal range 4.0-6.0 x10 L 4.5-10 x 10 L Within normal range DECREASE Presence of acute Infection.

Neutrophils Lymphocytes Eosinophil Monocytes Basophil Platelet Count

0.62 0.31 ----0.07 ----80

0.38-0.68 0.22-0.53 0.01-0.07 0.05-0.12 0.002-0.010 150-400 x 10 L

Within normal range Within normal range ---Within normal range ---DECREASE Due to viral infection.

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HEMATOLOGY Dec. 7, 2011 Test Hemoglobin Hematocrit RBC WBC Neutrophils Lymphocytes Eosinophil Monocytes Basophil Platelet Count Result 147 0.42 5.17 4.7 0.40 0.51 ----0.07 ----80 Normal Value 120-170 g/L Remarks Within normal range Significance

0.37-0.54 g/L Within normal range 4.0-6.0 x10 L 4.5-10 x 10 L 0.38-0.68 0.22-0.53 0.01-0.07 0.05-0.12 0.002-0.010 150-400 x 10 L Within normal range Within normal range Within normal range Within normal range ---Within normal range ---DECREASE Due to viral infection.

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HEMATOLOGY Dec. 8, 2011 Test Hemoglobin Result 107 Normal Value 120-170 g/L Remarks DECREASE Significance Low blood oxygen levels.

Hematocrit RBC WBC Neutrophils Lymphocytes

0.32 3.39 5.6 0.41 0.14

0.37-0.54 g/L Within normal range 4.0-6.0 x10 L 4.5-10 x 10 L 0.38-0.68 0.22-0.53 Within normal range Within normal range Within normal range DECREASE Decrease in lymphocytes due to sepsis.

Eosinophil Monocytes Basophil Platelet Count

0.03 0.12 ----120

0.01-0.07 0.05-0.12 0.002-0.010 150-400 x 10 L

Within normal range Within normal range ---DECREASE Due to viral infection.

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HEMATOLOGY Dec. 9, 2011 Test Hemoglobin Result 98 Normal Value 120-170 g/L Remarks DECREASE Significance Low blood oxygen levels.

Hematocrit RBC

0.30 3.48

0.37-0.54 g/L Within normal range 4.0-6.0 x10 L DECREASE Presence of infection.

WBC Neutrophils Lymphocytes Eosinophil Monocytes Basophil Platelet Count

7.2 0.50 0.36 0.03 0.11 ----150

4.5-10 x 10 L 0.38-0.68 0.22-0.53 0.01-0.07 0.05-0.12 0.002-0.010 150-400 x 10 L

Within normal range Within normal range Within normal range Within normal range Within normal range ---Within normal range

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HEMATOLOGY Dec. 10, 2011 Test Hemoglobin Result 109 Normal Value 120-170 g/L Remarks DECREASE Significance Low blood oxygen levels.

Hematocrit RBC WBC Neutrophils Lymphocytes Eosinophil Monocytes Basophil Platelet Count

0.32 3.84 5.7 0.40 0.44 0.04 0.12 ----300

0.37-0.54 g/L Within normal range 4.0-6.0 x10 L 4.5-10 x 10 L 0.38-0.68 0.22-0.53 0.01-0.07 0.05-0.12 0.002-0.010 150-400 x 10 L DECREASE Within normal range Within normal range Within normal range Within normal range Within normal range ---Within normal range Presence of infection.

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URINALYSIS Test Color Transparency Reaction Specific Gravity Sugar Protein Pus Cells RBC Bacteria Epithelial Amorphorous Result Yellow Hazy 6.0 1.015 Negative Negative 0.1 hpf 1-2 hpf Rare React Few

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VII. Pathophysiology

Predisposing Factor School age Environment Rainy weather

Precipitating Factor Presence of stagnant water

Multiplication of Aedes Aegypti Bite of an Aedes Aegypti thru the skin.

Virus would penetrate the bloodstream.

Body would recognize the virus as a foreign organism.

Virus would hamper the platelet in the bloodstream.

Releases of the pyrogens to kill the organism.

Decrease platelet

S/S Fever (38.9 C)

Decrease coagulation of the blood

Bleeding

S/S Epistaxis Petechiae Gingival Bleeding

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VIII. Theoretical Framework

Roys Adaptation Model: Roy focuses on the individual as a bio psychosocial adaptive system that employs a feedback cycle of input (stimuli), through-put (control processes), and output (behaviors or adaptive responses). Both the individual and the environment are sources of stimuli that require modification to promote adaptation, an ongoing purposive response. Adaptive responses contribute to health, which she defines as the process of being and becoming integrated; ineffective or maladaptive responses do not contribute to health. Each persons adaptation level is unique and constantly changing.

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DISCHARGE PLANNING M No medication was prescribed. E The client was encouraged to resume his ADLS. T No particular treatment was given. H Provided the cause of Dengue. Taught client the causes of the multiplication of the Aedes Aegypti, which includes: - stagnant water - open container of water tank - rainy weather Provided the effects, which includes: - high fever - body malaise - headache - bleeding O Client was scheduled to go back after 2 weeks as indicated by the physician. D The client was ordered to have Diet as Tolerated.

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