A Partial Requirement for RLE 104

I. HEALTH HISTORY: Subjective data of the client

A. Biographical Data

Name:

Address:

Sex:

Age:
 Birthdate:

Place of Birth:

Nationality:

Marital Status:

Religion:

Education:

Occupation:

Health Insurance:

B. Reason for Seeking Healthcare

C. Current Health Status

D. Past Health History

Childhood illnesses:

Hospitalizations and Surgeries:

Serious injuries:

Chronic illnesses if any:

Immunizations:

Allergies: None

Medications:

Travel: Recent:

E. Family History
Patient:

Brother:

Sister:

Father:

Mother:

Paternal Grandmother:

Paternal Grandfather:

Maternal Grandfather: Rene Montejo

Maternal Grandmother: Gemma Montejo

F. Review of Systems

General Health Survey:

During our interaction, Patient verbalized that she is feeling better but she added that
she has with limited activities. She still in the process of recovery. She needs an assistance of
some activities of daily living such as washing her clothes and cooking. She can do some of
activities such as tooth brushing and going to the toilet. She added that she experienced fever
once this year.

Skin, hair and nails:

Patient verbalized that there’s no changes about her skin lately and she doesn’t feel any
itchiness. She verbalized that she can distinguish hot and cold when it will be touch to her skin.
Patient has no dandruff and she said that she cut her fingernails every week.

Head and Neck:

Patient verbalized that she doesn’t feel headache and she can’t feel any lumps on his
neck. She also added that there’s no pain observed when she moves her head and neck. She
haven’t experience stiff neck since birth and she added that she undergone any head surgeries
and no history of loss of consciousness.

Nose and Sinuses:

Patient verbalized that her sense of smell is functioning well. She has no allergies which
can cause sneezing and she can distinguish any smell such as perfume, food or feces.

Mouth and Throat:

Patient verbalized that his sense of taste is functioning well. She verbalized that there’s
no changes in his voice lately and she has no difficulty of swallowing. She can distinguish
whether it’s sweet, sour, bitter and salty. She has no dentures and she said that she always
have dental hygiene twice a daily.
Eyes:

Patient verbalized that she is not using eyeglasses because her eyes are functioning
well. She said that she can distinguish all colours especially blue, red and green. She hasn’t
undergone any eye examination. Her vision was good and she said that her eyes are reacting to
light and she has no history of eye injury or surgery.

Ears:

Patient verbalized that her sense of hearing is functioning well. She always clean her ear
with cotton buds once a day. She can’t feel any ear pain and she can hear sounds without
difficulty.

Respiratory:

Patient verbalized that she has no breathing problems. She has no history of smoking.
She said that she’s not experiencing cough right now. And no shortness of breathing was
observed. No noisy respiration was observed.

Cardiovascular:

Patient verbalized that she has no history of high blood but she said that she had
relatives with hypertension. She hasn’t experience any numbness of legs or hasn’t experience
edematous of the feet. And she hasn’t undergone any cardiovascular test.

Breast:

Patient verbalized that when she palpated her breast, no masses were observed and
there’s no pain during palpation. And she hasn’t undergone any breast surgery.

Gastrointestinal:

Patient verbalized that she is in good appetite because she consumed 100% of food
served to her during breakfast. She also has a regular bowel pattern once a day.

Genitourinary:

Patient verbalized that she urinated twice from 5am to 10am during my shift. The color of
her urine was yellowish and no history of night time urination. She added that she has no
difficulty in urinating and no pain in urination.

Female Reproductive:

Patient verbalized that her vagina has no lesions and no palpable mass on her ovary. No
pain in intercourse and urination. She is performing Breast Self Examination once a month.

Neurological:
 Patient verbalized that she has no history of loss of consciousness. She has no speech
problems and no loss of sensations. Her memory was still intact because she can still memorize
her teachers during elementary. She has a limited activities but she has no problem in gait.

Musculoskeletal:

Patient verbalized that she has no history of sprain and fractures. She has a good range
of motion but she has limited activity daily living. No swelling and redness was observed.

Immune / Hematologic:

Patient verbalized that there’s no history of cancer and AIDS. She hasn’t undergone any
blood transfusion. And no swollen of glands observed.

Endocrine:

Patient verbalized that her weight is still the same. It’s 53 kgs. now and it was the same
when she was not confined yet. She has intolerance in too much hot and cold. She said that her
thirst didn’t increase and no increase of urination was observed.

G. Psychosocial Profile

Health Practices and Beliefs:

Patient verbalized that she taking good care of herself. She said that if she has a cough
and colds she take a medicine and drink plenty of water. She added that she is performing
Breast self Examination once a month.

Typical Day:

Patient verbalized that she woke up early to prepare a food for her brother and sister
and ready for school. She added that she has no problem of her household chores, she can
manage it.

Nutritional Patterns:

Patient verbalized that she can eats three times a day. She said that she eat fish, pork,
chicken, and beef. She doesn’t any food allergies and no food eating disorders. She added that
she prepared and cooked to their foods. She said that yesterday she eat rice with soup. She
also eats vegetables and fruits.

Activity and Exercise Pattern:

Activity and routine exercise can help maintain both physical and mental health. Patient
verbalized that she likes to play volleyball. They play volleyball together with her friends every
Saturday and Sunday.

Recreation, Pets and Hobbies:

Recreational activities, hobbies, and pets usually enhance health by reducing stress.
Patient verbalized that they have a dog in their house. She said that she love swimming and she
enjoy hiking together with her friends.

Sleep/ Rest Patterns:

 Patient verbalized that she sleeps at 10:00 in the evening and she awake at 5:00 or 6:00
in the morning. She added that she has no trouble falling asleep. She also sleeps in the
afternoon at 2:00pm-4:00pm.

Personal Habits:

Patient verbalized that she never smoked or used recreational drugs and she said that
she doesn’t take any vitamins.

Occupational Health Patterns:

Patient verbalized that she doesn’t have any work.

Socioeconomic Status:

Socioeconomic status can have a major impact on patient’s health and healthcare.
Patient verbalized that she has a Philhealth.

Environmental Health Patterns:

Patient verbalized that they lives in three-bedroom single home in suburban. She
considered her neighbourhood safe. Their police station, public transportation, accessibility to
food and drugs stores, easy access to churches, healthcare facilities, and community supports
within 10minutes driving distance from home.

Roles/Relationship/Self-concept:

Patient verbalized that she considered herself as a fairly attractive with good sense of
humour. She said that she is a shy person but she can manage it. She added that she is aware
of her strength and weaknesses; what her likes best and least about herself.

Cultural Influences:

Patient verbalized that there’s no specific cultural influences that would affect healthcare
practices.

Religious/Spiritual influences:

Religion and spirituality influence health beliefs and practices, dietary habits, family
roles, and life-and-death issues. Patient verbalized that her religion was Roman Catholic. She
said that she doesn’t consider herself as a religious person but she attended a mass every
Sunday.

Family Role and Relationship:

The family is an important support system for most ill people. Also, when people become
ill, their role in the family changes and the family unit may need recognize to sustain itself.
Patient verbalized that she is the eldest of their family. She doesn’t go to school but she guided
and helped her brother and sister in their studies. She also helped her parents in the household
chores like cooking, cleaning the house and washing clothes.

Sexuality Patterns:
 Patient verbalized that she not sexually active. She added that dating again is difficult
and she doesn’t have the time.

Social Support:

Patient verbalized that they lived with her family. Her parents support her financial
needs. She also verbalized that if she have a problem, she open-up with her friends. She
doesn’t belong to any organized groups, but she’s aware of such community resources.

Stress and Coping Patterns:

Patient verbalized that she usually deals with her stress by avoiding problem until it’s
staring her in the face and she has to deal with it. Job is stressful, but she can manages on a
day-to-day basis by the support of her family and friends.

II. HEAD TO TOE PHYSICAL ASSESSMENT

A. General Health Survey: no other illnesses, good exercise tolerance

B. Integumentary:

- Skin: light brown skin, no suspicious lesions

- Hair: evenly distributed, no changes

- Nails: transparent, smooth

C. HEENT

- Head and Neck: no seizures, no neck pain, has full range of motion of neck

- Eyes: parallel to each other

Eyebrows: symmetrical in size, extension, hair texture and movement

Eyelashes: distributed evenly and curved outward

Eyelids: same colour as skin, lids normally close symmetrically

- Ears: no hearing problems or infections

- Nose: smooth, symmetric with same colour as the face, no history of nosebleeds or
sinus infection

- Mouth and Throat: no further sore throats

Lips: symmetric, light pink

Gums: slightly pink colour, moist and tightly fit against each tooth

Tongue: moist, dull red

 Teeth: shiny

Hard and soft palate: light pink colour

D. Respiratory System: no breathing difficulties, no history of pneumonia, bronchitis, or

asthma

E. Cardiovascular Systems: no chest pain, palpitation

F. Breast: reports left breast slightly larger than right, no pain, masses or discharges

G. Female Genitourinary: no history of kidney stones, no problems with urination, voids

clear yellow urine several times a day

H. Motor-musculoskeletal: no muscle or joint pain/stiffness

I. Sensory neurologic: fully conscious, no history of loss of cognition or memory, no

balance of coordination problems, no loss of sensation. Behaviour and appearance:
makes eye contact with examiner, hyperactive expresses feelings with response to the
situation

III. PLANS OF NURSING CARE

Nursing Background Need Objective Intervention Rationale Evaluation

Diagnosis of the Study

Activity Independent:
Intolerance Activity S General:
related to Intolerance is > Assess
abnormal A The patient  This will Goal Met
generalized patient’s serve as
responses to will be able to
weakness F respirations: indicators of >Patient
energy- demonstrate
Rate, rhythm, respiratory demonstrat
consuming ADL through
Subjective: E depth and function and e ADL
body different
“ Dili pa kaayo breathing effort assess the
movements T nursing therapy
ko makalihok
involved in interventions. needed by
og Y
required or the patient
makalakaw-
desired daily  To facilitate
lakaw og good
tarong ky activities. Specific: >Place patient in interaction.
Since patient A
galuya pa comfortable
was dengue At the end of
akong position.  Adequate
kalawasan.” hemorrhagic N the shift, the energy
fever, he’s still patient will be >Assess patient reserves
Objectives: in the D able: nutritional status are one of
requirement
- : Weak and recovery time.
for activity.
has limited Even though
 Aids in
range of the sign and S defining
> To establish
movement or symptoms of what patient
stabilized
with limited dengue E >Assess is capable
Vital signs
ADL hemorrhagic patient’s level of of.
C noting results
: dry lips fever are mobility  To facilitate
within the oxygenation
:Vital signs: positive to U acceptable .
BP=90/70, her, she’s still range.
temperature= fortunate that R >Perform deep
36.2ºC, pulse it’s not DHF. > To breathing  To
I
rate=75, But due to participate in exercise if conserve
respiration fever, her T moderate patient is tired energy
rate= 16 body is still activities.
recovering Y >Encouraged
and she loss > To lessen adequate rest  Hypoxia is
muscle associated
some of her periods
weakness with signs
energy. And of increased
because of breathing
that she is > Monitor vital effort
suffering from signs, noting for
generalized changes in  Systemic
weakness. cardiac rhythm hypoxia
may be
Source: demonstrat
NANDA ed initially
by
> Assess level of restlessnes
consciousness s and
irritability.

 This
enhances
rest to lower
body’s
oxygen
requirement
s and
> Recommend reduces
strain on
quiet
the heart
atmosphere and and lungs
bed rest if
 indicated

 Drug
therapy
helps to
promote
maximum
Dependent: potential of
wellness.
• Administer
medications  To know if
as prescribed there’s a
by the presence of
physician melena

Collaborative:
>No dark color
food

IV. PHARMACOLOGY CHARTS AND TABLES

Name of Drug: Paracetamol

Actual Dosage: 500mg

Route: oral

Frequency: Q4 PRN

Mechanism of Action: Decreases fever by inhibiting the effects of pyrogens in the hypothalamic
heat regulating centers and by a hypothalamic action leading to sweating and vasodilation.
Relieves pain by inhibiting prostaglandin synthesis at the CNS but does not have anti-
inflammatory action because of its minimal effect on peripheral prostalglandin synthesis

Common Side Effects: Gastrointestinal problems or allergic skin reactions, rashes, pancreatitis

Actual Health Teachings:

- Remember the ten rights of administration.

 - Obtain baseline information on patient’s infection

- Assess patient’s fever, or pain

- Assess knowledge/teach patient appropriate use, possible side effects/appropriate

interventions and adverse symptoms to report.

- Give exactly as directed; do not increase dose-may take e 8 several days before
noticeable relief.

- Obtain C&S (culture and sensitivity) before beginning drug therapy to identify if
correct treatment has initiated.

- Assess for allergic reaction.

- Follow diet as physician recommends.

Name of Drug: Ranitidine

Actual Dosage: 50mg

Frequency: Q8

Route: IVTT

Mechanism of Action: Inhibits histamine at h2 receptor site in the gastric parietal cells, which
inhibits gastric acid secretion.

Common Side Effects: Malaise, dizziness, insomnia, blurred vision, diarrhea, nausea and
vomiting

Actual Health Teachings:

- Remember the ten rights of administration.

- Assess potential for interactions with other pharmacological agents patients may be
taking.

- Evaluate results of laboratory tests, therapeutic effectiveness and adverse reaction.

- Assess knowledge/teach patient appropriate use, possible side effects/appropriate

interventions and adverse symptoms to report.

- Give by direct IV

- Advise patient not to take any new medication during therapy without consulting
physician.
 - Give exactly as directed; do not increase dose-may take e 8 several days before
noticeable relief.

- Allow 1hr. between any other antacids and ranitidine.

- Follow diet as physician recommends.

- Report chest pain or irregular heartbeat; skin rash; CNS changes; unusual persistent
weakness or lethargy.

Name of Drug: Ciprofloxacin

Actual Dosage: 200mg

Frequency: BID

Route: oral

Mechanism of Action: used to treat bacterial infections

Common Side Effects: sickness, nausea, diarrhea, vomiting, headache, abdominal pain

Actual Health Teachings:

- Remember the ten rights of administration.

- Evaluate results of laboratory tests, therapeutic effectiveness and adverse reaction.

- Assess patient for signs and symptoms of infection before and during treatment.

- Assess for allergic reaction.

- Assess for renal function before and during therapy.

- Assess for possible side effects.

V. PHYSIOLOGY/PATHOPHYSIOLOGY

Blood is considered the essence of life because the uncontrolled loss of it can result to
death. Blood is a type of connective tissue, consisting of cells and cell fragments surrounded by
a liquid matrix which circulates through the heart and blood vessels. The cells and cell
fragments are formed elements and the liquid is plasma. Blood makes about 8% of total weight
of the body.
Blood is a specialized bodily fluid that delivers necessary substances to the body’s cell-
such as nutrients and oxygen-transport waste products away from those same cells.

Functions:

• Supply of oxygen to tissues (bound to hemoglobin, which is carried in red cells)

• Supply of nutrients such as glucose, amino acids, and fatty acids (dissolved in the blood
or bound to plasma proteins (e.g., blood lipids)
• Removal of waste such as carbon dioxide, urea, and lactic acid
• Immunological functions, including circulation of white blood cells, and detection of
foreign material by antibodies
• Coagulation, which is one part of the body's self-repair mechanism (the act of blood
clotting when you get cut to stop the bleeding.)
• Messenger functions, including the transport of hormones and the signaling of tissue
damage
• Regulation of body pH (the normal pH of blood is in the range of 7.35–7.45) . (covering
only 0.1 pH unit)
• Regulation of core body temperature
• Hydraulic function

Plasma is a pale yellow fluid that accounts for over half of the total blood volume. It
consists of 92% water and 8% suspended or dissolved substances such as proteins, ions,
nutrients, gases, waste products, and regulatory substances.

Plasma volume remains relatively constant. Normally, water intake through the GIT
closely matches water loss through the kidneys, lungs, GIT and skin. The suspended and
dissolved substances come from the liver, kidneys, intestines, endocrine glands, and immune
tissues as spleen.

Formed Elements:

Erythrocytes -transport oxygen and carbon dioxide

Leukocytes -

Neutrophil - Phagocytizes microorganism

Basophil - Releases histamine, which promotes inflammation, and heparin which prevents clot
formation.

Eosinophil - Releases chemical that reduce inflammation, attacks certain worm parasites.

Lymphocyte - Produces antibodies and other chemicals responsible for destroying

microorganisms, responsible for allergic reactions, graft rejection, tumor control, and regulation
of the immune system.

Monocyte - Phagocytic cell in the blood leaves the circulatory system and becomes a
macrophage which phagocytises bacteria, dead cells, cell fragments, and debris within tissues.
Platelet - Forms platelet plugs, release chemicals necessary for blood clotting.

PREVENTING BLOOD LOSS

When a blood vessel is damaged, blood can leak into other tissues and interfere with the
normal tissue function or blood can be lost from the body. Small amounts of blood from the body
can be tolerated but new blood must be produced to replace the loss blood. If large amounts of
blood are lost, death can occur.

BLOOD CLOTTING

Platelet plugs alone are not sufficient to close large tears or cults in blood vessels. When
a blood vessel is severely damaged, blood clotting or coagulation results in the formation of a
clot. A clot is a network of threadlike protein fibers called fibrin, which traps blood cells, platelets
and fluids.

The formation of a blood clot depends on a number of proteins found within plasma
called clotting factors. Normally the clotting factors are inactive and do not cause clotting.
Following injury however, the clotting factors are activated to produce a clot. This is a complex
process involving chemical reactions, but it can be summarized in 3 main stages; the chemical
reactions can be stated in two ways: just as with platelets, the contact of inactive clotting factors
with exposed connective tissue can result in their activation. Chemicals released from injured
tissues can also cause activation of clotting factors. After the initial clotting factors are activated,
they in turn activate other clotting factors. A series of reactions results in which each clotting
factor activates the next clotting factor in the series until the clotting factor prothrombin activator
is formed. Prothrombin activator acts on an inactive clotting factor called prothrombin.
Prothrombin is converted to its active form called thrombin. Thrombin converts the inactive
clotting factor fibrinogen into its active form, fibrin. The fibrin threads form a network which traps
blood cells and platelets and forms the clots.

CONTROL OF CLOT FORMATION

Without control, clotting would spread from the point of its initiation throughout the entire
circulatory system. To prevent unwanted clotting, the blood contains several anticoagulants
which prevent clotting factors from forming clots. Normally there are enough anticoagulants in
the blood to prevent clot formation. At the injury site, however, the stimulation for activating
clotting factors is very strong. So many clotting factors are activated that the anticoagulants no
longer can prevent a clot from forming.

CLOT RETRACTION AND DISSOLUTION

After a clot has formed, it begins to condense into a denser compact structure by a
process known as clot retraction. Serum, which is plasma without its clotting factors, is
squeezed out of the clot during clot retraction. Consolidation of the clot pulls the edges of the
damaged vessels together, helping the stop of the flow of blood, reducing the probability of
infection and enhancing healing. The damaged vessel is repaired by the movement of
fibroblasts into damaged area and the formation of the new connective tissue. In addition,
epithelial cells around the wound divide and fill in the torn area.
 The clot is dissolved by a process called fibrinolysis. An inactive plasma protein called
plasminogen is converted to its active form, which is called plasmin. Thrombin and other clotting
factors activated during clot formation, or tissue plasminogen activator released from
surrounding tissues, stimulate the conversion of plasminogen to plasmin. Over a period of a few
days the plasmin slowly breaks down the fibrin.

Circulatory System

Is the organ that passes nutrients (such as amino acids and electrolytes), gases,
hormones and blood cells to and from cells in the body to help fight diseases and help stabilize
body temperature and pH to maintain homeostasis. This system may be seen strictly as a blood
distribution network, but some consider the circulatory system as composed of cardiovascular
system, which distributes blood and a lymphatic system, which distribute lymph.

The main components of human circulatory system are the heart, the blood, and the
blood vessels. The circulatory system includes: the pulmonary circulation, a “loop” through the
lungs where blood oxygenated; and the systemic circulation, a “loop” through the rest of the
body to provide oxygenated blood.

Digestive system also works with the circulatory system to provide the nutrients the
system needs to keep the heart pumping.

Systemic circulation

Is the portion of the cardiovascular system which transport oxygenated blood away from
the heart, to the rest of the body, and returns oxygen-depleted blood back to the heart. It is a
distance, much longer than pulmonary circulation, transporting blood to every part of the body.

Pulmonary circulation

Is the portion of the cardiovascular system which transports oxygen-depleted blood

away from the heart, to the lungs, and returns oxygenated blood back to the heart.

Oxygen deprived blood from the vena cava enters the right atrium of the heart and flows
through the tricuspid valve into the right ventricle, from which is pumped through the pulmonary
semilunar valve into the pulmonary arteries which go to the lungs. Pulmonary veins return the
now oxygen-rich blood to the heart, where it enters the left atrium before flowing through the
mitral valve into the left ventricle. Then, oxygen-rich blood from the left ventricle is pumped out
via the aorta, and on the rest of the body.

Predisposing Precipitating
- Age - Environmental
- Gender - Areas With stagnant water
 -Uncleaned house
-Stagnant canals

Infected female mosquito bites the host

Dengue virus enters the cell through

endocytosis

Reduced pH of the Endocrine causes viral

envelope glycoprotein to have
rearrangement

Expose fusion lobe which allows individual

glycoprotein to move freely in viral membrane

Glycoprotein forms trimers (they are exposed

fusion lobes insert into the host cell
membrane

Envelope glycoprotein folds back on its

self

Causes two membranes to bend towards each other until the

outer bilayer liflets fuse

Stem origin kneels on the core forcing inner

liflets fuse

Fusion results rapidly expels delivering viral growth

into cytoplasm

Spread throughout the

body

Signs and symptoms Direct infection of bone marrow

- Fever megakaryocytes
(increase WBC to fight for infection)
 - Headache
- Vomiting
- Joint aches and muscle aches decrease platelet counts

Causes clotting factor to be affected

Epistaxis and melena can occur

hematemesis

Explanation:

When the infected mosquito bites the host, dengue virus enters the cell through
endocytosis which is a process by which cells absorbed molecules from outside the cell by
engulfing them with their cell membrane. Due to reduced pH of endozone, viral envelope
glycoprotein spread and rearranged. And it allows individual glycoprotein to move freely in
membrane. After it, glycoproteins form trimers whish is three identical molecules. And envelope
glycoprotein folds back on its self directing its cartoxiterminous which is anchored in the viral
membrane towards each other until the outer bilayer liflets fuse. And stem origin kneels on the
core forcing inner liflets to fuse and rapidly expels delivering viral growth into cytoplasm. And it
will spread to the body. Direct infection of bone marrow megakaryocytes can decrease platelets
and can cause the clotting factor to be affected. And epistaxis and melena can occur and also.
And the following signs and symptoms can also occur due to the virus.

VI. PATIENT EDUCATION CHART

A. Definition of the disease

Dengue Hemorrhagic Fever

- Is a more severe form of dengue. It can be fatal if unrecognized and not properly
treated. It is potentially deadly infection spread by certain species of mosquitoes.

B. Clinical manifestations:

- Headaches, pain felt behind the eye-ball, muscular pain, pain of joints, nausea and
vomiting, white or red rashes, change in taste sensation
 C. Assessment and diagnostic findings:

Activated Partial Thromboplastin Time (APTT)

Normal Values Result

Control 24-36sec. 32sec.
Ratio Up to 1.20 1.7

Prothrombin Time

Result
Patient’s Protrombin Time 14.9
Mean Normal Protrombin Time 11.8
% Activity 79%
INR 1.3

Blood Typing

ABO & Rh Blood Forward Typing Reverse Typing Blood Type

Group (Reaction Grade) (Reacting Grade)
A 0 +4 0 Rh positive (+)
B 0 +4 0 Rh positive (+)
Rh +3 0 Rh positive (+)

Hematology

Exam Name Result Unit Normal Values

Hemoglobin 145 g/L 110-150
Hematocrit 44 % 38-47
RBC 5.2 x10^g/L 4.0-5.5
WBC 4.9 X10^g/L 5.1-10.0
Neutrophils 0.36 0.50-0.65
Lympocytes 0.47 0.25-0.40
Monocytes 0.15 0.03-0.09
Eosinophils 0.02 0.01-0.03
Platelet Count 162 X 10^g/L 150-400

D. Preventions:

There is no vaccine to prevent dengue. Prevention centers on avoiding mosquito bites

when travelling to areas where dengue occurs and when in U.S. areas, especially along the
Texas-Mexico border, where dengue might occur. Eliminating mosquito breeding sites in these
areas is another key prevention measure.

Avoid mosquito bites when travelling in tropical areas:

- Use mosquito repellents on skin and clothing.

- When outdoors during times that mosquitoes are biting, wear long-sleeved shirts and
long pants tucked into socks.

- Avoid heavily populated residential areas.

- When indoors, stay in air-conditioned or screened areas. Use bed nets if sleeping
areas are not screened or air-conditioned.

- If you have symptoms of dengue, report your travel history to your doctor.

Eliminate mosquito breeding sites in areas where dengue might occur:

- Eliminate mosquito breeding sites around homes. Discard items that can collect rain
or run-off water, especially old tires.

- Regularly change the water in outdoor bird baths and pet and animal water
containers.

E. Nursing Management

Medications:

- Explain to the client what the purposes of medications given to her.

- Explain to the client the side effects which would possibly occur during taking of
medications.

- Tell the client not to take OTC drugs.

- Tell the client to take medications exactly on time so that it will be effective.

- Tell the client to stop medication on the given date of the physician.

- Tell the client to go back to the hospital at given time for check-up.

Exercise:

- Teach the client about good exercise such as walking, jogging and stretching.

- Tell the client to avoid heavy exercise such as lifting.

- Teach the client to have a regular exercise everyday for at least 30minutes.
Treatment:

During the disease process

- Dengue hemorrhagic fever is caused by a virus for which there’s no known cure or
vaccine, the only treatment is to treat signs and symptoms.

- Oxygen therapy may be needed to treat abnormally low blood oxygen.

- Intravenous fluid and electrolytes are also used to correct imbalance of electrolytes.

Health teaching:

- Avoid areas which are prone to Dengue Fever such as watery area and public
market.

- Clean canal areas at your house.

- Clean regularly surroundings of your house.

- Avoid storage of water in the drum to avoid mosquitoes.

- Use mosquito killer such as OFF or Baygon.

Out Patient:

- Teach about healthy lifestyle.

- Teach to have good compliance about medications

- Teach to take a rest and avoid stressful activities.

Diet:

- Eat vegetables

- Eat food rich in fibbers, protein, carbo, and rich in vitamins

- Eat fruits such as apple, mango, and banana for increasing immune system.

- Follow diet prescribed by the physician.

Spiritual:

- Always pray for good health and blessings

- Stay strong and always have a strong faith in God.