an2netlazarCENTRO ESCOLAR UNIVERSITY

City of Malolos, Bulacan

NURSING DEPARTMENT

COMPREHENSIVE NURSING CARE PLAN

SAN LAZARO HOSPITAL
Submitted by: Nicko Tri G San Pedro BSN-3A A1 Submitted to: Mrs. Filomena Borlongan

I. INTRODUCTION
Dengue fever, also known as breakbone fever, is an acute febrile infectious disease caused by the dengue virus. Typical symptoms include headache, a petechial rash, and muscle and joint pains; in a small proportion the disease progresses to lifethreatening complications such as dengue hemorrhagic fever (which may lead to severe hemorrhage) and dengue shock syndrome(where a very low blood pressure can cause organ dysfunction). Dengue is usually transmitted by the mosquito Aedes aegypti, and rarely Aedes albopictus. The virus has four different serotypes, and an infection with one usually gives lifelong immunity to it, but only short-term immunity to the others. There is

currently no available vaccine, but outbreaks can be prevented by reducing the habitat and number of mosquitoes, and limiting exposure to bites. Health officials last year warned of a possible epidemic of dengue fever in Asia. The World Health Organization said in July that 2007 could be on a par with 1998, when nearly 1,500 people died in the region from the disease. The Philippines has recorded nearly 40,000 cases of dengue fever in the first 11 months of the year, the health department said. The department has said about 290 people had died from dengue fever in the first 10 months of the year, Treatment of acute dengue is supportive, using either oral or intravenous rehydration for mild or moderate disease, and blood transfusions for more severe cases. Rates of infection have increased dramatically over the last 50 years with around 50100 million people infected yearly. A global disease, dengue is currently endemic in more than 110 countries with 2.5 billion people living in areas where it is prevalent. Early descriptions of the condition date from 1779, and its viral cause and the transmission were elucidated in the early 20th century. Dengue has become a worldwide problem since the Second World War.

II. CASE DESCRIPTION

NURSING HISTORY
A. BIOGRAPHICAL DATA Name: Address: Sex: Age: Birthday: Birthplace: Nationality: Civil Status: Religion: Admission: Physician: Admission Diagnosis: Edgardo De Luna Gomez Blk 10 Lt 25 Francisco Homes, San Jose Del Monte, Bulacan Male 52 years old November 29, 1958 Manila Filipino Married Catholic January 15, 2011; 6:12 PM Maria Luisa J. Nallica M.D Typhoid Fever vs. Dengue Fever

B. CHIEF COMPLAINT Ilang araw na akong nilalagnat at nagtatae. Pabalik balik lang. As verbalized by the patient.

C. HISTORY OF PRESENT ILLNESS January 7, 2011, Friday, 8 days Prior to Admission, the patient is at Quaipo, he attended a mass like he always do every Friday. After the mass, he ate fishballs at the street and drink water. January 8, 2011, 7 days prior to admission, the patient experience increased in body temperature. He managed it by drinking Paracetamol every 4 hours. January 9, 2011, the patient is at Luneta because he will participate in the feast of Nazareno, the patient is a devotee that is why even though he is not feeling well, he still attended the parade. And on that day, according to the patient, it also rained. January 10, 2011, the patient decided to seek consultation to a clinic at San Jose Del Monte Bulacan, he was advised to have a Complete Blood Count, and the result says that he has a decrease in platelet count. The doctor prescribed Paracetamol every 4 hours and Oral rehydration solution for 3 days. 1 day prior to admission, the patient is afebrile, with epigastric pain and (+) LBM, he seeks consultation at the Jose Reyes Hospital and then decided to transfer at San Lazaro Hospital and was admitted. Admission Diagnosis was Typhoid Fever vs Dengue Fever. D. PAST MEDICAL HISTORY On 1987, the patient is diagnosed with Kidney Stone, he undergo an operation to remove the stones at the Kidney Center. The patient is also Hypertensive. The patient cannot remember if he has a complete immunization status, not yet involved in any accidents or any injury. No allergies with food or medications. E. FAMILY HISTORY According to the patient, Hypertension is the disease the family had genetically. F. LIFESTYLE The patient had stopped smoking since 2000, he is not drinking alcohol. According to the patient, he has no vices and is living a healthy lifestyle. He is not eating foods rich in fats or those that can predispose any illnesses. He is eating food in moderation. G. DIET The patient eats at least 2-3 times a day. He is not eating foods rich in fats and uric acid, because fatty foods is not allowed because he is hypertensive and foods rich in uric acid can lead to gouty arthritis. He is eating in moderation. H.SLEEP AND REST PATTERN

Before the onset of the disease, the patients sleep pattern is, he is sleeping early in the evening like between 7:00 PM-08:00PM and wakes up about 4:00 in the morning. According to him, he was not able to sleep after that. After the onset of the disease, there is an alteration in his sleeping pattern because of the discomfort he is experiencing. I. SOCIAL DATA The patient has good relationship with his family. They are able to bond and be happy sometimes although there are problems. His support system is his children that are sometimes giving him money to be able to use for their daily living. J. EDUCATIONAL HISTORY The patient is a highschool graduate. K. OCCUPATIONAL HISTORY The patient is a tricycle driver, and since the onset of the disease, he was not able to work. L. HOME AND NEIGHBORHOOD CONDITION They have a good working relationship with their neighbors, according to the patient, their neighbors are good and they are willing to help them when they need their help. They do not have any problem in the community they are living.

II. CASE DESCRIPTION

PHYSICAL ASSESSMENT
I. General Appearance The patient has small body bulid with a height of 159 cm and a weight of 65.3 kg. Client has no breath odor. Client is appropriately dressed and well groomed. Vital signs were: BP-130/80mmHg; PR- 80 bpm; RR-18 cpm and temp-36.7C The client has erect and upright posture and the vital sign normal except for the BP of 130/80 mmHg.

II.

Skin The patient skin is dark brown in color. Skin is warm to touch with a temperature of 36.7C, slightly dry in skin folds. There is a decreased in skin turgor and dry skin. There is a decreased in skin turgor and dry skin because of decreased fluid in the body of the patient related dehydration because of the disease process.

III.

Hair The hair of the patient is black, evenly distributed and covers the whole scalp. The hair is not oily, thick and shiny. No infections or infestations noted, the amount of body hair is variable.

IV.

Nail The shape of the nail is convex curvature 160 degrees, the texture is smooth and has intact epidermis. The nail bed is pinkish in color and the nails color prompt return in less than 3 seconds while performing the blanch test capillary refill.

V. HEENT (head, eyes, ears nose, throat) Skull is normocephalic, no tenderness as we palpate it, and absence of masses and depressions. Facial features are symmetrical and move freely without difficulty. The clients face has a normal shape of skull and no abnormalities in the structure. For the eyes after a series of inspection and palpation reveals that the eyebrows are black and evenly distributed. The eyelashes are curled outwards while the eyelids close symmetrically with 16 blinks per minute. The bulbar conjunctiva is transparent with capillaries sometimes evident, the palpebral conjunctiva is shiny and pink in color while performing the cornea sensitivity test, the client blinks. The palpation of the lacrimal gland, lacrimal sac and nasolacrimal reveals that it s not tender. The pupils are equally round and reacts to light and accommodation. For the visual fields, the client see objects in periphery while for the ocular movement, the pupil move in unison. The patient is not using glasses or contact lenses, no pain, redness or excessive tearing felt. No double or blurred vision felt. For the ears, after a series of inspection and palpation it reveals that the auricles skin color is same with the facial color and is aligned with the outer canthus of the eye. The pinna recoils when folded and is mobile and firm. The

external ear canal inspection revels that there is a minimal amount of cerumen, no lesions, pus or blood present. For the nose, the external nose is symmetric and straight, the septum is straight, the color of the nose is as the same as the skin color. The sinuses are not tender and air moves freely while client breathe through the nares. VI. Mouth and oropharynx For the mouth assessment reveals that the lips is pinkish, moist and smooth, the teeth is well aligned with no filling. The gums are pinkish, moist and no swelling. The tongue is slightly rough on top and symmetrical; the frenulum is straight and is at the midline. The mouth floor is pinkish and moist. The hard and soft palate is pinkish and moist. The uvula is symmetrical, the tonsils are symmetrical, no discharge and non-inflamed. The gag reflex is present. No bleeding gums, no sore tongue, dry mouth or frequent sore throats. VII. Neck The client has no enlarged lymph nodes and able to move his neck freely without signs of difficulty. It is equal in size, same color as in the other parts and not tender upon palpation. The thyroid gland ascends during swallowing meaning it is normal and function well without any difficulty. The neck of the client has no sign of abnormalities. VIII. Thorax and Lungs Chest is symmetric and elliptical in shape. No bulges and tenderness. Respiratory excursion and diaphragmatic excursion are normal. Normal in Breath sound, and non productive cough. Respiratory rate is 18 cpm. Clients chest has a normal shape, not bulges and tenderness upon palpation.

IX.

Heart The palpation on the pericardium reveals that there are no pulsations on the aortic, tricuspid and pulmonary area. While auscultation reveals that loudest heart sound is heard most on the apical area. No hart trouble, hypertension, rheumatic fever, heart murmurs, chest pain or discomforts, palpitations felt by the patient.

X.

Breast and Axilla Area not assessed.

XI.

Abdomen The patient is not experiencing LBM, not vomiting. The patient is not experiencing trouble in swallowing, heartburn, nausea. The patient is not experiencing abdominal pain, food intolerance, or excessive belching or passing of gas. No gallbladder trouble and hepatitis.

XII. Musculoskeletal The clients muscle, joints, and bones are not swelling. Not tender upon palpation. XIII. Gross motor The client able to perform passive ROM exercise, and is ambulatory He can sit, and stand and he can walk to comfort room. The client was able to identify and perform the activities in fine motor and sensation test. The client can do passive ROM and can ambulate that decreases the possibility of bed sore and thrombosis.

II. CASE DESCRIPTION

PERSON GORDON APPROACH

PSYCHOLOGICAL I. Self perception Self-concept pattern: QUESTIONS CLIENTS RESPONSE INTERPRETATION

Description of self

The patient verbalized that he is kind, simple, and is religious.

Patient has a positive self concept. Self-concept is ones mental image of oneself. The client has positive self-concept which are better able too develop and maintain interpersonal relationships.(KOZIER p.1003) Patient is a positive thinker. Self-esteem is ones judgment of ones worth, that is, the clients standards and performances compare to others and to ones ideal self. (KOZIER p.1006) The patient is living a healthy lifestyle. Body image is how a person perceives the size, appearance, and functioning of the body and its parts. (KOZIER p.1005) The patient accepts all the challenges that is given to him. No desire to change his body image. A persons body image develops partly from others attitudes and responses to that persons body and partly from the individuals own exploration of the body. (KOZIER p.1005) Stressors can strengthen the self-concept as an individual copes successfully with problems. (KOZIER p.1007)

Feeling towards self

The patient stated that he is friendly and kind. And that he is a positive thinker.

Body image

Patient says that he will just avoid eating fat-rich foods to be able to maintain his body image.

Changes felt in the body and the desire to do something about them Changes in the feeling towards self when illness started

The patient says that he accepts everything that the Lord gives to him. The patient says that he will leave it all to God, and will pray for his condition.

Things, persons, situations that caused anger, fear, anxiety, Depression and measures done to alleviate them

The patient verbalized that when he is tired, he feels annoyed.

II. Role relationship pattern

Support system

Siblings

Family form and structure

Sufficiency income

He is living with his wife; some of his children have their own family already. Their support system is her daughter. Both of them are involve in decision making. Income of the family is just right for their needs, it is sufficient.

The family was able to distribute the roles for each family member. Role is a set of expectations about how the person occupying one position behaves. (KOZIER p.1006)

Structural characteristics (space, privacy, conduciveness during mealtime) Perceptions, feeling, transaction, degree of association of the family with the neighborhood.

The family was able to find ways to be able to supply their needs with a limited income. The greater the number of resources a person has and uses, the more positive the effect on the self-concept. (KOZIER p.1007) The patient stated that they Individual resources should have sufficient space at have internal and external home and its comfortable. structures. (KOZIER p.1007) The patient describes their The foundation of selfcommunity as helpful. And esteem is establihed during he has a good working early life experiences relationship with their usually within the family neighbors. structures and community. (KOZIER p.1006) The patient noted that they have health centers in their community, but they are not using it because it is far from their house.

Accessibility and utilization of health care and nutritional resources.

III. Sexual and Reproductive pattern Use of contraceptives The patient denied using any contraceptives. Using of contraceptives is to avoid to an unexpected baby but since this was their first baby they do not use contraceptives. Patient says it is too personal to ask. Since this is their first baby the client afraid to have an intercourse because afraid to lost her baby. Patient says it is too personal to ask. Satisfaction in ones life means having a sexual health in the integration of emotional and intellectual social aspect of sexual

Sexual Preferences

N/A

Satisfaction with sexual activity

N/A

being.

IV. Cognitive perceptual Hearing difficulty The patient stated that he do not have any hearing difficulty. The patient stated that he do not experience any visual changes. Normal sense of hearing. Sensory deficit is impaired reception, perception, or both, of one or more of the senses. (KOZIER p.982) Blindness and deafness are sensory deficits.

Visual problems

V. Coping stress tolerance pattern

Coping strategies and stress management methods to alleviate anxieties, fear crisis, situation, and efficacy Person most helpful in taking things over, availability of that person.

The patient stated that he always have that peace of mind because he always think on the positive side.

A positive growth-oriented perception of stressful events reinforces selfworth. (KOZIER p.1008)

According to the patient, it Self-esteem is derived from is God who is the most self and others. (KOZIER important person and is the p.1006) most helpful in taking things over.

VI. Value Belief Pattern

Satisfaction with ones life

The patient stated that he is satisfied in his life. He accepts whatever the Lord gives to him.

Although, the patient and his family has problems, he is still satisfied with his life.The sense of identity has provides a person with a feeling of continuity and unity of personality. The individual sees himself as unique (kozier p.1005) Patient was able to state persons he held as important. The greater the number of the resources a person has and uses, the more positive the effect on the self concept (kozier p.1005) Ones value are largely influenced by the family and culture (kozier, p.1007) Religion plays a great role in the patients well being and self-concept. Spiritual wellness is a way of living, a lifestyle that views and lives life as purposeful and pleasurable. (kozier p., 1043) Religion may affect some therapeutic regimen that is applicate to the patient, if the patient religion is against to that regimen.

Things and personal values; held as important

The patient verbalized that his family and their health is important to him. And also his faith to the Lord.

Family/social values that influenced ones life;

The patient stated that his mother influenced him for being religious. According to the patient religion is important to him, and he is a devotee of the Black Nazarene, he goes to the feast every year and attend the Holy Mass at Quiapo every Friday.

Spiritually, importance of life in religion:

Religion practices that affects hospitalization and related therapeutic regimen, including food:

The patient stated that there are no practices that may affect his hospitalization.

ELIMINATION

Bowel elimination pattern

The patient verbalized that he moves bowel regularly, before onset of disease, he defecate at least once a day usually in the morning. He is not experiencing any discomfort during elimination. After the onset of disease, his bowel elimination is affected because he is experiencing a LBM, his bowel elimination at this time is at least 3x or more a day and is loose. Before admission the patients urinary elimination is at least 5x a day because he is drinking water often. During admission, the patient still has increase in urinary elimination because of the increase intake of oral fluids plus the intravenous line to prevent dehydration.

Urinary elimination pattern

Use of aids

The patient do not have difficulty in his elimination that is why he is not using any aids.

REST AND ACTIVITY I. Activity exercise pattern Type and level of activities The patient is a tricycle driver, but in the morning, he weeps their house, water the plants and is taking care of chickens for a living. The human body was designed for motion, and regular exercise is necessary for its healthy functioning. Individuals who choose inactive lifestyles or who are forced into inactivity by illness or injury placed themselves at high risk for serious health problems. (Fundamentals of Nursing 5th edition by Taylor, page 1116)

Sufficiency of energy for completing desired activities

The patient has sufficient energy in completing his activities of daily living before his confinement.

Vigorous physical activity is not always needed to achieve positive result. (Fundamentals of Nursing 5th edition by Taylor, page 1117)

Exercise Program

Leisure Activities

The patient is walking every Lack of exercise, inactivity, morning which he considers or immobility related to as his exercise everyday. illness, or injury place a person at high risk for serious health problems. Immobility can affect the major body systems. Like the benefits, a person receives from exercise, complications resulting from immobility differ occurrence and severity based on the patients age and overall health status. When the patient has free (Kozier et.al, Fundamentals time, he usually watch the of Nursing 7th television. ed. Page 1118)

II. Sleep and Rest Pattern

Circadian rhythms, time, duration of sleep

The patient sleeps at 8pm, sometimes 9pm and wakes up at 4 am, and was not able to sleep again so the patient just start his activities of the day.

Use of supportive devices

The client stated that he does not use supportive aids to sleep.

Sleep onset problems, dreams and early awakenings

The patient experience difficulty in sleeping, he cannot sleep continuously since he was admitted at the hospital.

For no known reason, 8hours of sleep at night has been the accepted standard for adults despite obvious variations seen in the general population. It is important that a person follows a pattern of rest that maintains well being. Many factors affect a persons ability to rest illnesses and various life situations that causes physiological stress tends to disturb sleep. (Kozier et.al, Fundamentals of Nursing 7th ed. Page 1169-1170).

Generally rested and ready for daily activities after sleep

The patient is generally rested and ready for his activities of daily living after sleep.

SAFE ENVIRONMENT

Allergies

The patient does not have Allergies should be any allergies to any food or assessed to be able to drug. determine which food and drug is apppropriate for his treatment plan.

Skin integrity Changes temperature in The clients skin is slightly The patients temperature is body dry. in normal state. The patient is afebrile.

OXYGENATION Tolerance activities with daily The patient was able to perform activities of daily living without any difficulty on breathing or shortness of breath. Oxygenation status should be assessed to determine the need of oxygen therapy when needed especially during continuous works.

Airway clearance

The patients airway is clear, no difficulty in breathing, the air can move freely while the patient breathes on the nares.

In a healthy person, the respiratory system can provide sufficient oxygen to meet body needs.

Change in color of lips, His color is dark brown and The patient does not have a nails and skin his lips are slightly pale. clear airway clearance.

NUTRITION Daily food intake (24 hour Breakfast: diet recall) 1 cup of lugaw 1 bowl of soup 1 glass of water According to the RDA, the food intake of the patient is appropriate to the age.Nutrition is a basic human need that changes Lunch: throughout the life 1 cup of rice with cycle and along the soup wellness-illness continuum. 1 glass of water (Fundamentals of Nursing 5th edition by Taylor, page Dinner: 1 glass of milk 1135) 1 cup of rice and pasiw

Food/fluid preference

The patient stated that, he is not eating pork meats, and foods rich in uric acid like monggo beans and also fat-rich foods. He is usually eating fried fish at hoise.

Food budgeting

Food preparation

According to the food pyramid, the patient was able to eat right foods that is needed by the body, he was able to eat foods in moderation. An adequate food intake consists of balance essentials nutrients: water, carbohydrates, fats, proteins, vitamins and minerals. Habits about eating are affected by many factors like financial and health conditions. (Kozier et.al, Fundamentals of Nursing 7th ed. Page 1171,1175) The patient and his family An adult individual needs to are the one in-charge with balance energy intake with regards to food budgeting. his or her level of physical activity to avoid storing excess body at. Dietary practices and food choices are related to wellness and affect health, fitness, weight management, and the prevention of chronic They usually cook fried diseases such as foods and foods with soup. osteoporosis, cardiovascular diseases, cancer, and diabetes. (Kozier et.al, Fundamentals of Nursing 7th ed. P. 1190)

Degree of appetite and Delicious smell of food what seems to stimulate often stimulate the patients and dampen it appetite, and when he sees meat, it dampens his appetite.

II. CASE DESCRIPTION

DIAGNOSTIC PROCEDURES
Hematology It is a screening test used to diagnose and manage numerous diseases. The results can reflect problems with fluid volume/ loss of blood. This test can reveal problems with fluid volume/ loss of blood. The test can reveal problems with red blood cell production and destruction or help diagnose infections, allergies, and problem with blood clotting. Nursing Responsibilities: 1. Monitor and document vital signs. 2. Monitor intake and output. 3. A. COMPLETE BLOOD COUNT (CBC) A complete blood count (CBC) is a series of tests used to evaluate the composition and concentration of the cellular components of blood. It measures the following: The number of red blood cells (RBCs) The number of white blood cells (WBCs) The total amount of hemoglobin in the blood The fraction of the blood composed of red blood cells (hematocrit) The mean corpuscular volume (MCV) the size of the red blood cells

CBC also includes information about the red blood cells that is calculated from the other measurements: MCH (mean corpuscular hemoglobin) MCHC (mean corpuscular hemoglobin concentration)

The platelet count is also usually included in the CBC. Purpose:

The CBC provides valuable information about the blood and to some extent the bone marrow, which is the blood-forming tissue. The CBC is used for the following purposes: as a preoperative test to ensure both adequate oxygen carrying capacity and hemostasis to identify persons who may have an infection to diagnose anemia to identify acute and chronic illness, bleeding tendencies, and white blood cell disorders such as leukemia to monitor treatment for anemia and other blood diseases to determine the effects of chemotherapy and radiation therapy on blood cell production How Test is performed:

Blood is drawn from a vein, usually from the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic. An elastic band is placed around the upper arm to apply pressure and cause the vein to swell with blood. A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. During the procedure, the band is removed to restore circulation. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding. In infants or young children, the area is cleansed with antiseptic and punctured with a sharp needle or a lancet. The blood may be collected in a pipette (small glass tube), on a slide, onto a test strip, or into a small container. A bandage may be applied to the puncture site if there is any bleeding. Cell type Result Result Normal values Interpretation

01/16/11

01/15/11

WBC RBC Hemoglobin Hematocrit MCV MCH MCHC Platelet RDW Neutrophil Lymphocyte Eosinophil Monocyte Basophils

18.82 4.48 12.28 37.58 83.82 27.38 32.67 309 15.1 78.6 11.11 3 5.6 1.7

16.73 4.04 11.6 35.58 88.09 28.72 32.6 277 12.84 79.1 12.7 1.2 6 1

4.8-10.8 10^9/L 4.7-6.1 10^12/L 13-17 g/L 40-52 % 82-98 fl 28-33 pg 33-36 10^9/L 150-400 % 11.4-14.0 % 40-70 % 19-48 % 2-8 % 3-9 % 0-5 %

All cell type is within normal range except the white blood cells which is increase in number that may indicate presence of infection.

B. BLOOD CHEMISTRY Blood chemistry test measures levels of certain substances in the blood that may help the physician whether or not various organs are healthy and functioning during treatment. It is done to measure levels of enzyme, bilirubin, potassium, chloride, urea nitrogen levels, calcium levels and blood sugar levels. Nursing Responsibilities: 1. Explain the purpose of the procedure. 2. Prepare the client for blood extraction. Date Ordered Blood Chemistry Values obtained Normal Values Interpretation

11/17/11

Creatinine

576.90

71.00-115.00 umol/L

Increase in the normal values of creatinine.

Urea

19.07

2.50-7.20 mmol/L

Increase in the normal values of Urea

SGOT/AST

15.00

0.00-31.00 u/L

NORMAL

SGPT/AST

11.00

0.00-41.00 u/L

NORMAL

Alk.

326.00

53.00-128.00 u/L

Increase in the normal values of Alkaline in blood.

Phosphatase

---

---

----

C. MALARIAL SMEAR Proper therapy depends upon identification of the specific variety of malaria parasite. Release of trophozoites and RBC debris result in a febrile response. Periodicity of fever correlates with type of malaria. Parasites are most likely to be detected just before onset of fever which is predictable in many cases. Multiple sampling at different times in the fever cycle may prove successful Method: Microscopic examination of thick and thin peripheral blood smears stained with Romanovsky dye. Thick smears are more difficult to interpret but greatly increase sensitivity. Thick smears require considerable experience with malaria. Recent techniques: DNA hybridization probes for detection of malarial parasites Result: No malarial Parasite Seen Interpretation: Normal results.

III. DRUG STUDY

Brand name/ Generic name Dosage, Route, Administratio n Action Indication Side Effect Contraindication Nursing consideration

Acetaminophen (Paracetamol)

Adult and child: >12 yrs old: PO/RECT 325650 mg q4h prn, max 4g/day Child: PO 1015 mg/kg q4h

May block the pain impulses peripherally that occur in response to inhibition of prostaglandin synthesis; does not possess antiinflammatory properties; antipyretic action results from inhibition of prostaglandins in the CNS (hypothalamic heat-regulating center)

Symptomatic relief of pain and fever. Relief of headache, toothache, back pain, dysmenorrheal,myal gias,neuralgias, etc. Analgesics and anti pyretic for patients hypersensitive to aspirin

Hema: leukopenina, neutropenia, hemolytic anemia, thrombocytopenia, pancytopenia CNS: stimulations, drwosiness GI: nausea, vomiting, abdominal pain, hepatotxicity, hepatic seizure Integ: rash, urticaria GU: renal failure

Hypersensitivity, intolerance to tartazine (yellow dye #5), alcohol, table sugar, saccharin, depending on the product.

Assess for liver function studies: AST, ALT, bilirubin, creatinine prior to therapy Renal function studies Administer with food or milk to decrease gastric symptom if needed Teach patient not to excess recommended dosage Instruct patient signs of toxicity to drug: nausea, vomiting, abdominal pain, and refer to the prescriber. Notify prescriber of pain or fever lasting over 3 days.

Brand name/ Generic name

Dosage, Route, Administratio n

Action

Indication

Side Effect

Contraindication

Nursing consideration

Cefixime 10 mg caps BID

3Renal dose: CCr 21-60 ml/min give 75 % of dose, CCr <20 ml/min give 50% of the dose Adult: PO 400 mg qd as a single dose or 200 mg q12h Child >50 kg or >12 yrs: Po use adult dosage Child<50 kg or <12 yrs: PO 8 mg/kg/day as a single dose or 4 mg/kg q12h

Inhibits bacterial cell wall synthesis, rendering cell wall osmotically unstable, leading to cell death.

Uncomplicated UTI (E. Coli, P. Mirabilis), Pharyngitis and tonsillitis (S. Pyogenes), Otitis Media (H. Influenzae), Miraxella Catarrhalis, acute Bronchitis, and acute exacerbations of chronic bronchitis.

CNS: headache, dizziness, weakness, paresthesia, fever, chills GI: nausea, vomiting, diarrhea, pruritus, anorexia, glossitits, bleeding, increased AST, ALT, abdominal pain Hema: leucopenia, thrombocytopenia, anemia, agranulocytosis, hemolytic anemia Integ: rash, urticaria, dermatitis Syst: anaphylaxis, serum sickness

Hypersensitivity to penicillins, cephalosporins, infants <1 month,

Assess for sensitivity to penicillins, other cephalosporins Assess for nephrotoxicity: Increased BUN, creatinine, urine output, refer Assess for bowel pattern qd; if severe diarrhea occurs, discontinue the drug Change the IV site q72h to prevent phlebitis

Brand name/ Generic name

Dosage, Route, Administration

Action

Indication

Side Effect

Contraindication

Nursing consideration

Furosemide 20 mg IV STAT

Adult: O 20-80 mg/day in AM may give another dose in 6hr up to 600 mg/day IM/IV: 20-40 mg, increased 20mg q2h until desired response Child: PO/IM/IV: 2mg/kg may increase by 1-2 mg/kg q6h-8h up to 6 mg/kg

Inhibits reabsorption of sodium and chloride at proximal and distal tubule and in the loop of Henle.

Pulmonary edema, edema in CHF, liver disease, nephrotic syndrome, ascites, hypertension

CNS: headache, fatigue, weakness, vertigo, paresthesia CV: orthostatic hypotension, chest pain EENT: loss of hearing, ear pain, tinnitus ELECT: hypokalemia, hypochloremi c alkalosis, hypomagnes emia, hyperurecemi a, hypocalcemi a, hyponatremia , metabolic alkalosis

Hypersensitivity to sulfonamides, anuria, hypovelomia, infants, lactation, electrolyte depletion

Assess for signs of metabolic alkalosis: drowsiness, restlessness Signs of hypokalemia: postural hypotension, malaise, fatigue, leg cramps, tachycardia Instruct patient to eat foods rich in potassium Assess for vital signs before administration Laboratory studies before administration of medication

Brand name/ Generic name

Dosage, Route, Administration

Action

Indication

Side Effect

Contraindication

Nursing consideration

Amlodipine 5mg/tab OD

Angina: Adult: PO 5-10 mg qd Hypertension: Adult: PO 5 mg qd initially, max 10 mg/day

Inhibits calcium ion influx across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle, peripheral vascular smooth muscle, dilates coronary vascular arteries, increase myocardial oxygen delivery in patients with vasospastic angina.

Chronic stable angina pectoris, hypertension, vasospastic angina (Prinzmetals angina); may coadminister with other antihypertensives, antianginals.

CV: dysrhythmia, edema, bradycardia, hypotension, palpitations, syncope, AV block GI: nausea, vomiting, diarrhea, gastric upset, constipation, abdominal cramps, anorexia GU: nocturia, polyuria INTEG: rah, pruritus, urticaria, hair loss CNS: headache, fatigue, dizziness, anxiety, depression

Sick sinus syndrome, 2nd or 3rd degree heart block, hypotension less than 90mmHg systolic, hypersensitivity

Assess for vital signs before administration of the medication Record the I&O Instruct the patient to take the drug as prescribed, do not double or skip dose Instruct patient to avoid hazardous activities until stabilized on drug, dizziness is no longer a problem Instruct patient to change position slowly to prevent orthostatic hypotension Instruct patient to continue good oral hygiene.

III. NURSING CARE PLAN

Cues

Diagnosis

Scientific explanation

Planning

Implementation

Rationale

Evaluation

Subjective:

Hyperthermia related to Nilalagnat at increased nanghihina po metabolic ako. as verbalized rate and disease by the patient. process. Objective: Weakness and irritability. flushed skin Skin Warm to touch. Febrile Restlessness. Vital Signs taken as follows: (Admitting vital signs) T: 38.1C P: 80 bpm R: 17 cpm BP: 130/80 mmHg

Short-term goal: After 4 hours of Dengue Virus nursing interventions the patient will be able IgG adheres to to: the platelet List ways on how (initiates to maintain body destruction temperature of the platelet) Demonstrate techniques on how thrombocytopenia to lower body (50,000/mm3 or temperature less) Take medications that can lower Increased potential body temperature. for hemorrhage (epistaxis) Long-term goal After 4 days of stimulates nursing interventions intense the patient will be able inflammatory to maintain core body response temperature within normal range. petechial rash, high fever, headache

Aedes Aegypti

Independent: Establish rapport with the patient and patients relative Note chronological and developmental age Monitor temperature

To gain the trust and cooperation Children are more susceptible to heatstroke To have baseline data.

Monitor BP

Central hypertension or peripheral/postural hypotension may occur. Dysrhythmias and ECG changes are common. Hyperventilation may be present. Evaporation is decreased by environmental factors of high humidity. To prevent dehydration.

Monitor heart rate and rhythm. Monitor respirations Note presence or absence of sweating

After 4 hours of nursing interventions th patient was able to: List ways on how to maintain bod temperature Demonstrate techniques o how to lowe body temperature Take medications that can low body temperature

Advise increase fluid intake. Encourage TSB. To promote heat loss by evaporation and conduction. To promote heat loss by radiation and conduction.

Loosen clothing

 Provide cool environment and/or fan. Put local ice packs or wet towels areas of high blood flow, especially groin and axillae. Provide hypothermia blankets. Maintain bed rest

To promote heat loss by convection. To promote heat loss.

To minimize shivering. To reduce metabolic demands/oxygen consumption. For baseline data. Monitor and record I and O To lower temperature. Dependent: Administer meds as ordered, antipyretics and/or antibiotics. Administer fluid replacement as indicated by the physician. Interdependent: Provide high-calorie diet, tube feeding, parenteral nutrition. To support circulating volume and tissue perfusion. To meet increased metabolic demands.

Cues

Diagnosis

Scientific explanation

Planning

Implementation

Rationale

Evaluation

Subjective: Objective: Weakness and irritability. Restlessness.

Injury, risk for hemorrhage related to altered clotting factor.

Aedes Aegypti Dengue Virus IgG adheres to the platelet (initiates destruction of the platelet) thrombocytopenia (50,000/mm3 or less) Increased potential for hemorrhage (epistaxis) stimulates intense inflammatory response petechial rash, high fever, headache

After 4 hrs. Of nursing interventions, the client will be able to demonstrate behaviors that reduce the risk for bleeding.

Independent: Perform thorough assessments regarding safety issues when planning for client care.

Failure to accurately assess and intervene or refer these issues can place the client at needless risk and creates negligence issues for healthcare practitioner.

After 4 hours o nursing interventions, th client where abl to demonstrate behaviors that reduces the risk for bleeding.

Vital Signs taken as follows: (Admitting vital signs) T: 38.1C P: 80 bpm R: 17 cpm BP: 130/80 mmHg

Assess for signs and symptoms of The G.I tract The goal is me G.I bleeding. (esophagus and Check for secretions. rectum) is the Observe color most usual and consistency of stools or source of bleeding of its vomitus. mucosal fragility. Position the client on upright position with head To minimize the amount tilted slightly forward. of blood pressure on nasal vessels and to keep blood moving forward, not back to the nasopharynx. Using your fingers apply pressure to the sides of the To minimize or stop nose. bleeding. Apply nasal pack or cold compress. To minimize or stop bleeding. Observe for presence of Sub-acute disseminated petechiae, ecchymosis, Intravascular coagulation bleeding from one more (DIC) maydevelop

sites. Monitor pulse, Blood pressure.

Note changes in mentation and level consciousness. Avoid rectal Temperature.

secondary to altered clotting factors. An increase in pulse with decreased Blood pressure can indicate loss of circulating blood volume. of Changes may Indicate cerebral perfusion secondary to hypovolemia, hypoxemia. Rectal vessels are most vulnerable to rupture.

Encourage use of soft toothbrush, avoiding In the presence of straining clotting factor disturbances, for stool, and forceful nose minimal trauma can cause blowing. mucosal bleeding. Use small needles for Minimizes damage to injections. Apply pressure to tissues, reducing risk for venipuncture sites for longer bleeding and hematoma. than usual. Recommend avoidance of Prolongs coagulation, aspirin containing products. potentiating risk of hemorrhage. Dependent: Administer medications and To treat the underlying infusions as prescribed and cause of the disease. by using 5 rights system

(right patient, right medication, right route, right dose,right time) Interdependent: Monitor Hgb and Hct and clotting factors. Indicators of anemia, active bleeding, or impending complications.