CAPITOL MEDICAL CENTER COLLEGES

Bachelor of Science in Nursing

In Partial Fulfillment of the Requirements in
RELATED LEARNING EXPERIENCE

Dengue Hemorrhagic Fever

Presented to: Mrs. Mary Grace O. Gutierrez RN, MAN

Presented by:
Emralino, Ma. Deony lyn L.
 I. Introduction

Dengue Fever is caused by one of the four closely related, but antigenically distinct,
virus serotypes Dengue type 1, Dengue type 2, Dengue type 3, and Dengue type 4 of
the genus Flavivirus and Chikungunya virus. Infection with one of these serotype provides
immunity to only that serotype of life, to a person living in a Dengue-endemic area can have
more than one Dengue infection during their lifetime. Dengue fever through the four
different Dengue serotypes are maintained in the cycle which involves humans and
Aedes aegypti or Aedes albopictus mosquito through the transmission of the viruses to
humans by the bite of an infected mosquito. The mosquito becomes infected with the
Dengue virus when it bites a person who has Dengue and after a week it can transmit the
virus while biting a healthy person. Dengue cannot be transmitted or directly spread from
person to person. Aedes aegypti is the most common aedes specie which is a domestic, day-
biting mosquito that prefers to feed on humans.
INTUBATION PERIOD: Uncertain. Probably 6 days to 10 days
PERIOD OF COMMUNICABILITY: Unknown. Presumed to be on the 1st week of
illness when virus is still present in the blood.
CLINICAL MANIFESTATIONS:
First 4 days:
>febrile or invasive stage --- starts abruptly as high fever, abdominal pain and headache;
later flushing which may be accompanied by vomiting, conjunctival infection and epistaxis
4th to 7th day:
>toxic or hemorrhagic stage --- lowering of temperature, severe abdominal pain, vomiting
and frequent bleeding from GIT in the form of melena; unstable BP, narrow pulse pressure
and shock; death may occur; vasomotor collapse
7th to 10th day:
>convalescent or recovery stage --- generalized flushing with intervening areas of blanching
appetite regained and blood pressure already stable
MODE OF TRANSMISSION:
Dengue viruses are transmitted to humans through the infective bites of female Aedes
mosquito. Mosquitoes generally acquire virus while feeding on the blood of an infected
person. After virus incubation of 8-10 days, an infected mosquito is capable, during probing
and blood feeding of transmitting the virus to susceptible individuals for the rest of its life.
Infected female mosquitoes may also transmit the virus to their offspring by
transovarial (via the eggs) transmission.Humans are the main amplifying host of the
virus. The virus circulates in the blood of infected humans for two to seven days, at
approximately the same time as they have fever. Aedes mosquito may have acquired the
virus when they fed on an individual during this period. Dengue cannot be transmitted
through person to person mode.

CLASSIFICATION:
1. Severe, frank type
 >flushing, sudden high fever, severe hemorrhage, followed by sudden drop of
temperature, shock and terminating in recovery or death
2. Moderate
>with high fever but less hemorrhage, no shock present
3. Mild
>with slight fever, with or without petichial hemorrhage but epidemiologically
related to typical cases usually discovered in the course of invest or typical cases

GRADING THE SEVERITY OF DENGUE FEVER:

Grade 1:
>fever
>non-specific constitutional symptoms such as anorexia, vomiting and abdominal
pain
>absence of spontaneous bleeding
>positive tourniquet test
Grade 2:
>signs and symptoms of Grade 1: plus
>presence of spontaneous bleeding: mucocutaneous, gastrointestinal
Grade 3:
>signs and symptoms of Grade 2 with more severe bleeding: plus
>evidence of circulatory failure: cold, clammy skin, irritability, weak to
compressible pulses, narrowing of pulse pressure to 20 mmhg or less, cold
extremities, mental confusion
Grade 4:
>signs and symptoms of Grade 3, declared shock, massive bleeding, pulse less
and arterial blood Pressure = 1 mmhg (Dengue Syndrome/DS)

DENGUE PREVENTION:
There is no vaccine to prevent dengue. Prevention centers on avoiding mosquito bites
when traveling 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 traveling 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
bednets 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.

II. Theoretical Framework

Florence Nightingale (1820–1910), considered the founder of educated and scientific
nursing and widely known as "The Lady with the Lamp” wrote the first nursing notes that
became the basis of nursing practice and research. The notes, entitled Notes on Nursing:
What it is, What is not (1860), listed some of her theories that have served as foundations of
nursing practice in various settings, including the succeeding conceptual frameworks and
theories in the field of nursing.[2] Nightingale is considered the first nursing theorist. One of her
theories was the Environmental Theory, which incorporated the restoration of the usual health
status of the nurse's clients into the delivery of health care—it is still practiced today.
She stated in her nursing notes that nursing "is an act of utilizing the environment of the
patient to assist him in his recovery" (Nightingale 1860/1969) , that it involves the nurse's
initiative to configure environmental settings appropriate for the gradual restoration of the
patient's health, and that external factors associated with the patient's surroundings affect life
or biologic and physiologic processes, and his development.
III. PERSONAL DATA

My patients name is Patient XYZ, He lives in Malabon City, He is 12 years of age, Single and
he is a Roman Catholic, He was born on June 29, 1998. He was admitted at CMC Hospital and
currently at the 6th floor at room 645. Dr R.G Henson is his attending physician and his medical
diagnosis is Dengue fever while the patients chief complain is fever.

IV. MEDICAL HISTORY

4 days prior to admission when the patient started to fever at 38 degrees celsius the paracetamol
was given. 3 days prior to admission the patient was still febrile with an episode of vomiting of
previously ingested food which was shanghai. 2 days prior to admission, there was persistence of fever
and now with cough and colds. Consult with the physician was done.

He had an impurfonate anus since birth. He has no family medical history. He is a grade 6
student in Lourdes school and he indicated that he always drinks mineral water.

His immunization background is complete except for Hepa A and Typhoid. His OPV, DPT,
Hepa B, BCG, Measles, MMR, Varicella are all complete from 1st dose up to 3rd dose except for the
booster.

As for his developmental history he started regard and social smile in his 1-2 months of age.
Turned on abdomen, crept, sat aided in his3-4 months of age. Then sat alone, stood aided in his 5-6
months of age. He developed his 1st step, walked, and said words in his 7-8 months while his sentences
and bladder control developed at his 1-2 years of age and his bowel control and first tooth when he was
3 years old.

V. PATTERNS OF FUNCTIONING
 BEFORE DURING INTERPRETATION/
HOSPITALIZATION HOSPITALIZATION ANALYSIS
Health Perception- The patient perceived He sees himself as a The patient values his
Health Management his health in the state of total ill person because health by taking
pattern. good condition. He he cannot do anymore vitamins C everyday
values his health a lot the things he usually before going to school.
does. Like playing with
his siblings. The patient
perceived that he is not
healthy because of his
condition
Nutritional- Metabolic The patient eats 3times The patient has less his The patient doesn't have
Pattern a day and with appetite and hasn't eaten any problem about his
afternoon snacks after a lot. He is on DAT and appetite.
coming from school. NDCF.
His appetite is moderate
and usually depends on
the food being served.
He didn't complain any
difficulty in swallowing.
Elimination Pattern He usually Urinates 4-5 The patient urinates 3-4 The patient doesn't any
times a day without times a day. The color of problem urinating.
difficulty. The patient his urine is yellow. The
defecates once a day patient defecates once
usually early in the every two days.
morning before going to
school.
Activity- Exercise He could perform His activity was limited He is a very active boy
Pattern activities of his daily lying on bed. and always plays with
living. According to him his siblings.
he often plays with his
siblings and this serves
as a form of exercise for
him.
Sleep- Rest Pattern He has the normal 6-8 He does not have the Patient sleep is
hours of sleep. He also adequate time of sleep disturbed when he
has his nap time for 1-2 since he is disturbed by arrived at the hospital.
hours a day. Sleeping the nurse every now and
and watching the then, and also because
television are his forms of environmental
of rest. changes.
Cognitive- Perceptual He is normal in terms of He was normal as Patient doesn't have any
Pattern his cognitive abilities. before. He responds problem with his skills.
He has good memory appropriately to verbal
and listening skills. In and physical stimuli and
 terms of his perceptual obeys simple
pattern he has no commands.
problem with with his
senses.
Self Perception – He sees himself as a He doesn't have any The patient doesn't have
Self Concept Pattern person with a good changes during any problem with his
personality. He has been hospitalization. family, and according to
a good friend, brother him he is just a simple
and son. He said he has person.
to be a good person in
order not to hurt others.
He also describes
himself as a typical type
of student and person.
Role Relationship He is close with his He had more times to Patient is happy when
Pattern family. He is also a bond with his family. He he discovered that his
responsible student and said that it was a nice family supports him all
knows all his duties as a feeling to know that the way.
friend. your family is so
supportive to him.
Sexuality Reproductive According to him, He He doesn't have any Patient doesn't have any
Pattern doesn't think of the changes during interest with sexuality as
things of the things like hospitalization. of now.
having a girlfriend and
getting married yet. He
is still young for such
matters.
Coping-Stress Tolerance He does not fully He shares his problems Patient is stress free.
Pattern identify his situations to his family he
having stress, but he verbalizes his feelings.
always tell his parents
when something is
wrong
Value- Belief Pattern He is a Roman Catholic He can't go with his He is a very religious
devotee. He always goes family for the mass due person. He does believe
with his family even to hospitalization. and fear of god.
sunday to go to mass.
He was taught by family
to believe and have fear
of God.

VI. HEMATOLOGY REPORT

February 15, 2011

LABORATORY RESULTS NORMAL/VALU ANALYSIS INTERPRETATI

EXAMINATION ES ON
Hemoglobin 136 Female 120 - 150 Normal View of
Male 135 - 160 Hematology is
Normal
Hematocrit 0.41 Female 0.37 – 0.45 Normal View of
Male 0.40 – 0.48 Hematology is
Normal
Erythrocytes 5.33 Female 4.0 – 5. 0 High Loss of blood
Male 4.5 – 5.0 plasma, The liquid
component of
blood creates
Relatively high
level of RBC.
MCV 77.3 80 - 96 Low It has iron
deficiency due to
blood loss or
parasites.
MCH 25.5 27 - 33 Low It has iron
deficiency due to
blood loss or
parasites.
MCHC 33 33 - 36 Normal View of
Hematology is
Normal
Platelets 200 150 - 440 Normal View of
Hematology is
Normal
Total WBC 4 5.0 - 10 Low It has an infection
Neutrophils 0.5 0.55 – 0.65 Low It has low immune
system
Lymphocytes 0.32 0.25 – 0.40 Normal View of
Hematology is
Normal
Monocytes 0.15 0.02 – 0.06 Normal View of
Hematology is
Normal
Eosinophils 0.01 0.01 – 0.050 Normal View of
Hematology is
Normal
Basophils 0 0 – 0.005 Normal View of
 Hematology is
Normal
Stabs 0.02 0.01 – 0.05 Normal View of
Hematology is
Normal

VII. PHYSICAL ASSESSMENT

Initial Vital Signs : T- 36.2C , RR:23 bpm , BP: 40/60 mmhg , PR: 70bpm
 Area Technique Normal Findings Actual Findings Evaluation
Assessed
Skin
Color Inspection Light brown, Light brown skin Normal
tanned skin (vary
according to race)
Soles and Inspection Lighter colored Lighter colored Normal
palms palms, soles palms, soles
Moisture Inspection/ Skin normally dry Skin normally dry Normal
Palpation
Temperature Palpation Normally warm Normally warm Normal
Texture Palpation Smooth and soft Smooth and soft Normal
Turgor Palpation Skin snaps back Skin snaps back Normal
immediately immediately
Skin
appendages
a. Nails Inspection Transparent, Transparent, Normal
smooth and convex smooth and convex
Nail beds Inspection Pinkish Pale Due to decreased
blood flow
Nail base Inspection Firm Firm Normal
White color of nail Returns within 2-3 Normal
bed under pressure seconds
Capillary Inspection/ should return to
refill Palpation pink within 2-3
seconds
b. Hair
Distribution Inspection Evenly distributed Evenly distributed Normal
Color Inspection Black Black Normal
Texture Inspection/ Smooth Smooth Normal
Palpation
Eyes
Eyes Inspection Parallel to each Parallel to each Normal
other other
Visual Acuity Inspection PERRLA- Pupils PERRLA- Pupils Normal
(penlight) equally round react equally round react
to light and to light and
accommodation accommodation
Eyebrows Inspection Symmetrical in Symmetrical in Normal
size, extension, hair size, extension, hair
texture and texture and
movement movement
Eyelashes Inspection Distributed evenly Distributed evenly Normal
and curved outward and curved outward
Eyelids Inspection Same color as the Same color as the Normal
skin skin
 Blinks involuntarily Blinks involuntarily
and bilaterally up to and bilaterally up to Normal
20 times per minute 18 times per minute

Do not cover the Do not cover the

pupil and the pupil and the sclera, Normal
sclera, lids lids normally close
normally close symmetrically
symmetrically
Conjunctiva Inspection Transparent with Transparent with Normal
light pink color light pink color
Sclera Inspection Color is white Color is white Normal
Cornea Inspection Transparent, shiny Transparent, shiny Normal
Pupils Inspection Black, constrict Black, constrict Normal
briskly briskly
Iris Inspection Clearly visible Clearly visible Normal
Ears
Ear canal Inspection Free of lesions, Free of lesions, Normal
opening discharge of discharge of
inflammation inflammation

Canal walls pink Canal walls pink Normal

Hearing Inspection Client normally Client normally
Acuity hears words when hears words when Normal
whispered whispered
Nose
Shape, size Inspection Smooth, symmetric Smooth, symmetric
and skin color with same color as with same color as Normal
the face the face

Nares Inspection Oval, symmetric Oval, symmetric

and without and without Normal
discharge discharge

Mouth and
Pharynx
Lips Inspection Pink, moist Light pink, dry, Lack of fluid intake
symmetric symmetric
Buccal Inspection Glistening pink soft Glistening pink soft Normal
mucosa moist moist
Gums Inspection Slightly pink color, Slightly pink color,
moist and tightly fit moist and tightly fit Normal
against each tooth against each tooth
Tongue Inspection Moist, slightly Moist, slightly
rough on dorsal rough on dorsal Normal
surface medium or surface medium or
dull red dull red
Teeth Inspection Firmly set, shiny Firmly set, shiny Normal
With tooth decay
Hard and soft Inspection Hard palate- dome- Hard palate- dome-
palate shaped shaped Normal
Soft Palate- light Soft Palate- light
pink pink
Neck
Symmetry of Neck is slightly Neck is slightly
neck muscles, Inspection hyper extended, hyper extended, Normal
alignment of without masses or without masses or
trachea asymmetry asymmetry
Neck ROM Inspection Neck moves freely, Neck moves freely, Normal
without discomfort without discomfort
Thyroid gland Palpation Rises freely with Rises freely with Normal
swallowing swallowing
Thorax and Auscultation Clear breath sounds Clear breath sounds Normal
Lungs
Abdomen Inspection Skin same color Skin same color Normal
with the rest of the with the rest of the
body body

Bowel sounds Auscultation Normal

Clicks or gurling Clicks or gurling
sounds occur sounds occur
irregularly and irregularly and
range from 5-35 per range from 20 per
minute minute
Neurology
system
Level of Inspection Fully conscious, Fully conscious,
consciousness respond to respond to Normal
questions quickly, questions quickly
perceptive of perceptive of events
events

Behavior and Inspection Makes eye contact Makes eye contact

appearance with examiner, with examiner,
hyperactive hyperactive Normal
expresses feelings expresses feelings
with response to the with response to the
situation situation

VIII. Anatomy and Physiology

The lymphatic system in vertebrates is a network of conduits that carry a clear
fluid called lymph. It also includes the lymphoid tissue through which the lymph
travels. Lymphoid tissue is found in many organs, particularly the lymph nodes,
and in the lymphoid follicles associated with the digestive system such as the
tonsils. The system also includes all the structures dedicated to the circulation and
production of lymphocytes, which includes the spleen, thymus, bone marrow and
the lymphoid tissue associated with the digestive system.[1] The lymphatic system
as we know it today was first described independently by Olaus Rudbeck and
Thomas Bartholin.The blood does not directly come in contact with the
parenchymal cells and tissues in the body, but constituents of the blood first exit
the microvascular exchange blood vessels to become interstitial fluid, which comes
into contact with the parenchymal cells of the body. Lymph is the fluid that is
formed when interstitial fluid enters the initial lymphatic vessels of the lymphatic
system. The lymph is then moved along the lymphatic vessel network by either
intrinsic contractions of the lymphatic vessels or by extrinsic compression of the
lymphatic vessels via external tissue forces (e.g. the contractions of skeletal
muscles).
The lymphatic system has three interrelated functions: it is responsible for the
removal of interstitial fluid from tissues; it absorbs and transports fatty acids and
fats as chyle to the circulatory system; and it transports immune cells to and from
the lymph nodes. The lymph transports antigen presenting cells (APCs), such as
dendritic cells, to the lymph nodes where an immune response is stimulated. The
lymph also carries lymphocytes from the efferent lymphatics exiting the lymph
nodes.
The study of lymphatic drainage of various organs is important in diagnosis,
prognosis, and treatment of cancer. The lymphatic system, because of its physical
proximity to many tissues of the body, is responsible for carrying cancerous cells
between the various parts of the body in a process called metastasis. The
intervening lymph nodes can trap the cancer cells. If they are not successful in
destroying the cancer cells the nodes may become sites of secondary tumors.
Diseases and other problems of the lymphatic system can cause swelling and other
symptoms. Problems with the system can impair the body's ability to fight
infections.
Organization
The lymphatic system can be broadly divided into the conducting system and the
lymphoid tissue.
The conducting system carries the lymph and consists of tubular vessels that
include the lymph capillaries, the lymph vessels, and the right and left thoracic
ducts.
The lymphoid tissue is primarily involved in immune responses and consists of
lymphocytes and other white blood cells enmeshed in connective tissue through
which the lymph passes. Regions of the lymphoid tissue that are densely packed
with lymphocytes are known as lymphoid follicles. Lymphoid tissue can either be
structurally well organized as lymph nodes or may consist of loosely organized
lymphoid follicles known as the [[mucosa-associated lymphoid tissue](MALT)].
Formation of lymph
Blood supplies nutrients and important metabolites to the tissues, and collects
back the waste products that they produce, which requires exchange of respective
constituents between the blood and tissues. This exchange is not direct, however,
and is effected through an intermediary called interstitial fluid or tissue fluid that
the blood forms. Interstitial fluid (ISF) is the fluid that occupies the spaces between
the cells and acts as their immediate environment. As the blood and the
surrounding cells continually add and remove substances from the ISF, its
composition keeps on changing. Water and solutes can freely pass (diffuse)
between the ISF and blood, and thus both are in dynamic equilibrium with each
other; exchange between the two fluids occurs across the walls of small blood
vessels called capillaries.
ISF forms at the arterial (coming from the heart) end of the capillaries
because of higher pressure of blood, and most of it returns to its venous ends and
venules; the rest (10—20%) enters the lymph capillaries as lymph. Thus, lymph
when formed is a watery clear liquid with the same composition as the ISF. As it
flows through the lymph nodes, however, it comes in contact with blood and tends
to accumulate more cells (particularly lymphocytes) and proteins.
The two primary lymph systems are the thymus gland and the bone marrow,
where the immune cells form or mature. The secondary lymph system is made up
of encapsulated and unencapsulated diffuse lymphoid tissue. The encapsulated
tissue includes the spleen and the lymph nodes. The unencapsulated tissue
includes the gut-associated lymphoid tissues and the tonsils.
 Lymphoid tissue
Lymphoid tissue associated with the lymphatic system is concerned with
immune functions in defending the body against the infections and spread of
tumors. It consists of connective tissue with various types of white blood cells
enmeshed in it, most numerous being the lymphocytes.
T The lymphoid tissue may be primary, secondary, or tertiary depending upon
the stage of lymphocyte development and maturation it is involved in. Primary
(central) lymphoid tissues serve to generate mature virgin lymphocytes from
immature progenitor cells. Secondary (peripheral) lymphoid tissues provide a
place where lymphocytes can talk to each other; an environment for antigen
focusing, where lymphocytes can 'study' an antigen and sharpen up the immune
response by clonal expansion and affinity maturation; and provide a home for
lymphocytes, where they can be available when they are needed.
The thymus and the bone marrow constitute the primary lymphoid tissues
involved in the production and early selection of lymphocytes. Secondary lymphoid
tissue provides the environment for the foreign or altered native molecules
(antigens) to interact with the lymphocytes. It is exemplified by the lymph nodes,
and the lymphoid follicles in tonsils, Peyer's patches, spleen, adenoids, skin, etc.
that are associated with the mucosa-associated lymphoid tissue (MALT). The
tertiary lymphoid tissue typically contains far fewer lymphocytes, and assumes an
immune role only when challenged with antigens that result in inflammation. It
achieves this by importing the lymphocytes from blood and lymph.

Lymph nodes

A lymph node showing afferent and efferent lymphatic vessels

A lymph node is an organized collection of lymphoid tissue, through which the
lymph passes on its way to returning to the blood. Lymph nodes are located at
intervals along the lymphatic system. Several afferent lymph vessels bring in
lymph, which percolates through the substance of the lymph node, and is drained
out by an efferent lymph vessel.
The substance of a lymph node consists of lymphoid follicles in the outer portion
called the "cortex", which contains the lymphoid follicles, and an inner portion
called "medulla", which is surrounded by the cortex on all sides except for a portion
 known as the "hilum". The hilum presents as a depression on the surface of the
lymph node, which makes the otherwise spherical or ovoid lymph node bean-
shaped. The efferent lymph vessel directly emerges from the lymph node here. The
arteries and veins supplying the lymph node with blood enter and exit through the
hilum.
Lymph follicles are a dense collection of lymphocytes, the number, size and
configuration of which change in accordance with the functional state of the lymph
node. For example, the follicles expand significantly upon encountering a foreign
antigen. The selection of B cells occurs in the germinal center of the lymph nodes.
Lymph nodes are particularly numerous in the mediastinum in the chest, neck,
pelvis, axilla (armpit), inguinal (groin) region, and in association with the blood
vessels of the intestines.

Lymphatics
lymphatic system
Tubular vessels transport back lymph to the blood ultimately replacing the volume lost
from the blood during the formation of the interstitial fluid. These channels are the
lymphatic channels or simply called lymphatics.

General structure of Lymphatics

The general structure of lymphatics is based on that of blood vessels. There
is an inner lining of single flattened cells composed of a type of epithelium that is
called endothelium, and the cells are called endothelial cells. This layer functions
to mechanically transport fluid and since the basement membrane on which it
rests is discontinuous; it leaks easily. The next layer is that of smooth muscles that
are arranged in a circular fashion around the endothelium, which by shortening
(contracting) or relaxing alter the diameter (caliber) of the lumen. The outermost
layer is the adventitia that consists of fibrous tissue. The general structure
described here is seen only in larger lymphatics; smaller lymphatics have fewer
layers. The smallest vessels (lymphatic or lymph capillaries) lack both the muscular
layer and the outer adventitia. As they proceed forward and in their course are
joined by other capillaries, they grow larger and first take on an adventitia, and
then smooth muscles.
The whole lymphatic conducting system broadly consists of two types of
channels—the initial lymphatics, the prelymphatics or lymph capillaries that
specialize in collection of the lymph from the ISF, and the larger lymph vessels that
propel the lymph forward.
Unlike the cardiovascular system, the lymphatic system is not closed and
has no central pump. Lymph movement occurs despite low pressure due to
peristalsis (propulsion of the lymph due to alternate contraction and relaxation of
smooth muscle), valves, and compression during contraction of adjacent skeletal
 muscle and arterial pulsation.

Lymph capillaries

Propulsion of lymph through lymph vessel

The lymphatic circulation begins with blind ending (closed at one end) highly
permeable superficial lymph capillaries, formed by endothelial cells with button-like
junctions between them that allow fluid to pass through them when the interstitial
pressure is sufficiently high. These button-like junctions consist of protein filaments
like platelet endothelial cell adhesion molecule-1 or (PECAM-1). A valve system in
place here prevents the absorbed lymph from leaking back into the ISF. There is
another system of semilunar (semi=half; lunar=related to the Moon) valves that
prevents back-flow of lymph along the lumen of the vessel. Lymph capillaries have
many interconnections (anastomoses) between them and form a very fine network.
Rhythmic contraction of the vessel walls through movements may also help
draw fluid into the smallest lymphatic vessels, capillaries. If tissue fluid builds up
the tissue will swell; this is called edema. As the circular path through the body's
system continues, the fluid is then transported to progressively larger lymphatic
vessels culminating in the right lymphatic duct (for lymph from the right upper
body) and the thoracic duct (for the rest of the body); both ducts drain into the
circulatory system at the right and left subclavian veins. The system collaborates
with white blood cells in lymph nodes to protect the body from being infected by
cancer cells, fungi, viruses or bacteria. This is known as a secondary circulatory
system.

Lymph vessels
The lymph capillaries drain the lymph to larger contractile lymphatics, which
have valves as well as smooth muscle walls. These are called the collecting
lymphatics. As the collecting lymph vessel accumulates lymph from more and
more lymph capillaries in its course, it becomes larger and is called the afferent
lymph vessel as it enters a lymph node. Here the lymph percolates through the
lymph node tissue and is removed by the efferent lymph vessel. An efferent lymph
vessel may directly drain into one of the (right or thoracic) lymph ducts, or may
empty into another lymph node as its afferent lymph vessel. Both the lymph ducts
return the lymph to the blood stream by emptying into the subclavian veins
The functional unit of a lymph vessel is known as a lymphangion, which is
the segment between two valves. Since it is contractile, depending upon the ratio
of its length to its radius, it can act either like a contractile chamber propelling the
fluid ahead, or as a resistance vessel tending to stop the lymph in its place.

IX. PATHOPHYSIOLOGY

Precipitating
Predisposing Factor: Environmental
Geographical area – tropical conditions (open
islands in the Pacific spaces with water pots,
Philippines and Asia and plants)
- Environment Mosquito carrying
dengue virus
Environment

↓
Bite of a aedes aegypti mosquito carrying a virus
↓
Virus goes into the circulation
↓
Infects cells & generate cellular response
↓
Initiates destruction of the platelet
↓
 Potential for hemorrhage
↓
Stimulates intense inflammatory response
↓
Release of exogenous pyrogens
↓

↑ WBC (Neutrophils & Macrophages)

↓
Release of endogenous pyrogens
↓
Reset of hypothalamic thermostat
↓

Fever

X. NURSING CARE PLAN

ASSESS DIAGNOSIS PLANNING IMPLEMENTATI RATIONAL EVALUAT

MENT ON E ION

Subjecti READINESS Short Term: *Assess clients *Indicate GOAL

ve: FOR perceptions of deficient ACHIEVE
“Ano ba ENHANCED After 4hrs of their current knowledge D
ang KNOWLEDGE Nursing health problems or
pwede : Health Intervention the misinformati After 4hrs
kong client will be *Determine on of Nursing
gawin?” able to motivation/ Interventio
as verbalize expectations for n the
verbalize understanding learning *To develop client had
d by the of information plan for been able
patients gained. *Ascertain learning to
guardian preferred verbalize
methods of understan
learning ding of
*To facilitate informatio
 *Provide learning n gained.
information process
Objectiv about additional
e: learning
The client resources. Such *Promotes
manifeste as: ongoing
d: -books learning at
*cooperati -magazines own pace
ve -t.v programs
*follows
instructio *to promote
ns *Review specific wellness
*active dietary changes/
*asking retrictions with
about the client
normal
condition
of her
sons
health

NURSING CARE PLAN

Assessment Nursing Diagnosis Objectives Evaluation

1. Presence of Related to possible Promote avoidance of the The family must be able to
risk factors of occurrence of disease through the perform the necessary
specific dengue as implementation of an method of maintaining water
diseases manifested by effective method cleanliness by covering water
Presence of presence of hordes containers
breeding or of mosquitoes
resting sites of
vectors of
diseases

2. Poor home Inability to provide After weeks of session and The family will have a
and a home health teaching the family healthy lifestyle giving
environmental environment should be able to: importance to health
condition conducive to health wellness, conducive and
 maintenance 1. know the importance carefree life.
related to the of long-term benefits
presence of of investing in health
breeding sites and maintenance, hygiene
improper refuse of and sanitation
trashes.
2. carry out measure in
preventing cross
infection of illnesses

3. utilize the
community resources
for healthcare

4. disseminate
information and be a
good role to other
family

5. Learn proper waste

segregation
6. Understand the
importance of health
maintenance, hygiene
and preventive
measure of the illness

NURSING CARE PLAN

ASSESSMENT NURSING OBJECTIVES NURSING EVALUATION
DIAGNOSIS INTERVENTION
S

Subjective: Hyperthermia After 8 hrs. Of Independent: After 8 hrs.

related to nursing  Monitor Of nursing
“Mainit dehydration Interventions, heart intervention, the
angpakiramdam the patient will rate and patient was able
ko” as verbalized maintain core rhythm. maintain core
by the patient. temperature temperature
within normal  Record within normal
Objective: range. all range.
sources
- Flushed of fluid Goal was met.
skin, warm loss such
to touch. as urine,
 - Restlessn vomiting
ess and
diarrhea.
- V/S taken
as follows:  Promote
surface
T: 38.1C cooling
by
P: 70bpm means of
tepid
R: 20bpm sponge
bath.
BP: 90/60mmhg
 Wrap
extremiti
es with
cotton
blankets.

Collaborative
 Administ
er
replacem
ent fluids
and
electrolyt
es.

 Administ
er
antipyreti
cs orally
or
rectally
as
prescribe
d by the
physician
.
XI. DRUG STUDY

Paracetamol Dosage Classification Indication Action Contraindicati Nursing

on Consideration
Tempra 500 mg Nonopiod Mild pain or Produce Patients with Use liquid
analgesics fever Analgesia by hypersensitiv form for
and blocking pain e to drug children and
Antipyretics impulses by patients who
Inhibiting have
synthesis of difficulty in
prostaglandin swallowing.
in the CNS -In children,
or of other don't exceed
substance in 24Hrs.
that sensitize
pain
receptors to
stimulation.
The drug
may relieve
fever through
central action
in the
hypothalmic
heat
regulating
center.
XII. Discharge Plan

A. Patient's Name: Patient XYZ

> A twelve year-old male patient, who was diagnosed with Dengue
Hemorrhagic Fever.
>M- Medication: remind to take prescribed medicine from time to time and the right frequency
>E- Exercise: Instruct to avoid excessive activities that may result to stress
>T- Treatment: Instruct to drink plenty of water or fluids that available at home and eat nutritious diet.
>H- Hygiene: Encourage to continue routinely hygienic care of the patient.
>O- Out Patient Follow Up: Instruct family members to have a checkup or consult physician one a
while to monitor patient condition.
>D- Diet: Give client protein rich foods, Such as meat, Vegetables, and fruits.
B. Health Teaching:
> D- discuss the possible source of infection of the disease.
> E- educate the family/patient on how to eliminate those vectors.
> N- Never stocked water in a container without cover.
> G- Gallon, container and tires must have proper way of disposal.
> U- Use insecticides at home to kill or reduce mosquito.
> E- Encourage the family of the patient to clean the surroundings to destroy the
breeding places of mosquito.