MAKATI MEDICAL CENTER COLLEGE OF NURSING ________________________________ Care of a Client with Dengue Hemorrhagic Fever _______________________________ A Case Study

submitted to:

Submitted by: Agustin, Aira Alyssa S. Fabon, Krystel Mariz S. Submitted On: September 02, 2011

TABLE OF CONTENTS CHAPTER I Introduction Purpose of the study 5 Significance of the study Scope and Limitation 6 Background of the Study 7 CHAPTER II Review of Related Literature 8 Synthesis CHAPTER III Client Presentation CHAPTER IV Analysis and Interpretation CHAPTER V Summary of Findings Conclusion and Recommendation BIBLIOGRAPHY APPENDICES 3

Concept Map Nursing Care Plan Drug Study Pathophysiologic Diagram CHAPTER I INTRODUCTION Dengue fever is a disease ranging from mild to severe caused by four related viruses spread by a particular species of mosquito. Mild dengue fever causes high fever, rash, and muscle and joint pain. More-severe forms of the disease dengue hemorrhagic fever and dengue shock syndrome can additionally cause severe bleeding, a sudden drop in blood pressure (shock) and death. It is a severe, flu-like illness that affects infants, young children and adults, but seldom causes death. (http://www.who.int) Early symptoms of dengue hemorrhagic fever are similar to those of dengue fever, but after several days the patient becomes irritable, restless, and sweaty. These symptoms are followed by a shock -like state. Bleeding may appear as tiny spots of blood on the skin (petechiae) and larger patches of blood under the skin (ecchymoses). Minor injuries may cause bleeding. Early symptoms include: Decreased apettite, fever, headache, joint aches, malaise, muscle aches, vomiting. Dengue viruses are transmitted to humans through the bites of infective female Aedes mosquitoes. Mosquitoes generally acquire the virus while feeding on the blood of an infected person. After virus incubation for eight to 10 days, an infected mosquito is capable, during probing and blood feeding, of transmitting the virus for the

rest of its life. Infected female mosquitoes may also transmit the virus to their offspring by transovarial (via the eggs) transmission, but the role of this in sustaining transmission of the virus to humans has not yet been defined. Because Dengue hemorrhagic fever is caused by a virus for which there is no known cure or vaccine, the only treatment is to treat the symptoms. A transfusion of fresh blood or platelets can correct bleeding problems, IV fluids and electrolytes are also used to correct electrolyte imbalances and also to treat dehydration, Oxygen therapy to treat abnormally low blood oxygen. Tests may include: Arterial blood gases, Coagulation studies, Electrolytes, Hematocrit, Liver enzymes, Platelet count, Serologic studies (demonstrate antibodies to Dengue viruses), Serum studies from samples taken during acute illness and convalescence (increase in titer to Dengue antigen), Tourniquet test (causes petechiae to form below the tourniquet), X-ray of the chest (may demonstrate pleural effusion) (http://www.nlm.nih.gov) There is no vaccine available to prevent dengue fever. Use personal protection such as full-coverage clothing, netting, mosquito repellent containing DEET, and if possible, travel during periods of minimal mosquito activity. Mosquito abatement programs can also reduce the risk of infection. The incidence of dengue has grown dramatically around the world in recent decades. Some 2.5 billion people two fifths of the world's population are now at risk from dengue. WHO currently estimates there may be 50 million dengue infections worldwide every year. In 2007 alone, there were more than 890 000 reported cases of

dengue in the Americas, of which 26 000 cases were DHF. An estimated 500 000 people with DHF require hospitalization each year, a very large proportion of whom are children. About 2.5% of those affected die. (http://www.who.int)

PURPOSE OF THE STUDY This study is for the general purpose of analyzing the variables that contributed to the development of the actual and potential problems of the client. Specifically, the study aims to: 1. Identify the factors that led to the development of the problem. 2. Explain the interrelationship of factors that led to the development of the problem. 3. Discuss the relevant interventions that were utilized to resolve the problem. 4. Describe the patients response toward the interventions.

SIGNIFICANCE OF THE STUDY The case study is intended to give benefit to the following: To the patient, as the primary recipient of care, the findings of this study as well as the implemented nursing care will help improve in health condition. To the nursing students, the result of the study will enhance their knowledge, skill and quality of nursing care, as a tool for better care plan to be rendered to a client with the same case.

To the clinical instructors, this study will serve as a reference for them future clinical discussion regarding the effectiveness of the implemented nursing interventions directing students who will be handling the same case. To the health care team, the result of the study can be used as reference for future similar cases and will help them to improve the quality of care. To the future researchers, this study will serve as a guide and reference for future studies that will develop the quality of nursing care for clients with the same condition. In addition, the result of the study would serve as a research material and guide for comparison and improvement of a better care plan and reference for further studies with similar or related case.

SCOPE AND LIMITATIONS The study was a retrospective A type, that starts with the present condition of the patient and collects data about their past history to explain their current condition within the shift, and through interaction with the patient and through the patients chart. The focus of the study is about the care of a patient with Dengue Hemorrhagic Fever and the appropriate nursing interventions to the identified actual and potential problems. Another focus of the study is to be able to develop appropriate nursing interventions in the care of this patient, and other patients with the same case, explain the interventions that was chosen for the care of the patient with this case, identify and explain the interventions that are being used by the nurse, with collaboration with the healthcare team, and to be able to explain the response of the patient towards the chosen interventions.

The study was conducted during the hospitalization on Aug. 09, 2011 and Aug. 10, 2011 at 0800H. The client is Mr. M.R.S., a client that was selected from a selected tertiary hospital in Makati, who has Dengue Hemorrhagic Fever Data collection was done through interview with the parents of the client, nursing history taking, physical examination, review of medical records, obtaining information from the primary nurses during the shift and from the general observation of the researchers. The tools that were used in the data gathering are the Nursing History Form, Medical Records, and usage of reference materials that contains information about Dengue Fever. Limitations of the study include the following: the patient was only handled four days. The researcher handled the patient for only 8 hours of August 9-10, 2011, AM shift. The researchers were not able to admit and discharge the patient because it was done beyond the shifts of the researchers.

BACKGROUND OF THE STUDY The study was conducted during the second clinical rotation of the 1st semester school year 2011-2012 during a 0600H- 1400H clinical duty from Monday to Wednesday. The focus for this rotation is the care of an adult to senile male and female client in the hospital setting utilizing the nursing process in meeting the needs of the client, taking into consideration the twelve core competencies as a standard of nursing care. The study took place at the tertiary hospital located at Makati City. The hospital offers a wide array of services for treatment and specialization. Its vision is to be an internationally recognized medical center dedicated to excellence in healthcare. With its

mission, to provide high-quality health care services through integrated specialty centers operated by highly qualified physicians and nurses, as well as technical and management staff, sustained by well-developed research and training programs and enabled by stateof-the-art professional equipment and specialized tools. In this present time, there is a new Annex building was constructed and the existing building with the state-of-the art medical equipment and facilities that will cater to the needs of clients concerning their health was renovated. Specifically, the study was conducted on Male Ward of C.P. Manahan Complex located at the second floor of the said hospital. In the Male and Female Ward, the total bed capacity is 51. However, pediatric clients do not occupy the total bed capacity. Mostly female and male adolescent pediatric clients are admitted in the Male and Female ward due to incapacity of the bed in Pediatric Ward to accommodate such client. The Female ward has 1 Nurses station, but the charts are separated as to male and female. A medication area, sink beside the comfort room, and a refrigerator can be found beside the Nurses station and before entering the pantry. On the other side of the Nurses station, linens, towels, gowns, and pillowcases are stored for the patients use. The ward has two comfort rooms and is separated for male and female patients who are capable of walking to go to the comfort room and patients who are assisted by a wheelchair. The researchers chose the case of Mr. M.R.S. with Dengue Fever, in the interest of the researchers for their belief that the case study will produce a learning experience and opportunity to the researchers as well as the readers. In addition, the patients condition stimulates the students interest and give them the opportunity to apply the knowledge, skills and attitude they have learned in their lectures.

CHAPTER II REVIEW OF RELATED LITERATURE This chapter places the current study into the context of previous related research. As such, this will emphasize the relatedness between the current study and the work of others. Of central importance, this will provide information and explanation which will guide and support the formulation of the case.

Dengue Hemorrhagic Fever. Retrieved: August 31, 2011 on: www.scribd.com

1. Anatomy and Physiology: BLOOD Blood is a connective tissue composed of a liquid extracellular matrix called blood plasma that dissolves and suspends various cells and cell fragments. 1. Formed elements Red Blood Cells (Erythrocytes) White Blood Cells (Leukocytes) Platelets (Thrombocytes)

2. Plasma = water + dissolved solutes

Characteristics of Blood Bright red Dark red/purplish Much more dense than pure water pH range from 7.35 7.45 slightly warmer than body temperature typical volume in an adult is 5 liters 8% of body weight Major Functions of Blood Distribution & Transport Regulation (maintenance of homeostasis) Protection Formed Elements RBC Biconcave disc shape A hemoglobin carrier A nucleate No mitochondria 120 lifespan Erythropoietin is the hormone that stimulates RBC production

WBC

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Protection from microbes, parasites, toxins, cancer 1% of blood volume; 4- 11,000 per cubic mm blood Amoeboid motion Chemotaxis Leukocytocis Leukopoiesis Colony stimulating factors and Interleukins- stimulates WBC formation

Types of WBC: Lymphocyte Monocyte Eosinophil Basophil Neutrophil

dengue. (2010). Encyclopdia Britannica. Encyclopaedia Britannica Ultimate Reference Suite. Chicago: Encyclopdia Britannica. 2. Definition

Dengue is also called breakbone fever, or dandy fever. It is an acute, infectious, mosquito-borne fever that is temporarily incapacitating but is rarely fatal. Besides fever, the disease is characterized by an extreme pain in and stiffness

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of the joints (hence the name breakbone fever). Complication of dengue fever can give rise to a more severe form, called dengue hemorrhagic fever (DHF), which is characterized by hemorrhaging blood vessels and thus bleeding from the nose, mouth, and internal tissues. Untreated DHF may result in blood vessel collapse, causing a usually fatal condition known as dengue shock syndrome. Dengue is caused by one of four viral serotypes (closely related viruses), designated DEN-1, DEN-2, DEN-3, and DEN-4. These serotypes are members of the Flavivirus genus, which also contains the viruses that cause yellow fever, and can occur in any country where the carrier mosquitoes breed.

Viral transmission The carrier incriminated throughout most endemic areas is the yellow-fever mosquito, Aedes aegypti. The Asian tiger mosquito, A. albopictus, is another prominent carrier of the virus. A mosquito becomes infected only if it bites an infected individual (humans and perhaps also certain species of monkey) during the first three days of the victim's illness. It then requires 8 to 11 days to incubate the virus before the disease can be transmitted to another individual. Thereafter, the mosquito remains infected for life. The virus is injected into the skin of the victim in minute droplets of saliva. The spread of dengue is especially unpredictable because there are four serotypes of the virus. Infection with one typethough it confers lifetime immunity from reinfection with that type of denguedoes not prevent an individual from being infected by the other three types.

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Diagnosis and treatment Diagnosis is made on clinical findings, namely, sudden onset, moderately high fever, excruciating joint pains, intense pain behind the eyes, a second rise in temperature after a brief remission, and particularly the type of rash and decided reduction in neutrophilic white blood cells. There is no specific therapy; therefore attention is focused on relieving the symptoms. In DHF prompt medical attention on maintaining circulating fluid volume can improve chances for survival. Temporary preventive measures must be taken to segregate suspected as well as diagnosed cases during their first three days of illness and, by screens and repellents, to keep mosquitoes from biting more people. Fundamental in the control of the disease is the destruction of mosquitoes and their breeding places.

Dengue through history The earliest account of a dengue like disease comes from the Jin dynasty (AD 265420) in China. There is also evidence that epidemics of illnesses resembling dengue occurred in the 17th century. However, three epidemics that took place in the late 18th century mark the arrival of the disease that is today recognized as dengue fever. Two of these outbreaks involved an illness decidedly similar in symptoms and progression to dengue, and both occurred in 1779one in Cairo and the other in Batavia (now Jakarta) in the Dutch East Indies (now Indonesia), which was reported by Dutch physician David Bylon. The third epidemic happened in 1780 in Philadelphia, Pa. American statesman and

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physician Benjamin Rush, who treated afflicted patients during the Philadelphia epidemic, provided the first clinical description of dengue in his Account of the Bilious, Remitting Fever, which was published in 1789. Because all three 18th-century epidemics involved very similar diseases and occurred in port cities, it is believed that dengue virus was spread from one continent to another via ships. Thus, the spread of dengue depended on overseas survival of mosquito vectors, as well as on arrival in areas with both the necessary environmental conditions to support vector survival and a susceptible population into which the virus could be introduced. This pattern of transport probably also facilitated the emergence of new viral serotypes. In the early 1900s Australian naturalist Thomas Lane Bancroft identified Aedes aegypti as a carrier of dengue fever and deduced that dengue was caused by an organism other than a bacterium or parasite. During World War II, dengue emerged in Southeast Asia and rapidly spread to other parts of the world, inciting a pandemic. Around this time the causative flavivirus was isolated and cultured independently by Japanese physicians Susumu Hotta and Ren Kimura and by American microbiologist Albert Bruce Sabin. In the 1950s hemorrhagic dengue appeared in Southeast Asia, where it became a common cause of death among children in the 1970s. The serotypes continued to spread on a pandemic level, eventually reaching areas of South and Central America, Cuba, and Puerto Rico, where in 1977 an epidemic lasting from July to December affected some 355,000 people. In the following decades the increasing incidence of dengue, particularly DHF, persisted. In 2008 the World Health Organization reported that approximately 2.5 billion people worldwide were at risk of dengue and that the disease was endemic in more than 100 countries.

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Retrieved: August 31, 2011 from: http://www.who.int/mediacentre/factsheets/fs117/en/ Transmission Dengue viruses are transmitted to humans through the bites of infective female Aedes mosquitoes. Mosquitoes generally acquire the virus while feeding on the blood of an infected person. After virus incubation for eight to 10 days, an infected mosquito is capable, during probing and blood feeding, of transmitting the virus for the rest of its life. Infected female mosquitoes may also transmit the virus to their offspring by transovarial (via the eggs) transmission, but the role of this in sustaining transmission of the virus to humans has not yet been defined. Infected humans are the main carriers and multipliers of the virus, serving as a source of the virus for uninfected mosquitoes. The virus circulates in the blood of infected humans for two to seven days, at approximately the same time that they have a fever; Aedes mosquitoes may acquire the virus when they feed on an individual during this period. Some studies have shown that monkeys in some parts of the world play a similar role in transmission. Characteristics Dengue fever is a severe, flu-like illness that affects infants, young children and adults, but seldom causes death. The clinical features of dengue fever vary according to the age of the patient. Infants and young children may have a fever with rash. Older children and adults may have either a

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mild fever or the classical incapacitating disease with abrupt onset and high fever, severe headache, pain behind the eyes, muscle and joint pains, and rash. Dengue haemorrhagic fever (DHF) is a potentially deadly complication that is characterized by high fever, often with enlargement of the liver, and in severe cases circulatory failure. The illness often begins with a sudden rise in temperature accompanied by facial flush and other flu-like symptoms. The fever usually continues for two to seven days and can be as high as 41C, possibly with convulsions and other complications. In moderate DHF cases, all signs and symptoms abate after the fever subsides. In severe cases, the patient's condition may suddenly deteriorate after a few days of fever; the temperature drops, followed by signs of circulatory failure, and the patient may rapidly go into a critical state of shock and die within 12 to 24 hours, or quickly recover following appropriate medical treatment. Treatment There is no specific treatment for dengue fever. For DHF, medical care by physicians and nurses experienced with the effects and progression of the complicating haemorrhagic fever can frequently save lives - decreasing mortality rates from more than 20% to less than 1%. Maintenance of the patient's circulating fluid volume is the central feature of DHF care. Immunization There is no vaccine to protect against dengue. Although progress is underway, developing a vaccine against the disease - in either its mild or severe form - is challenging.

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Prevention and control At present, the only method of controlling or preventing dengue virus transmission is to combat the vector mosquitoes. In Asia and the Americas, Aedes aegypti breeds primarily in man-made containers like earthenware jars, metal drums and concrete cisterns used for domestic water storage, as well as discarded plastic food containers, used automobile tyres and other items that collect rainwater. In Africa the mosquito also breeds extensively in natural habitats such as tree holes, and leaves that gather to form "cups" and catch water.

Retrieved on September 2, 2011 from: http://www.tarakharper.com/v_dengue.htm 3. Signs and Symptoms Characterized by sudden onset of high fever, weakness and prostration, severe headaches, retro-orbital pain, joint and muscle pain (myalgia), nausea, vomiting, and rash. The fever rises rapidly to as high as 104 F, and may be accompanied by bradycardia. The petechiae rash appears 3-4 days after the onset of fever, and usually appears on the trunk first, before spreading peripherally. Symptoms usually persist for 7 days, hence one of the common names for the disease: seven-day fever. Symptoms of hemorrhagic dengue are initially indistinguishable from dengue fever, but progress to faintness, shock, and systemic bleeding (gastrointestinal hemorrhage, etc.). The mortality rate for hemorrhagic dengue is 5%. Dengue does not produce long-term complications.

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Dengue can be confused clinically with influenza, measles, malaria, Colorado tick fever, scarlet fever, typhus, yellow fever, and other hemorrhagic fevers.

Retrieved on Spetember 2, 2011 from: www.who.int/mediacentre/factsheets/fs117/en/ 14. Statistics The incidence of dengue has grown dramatically around the world in recent decades. Some 2.5 billion people two fifths of the world's population are now at risk from dengue. WHO currently estimates there may be 50 million dengue infections worldwide every year. In 2007 alone, there were more than 890 000 reported cases of dengue in the Americas, of which 26 000 cases were DHF. The disease is now endemic in more than 100 countries in Africa, the Americas, the Eastern Mediterranean, South-east Asia and the Western Pacific. South-east Asia and the Western Pacific are the most seriously affected. Before 1970 only nine countries had experienced DHF epidemics, a number that had increased more than four-fold by 1995. Not only is the number of cases increasing as the disease is spreading to new areas, but explosive outbreaks are occurring. In 2007, Venezuela reported over 80 000 cases, including more than 6 000 cases of DHF. Some other statistics:

During epidemics of dengue, infection rates among those who have not been previously exposed to the virus are often 40% to 50%, but can reach 80% to 90%.

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An estimated 500 000 people with DHF require hospitalization each year, a very large proportion of whom are children. About 2.5% of those affected die.

Without proper treatment, DHF fatality rates can exceed 20%. Wider access to medical care from health providers with knowledge about DHF - physicians and nurses who recognize its symptoms and know how to treat its effects - can

Retrieved: September 2, 2011 on: http://www.wisegeek.com/what-is-an-infection.htm INFECTION An infection is caused by the invasion of foreign cells, like bacteria in humans that cause harm to the host organism. Generally the host organism is considered colonized by cells that dont belong to it. These foreign cells must be harmful to the host organism in order for the colonization to be considered an infection. There are many instances of living creatures that benefit from colonization by other cells. Two discrete organisms can have a symbiotic relationship to each other, which harms neither organism. Alternately, a colony of cells (or parasites) might have no effect on the host organism, but might benefit the colony. Numerous agents can cause an infection. Not only bacteria, but also viruses, parasites, andfungi can create problems for a host organism. Sometimes these non-host cells actually work in conjunction to keep infection from occurring.

Retrieved on September 03, 2011 from: http://en.wikipedia.org/wiki/Hyperthermia HYPERTHERMIA

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Hyperthermia is an elevated body temperature due to failed thermoregulation. Hyperthermia occurs when the body produces or absorbs more heat than it can dissipate. When the elevated body temperatures are sufficiently high, hyperthermia is a medical emergency and requires immediate treatment to prevent disability or death. A fever occurs when the body sets the core temperature to a higher temperature, through the action of the pre-optic region of the anterior hypothalamus. For example, in response to a bacterial or viral infection, the body will raise its temperature, much like raising the temperature setting on a thermostat. In contrast, hyperthermia occurs when the body temperature rises without a change in the heat control centers. Hyperthermia is defined as a temperature greater than 37.538.3 C (100101 F), depending on the reference, that occurs without a change in the body's temperature setpoint. The normal human body temperature in a healthy adult can be as high as 37.7 C (99.9 F) in the late afternoon. Hyperthermia requires an elevation from the temperature that would otherwise be expected. Such elevations range from mild to extreme; body temperatures above 40 C (104 F) can be life-threatening

Retrieved on September 02, 2011 from: http://nursingcrib.com/nursing-careplan/ineffective-tissue-perfusion / INEFFECTIVE TISSUE PERFUSION

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Decrease in oxygen resulting in the failure to nourish the tissues at the capillary level. (Tissue perfusion problems can exist without decreased cardiac output; however, there may be a relationship between cardiac output and tissue perfusion) Related Factors

Interruption of Flow arterial, venous Exchange Problems Hypervolemia, hypovolemia Mechanical reduction of venous and/or arterial blood flow Decreased Hb concentration in blood Altered affinity of hemoglobin for O2; enzyme poisoning Impaired transport of the O2 across alveolar and/or capillary membrane Mismatch of ventilation with the blood flow Hypoventilation

SYNTHESIS From the different sources, various concepts regarding the variables of the study were described. These topics are all interrelated to create a subject wherein the researchers were able to explain the case of the patient, together with the causes, risk factors, complications, and medical treatment.

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In this study, we found out that Dengue Hemorrhagic Fever is a leading cause of serious illness among children in some Asian countries. It also shows that there is no specific treatment for dengue, but appropriate medical care frequently saves the lives of patients with the more serious dengue hemorrhagic fever. The only way to prevent dengue virus transmission is to combat the disease-carrying mosquitoes.

CHAPTER III CLIENT PRESENTATION This is a case of a patient M.R.S., a 36 year old male diagnosed with Dengue Hemorrhagic fever. M.R.S. is currently working as an employee in a company in Makati City; is married and has three children. He is a Roman Catholic who was born on August 21, 1974. He resides at Makati City with his family. His nationality is Filipino. Based on the medical records, Mr. M.R.S., was admitted last August 8, 2011 with a chief complaint of abdominal pain with vomiting. He was rushed to the hospital where he had episodes of vomiting. The patient was observed to have flushed skin, red sclera on both eyes, and body weakness. The patient has abdominal pain, has high grade fever and cough, has headache, and positive for vomiting. The admitting medical impression of the physician of Mr. M.R.S. was Dengue Fever.

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History of present Illness showed those 4 days prior to admission the client suffers from having a high grade fever with a temperature of 39.4 C, Paracetamol was given for relief. After 2 days the fever subsides and abdominal pain and vomiting took place which prompted his hospitalization. Upon admission the patient have experienced gum bleeding and have presence of petechiae over the face accompanied by fatigue and loss of appetite. During the interview session he has a fever and experiences no bleeding at all. His abdominal pain also ceases Past medical history revealed that he had chicken pox. No past hospitalizations. He completed his immunizations in BCG, OPV, Anti-Hepatitis, and Tetanus Toxoid. Laboratory Examinations that patient undergone were CBC, PTT, Activated Partial Thromboplastin Time, and Blood typing. Lab. Exams shows that patient has decreased WBC: 3.9 x 10 g/L (N.V. = 5-10 x 10 g/L), decreased Hemoglobin: 10.2 g/dL (N.V. = 13.0-18.0 g/dL), and decreased Hematocrit: 31% (N.V. = 39-54%). No allergies in food, medication, animals etc. were noted. Personal history revealed that he has an average self-esteem, has a close relationship within family members and values her belief system such as po, opo, and mano po. The patient can feed and do hygienic practices by himself but would sometimes need help. Mobility was limited, exercise was irregular, sleeps with difficulty and pattern of elimination is irregular. He eats three times a day and his diet specification is DAT. Social history showed that he can speak English, Tagalog, and Ilocano. He considers friends and relatives his significant others, has no participation or membership with any organization.

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Environmental history revealed they owned their house which has one comfort rooms, water supply is supplied by Manila Water Supply System (MWSS), has means of electricity, and has private and public means of transportation, and their garbage is collected weekly. Community resources include a church, mall, sports facilities, hospital, and schools.

CHAPTER IV ANALYSIS AND INTERPRETATION Risk for infection related to inadequate secondary defense: decreased HgB

An infection is caused by the invasion of foreign cells, like bacteria in humans that cause harm to the host organism. Generally the host organism is considered colonized by cells that dont belong to it. (http://www.wisegeek.com) Generally, infection is the process by which germs or viruses enter a susceptible site in the body and multiply, resulting in disease. In the case of Mr. M.R.S. The presence of Risk for infection was formulated. Our environment is full of microorganisms (microscopic organisms) referred to as microbes. Microbes include bacteria, fungi, protozoa, and viruses. The majority of microbes are nonpathogenic, meaning they do not cause disease under normal conditions.

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Microbes that are capable of causing disease (ie., pathogenic) are called pathogens. If a pathogen invades the body and the conditions are favorable for it to multiply and cause injurious effects or disease, the resulting condition is called an infection. In relation to the patient, lab results shows that the patient has decreased WBC, Hemoglobin and Hematocrit; CBC count: WBC: 3.9 x 10 g/L Hemoglobin: 10.2 g/dL Hematocrit: 31%. The patient also experienced vomiting, abdominal pain, fever, and headache. Physical assessment to the patient was done; Petechia, red sclera in both eyes was observed to the patient. Thus, the student nurses interventions were to monitor the vital signs such as the Blood pressure, Respiratory rate, Pulse rate, and Body temperature, intake and output, Observe for localized signs of infection in the body, Assess and document the skin condition of the patient. The goal was partially met

Fluid volume deficit related to less than body requirement Deficient fluid volume is a decreased intravascular, interstitial, and/or intracellular fluid. This refers to dehydration, water loss alone without change in sodium. (NANDA, Doenges) In the case of the patient lab results shows that the patient has decreased WBC, Hemoglobin and Hematocrit; CBC count: WBC: 3.9 x 10 g/L Hemoglobin: 10.2 g/dL Hematocrit: 31%. Vital signs were as follows; BP: 100/90 mmHg; Temp: 38.6 C; PR: 78; RR: 18. Output was 60-65/hour. Patient experienced fever with vomiting and abdominal pain, patient is also felt body malaise. The goal was to maintain the fluid volume in the body. The relevant interventions done to the patient were as follows: monitoring the vital signs such as the BP,

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temperature, RR, and PR and also pain scale if such pain occurs. Observed and measure the urinary output of the patient, reviewed the laboratory data, encouraged the patient to increase fluid intake. After performing the interventions, the patient did not manifest any signs and symptoms of fluid and electrolyte imbalance. The goal was fully met.

Hyperthermia related to present illness: Dengue hemorrhagic fever Hyperthermia is an elevated body temperature due to failed thermoregulation. Hyperthermia occurs when the body produces or absorbs more heat than it can dissipate. When the elevated body temperatures are sufficiently high, hyperthermia is a medical emergency and requires (www.wikipedia.org) Hyperthermia is defined as a temperature greater than 37.538.3 C (100101 F), depending on the reference, that occurs without a change in the body's temperature setpoint. The normal human body temperature in a healthy adult can be as high as 37.7 C (99.9 F) in the late afternoon. Hyperthermia requires an elevation from the temperature that would otherwise be expected. Such elevations range from mild to extreme; body temperatures above 40 C (104 F) can be life-threatening immediate treatment to prevent disability or death.

In relation to the patients case vitals were as follows; BP: 100/90 mmHg; Temp: 38.6 C; PR: 78; RR: 18. Lab results showed that there is a decrease in WBC. Hemoglobin and Hematocrit. The patient experienced fever with headache and chills.

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The patient also verbalized: miss kukuhain nyo nab a temperature ko? Nilalagnat ako kanina pa The goal was to maintain the core temperature within the normal range. Such interventions were done; Promoted surface cooling by means of undressing; cool environment and fans and tepid sponge baths, Assist with internal cooling methods to treat malignant

hyperthermia to promote rapid core cooling , Discuss importance of adequate fluid intake to prevent dehydration. After performing the interventions, the patient partially did not manifest any signs and symptoms of weakness, fatigue and poor muscle tone. The goal was partially met.

Ineffective tissue perfusion related to decreased. HbG concentration in the blood secondary to dengue hemorrhagic fever Decrease in oxygen resulting in the failure to nourish the tissues at the capillary level. (Tissue perfusion problems can exist without decreased cardiac output; however, there may be a relationship between cardiac output and tissue perfusion) In the case of the patient lab results shows that the patient has decreased WBC, Hemoglobin and Hematocrit; CBC count: WBC: 3.9 x 10 g/L Hemoglobin: 10.2 g/dL Hematocrit: 31%. Vital signs were as follows; BP: 100/90 mmHg; Temp: 38.6 C; PR: 78; RR: 18. Patient experienced body weakness and headache. Output is 60-65/hour. The goal is to improve the circulation. Such interventions were done; Monitored the Vital Signs, Assessed patients condition,Promoted quiet & restful atmosphere, Instructed to avoid tiring activities, Encourage use of relaxation techniques

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After performing the interventions, the patient partially did not manifest any signs and symptoms of weakness, fatigue and poor muscle tone. The goal was partially met.

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