Patients name: Michael Ortiz Address: 390 capulong St.

tondo, Manila Age: 16 years old Date of admission: May 7, 2012 BRANDNAME: Biogesic GENERIC NAME :Paracetamol DATE OF ORDER:O5-14-12 CLASSIFICATION: analgesic DOSAGE & FREQUENCY: 325-650 mg(adult) 650 po(children) MECHANISM OF ACTION: Produces analgesia by blocking generation of pain impulses. This action is probably caused by inhibition of prostaglandin synthesis; it may also be caused by inhibition of the synthesis or action of other substances those sensitive pain receptors to mechanical or chemical stimulation. It relives fever by central action in the hypothalamic heat-regulating center. INDICATION: Treat mild pain and fever CONTRAINDICATION: Contraindicated the patient with hypersensitivity. ADVERSE REACTIONS: Hematologic:hemolytic anemia,neutropenia Hepatic:jaundice

chief complain: fever on & off x4days diagnosis: Dengue hemorrhagic fever pavilion: 7 Student nurse: Katrina C. Agoc NURSING CONSIDERATIONS: Use liquid form for children and patient who have difficulty swallowing. In children, dont exceed five doses in 24 hours Once the desired clinical effect is achieved using repulse, consider tapering to the lowest effective dose For those not responding adequately when using the repulse consider giving them to total daily dose as a divided dose if a once-daily dosing schedule was followed

Patients name: Melanie Mangaleno Address: San Jose, Antipolo City Age: 43 Years old Date of admission: May 13, 2012

chief complain: swelling left arm diagnosis: cillulitis pavilion; 2 student nurse: Katrina C. Agoc

NURSING CARE PLAN

ASSESSMENT Subjective: may sugat ang kaliwang kamay koas verbalized by the patient.

DIAGNOSIS Impaired skin integrity related to altered clotting factor as manifested by swelling left arm.

PLANNING After 3 hrs of nursing interventions, the client will be able to demonstrate behaviors that reduce the skin integrity.

Objective: (+) chills (+)swelling left arm (+)erythema (+)slight numbness (+)tenderness (+)Pus exudates @ affected arms V/S Taken: BP-110/70 mmHg PR-98 bpm RR-11cpm T-37 C

INTERVENTION DEPENDENT: Advice importance of good hygiene Emphasize importance of adequate nutrition and fluid intake Advice to e elevate the affected arm INDEPENDENT: Assess skin noted color, turgor and sensation. Provide and applied wound dressings carefully COLLABORATIVE: Administer medication per doctors order Follow up salmonella ELA,done

EVALUATION After 3 hrs nursing interventions the client was able to demonstrate behaviors that reduce the skin integrity.

Patients name: Melanie Mangaleno Address: San Jose, Antipolo City Age: 43 years old Date of admission: May 13, 2012

chief complain: swelling left arm diagnosis: cillulitis pavilion:2 student nurse: Katrina C. Agoc

DRUG STUDY

BRAND NAME: Acetaminophen GENERIC NAME: paracetamol DATE OF ORDER: 05-16-12/2:00 PM CLASSIFICATION: Non narcotic Analgesics & antipyretics DOSAGE & FREQUENCY: 11 to 10 years old: 480 mg/dose 9 to 10 years old :480 mg/dose 6 to 8 years old: 320mg/dose 4 to 5 years old: 240mg/dose 2 to 3 years old: 160mg/dose 12 to 23 months:120mg/dose 4 to 11 months: 80mg/dose Up to 3 months: 40mg/dose

MECHANISM OF ACTION; Produces analgesia by blocking generation of pain impulses. This action is probably caused by inhibition of prostaglandin synthesis; it may also be caused by inhibition of the synthesis or action of other substances those sensitive pain receptors to mechanical or chemical stimulation. It relives fever by central action in the hypothalamic heat-regulating center. INDICATION: Mild pain or fever adults and children over 11 years:225 to 650 mg P.O or rectally q4 hours; or 1g P.O, qid,prn. CONTRAINDICATION: Maximum dosage should not exceed 4g daily. Dosage for long term therapy should not exceed 2.6 daily. ADVERSE REACTIONS: Hepatic: severe liver damage with toxic dose Skin:rash,urticaria

NURSING CONSIDERATIONS: Repeated use is contraindicated in anemia or renal or hepatic disease Has no significant anti inflammatory effect Warm patient that high doses or unsupervised chronic use can cause hepatic damage Excessive ingestion of alcoholic beverages may increase the risk of hepatotoxity Recommend the liquid form of children and for all patients who have difficulty swallowing

Patients name: Michael Ortiz Address: 390 capulong st.tondo manila Age: 16 years old Date of admission: may 7 2012 NURSING CARE PLAN ASSESSMENT Subjective: mainit ang pakiramdam koas verbalized by the patient. DIAGNOSIS Hyperthermia related to dehydration as manifested by flushed skin warm to touch. PLANNING After 3 hours of nursing interventions. The patient will maintain core temperature within normal range

chief complain: fever & off (4days) diagnosis: Dengue Hemorrhagic Fever pavilion:7 student nurse: Katrina C. Agoc

Objective: Flushed skin, warm to touch. Body weakness noted Restlessness noted V/S taken: Bp-120/80mmHg PR-72bpm RR-19cpm T-38.2 C

INTERVENTION Dependent: Emphasized importance of adequate fluid intake. Advice to position the patient comfort Independent: Monitor heart rate and rhythm Record all sources of fluid loss such as urine, vomiting and diarrhea Promote surface cooling by means of tepid sponge bath.

EVALUATION After 3 hrs of nursing interventions, the patient was able maintain core temperature within normal range.

Collaborative: Administer antipyretics orally as prescribed by the physician

Patients name: Michael Ortiz Address: 390 capulong St.tondo, Manila Age: 16 years old Date of admission: May 7, 2012 DRUG STUDY BRAND NAME: chloramycetin,novochlorocap GENERIC NAME: chlorampenicol DATE OF ADMISSION: 05-15-12/3PM CLASSIFICATION: Antimicrobial

chief complain: fever on & off x4days diagnosis: Dengue hemorrhagic fever pavilion: 7 Student nurse: Katrina C. Agoc

MECHANISM OF ACTION: Inhibits protein binding to the 50S subunit of the ribosome INDICATION: Hemophilus influenza meningitis, acute salmonella typi infection and meningitis bacteramia or others severe infections caused by sensitive salmonella species, rickettsia lymphogranuloma, psittacosis or various sensitive gram-negative organisms.

NURSING RESPONSIBILITIES: Use cautiously in impaired hepatic or renal function and with other drugs causing bone marrow depression or blood disorders. Obtain specimen for culture and sensitivity test before dose. Therapy may begin pending test results Tell patient to take medications for as long as prescribed. Exactly as directed ,even after he feels better

Patients name: Melanie Mangaleno Address: San Jose, Antipolo City Age: 43 Years old Date of admission: May 13, 2012

chief complain: swelling left arm diagnosis: cillulitis pavilion; 2 student nurse: Katrina C. Agoc

NURSE PATIENT INTERACTION

STUDENT NURSE Magandang hapon po mam Kamusta po pakiramdam niyo mam? Ano pong nanyari sa kamay niyo mam? Mga ilang arw na po kayo dito mam? Importante po na linisan po yon gilid ng iyong sugat at uminom kayo ng maraming tubig at kumain ng sapat na nutrisyon,. Wala pong anuman mam balik nalang po kami maya

PATIENT
Magandang hapon din Medyo masakit pa yon sugat sa kaliwang kamay ko Nasuagat ng kahoy 4 na araw Salamat Oh sige.

First, I greet. Second, I asked her what she feels and her condition, and lastly before I go ,I integrated some health teachings like importance of good hygiene and importance of adequate nutrition and fluid intake .

Patients name: Michael Ortiz Address: 390 capulong St.tondo, Manila Age: 16 years old Date of admission: May 7, 2012

chief complain: fever on & off x4days diagnosis: Dengue hemorrhagic fever pavilion: 7 Student nurse: Katrina C. Agoc

NURSE PATIENT INTERACTION STUDENT

NURSE

PATIENT
Good afternoon Mainit ang pakiramdam ko,nilalagnat ako Mga apat na araw na po May dengue ako Maraming salamat

Good afternoon sir,Im katrina,UCU student from pangasinan Musta po pakiramdam niyo sir? Ilang araw na po kayong nilalagnat sir? Ano po dahilan at nandito po kayo ngayon sa hospital? Importante sir ang pag inom ng maraming tubig,iwasan niyo pong kumain ng mga dark colored na pagkain tulad ng chocolate,importante din pong kumain ng masusustansyan pagkain.panatilihin din maghugas ng kamay. Wala pong anumang balik nalang po kami maya

sige

May 7, 2012, I assigned one of the patients Mr. Michael Ortiz. I introduce myself to him, I discovered that patient is diagnosed having dengue., before I go, I integrated some health teaching like importance of adequate fluid intake, avoid eating dark colored food, importance of eating nutritious food and importance of hand washing.

Diagnosis
Both chickenpox (varicella) and shingles (zoster) can usually be diagnosed by symptoms alone. If a diagnosis is still unclear after a physical examination, diagnostic tests may be required. RULING OUT OTHER DISORDERS Either variation of the virus may be confused with other disorders. Ruling out Disorders that Resemble Chickenpox. Chickenpox, particularly in early stages, may be confused with herpes simplex (the disorder more commonly referred to as "herpes"), or impetigo, insect bites, and scabies. Ruling out Disorders that Resemble Shingles. The early prodrome stage of shingles can cause severe pain on one side of the lower back, chest, or abdomen before the rash appears. It therefore may be mistaken for disorders, such as gallstones, that cause acute pain in internal organs. In the active rash stage, shingles may be confused with herpes simplex, particularly in young adults, if the blisters occur on the buttocks or around the mouth. Herpes simplex, however, does not usually generate chronic pain. A diagnosis may be difficult if herpes zoster takes a non-typical course in the face, such as with Bell's palsy or Ramsay Hunt syndrome, or if it affects the eye or causes fever and delirium. TEST TO IDENTIFY THE VIRUS In most cases of chickenpox and shingles, the symptoms alone are enough for a health care provider to make a diagnosis. If the symptoms are not straightforward in some patients, such as those who are immunosuppressed, the doctor performs one or more additional tests to detect the virus itself. The tests usually aim to distinguish between varicella-zoster and herpes simplex viruses. Virus Culture. A viral culture uses specimens taken from the blister, fluid in the blister, or sometimes spinal fluid. They are sent to a laboratory, where it takes 1 - 14 days to detect the virus in the preparation made from the specimen. It is also sometimes used in vaccinated patients to determine if a varicella-like infection is caused by a natural virus or by the vaccine. This test is useful, but it is sometimes difficult to recover the virus from the samples. Immunofluorescence Assay. Immunofluorescence is a diagnostic technique used to identify antibodies to a specific virus. In the case of herpes zoster, the technique uses ultraviolet rays applied to a preparation composed of cells taken from the zoster blisters. The specific characteristics of the light as seen through a microscope will identify the presence of the antibodies. This test is less expensive than a culture, more accurate, and results are faster. Polymerase Chain Reaction (PCR). Polymerase chain reaction (PCR) techniques use a piece of the DNA of the virus, which is then replicated millions of times until the virus is detectable. This technique is expensive but is useful for unusual cases, such as identifying infection in the central nervous system.

Related tests: Epstein Barr Virus (EBV); Antibody tests; Cytomegalovirus (CMV)
There are several methods of testing for VZV:

Antibody testing When you are exposed to VZV, your immune system responds by producing antibodies to the virus. Two types of VZV antibodies may be found in the blood: IgM and IgG. IgM antibodies are the first to be produced by the body in response to a VZV infection. They are present in most individuals within a week or two after the initial exposure. IgM antibody production rises for a short time period and declines. Eventually, the level (titer) of VZV IgM antibody usually falls below detectable levels. Additional IgM may be produced when latent VZV is reactivated. IgG antibodies are produced by the body several weeks after the initial VZV infection to provide long-term protection. Levels of IgG rise during the active infection, then stabilize as the VZV infection resolves and the virus becomes inactive. Once a person has been exposed to VZV, they will have some measurable amount of VZV IgG antibody in their blood for the rest of their life. VZV IgG antibody testing can be used, along with IgM testing, to help confirm the presence of a recent or previous VZV infection. Viral detection Viral detection involves finding VZV in a blood, fluid, or tissue sample. This can be done either by culturing the virus or by detecting the viruss genetic material (VZV DNA).

VZV culturea sample of fluid is collected from a vesicle (the most common sample). It is incubated in a culture of live cells and nutrients to grow and isolate the virus. This test is sensitive and specific, but it takes 2 or more days to complete. Fresh lesions are the best for this test. Viral shedding decreases over time and can lead to a false negativeresult. VZV DNA testingperformed to detect VZV genetic material in a patient sample. This method is sensitive. It can identify and quantitate the virus. Direct Fluorescent Antibody (DFA) this test visualizes the presence of VZV in the cells taken from the patients skin lesion using a special microscope and labeled antibody. It is rapid, but less specific and sensitive than the VZV culture and DNA testing.

The choice of tests and samples collected depends on the patient, their symptoms, and on the doctors clinical findings.

When is it ordered?
VZV antibody tests may be ordered to check immune status and/or to identify a recent infection. VZV culture or DNA tests may be ordered when a newborn or immune-compromised person has been exposed to VZV and is ill with atypical and/or severe symptoms to detect an active primary VZV infection in the baby or a primary or reactivated infection in the immune-compromised person.

What does the test result mean?

Care must be taken when interpreting the results of VZV testing. The doctor evaluates the results in conjunction with clinical findings. It can sometimes be difficult to distinguish between a latent and active VZV infection. This is possible for several reasons, including:

A healthy person who has been infected with VZV will continue to harbor the virus after the symptoms disappear. The VZV can reactivate intermittently, often sub-clinically, shedding small amounts of virus into body fluids but not causing symptoms. An infant or immune-compromised person may not have a strong antibody response to the VZV infection their IgMand IgG levels may be lower than expected even though they have an active case of VZV. The virus may not be present in sufficient number in the particular fluid or tissue tested to be detected.

Antibody detection If both VZV IgG and IgM are present in a symptomatic person, then it is likely that she has either recently been exposed to VZV for the first time and has chickenpox or that the previous VZV infection has been reactivated and she has shingles. If only IgM is present, then the infection may have been very recent. If a newborn has IgM antibodies, then he has acongenital VZV infection. If a person is symptomatic but has low or undetectable levels of IgG and/or IgM, it may mean that he either has a condition other than VZV or that his immune system is not responding normally not producing a detectable level of VZV antibody.

Viral detection If someone is symptomatic and the culture is positive for varicella zoster virus, then the person likely has an active VZV infection. If the culture is negative, then the persons symptoms may be due to another cause or the VZV virus is not detectable in the sample tested. If a test for VZV DNA is positive, then VZV is present. High levels of viral DNA tend to indicate an active infection. Low levels indicate a VZV infection but may not indicate a symptomatic condition. Negative results do not rule out VZV infection the virus may be present in very low numbers or may not be present in the body sample tested.

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Patients name: Melanie Mangaleno Address: San Jose, Antipolo City Age: 43 years old Date of admission: May 13, 2012

chief complain: swelling left arm diagnosis: cillulitis pavilion:2 student nurse: Katrina C. Agoc