Far Eastern University Institute of Nursing BSN402 Group 5b

Case Presentation
Dengue Hemorrhagic Fever (DHF) Stage II
Submitted to and For the viewing pleasure of: Mam. Raquel Sta. Ana RN. MAN.

Agito, Noel Balilia, Lorelyn C. Balmeo, Samara Jasmine S. Bangay, Regina D. Cruz, Don Darryl G.

Biographical Data
Name: M.A.P. Address: 44 Chicadee St, VV Country Homes Age: 12 years old Marital Status: Single Gender: Male Occupation: Student Religious Affiliation: Roman Catholic Room and Bed: Private Room: 203 Chief Complaint: Fever Provisional Diagnosis: Dengue hemorrhagic fever stage II Physician: Dr. Josephine Oleta

Nursing History
Past Health History
According to the mother of the client, he has no illness during his childhood years. Also added that he has completely immunized and in addition, he has his flu vaccine every year. The client has no known allergy and no known accidents happened. He has been hospitalized before due to vomiting and according to the mother, Ano ba yong tawag dun abdominal flu? The client was hospitalized in Metro Rizal Doctors Hospital and based from the diagnosis of the doctor, it was Acute Gastroentiritis.

Past Health History continued

In regards with foreign travels, the mother stated that they went to Hong Kong last April, 2012. They stayed there for about 5 days.

History of Present Illness

Three days prior to admission of the client, he has on-and-off fever with the range of 37.6 39o C and at the same time he also experienced chills. Also with headache, dizziness when standing and sitting for a long time, vomiting, cough with greenish phlegm and he also experienced night sweats. He also noticed that he has blushed skin and body malaise.

Family Health History

Family Health History

The client belongs to a family with six members and he is the youngest son. His parents have no known hereditary illness. At the same time, his grandfather on his father side died due to old age while his grandmother on his father side is still alive, however has been diagnosed for arthritis. His grandparents on his mother side are already dead due to old age.

Patterns of Functioning
Psychological Health
According to the client whenever he has problem, he just ignore it and he stated Wala akong pakialam He is close to his family especially to his mother but he also said Mahal ko naman si papa and at the same time he is also close to his friends and very happy every time he was with his friends. His mother said Minsan nga nung nasa bahay yong mga friends niya dumaan ako parang wala lang hindi niya ako pinapansin but his mother also said that sometimes his son will sleep with them. In addition, he has balance time with his family, friends and study.

Psychological Health
He is currently in grade six and studying at San Beda, Taytay. The mother said that his son has no difficulty in reading and writing and added Actually accelerated siya nung kinder siya In regards to his self- concept, his mother stated that whenever his son likes a hairstyle, his son will not have his haircut yet until the length of his hair is enough for the hairstyle that he wanted. With regards to his attitude and emotions, his mother said that Mahiyain yan, ayaw niya na pinag-uusapan siya

Psychological Health
and his mother also added that in regards to his feelings Hindi niya gaano maexpress, mahiyain sa nararamdaman mas naiexpress niya through letter and even added Nung minsan nga may touchy letter siya para sa akin ang sabi niya sa akin mamaya ko na daw basahin nahihiya daw siya

Psychological Health
Interpretation: Based from the data gathered, the client has slightly strong relationship with his family because there are times where he was unable to express his feelings and problem to his family verbally. At his age, he is not yet in to solving his own problem. He is very much particular of the things that people would say about him and pay particular attention to the hairstyle that he think would fit him. He most specifically spent most of his time with family, friends and study.

Psychological Health
Analysis: Psychological and cognitive changes as an individual enter into adolescent stage (12 to 18 years old). According to Erikson (1963), the psychological task of adolescent is the establishment of identity. Also Erikson says that adolescent help one another through this identity crisis by forming cliques and a separate youth culture. Adolescent usually concerned about their body, appearance and physical abilities.

Psychological Health
Adolescents who are accepted, loved, and valued by family and peers generally tend to gain confidence and feel good about themselves. Adolescents still need guidance from their parents. Peers assume a great importance because it provides sense of belongingness, pride, social learning and sexual roles. According to Piagets formal operation stage of cognitive development, adolescents become more informed about the world and environment and use the new

Psychological Health
information to solve everyday problems and can communicate with adults on most subjects. (Kozier & Erb. Fundamentals of Nursing, 8th edition, Volume 1. pp. 384386)

Activities of Daily Living

ADL
Nutrition

Before Hospitalization
According to the patient, he is not a picky eater, he eats whatever is served. His mother mentioned that the patient eats more on vegetables, fish and chicken and seldom eats pork and beef and that he usually eats 1 cup of rice per meal and usually drinks maximum of 8 glasses day. She also mentioned she that he only drinks soda once in while and verbalized hindi ko sila pinapayagan kumain lagi ng junkfoods, once a week lang, every Sunday lang

During Hospitalization
According to the mother of the patient During the hospitalization, He ate 3 slices of bread, I banana, peeled grapes, lychees, chicken, yakult, milk and 1 serving of fish and vegetables. 1 cup of rice per meal. She also mentioned that the patient 200 ml

Interpretation and Analysis

Interpretation: Analysis:

Activities of Daily Living

Elimination According to the Urinate 7 times and Interpretation: patient he usually has not defecated Analysis: urinates 4 times a day, yet he described it as clear and light yellow in color, HE defecates once a day without any difficulty or discomfort. The mother of the patient verbalized, pawisin siya, nakaka 4 na palit ng damit sa isang araw

Activities of Daily Living

Exercise Based on the Only laying and interview, the patient sitting on bed. considers, his P.E class (once a week) as his exercise and during weekends he plays basket ball for 12 hours, the patients mother verbalized hinihingal na siya pag matagal naglaro Interpretation: Analysis:

Activities of Daily Living

Hygiene According the patient, he takes a bath and brushes his teeth twice a day. Cuts his nails once a week and gets a hair cut once a month. According to his Interpretation: mother, he only Analysis: gets regular sponge bath before changing clothes and before bed time

Activities of Daily Living

Substance Use According to the patient, he takes Vitamin C every day which is Poten- cee Interpretation: Analysis:

Activities of Daily Living

Sleep and Rest According to the patient, he usually sleeps at 9:00 pm during weekdays and wakes up at 4:00 am. He also mentioned that he does not have any difficulty in sleeping. However, he verbalized tinatamad ako pag gigising ng maaga However, he thinks that he still gets enough sleep and rest Sleeps more than 8 Interpretation: hours per day, Analysis: takes nap during the afternoon.

Physical Assessment
General Survey Normal Findings Actual Findings Impression

Posture/ Gait

Posture is erect and comfortable for age; Gait is rhythmic and coordinated with arms swinging at side.

Skin color

Color is even without obvious lesions: light to dark beige-pink in light-skinned client; light tan to dark brown or olive in dark-skinned clients.

Physical Assessment
Personal Hygiene The client is clean and groomed appropriately for occasion. Stains on hands and dirty nails may reflect certain occupations such as gardener or mechanic.

Nutritional Status Age appropriateness

Well nourished Client appears to be his stated chronological age.

Physical Assessment
Verbal behavior Speech is clear, moderately paced, and culturally appropriate.

Non-verbal behavior

Client is alert and oriented to what is happening at the time of the interview and physical assessment. Client responds to questions and interacts appropriately.

Physical Assessment
Vital Signs
Temperature Below 380C

Pulse Rate

60-100beats/min

Respiratory Rate 12-20cpm

Blood Pressure

Systolic: <120mmHg Diastolic: <80mmHg

Physical Assessment
Body Parts Normal Findings Actual Findings Impression

Course in the Ward

Laboratory Results
Date Procedure Norms Color: Straw to amber Transparency: Clear Odor: No to low Specific Gravity: 1.015 pH: 6.0-6.4 Reaction: Acidic Leukocytes: Negative Nitrite: Negative Protein: Negative Glucose: Negative Ketones: Negative Urobilinogen: Negative Bilirubin: Negative Blood: Negative Hemoglobin: Negative Result Interpretation and Analysis

Urinalysis

Laboratory Results
Hematology RBC count:
Male: 4.2-5.4 x 106 /l Female: 3.6-5.0 x 106 /l Hematocrit: Male: 40%-50% Female: 37%-47% Hemoglobin: Male:14.0-16.5 g/dL Female: 12.0-15.0 g/dL Reticulocyte count: 1.0%-1.5% total RBC WBC Count: 4.4-11.3 x 103/ l Basophils: 0%-2% Eosinophils: 0%-3% Lymphocytes: 24%- 40% Monocytes: 4%-9% Neutrophils(Segmenters) 47%-63% Neutrophil (Bands): 0%-

Medications
Drug Dose Route Indicatio Contraindicati Action ns ons Oral Used for the relief of fever, headaches, and other pains regarding surgical wound Contraindicated with allergy to acetaminophenon any component. Use cautiously with impaired hepatic function, chronic alcoholism, and pregnancy lactation Reduces fever by acting on the hypothal amus to cause vasodila tion and sweating . Adverse Reaction Chest pain Dyspnea Rash Head ache Hepatic toxicity and failure Acute renal failure, renal tubular necrosis fever

Generic Name: 500 mg, Paracetamol tab , Brand name: RTC, Q4 Biogesic Classification: Analgesic and Antipyretic

Medications
Nursing Consideration

Assessment History: allergy to acetaminophen, impaired hepatic function, chronic alcoholism, pregnancy, lactation Physical: Skin color, lesions, T; liver evaluation, CBC, LFTs, renal fxn test Interventions: Do not exceed the recommended dosage Reduce dosage with hepatic impairment Avoid using multiple preparation containing acetaminophen. Carefully check all OTC products. Give drug with food if GI upset occurs Discontinue drug if hypersensitivity reactions occur Treatment of overdose: Monitor serum levels regularity, N-acetylcysteine should be available as a specific antidote, basic life support measures may be necessary.

Medications
D5LR Class: Hypertonic solution 1 Liter IV Rehydrates Electrolyte and caloric replenisher Renal failure Liver dysfunction Diabetes Mellitus Lactic acidosis Alkalosis Hyperkalemia Homeosta sis through osmosis wherein homeosta sis is the maintena nce of bodys normal fluid volume and compositi on which increases intracellul ar fluid

Medications
Nursing Consideration 1. Never stop hypertonic solutions abruptly. 2. Dont give concentrated solutions I.M. or subcutaneously. 3. Monitor glucose level carefully. 4. Check vital signs frequently. Report adverse reactions. 5. Monitor fluid intake and output and weight carefully. Watch closely for signs and symptoms of fluid overload. 6. Monitor patient for signs of mental confusion

Medications
Generic name: cefuroxime

Brand name:
Zinacef Classification: Therapeutic: anti-infectives;

500 mg, IV 1 tab, TID

Pharmacologic: second-generation cephalosporins

Treatment of the following infections caused by susceptible organis ms: Respiratory tract infections, Skin and skin structure infections, Bone and joint infections (not cefaclor or cefprozil), Urinary tract infections (not cefprozil). Cefotetan and cefoxitin: Intraabdominal and gynecologic infections. Cefuroxime: Meningiti s, gynecologic infections, and Lyme disease. Cefaclor, cefprozil, cefuroxime: Otitismedia. Cefoxitin and cefuroxime: Septicemia. Cefotetan, cefoxitin, cefuroxime: Perioperative prophylaxis.

Hypersensitivity to cephalosporins; Serious hypersensitivity to penicillins. Use Cautiously in: Renal impairment ( decrease dose/ increase dosing interval recommended for: cefotetan if CCr 30 ml/min, cefoxitin if CCr 50 ml/min, cefprozil if CCr <30 ml/min, cefuroxime if CCr 20 ml/min);

Bind to bacterial cell wall e, ll death.

CNS: SEIZURES (high doses). GI: PSEUDOMEMBRANO cramps, nausea, rashes, urticaria.

membran US COLITIS, diarrhea, causing ce vomiting. Derm: Therapeut Hemat: ic Effects: agranulocytosis,

Cefotetan and cefoxitin: Patients with

hepatic dysfunction, poor nutritional state, or cancer may be at increase risk for bleeding; History of GI disease, especially colitis; Cefprozil (oral suspension) contains as partame and should be avoided in

Bactericid bleeding ( with

bactericid cefotetan and al action sceptible bacteria. cefoxitin), eosinophilia neutropenia, thromboc ytopenia. Local: pain at IM site, against su , hemolytic anemia,

patients with phenylketonuria;

Geri: Dosage adjustment due to agerelated decrease in renal function may be necessary; may also be at increase risk for bleeding with cefotetan or cefoxitin; OB: Pregnancy and lactation (have been used safely).

phlebitis AT IV SITE.
Misc: allergic reactions including ANAPHYLA XIS and SERUM SICKNESS, superinfection.

Medications

Medications