Dengue Hemorrhagic Fever- Case Study

Page | 1
I. INTRODUCTION
A. OVERVIEW
Dengue is a mosquito-borne disease cause by any one of four closely related
dengue viruses (DENV -1,-2,-3 and -4). Infection with one serotype of DENV provides
immunity to that serotype for life, but provides no long-term immunity to other
serotypes. Thus, a person can be infected as many as four times, once with each
serotype.
Dengue Hemorrhagic Fever, also known as Severe Dengue, was first recognized
in the 1950s during dengue epidemics in the Philippines and Thailand. Today, severe
dengue affects most Asian and Latin American countries and has become a leading
cause of hospitalization and death among children in these regions. Typical cases of
DHF are characterized by four major clinical manifestations: high fever, hemorrhagic
phenomena, and often, hepatomegaly and circulatory failure.
Infected humans are the main carriers and multipliers of the virus, serving as as
source of the virus for uninfected mosquitoes. Patients who are already infected with the
dengue virus can transmit the infection (4-5 days, maximum 12) via Aedes mosquitoes
after their first symptoms appear.
Reference: World Health Organization (WHO) 2011. Retrieved from: http://who.int.com

Page | 2
Mode of Transmission
1. Bite of an infected mosquito, principally the Aedes Aegypti.
a. Aedes aegypti is a day-biting mosquito (they appear two hours after sunrise
and two hours before sunset).
b. It breeds in an areas of stagnant water.
c. It has limited, low flying movement.
d. It has fine whole dots at the base of the wings and white bands on the legs.
2. Aedes Albopictus may contribute to the transmission of the dengue virus in rural
areas.
3. Other contributory mosquitoes:
a. Aedes polynensis
b. Aedes scutellaris simplex
Incubation Period
The incubation period is 3-14 days; commonly 7-10 days.
Period of Communicability
1. Patients are usually infective to the mosquito from a day before the febrile period
to the end of it.
2. The mosquito becomes infective from day 8 to 12 after the blood meal and
remains infective throughout its life.
Sources of Infection
1. Infected persons- the virus is present in the blood of patients during the acute
phase of the disease and will become a reservoir of the virus, sucked by
mosquitoes, which may then transmit the disease.
2. Standing water- any stagnant water in the household and its premises are usual
breeding places of these mosquitoes.

Page | 3
Dengue Hemorrhagic Fever (DHF)
This severe form of dengue virus infection id manifested by fever, hemorrhagic,
diathesis, hepatomegaly and hypovolemic shock.
Classification According to Severity
Grade 1
There is fever accompanied with non-specific constitutional symptoms and the
only hemorrhagic manifestations is positive (+) in the tourniquet test.
Grade 2
All signs of Grade 1, plus spontaneous bleeding from the nose, gums,, and GIT,
are present.
Grade 3
There is the presence of circulatory failure, as manifested by a weak pulse, narrow
pulse pressure, hypotension, cold, clammy skin, and restlessness.
Grade 4
There is profound shock, and undetectable blood pressure and pulse.

Page | 4
Complications
1. Dengue Fever
a. Epistaxis; menorrhagia
b. Gastrointestinal bleeding
c. Concomitant gastrointestinal disorder (peptic ulcer)
2. DHF
a. Metabolic acidosis
b. Hyperkalemia
c. Tissue anoxia
d. Hemorrhage into the CNS or adrenal glands
e. Uterine bleeding may occur
f. Myocarditis
3. Severe manifestations
Dengue encephalopathy is manifested by increasing restlessness, apprehension or
anxiety, disturbed sensorium, convulsions, spacity, and hyporeflexia.
Reference: Handbookof CommonCommunicable andInfectious Disease, 3rd
edition;Dionesia Mondejar-NavalesRN. Maed, p.71-73
Vaccine
Dengvaxia, world’s first dengue vaccine was approved in Mexico. The Federal
Commission for the Protection against Sanitary Risks (COFEPRIS) has approved
Dengvaxia®, tetravalent dengue vaccine, for the prevention of disease caused by all four
dengue virus serotypes in preadolescents, adolescents and adults, 9 to 45 years of age
living in endemic areas.

Page | 5
It took the multinational pharmaceutical company Sanofi Pasteur more than 20
years to develop the vaccine with clinical trials in five Asian and five Latin American
countries where dengue is endemic.
The vaccine was launched in the Philippines since it was the only country where
all three phases of the clinical development were conducted.
Health authorities said the vaccine will have side effects, including fever,
headache, muscle pain, weakness, redness and swelling.
The DOH also said that the medical breakthrough is no excuse to stop the fight
against dengue. Communities should work towards prevention by cleaning possible
mosquito breeding sites.
Health Secretary Janette Garin said the agency would get a discounted price for
the vaccine that would be used in the vaccination program starting March.
The DOH will begin vaccinating Grade 4 students in public schools in Metro
Manila, and in Southern and Central Luzon. The vaccine will be given in three doses,
with six-month intervals.
It will give the vaccine to over a million students this year but the health
department is planning to hold a nationwide vaccination on 2017.
Reference: http://www.sanofipasteur.com/en/articles/dengvaxia-world-s-first-dengue-vaccine-approved-in-mexico.aspx; Lyon,France
- December 9, 2015
B. STATISTICS
Local
The number of dengue cases in the country spiked from around 120,000 in 2014
to over 200,000 in 2015.
Despite the sharp increase in dengue cases, the Department of Health (DOH) said
there was no corresponding increase in the number of deaths--with 598 in 2015 compared
to 465 in 2014.
The DOH estimated that some 220 Filipinos a day may be infected by the disease.

Page | 6
Reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222740/ Lulu Bravo ,* Vito G. Roque, Jeremy Brett, Ruby
Dizon, and Maïna L'Azou, 2014 Nov 6
International
The incidence of dengue has grown dramatically around the world in recent
decades. The actual numbers of dengue cases are underreported and many cases are
misclassified. One recent estimate indicates 390 million dengue infections per year (95%
credible interval 284–528 million), of which 96 million (67–136 million) manifest
clinically (with any severity of disease). Another study, of the prevalence of dengue,
estimates that 3900 million people, in 128 countries, are at risk of infection with dengue
viruses.
Member States in 3 WHO regions regularly report the annual number of cases. In
2010, nearly 2.4 million cases were reported. Although the full global burden of the
disease is uncertain, the initiation of activities to record all dengue cases partly explains
the sharp increase in the number of cases reported in recent years.
Other features of the disease include its epidemiological patterns, including
hyper-endemicity of multiple dengue virus serotypes in many countries and the alarming
impact on both human health and the global and national economies.

Page | 7
Cases across the Americas, South-East Asia and Western Pacific exceeded 1.2
million in 2008 and over 3 million in 2013 (based on official data submitted by Member
States). Recently the number of reported cases has continued to increase. In 2013, 2.35
million cases of dengue were reported in the Americas alone, of which 37 687 cases
were of severe dengue.
Reference: http://www.who.int/mediacentre/factsheets/fs117/en/ May, 2015
C. SCOPE AND LIMITATION
We handled our patient last January 30, 2016 on our 6am to 2pm shift, bed #15,
Female-Ward at Laguna Medical Center under the supervision of Gloria Ramos,
Ph.D,MAN, RN.
We received the patient lying on bed with IVF Sodium Chloride 0.9 1 L on right
metacarpal vein. The exposure of our duty comprised Nurse-Patient-Interaction, Head-
to-Toe Assessment, IV regulation, vital signs monitoring and recording, drug
administration via oral route, IV drug medication study and charting.
To have further assessment, our group conducted a home visit on February 25,
2015 in the residence of Patient DLB in Lumban, Laguna. First and foremost, we asked
consent and stated the purpose of the home visit. As we gathered data and information
about the patient and his progress, the patient as well as the family members participated
and cooperated hospitably.
D. OBJECTIVES
General Objective:
At the end of the case study, the Level III nursing students will be able to
expound and incorporate all the ideas and knowledge gained to the nursing approach in
providing valid and outmost care connected with the patient diagnosed of Dengue
Hemorrhagic Fever.

Page | 8
Specific Objectives:
As supported by our main objective, the level 3 student nurses will be able to:
1. Familiarize with the background of what Dengue Hemorrhagic Fever is all about;
2. Recognize predisposing and precipitating factors that may increase the development
of Dengue Hemorrhagic Fever;
3. Review and understand the Anatomy and Physiology of the Circulatory system and
Lymphatic system.
4. Explain and illustrate the pathophysiology of Dengue Hemorrhagic Fever;
5. Determine what specific laboratory results that may lead to Dengue Hemorrhagic
Fever;
6. Describe the potential complications related to Dengue Hemorrhagic Fever;
7. Develop a comprehensive nursing care plan, with a principle of SMART, that is
applicable to the client diagnosed with Dengue Hemorrhagic Fever;
8. Provide a well-develop Health Teaching using the METHODS formula to
promote positive continuity of care to the patient after discharge which would be in great
help for his continuity of care to the patient after discharge which would be in
great help for his condition.

Page | 9
II. PATIENT’S PROFILE
Hospital Number: 137170
Patient’s Name: Patient DLB
Address: Segundo Pulo, Lumban, Laguna
Gender: Male
Birthday: 11/22/2001
Age: 14 y/o
Birthplace: Lumban, Laguna
Nationality: Filipino
Civil Status: Single
Religion: Roman Catholic
Educational Level: Grade 8
Allergies: (+) Penicillin
Admitting Time: 6:30am
Admitting Date: 01/29/16
Admitting Diagnosis: Severe Dengue
Admitting Physician: Dra. Abadier
Chief Complaint: Epistaxis, headache, nausea and vomiting
and body malaise

Page | 10
III. PATIENT’S HISTORY
A. Past History
According to Patient DLB, he had experienced cough, cold, fever and
chicken pox before. He has no history of hospitalization but seeks medical
advice to clinics in their barangay and other clinic to the near towns.
B. Present History
 5 days prior to admission, the patient experienced on and off fever. The
patient drinks tawa-tawa extract and antipyretic medications like biogesic and
tempra to relieve fever.
 After a day, when the patient is still with fever, the patient decided to seek
medical attention in a small Clinic in Unson. They checked the platelet count
which is 187 X10/L and blood pressure of 100/80mmHg. Then he was given a
prescribed medication of Biogesic 500mg for his fever.
 Two days prior to hospitalization, the patient is still with fever. He consults to
his paediatrician, Dra. Aquino and checked again for the platelet count that
has a result of 24 x10/L so he was advised to go to the hospital.
 One day prior to admission, the patient was experiencing fever, loss of
appetite and epistaxis so the family decided to take him to Laguna Medical
Center, Sta. Cruz, Laguna.
 January 29, 2016, at 6:30am he was admitted with a diagnosis of Severe
Dengue by attending physician Dra. Abadier with a blood pressure of
100/78mmHg.
Patient’s vital signs during our shift whereas follows:
Temperature: 38.2 °c
Pulse Rate: 98 bpm
Respiratory Rate: 20 cpm
Blood Pressure: 100/60 mmHg

Page | 11
C. Psychological
Patient is unable to answer some of the questions properly because he
cannot recall what happened during hospitalization. Nevertheless, the patient
demonstrates an understanding and acceptance concerning on the health teaching
about the health condition he experienced.
D. Family History
There is no history of dengue cases within patient's family members except
with his two cousins who lived in the same Barangay.
E. Spiritual
Patient DLB’s religious affiliation is Roman Catholic. He stated that their
family do not usually go to church but always pray and ask guidance for them.
F. Sociocultural
The patient consults to hilot as one of their health care provider. Prior to
admission, patient DLB sipped tawa-tawa extract and had self-medication of advil,
biogesic, and tempra as a relieved for fever. He also consults in health care clinic
in their town.
G. Exercise
Patient is usually staying in their bedroom after school and during weekends.
But at times he used to walk in going to school that is about 1km away from their
residence.
H. Nutritional
The patient eats vegetables like radish, cabbage and mongo beans more
often than not. He said that he just consumes what is served by his mother and

Page | 12
does not usually fond of eating junkfoods or processed foods. He drinks 6-8
glasses of water a day.
I. Developmental
Erik Erikson’s stages of psychosocial development are a comprehensive
psychoanalytic theory that identifies a series of eight stages, in which a healthy
developing individual should pass through infancy to late adulthood. All stages are
present at birth but only begin to unfold according to both natural scheme and one’s
cultural and ecological upbringing. Each stages builds upon the successful completion
of earlier stage.
STAGE DESCRIPTION RESULT JUSTIFICATION
Ages 12 to 18 years
old
Identity
Vs.
Role Confusion
The adolescent is
newly concerned
with how they
appear to others.
Superego identity is
the accrued
confidence that the
outer sameness and
continuity prepared
in the future are
matched by the
sameness and
continuity of one’s
meaning for oneself,
as evidenced in the
promise of a career.
It was attained by
the patient.
The patient
accomplished the
ability to settle in the
school. He ponders the
roles he wants to do in
the future. He knows
what he wants to do
and he expresses
himself in the way he is
known to be. He
manages to spend time
with his family and had
good relationship with
his classmates and
knows his priorities.

Page | 13
J. Hygiene
Before Hospitalization During Hospitalization After Hospitalization
Patient takes a bath every
day before going to school
and brushes his teeth twice
a day. He performs hand
washing before meal and
he usually eat with the use
of spoon and fork instead
of the use of his bare
hands.
The patient is unable to go
to the bathroom by himself
due to muscle weakness so
the family members prefer
to perform sponge bath
when he was in the
hospital. He brushed his
teeth once a day and does
not wash his hands during
hospitalization.
The patient takes a bath
once a day and brushes his
teeth every morning and
before going to bed. He
demonstrates hand
washing with soap and
running water.
K. Elimination
Urination
The patient voids 5-6
times a day, yellowish in
color and with moderate
amount.
Defecation
Patient usually defecate
twice a day, light brown in
color and formed in
appearance.
Urination
Patient has no urinary
catheter inserted. He voids
3-4 times per shift,
transparent in color and
with an estimated amount
of 600 ml.
Defecation
During hospitalization, the
patient defecates 5-6 times
a day, black in color.
Urination
Patient voids 5-6 times a
day, approximately 600ml
and yellowish in color.
Defecation
The patient’s stool is light
brown in color and formed
in appearance. He
defecates twice daily.

Page | 14
L. Sleepand Rest
Patient is able to sleep at 9
in the evening and wakes
up 5 in the morning to
prepare for school. He has
adequate rest every day.
The patient sleeps at 7pm,
but wakes up every time
he feels tenderness and has
uncomfortable sensation.
The patient is able to sleep
with his normal sleeping
pattern and has no
difficulty resting.

Page | 15
IV. NUTRITIONAL ASSESSMENT
24 hour Food Recall
Before Hospitalization After Hospitalization
1. What time did you go to
bed the night before?
Was this the usual time?
“I slept as early as 7pm but
not continuous, sometimes I
woke up when I feel
uncomfortable.”
“No. I usually go to sleep
around 9pm.”
Patient stated that he sleeps
at 9pm in the evening.
“Yes.”
2. What time did you get
up yesterday?
Was this the usual time?
When was the first time
you had anything to eat
or drink?
What did you have and
how much?
“Around 8am.”
“No. I usually wake up
earlier.”
“At lunch time.”
“Just a piece of biscuit and
sipped as small amount of
water.
“I woke up 6 in the
morning.”
“Yes, it is.”
“I had my breakfast at
6:30am.”
“I ate a cup of rice and one
hotdog.”
3. When did you eat again? “The next meal was my
dinner.”
“I ate my snack at 10am.”
4. Where?
What and how much?
“In our house.”
“I drink a half glass of
water and one spoonful of
rice with egg pugo.”
“In our house.”
“I had 3 pieces of bread and
one glass of ice tea.”
5. When did you eat next?
What did you eat and
how much?
“At 10 pm.”
“A piece of tasty.”
“Lunchtime.”
“1 ½ cup of rice and
sinigang.”
6. Did you eat or drink
anything else?
a. Anything from 1st
“I had a glass of water and
half bottle of gatorade.”
“None.”
“Yes. I ate at 6:30 in the
evening.”
“I drink a glass of water

Page | 16
meal to 2nd meal?
b. Anything from 2nd to
3rd meal?
c. Anything from 3rd
meal to bed time?
“None.”
“None.”
about 150ml.”
“I drink a half glass of
water.”
“I had a glass of water.”
7. Was this day’s food
intake differing from
usual?
If so, why?
“Yes.”
“I lose my appetite and feel
nauseated every time I eat.”
“No.”
8. Is weekend eating
different?
If so, why?
“Sometimes.”
“It depends on what food is
available in our house.”
“At times.”
“It depends on what food is
available in our house.”

Page | 17
V. PHYSICAL ASSESSMENT
Area Method Findings Post-Findings Interpretation
Hair Inspection Hair is black
and equally
distributed
Hair is black and
equally
distributed
Normal
Palpation No signs of
tenderness and
nodules while
palpating
No signs of
tenderness and
nodules while
palpating
Normal
Skin Inspection Generalized
pallor
Presence of
hematoma on
the upper right
arm
Dengue virus induces bone
marrow suppression. Since bone
marrow is the manufacturing
center of blood cells its
suppression causes deficiency
of blood cells leading to low
hemoglobin count.
Paleness is caused by reduced
blood flow or a decreased
number of red blood cells.
Reference: K. Kafeel (2011). Retrieved from:
http://www.onlymyhealth.com/cause-low-
platelet-count-in-dengue-fever-1301653922
The presence of the virus
(arbovirus) within the blood
vessels, especially those feeding
the skin, causes changes to
these blood vessels. The vessels
swell and leak because of
increase capillary permeability.
As the blood vessels become
more damaged the blood vessels
start to leak. When blood leaves
the circulatory system and
becomes stagnant, there is
almost immediate clotting.
Reference: C. Dewit. Dengue Fever (2006).
Retrieved from:
http://www.encyclopedia.com/topic/dengue_fev
er.aspx
C. Davis. Hematoma (2015). Retrieved from:
http://www.emedicinehealth.com/hematoma/pag
e2_em.htm

Page | 18
Palpation Warm to touch With moist skin
and with good
skin turgor
Warm to touch because of the
body’s compensation to the
virus.
The patient’s body temperature
was 38.2 °c.
Reference: W. Lloyd. (2013). Retrieved from:
http://www.healthgrades.com/symptoms/clamm
y-skin
Nails Inspection Nail surface is
slightly curved
No clubbed
finger
Nail surface is
slightly curved
No clubbed
finger
Normal
Palpation Capillary refill
of more than 3
sec
With pale nail
beds
Capillary refill
of less than 3 sec
With pinkish nail
beds
Damage to an artery or vein
allows blood to escape the
circulatory system. Thus, a low
hemoglobin count cause
alteration in blood flow.
Eyes Inspection With pale
conjunctiva
Pupil Equally
Round Reactive
to Light and
Accommodatio
n
With equally
distributed eye
lid and eye
lashes
With moist and
pinkish
conjunctiva
Pupil Equally
Round Reactive
to Light and
Accommodation
With equally
distributed eye
lid and eye
lashes
circulatory system. Thus, a low
Palpation No signs
tenderness
when palpating
No signs
tenderness when
palpating
Normal
Ears Inspection Symmetrical,
no presence of
discharge or
redness
Can react to
sound
No presence of
cerumen
Symmetrical, no
presence of
discharge or
redness
Can react to
sound
No presence of
cerumen
Normal
Palpation No tenderness
and nodules
No tenderness
and nodules
Normal
Nose
and
Sinuses
Inspection No nasal
discharge
No redness and
No nasal
discharge
No redness and
Normal

Page | 19
inflammation
No nasal
deviation
inflammation
No nasal
deviation
upon palpation
No tenderness
upon palpation
Normal
Mouth Inspection Dry lips
With pale
palate
Can able to
move the
tongue in all
direction
Uvula is at the
midline
No presence of
inflammation in
oral mucosa
Moist and
pinkish mucus
membrane
Can able to
move the tongue
in all direction
Uvula is at the
midline
If the amount of fluid in the
intravascular space is decreased,
the body compensates. (fluid
depletion)
circulatory system. Low
when palpating
for the soft and
hard palate
With intact gag
reflex
No presence of
inflammation in
oral mucosa
No tenderness
when palpating
for the soft and
hard palate
With intact gag
reflex
Normal
Neck Inspection No swelling and
no venous
distention
No swelling and
no venous
distention
Normal
Palpation No masses
lymph nodes
and thyroid
gland
enlargement
No masses
lymph nodes and
thyroid gland
enlargement
Normal
Lungs
and
Thorax
Inspection symmetrical
anterior chest
wall
symmetrical
anterior chest
wall
Normal

Page | 20
With no
difficulty of
breathing
With no signs of
difficulty of
breathing
Normal
Percussion Resonance in
sound
Resonance in
sound
Normal
Auscultation With clear
breath sounds
With clear
breath sounds
Normal
With Systolic of
100 mmHg and
Diastolic of
60mmHg
With systolic of
120 mmHg and
Diastolic of 80
mmHg
Normal
Abdom
en
Inspection No abdominal
distention with
no signs of
tenderness or
masses
No abdominal
distention with
no signs of
tenderness or
masses
Normal
Auscultation Bowel sound
heard
RLQ= 7
RUQ= 6
LUQ= 9
LLQ= 8
Bowel sounds
heard
RLQ= 5
RUQ= 7
LUQ= 5
LLQ= 9
Normal
Percussion With tympanic With tympanic Normal
Palpation Abdomen is
soft
With no signs
of tenderness or
masses
Abdomen is soft
With no signs of
tenderness or
masses
Normal
Muscle Inspection
and Palpation
Able to obey
command
muscle
strength of 4/5
Able to obey
command
muscle strength
of 5/5
The dengue virus causes of
measurable muscle weakness.
The muscle can move the joint
it crosses through a full range of
motion against gravity moderate
resistance.
Extremi
ties
Inspection Presence of
petechiae in
upper and
lower
extremities
Has no signs of
lesions
It caused by capillary fragility.
The blood vessels start to leak
and cause bleeding. Petechiae
(small skin hemorrhages).

Page | 21
VI. ANATOMY AND PHYSIOLOGY
Blood
Blood is made up of liquid (called plasma) and solid cells. Blood cells are made in
the bone marrow. Bone marrow is the soft, spongy substance in the centre of bones.
Structure
In adults, the most active bone marrow is found in the pelvic bone, shoulder
bones, back bones (vertebra), ribs, breast bone and skull. Immature blood cells in the
bone marrow are called stem cells. Stem cells can also be found in smaller amounts in the
bloodstream. These are called peripheral blood stem cells.
All of our blood cells develop from stem cells. The process of blood cell
development is called hematopoiesis. In the earliest stage of blood cell development,
stem cells begin to develop either along the lymphoid cell line or the myeloid cell line. In
both cell lines, the stem cells become blasts, which are still immature cells.
Lymphoid cell line
Lymphoid stem cells develop into lymphocytes (also called lymphoblasts).
Lymphocytes are another type of white blood cell (also called leukocytes). Lymphocytes
help fight infection and destroy abnormal cells.

Page | 22
Myeloid cell line
Myeloid stem cells develop into red blood cells, platelets and some types of white
blood cells. Red blood cells carry oxygen to all tissues of the body. Platelets form clots in
damaged blood vessels to stop bleeding.
Myeloid stem cells develop into 2 different types of white blood cells, called
granulocytes and monocytes. These white blood cells destroy bacteria and other foreign
invaders and help to fight infection.
Functions
The main function of blood is to carry nutrients, gases, waste products, cells and
hormones. Each type of blood cell has a specific job.
 Red blood cells carry oxygen from the lungs to the rest of the body. They also
carry carbon dioxide from the body to the lungs so it can be breathed out.
 Platelets form blood clots in damaged vessels to stop bleeding.
 White blood cells help prevent and fight infection by destroying bacteria, viruses
and other foreign cells or substances.

Page | 23
Types of white blood cells
White blood cells are the cells that help the body fight infection. There are a
number of different types and sub-types of white blood cells which each have different
roles to play.
The three major types of white blood cells are:
 Granulocytes
 Monocytes
 Lymphocytes
Granulocytes
There are three different forms of granulocytes:
 Neutrophils
 Eosinophils
 Basophils
Granulocytes are phagocytes, that is they are able to ingest foreign cells such as
bacteria, viruses and other parasites.
Granulocytes are so called because these cells have granules of enzymes which help to
digest the invading microbes. Granulocytes account for about 60% of our white blood
cells.
Neutrophils are by far the most prevalent of these cells. Each neutrophil cell can
ingest up to between around 5 and 20 bacteria in its lifetime.
Eosinophils are involved in allergic reactions and can attack multicellular
parasites such as worms.
Basophils are also involved in allergic reactions and are able to release histamine,
which helps to trigger inflammation, and heparin, which prevents blood from clotting.
Monocytes
Monocytes can develop into two types of cell:
Dendritic cells are antigen-presenting cells which are able to mark out cells that are
antigens (foreign bodies) that need to be destroyed by lymphocytes.
Macrophages are phagocyte cells which are larger and live longer than neutrophils.
Macrophages are also able to act as antigen-presenting cells.

Page | 24
Lymphocytes
Lymphocytes are cells which help to regulate the body's immune system.
The main types of lymphocytes are:
 B lymphocytes (B cells)
 T lymphocytes (T cells)
 Natural Killer Cells

Page | 25
VII. PATHOPHYSIOLOGY
Precipitating Factors
 Environmental conditions (open
spaces with water)
 Presence of 2 Dengue cases in
the community
Predisposing Factors
 Geographical area-tropical island
in the Pacific (Philippines)
Aedes Mosquito
(Carrier of Dengue Virus)
Bite from mosquito to skin
(Portal of Entry)
Virus will circulate in the
blood
Infection primarily targets
the reticulo endothelial
system (blood,bone
marrow, lymph nodes)
Production of immune
mediators
Activation of immune
response
Destructive actions of the virus or
bone marrow precursor cells
Release of cytokines
Stimulate WBC and
Pyrogens
Fever 38.2°C
Viral replication and
Cellular destruction

Page | 26
DENGUE HEMORRHGIC
FEVER
URINARY TRACT INFECTION
Muscle
weakness
4/5
Thrombocytopenia
Platelet Count=38x109
/L
Low
Lymphopenia
Lymphocytes=2.29 %
Low
Leukopenia
WBC=3.83 x 109
/L
Low
Capillary fragility Petechiae
GI
Bleeding
MelenaRelease of Histamine
↑ Capilliary
permeability
Plasma leakage
Epistaxis
↑ Glomerular
Permeabilty
↑ Amount of
plasma protein
Urinalysis Result:
(+) 4 protein
2-4 hpf RBC
Few Bacteria
Hemoglobin=86
g/L
RBC=2.69x 1012
/L
Hematocrit=23.9 %

Page | 27
VIII. MEDICAL MANAGEMENT
Date Doctor’s Order Interpretation
Day 1
January 29, 2016,
6:30 am
Epistaxis
Dengue
Hemorrhagic
fever
Typhoid fever
4:00 pm
(+) epistaxis
 Please admit to
medicine ward
 Secure consent
 TPR every shift
 DAT except dark
colored food
 Hospital policy designates the exact
procedure that should be followed when
admitting the patient to the holding area or
operating room suite. Admission will help
to monitor the client’s condition. The
admitting procedure is continued with
reassessment of the patient and allowance of
time for last minute question. (references:
Medical-Surgical Nursing 5th
edition by Lewis,
Heitkemper &Dirksen Chapter 17, page 380)
 Informed consent is the patient’s
autonomous decision about whether to
undergo a procedure. Before signing the
consent, the risks and benefits of the
procedure must be explained in terms the
patient could easily understand. This is to
prepare patient psychologically and the
health care workers from battery. (references:
Maternal and Child Health Nursing 6th
edition by Adelle
Pilliteri Chapter 24, page 658 and Brunner & Suddarth’s
Textbook of Medical-Surgical Nursing 13th
edition by
Janice L. Hinkle & Kerry H. Cheever Chapter 17 page
406)
 The recording of Temperature, Pulse rate,
and Respiration are part of physical
examination. Acute changes and trends over
time are documented and unexpected
changes and values that deviate significantly
from a patient’s normal values are brought
to the attention of the patient’s primary
health care provider. (references: Brunner &
Suddarth’s Textbook of Medical-Surgical Nursing 13th
edition by Janice L. Hinkle & Kerry H. Cheever Chapter 5
page 67)
 Dark colored foods may alter the color of
the stool of the patient. It is advice to patient
which will undergo fecalysis exam to
determine Blood Occult in the stools.
Highly colored foods, dark green leafy
vegetables and Iron supplements are
avoided as these tend to interfere with the

Page | 28
TVF:
 D5LR 1L × 60
gtts/min × 2
cycles
Laboratories:
 Complete blood
count with PC,
typing
 Urine analysis
 Hematocrit
monitoring at
every 6 hours
test. (reference: Nutrition and Diet Therapy for Nursing
2011 by Adela Jamorabo-Ruiz Chapter 13 page 301-302)
 D5LR is an hypertonic solution that is
given to prevent dehydration. Dengue is a
disease of DEHYDRATION. Much like a
Diarrhea except that the body fluids don’t
come out with the patient’s stool but
through PLASMA LEAKAGE. Imagine
that the arteries and veins of a patient have
thousands of pinpoint holes due to the
body's reaction to the Dengue virus,
causing the fluids inside the blood vessels
to sip out. (reference: Fundamentals of Nursing 8th
edition of 2008 Volume 2 by Snyder, Berman, Kozier
and Erb Chapter 52 Fluid, Electrolyte and Acid – Base
Balance page 1456)
 CBC is done to the patient to test if there is
blood loss. To look for low platelet count
typical of the later stages of the illness and
to detect the decrease in hemoglobin,
hematocrit, and red blood cell (RBC) count
(evidence of anemia) that would occur with
blood loss associated with severe dengue
fever. (references: cell medicine, 24th edition by
Golman and Schater page 345)
 Urinalysis is done to the patient to detect
possible abnormalities in the urinary tract.
It is ordered to determine presence of
bacteria or blood (hematuria) in the urine
of the patient.( reference:Medical Surgical Nursing
8th edition volume 2, Chapter 45 Urinary System page
1150 )
 A blood sample's hematocrit or the red
blood cell volume percentage, and become
a point of reference of its capability of
delivering oxygen. The patient’s
hematology result of Hct: 37.1 % as of 01-
29-2016. (reference: retrieved from
https://en.wikipedia.org/wiki/Hematocrit )

Page | 29
Medications:
 Ascorbic acid 500
mg 1 tab BID
 Tranexamic acid
500 mg TIV
every 8 hours x 3
days
 For transfusion of
platelet 6 units
properly typed
and cross matched
 If platelet
concentrate not
cross matched
may transfused
FFP 4 units
 Supplemental therapy in some GI diseases,
during long term parenteral nutrition.
Increases protection
mechanism of the immune system thus,
resistance to infection. (Reference: Davis’s Drug
Guide for Nurses fifth edition 2010 (ascorbic acid, page
105)
 Inhibits activation of plasminogen thereby
preventing the conversion of plasminogen
to plasmin.
Treatment for bleeding. Patient
experienced epistaxis and melena. Reference:
Davis’s Drug Guide for Nurses fifth edition
2010(tranexamic acid, page 1179)
 Platelet transfusions are used to prevent
spontaneous bleeding or to stop established
bleeding in patients with a deficiency in
platelet number or function. In Dengue
patients, transfusion is done when platelet
count is 10000-20000/ul and
thrombocytopenic bleeding is present. All
the patients of Dengue Shock syndrome
require platelet support. The patient’s
platelet revealed 8x 109
/L as of 01-29-
2016 and positive for epistaxis. Doctors
use blood typing and cross matching to
make sure that the patient receiving a blood
transfusion is getting the correct type of
blood. Crossmatching is used by a doctor
to make sure that the specific donor blood
that will be used during a transfusion does
not react with a patient’s blood.
(reference:http://ijtm.in/view_article.php?id=21)
 Plasma contains all of the coagulation
factors. Fresh frozen plasma (FFP) infusion
can be used for reversal of anticoagulant
effects. Plasma transfusion is
recommended in patients with active
bleeding. The patient experienced nose
bleeding. FFP does not need to be cross-
matched but should be ABO compatible.
(reference:
http://www.aafp.org/afp/2011/0315/p719.html)

Page | 30
 Godex 1 cap 300
mg PO BID
 Omeprazole 40
mg TIV OD
 Ceftriaxone 1g
TIV every 12
hours
 Intake and output
every shift
 To prevent damage to liver, one of the
complication of DHF. Godex acts by
transporting excess, long-chain fatty acids
into the mitochondria to produce high
amounts of energy to produce high
amounts of energy to provide cell
protection and fast treatment of liver
disease.(http://www.mergersdrugfil.com.ph/index.php
/godex-ds )
 Treatment and prevention of
hypersecretions of stomach acid.
Omeprazole is used to prevent upper
gastrointestinal tract bleeding. Due to
patient’s lost appetite with DHF it will
cause abdominal pain. (retrieve from
:http://www.mayoclinic.org/drugs-
supplements/omeprazole-oral-route/description/drg-
2006683)
 To treat infection. Interferes with bacterial
cell wall synthesis by inhibiting cross-
linking of peptidoglycan strands.
Peptidoglycan makes the cell membrane
rigid and protective. Without it, bacterial
cells rupture and die. The patient’s
urinalysis revealed a presence of few
bacteria in urine as of Jan. 31, 2016.
(reference : Jones and Bartlett Nurse’s Drug Handbook
2015 (ceftriaxone page 223)
 Accurate intake and output is necessary for
determining fluid replacement needs and
reducing risk of fluid overload and reflects
circulating fluid shifts, and response to
therapy. Dengue Hemorrhagic Fever can
cause fluid shifting from intracellular spaces
to intravascular space that leads to
dehydration. (references: Nursing Care Plan 8th
edition
of 2010 by Marlynn E. Doenges Capter 10 page 542)

Page | 31
 Vital sign every 1
hour and record
 For close
monitoring
Notify Dra.
Abralzado
Refer
 IVF to following
D5LR 1L x 70
gtts/min x 2 cycles
 Give
Hydrocortisone
250 mg IV now
 The vital signs are body temperature,
pulse, respirations and blood pressure,
which should be looked at in total, are
checked to monitor the function of the
body which may alter the normal function
of the body.(Reference: Fundamentals of Nursing 8th
Edition of 2008 Volume 1 by Berman, Snyder, Kozier
and Erb Chapter 29 Vital signs page. 527)
of the body. Since the patient’s blood count
especially the hemoglobin and platelet is
decreasing he needs more attentive care.
(Reference: Fundamentals of Nursing 8th Edition of 2008
Volume 1 by Berman, Snyder, Kozier and Erb Chapter 29
Vital signs page. 527)
Balance page 1456)
 Management for Dengue shock syndrome.
Corticosteroids are potent anti-
inflammatory agents that have a wide
range of effects on immunological
processes and have found use in a broad
spectrum of diseases (Reference : Jones and
Bartlett Nurse’s Drug Handbook 2015( hydrocortisone
page 256)
Day 2
January 30, 2016
3:00 am
 Diphenhydramine
50 mg TIV now
 To prevent allergic reaction after blood
transfusion. Acts on blood vessels, GI,
respiratory system by competing with

Page | 32
BP 100/70
PR 86
RR 21
(-) PC
10:00 am
(+) black stool
2:00 pm epistaxis
4:00 pm
Severe dengue
Restless
(+) epistaxis
(+) petechia
(+) hematoma
right forearm
Poor pulse
(+) epigastric
tenderness
Clear breath
sounds
6:00 pm
BP 126/79
O2sat 99%
Full pulses
 Hydrocortisone
100 mg TIV now
 Secure and
transfuse 5 units
platelet properly
typed
 Secure and
transfuse either 5
units Platelet
Concentrate or 5
units Fresh Frozen
Plasma
(whichever is
available)
properly typed
and cross
matched)
 Regulate
accurately present
hydration rate
histamine for 𝐻1 –receptor site; decreases
allergic response by blocking histamine.
(Reference : Jones and Bartlett Nurse’s Drug Handbook
2015 ( diphenhydramine page 325)
 Management for Dengue shock syndrome.
Corticosteroids are potent anti-
inflammatory agents that have a wide
range of effects on immunological
processes and have found use in a broad
spectrum of diseases (Reference : Jones and
Bartlett Nurse’s Drug Handbook 2015( hydrocortisone
page 256)
platelet number or function. In Dengue
patients, transfusion is done when platelet
count is 10000-20000/ul and
thrombocytopenic bleeding is present. All
the patients of Dengue Shock syndrome
require platelet support. Doctors use blood
typing to make sure that the patient
receiving a blood transfusion is getting the
correct type of blood.
(reference:http://ijtm.in/view_article.php?id=21)
platelet number or function. On the other
hand,. Fresh frozen plasma (FFP) infusion
bleeding and presence of blood in the stool.
(reference:http://ijtm.in/view_article.php?id=21,
 To prevent dehydration causes by Dengue
virus.

Page | 33
 Facilitate
paracetamol IV
150mg/ml PRN
fever
 Tepid sponge bath
care out
companion
(please facilitate)
 Hook to O2
support via nasal
canulla x 3 cpm
 Transfer to ICU
please
 Appraised mother
 Paracetamol is an antipyretics use to
decreases fever by inhibiting the effects of
pyrogens on the hypothalamus heat
regulating centers & by a hypothalamic
action leading to sweating &
vasodilatation. (reference: retrieved from
https://www.scribd.com/doc/36795690/Drug-Study-
Paracetamol)
 Tepid sponge bath is considered as one of
the best cooling treatments. This method is
recommended for febrile individuals,
especially those with fever ranging from
102.2F or higher. It is effective in relieving
fever by reducing high temperature and
also helpful in alleviating pain
or discomfort. (reference:
https://www.scribd.com/doc/38235959/Tepid-Sponge-
Bath)
 Administration of oxygen helps increase
the percentage of oxygen in inspired air.
The goal of oxygen administration is to
supply the patient with adequate oxygen to
maximize oxygen carrying ability of the
blood. Patient’s hemoglobin revealed 69
g/L (low). References: Medical Surgical Nursing by
LweisHeitkemper Dirksen, Fifth Edition at pages 689)
 Seriously ill patients require close
observation and monitoring. Since the
patient’s blood profile is continuously
decreasing the doctor ordered to transfer
him to ICU.
(reference:http://www.cpmc.org/learning/documents/icu-
ws.html)
 The family should have an accurate
knowledge about the medical condition of
her child to alleviate stress. It allows the
individual to accept and minimize reaction
to difficult situations. (Reference:
http://www.hindawi.com/journals/nrp/2011/392705/)

Page | 34
 IVF to follow
D5LR 1L x 70gtts
2 cycles
 Omeprazole 40
mg IV OD
 Fecalysis with
occult
 Tranexamic acid
500g IV run q 8
 Vitamin K 1 amp
IV every 8 hours
Balance page 1456)
gastrointestinal tract bleeding. Due to
patient’s lost appetite with DHF it will
cause abdominal pain. (retrieve from
2006683)
 Since the patient was diagnosed of dengue
hemorrhagic fever, these examination finds
out to see if there was melena in the stool
of the patient. ( reference: Brunner and Suddarth’s
Textbook of Medical Surgical Nursing Twelfth Edition by
Smeltzer, Bare, Hinkle and Cheever page 987)
 Inhibits activation of plasminogen thereby
preventing the conversion of plasminogen
to plasmin.
Treatment for bleeding. Patient
experienced epistaxis and melena.
(Reference: Davis’s Drug Guide for Nurses fifth edition
2010(tranexamic acid, page 1179)
 To treat bleeding.The patient manifested
epistaxis and black tarry stool at 2:00 pm
as of Jan. 30, 2016. Required for hepatic
synthesis of blood coagulation factors II
(prothrombin), VII, IX, and X. An

Page | 35
 Line no 1L PNSS
500cc then
maintain at
55gtts/min (5
cycles)
 Line no 2 D5LR
1L x 55gtts/min
(5)
Refer for next
IVF
 For Fresh Whole
Blood transfusion
properly typed
and crosmatched
x 5 hrs 2 doses,
6hrs
 Furosemide 20mg
PO every after
Blood transfusion
 Please monitor
antihemorrhagic actor that promotes
hepatic formation of active prothrombin.
(Reference: Davis’s Drug Guide for Nurses fifth edition 2010
(vitamin K, page 970)
 Used because it has little to no effect on the
tissues and make the person feel hydrated
preventing hypovolemic shock
or hypotension. (reference:
https://www.scribd.com/doc/109761163/PNSS-drug-
study)
Balance page 1456)
(reference:
 To prevent fluid overload that may be
imposed by the additional blood volume
delivered during transfusion. Inhibits the
reabsorption of sodium and chloride from
the loop of Henle and distal renal tubule.
(Reference: Davis’s Drug Guide for Nurses fifth edition
2010(Diuretics (Loop), page 392)

Page | 36
vital sign blood
pressure every 1
hour and record
Refer
 Hold vitamin K,
and do please PT,
PTT
 Intake and output
every shift
 Complete blood
count every 8
hours
 Please include
SGPT/SGOT (
Serum Glutamic
Pyruvic
Transaminase),
SGOT ( Serum
of the body.(Reference: Fundamentals of Nursing 8th
Edition of 2008 Volume 1 by Berman, Snyder, Kozier
and Erb Chapter 29 Vital signs page. 527)
 The PTT is used primarily to investigate
unexplained bleeding or clotting. It may be
ordered along with a prothrombin time
(PT) test to evaluate hemostasis, the
process that the body uses to form blood
clots to help stop bleeding. These tests are
usually the starting points for
investigating excessive bleeding or clotting
disorders. (reference: retrieved from
https://labtestsonline.org/understanding/analytes/aptt/tab/
test/)
 Accurate intake and output is necessary for
determining fluid replacement needs and
reducing risk of fluid overload and reflects
circulating fluid shifts, and response to
therapy. Dengue Hemorrhagic Fever can
cause fluid shifting from intracellular spaces
to intravascular space that leads to
dehydration. (references: Nursing Care Plan 8th
edition
of 2010 by Marlynn E. Doenges Capter 10 page 542)
 CBC is done to the patient to test if there is
blood loss. To look for low platelet count
typical of the later stages of the illness and
to detect the decrease in hemoglobin,
hematocrit, and red blood cell (RBC) count
(evidence of anemia) that would occur with
blood loss associated with severe dengue
fever. (references: cell medicine, 24th edition by
Golman and Schater page 345)
 Liver function tests are one of the blood
tests that are performed to assess the
function of the liver. Liver damage is
detected initially by performing a simple
blood test that determines the level of
various liver enzymes present in the blood.
Liver damage is one of the complication of

Page | 37
Glutamic
Oxaloacetic
Transaminase) on
next CBC
extraction
 O2 at 6 cpm via
face mask
 IVF line no. 1
PNSS at 55
gtts/min (5) x 2
 fused no. 2 D5LR
at 25gtts/min (2)
x 2 hours
Refer
Dengue Hemorrhagic Fever.(reference:
retrieved from http://www.med-health.net/Sgot-Sgpt.html)
 Administration of oxygen helps increase
the percentage of oxygen in inspired air.
The goal of oxygen administration is to
supply the patient with adequate oxygen to
maximize oxygen carrying ability of the
blood. The patient’s hemoglobin revealed
69 g/L (low). (References: Medical Surgical Nursing
by LweisHeitkemper Dirksen, Fifth Edition at pages 689)
study)
Balance page 1456)
Day 3
January 31, 2016
12:29 am
BP 113/62
PR 98
T 37.4
O2sat 99%
 IVF line 1 PNSS
at 25gtts/min x
(2) x 4 hours
 Line 2 D5LR at
study)

Page | 38
(+) mild headache
6:00 am
BP 114/67
(-) Bleeding
8:00 am
(-) melena
(-) epistaxis
Awake
Confused
No epigastric
tenderness
Full pulse
Clear breath sounds
10:00 pm
Coherent
Full pulse
No epistaxis
25gtts/min (2) x 4
hours
Refer
 Paracetamol 1
amp 150mg/ml
IV every 4 hours
 Continue present
management
 Continue
paracetamol PRN
 Facilitate Fresh
Whole Blood
transfuse 2nd dose
Balance page 1456)
Paracetamol)
 For supportive Drug; supports body
function until other treatments or the
body’s treatments or body’s response can
take over; because medication is a
substance administered for the diagnosis,
cure treatment or relief of symptoms of for
prevention of disease. (Reference: Fundamentals
of Nursing 8th Edition of 2008 by Berman, Synder,
Kozier and Erb Chapter 35 Medications page 830
Paracetamol)

Page | 39
(reference:
Day 4
February 01, 2016
8:30 am
Coherent
BP 100/60
PR 99
37
(-) Epistaxis
9:30
(-) bleeding
 PNSS 1L x 15
gtts/min (1)
 D5LR 1L x 15
gtts/min (1)
study)
Balance page 1456)
Day 5 February 2,
2016 6:00 am
(-) bleeding
Platelet 198
 May go home
Home Meds:
 Godex 1 cap
300mg BID x 5
days
 Discharge planning is the process of
preparing a client to receive one level of
care for another within or outside of the
current health care agency; usually refers
to the client leaving hospital for home.
( Fundamentals of Nursing 8th Edition of 2008 by
Berman, Synder, Kozier and Erb Chapter 7 Community-
based nursing and care continuity page 113 )
 To prevent damage to liver, one of the
complication of DHF. Godex acts by
transporting excess, long-chain fatty acids
into the mitochondria to produce high
amounts of energy to produce high
amounts of energy to provide cell
protection and fast treatment of liver
disease.(http://www.mergersdrugfil.com.ph/index.php
/godex-ds )

Page | 40
 Cefixime 200mg
cap BID x 7 days
 Omeprazole 20
mg cap OD
 Ascorbic acid 500
mg tab OD
 Cefixime is a cephalosporin antibiotic used
to treat infections such as urinary tract
infections, because the patient’s urinalysis
revealed presence of few bacteria in
urine.(reference: retrieved from
https://www.nlm.nih.gov/medlineplus/druginfo/meds/a69
0007.html)
gastrointestinal tract bleeding. (retrieve from
2006683)
 Supplemental therapy in some GI diseases,
during long term parenteral nutrition.
Increases protection
mechanism of the immune system thus,
resistance to infection. (Reference: Davis’s Drug
Guide for Nurses fifth edition 2010 (ascorbic acid, page
105)

Page | 41
VIX. LABORATORY TEST
Urinalysis
Date: Jan. 31, 2016
Provides important clinical information about kidney formation and help diagnose other
diseases.
( Brunner andSuddarth’s Textbook of Medical Surgical Nursing 13th
Edition by Smeltzer, Bare, Hinkle and Cheever chapter 53
Assessment of Kidney and Urinary Function page 1518 )
Test Reference
Value
Result Implication
Physical
Properties
Light
Yellow
Normal
Transparency Slightly
Hazy
Normal
Chemical
Properties
pH 5 – 9 7.0 Normal
Specific Gravity 1.005 -
1.030
1.015 Normal
Sugar Negative Negative Normal
Protein Negative
(<10mg/d
L/100ml)
+4 The glomerulus is the network of capillaries
in the kidneys that filters low molecular
weight solutes such as urea, glucose, and
salts, but normally prevents passage of
protein or cells from blood into filtrate. Due
increased glomerular permeability; this
permeability allows increased amounts of
plasma proteins (sometimes very large
amounts) to pass into the filtrate.
Reference: A.Shah. Proteinuria (2013)
http://www.merckmanuals.com/professional/genitourinary-
disorders/symptoms-of-genitourinary-disorders/proteinuria
Leukocytes Negative Negative Normal
Nitrite Negative Negative Normal
Urobilinogen Normal Normal Normal
Blood Negative Negative Normal
Ketone Negative Negative Normal
Bilirubin Negative Negative Normal
Ascorbic Acid Negative Negative Normal
Microscopic
examination
RBC Negative 2– 4/hpf Due to increase in vascular permeability it
will leads to leakage of RBC.
Reference: National Instituteof Allergy and Infectious Diseases,
NIH: Volume 2
Pus Cells (WBC) Negative 2– 4/hpf Occurrence of pus cells in urine may be

Page | 42
Interpretation Nursing Responsibility
Presence of protein, RBC and WBC in the
urine cause by increase in capillary
permeability thus permitting plasma
protein and blood cells to pass into the
urine.
1. Use clean container.
2. Obtain first morning sample
3. Immediately send specimen to the
laboratory with proper label.
( Medical Surgical Nursing 8th
Edition page 1138 ) ( Medical Surgical Nursing 8th
Edition page 1146 )
taken to be an indicator of an infection,
either on the upper or the lower urinary
tract.
( Retrieved from: http://www.newhealthguide.org/Pus-Cells-in-
Urine.html )
Mucus threads Few If they are present in large amounts then this
means there is some underlying infection in
any part of the urinary tract. If the mucus
threads in urine are associated with red
blood cells (blood), bacteria or yeast then
this indicates to some sort of infection,
irritation or other problems.
(Retrieved from: http://bestwebhealth.org/Mucus-Threads-In-
Urine--What-Does-It-Mean-And-How-To-Treat.html )
Amorphous
Phosphates
- -
Bacteria Negative Few Bacteria in urine can suggest infection due
to vascular permeability.

Page | 43
Complete Blood Count
Date: 01-29-2016
Test Result Normal
Range
Interpretation Implication
WBC 3.83 4.00-10.00 Low WBC is made in the bone
marrow and circulates in the
bloodstream. Dengue virus
induces the suppression of the
bone marrow that results of
producing not enough WBC
to defend against bacterial
infections.
Reference:
http://www.medicinenet.com/script/main/art.
asp?articlekey=6017
Neutrophils 2.52 2.00-7.00 Normal
Lymphocytes 0.83 0.80-4.00 Normal
Monocytes 0.43 0.12-1.20 Normal
Eosinophils 0.04 0.02-0.50 Normal
Basophils 0.01 0.00-0.10 Normal
Neu% 65.7 50.0-70.0 Normal
Lym 21.8 20.0-40.0 Normal
Mon 11.2 3.0-12.0 Normal
Eos 1.1 0.5-5.0 Normal
Bas 0.2 0.0-1.0 Normal
RBC 4.43 4.00-5.50 Normal
HGB 140 120-160 Normal
HCT 40.0 40.0-54.0 Normal
MCV 90.3 80.0-100.0 Normal
MCH 31.6 27.0-34.0 Normal
MCHC 350 320-360 Normal
RDW-CV 10.4 11.0-16.0 Low A low RDW means that the
red blood cells vary very little
in size.
Red cell distribution width
(abbreviated as RDW) and
Coefficient Variation
(abbreviated as CV) is a
measurement of the amount
that red blood cells vary in
size. Red blood cells help
carry oxygen in the blood.
Reference:
http://www.medfriendly.com/red-cell-
distribution-width.html
RDW-SD 34.9 35.0-56.0 Low A low RDW means that the

Page | 44
in size.
Standard Variation
(abbreviated as SD) is a
Reference:
PLT 11 170-400 Low Dengue virus induces bone
marrow suppression. Since
bone marrow is the
manufacturing center of blood
cells its suppression causes
deficiency of blood cells
leading to low platelet count.
Reference:
K. Kafeel (2011). Retrieved from:
MPV 6.2 6.5-12.0 Low Mean platelet volume
(MPV) reflects the average
size of platelets present in a
person's sample of blood.
MPV is low with low platelet
count due to dengue virus
affecting production by the
bone marrow.
Reference:
https://labtestsonline.org/understanding/analy
tes/platelet/tab/faq/
PDW 18.8 9.0-17.0 High Platelet Distribution Width
(PDW) PDW is the variability
in the size of platelets.
Normally PDW increases
with MPV. The patient shows
a low MPV but a high PDW.
Due to the bone marrow
suppression.
Reference:
https://allaboutblood.com/tag/pdw/
PCT 0.007 0.108-
0.282
Low Low PCT (procalcitonin)
values (<0.25 µg/L) in
patients with clinical signs of
infection (CAP, UTI) indicate
a low probability for blood

Page | 45
culture proof of bacterial
infection. One major
advantage of PCT compared
to other parameters is its early
and highly specific increase in
response to bacterial
infections and sepsis.
Reference:
http://www.procalcitonin.com/default.aspx?tr
ee=_2_2
P-LCR 7.6 11.0-45.0 Low P-LCR means Platelet large
cell ratio. It provides
information about the
underlying conditions of
thrombocytopenia.
Reference:
http://www.ehj.eg.net/article.asp?issn=1110-
1067;year=2014;volume=39;issue=3;spage=
134;epage=138;aulast=Elsewefy
Date: 01-30-2016
Test Result Normal
Range
WBC 4.86 4.00-10.00 Normal
Neutrophils 1.65 2.00-7.00 Low Neutrophils are major players
in the body's defense against
bacterial infections.
Neutrophils are made in
the bone marrow and circulate
in the bloodstream. Dengue
virus induces the suppression
of the bone marrow that results
of producing not enough
neutrophils to defend against
Reference:
http://www.medicinenet.com/script/main/art.as
p?articlekey=6017
Neu% 33.9 50.0-70.0 Low Neutrophils are manufactured
in bone marrow — the spongy
tissue inside some of our larger
bones. Anything that disrupts
neutrophil production can

Page | 46
result in neutropenia. The
dengue virus induces bone
marrow suppression.
Reference:
http://www.mayoclinic.org/symptoms/neutrope
nia/basics/causes/sym-20050854
Lym 44.0 20.0-40.0 High It is high because of the
bacteria presence in the urine
of the patient. Lymphocytes
provide a means for immunity
against antigens.
Reference:
http://biology.about.com/od/cellbiology/ss/lym
phocytes.htm
Mon 21.6 3.0-12.0 High Monocytes play important
roles in the immune defense,
inflammation and tissue
remodelling and it do so by
phagocytosis, antigen
processing and presentation
and by cytokine production. It
is high because of the bacteria
presence in the urine of the
patient.
Reference:
http://www.monocytes.de
Eos 0.4 0.5-5.0 Low A low eosinophil level is
usually not a cause for concern
and is actually quite
common. They are very helpful
in defending the body
against parasites. Eosinophils
can be too low due to
administration of steroids.
Steroids are any of a large
number of hormone substances
with a similar and basic
chemical structure. Hormones
are natural chemicals produced
by the body and
released into the blood that
have a specific effect on tissues
in the body.
The patient is administered by
Hydrocortisone.
Reference:
http://www.medfriendly.com/eosinophil.html
RBC 2.22 4.00-5.50 Low Red blood cells circulate in the
blood and carry oxygen

Page | 47
throughout the body. They are
produced in the bone
marrow and then released into
the bloodstream as they
mature. Dengue virus damage
the bone marrow that results to
low RBC production.
Reference:
https://labtestsonline.org/understanding/analyte
s/rbc/tab/test/
HGB 69 120-160 Low RBCs contain hemoglobin,
which carries oxygen
throughout your body. It is low
because the patient
experienced epistaxis and
melena. It is low because the
patient experienced epistaxis
and melena. Moreover, the
marrow suppression
HCT 20.0 40.0-54.0 Low The hematocrit is routinely
ordered as a part of
the complete blood count
(CBC). It may also be ordered
by itself or with a hemoglobin
level as part of a general health
examination. It results from
decrease production of
hemoglobin and damage to
bone marrow.
Reference:
https://labtestsonline.org/understanding/analyte
s/hematocrit/tab/test/
MCV 90.0 80.0-100.0 Normal
MCH 31.1 27.0-34.0 Normal
RDW-CV 10.6 11.0-16.0 Low A low RDW means that the red
blood cells vary very little in
size.
size. Red blood cells help carry
oxygen in the blood.
Reference: http://www.medfriendly.com/red-
cell-distribution-width.html

Page | 48
RDW-SD 34.8 35.0-56.0 Low A low RDW means that the red
blood cells vary very little in
size.
Standard Variation
(abbreviated as SD) is a
size. Red blood cells help carry
oxygen in the blood.
bone marrow is the
Reference:
MPV 9.2 6.5-12.0 Normal
Normally PDW increases with
MPV. The patient shows a low
MPV but a high PDW. Due to
the bone marrow suppression.
Reference:
PCT 0.035 0.108-
0.282
values (<0.25 µg/L) in patients
with clinical signs of infection
(CAP, UTI) indicate a low
probability for blood culture
proof of bacterial infection.
One major advantage of PCT
compared to other parameters
is its early and highly specific
increase in response to
bacterial infections and sepsis.
Reference:
http://www.procalcitonin.com/default.aspx?tre
e=_2_2
P-LCR 34.2 11.0-45.0 Normal

Page | 49
Date: 01-31-2016
Test Result Normal
Range
WBC 5.91 4.00-10.00 Normal
tissue inside some of our
larger bones. Anything that
disrupts neutrophil production
can result in neutropenia.
Reference:
http://www.mayoclinic.org/symptoms/neutro
penia/basics/causes/sym-20050854
Lym 33.8 20.0-40.0 Normal
Mon 16.3 3.0-12.0 High Monocytes perform their
functions by surrounding and
engulfing bacteria (a process
known as phagocytosis).
Monocytes can engage in
phagocytosis by coating the
foreign material with
complement or antibodies.
High Monocytes happen for
several reasons such as stress,
inflammation, a fever from a
virus, severe infection
(because more macrophages
are needed to fight it),
premature cell death in living
tissue, diseases that result
from abnormal activity of the
immune system, and
regeneration of red blood
cells.
Reference:
http://www.medfriendly.com/monocyte.html
Eos 0.3 0.5-5.0 Low A low eosinophil level is
usually not a cause for
concern and is actually quite
common. They are very
helpful in defending the body

Page | 50
against parasites. Eosinophils
can be too low due to
administration of steroids.
Steroids are any of a large
number of hormone
substances
with a similar and basic
chemical structure. Hormones
are natural chemicals
produced by the body and
released into the blood that
have a specific effect on
tissues in the body.
The patient is administered by
Hydrocortisone.
Reference:
http://www.medfriendly.com/eosinophil.html
RBC 2.69 4.00-5.50 Low Red blood cells circulate in
the blood and carry oxygen
the bone marrow that results
to low RBC production.
Reference:
tes/rbc/tab/test/
throughout your body. It is
low because the patient
marrow suppression.
level as part of a general
health examination. It results
from decrease production of

Page | 51
bone marrow.
Reference:
tes/hematocrit/tab/test/
MCV 88.9 80.0-100.0 Normal
MCH 32.0 27.0-34.0 Normal
in size.
Reference:
RDW-SD 35.0 35.0-56.0 Normal
bone marrow is the
Reference:
MPV 9.1 6.5-12.0 Normal
in the size of platelets. Due to
the bone marrow suppression.
Reference:
PCT 0.046 0.108-
0.282

Page | 52
Reference:
ee=_2_2
P-LCR 34.7 11.0-45.0 Normal
Date: 01-31-2016
Test Result Normal
Range
WBC 5.79 4.00-10.00 Normal
Lymphocytes 2.29 0.80-4.00 Low It is low because the dengue
virus induces the bone
marrow suppression.
Reference:
http://biology.about.com/od/cellbiology/ss/ly
mphocytes.htm
tissue inside some of our
larger bones. Anything that
disrupts neutrophil production
can result in neutropenia.
Reference:
http://www.mayoclinic.org/symptoms/neutro
penia/basics/causes/sym-20050854
Lym 39.6 20.0-40.0 Normal
Mon 20.2 3.0-12.0 High Monocytes play important
roles in the immune defense,
inflammation and tissue
remodelling and it do so by
phagocytosis, antigen
processing and presentation
and by cytokine production. It
is high because of the bacteria
presence in the urine of the
patient.
Reference:
http://www.monocytes.de
Eos 0.8 0.5-5.0 Normal
RBC 3.31 4.00-5.50 Low Red blood cells circulate in
the blood and carry oxygen

Page | 53
the bone marrow that results
to low RBC production.
Reference:
tes/rbc/tab/test/
marrow suppression
level as part of a general
health examination. It results
from decrease production of
bone marrow.
Reference:
tes/hematocrit/tab/test/
MCV 86.8 80.0-100.0 Normal
MCH 30.8 27.0-34.0 Normal
in size.

Page | 54
RDW-SD 35.3 35.0-56.0 Normal
bone marrow is the
Reference:
MPV 9.6 6.5-12.0 Normal
Normally PDW increases
with MPV. Due to the bone
marrow suppression.
Reference:
PCT 0.071 0.108-
0.282
Reference:
ee=_2_2
P-LCR 35.4 11.0-45.0 Normal

Page | 55
Hematology
Date: 01-28-2016
Test Result Normal
Range
Interpreta
tion
Implication
Hemoglobin 16.4 13-17 Normal
Hematocrit 50.2 40-52% Normal
RBC 5.45 4.7-
6.1ml/mm3
Normal
WBC 2500 4800-
10000/mm3
Low WBC is made in the bone
marrow and circulate in the
bloodstream. Dengue virus
induces the suppression of the
bone marrow that results of
producing not enough WBC
to defend against bacterial
infections.
Reference:
asp?articlekey=6017
DIFFERENTIAL
COUNT
Neutrophils 77 40-74% High Neutrophils are major players
in the body's defense against
Neutrophils are made in
the bone marrow and circulate
in the bloodstream. Dengue
virus induces the suppression
of the bone marrow that
results of producing not
enough neutrophils to defend
against bacterial infections.
Reference:
asp?articlekey=6017
Lymphocytes 21 20-40% Normal
Eosinophils - - -
Monocytes 2 3-7% Low Monocytes are a type of white
blood cell that fight certain
infections and help other
white blood cells which is
also regulate immunity
against foreign substances.
Monocytes are produced in
the bone marrow and then
enter the blood. A low number

Page | 56
of monocytes in the blood
(monocytopenia) can be
caused by anything that
decreases the overall white
blood cell count
(see Neutropenia and see
also Lymphocytopenia), such
as a bloodstream infection or
a bone marrow disorder.
Reference:
https://www.merckmanuals.com/home/blood-
disorders/white-blood-cell-
disorders/monocyte-disorders
Platelet count 24000 130-500000 Low Dengue virus induces bone
bone marrow is the
Reference:
Bleeding time - - -
Clotting time - - -
MCV 92.2 80-96FL Normal
MCH 30.1 27-33PG Normal
MCHC 32.7 32-36% Normal
Date: 01-29-16
Test Result Normal
values
Hemoglobin - 11.5-14.8
Hematocrit 37.1 38-44% Low The hematocrit is routinely
(CBC). It may also be
ordered by itself or with a
hemoglobin level as part of a
general health examination.
It results from decrease
production of hemoglobin
and damage to bone marrow.
Reference:
https://labtestsonline.org/understanding/anal
ytes/hematocrit/tab/test/
Platelet count 18 250- Low Dengue virus induces bone

Page | 57
510x10/L marrow suppression. Since
bone marrow is the
manufacturing center of
blood cells its suppression
causes deficiency of blood
cells leading to low platelet
count.
Reference:
Date: 01-29-16
Test Result Normal
values
Hemoglobin - 11.5-14.8 -
Hematocrit 41.6 38-44% Normal
Platelet count 12 250-
510x10/L
Low Dengue virus induces
bone marrow
suppression. Since bone
marrow is the
blood cells its
suppression causes
leading to low platelet
count.
Reference:
http://www.onlymyhealth.com/cause-
low-platelet-count-in-dengue-fever-
1301653922
Date: 01-30-16
Test Result Normal
values
Hematocrit 21% 38-44% Low The hematocrit is routinely
hemoglobin level as part of
a general health
damage to bone marrow.

Page | 58
Reference:
https://labtestsonline.org/understanding/a
nalytes/hematocrit/tab/test/
510x10/L
Low Dengue virus induces bone
bone marrow is the
count.
Reference:
1301653922
Date: 01-30-16
Test Result Normal
values
Hemoglobin - 11.5-14.8
Hematocrit 35.7% 38-44% Low Hematocrit is the
amount of red blood
cells in your blood. It is
experienced epistaxis
and melena. Moreover,
the dengue virus induces
bone marrow
suppression.
510x10/L
Low Dengue virus induces
bone marrow
suppression. Since bone
marrow is the
blood cells its
suppression causes
leading to low platelet
count.
Reference:
1301653922

Page | 59
Date: 01-30-16
Test Result Normal
values
Hematocrit 29.7% 38-44% Low The hematocrit is routinely
a general health
damage to bone marrow.
Reference:
https://labtestsonline.org/understanding/a
nalytes/hematocrit/tab/test/
510x10/L
Low Dengue virus induces bone
bone marrow is the
count.
Reference:
1301653922
Date: 02-01-2016
Test Result Normal
values
Hemoglobin 98 115-148 Low RBCs contain hemoglobin,
melena. It is low because
the patient experienced
epistaxis and melena.
Moreover, the dengue virus
induce bone marrow
suppression.
Hematocrit 29% 38-44 Low The hematocrit is routinely

Page | 60
a general health
bone marrow.
Reference:
https://labtestsonline.org/understanding/an
alytes/hematocrit/tab/test/
RBC 3.35 38-54 Low RBCs contain hemoglobin,
melena. Moreover, the
marrow suppression.
Platelet 88 250-510 Low Dengue virus induces bone
bone marrow is the
count.
Reference:
platelet-count-in-dengue-fever-
1301653922
WBC 7-9 4-11 Normal
Segmented
neutrophils
52 45-55 Normal
Lymphocytes 40.3 38-45 Normal
Monocytes 7-5 3-6 High Monocytes perform their
functions by surrounding
and engulfing bacteria (a
process known as
phagocytosis). Monocytes
can engage in phagocytosis
by coating the foreign
material with complement
or antibodies.
High Monocytes happen for
several reasons such as

Page | 61
stress, inflammation, a fever
from a virus, severe
infection (because more
macrophages are needed to
fight it), premature cell
death in living tissue,
diseases that result from
abnormal activity of the
immune system, and
regeneration of red blood
cells.
Reference:
http://www.medfriendly.com/monocyte.ht
ml
Date: 02-02-2016
Test Result Normal
Range
Hemoglobin 96 115-148 Low RBCs contain hemoglobin,
induces bone marrow
suppression.
Hematocrit 26.8 38-44 Normal
RBC 3.14 3.8-5.4 Normal
MCV 85 80-100 Normal
MCH 30.5 27-32 Normal
RDW-CV 13.5 11.0-16.0 Normal
RDW-SD - 37-54 Normal
Platelet 198 250-510 Normal
PCT 0.188 0.15-0.50 Normal
MPV 9.5 6-11 Normal
PDW 18.6 11-18 Normal
WBC 8.0 4-11 Normal
Segmented
neutrophils
54.1 45-55 Normal
lymphocytes 38.3 38-45 Normal
monocytes 7.6 3-6

Page | 62
Date: 02-03-16
Test Result Normal
values
Hemoglobin 9.9 11.5-14.8 Low RBCs contain hemoglobin,
induces bone marrow
suppression.
a general health
bone marrow.
Reference:
alytes/hematocrit/tab/test/.
510x10/L
Normal
Date: 02-03-16
Test Result Normal
values
Hemoglobin - 11.5-14.8 Low RBCs contain hemoglobin,
induces bone marrow
suppression.

Page | 63
a general health
bone marrow.
Reference:
alytes/hematocrit/tab/test/
510x10/L
Normal
TyphiDOT
Date: 01-29-16
Test Result
Salmonella IgG Negative
Salmonella IgM Negative
The patient TyphiDOT test is negative to Salmonella IgG and salmonella IgM.
The Typhidot test gave a sensitivity of 100 per cent and specificity of 80 per cent
when bacteraemic patients were analysed.
The TyphiDot is a DOT enzyme immunoassay that detects either IgM or IgG
antibodies against a specific antigen on the outer membrane protein of serotype Typhi.
Reference:
https://www.researchgate.net/publication/10894775_Typhidot_test_to_detect_IgG_IgM_antibodies_in_t yphoid_fever

Page | 64
DENGUE NS1 IgA/IgG/IgM
Date: 01-29-2016
Test Result
Dengue NS1 Positive
Dengue IgA Negative
Dengue IgG Positive
Dengue IgM Negative
The patient’s antibody test revealed positive in Dengue NS1 and Dengue IgG.
The non-structural protein 1 (NS1) of the dengue viral genome has been shown to
be useful as a tool for the diagnosis of acute dengue infections. Dengue NS1 antigen has
been detected in the serum of DENV infected patients as early as 1 day post onset of
symptoms (DPO), and up to 18 DPO.
Antibody tests, IgM and IgG- detect antibodies produced by the immune system
when a person has been exposed to the virus; these tests are most effective when
performed at least 7-10 days after exposure.
Reference:
http://www.cdc.gov/dengue/clinicalLab/laboratory.html
https://labtestsonline.org/understanding/analytes/dengue/tab/sample/
BLOOD TYPE TEST
Date: January 29, 2016
ABO Rhesus D
O (+)

Page | 65
X. PROBLEM PRIORITIZATION
1. Ineffective Tissue Perfusion
2. Hyperthermia
3. Imbalance Nutrition
4. Impaired Tissue Integrity
5. Risk for Injury

Page | 66
XI. NURSING CARE PLAN

Page | 67
Assessment Nursing
Diagnosis
Planning Intervention Rationale Expected Outcome
O:
 Hemoglobin
results
revealed 69
mg/dl as of
01-30-16
 BP: 100/60
mmHg
 RR: 20 cpm
 PR: 98 bpm
 Headache
 Generalized
pallor
 Capillary
refill of
more than 3
sec
 With pale nail
beds
Ineffective
tissue
perfusion
related to
decreased
hemoglobin
concentration
in the blood.
After 8 hours of nursing
intervention, the client
will be able to:
 Demonstrate
different ways to
improve blood
oxygenation and
circulation.
 Verbalize
understanding of
condition and
importance
of treatment
regimen.
 Demonstrate
increased tissue
perfusion.
 Monitor vital
signs.
 Elevate head
of bed to about
10 degrees.
 Discourage
strenuous
activities.
 Provide health
teaching
regarding DHF.
 Provide health
teaching on
drugs being
taken.
Collaborative:
 Administer
Tranexamic
Acid 50mg IV
q8 as ordered.
 Serve as basis for
any alteration in
system functions.
 To promote
circulation and
venous drainage.
 To avoid increasing
oxygen demand.
 To help client
understand his
health condition.
 To maintain
compliance to
meds.
 To control
bleeding.
After 8 hours of nursing
intervention, the
client was be able to:
 Demonstrate different
ways to improve
blood oxygenation
and circulation.
 Verbalize
understanding
of condition and
importance
of treatment
regimen.
 Demonstrate
increased tissue
perfusion.

Page | 68
 With pale
conjunctiva
and palate
 Muscle
strength :
4/5
 Administer and
regulate IVF as
ordered.
 Administer
packed RBC’s
as ordered.
 Monitor lab
studies ( Hb,
Hct, RBC
count).
 Maintain hydration
and help wash
away toxins.
 Packed RBC’s are
adequate for stable
patients with
subacute/chronic
bleeding to
increase oxygen
carrying capability
 Aids in
establishing blood
replacement needs
& monitoring for
effectiveness of
therapy.

Page | 69
Assessment Nursing Diagnosis Planning Intervention Rationale Expected Outcome
O:
 Temp: 38.2 °c
 Warm to touch
 Chills
 Weak in
appearance
 Easy fatigability
 Dry lips
 Pale
Hyperthermia
related to presence
of Arbovirus in
patient’s body
causing release of
pyrogens.
After 2 hours
of nursing
interventions, the
patient will be able
to:
Manifest reduction
of core temperature
from 38.2 to a
normal range of 36.5
C- 37.5 C
 Monitor
patient’s vital
signs.
 Note
chronological an
d developmental
age of client
 Note presence/
absence
of sweating.
 Initiate tepid
sponge bath.
 Promotes surface
cooling through
undressing or
removing extra
linens.
 Encourage
adequate fluid
intake.
 Serves as base
line data for
future
comparison.
 Assess for
causative/
contributing
factor.
 To assess
degree of
hyperthermia.
 Facilitates heat
through
conduction and
evaporation.
 Facilitates heat
loss by
radiation.
 To promote
heat loss and
hydration.
After 2 hours
of nursing
interventions, the
patient will be able
to:
Manifest reduction
of core temperature
from 38.2 to a
normal range of 36.5
C- 37.5 C

Page | 70
 Encourage
adequate
bedrest.
 Instruct patient
and SO to report
signs and
symptoms
of hyperthermia
like flushed skin,
increasing
respiratory rate
and body
temperature.
Collaborative:
 Administer
Paracetamol 1
amp IV, as
ordered.
 To reduce
metabolic
consumption
and oxygen
demands.
 To promote
wellness.
 To relieve high
temperature by
inhibiting the
synthesis of
prostaglandin

Page | 71
Assessment Nursing
Diagnosis
S: “Wala akong
ganang kumain“ as
verbalized by the
patient.
O:
 Lethargic
 Easy
fatigability
 Weak in
appearance
 Had 2
crackers in
shift
 Pale
 24 hours
dietary recall
Imbalanced
nutrition less than
body
requirements
related to loss of
appetite.
ST: within 4 hours of
giving nursing
intervention patient
will be able to
experience an
increase in the
amount or type of
nutrients ingested.
LT: within 8 hours of
giving nursing
intervention and
medical management
patient will be able to
experience adequate
nutrition through oral
intake.
 Assess and
document
patient’s dietary
history, patters
of ingestion,
intolerance to
foods.
 Auscultate bowel
sounds.
 Instruct
pt. on good oral
hygiene before
and after
feedings.
 Emphasize the
importance of
adequate
 To determine daily
nutrition needs.
 Hypermotility of
intestinal tract is
common and is
associated with
vomiting and
diarrhea, which
may affect choice
of diet/route.
 To promote god
appetite.
 Promotes comfort
to the patient and
encourages a good
After giving
effective nursing
interventions patient
will be able to
partially demonstrate
behavior, lifestyle
changes to regain
appropriate weight.

Page | 72
nutrition.
 Promote pleasant
relieving
environment
including
socialization.
Collaborative:
 Monitor
BUN, protein,
prealbumin, or
albumin, glucose,
nitrogen balance as
indicated.
 Advance diet
as tolerated, avoid
dark colored foods.
eating habit.
 For education of
the patient for
appropriate
recovery from
nutritional
imbalance.
 Reflects organ
function and
nutritional status
and needs.
 Careful
progression of diet
when intake is
resumed reduces
risk of gastric
irritation and to
provide accurate
assessment in
stool.

Page | 73
Assessment Nursing Diagnosis Planning Intervention Rationale Expected Outcome
O:
 Temp: 38.2 °c
 Hematoma on
the upper right
arm
 Capillary refill
of more than 3
sec
 Weak in
appearance
 Dry lips
 Headache-
Pain scale 5/10
 Pale
 Muscle strength :
4/5
Impaired tissue
integrity related to
mechanical and
chemical factor of
skin test and blood
test; secondary to
haematoma as
evidence by
collection of blood
on the upper right
arm.
After 4 hours of
nursing
interventions
patient will
demonstrate
behavior to reduce
the hematoma.
After 2 weeks of
nursing
interventions
presence of
hematoma will be
reduce.
 Provide
comfortable
environment.
 Provide
comfort
measures by
AM care,
changing the
linen and touch
therapy.
 Provide safety
by placing
pillows at the
side of the bed.
 Vital signs
monitor and
record.
 To ease patient’s
anxiety and to
help the patient
recover faster for
proper hygiene of
the patient.
 For proper
hygiene of the
patient.
 To avoid patient
from injury.
 To have baseline
data.
After 4 hours of
nursing interventions
the patient shall have
demonstrate
behavior to reduce
the hematoma.
After 2 weeks of
nursing interventions
the patient shall have
no presence of
hematoma.

Page | 74
 Identify
underlying
condition
involves in
tissue injury.
 Monitor
laboratory
studies.
 Help patient
and family to
identify
effective
successful
coping
mechanism and
to implement
them.
 Suggest treatment
options, desire/
ability to protect
self and potential
self and potential
to recurrence of
tissue damage.
 To changes
indicative of
healing or
infection
complications.
 To reduce
discomfort and
improve quality of
life.

Page | 75
Assessment Nursing
Diagnosis
O:
 Weak in
appearance
 Capillary refill
of more than 3
sec.
 Easy fatigability
 Hematoma at
the right upper
arm
 Delirium
 Platelet count
results revealed 8
x109
/L as of 01-
30-16
Risk for
injury related
to abnormal
blood profile
as evidenced
by decreased
platelet count.
After 4 hours of
nursing
management, the
patient will
demonstrate
behaviors to
reduce risk factors
and protect self
from injury.
 Establish rapport.
 Monitor and record
vital signs.
 Assess mood, coping
abilities, and
personality styles
(aggression and
impulse behavior).
 Observe for presence
of petechiae,
ecchymosis, bleeding
from one more sites.
 Maintain bed in a
lowest position with
wheels locked.
 Advise SO that those
self inflicting
materials such as
 To gain patient’s
trust and
cooperation.
 For baseline data.
 Aggressive and
impulsive
behavior indicates
self harm to the
patient.
 Observing those
signs will help to
reduce the risk for
injury to the other
parts of the body.
 Ensuring the
patient’s safety.
 To prevent further
injury to the
patient.
After 4 hours of
nursing management
the patient will
demonstrate
behaviors to reduce
risk factors and
protect self from
injury.

Page | 76
(utensils, knife and
syringes) should be
keep.
 Encourage the SO
not to leave the
patient unattended
 Leaving the
patient unattended
may increase
anxiety to the
patient.

Page | 78
Reference : Jones and Bartlett Nurse’s Drug Handbook 2015 ( diphenhydramine page 325)
Name of Drug Dosage and
Frequency
Indications and
Contraindications
Side Effects Mode of
Action
Classification Nursing Responsibilities
Generic Name:
Diphenhydramine
Brand Name:
Benadryl
Date ordered:
01-30-2016
50 mg
PO
TID
Peak: 15-60 min
Onset: 1-4 hr
Duration: 4-8 hr
Indication:
To prevent allergic
reaction after blood
transfusion.
Transfusion reaction
symptoms include:
 back pain
 blood in your urine
 chills
 fainting or dizziness
 fever
 flank pain
 skin flushing
Contraindications:
Hypersensitivity to 𝐻1 –
receptor antagonist,
acute asthma attack,
lower respiratory tract
disease, neonates.
 Dizziness
 Drowsiness
 fatigue
anxiety
 Nausea
Acts on blood
vessels, GI,
respiratory
system by
competing with
histamine for
𝐻1 –receptor
site; decreases
allergic
response by
blocking
histamine.
Antihistamine  Medication may
cause drowsiness.
 Advised the
patient to avoid
activities requiring
alertness until response
of drug is unknown.
 Inform the patient
that this drug may
cause dry mouth.
 Frequent oral
rinses, good oral
hygiene, and candy
that may minimize this
effect.
 Teach patient and
significant other that
this drug may cause
drowsiness.

Page | 79
Frequency
Indications and
Contraindication
s
Side Effects Mode of Action Classification Nursing Responsibilities
Generic Name:
Cefixime
Brand Name:
Suprax
Date ordered:
02- 02- 2016
200 mg
PO
BID
Peak: rapid
Onset: 2-6 hr
Duration: 24 hr
Indication:
Treatment for
infection.
The patient’s
urinalysis revealed
a presence of few
bacteria in urine as
of Jan. 31, 2016.
Contraindication
s:
Hypersensitivity to
cephalosporin or
their
Components.
 Chills
 fever
 headache
 seizures
 Abdominal
cramps
 diarrhea
 elevated
 liver function
test results
 hepatic failure
 hepatitis
 hepatomegaly
 jaundice
 nausea
Interferes with
bacterial cell
wall synthesis
by inhibiting the
final step in the
crosslinking
of peptidoglycan
strands.
Peptidoglycan
makes cell
membranes rigid
and protective.
Without it,
bacterial cells
rupture and die.
Antibiotic  Be aware that an
allergic reaction may
occur a few days after
therapy starts.
 Assess bowel pattern
daily.
 Assess for signs of
superinfection, such as
perineal itching, fever,
malaise, redness, pain,
swelling, drainage,
rash, diarrhea, and
cough or sputum
changes.
 Instruct patient and
significant other to
complete the prescribed
course of therapy.
 Tell patient and S.O. to
report severe diarrhea
to prescriber
immediately.
Reference : Jones and Bartlett Nurse’s Drug Handbook 2015 (cefixime page 205)

Page | 80
Reference : Jones and Bartlett Nurse’s Drug Handbook 2015 (ceftriaxone page 223)
Frequency
Indications and
Contraindications
Side Effects Mode of
Action
Classificatio
n
Nursing
Responsibilities
Generic Name:
Ceftriaxone
Brand Name:
Rocephin
Date ordered:
02-02-16
1 g
IV
every 12 hours
Peak: rapid
Onset: end of
infusion
Duration: 12-24
hr
Indication:
To treat infection.
The patient’s
urinalysis revealed a
presence of few
bacteria in urine as of
Jan. 31, 2016.
Contraindications:
Hypersensitivity to
ceftriaxone, other
cephalosporins, or
their components
 Abdominal
cramps
 elevated
liver
function test
results
 Edema
 Arthralgia
 Allergic
pneumonitis
,
 dyspnea
Interferes with
bacterial cell
wall synthesis
by inhibiting
cross-linking of
peptidoglycan
strands.
Peptidoglycan
makes the cell
membrane rigid
and protective.
Without it,
bacterial cells
rupture and die.
Antibiotic  Assess bowel
pattern daily.
 Assess for
pharyngitis,
ecchymosis,
bleeding, and
arthralgia; they
may indicate a
blood dyscrasia.
 Advise patient and
S.O. to report any
hypersensitivity
reactions, such as
a rash, itching
skin, or hives, to
prescriber
immediately and
to stop taking the
drug.

Page | 81
Name of
Drug
Dosage and
Frequency
Indications and
Contraindications
Side effects Mode of Action Classification Nursing
Responsibilities
Generic
Name:
Vitamin K
Brand
name:
Phytonadione
Date
ordered:
01-30-16
1 amp
10mg/ml
IV
every 8 hours
Peak: 1-2 hr
Onset: unknown
Duration:
unknown
Indication:
To treat bleeding.
The patient
manifested
epistaxis and black
tarry stool at 2:00
pm as of Jan. 30,
2016.
Contraindications:
Hypersensitivity to
benzyl alcohol
(Aquamephyton
only)
 Gastric upset
 Unusual taste
 Rash
 Urticaria
 Flushing
 Erythema
 Allergic
reactions
Required for
hepatic synthesis
of blood
coagulation
factors II
(prothrombin),
VII, IX, and X.
An
antihemorrhagic
actor that
promotes hepatic
formation of
active
prothrombin.
Fat soluble
vitamins  Monitor the
patient for
gastric upset.
 Monitor
patient for the
possible side
effects that
may occur.
 To report any
signs and
symptoms of
allergic
reactions.
Reference: Davis’s Drug Guide for Nurses fifth edition 2010 (vitamin K, page 970)

Page | 82
Name of
Drug
Dosage and
Frequency
Indications and
Contraindicatio
ns
Side effects Mode of Action Classification Nursing
Responsibilities
Generic
Name:
Omeprazole
Brand
Name:
Losec
Ordered at:
01-29-16
6:30 am
01-30-16
10:00 am
02-01-16
6:00 am
40 mg
IV
OD
Peak: unknown
Onset: 10-90
min
Duration:
unknown
Indication:
Treatment and
prevention of
hypersecretions
of stomach acid.
Due to patient’s
lost appetite with
DHF it will
cause abdominal
pain.
Contraindicatio
ns:
Hypersensitivity
 Weakness
 Dizziness
 Headache
 Fatigue
 Abdominal
pain
 Acid
regurgitatio
n
 Constipatio
n
 Diarrhea
 Flatulence
 Nausea
 Vomiting
 Rash
 Itching
Suppresses gastric
secretion by
inhibiting
hydrogen;
characterized as
gastric pump
inhibitor
Anti-ulcer,
proton pump
inhibitor
 Inform the patient
and significant other
about the reason why
drug is given and how it
is process inside the
patient's body.
 Monitor for diarrhea
and abdominal pain.
 Take the drug before
meals.
 Report severe
headache, worsening
of symptoms, fever,
chills. Swallow the
capsules whole; do not
chew, open, or crush
them.
 Inform patient and
S.O. that he/she may
experience these side
effects: Dizziness;
headache; nausea,
vomiting, diarrhea;
symptoms of URI,
cough.
Reference: Davis’s Drug Guide for Nurses fifth edition 2010 (omeprazole, page 878)

Dengue Hemorrhagic Fever- Case Study

Dengue Hemorrhagic Fever- Case Study

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Andere mochten auch

Andere mochten auch (20)

Ähnlich wie Dengue Hemorrhagic Fever- Case Study

Ähnlich wie Dengue Hemorrhagic Fever- Case Study (20)

Mehr von Rozelle Mae Birador

Mehr von Rozelle Mae Birador (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Dengue Hemorrhagic Fever- Case Study