ENGLISH LANGUAGE II

NURSING CARE PLAN

GROUP 4

1. Putri Wahyu Utami 2011312008

2. Weli Puspita Sari 2011312026
3. Fadillah Buyatma Putri 2011312017
4. Diva Erlinda 2011312005
5. Kholik Mikro Jatortu Daulay 2011312029
6. Odelia Sabrina Visandri 2011312011
7. Intan dwi putri 2011312032
8. Afnila Angraini 2011312014
9. Afdalina Rahmida Wati 2011312020
10. Elvina Dwita 2011312023

FACULTY OF NURSING

ANDALAS UNIVERSITY

2020/2021
Case:

A nurse nursing profession student B, is in charge of caring for a male patient, Mr. Y, 37 years
old. The patient came to the hospital emergency room 1 day ago with the main complaint of
fever since 5 days before being admitted to the hospital, the fever persisted. The patient has
taken febrifuge, but the fever drops for a while and then rises again. After examination by a
doctor, the patient was diagnosed with DHF (Dengue Hemorrhagic Fever).
Nurse B then conducted a deeper assessment of this patient, and obtained the following data:

The patient has fever, nausea, vomiting, headache, muscle and joint pain, decreased appetite, a
reddish rash on the hands and feet
Composmentis awareness (CM)
TTV: TD: 100/70 mmHg
Temperature: 38 ℃
Pulse: 100x / minute
Respiratory rate: 20x / minute

From a laboratory examination, it was obtained Hb 14 g / dl, leukocytes 7,200 / mm³, platelets
63,000, Ht 46.5%

Assesment Diagnoses Planning Implementation Evaluation

Objectiv Data: Hyperthermia Fever Treatment Giving Warm 1. Body
1. The patient's associated with Treatment of Compress temperature
skin feels hot the disease Fever: within normal
2. S = 38 ℃ process (viral management of A warm ranges
3. TD = 100/70 infection) symptoms and compress is a 2. Blood
mmHg Hyperthermia: associated method of pressure, pulse,
4. N = 100x / An increase in conditions maintaining and respiratory
minute body associated with body rate are within
5. RR = 20x / temperature elevated body temperature normal ranges
minute above the temperature is using fluids or 3. Less
6. Leukocytes normal range both priogen tools that can headaches
7,200 / mm³ Characteristic and endogenous cause warmth or 4. No change in
7. Platelets: limitations: mediated coldness to the skin color
63,000 / μ - Convulsions 1. Monitor body parts
8. There was a - reddish skin temperature which improve
reddish rash on - increase in and vital signs blood
the patient's body circulation, and
hands and feet temperature reduce pain or
Subjective Data: - convulsions 2. Monitor skin soreness
1. The patient - tachycardia color and (Andormoryo,
says he still has - tachypnea temperature 2013).
fever - skin feels warm 3.Monitor the
2. The patient intake and
feels weak output,
3. The patient 4. fluid changes
says there is a that are not felt
reddish rash on 5. Give drugs or
the hands and IV fluids
feet 6. Give anti-
hyperic oats as
recommended
by your doctor
7. Apply warm
compresses to
the patient's
groin and axilla
8. Monitor the
patient's fever
complications
9. Facilitate
consumption of
fluids according
to their integrity