TANCHULING COLLEGE, INC.

College of Nursing
Imperial Court Subdivision, Phase II,
Legazpi City 4500 Philippines
Tel. # (052) 480 -6106/(052) 742 -0098
http://www.tanchuling.edu.ph

DENGUE HEMORRHAGIC
FEVER

Presented by (2BSNA – Group 3)

Rovic Domino
Christelle Mae B. Hebres
Maria Nicole Jumetilco
Chelsea Lisay
Gleza Mae Miralles
Antoinette Nopia
Jessa Obogne
Jian Sevillano
Joannie Maxine Totanes
Arabella Rebueno
 TANCHULING COLLEGE, INC.
College of Nursing
Imperial Court Subdivision, Phase II,
Legazpi City 4500 Philippines
Tel. # (052) 480 -6106/(052) 742 -0098
http://www.tanchuling.edu.ph

CASE PRESENTATION

PATIENT’S PROFILE

I. IDENTIFICATION DATA
Client Name Patient M

Age/Sex 5 years old/ Male

Father/Spouse Name (asawa) NA

Hospital Registration number #0896

Ward PEDIA

Bed No. 324

Address P2 VICTORY VILLAGE LEGAZPI CITY

Education Kinder 2

Occupation NA

Marital Status CHILD

Religion Roman Catholic

Date of Admission March 19, 2023 (9:31pm)

Date of Discharge March

Diagnosis Dengue Hemorrhagic Fever

Surgery (if any) NONE

Date of Surgery NA

I. HISTORY OF ILLNESS

Chief Complaint Fever and Epistaxis

Present medical history (complaints of dyspnea,
low blood pressure, cold, and clammy skin)
Present surgical history (complaints of backache,
low blood pressure, fever, etc)
Past medical history (history of any hypertension, NONE
diabetes mellitus, asthma, COPD, or other
disease.
Past surgical history (history of any surgery in
the past)
1 day PTA, patient has onset of undocumented
fever with associated cough and cold. No consults
were done. Few hours PTA, still with above
symptoms and now with vomiting with several
episodes then later epistaxis was noted. Brought to
ER and subsequent admission.
NONE
NONE

GORDON’S FUNCTIONAL PATTERN

A. HEALTH PERCEPTION AND MANAGEMENT

PRIOR TO ADMISSION DURING HOSPITALIZATION

• Complete immunization. • The patient is willing to follow the
treatment procedure only with his
parents beside him.

B. NUTRITION AND METABOLSIM

PRIOR TO ADMISSION DURING HOSPITALIZATION

• He usually eats any available kind of food • Eats food rich in carbohydrates,
(Fish, meat, vegetables, and fruits but leafy greens and fruits.
sometimes he eats some unhealthy foods. • Drinks milk and more bottle of
• He drinks 6-8 glasses of water a day. Pocari sweat.
C. ELIMINATION

PRIOR TO ADMISSION DURING HOSPITALIZATION

• He was able to urinate 3x a day and • He was able to urinate 3 times and
defecate (poop) 1 to 2x a day. defecate (poop) 1 to 2x a day.

D. ACTIVITY/EXERCISE

PRIOR TO ADMISSION DURING HOSPITALIZATION

• Daily routine is going to • He interacts with his aunts,
school, playing with friends mother, and visitors.
outside of their house and
sometimes watch YouTube or
videos on cellphone.

E. COGNITION AND PERCEPTION PATTERN

PRIOR TO ADMISSION DURING HOSPITALIZATION

• There is no problem with his senses, • Responsive but shy when asked.
he can comprehend responses to
physical and verbal cues.

F. SLEEP AND REST PATTERN

PRIOR TO ADMISSION DURING HOSPITALIZATION

• He sleeps for a long time, reaching • Sleeps as much as he can and wakes
7 to 8 hours. up to eat and take medication.
G. SELF- PERCEPTION AND SELF CONCEPT PATTERN

PRIOR TO ADMISSION DURING HOSPITALIZATION

• Jolly and obedient child. • Follows treatment procedure as
guided by his parents.

H. ROLES AND RELATIONSHIP PATTERN

PRIOR TO ADMISSION DURING HOSPITALIZATION

• He is the source of joy and strength • Strongly supported and taken care
of her parents. by his parents.
• Strongly supported and taken care
by his parents.

I.SEXUALITY AND RELATIONSHIP PATTERN

PRIOR TO ADMISSION DURING HOSPITALIZATION
• Child • Child

J. COPING AND STRESS TOLERANCE

PRIOR TO ADMISSION DURING HOSPITALIZATION
• Eats while watching kids shows in • Amuse himself watching kiddie shows
YouTube. and often takes a nap.
K. VALUES AND BELIEF PATTERN
PRIOR TO ADMISSION DURING HOSPITALIZATION
• He is a Roman Catholic who loves to • Pray before eating and before bedtime.
pray before sleep.

FAMILY HISTORY

Family Members Age/Sex Occupation Relation to Health Status Educational Attainment

Patient

R. Mesias 32 Crew member Father Healthy College undergraduate

L. Mesias 29 Housewife/Online Mother Healthy College undergraduate

Seller

PERSONAL HISTORY

Dietary Habits (vegetarian/ non vegetarian) The patient eats 3meals and 2 snacks a day. He
eats fruits and vegetables and drinks milk
However he also has a bad habit of eating
unhealthy foods such as chips, sweets, etc.

Addiction: history of smoking, drug addiction, None

alcohol consumption, etc.

The family belongs to the low-income class

Socio-economic status: family category; however, they can sustain
their everyday expenses.
 PHYSICAL EXAMINATION

GENERAL APPEARANCE FINDINGS

Body built Ectomorph

Height 105.9 cm

Weight 18kg

VITAL SIGNS

Temperature: 37.6°C

Pulse: 118 bpm

Respiration: 30 bpm

B.P: -

Color of the skin (-) jaundice

(-) pallor

Overall skin color is brown.

HEAD

Shape and size of skull: Head symmetrical in shape.

Scalp: Smooth, shiny free from dandruff and any lesion.

Face: Face facial symmetry, no facial drooping noted.

EYES

Vision: 17/20

Eyebrow and eyelid: Eyebrows are thick and eyelids are normal.

Eyeball: Eyeballs are symmetrical in size and position.

Conjunctiva: Pale

Sclera: White

Cornea and iris: Translucent

Pupil: Equal

Lens: Clear
EAR

External ear: Normal & symmetrical

Tympanic membrane: Pearly gray, shiny, translucent, with no bulging or

retraction.

Hearing problem:
No hearing problem.

NOSE

External nares: Nose is symmetric, midline, and (+) sign of

bleeding.

Both nostrils are patent.

Nostrils:

MOUTH & PHARYNX

Mouth: Mouth is dry.

Teeth: Teeth cavities are present.

Tongue: White plaque is present.

Throat and pharynx: No sign of inflammation, swelling exudate.

 GENERAL APPEARANCE FINDINGS

NECK

Thyroid gland: Symmetrical movement with swallowing. No masses,

tenderness, or enlargement. Unable to palpate or see
nodes.

Lymph node: There is no tenderness upon palpation of lymph nodes, it

has smooth, sharply edged, and elastic in consistency.

ROM is limited on arms due to body weakness.

Range of motion:

CHEST

Breath sounds: Clear

Lungs: Normal/Clear

Heart: Normal
 ABDOMEN

Inspection: No Distension found in the abdomen.

Auscultation: Sounds are low-pitched and gurgling, and the rate is normally
2 to 5/min.

Palpation:
No tenderness upon palpation.

Percussion:
No sign of abnormalities upon percussion

EXTREMITIES

Upper: Weakness and muscle aches on the upper arms and legs
are noted, there is no sign of lesions & deformity. There
is limited range of motion on both upper and lower
extremities.
Lower:

Back: No redness and bed sores found in the back.

Genital: No ecchymosis, excoriation, nodule, swelling, rash, and

lesion

No excessive pain, tenderness induration irregularities, or

Rectum: nodules in the rectum or rectal wall
 SYSTEMIC EXAMINATION

Central nervous system The patient looks distracted and uncomfy due to
headaches and dizziness, there is no motor deficits noted,
Sensation is intact bilaterally.

Sensory system: 17/20 vision, Sunken eyeballs, Conjunctiva pale

Respiratory system: The breathing pattern is symmetry. no tenderness upon

palpation of the chest wall. Patient does not exhibit signs
of respiratory distress. Lung sound is clear on all lobes.
resonance sound is percussed.

The external chest is normal in appearance without lifts,

Cardiovascular system: heaves, or thrills. Heart rate and rhythm are normal.

Gastrointestinal system: Digestion problem due to recurrent vomiting.

Musculoskeletal system: Presence of muscle aches

Genitourinary system: No sign of inflammation swelling exudate.

Integumentary system: Dry and pale-looking skin

 ANATOMY & PHYSIOLOGY

HUMAN CELL
Cells have long been recognized as the simplest units of living matter that can maintain life
and reproduce themselves. The human body, which is made up of numerous cells, begins as a
single, newly fertilized cell.
Structure of Cell
Almost all human cells are microscopic in size. To give you an idea how small a cell is, one
average-sized adult body, according to one estimate, consists of 100 trillion cells! There are many
different types, sizes, and shapes of cells in the body. For descriptive purposes, the concept of a
"generalized cell" is introduced. It includes features from all cell types. A cell consists of three
parts: the cell membrane, the nucleus, and, between the two, the cytoplasm. Within the cytoplasm
lie intricate arrangements of fine fibers and hundreds or even thousands of miniscule but distinct
structures called organelles.
1. Cell Membrane - It maintains the integrity of a cell and controls passage of materials into and
out of the cell. All materials within a cell must have access to the cell membrane (the cell's
boundary) for the needed exchange.
2. Nucleus and Nucleolus -The nucleus, formed by a nuclear membrane around a liquid
nucleoplasm is the control center of the cell. The nucleolus is a dense region of ribonucleic
acid (RNA) in the nucleus and is the site of ribosome formation. The nucleus determines how the
cell will function, as well as the basic structure of that cell.
3. Cytoplasm - All the functions for cell expansion, growth and replication are carried out in the
cytoplasm of a cell. Within the cytoplasm, materials move by diffusion, a physical process that
can work only for short distances.
4. Cytoplasmic Organelles - Cytoplasmic organelles are "little organs" that are suspended in the
cytoplasm of the cell. Each type of organelle has a definite structure and a specific role in the
function of the cell.
SKIN
Skin provides numerous functions vital to life and is important for overall health. The skin's
health and appearance can be an indicator of general health, and skin integrity failure often
accompanies the failure of other organ systems within the body. The human skin is divided into
three main layers: the epidermis, dermis, and subcutaneous tissue. The dermis and epidermis are
separated by a structure called the basement membrane. The thickness of skin varies depending on
the location of the body and is primarily determined by the varying thickness of either the dermis
or epidermis.

1. Epidermis - The epidermis is the avascular outermost layer of the skin. They play an
important role in the function of the skin as a protective barrier and through epithelization,
restore the integrity of the skin during wound healing. Dendritic cells, on the other hand, play
an important role in the immune system.
2. Dermis - The dermis is the thickest, vascular layer of the skin. The blood vessels in the dermis
are responsible for maintaining homeostasis, providing nutritional support, and
thermoregulation. Even though the blood vessels do not enter into the epidermis, the cells of
 the epidermis derived their oxygen and nutrients brought by the vasculature in the dermis
through simple diffusion.
3. Hypodermis - The hypodermis, or the subcutaneous tissue, is the bottom-most layer of skin
and lies just below the dermis. The hypodermis acts as an insulator, and an energy reservoir,
and provides cushioning to the skin.

BLOOD CELLS
Blood is important for regulation of the body’s systems and homeostasis. Blood helps maintain
homeostasis by stabilizing pH, temperature, osmotic pressure, and by eliminating excess heat.
Blood supports growth by distributing nutrients and hormones, and by removing waste. Blood is
made of several components, including red blood cells, white blood cells, platelets, and plasma,
which contains coagulation factors and serum.
Structure of 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 center of bones. The most active bone
marrow is found in the pelvic bone, shoulder bones, back bones, ribs, breastbone, and skull.
Immature blood cells in the bone marrow are called stem cells. Stem cells can also be found in
smaller amounts in the blood stream. These are called peripheral blood stem cells.
All 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.

1. Lymphoid cell line - Lymphoid stem cells develop into lymphocytes (also called lymphoblast).
Lymphocytes are another type of white blood cell (leukocytes). Lymphocytes help fight infection
and destroy abnormal cells.
2. 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.

The Components of Blood and it’s role

Red blood cells- contain hemoglobin, which binds oxygen. These cells deliver oxygen to the cells
and remove carbon dioxide. Red blood cells are disc- shaped and puckered in the middle.

Platelets- Blood plays a protective role by transporting clotting factors and to prevent blood loss
after injury. If a blood vessel is damaged, the body sends signals to platelets which cause them to
travel to the injured area. Once the platelets arrive at the site, they clump together to form a clot
that helps stop bleeding. Platelets are long and thin and about half length of the RBC.
Plasma and Serum- The plasma component of blood without coagulation factors is called
the serum. Serum is similar to interstitial fluid in which the correct composition of key ions acting
as electrolytes is essential for normal functioning of muscles and nerves. Other components in the
serum include proteins that assist with maintaining pH and osmotic balance while giving viscosity
to the blood.

White blood cells-The role of white blood cells is very different than that of red blood cells: they
are primarily involved in the immune response to identify and target pathogens, such as invading
bacteria, viruses, and other foreign organisms. White blood cells are formed continually; some
only live for hours or days, but some live for years. These cells—including neutrophils, monocytes,
lymphocytes, eosinophils, and basophils—are involved in the immune response.

• Neutrophils - 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 are a critical component of the innate immune system. They are
the source of many other vital elements of the immune system. Monocytes play a role in
both the inflammatory and anti-inflammatory processes that take place during an immune
response. Monocytes typically circulate through the blood for 1–3 days before migrating
into tissues, where they become macrophages or dendritic cells.
• Dendritic cells (antigen-presenting cells which can mark out cells that are antigens
(foreign bodies) that need to be destroyed by lymphocytes. Initiate and regulate the highly
pathogen-specific adaptive immune responses and are central to the development of
immunologic memory and tolerance.
• Macrophages (are phagocyte cells which are larger and live longer than neutrophils. It
also ables to act as antigen-presenting cells.) A critical effectors and regulators of
inflammation and the innate immune response, the immediate arm of the immune system.
• Lymphocytes - are a type of white blood cell. Lymphocytes help your body's immune
system fight cancer and foreign viruses and bacteria (antigens). Lymphocytes help your
immune system remember every antigen it comes in contact with cells which help to
regulate the body’s immune system. Lymphocytes include natural killer cells, T cells, and
B cells. They are the main type of cell found in lymph,

B lymphocytes - cells produce antibodies that are used to attack invading bacteria, viruses,
and toxins.
T lymphocytes - destroy the body's own cells that have themselves been taken over by viruses
or become cancerous.
Natural Killer cells - and they play essential roles in the frontline's defense of the innate
immune system. The term natural killer suggests that these cells can kill the target cells without
pre-stimulation.
 LABORATORY
LAB INVESTIGATION
HEMATOLOGY TEST – A laboratory analysis performed on a blood sample that is usually
extracted from a vein in the arm using a hypodermic needle, or via finger prick.

Date: 03/19/23 09:54pm

HEMATOLOGY
Investigation Normal Value Patient’s Clinical
Name Value significant/indicators/Remarks
HCT 34.0 – 49.0 % 34.3% NORMAL
HGB 120 – 150 g/L 117.0 g/L Low hemoglobin level
indicates low red blood cell
count (anemia).
WBC 5.0 – 13.0 10^3/uL 7.58 10^3/uL NORMAL
PLT 150.0 – 450.0 190 10^3/uL NORMAL
10^3/uL
RBC 3.8 – 5.4 10^6/uL 4.82 10^6/uL NORMAL
WBC DIFFERENTIAL COUNT
NEUT% 30.0 – 49.0 % 70.1% High neutrophil level is a sign
that the body has an infection.
LYMPH% 20.0 – 50.0 % 22.8% NORMAL
MONO% 3.0 – 14.0 % 6.6% NORMAL
EO% 0.0 – 7.0 % 0.0 NORMAL
BASO% 0.0 – 1.5 % 0.5% NORMAL
IG% 0.3% NORMAL
BLOOD INDICES
MCV 76.0 – 89.0 fL 71.2 fL Low MCV means that RBC are
smaller than normal and may
indicate microcytic anemia.
MCH 23.0 – 29.0 pg 24.3 pg NORMAL
MCHC 31.0 – 35.0 g/L 34.1 g/L NORMAL
MPV 7.0 – 12.0 fL 9.7 Fl NORMAL
PDW 9.0 – 17.0 fL 9.6 fL NORMAL

Date: 03/21/23 08:58am

HEMATOLOGY
Investigation Normal Value Patient’s Clinical
Name Value significant/indicators/Remarks
HCT 34.0 – 49.0 % 35.4% NORMAL
HGB 120 – 150 g/L 121.0 g/L NORMAL
WBC 5.0 – 13.0 10^3/uL 5.50 10^3/uL NORMAL
PLT 150.0 – 450.0 196 10^3/uL NORMAL
10^3/uL
RBC 3.8 – 5.4 10^6/uL 4.97 10^6/uL NORMAL
 WBC DIFFERENTIAL COUNT
NEUT% 30.0 – 49.0 % 65% High neutrophil level is a sign
that the body has an infection.
LYMPH% 20.0 – 50.0 % 29.6% NORMAL
MONO% 3.0 – 14.0 % 3.8% NORMAL
EO% 1.0 – 7.0 % 0.0 NORMAL
BASO% 0.0 – 1.5 % 0.7% NORMAL
IG% 0.2% NORMAL
BLOOD INDICES
MCV 76.0 – 89.0 fL 71.2 fL Low MCV means that RBC are
smaller than normal and may
indicate microcytic anemia.
MCH 23.0 – 29.0 pg 24.3 pg NORMAL
MCHC 31.0 – 35.0 g/L 34.2 g/L NORMAL
MPV 7.0 – 12.0 fL 9.0 Fl NORMAL
PDW 9.0 – 17.0 fL 9.7 fL NORMAL

Date: 03/23/23 06:43am

HEMATOLOGY
Investigation Normal Value Patient’s Clinical
Name Value significant/indicators/Remarks
HCT 34.0 – 49.0 % 38.7% NORMAL
HGB 120 – 150 g/L 129.0 g/L NORMAL
WBC 5.0 – 13.0 10^3/uL 6.50 10^3/uL NORMAL
PLT 150.0 – 450.0 139 10^3/uL A low platelet count can make
10^3/uL it difficult for the blood to clot,
putting a person at risk of
excessive bleeding.
RBC 3.8 – 5.4 10^6/uL 5.33 10^6/uL NORMAL
WBC DIFFERENTIAL COUNT
NEUT% 30.0 – 49.0 % 27.3% Low neutrophil can
cause swelling and repeated
infections. This makes it harder
for the body to fight off
pathogens.
LYMPH% 20.0 – 50.0 % 69.1% High lymphocyte blood levels
often indicate your body is
dealing with an infection or
other inflammatory condition.
MONO% 3.0 – 14.0 % 2.8% Low level of monocytes may
indicate your body is more
susceptible to infection.
EO% 2.0 – 7.0 % 0.0 NORMAL
BASO% 0.0 – 1.5 % 0.8% NORMAL
IG% 0.2% NORMAL
 BLOOD INDICES
MCV 76.0 – 89.0 fL 72.6 fL Low MCV means that RBC are
smaller than normal and may
indicate microcytic anemia.
MCH 23.0 – 29.0 pg 24.2 pg NORMAL
MCHC 31.0 – 35.0 g/L 33.3 g/L NORMAL
MPV 7.0 – 12.0 fL 10.3 Fl NORMAL
PDW 9.0 – 17.0 fL 11.6 fL NORMAL

SEROLOGY TEST - serology tests check for the presence or level of specific antibodies in the
blood. Antibodies are proteins that your immune system makes to fight foreign substances.
These substances are often pathogens, (disease-causing germs) such as viruses and bacteria.
Date: 03/19/23
SEROLOGY TESTS Results Clinical
(Dengue Duo) significant/indicators/Remarks
NS1 POSITIVE A positive NS1 test result
is indicative of a dengue
infection.
IgG NEGATIVE This means that the antibody
test cannot detect an infection in
the initial stages.
IgM NEGATIVE It indicates you have not been
infected with the virus.

URINALYSIS TEST – a standard test that examines a little sample of your urine. It can aid in
the detection of disorders that require treatment, such as infections or renal issues. It can also aid
in the detection of major disorders in their early stages, including as renal disease, diabetes,
including as liver disease.

Date: 03/20/23
URINALYSIS
Investigation Normal Value Patient’s Value Clinical
Name significant/indicators/Remarks
PHYSICAL
Color Pale yellow to YELLOW NORMAL
deep amber
Transparency Light yellow in SLIGHTLY NORMAL
color that is HAZY
transparent
pH 4.6 – 8.02 6.0 NORMAL
Albumin Less than 30 NEGATIVE NORMAL
mg/g
Glucose 0 – 0.8 mmol/L NEGATIVE NORMAL
Specific gravity 1.005 – 1.025 1.030 High specific gravity suggests
that the concentration of urine is
 too high. This can be a sign of
dehydration.
MICROSCOPIC
Pus Cells 0 – 5 HPF 2 – 3 /HPF NORMAL
RBC 4 HPF 0 – 1 /HPF NORMAL
Epithelial Cells Less than or FEW NORMAL
equal to 15 – 20
cells per HPF
Bacteria None NONE NORMAL
 MEDICATIONS

Name of Dose Classification Action Side Effects Nursing

Drug or Responsibilities
Route

IV Fluid

PNSS 500 Crystalloid Normal saline Hypotension, Monitor patient

ml x Fluid is a sterile, Febrile response frequently for -
60 cc/ nonpyrogenic venous thrombosis sign of
hr IV solution for or phlebitis infiltration.
fluid and extending from the -sign of
electrolyte site of injection. phlebitis/infection
replenishment Extravasation Check the level of
Hypervolemia the IVF.
-Correct solution
and volume
-Check and
regulate the drop
rate
-Change IVF
solution if needed

Paracetamol 150 Analgesics May block GI: Nausea, • Check I&O

mg pain impulses vomiting, ratio, decreasing
IV peripherally abdominal pain; output may
q4 that occur in hepatotoxicity, indicate renal
response to hepatic seizure failure (long-term
inhibition (overdose), GI therapy)
of bleeding • Assess for fever
prostaglandin GU: Renal failure and pain: type of
synthesis; does (high, prolonged pain, location,
not possess. doses) intensity,
anti- HEMA: duration, temp,
inflammatory Leukopenia, diaphoresis
properties; neutropenia, • Assess for
antipyretic hemolytic anemia chronic
action (long-term use), poisoning: rapid,
results from thrombocytopenia, weak
inhibition of pancytopenia pulse; dyspnea;
prostaglandins INTEG: Rash, cold, clammy
in the urticaria extremities;
CNS SYST: report
(hypothalamic Hypersensitivity immediately to
heat- prescriber
regulating • Assess
center) hepatotoxicity:
dark urine, clay-
colored stools,
yellowing of skin
and sclera;
itching,
abdominal pain,
fever, diarrhea if
patient is on long-
term therapy
• Assess allergic
reactions: if rash,
urticaria
occur, product
may have to be
discontinued
Patient/family
education
Teach patient not
to exceed
recommended
dosage; the elixir,
liquid, and
suspension come
in several
concentrations,
read label
carefully; acute
poisoning
with liver damage
may result; acute
toxicity
includes
symptoms of
nausea, vomiting,
and abdominal
pain; prescriber
should be
notified
immediately
• Inform patient
that toxicity may
occur when
used with other
combination
products
• Advise patient
not to use with
alcohol, OTC
products, or
herbals without
prescriber
approval
 • Teach patient to
recognize signs of
chronic
overdose:
bleeding,
bruising, malaise,
fever,
sore throat.

ORAL

Cetirizine 5ml Antihistamine Decreases Tinnitus, • Assess

syrup allergic restlessness, respiratory status:
BID response tremors, rate, rhythm;
by blocking parodoxical increase in
pharmacologic excitation in bronchial
effects of children or secretions,
histamine; geriatric wheezing, chest
minimal GI: Dry mouth, tightness; provide
anticholinergic increased liver fluids to 2 L/day
or sedative function tests, to decrease
action. constipation secretion
INTEG: Rash, thickness
eczema, • Assess for
photosensitivity, allergy
urticaria symptoms:
RESP: Thickening pruritus, urticaria,
of bronchial watering eyes,
secretions; baseline, during
dry nose, and treatment.
throat.
• Instruct patient
to take without
regard to
meals
• Instruct patient
not to exceed
recommended
dose;
dysrhythmias
may occur
• Advise patient to
avoid using if
breastfeeding
• Advise patient to
avoid exposure to
sunlight;
burns may occur
• Advise patient to
use sugarless
gum, candy,
frequent sips of
water to minimize
dry mouth.
• Advise patient to
avoid alcohol,
OTC
antihistamines,
other CNS
depressants.
 DISCHARGE PLAN

M - Medicine • Advice the parents to continue the prescribed home medication to ensure
optimum recovery.
• Encourage the parents to keep taking the medication that was prescribed
by the physician.
E - Exercise • Instruct the parents to encourage their son to walk in the morning as a
form of exercise but make sure that the patient has no pain
T - Treatment • Encourage the patient to increase fluid intake.
• Instruct the parents to let their son rest.
H - Health • Hanapin at sirain ang mga lugar na maaaring pangitlugan ng mga lamok.
Education • Alisan ng laman, linisin, kuskusin ng isang beses kada linggo ang mga
dram, timba, plorera, tray at basurahan.
• Itaob ang mga bote, lata at butasan din ang mga gulong upang hindi
maipunan ng tubig.
• Linisin ang alulod ng bubong ng bahay.
• Ugaliing maglinis ng kapaligiran lalo na sa mga lugar na madaling
pangitlugan ng mga lamok tulad ng kanal at iba pang lugar kung saan
naiipunan ng tubig.
• Ugaliing mag pausok o misting dalawang araw sa isang linggo upang
mabulabog ang pagpapadami ng mga lamok. Mas epektibo ito kung
mapapanatili ang kalinisan ng kapaligiran.
• Ugaliin maligo araw araw.
• Mag lagay ng pampahid sa katawan o insect repellent laban sa lamok at
iba pang mga insekto.
• Magsuot ng mahahabang kasuotan upang mas mabawasan
ang pagkalantad ng balat sa lamok.
• Manatili sa mas preskong lugar upang maiwasan ang pagpapawis at
pagtaas ng temperatura ng katawan. Mas mataas ang tyansa na dapuan ng
lamok ang mabasa basang balat at may mataas na temperatura.
• Dapat magpahinga ng mabuti.
• Uminom ng sapat (pinaka-mainam ang Oral Rehydration Salt or ORS
solution). Maari rin ang mga fruit juice tulad ng buko at iba pa; rice water
• Uminom ng paracetamol para sa lagnat.
• Maari rin mag tepid- sponge bath o magpunas gamit ang maligamgam na
tubig.
• Bumalik sa health center o RHU para sa follow-up at maulit ang CBC.
• Hanapin at sirain ang pinamumugaran ng mga kiti-kiti at pinangingitlugan
ng mga lamok.
• Bantayan at obserbahan ang progreso ng mga sintomas at pag develop ng
tinatawag na warning signs.
• Kung ang pasyente ay maobserbahan na magkaroon ng isa sa mga
sumusunod na warning signs, pumunta agad sa pinakamalapit na ospital:
• Kahit anong pagdurugo (mula sa ilong o gilagild; pagsuka ng
dugo, malakas na pagmens para sa mga babae, pag obserba ng
mga mapupulang spots sa balat o petechiae.
• Madalas o tuloy-tuloy na pagsusuka.
• Matinding sakit ng tiyan.
• Pagkaantok o pagkahilo; seizure o kombulsyon.
 • Pag-putla at panlalamig ng kamay at paa.
• Nahihirapan sa paghinga

O - Out Patient • Instruct patient to continue follow-up checks up to the doctor.

Department
(OPD)
D- Diet • Eat healthy foods such as fruits, vegetables, and meat.
• Drink a lot of water at least 8-10 glasses of water a day.

S - Spirituality • Instruct the parents and patient to pray to protect them from any harm.
 REFERENCES
Doenges M., Moorhouse M et.al, 2019. Nurses Pocket Guide, Diagnoses, Prioritized Interventions,
and Rationales 15th Ed. F.A Davis
Hitchings A. et. Al, 2015. The Top 100 Drugs, Clinical Pharmacology and Practical Prescribing.
Churchill Livingstone Elsevier
Katzung, B & Trevor, A, 2015. Basic and Clinical Pharmacology 13th Ed. Mc Graw Hill Education

Hoffman (2021), Picture of Blood. WebMD.

https://www.webmd.com/heart/anatomy-picture-of-
blood?fbclid=IwAR1Z0Ji7IiZqupSKcsSSFVwjyoIf0iGJ9baMcX3Fe_fVZ1CZipPvangzr
2U
An overview of blood. Pressbooks. http://pressbooks-
dev.oer.hawaii.edu/anatomyandphysiology/chapter/an-overview-of-
blood/?fbclid=IwAR3gSGqJ03n1KzUU_7vhc-
FmNqOs8mxdJ964hNFaxwEW2YPoU_LFvxSZyAY
Neural Academy, Dengue Fever Pathophysiology.
https://www.youtube.com/watch?v=hK2bDSYLH8E&pp=ygUoZGVuZ3VlIGhlbW9ycmhhZ2ljI
GZldmVyIHBhdGhvcGh5c2lvbG9neQ%3D%3D
JJ Medicine, Dengue Fever, https://www.youtube.com/watch?v=ZQwOvNe9-
Yo&pp=ygUoZGVuZ3VlIGhlbW9ycmhhZ2ljIGZldmVyIHBhdGhvcGh5c2lvbG9neQ%3D%3D
CDC, Plasma Leakage,
https://www.youtube.com/watch?v=U9e9__bjmnY&pp=ygUoZGVuZ3VlIGhlbW9ycmhhZ2ljIG
ZldmVyIHBhdGhvcGh5c2lvbG9neQ%3D%3D
https://www.facebook.com/dostcalabarzon/photos/pcb.1151424791732747/11514232150
66238/?type=3&theater