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DHF III Casepres
DHF III Casepres
DHF III Casepres
PRESENTATION
Presented by:
Vernalin B. Terrado
Dengue Hemorrhagic Fever
General Objectives:
• The ultimate purpose of this study is to refresh
the learned concepts about dengue
hemorrhagic fever and to develop the
understanding on the particular disease in
accordance with further research and
presentation based on the patients situation.
Specific Objectives:
This case presentation seeks to provide different
information about the disease to be presented and
about the client being considered with the
following specific objectives:
• Give a brief introduction about Dengue
hemorrhagic fever together with its signs and
symptoms.
• Discuss the theoretical framework that is
related to the client’s condition.
• Present the client’s demographic data and
health history with its Gordon’s pattern of
functioning.
• Present the abnormal results of the Physical
Assessment made on the client.
• Present the different laboratory results or test
done to the client with its interpretation.
• Discuss the normal Anatomy and Physiology
of the Blood.
• Explain the Pathophysiology of Dengue
Hemorrhagic Fever
• Discuss the drugs prescribed to the client by a
Drug Study.
• Present an appropriate Nursing Care Plan for
the most prioritized problem.
• Give a Discharge Plan that the client may use
upon discharge to the hospital
Introduction:
Dengue hemorrhagic fever is an
acute febrile diseases found in
tropics.It is a complication of
Dengue fever with hemorrhages. It
is characterized by abnormal
vascular permeability,
hypovolemia and abnormal blood
clotting mechanism. The
Dengue virus type 1,2,3,4, along
with other arboviruse which are
chikungunya, O’ nyong-nyong,
west nile and flavi virus are
classified as the causative agents.
The vector responsible for the
transmission of the virus is the
domestic, day- biting mosquito
known as the Aedes aegypti.The
vector responsible for the
transmission of the virus is the
domestic, day-biting mosquito
known as the Aedes aegypti.
Clinical manifestations according to its grade
are persistent high fever, complains of pain,
nausea and vomiting, and pathological
vascular changes which is classified as
Grade I, Grade II is persistence of signs and
symptoms of Grade I with bleeding while
Grade III has additional signs of circulatory
failure and Grade IV with signs and
symptoms of hypovolemic shock that can lead
to death.
Diagnostic test used to determine DHF are Rumpel
leads test otherwise known as Tourniquet test and
platelet count test that is shown in hematology
examination.Treatment is mainly symptomatic and
supportive.
Theoretical Framework:
Nightingale's core nursing
theory has an environmental
focus: It was her belief that the
environment is an alterable
medium that can be used to
improve the conditions of
Nature and encourage healing.
Ventilation, clean air, clean
water, control of noise,
provision for light, and
Adequate waste management
are just a some of the elements
She believed could be
Monitored and improved when
necessary.
Nightingale’s theory addresses the prevention of
occurrences of Dengue Hemorrhagic Fever. In
facilitating proper environmental sanitation we can
achieve a surroundings with no presence of any vector
that cause its transmission as they can no longer exist if
the environment is not suited for their survival hence
decreasing the morbidity rate of Dengue in our country.
We should be knowledgeable on how to keep our
surroundings free from any breeding sites that could
serve as a reservoir for the mosquito. As a nurse we
should teach our clients how to do proper water storage
and environmental sanitation so as to prevent disease
occurrence and recurrence.
Comprehensive History:
Biographic Data:
• Name: E.D.B
• Date : 7-21-09
• Time of Admission 10:45 AM
• Unit/Room: Pedia isolation
room
• Address: Norzagaray,
Baliuag, Bulacan
• Age: 8 y/o
• Gender: Female
• Status: N/A
• Religion: Roman Catholic
• Citizenship: Filipino
• Birth date: February 25, 2001
• Birthplace: OLSJDM
• Attending Physician:
• Final Diagnosis: DHF III
• Working Diagnosis: DFS I
• Chief Complaint: Abdominal pain
with vomiting
Nursing History
Past Medical History
According to her mother the patient doesn’t
experience any illness before that they treat of as an
immediate concern aside from developing UTI when she
was 5 years old. The patient only experienced having
common cough and colds occasionally. She also
experiences fever before and it was relieved by over the
counter drugs and rest. Their family don’t seek
consultation for regular health check up. She hasn’t been
hospitalized and only seeks consultation to their
Baranggay Health center whenever any health problem
arises. She doesn’t also receive an immunization vaccine
for measles.
History of Present Illness:
Five days prior to admission the client suffers from
having a high fever with a temperature of 39. 4 degrees
celcius, Paracetamol was given for relief. After three
days the fever subsides and abdominal pain and
vomiting of brownish colored vomitus takes place which
prompted her hospitalization.
A. SKIN Inspection, palpation Varies from light toDark brown in color-Indicates impaired skin
deep brown, from ruddycomplexion with someintegrity.
pink to light pink, frompresence of wounds and-Hyperthermia
yellow overtones toabrasions in the extremities
olive, generally uniformof the client. No nodes or
skin temperature. mass elevation can be
palpated.. Hot to touch and
flushing skin.
K. UPPER ANDInspection Equal size on bothEqual size on both sides ofNot normal
LOWER sides of the body,the body. An ongoing IVFPalpable lymph nodes
EXTREMITIES weakness on the lowerof D5LR hooked @ rightindicates infection.
and upper extremities. arm regulated at 35Wounds indicates
gtts/min. Lymph nodes inimpaired skin integrity.
the Axilla and groins are
palpable. Noticeable
presence of wounds on the
lower right extremity and
both forearm.
1. SKULL Inspection, Palpation Proportional to the sizeProportional to the size ofNormal
of the body, round withthe body with prominence in
prominences in thethe frontal and occipital
frontal and occipitalarea, symmetrical in all
area, symmetrical in allplaces.
places.
2. SCALP Inspection White, clean, free fromWhite, slightly oily, withoutImproper hygiene..
masses, lumps, scars,presence of masses, lumps,
and lesions, no areas ofscars, and lesions but with
tenderness presence of lice.
1 - Formed elements:
• Red blood cells (or
erythrocytes)
• White blood cells (or
leucocytes)
• Platelets (or
thrombocytes)
2 - Plasma = water + dissolved
solutes
Characteristics of Blood:
• bright red
• dark red/purplish
• much more dense than pure water
• pH range from 7.35 to 7.45
• slightly warmer than body temperature
• typical volume in an adult is 5 liters
• 8% of body weight
Major Functions of Blood:
• Distribution & Transport
• Regulation (maintenance of homeostasis)
• Protection
Formed elements
RBC
• biconcave disk shape
• a hemoglobin carrier
• anucleate
• No mitochondria
• 120 lifespan
• erythropoietin is the
hormone that stimulates
RBC production
Erythropoiesis
platelets aggregation
Pathophysiology Poor environmental sanitation
Pleural Effusion
Drug study
•Ranitidine
•Paracetamol
Medication Action Indication Contraindication Side Effects Nursing
Responsibilities
Subjective Cues: After 3 days of >Plan Assessed skin. Establishes After 3-days
Impaired skin Nursing intervention Noted color, comparative baseline of nursing
“Makati po ang integrity related that will turgor, and providing
intervention intervention,
mga sugat ko sa sa to mechanical promote sensation. opportunity for
factors as the client will be wound Described and the client was
braso at binti” as
evidence by able to display healing in a measured timely intervention. able to
verbalized by the disruption of given span of wounds and
improvement in Display
client skin surface time. observed
wound healing as Improvement
>formulate changes
Objective Cues: evidenced by: ways on how Demonstrated Maintaining clean, in wound
>presence of Scientific
•Intact skin or to teach good skin dry skin provides a healing as
wounds in the Explanation
minimized significant hygiene, e.g., barrier to infection. Evidenced
lower right Alteration of the others in
presence of wash thoroughly Patting skin dry by:
extremity and both Epidermis proper caring and pat dry instead of rubbing •Minimized
wound..
because of of the carefully. reduces risk of
forearm. •Absence of presence of
external factors wounds. dermal trauma to
>pruritus Redness >Use wounds.
such as shearing fragile skin.
>warm to touch orerythema. methods to Instructed •Several
force Skin friction
wound surface. •Absence of improve skin family to caused by stiff or wounds have
>with watery integrity in an maintain clean, rough clothes leads
Purulent accessible anddry clothes, dried up.
discharge. discharge. to irritation of fragile •Minimized
easy way. preferably skin and increases
•Absence of cotton fabric risk for infection Erythema
itchiness. •Minimized
(any T-shirt).
itchiness
Cues Nursing Nursing Planning Nursing intervention Rationale Evaluation
diagnosis objective