CASE PRESENTATION:

DENGUE FEVER WITH

PLEURAL EFFUSION
 DEMOGRAPHIC DATA

Name: Z. M. S. T Civil Status: Single

Sex: Female Educational Attainment: : N/A
Address: Cangmunag, San Juan, Siquijor_
Religion: Roman Catholic Age: 2 Occupation: N/A
Room and Bed No.:435-A Doctor(s) in Charge: ADCinco
Nationality: Filipino
Date and Time of Admission: February 2, 2018 at 8:17 p.m

Chief Complaints: Cough & Fever

Diagnos(es): _Dengue Fever with Pleural Effusion

 GROWTH AND DEVELOPMENT

 ZMST’s weight is 11.4 kg, height is 84 cm, Head circumference is 46

cm and abdominal circumference is 47 cm.

 The term terrible twos has often been used to describe the toddler
years, the period from 1 to 3 years old (12-36 mos.). It is a time of
intense exploration of the environment as children attempt to find
out how things work and how to control others through temper
tantrums, negativism, and obstinacy. Although this can be a
challenging time for parents and child as each learns to know the
other better, it is an extremely important period for developmental
achievement and intellectual growth.

 Z.M.S.T belongs to this age group. She is very active and curious.
She has temper tantrums. When she is frustrated she throws things
but mother is able to discipline her.
 DEVELOPMENTAL MILESTONE

 The major gross motor skill during the toddler years is the
development of locomotion. At age 2 years, toddlers can walk up
and downstairs using both feet and same step at the same time
and by age 2.5 years they can jump, using both feet, stand on one
foot for a second or two and manage a few steps on tiptoe. Fine
motor development is demonstrated in increasingly skillful
manual dexterity. By 2 years of age toddlers use their hands to
build towers and can open doors by turning door knobs, and
unscrew lids. Mastery of gross and fine motor skill is evident in
all phases of the child’s activity such as play, dressing, language,
and comprehension, response to discipline, social interaction
and propensity to injuries.

 ZMST is able to walk, she can remove clothing on her own, able
to communicate with others and follows when being disciplined.
 EMOTIONAL DEVELOPMENT: Autonomy vs
Shame and Doubt
 According to Erick Erickson (1993), the developmental task of toddlerhood
is acquiring a sense of autonomy while overcoming a sense of doubt and
shame. Several characteristics, especially negativism and ritualism, are
typical of toddlers in their quest for autonomy. As toddlers attempt to
express their will they often act with negativism. The words “No” or “Me
Do!” can be sole vocabulary. Emotions become very strongly expressed,
usually in rapid mood swings. One minute, toddlers can be engrossed in an
activity and the next minute they might be violently angered. If scolded for
doing something wrong, they can have a temper tantrum and almost
instantaneously pull at the parent’s legs to be picked up and comforted. In
contrast to negativism, which frequently disrupts the environment,
ritualism, the need to maintain sameness and reliability provides a sense of
comfort. Toddlers can venture out with security when they know that
familiar people, places, and routines still exist.

 ZMST has achieved this developmental task. She frequently says no and
has temper tantrums when frustrated. She is very comfortable around her
mother. She is afraid when nurses and other hospital personnel are
around. When hospital procedures are done she always says no.
However, she always finds comfort when mother and father is around.
 COGNITIVE DEVELOPMENT

 The period from 12 -24 months of age is a continuation of the final two
stages of the sensory motor phase. During this time the cognitive
processes develop rapidly and at times seem similar to those of mature
thinking. However, reasoning skills are still quite primitive and need to
be understood to effectively deal with the typical behaviors of a child of
this age. In stage 5 – Tertiary circular reaction (12-18 mos.), a toddler is
described as a “little scientist”. In stage 6 – Invention of New Means
through Mental Combination (18 – 24 mos.) where toddlers are able to
try out various actions mentally rather than having to actually perform
them. One of the most dramatic achievements is in the area of complete
object permanence. There is a greater symbolization of imitation. The
child is acutely aware of others’ actions and attempts to copy them in
gestures and in words which can be classified to as Domestic mimicry
which is imitating household activities.

 ZMST exhibits domestic mimicry by imitating household activities like

sweeping and cooking.
 SOCIAL DEVELOPMENT

 A major task of the toddler period is differentiation of

self from significant others, usually the mother.
Differentiation consists two phases. The separations
emerge from symbolic fusion with the mother.
Individuation marks the children’s assumption of their
individual characteristics in the environment. Toddlers
show less fear of stranger when parents are present but
when left alone with the stranger they become very
fearful and acutely anxious.

 ZMST is very anxious around strangers but gets

comfortable and secure when mother is around.
 Language

 Toddlerhood is a critical time for language development.

More striking characteristic is the increasing level of
comprehension. At 2 years approximately 300 words can
be spoken and uses multiword sentences by stringing
together two or three words. They have the ability to
comprehend and understand speech is much greater
than the number of words the child can say.

 ZMST is able to comprehend and understand when she

is being talked to. She has the ability to communicate
and her speech is understandable according to mother.
 Play

 This magnifies the toddler’s physical and

psychosocial development. Interaction with people
becomes increasingly important. The solitary play of
infancy progresses to parallel play where the toddler
plays alongside, not with, other children.

 ZMST plays together with neighbors and siblings

 NURSING THEORY

 The Nursing Need Theory was developed by Virginia A.

Henderson to define the unique focus of nursing practice.
The theory focuses on the importance of increasing the
patient’s independence to hasten their progress in the
hospital. Henderson’s theory emphasizes on the basic
human needs and how nurses can assist in meeting those
needs.
 NURSING DIAGNOSIS

 Deficient fluid volume r/t vascular leakage s/t dengue

fever
 Ineffective tissue perfusion r/t decreased lung expansion
s/t pleural effusion
 Risk for bleeding r/t possible impaired liver function and
plasma & platelet leakage s/t dengue fever
 Altered health maintenance related to inadequate health
seeking behavior
 Knowledge deficit related to importance of seeking
regular health check-ups
 Fatigue R/T physical weakness secondary to Dengue
fever
 Altered bowel elimination pattern r/t constipation