61271724 case-study-dengue

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https://www.homeworkping.com/PAMANTASAN NG LUNGSOD NG PASIG
Alcalde Jose St., Kapasigan, Pasig City
COLLEGE OF NURSING
In partial fulfillment in our Related Learning Experience
A Case Study of
DENGUE HEMORRHAGIC FEVER
(DHF)
STUDENT STAFF NURSES
LUNGAN, Aryan Tereza C.
MENDOL, Jessica A.
ACEVEDA, Keofome L.
STUDENT HEAD NURSE
CLINICAL INSTRUCTOR
Ma’am Josefina R. Maquiling
December 14, 2010 (TUESDAY)
PEDIA WARD

I N T R O D U C T I O N
The purpose of the study is to be familiarized with Dengue Hemorrhagic Fever
(DHF); its transmission, disease process, signs and symptoms and most especially on how this can
be treated or prevented.
Dengue hemorrhagic fever (also called H-fever, Breakbone or Dandy fever) is a severe,
potentially deadly infection spread by certain species of mosquitoes (Aedes aegypti). Aedes aegypti,
the transmitter of the disease, is a day-biting mosquito which lays eggs in clear and stagnant water
found in flower vases, cans, rain barrels, old rubber tires, etc. Four serotypes of dengue viruses (1,
2, 3, and 4 Group B Arboviruses) are known to cause dengue hemorrhagic fever. There are three
other arboviruses that have been identified with dengue-like diseases namely Chikungunya,
O’nyong nyong and West Nile fever. Dengue hemorrhagic fever occurs when a person catches a
different type dengue virus after being infected by another one sometime before. Prior immunity to
a different dengue virus type plays an important role in this severe disease.
The Department of Health warned the public about the rising number of dengue cases in the
country, which reached 11,803 cases from January 1 to March 27, 2010. The DOH said the number
of dengue cases is 61% higher than the 7,335 cases recorded during the same period last year. Dr.
Eric Tayag, head of the DOH National Epidemiology Center, said the El Niño phenomenon could
have something to do with the increase in dengue cases. He said the number of dengue cases also
shot up in 1998 when the El Niño phenomenon was felt in the country.
Sources
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 virus, accessible to mosquitoes which may
transmit the disease.
2. Standing water within the household and premises are usual breeding places.
Incubation Period
 4- 6 days (minimum=3days; maximum=10days)
Period of Communicability

 Unknown. Presumed to be on the 1st week of illness—when virus is still present in the blood.
Susceptibility, Resistance and Occurrence
All persons are susceptible. Both sexes are equally affected. Age groups predominantly
affected are the preschool and school age. Adults and infants are not exempted. Peak age affected 5-
9 years. Occurrence is sporadic throughout the year. Epidemic usually occur during the rainy
seasons—June-November. Acquired immunity may be temporary but usually permanent.
Signs and Symptoms
An acute febrile infection of sudden onset with clinical manifestation of 3 stages:
• First 4 days—Febrile or invasive stage starts abruptly as high fever, abdominal pain and
headache; later flushing which may be accompanied by vomiting, conjunctival infection and
epistaxis. Petechiae may be observed in pressure areas usually first on the face or distal
portions of the extremities.
• 4th-7th days—Toxic or hemorrhagic stage—lowering of temperature, severe abdominal
pain, vomiting and frequent bleeding from gastrointestinal tract in the form of hematesis or
melena. Unstable BP, narrow pulse pressure and shock may occur. Tourniquet test which
may be negative due to low or vasomotor collapse.
• 7th-10th days—convalescent or recovery stage generalized flushing with intervening areas
of blanching appetite regained and blood pressure already stable.
Grading of Dengue Fever
The severity of DHF is categorized into four grades:
• Grade I, fever without overt bleeding but with positive tourniquet test
• Grade II, manifestation of Grade I with clinical bleeding diathesis such as epistaxis, gum bleeding,
GI bleeding and hematemesis
• Grade III, circulatory failure manifested by a rapid and weak pulse with narrowing pulse
pressure (20 mmHg) or hypotension, with the presence of cold clammy skin and restlessness; and
• Grade IV, profound shock in which pulse and blood pressure are not detectable. It is noteworthy
that patients who are in threatened shock or shock stage, also known as dengue shock syndrome,
usually remain conscious.
 Grade III and IV are considered to be Dengue Shock Syndrome

Laboratory and Diagnostic Tests
1.) Tourniquet Test (Rumpel Leads Tests)
• Inflate the blood pressure cuff on the upper arm to a point midway between the systolic and
diastolic pressure for 5 minutes
• Release cuff and make an imaginary 2.5 cm square or 1 inch just below the cuff, at the antecubital
fossa
• Count the number of petechiae inside the box
• A test is (+) when 20 or more petechiae per2.5 cm square or 1 inch square is observed.
2.) A confirmed diagnosis is established by culture of the virus, polymerase chain reaction (PCR)
tests, or serologic assays.
The diagnosis of dengue hemorrhagic fever is made on the basis of the following triad of
symptoms and signs: Hemorrhagic manifestations; a platelet count of less than 100, 000 per cubic
millimeter (thromobocytopenia); and objective evidence of plasma leakage, shown either by
fluctuation of packed cell volume (greater than 20 percent during the course of the illness) or by
clinical signs of plasma leakage, such as pleural effusion, ascites or hypoproteinemia. Hemorrhagic
manifestations without capillary leakage do not constitute dengue hemorrhagic fever.
Management
Supportive and symptomatic treatment should be provided:
• Promote rest
• Medication
 There are no specific antivial drugs.
 Paracetamol – for fever
 Analgesic (Acetaminophen (Tylenol) and codeine) – for severe headache and joint and
muscle pains
 Aspirin and nonsteroidal antiinflammatory drugs should be avoided
o Rapid replacement of body fluids is the most important treatment

 Give ORESOL to replace fluid as in moderate dehydration at 75ml/kg in 46 hours or up to
23L in adults. Continue ORS intake until paient’s condition improves.
 Intravenous fluid
o For hemorrhage
 Keep patient at rest during bleeding periods
 For epistaxis – maintain an elevated position of trunk and promote vasoconstriction in
nasal mucosa membrane through an ice bag over the forehead.
 For melena – ice bag over the abdomen. Provide support during the transfusion therapy
o Diet
 Low fat, low fiber, nonirritating, noncarbonated
 Noodle soup may be given
o Observe signs of deterioration (shock) such as low pulse, cold clammy perspiration,
prostration.
o For shock
 Place in dorsal recumbent position to facilitate circulation
 Provision of warmth through lightweight covers (overheating causesvasodilatation which
aggravates bleeding)
Prevention
The best way to prevent dengue fever is to take special precautions to avoid contact with
mosquitoes.
 Eliminate vector by:
 Changing water and scrubbing sides of lower vases once a week
 Destroy breeding places of mosquito by cleaning surroundings
 Proper disposal of rubber tires, empty bottles and cans
 Keep water containers covered because Aedes mosquitoes usually bite during the day, be
sure to use precautions especially during early morning hours before daybreak and in the
late afternoon before dark.
Other precautions include:
 When outdoors in an area where dengue fever has been found
 Use a mosquito repellant containing DEET, picaridin, or oil of lemon eucalyptus

 Dress in protective clothing long sleeved shirts, long pants, socks, and shoes
 Keeping unscreened windows and doors closed
NURSE-CENTERED OBJECTIVES
General Objective
 To be knowledgeable about the nature of Dengue Hemorrhagic Fever, management and
treatment to be able to render effective nursing care to the client.
Specific Objectives
Upon the completion of this case study, the student-nurses shall have:
 Understood the accurate information about the clients past history and illness in relation to
clients condition
 Exhibited the anatomy and physiology of the body system involved in the disease.
 Acquired knowledge about the specific medications of the patient as well as its action,
indication, contraindications and adverse reaction.
 Utilized all the nursing interventions in abiding to the nursing process.
 Expounded on the laboratory and diagnostic procedures done with the patient, their
purposes, and specific nursing responsibilities before, during and after the procedure.
 And integrated the appropriate health teachings for proper home management of the health
problem and promotion of self care.
O B J E C T I V E S

BIOGRAPHIC DATA:
Client X is a 14 year old female who is currently residing at 17th
St. Luzviminda Kenneth
Road, Nagpayong Pinagbuhatan, Pasig City. She was born on September 1, 1996. She was the only
child of her parents. She is a Roman Catholic. She is a second year student in Nagpayong High
School.
CHIEF COMPLAINT:
“pabalik balik ‘yung lagnat ko”, as verbalized by the client.
HEALTH HISTORY:
A. History of Present Illness
Three days prior to admission, the client had fever, headache and abdominal pain. Before
she had fever, she came from school for their practice. After three days, they went to Bro. Francisco
Perez Clinic in Taytay, Rizal for check-up because of abdominal pain. Her blood test results revealed
decrease number of platelets (80g/L) and WBC (2.5g/L). she was diagnosed there having dengue
fever syndrome and was refer to any hospital with request for Complete Blood Count with Platelet
Count, Urinalysis and ordered to take paracetamol by lunch. Then they went to the emergency
room of Pasig City General Hospital.
On the day of admission, the client was ambulatory, had stable vital signs, had weight of
28.3 kg and with flushed skin.
B. Past History
The client already had mumps and chicken pox during childhood. She had complete
immunizations, as verbalized by her mother. She already had fever, cough and colds. She doesn’t
have any food, drug or environmental allergy. As stated by the client, she doesn’t experience any
accidents in the past and this is the first time she was confined into a hospital.
C. Family History
N U R S I N G H E A L T H H I S T O R Y

The client is the only child in the family. Her father is already 43 years old and currently
working as a painter, carpenter, or as a construction worker depending on the available job. While
her mother, age 42, is a plain house wife taking care of household chores. Her mother has
hypertension. Her mother also added that they don’t have a history of Tuberculosis, Diabetes, Heart
Disease and Cancer.
FUNCTIONAL HEALTH PATTERNS
1. Health Perception and Health Management Pattern
The client stated that her general health is good for she seldom get sick. She doesn’t have
regular exercise except or the activities in school and the morning exercise during flag ceremonies
on Monday. No cough and colds was noted 3 weeks PTA. She is not drinking liquor nor smoking
cigarettes ever since. It was her first time to be admitted in the hospital. The client said that she
may have acquired her illness from school since there were reported cases of dengue at their
school few days before she was admitted. The important thing she keeps on her mind while she is
in the hospital is that she needs to follow orders from the doctors and nurses to be well so that she
can go to school. Her mother thinks that we can help them by answering their question whenever
something is not clear to them and also by monitoring her daughter’s vital signs. Whenever
someone is sick in the family, they immediately consult their barangay health center and also seek
what they called “albularyo.” They believe in “tawas and hilot” but health center is where they
always consult first.
2.Nutrition and Metabolic Pattern
BEFORE ADMISSION
The client usually eat any available kind of food (fish, meat, vegetables, fruits) but most especially
viands with soup for three meals per day; around 6:00 in the morning, her breakfast comprises of a cup
of fried rice with a fried fish or egg. During morning snacks, she used to eat sandwich or any viand
available at school. During lunch time, her mother prepares a meal comprises of dishes like “nilagang
baka”. She consumes 1-2 cups of rice on the said meal. She used to eat bread or during merienda time.
During dinner, he usually eats “sinigang na baboy”. She drinks 6-8 glasses of water a day, approximately
2000 ml of water (1 cup= 250ml). She doesn’t drink soda because she’s afraid her father might scold
her. She’s is also not fond of eating junk foods and sweets. She used to take supplements and vitamins.
There’s no change in her appetite and there’s no discomfort during eating or drinking. The client
doesn’t have any dentures. She also said that there is no food that she is allergic to.
DURING CONFINEMENT

The client stated that in the hospital, she doesn’t eat a lot but any food available will do. According
to her his appetite slightly decreased because of her not-so-good condition. She consumes three meals a
day. Her meal usually comprises of food with soup and she drinks 6-8 glasses of water a day,
approximately 2000 ml of water (1 cup= 250 ml). She increases her water intake as ordered by the
doctor and nurse.
3.Elimination Pattern
BEFORE ADMISSION
The client’s bowel elimination pattern is once a day-every afternoon. The color of his stool
is from yellow to brown. She also said that she have no difficulty in defecation. With regards to
her urine elimination pattern, she stated that she urinates about 4x a day. The color of her urine is
yellowish one. She doesn’t have any difficulty in urination and doesn’t have excess perspiration.
DURING CONFINEMENT
The client’s bowel elimination and urine elimination does change a little. She urinates more
than 5x a day. The color of the urine is a yellowish one. He defecates once a day at different times
of times of the day. The color of her stool is not dark and it is formed in shape. He has excess
perspiration and odor problems.
4.Activity and Exercise Pattern
BEFORE ADMISSION
The client said that she has a sufficient energy for completing desired required activities at
school and at home. She has no regular exercise except for the activities at school and the
morning exercise during Monday flag ceremonies During her spare time, she used to watch TV
but only for about an hour because most of her time is allocated for doing her assignments and
projects.
DURING CONFINEMENT
Due to the client’s condition, she has little energy for completing desired required activities.
She can’t do all things that she usually do when she was admitted in the hospital.

5. Sleep Rest Pattern
BEFORE ADMISSION
The client stated that she has a continuous sleep, which comprises of 5-7 hrs of sleep. She’s
not taking any nap during afternoon because of school assignments. She usually sleeps on a side
lying position. She’s not taking any sleeping pills. She also added that she don’t feel any tiredness
upon waking up.
DURING CONFINEMENT
Now that the client is in the hospital, her sleep is always interrupted due to frequent
monitoring of Vital Signs. Her sleep is also interrupted due to the environment in the hospital. But
sometimes she sleeps for about 4-8 hours. She sleeps in a supine position. Client perceives that the
quality of sleep was the most important rather than the quantity of sleep.
6. Cognitive Perceptual Pattern
The client verbalized that she’s have no hearing difficulty in both ears and so she is not
using hearing aids. She also stated that she doesn’t wear any eyeglasses ever since. She doesn’t have
any history of check- up in any ophthalmologist. His pupils are equally rounded and reactive to light
and accommodation. The client verbalized that she doesn’t have difficulty in reading small writings.
There are no changes in her memory lately, upon assessment it was found out that the client is
oriented to time and place. The easiest way for the client to learn things are through reading. He
doesn’t have any difficulty in learning new things.
7. Self Perception and Self Concept Pattern
The client describes herself as a simple girl living a simple life. She’s a happy person and not
irritable. Before the illness started, there is no hindrance for her to do any activity except that she’s
really not into sports coz of her slim body. She doesn’t mind those few people who make her angry.
1st
DAY INTERVIEW ( November 15, 2010)
She has perceived ability for:
Feeding – 0 and sometimes 2
Grooming – 0
General Mobility – 0
Toileting - 0
Cooking – N/A
Home maintenance – N/A
Dressing – 2 because of her IV infusion
Shopping – N/A
NOTE:
Level 0: Full Self Care
Level 1: Requires use of equipment or device
Level 2: Requires assistance or supervisions from
another person
Level 3: Requires assistance or supervision from
another person/or device
Level 4: Is dependent and does not participate
N/A: Not Applicable

She used to just ignore them and just continue with her own life. The thing that makes her cry is
when she can’t go to school or can’t pay school fees because she’s afraid that her teacher might
scold her. She easily cries when she can’t do her projects related to financial matters. Despite of her
condition now she still has positive attitudes about herself.
8. Role-Relationship Pattern
The client belongs to a nuclear family. She is living with her mother and father. She doesn’t
have problems that are difficult to handle. Her family does depends on her father especially on
financial aspects. Everytime she has problems, she immediately consult her mother because most of
the time, her father is at work. Every time their family encounters a problem, they talk about it at
once for them not to prolong their problem. The most common problem that they encounter is
financial. Her support system in time of stress is her friends and family especially her mother.
Whenever her father can support their financial needs just like during her hospitalization, they seek
help from their other relatives. She doesn’t feel alone frequently; in fact she is a cheerful person.
9. Sexually-Reproductive Pattern
The client is already in the latency stage based on Freud’s Psychosexual stages of
development wherein in sexual urges sublimated in to sports and hobbies. She is fond of drawing
but not into sports. She is not active in sexual intercourse. She already had her first menstruation
when she was 13 years old. According to Erickson’s Psychosexual stages of development, he client
is in the stage of identity versus role confusion wherein it’s the time for her to develop an identity,
and decide for her career goals. According to her mother, she is really fond of drawing and very
eager to study and finishes her tasks ahead of time.
10. Coping Stress Tolerance Pattern
The term coping refers to the strategies a person utilize to adapt to physiological and
psychological problem or change. Upon assessment, she feels comfortable and not stress. Things
that stress her are more of the school projects that cause her to sleep late at night sometimes. The
client explained that whenever something bothers her, she easily talks to her mother about it and
so in that way, stress is avoided since her mother is always there to help her.
11. Value-Belief Pattern
The client’s mother verbalized that her daughter is very religious. The client goes to church
every Sunday. And if her mother can’t come with her to church, she goes with her Aunt and doesn’t
want to skip mass on Sundays. She says a prayer every night before she goes to sleep. She knows

that he can’t have everything that she wanted and accepted that but when it comes to school fees,
she really wanted to afford those to avoid being scold. The most important thing in his life now is
her family, health and studies. On a scale of 1-10; 10 being the highest she chose 10. That’s how
much important her family is. She stated that her religious beliefs and practices don’t interfere with
her hospitalization. But being hospitalized interfere with her religious practices since she can’t go
to mass when Sunday.
PARTS METHOD USED FINDINGS INTERPRETATION
GENERAL
LOC
Appearance
Development
Nutritional status
Emotional state
Gait
INSPECTION
Alert, coherence, oriented
No signs of distress
Ectomorph
Cachexic
Calm
Coordinated
NORMAL
SKIN
Color
Texture
Turgor
Temperature
Moisture
Others
INSPECTION
Flushed
Smooth
Fair
Warm
Moist, slightly oily
No lesions, some petechial
rash on legs.
NORMAL
HEAD
Configuration
Hair
Scalp
Face
INSPECTION
Normocephalic
Evenly distributed
Presence of dandruff
Symmetry
NORMAL
EYES
Lids
Conjunctiva
Sclera
Cornea & Lens
Pupil Size
Visual acuity
INSPECTION
Symmetrical
Pinkish, no discharge
Anicteric
Smooth, clear
Equal
Normal, do not wear eye
glasses.
NORMAL
EARS
External Pinnae
External Canal
Gross Hearing
INSPECTION
Symmetrical, no
tenderness
No discharge
symmetrical
NORMAL
P H Y S I C A L E X A M I N A T I O N

NOSE&SINUSES
Mucosa
Patency
Gross smell
Sinuses
INSPECTION
&
PALPATION
Pinkish, no discharge
Both are patent
Symmetrical
nontender
NORMAL
EYESMOUTH&PHARYNX
Lips
Tongue
Teeth
Gums
Mucosa
Speech
Uvula
Tonsils
INSPECTION
&
PALPATION
Slightly dry
Pinkish, midline
Caries, 3 missing teeth
Pinkish, non tenderness
Pinkish
Intact
Deviation to the R
Non inflamed NORMAL
NECK
Trachea
Lymph nodes
Thyroids
INSPECTION
&
PALPATION
Midline
Nonpalpable
Nonpalpable
NORMAL
BREAST
PATIENT REFUSED
THORAX&LUNGS
Breathing pattern
Shape of chest
Percussion
Breath sounds
AUSCULTATION
INSPECTION
PALPATION
PERCUSSION
Eupnea
AP ratio 1:2
Resonant
Vesicular
NORMAL
ABDOMEN
Skin
Umbilicus
Configuration
Bowel sounds
Percussion
INSPECTION
AUSCULTATION
PERCUSSION
PALPATION
Same with the skin color
Sunken
Flat
Slightly hyperactive
Tympanic
NORMAL

GENITAL&RECTAL
PATIENT REFUSED
UPPER/LOWEREXTREMITIES
Size
Skin color
Lesions
Temperature
Others:
INSPECTION
AND PALPATION
Equal size
Light to deep
No lesions
Warm
Symmetry with visible
veins; fingers, arm,
shoulder and wrist can
move freely in different
direction; mark of some
petechial rash
NORMAL
The group used the following 4 nursing theories to achieve their aim – health-
promoting behavior of the patient: (1) Lydia Hall’s Core, Care and Cure Model, (2)
Hildegard Peplau’s Interpersonal Relationship Theory, (3) Florence Nightingale’s
Environmental Theory and (4) Imogene King’s Goal Attainment Theory.
T H E O R E T R I C A L F R A M E W O R K

The theories of Lydia Hall, Hildegard Peplau, Florence Nightingale and Imogene King
are combined to each other because of their intense interrelationship. Hildegard Peplau’s
Interpersonal Relationship Theory is the backbone of Figure 1, for it illustrates the
interpersonal communication between the patient and healthcare team which affects the
healthcare decision-making and delivery. We may say that Lydia Hall’s Core, Care and Cure
Model & Imogene King’s Goal Attainment Theory and Florence Nightingale’s Environmental
Theory, Imogene King’s Goal Attainment Theory and Care part of Core, Care and Cure
Model happen simultaneously. Environmental Theory is centered at the Care part of Lydia
Hall’s Core, Care and Cure Model. But, it is affected by Imogene King and Hildegard Peplau.
Nightingale states 5 components of environment that the nurse should modify to satisfy the
Care part of Hall’s theory. Modification of the environment should be facilitated by the
nurse because this is an independent nursing intervention. While, Core, Care and Cure
Model and Goal Attainment Theory illustrate the implementation of different specific
needed interventions by the patient, nurse and doctors or other health care team members
through their continuous reaction and interaction. The Transaction phase of Goal
Attainment Theory signifies the evaluation of nursing process. It shows if the goal is met or
not which is health-promoting behavior. Therefore, ongoing assessment will be very
essential to adjust interventions when necessary.
THE SYSTEMIC CIRCULATION
A N A T O M Y & P H Y S I O L O G Y

Major ARTERIES (in bright red) and VEINS (dark red) of the system
 Blood from the aorta passes into a branching system of arteries that lead to all parts of the
body. It then flows into a system of capillaries where its exchange functions take place.
 Function only: to supply materials to — and remove materials from — the capillaries. Blood
from the capillaries flows into venules which are drained by veins.
o Veins draining the upper portion of the body lead to the superior vena cava.
o Veins draining the lower part of the body lead to the inferior vena cava.
o Both empty into the right atrium.
BLOOD
 Blood is a liquid tissue. Suspended in the watery plasma are seven types of cells and cell
fragments.
• red blood cells (RBCs) or erythrocytes
• platelets or thrombocytes
• kinds of white blood cells (WBCs) or leukocytes
• Three kinds of granulocytes
• Neutrophils
• eosinophils
• basophils
 Two kinds of leukocytes without granules in their cytoplasm
• lymphocytes
• monocytes
FUNCTIONS OF THE BLOOD
 Blood performs two major functions:
• transport through the body of
• oxygen and carbon dioxide
• food molecules (glucose, lipids, amino acids)
• ions (e.g., Na+, Ca2+, HCO3−)
• wastes (e.g., urea)

• hormones
• heat
• Defense of the body against infections and other foreign materials. All the WBCs participate
in these defenses
TYPES OF BLOOD CELLS
• Are produced in the bone marrow (some 1011 of them each day in an adult human!).
• Arise from a single type of cell called a multipotent stem cell.
STEM CELLS
• are very rare (only about one in 10,000 bone marrow cells);
• are attached (probably by adherens junctions) to osteoblasts lining the inner surface of bone
cavities;
• produce, by mitosis, two kinds of progeny:
• More stem cells (A mouse that has had all its blood stem cells killed by a lethal dose of
radiation can be saved by the injection of a singleliving stem cell!).
• Cells that begin to differentiate along the paths leading to the various kinds of blood cells.
P A T H O P H Y S I O L O G Y
Precipitating Factors:
 Previous dengue infection
 Environmental condition
 Mosquito carrying a different strain
Predisposing Factors:
 Age – 32y/o

Macrophages &
monocytes
Immunoglobulins
(Specific antibodies of
previous virus strain)
Attachment to
the dengue virus
to facilitate
phagocytosis
Phagocytize the
dengue virus
through the Fc
receptor (FcR)
Unable to
deactivate
the virus
Inflammatory Response
Aedes aegypti (dengue virus carrier): 8-12 days of
viral replication on mosquitos’ salivary glands
Bite from mosquito (Portal of Entry in the Skin)
Inoculation of dengue virus in the circulation/blood
(Incubation Period: 3-14 days)
Rapid dissemination of dengue virus in the blood
Redness;
itchiness in the
area
Virus Replication
takes place –
Multiplies & Release
to the blood stream
Systemic
Infection
Dengue Fever
Decreased WBC
Fever, body
weakness,
diaphoresis,
headache,
warm skin.

PARACETAMOL (Biogesic) 325mg/Tab for FEVER (temp. ≥37.8 0
C)
Brand Name Acetaminophen,
Classification ANALGESIC
Action
Decreases fever by inhibiting the effects of pyrogens on the hypothalamic heat regulating
centers and by hypothalamic action leading to sweating & vasodilations.
N U R S I N G C A R E P L A N
D R U G S T U D Y

Indications Relief of mild-moderate pain; treatment of fever.
Contraindications Hypersensitivity, intolerance to tartrazine, alcohol, table sugar and saccharin.
Adverse Effects
CNS: Headache
CV: Chest pain, dyspnea, myocardial damage when doses of 5–8 g/day are ingested daily
for several weeks or when doses of 4 g/day are ingested for 1 yr
GI: Hepatic toxicity and failure, jaundice
GU: Acute kidney failure, renal tubular necrosis
Hematologic: Methemoglobinemia—cyanosis; hemolytic anemia—hematuria, anuria;
neutropenia, leukopenia, pancytopenia, thrombocytopenia, hypoglycemia
Hypersensitivity: Rash, fever
Drug Interaction
Toxicity may be increased in patients receiving other potentially hepatoxic drugs that
induce liver microsomal enzymes. The absorption on paracetamol may be accelerated by
drugs such as metoclopramide.
Nursing
Considerations
 Do not exceed the recommended dosage.
 Consult physician if needed for children < 3 yr; if needed for longer than 10 days; if
continued fever, severe or recurrent pain occurs (possible serious illness).
 Avoid using multiple preparations containing acetaminophen. Carefully check all OTC
products.
 Give drug with food if GI upset occurs.
 Discontinue drug if hypersensitivity reactions occur.
 Treatment of overdose: Monitor serum levels regularly,
 -acetylcysteine should be available as a specific antidote; basic life support measures
may be necessary.
Teaching Point:
 Do not take for longer than 10 days.
 Take the drug only for complaints indicated; it is not an anti-inflammatory agent.
 Avoid the use of other over-the-counter preparations. They may contain
acetaminophen, and serious overdosage can occur. If you need an over-the-counter
preparation, consult your health care provider.
 Report rash, unusual bleeding or bruising, yellowing of skin or eyes, changes in
voiding patterns.
RANITIDINE 30mg IV every 8 hours
Name Zantac, Ramadine
Classification Gastrointestinal Drugs
Action
Inhibits histamine at H2 receptor site in the gastric parietal cells, which inhibits gastric
acid secretions.
Indications Use in management of various GI disorders such as dyspepsia, GERD, peptic ulcer.
Contraindications Hypersensitivity. History of acute porphyria. Long-term therapy.
Adverse Effects CNS: Headache, malaise, dizziness, somnolence, insomnia, vertigo
CV: Tachycardia, bradycardia, PVCs (rapid IV administration)
Dermatologic: Rash, alopecia
GI: Constipation, diarrhea, nausea, vomiting, abdominal pain, hepatitis, increased
ALT levels
GU: Gynecomastia, impotence or decreased libido
Hematologic: Leukopenia, granulocytopenia, thrombocytopenia, pancytopenia
Local: Pain at IM site, local burning or itching at IV site

Other: Arthralgias
Drug Interaction
It can increased effects of warfarin, TCAs, Decreased effectiveness of diazepam,
Decreased clearance and possible increased, toxicity of lidocaine, nifedipine
Nursing
Considerations
Observed the 10 RIGHT’s in drug administration.
Assess potential for interaction of other pharmacological agents patient may be taking.
Assess the knowledge/teach patient about the possible side effects, appropriate
intervention and adverse symptoms to report.
Monitor AST, ALT, serum creatinine when used to prevent stress-related GI bleeding.
Inform the patient that it will take several days before noticeable relief.
Allow 1 hr between any other antacids & ranitidine.
Follow diet as recommended.
If you miss a dose, use it as soon as you remember. If it is near the time of the next dose,
skip the missed dose and resume your usual dosing schedule. Do not double the dose to
catch up.
TERBUTALINE 2.5mg/tab 2x a day
Name Bricanyl , Brethine
Classification Respiratory drugs
Action
Specific beta 2 adrenergic receptor stimulant, resulting to bronchodilation and relaxation
of peripheral vasculature. It also causes relaxation of uterine smooth muscles and has
minimal beta 1 activity.
Indications
Terbutaline is given as the sulfate for its bronchodilating properties in reversible airways
obstruction. It also decreases uterine contractility and may be used to arrest premature
labour.
Contraindications
Hypersensitivity to sympathomimetic agents. Thyrotoxicosis; pregnancy 1st
trimester.
Cardiac arrhythmias associated with tachycardia.
Adverse Effects
Palpitation, tachycardia, chest discomfort, arrhythmias, hypertension, CNS stimulation,
tremor, dizziness, headache, weakness, nausea, vomiting, GI distress, hypokalemia(high
doses), dyspnea, sweating, muscle cramps, ECG changes, increased heart rate, seizures.
Drug Interaction
Beta-blockers, monoamine oxidase inhibitors, tricyclic antidepressants.
Combining terbutaline with thioridazine (Mellaril) may increase the occurrence of abnormal heart
rhythms because both drugs can cause abnormal heart rhythms.

Nursing
Considerations
 Assess patient’s condition before the therapy and regularly monitor drug
effectiveness.
 Assess respiration (rate, rhythm and character).
 Monitor and report evidence of allergic reactions, rash, pruritus and urticaria.
 Monitor for possible drug induced adverse reactions: CNS: nervousness, headache,
drowsiness, dizziness, weakness CV: palpitations, tachycardia, arrhythmia, flushing GI:
vomiting, nausea, heartburn METABOLIC: hypokalemia, RESPI: paradoxical
bronchospasm, dyspnea SKIN: diaphoresis.
 Assess patient’s knowledge on drug therapy.
 Tech patient to monitor for and report adverse reaction.
L-CARNITINE 330mg/tab 2x a day
Brand Name Carnitor
Classification Amino acid supplement
Action
It is needed to release energy from fat. It transports fatty acids into mitochondria, the powerhouses
of cells.
Indications
For the acute and chronic treatment of patients with an inborn error of metabolism which results
in secondary carnitine deficiency.
For the prevention and treatment of carnitine deficiency in patients with end stage renal disease
who are undergoing dialysis.
Used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of
hyperlipoproteinemias.
Contraindications
None known.
The safety and efficacy of oral levocarnitine has not been evaluated in patients
with renal insufficiency, pregnant and nursing mothers.
Adverse Effects
Side effects includes abdominal pain, back pain, headache, hypertension, tachycardia, anorexia,
diarrhea, dyspepsia, nausea, vomiting, dizziness, weight decrease, paresthesia, pharyngitis,
dyspnea, rhinitis.
L-carnitine has not been consistently linked with any toxicity.
Drug Interaction
The body needs lysine, methionine, vitamin C, iron, niacin, and vitamin B6 to produce carnitine.
Phenobarbitals resulted in reduced blood levels of L-carnitine.
Nursing
Considerations

IVF SOLUTIONS
TYPE OF SOLUTION DATE /TIME INDICATION
D5LR 510cc x 6 hours 11-30-10 to 12-03-10 Resembles blood serum and rehydration

PNSS 1L x KVO 12-02-10
Replace ECF, water overload, medication diluents
& compatible with blood.
D5NM 550cc x 8 hours 12-03-10
Provides water and electrolytes for maintenance
of daily fluid and
electrolyte requirements, plus minimal
carbohydrate calories.
L A B O R A T O R Y S T U D Y
HEMATOLOGY Date : 11/30/10
TEST INDICATION NORMAL VALUE RESULT INTERPRETATION
Neutrocyte
To identify acute
and chronic
illness, bleeding
tendencies, and
white blood cell
disorders
0.35-0.65% 0.43% Normal
Lymphocyte 0.20-0.40% 0.37% Normal
WBC
4.50-11.00 x 10
g/L
2.5/l Low
Hemoglobin 115-160g/L 158g/l Normal
Hematocrit 0.40-0.50g/L 0.47g/l Normal
Platelet count 150-400 x 10g/L 80g/l
Decreased; possible immune
disorder
HEMATOLOGY Date : 11/30/10
Hemoglobin
To identify acute
and chronic
illness, bleeding
tendencies, and
white blood cell
disorders
115-160g/L 165/l
Increased possible for
Polycythemia, dehydration
Hematocrit 0.40-0.50g/L 0.46/l Normal
Platelet count 150-400 x 10g/L 337/l Normal
HEMATOLOGY Date : 12/01/10 (11:54am)
WBC
To identify acute
and chronic
illness, bleeding
tendencies, and
white blood cell
disorders
4.50-11.00 x 10
g/L
5.7g/l Normal
Hemoglobin 115-160g/L 169g/l
Polycythemia, dehydration
Hematocrit 0.40-0.50g/L 0.53/l
polycythemia,
hemoconcentration.
Platelet count 150-400 x 10g/L 30g/l
disorder

HEMATOLOGY Date : 12/01/10 ( 9:53 pm)
Platelet count
To identify acute
and chronic
illness, bleeding
tendencies, and
white blood cell
disorders
150-400 x 10g/L 40g/l
disorder
HEMATOLOGY Date : 12/02/10 (1:44 pm)
Platelet count
To identify acute
and chronic
illness, bleeding
tendencies, and
white blood cell
disorders
150-400 x 10g/L 88g/l
disorder
HEMATOLOGY Date : 12/03/10 (3:06 pm)
Platelet count
To identify acute
and chronic
illness, bleeding
tendencies, and
white blood cell
disorders
150-400 x 10g/L 85g/l
disorder
HEMATOLOGY Date : 12/04/10 (11:18am)
Platelet count
To identify acute
and chronic
illness, bleeding
tendencies, and
white blood cell
disorders
150-400 x 10g/L 99g/l
disorder
BLOOD CHEMISTRY (Cardiac Enzymes & Proteins) Date : 12/04/10 (10:01am)
CK-MB Specific indication
for the diagnosis
of myocardial
infarction.
313. – 618. 995. High (possible MI)
LDH 0. – 16. 24.
High
(Possible for Acute MI)

M- Medication
• Continue taking prescribe medication for the patient on exact dosage, time, and frequency
making sure that the purpose of the medication is truly discussed by the health care
provider.
• Instruct the patient to follow the instruction when administering meds.
• Advice the patient not to stop intake of prescribed meds, unless approved by the physician.
• Don’t give aspirin and NSAID’s; they increase the risk of bleeding. Any medicines that
decrease platelet count should be avoided.
E- Exercise
Instruct to avoid excessive activities that may result to stress. Just advised to perform range
of motions and repetitive body movements for promotion of optimum health. Remind about the
need for health promotion activities such as reading, watching T.V, etc
T – Treatment
• Bed rest is advisable during the re-occurrence of fever phase.
• Instruct to drink plenty of water or fluids that are available at home and eat nutritious diet.
• Advised to look for re-occurrence of danger signs and symptoms and report immediately.
H – Hygiene
Encourage to continue the routinely hygienic care of the patient
BLOOD CHEMISTRY (Cardiac Enzymes & Proteins) Date : 12/04/10 (10:01am)
CK-MB Specific indication
for the diagnosis
of myocardial
infarction.
313. – 618. 1107. High (possible MI)
LDH 0. – 16. 17. Slightly Elevated
D I S C H A R G E P L A N

O – OPD
Instruct the family members to have a check-up or to consult physician once a while to
monitor patient’s condition and for detection of recurrences and other complications that may arise
on to it.
D – Diet
Instruct the family members to give the client protein rich foods such as meat, fish, eggs and
dairy products.

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