POLYTECHNIC COLLEGE OF DAVAO DEL SUR INC.

8002, McArthur Highway, Brgy. Kiagot, Digos City, Davao del Sur

A CASE PRESENTATION ON DENGUE FEVER

In Partial Fulfillment of the Requirement in NCM 121-RLE Medical-Surgical Nursing

The Bachelor of Science in Nursing IV

Presented to:

Jenny B. Artiaga, RN

Presented by:

Campugan, Britney Pearl

Calixtro, Karl Vincent

Bulahan, Ferneth Feel

Colata, Lady Jean

Cossid, Rischelle

APRIL 2024
 ACKNOWLEDGEMENT

A case presentation is akin to nurturing a delicate bloom, requiring sacrifice of cherished

moments, forsaking familial ties, and immersing oneself in the labor of love that is our work. In

extending our heartfelt gratitude, the researchers of this nursing case study wish to acknowledge

the invaluable contributions of those who have cultivated this endeavor, nurturing it to fruition

amidst the challenges:

To Mr. Morsid K. Tulao, RN MAN CHA, the Dean of the Nursing Department at the

esteemed institution of Polytechnic College of Davao del Sur Inc., we express gratitude for the

unwavering support and for graciously opening the doors to the department's abundant

resources. To Mr. Lexter Gabica RN LPT, the School Nursing Coordinator, we extend appreciation

for his attentive guidance, sagacious counsel, and uplifting words that have served as

nourishment along this journey. To Ma’am Jenny B. Artiaga, PHRN, AURN, we offer profound

thanks for bestowing upon us the essential skills, knowledge, and mentorship that have

empowered us to navigate the intricate pathways of the clinical realm with confidence.

Above all, we humbly acknowledge the benevolent grace of our Almighty Father, who has

bestowed upon us the strength, wisdom, and fortitude to persevere through the trials of this

undertaking. We also extend heartfelt gratitude to our beloved parents, whose unwavering

support has been a perennial source of inspiration amidst the challenges of online blended

learning. Additionally, we express sincere appreciation to our dear group mates, whose

collaborative spirit and unwavering assistance have illuminated even the darkest of times.
 OBJECTIVES OF THE STUDY

General Objective:

The researcher's general objective is to be able to present the case study of the selected

patient with chronic kidney disease, which would provide a thorough discussion of the

pathological mechanism of the disease with an emphasis on diagnosis and treatment using both

current and emerging treatment options that yield significant information for the case study.

Specific Objective:

In order to meet the general objective, the researcher aims to:

Establish rapport to the patient and the patient’s significant others,

Interpret the patient data gathered from the patient and his significant others, state

past and present health history of the patient.

To raise awareness and provide knowledge about chronic kidney disease.

To describe the factors that can increase your risk of having chronic kidney disease.

Present the cephalocaudal assessment obtained from the patient.

Discuss the anatomy and physiology of the organ involved in the patient’s disease,

Present the etiology and symptomatology of the patient’s disease

 Trace the pathophysiology of the patient’s disease. Obtain and rationalize the doctor’s

order, Interpret the laboratory test results of the patient, Discuss the nature of the

drugs given to the patient, Discuss the surgical procedure performed to the patient,

Present a specific, measurable, attainable, realistic and time-bounded nursing care plan

for the client, Justify the patient’s prognosis according to the different criteria,

Provide the patient and family with proper discharge planning (M.E.T.H.O.D.S.),

Outline recommendations based on the case study’s findings.

IDENTIFICATION OF THE CASE

A. PERSONAL IDENTIFICATION

Name: “Patient X”

Address: Digos City, Davao del Sur

Birthdate: October 29, 2013

Age: 10 years old

Civil Status: Single

Sex: Male

Religion: Catholic

Nationality: Filipino
Filipino Height: 127 cm

Weight: 28 kg

CLINICAL DATA

Date of Admission: March 31, 2024

Chief Complaint: Fever

Final Diagnosis: Dengue Fever without warning signs

Proposed Surgical Procedure: None

Hospital: Medical Center of Digos Cooperative

Ward: Pediatrics

Attending Physician: Dr. Villegas

Source of Information: Patient, Patient’s significant other, and patient’s chart

B. BACKGROUND/ HISTORY

“Patient X" is a grade 4 student in Elementary education. He is the second child among of

his 4 siblings. He is Filipino, who is Catholic and was born on October 29, 2013. His parents were

separated but they were still constantly supporting him financially and emotionally.

C. MEDICAL HISTORY

“Patient X" had an undocumented fever, cough and cold 4 days prior to admission.
D. FAMILY HISTORY

"Patient X" parents do not have any medical history, but on his mother's side, his

grandfather had a history of diabetes. On his father's side, his grandfather had a history of

kidney disease. There is no other significant health history related to Dengue among his family.

E. HISTORY OF PRESENT ILLNESS

"Patient X" enjoys playing outside often times. He stated that he and his classmates used

to play in some areas of their school, which lots of plants and stagnant water are present there.
 ETIOLOGY & SYMPTOMATOLOGY

Predisposing Factors Present/Absent Justification

In certain populations such as in the

Philippines, specific genetic variants

are associated with severe

complications of dengue. However,

Genetic Present
there is genetic susceptibility that is

universal, that is, the same alleles

increase or reduce susceptibility in

diverse regions of the world

Kardia et al., (2018)

Data from several South-east Asian

countries have shown that the

average/mean age of reported

dengue cases has increased from 5–

Age Present
12 years to older children and

adults. In Thailand, affected adults

over 15 years of age comprise 30–

40% of dengue cases.

 Dengue fever is endemic in the

Philippines, and the risk of

transmission is highest during and

immediately following the rainy

season, which typically occurs May-

Geographical Area Present
November. Urbanization, increasing

population, inadequate public

health infrastructure, poor solid

waste management, and lack of an

effective mosquito surveillance

system contribute to the growing

dengue challenge.

Precipitating Factors Present/Absent Justification

Being in tropical and subtropical

areas increases your risk of

exposure to the virus that causes

Environmental Factor (Living Present
dengue fever. Especially high-risk
the Dengue-risk area)
areas include Southeast Asia, the

Philippines including Davao Region.

NHS, (2023)
 Low immunity and immature

Decrease in immune system Present hemodynamic systems render the

children susceptible to severe

forms of this illness which can be

potentially life-threatening. Severe

illness is particularly seen in less

than 1 year and those between 4-

10 years.

Tucker et al., (2023)

The risk of dengue hemorrhagic

fever increases with poor

environmental sanitation, including

the presence of used goods around

the house, poor house lighting, and

Poor environmental Present
sanitation (Open spaces with the presence of larvae. Dengue
stagnant water)
mosquitoes are usually in dark

places and they breed in clear

stagnant water. The

metamorphosis from larvae to

mosquito usually takes 10-12 days.

Uclahealth, (2019)
 SYMPTOMATOLOGY

Symptoms Present Absent Justification

They help the immune system recognize

Fever ✔ dengue-infected cells and help protect

uninfected cells from infection. As the

immune system fights the dengue

infection, the person experiences a

fever.

This is mainly associated with vitamin D3

Pain on muscles & joints ✔ deficiency. Maintaining holistic health

and good nutrition balance helps

combat the issue. Micronutrient-

deficient people showcase persisting

joint and muscle pain.

The headache associated with dengue

Severe headache ✔ fever is considered to be very intense,

bilateral, throbbing, frontal, and retro-

orbital. New daily persistent headache

(NDPH) is a relatively rare headache

entity. It has already been reported that

systemic infectious disease may precede

the onset of NDPH.

While the etiology of hemorrhage in

Mild bleeding ✔ patients with dengue is poorly

understood, mild hemorrhagic

 manifestations might be due to

increased capillary fragility as a result of

thrombocytopenia or platelet

dysfunction.

The mild forms of hemorrhages seen

✔
Petechiae rash early in infection, such as petechiae,

result from different mechanisms

related to virus infection in combination

with the release of vasculogenic

cytokines.

The patient also may have early signs of

Restlessness ✔ shock, including restlessness, cold

clammy skin, rapid weak pulse, and

narrowing of the pulse pressure (systolic

blood pressure − diastolic blood

pressure).

Warning signs include severe stomach

Vomiting ✔ pain, vomiting, difficulty breathing, or

blood in your nose, gums, vomit or

stools.
 HUMAN ANATOMY AND PHYSIOLOGY

LYMPHATIC AND IMMUNE SYSTEM

The immune system is the complex collection of cells and organs that destroys or neutralizes
pathogens that would otherwise cause disease or death. The lymphatic system, for most people,
is associated with the immune system to such a degree that the two systems are virtually
indistinguishable. The lymphatic system is the system of vessels, cells, and organs that carries
excess fluids to the bloodstream and filters pathogens from the blood. The swelling of lymph
nodes during an infection and the transport of lymphocytes via the lymphatic vessels are but two
examples of the many connections between these critical organ systems.

Functions of the Lymphatic System

A major function of the lymphatic system is to drain body fluids and return them to the
bloodstream. Blood pressure causes leakage of fluid from the capillaries, resulting in the
accumulation of fluid in the interstitial space—that is, spaces between individual cells in the
tissues. In humans, 20 liters of plasma is released into the interstitial space of the tissues each day
due to capillary filtration. Once this filtrate is out of the bloodstream and in the tissue spaces, it is
referred to as interstitial fluid. Of this, 17 liters is reabsorbed directly by the blood vessels. But
what happens to the remaining three liters? This is where the lymphatic system comes into play.
It drains the excess fluid and empties it back into the bloodstream via a series of vessels, trunks,
and ducts. Lymph is the term used to describe interstitial fluid once it has entered the lymphatic
system. When the lymphatic system is damaged in some way, such as by being blocked by cancer
cells or destroyed by injury, protein-rich interstitial fluid accumulates (sometimes “backs up” from
the lymph vessels) in the tissue spaces. This inappropriate accumulation of fluid referred to as
lymphedema may lead to serious medical consequences.

As the vertebrate immune system evolved, the network of lymphatic vessels became convenient
avenues for transporting the cells of the immune system. Additionally, the transport of dietary
lipids and fat-soluble vitamins absorbed in the gut uses this system.

Cells of the immune system not only use lymphatic vessels to make their way from interstitial
spaces back into the circulation, but they also use lymph nodes as major staging areas for the
development of critical immune responses. A lymph node is one of the small, bean-shaped organs
located throughout the lymphatic system.

Structure of the Lymphatic System

The lymphatic vessels begin as open-ended capillaries, which feed into larger and larger lymphatic vessels,
and eventually empty into the bloodstream by a series of ducts. Along the way, the lymph travels through
the lymph nodes, which are commonly found near the groin, armpits, neck, chest, and abdomen. Humans
have about 500–600 lymph nodes throughout the body.
A major distinction between the lymphatic and cardiovascular systems in humans is that lymph is not
actively pumped by the heart, but is forced through the vessels by the movements of the body, the
contraction of skeletal muscles during body movements, and breathing. One-way valves (semi-lunar
valves) in lymphatic vessels keep the lymph moving toward the heart. Lymph flows from the lymphatic
capillaries, through lymphatic vessels, and then is dumped into the circulatory system via the lymphatic
ducts located at the junction of the jugular and subclavian veins in the neck.

Lymphatic Capillaries

Lymphatic capillaries, also called the terminal lymphatics, are vessels where interstitial fluid enters the
lymphatic system to become lymph fluid. Located in almost every tissue in the body, these vessels are
interlaced among the arterioles and venules of the circulatory system in the soft connective tissues of the
body. Exceptions are the central nervous system, bone marrow, bones, teeth, and the cornea of the eye,
which do not contain lymph vessels.
Lymphatic capillaries are formed by a one cell-thick layer of endothelial cells and represent the open end
of the system, allowing interstitial fluid to flow into them via overlapping cells (see Figure 21.3). When
interstitial pressure is low, the endothelial flaps close to prevent “backflow.” A s interstitial pressure
increases, the spaces between the cells open up, allowing the fluid to enter. Entry of fluid into lymphatic
capillaries is also enabled by the collagen filaments that anchor the capillaries to surrounding structures.
As interstitial pressure increases, the filaments pull on the endothelial cell flaps, opening up them even
further to allow easy entry of fluid.

In the small intestine, lymphatic capillaries called lacteals are critical for the transport of dietary lipids and
lipid-soluble vitamins to the bloodstream. In the small intestine, dietary triglycerides combine with other
lipids and proteins, and enter the lacteals to form a milky fluid called chyle. The chyle then travels through
the lymphatic system, eventually entering the bloodstream.

Larger Lymphatic Vessels, Trunks, and Ducts

The lymphatic capillaries empty into larger lymphatic vessels, which are similar to veins in terms of their
three-tunic structure and the presence of valves. These one-way valves are located fairly close to one
another, and each one causes a bulge in the lymphatic vessel, giving the vessels a beaded appearance.

The superficial and deep lymphatics eventually merge to form larger lymphatic vessels known as
lymphatic trunks. On the right side of the body, the right sides of the head, thorax, and right upper limb
drain lymph fluid into the right subclavian vein via the right lymphatic duct (Figure 21.4). On the left side
of the body, the remaining portions of the body drain into the larger thoracic duct, which drains into the
left subclavian vein. The thoracic duct itself begins just beneath the diaphragm in the cisterna chyli, a sac-
like chamber that receives lymph from the lower abdomen, pelvis, and lower limbs by way of the left and
right lumbar trunks and the intestinal trunk.

The overall drainage system of the body is asymmetrical (see Figure 21.4). The right lymphatic
duct receives lymph from only the upper right side of the body. The lymph from the rest of the
body enters the bloodstream through the thoracic duct via all the remaining lymphatic trunks. In
general, lymphatic vessels of the subcutaneous tissues of the skin, that is, the superficial
lymphatics, follow the same routes as veins, whereas the deep lymphatic vessels of the viscera
generally follow the paths of arteries.

The Organization of Immune Function

The immune system is a collection of barriers, cells, and soluble proteins that interact and
communicate with each other in extraordinarily complex ways. The modern model of immune
function is organized into three phases based on the timing of their effects. The three temporal
phases consist of the following:

• Barrier defenses such as the skin and mucous membranes, which act instantaneously to
prevent pathogenic invasion into the body tissues
• The rapid but nonspecific innate immune response, which consists of a variety of specialized
cells and soluble factors
• The slower but more specific and effective adaptive immune response, which involves many
cell types and soluble factors, but is primarily controlled by white blood cells (leukocytes)
known as lymphocytes, which help control immune responses
The cells of the blood, including all those involved in the immune response, arise in the bone
marrow via various differentiation pathways from hematopoietic stem cells (Figure 21.5). In
 contrast with embryonic stem cells, hematopoietic stem cells are present throughout adulthood
and allow for the continuous differentiation of blood cells to replace those lost to age or function.
These cells can be divided into three classes based on function:

• Phagocytic cells, which ingest pathogens to destroy them

• Lymphocytes, which specifically coordinate the activities of adaptive immunity
• Cells containing cytoplasmic granules, which help mediate immune responses against
parasites and intracellular pathogens such as viruses

Lymphocytes: B Cells, T Cells, Plasma Cells, and Natural Killer Cells

As stated above, lymphocytes are the primary cells of adaptive immune responses (Table 21.1). The two
basic types of lymphocytes, B cells and T cells, are identical morphologically with a large central nucleus
surrounded by a thin layer of cytoplasm. They are distinguished from each other by their surface protein
markers as well as by the molecules they secrete. While B cells mature in red bone marrow and T cells
mature in the thymus, they both initially develop from bone marrow. T cells migrate from bone marrow
to the thymus gland where they further mature. B cells and T cells are found in many parts of the body,
circulating in the bloodstream and lymph, and residing in secondary lymphoid organs, including the spleen
and lymph nodes, which will be described later in this section. The human body contains approximately
1012 lymphocytes.

B Cells

B cells are immune cells that function primarily by producing antibodies. An antibody is any of the group
of proteins that binds specifically to pathogen-associated molecules known as antigens. An antigen is a
chemical structure on the surface of a pathogen that binds to T or B lymphocyte antigen receptors. Once
activated by binding to antigen, B cells differentiate into cells that secrete a soluble form of their surface
antibodies. These activated B cells are known as plasma cells.

T Cells

The T cell, on the other hand, does not secrete antibody but performs a variety of functions in the
adaptive immune response. Different T cell types have the ability to either secrete soluble factors that
communicate with other cells of the adaptive immune response or destroy cells infected with
intracellular pathogens. The roles of T and B lymphocytes in the adaptive immune response will be
discussed further in this chapter.

Plasma Cells

Another type of lymphocyte of importance is the plasma cell. A plasma cell is a B cell that has
differentiated in response to antigen binding, and has thereby gained the ability to secrete soluble
antibodies. These cells differ in morphology from standard B and T cells in that they contain a large amount
of cytoplasm packed with the protein-synthesizing machinery known as rough endoplasmic reticulum.

Natural Killer Cells A fourth important lymphocyte is the natural killer cell, a participant in the innate
immune response. A natural killer cell (NK) is a circulating blood cell that contains cytotoxic (cell-killing)
granules in its extensive cytoplasm. It shares this mechanism with the cytotoxic T cells of the adaptive
immune response. NK cells are among the body’s first lines of defense against viruses and certain types
of cancer.

Type of lymphocyte Primary function

B lymphocyte Generates diverse antibodies

T lymphocyte Secretes chemical messengers

Plasma cell Secretes antibodies

NK cell Destroys virally infected cells

Primary Lymphoid Organs and Lymphocyte Development

Understanding the differentiation and development of B and T cells is critical to the understanding of the
adaptive immune response. It is through this process that the body (ideally) learns to destroy only
pathogens and leaves the body’s own cells relatively intact. The primary lymphoid organs are the bone
marrow and thymus gland. The lymphoid organs are where lymphocytes mature, proliferate, and are
selected, which enables them to attack pathogens without harming the cells of the body.

Bone Marrow

In the embryo, blood cells are made in the yolk sac. As development proceeds, this function is taken over
by the spleen, lymph nodes, and liver. Later, the bone marrow takes over most hematopoietic functions,
although the final stages of the differentiation of some cells may take place in other organs. The red bone
marrow is a loose collection of cells where hematopoiesis occurs, and the yellow bone marrow is a site of
energy storage, which consists largely of fat cells (Figure 21.6). The B cell undergoes nearly all of its
development in the red bone marrow, whereas the immature T cell, called a thymocyte, leaves the bone
marrow and matures largely in the thymus gland.

The thymus lies above the heart. The trabeculae and lobules, including the darkly staining cortex and the
lighter staining medulla of each lobule, are clearly visible in the light micrograph of the thymus of a
newborn. LM × 100.

The connective tissue capsule further divides the thymus into lobules via extensions called trabeculae.
The outer region of the organ is known as the cortex and contains large numbers of thymocytes with some
epithelial cells, macrophages, and dendritic cells (two types of phagocytic cells that are derived from
monocytes). The cortex is densely packed so it stains more intensely than the rest of the thymus (see
Figure 21.7). The medulla, where thymocytes migrate before leaving the thymus, contains a less dense
collection of thymocytes, epithelial cells, and dendritic cells.

Secondary Lymphoid Organs and their Roles in Active Immune Responses

Lymphocytes develop and mature in the primary lymphoid organs, but they mount immune responses
from the secondary lymphoid organs. A naïve lymphocyte is one that has left the primary organ and
entered a secondary lymphoid organ.
Naïve lymphocytes are fully functional immunologically, but have yet to encounter an antigen to respond
to. In addition to circulating in the blood and lymph, lymphocytes concentrate in secondary lymphoid
organs, which include the lymph nodes, spleen, and lymphoid nodules. All of these tissues have many
features in common, including the following:

• The presence of lymphoid follicles, the sites of the formation of lymphocytes, with specific B cell-
rich and T cell-rich areas
• An internal structure of reticular fibers with associated fixed macrophages
• Germinal centers, which are the sites of rapidly dividing and differentiating B lymphocytes
• Specialized post-capillary vessels known as high endothelial venules; the cells lining these venules
are thicker and more columnar than normal endothelial cells, which allow cells from the blood to
directly enter these tissues

Lymph Nodes

Lymph nodes function to remove debris and pathogens from the lymph, and are thus sometimes referred
to as the “filters of the lymph” (Figure 21.8). Any bacteria that infect the interstitial fluid are taken up by
the lymphatic capillaries and transported to a regional lymph node. Dendritic cells and macrophages
within this organ internalize and kill many of the pathogens that pass through, thereby removing them
from the body. The lymph node is also the site of adaptive immune responses mediated by T cells, B cells,
and accessory cells of the adaptive immune system. Like the thymus, the bean-shaped lymph nodes are
surrounded by a tough capsule of connective tissue and are separated into compartments by trabeculae,
the extensions of the capsule.

The major routes into the lymph node are via afferent lymphatic vessels. Cells and lymph fluid that leave
the lymph node may do so by another set of vessels known as the efferent lymphatic vessels. The afferent
lymph channels bring lymph with either free floating or complement bound antigen into the subcapsular
space. The afferent lymph vessels extend to the deeper areas of the lymph node by way of the trabecular
extensions of the cortex. The fluid then travels from here to the cortical sinuses; which are branches of
the subcapsular sinus. The cortical sinuses are also known as trabecular sinuses because they travel along
the trabecular network within the lymph node.

In addition to the structure provided by the capsule and trabeculae, the structural support of the lymph
node is provided by a series of reticular fibers laid down by fibroblasts. Within the cortex of the lymph
node are lymphoid follicles, which consist of germinal centers of rapidly dividing B cells surrounded by a
layer of T cells and other accessory cells. As the lymph continues to flow through the node, it enters the
medulla, which consists of medullary cords of B cells and plasma cells, and the medullary sinuses where
the lymph collects before leaving the node via the efferent lymphatic vessels.
Spleen

In addition to the lymph nodes, the spleen is a major secondary lymphoid organ (Figure 21.9). It is about
12 cm (5 in) long and is attached to the lateral border of the stomach via the gastrosplenic ligament. The
spleen is a fragile organ without a strong capsule, and is dark red due to its extensive vascularization. The
spleen is sometimes called the “filter of the blood” because of its extensive vascularization and the
presence of macrophages and dendritic cells that remove microbes and other materials from the blood,
including dying red blood cells. The spleen also functions as the location of immune responses to blood-
borne pathogens.
 The spleen is also divided by trabeculae of connective tissue, and within each splenic nodule is
an area of red pulp, consisting of mostly red blood cells, and white pulp, which resembles the
lymphoid follicles of the lymph nodes. Upon entering the spleen, the splenic artery splits into
several arterioles (surrounded by white pulp) and eventually into sinusoids. Blood from the
capillaries subsequently collects in the venous sinuses and leaves via the splenic vein. The red pulp
consists of reticular fibers with fixed macrophages attached, free macrophages, and all of the
other cells typical of the blood, including some lymphocytes. The white pulp surrounds a central
arteriole and consists of germinal centers of dividing B cells surrounded by T cells and accessory
cells, including macrophages and dendritic cells. Thus, the red pulp primarily functions as a
filtration system of the blood, using cells of the relatively nonspecific immune response, and white
pulp is where adaptive T and B cell responses are mounted.

Lymphoid Nodules
The other lymphoid tissues, the lymphoid nodules, have a simpler architecture than the spleen and lymph
nodes in that they consist of a dense cluster of lymphocytes without a surrounding fibrous capsule. These
nodules are located in the respiratory and digestive tracts, areas routinely exposed to environmental
pathogens.
Tonsils are lymphoid nodules located along the inner surface of the pharynx and are important in
developing immunity to oral pathogens (Figure 21.10). The tonsil located at the back of the throat, the
pharyngeal tonsil, is sometimes referred to as the adenoid when swollen. Such swelling is an indication of
an active immune response to infection. Histologically, tonsils do not contain a complete capsule, and the
epithelial layer invaginates deeply into the interior of the tonsil to form tonsillar crypts. These structures,
which accumulate all sorts of materials taken into the body through eating and breathing, actually
“encourage” pathogens to penetrate deep into the tonsillar tissues where they are acted upon by
numerous lymphoid follicles and eliminated. This seems to be the major function of tonsils—to help
children’s bodies recognize, destroy, and develop immunity to common environmental pathogens so that
they will be protected in their later lives. Tonsils are often removed in those children who have recurring
throat infections, especially those involving the palatine tonsils on either side of the throat, whose
swelling may interfere with their breathing and/or swallowing.
Bronchus-associated lymphoid tissue (BALT) consists of lymphoid follicular structures with an overlying
epithelial layer found along the bifurcations of the bronchi, and between bronchi and arteries. They also
have the typically less-organized structure of other lymphoid nodules. These tissues, in addition to the
tonsils, are effective against inhaled pathogens.

When someone is infected with dengue, the body's innate and adaptive immune
responses work together to fight the virus. B cells from the immune system
produce antibodies that recognize and neutralize dengue viral particles, and
cytotoxic T cells recognize and kill cells that are infected with the virus.
PATHOPATHOLOGY
 MEDICAL MANAGEMENT

This chapter discussed the procedure and the drugs utilized in the medical
management of Patient D’s diagnosis. In this case Dengue fever, a 10 -years-old was
admitted due to his complaint of fever. The following are some of the medical diagnostic
test and management strategies which are used to determine the most appropriate treatment
of the patient’s health condition.

IDEAL

A. Laboratory Examinations

Complete Blood Count To look for low platelet, count typical of the later stages
of the illness and to detect the decrease in hemoglobin,
(CBC). hematocrit, and red blood cell (RBC) count (evidence of
anemia) that would occur with blood loss associated
with severe dengue fever.

Electrolytes To detect a problem with the body's electrolyte balance

Hemoglobin test measures the levels of hemoglobin in your blood.

Hemoglobin is a protein in your red blood cells that
carries oxygen from your lungs to the rest of your body.
If your hemoglobin levels are abnormal, it may be a sign
that you have a blood disorder.

Platelets test shows your platelet count and other blood cells in
your blood. Platelet disorders are grouped based on
platelet count, which is the platelet count in a certain
amount of blood.

Red blood cell results of an RBC count can be used to help diagnose
blood-related conditions, such as iron deficiency
anaemia (where there are less red blood cells than
normal).

White blood cell a test that measures the number of white blood cells in
your body.

Hematocrit is a blood test that measures how much of a person's

blood is made up of red blood cells.

Mean Corpuscular hemoglobin refers to the amount of hemoglobin in a red blood cell.

Red blood cell distribution width test measures the differences in the volume and size of
your red blood cells (erythrocytes). Red blood cells
carry oxygen from your lungs to every cell in your body.
B. Diagnostic Procedure

rRT-PCR Presence of virus by rRT-PCR or NS1

antigen in a single diagnostic specimen is
considered laboratory confirmation of
dengue in patients with a compatible
clinical and travel history.

IgG antibody testing IgG detection by ELISA in a single serum

sample is not useful for diagnostic testing
because it remains detectable for life after a
dengue virus infection.

IgM Doctors may check immunoglobulin levels

to see if a person has an infection or is
protected from getting an infection (is
immune to it). Doctors also use
immunoglobulin tests to help diagnose
immune deficiencies (when the immune
system isn't working as it should).

C. Medications

Analgesics and Antipyretics Acetaminophen (paracetamol) is

recommended for treatment of pain and
fever. Aspirin, other salicylates, and
“Acetaminophen (paracetamol)” nonsteroidal anti-inflammatory drugs
(NSAIDs) should be avoided. Patients with
dengue hemorrhagic fever or dengue shock
syndrome may require intravenous volume
replacement.

0.9% normal saline solution An ideal intravenous fluid for patients with
dengue is one that is isotonic. It should be
considered in order to prevent shock.

D. Surgery

Surgery is generally not considered as a primary treatment option for Dengue Fever. Dengue fever

is typically managed with medications as mentioned earlier. Surgery is usually reserved for

specific cases where complications arise or if there is an underlying condition that requires surgical

intervention.
ACTUAL

03/30/2024 @ around 10 AM JUSTIFICATION /RATIONALE

• Please admit the patient under the - To monitor closely and ensure that clients
concern will be addressed immediately with
service of Dr. Villegas proper interventions.

• Secured Consent - To establish rapport between the health

care provider and client by ensuring
understanding and to give approval to
medical management.

- PNSS is to supply water and salt (sodium

• START IVF PNSS 1L to run @ 80 cc/hr chloride) to the body.

•MEDICATIONS:

• Paracetamol 500 mg/tab 1 tab P.O q4 hours prn - It's typically used to relieve mild or
for fever moderate pain, such as headaches,
toothache or sprains, and reduce fevers
caused by illnesses such as colds and flu
Immunomax forte 1tsp OD
- Enhances immune function and helps in
reducing susceptibility to infection.

• VS Q4
- Helps monitor patient’s vital conditions.

• I & O q Shift -Helps track intake and output which will

indicate the fluid balance for a patient.

03//31/24
 • Bed rest To reduce the metabolic demand of the
body, thus improving healing and recovery.

• VS q2 include pulses Helps monitor patient’s vital conditions

• Update AP qshift

04/01 /24 6AM

Repeat Ph, Hct results This allows your doctor to monitor your
overall health and assess the effectiveness
Repeat CBC, plt, tomorrow AM- @ lab of treatment.

• START IVF D5W 1L to run 80 cc/hr Intravenous sugar solution, also known as
dextrose solution, is a mixture of dextrose
and water. It is used to treat low blood
sugar or water loss without electrolyte loss.
 COMPLETE BLOOD COUNT

TEST NAME RESULT UNIT REF. RANGE JUSTIFICATION

HEMOGLOBI 152 mg/dL 120-150 Increased

N

HEMATOCRIT 0.451 ℅ 37- 47 Low

WHITE 2.9 L /L 5.0-13.0 × Low

BLOOD CELL 10^9

NEUTROPHIL 36.0 % 55-65 Low

S

LYMPHOCYT 61.7 H % 10.0-58.5 Increased

E

MONOCYTE 20.6 H % 4.8-79.7 Result is within normal range

EOSINOPHIL 2.4 H % 0.3-0.8 Increased

BASOPHIL 0.8 H % 0.1-0.6 Increased

RED BLOOD 4.88 /L 3.80- Result is within normal range

CELL 5.40×10^12

PLATELET 131 /L 150-450×10 Low

9L

MCV 85.7 fL 80.0 – 97.0 Result is within normal range

MPV 7.9 fL 7.0- 10.0 Result is within normal range

MCH 30.3 pg 25.0 - 32.0 Result is within normal range

MCHC 13.8 % 11.5- 14.5 Result is within normal range

 Nursing Theory

“WATSON’S THEORY OF TRANSPERSONAL CARING” - Jean Watson

The Philosophy and Science of Transpersonal Caring by Jean Watson discusses how nurses

care for their patients and how that caring leads to improved healthcare plans to help patients get

healthy. The advantages are indescribable and encourage self-actualization on both a professional

and personal level. According to the nursing model, “nursing is concerned with promoting health,

preventing illness, caring for the sick, and restoring health”. It focuses on both health promotion

and disease treatment. Caring, according to Watson, is necessary for patients and promotes health

more efficiently than a simple medical treatment. She thinks that a comprehensive health care

approach is essential to nursing practice. Nurses, according to her theory, can demonstrate and

practice caring. Caring for patients fosters development; a caring environment accepts a person as

they are while also anticipating what they might become.

During our exposure, we regarded as essential to the nurse's maturation, which encourages

altruistic behavior toward others. Also, being present and supportive to the patient of the

expression of positive and negative emotions as a connection with a higher spirit and self, as well

as the one being cared for. Providing information that may help to alleviate the worries of the

patient. Assisting with basic needs, with a deliberate caring consciousness, administering "human

care essentials" that promote mind-body-spirit alignment, fulfillment, and unification of being in

all aspects of care.

NOLA PENDER’S- HEALTH PROMOTION MODEL

Health Promotion Model: This theory, provides planners with the skills they need to go

beyond perception to create and assess health behavior and health promotion interventions that are

based on behavioral understanding. A road map for analyzing problems, creating appropriate

interventions, and evaluating their success is provided by theory. Nola Pender, focuses on

empowering patients to take an active role in their health.

Self-Care Theory developed by Dorothea Orem

Dorothea Orem's Self-Care Deficit Theory focuses on each “individual's ability to perform

self-care, defined as 'the practice of activities that individuals initiate and perform on their own

behalf in maintaining life, health, and well-being. The theory emphasizes the patient's ability to

engage in self-care activities to maintain their health and well-being. Nurses can educate patients

about other self-care strategies to manage dengue fever symptoms. Nurses can also provide

information on over-the-counter medications that can help alleviate symptoms. By incorporating

the principles of the Self-Care Theory into the care of patients with dengue fever, nurses can

promote patient autonomy and empower individuals to actively participate in their own care. This

approach can lead to improved symptom management, prevention of exacerbations, and overall

better patient outcomes.

 NURSING ASSESSMENT

GENERAL APPEARANCE:

NEUROLOGICAL: The patient is awake, alert and not in respiratory distress. For the level of

consciousness, the patient has a GCS of 15. Memory is intact. No motor deficits are noted.

EYE/VISION: Anicteric sclera, pale palpebral conjunctiva, puffy eyelids. Vision is not impaired,

diplopia not noted vision, no spots before the eyes (Scotoma) are noted.

NOSE: There were no eye, ear and nose discharges. No tenderness, masses or underlying deviation

and no discharges. Nasal structures are firm and stable.

MOUTH/TONGUE/TEETH/SPEECH: Nasal septum in midline, dry pale lips, moist oral

mucosa, tonsils non-hyperemic, non-hypertrophic.

THROATT/NECK: Neck had no cervical lymphadenopathy, equally chest expansion is noted.

RESPIRATORY SYSTEM: The patient has regular breathing pattern and with respiratory rate

of 21 cpm. The chest expansion is symmetrical.

CIRCULATORY/CARDIOVASCULAR: The patient has a cardiac rate of 86 bpm. Heart has a

dynamic precordium, normal rate and regular rhythm. Clear breath sounds.

GASTROINTESTINAL: Abdomen is round; no mass or lesions on the outside appearance.

GENITOURINARY: There I urinary incontinence noted, no palpable mass upon palpation, and

no urinary distension noted.

MUSCULOSKELETAL: The patient’s radial and brachial pulses were regular. Extremities have

a good range of motion.

INTEGUMENTARY: The patient has fair complexion, there is rashes, and no jaundice. Skin is

pail and has CRT (Capillary refill time) of more than 2 seconds (4 seconds in particular).

PRESENT BEHAVIOR: Awake and well-oriented; cooperative and interactive in answering

questions; able to answer with promptness and conciseness.

NURSING MANAGEMENT
 GOALS
DATE/ NURSING SCIENTIFIC NURSING EVALUATI
CUES NEEDS OBJECTIVES RATIONALE
TIME DIAGNOSIS BASIS INTERVENTIONS ON
CRITERIA
03/ 31/ S: Maslow’s Acute Pain Acute pain is Within 8 hours of Assess the patient’s Allows healthcare providers GOAL
2024 The patient Hierarchy related to severe defined as an nursing pain level and to evaluate the effectiveness MET
12 P.M complained of joint of Needs headaches, joint unpleasant interventions, the characteristics of current pain management
and muscle pain, and pain, and emotional and patient pain will regularly. strategies and make After 8 hours
high fever. Physiologic abdominal sensory improve aeb: adjustments as needed. of nursing
The patient reports al needs discomfort. experience. It is interventions,
feeling fatigued and most often The patient will Administer the patient
weak. associated with experience relief prescribed pain To provide relief from pain had improved
The patient damage to the from discomfort. medications as and improve the patient's aeb:
expresses anxiety body's tissues. appropriate, ensuring comfort and quality of life.
and distress due to timely administration The patient
the symptoms. and monitoring for reports a
side effects. reduction in
O: discomfort
Grimace face Apply cold Cold compresses can provide and
noted compresses or immediate pain relief by alleviation of
Elevated provide comfort numbing the area and acute pain
body measures, such as reducing inflammation to with the help
temperature relaxation techniques alleviate pain. of
of 38.5 or distraction appropriate
Presence of pain
rash on the Collaborate with the Healthcare providers from management
body healthcare team to various disciplines bring interventions.
address any unique perspectives and
VS taken as follow: underlying causes of expertise to the assessment
T - 38.5 pain, such as and management of pain.
PR- 115 bpm abdominal
RR- 24 cpm complications or
severe joint pain.
 GOALS
DATE/ NURSING SCIENTIFIC NURSING EVALUATI
CUES NEEDS OBJECTIVES RATIONALE
TIME DIAGNOSIS BASIS INTERVENTIONS ON
CRITERIA
03/ 31/ S: Maslow’s Risk for Fluid volume Within 8 hours of Monitor vital signs, To assess fluid balance. GOAL
2024 The patient reports Hierarchy Deficient Fluid deficit results nursing intake, and output MET
12 P.M feeling fatigued and of Needs Volume related from the loss of interventions, the closely
weak. to increased body fluids and patient will After 8 hours
Physiologic insensible fluid occurs more improve aeb: Encourage oral fluid Increasing oral fluid intake of nursing
O: al needs losses and rapidly when intake helps prevent dehydration and interventions,
Persistent decreased oral coupled with A. The client is ensures optimal bodily the patient
vomiting intake. decreased fluid normovolemic as functions. has improved
noted intake. Risk evidenced by as aeb:
Elevated factors for systolic BP Administer IV fluids are rapidly absorbed
body deficient fluid greater than or intravenous fluids as into the bloodstream, Maintained
temperature volume are as equal to 90 mm prescribed to providing rapid hydration. fluid balance
of 38.5 follows: HG (or client’s maintain adequate status with
Presence of vomiting, baseline), absence hydration and adequate
rash on the diarrhea, GI of orthostasis, HR prevent hydration and
body suctioning, 60 to 100 hypovolemia. prevention of
Decreased sweating, beats/min, urine hypovolemia.
platelet count decreased intake, output greater Assess for signs of Recognizing early signs of
122/mcL. nausea, inability than 30 mL/hr, fluid overload or fluid overload allows for
to gain access to and normal skin impending shock, prompt intervention to
VS taken as follow: fluids, adrenal turgor. such as respiratory prevent complications and
T - 38.5 insufficiency, distress or improve patient outcomes.
PR- 115 bpm osmotic diuresis, B. The client hypotension, and
RR- 24 cpm hemorrhage, verbalizes promptly report to
coma, third-space awareness of the healthcare team.
fluid shifts, causative factors
burns, ascites, and behaviors Provide parenteral or Enteral nutrition is preferred,
and liver essential to enteral nutrition promoting GI function
dysfunction. correct the fluid therapy. through direct exposure to
deficit. nutrients.
 GOALS
DATE/ NURSING SCIENTIFIC NURSING EVALUATI
CUES NEEDS OBJECTIVES RATIONALE
TIME DIAGNOSIS BASIS INTERVENTIONS ON
CRITERIA
03/ 31/ O: Maslow’s Risk for Risk for bleeding Within 8 hours Monitor the patient’s Regular monitoring helps GOAL
2024 Grimace face Hierarchy Bleeding related happens with of nursing platelet count healthcare providers identify MET
12 P.M noted of Needs to decreased disorders that interventions, regularly these conditions early and
Elevated platelet count. reduce the quality the patient will; intervene appropriately. After 8 hours
body Physiologic or quantity of of nursing
temperature al needs circulating A. The patient Implement bleeding Bleeding precautions aim to interventions,
of 38.5 platelets. will maintain precautions, such as reduce the likelihood of the patient
Presence of Platelets hemostasis and using a soft injury in individuals who are was free from
rash on the (thrombocytes) prevent bleeding toothbrush, avoiding at an increased risk of bleeding aeb;
body are colorless complications. invasive procedures, bleeding.
Decreased blood cells that and minimizing the A. The
platelet count help blood clot. use of venipuncture. patient-
122/mcL Platelets stop Apply pressure to Applying pressure helps to maintained
bleeding by injection sites for an prevent or minimize bleeding hemostasis
VS taken as follow: clumping and appropriate duration at the injection site. and
T - 38.5 forming plugs in after injections. prevented
PR- 115 bpm blood vessel bleeding
RR- 24 cpm injuries. Monitor for signs of Detecting these signs early complication
bleeding, such as allows healthcare providers to s.
petechiae, ecchymosis, initiate appropriate diagnostic
or hematuria. testing and treatment to
prevent complications.

Report any abnormal Prompt reporting of abnormal

bleeding immediately bleeding allows healthcare
to the healthcare providers to intervene early
provider. and implement appropriate
measures.
 POLYTECHNIC COLLEGE OF DAVAO DEL SUR, INC.

MacArthur Highway, Brgy. Kiagot, Digos City, Davao del Sur, Philippines 8002

DRUG STUDY

Name of Patient: Patient X Attending Physician: DR. MALAZA

Age: 10 Sex: MALE Civil Status: SINGLE Diagnosis: DENGUE FEVER
Occupation: NONE Religion: CATHOLIC Chief Complaint: FEVER
Address: ZONE 3, DIGOS CITY, DAVAO DEL SUR

DATE/ ROUTE/ PRECAUTION

TIME BRAND NAME ACTION INDICATION DOSAGE/ DRUG ADVERSE EFFECT CONTRAINDICATIONS NURSING
ORDER TIME INTERACTION RESPONSIBILI
ED INTERVAL TIES
3-11 Ceftriaxone is a This drug is ⚫ The risk or severity of Local reactions, • Watch out for ⚫ Take the VS
04/03/20 bactericidal indicated for Ceftriaxon nephrotoxicity can be hematologic effects Penicillin or other of patient to
24 ROCEPHIN agent that acts by susceptible e 500 mg increased when Ceftriaxone (eg, eosinophilia), beta-lactam determine
inhibition of bacterial IVTT BID is combined with rash, diarrhea, allergy. the baseline
data.
bacterial cell infections of the Aceclofenac. elevated liver
• Discontinue if ⚫ Observe the
wall synthesis. lower ⚫ The risk or severity of enzymes; 10 rights of
GENERIC HALF- urolithiasis,
Ceftriaxone has respiratory nephrotoxicity can be hypersensitivity oliguria, renal or drug
NAME LIFE
activity in the tract, skin and increased when Ceftriaxone reactions, C.difficile- gallbladder administratio
CEFTRIAXONE presence of skin structure, is combined with associated diarrhea, sonographic n
(5.8 to 8.7
some beta- bone and joint, Acemetacin. hemolytic anemia, abnormalities, ⚫ Ensure
hours)
lactamases, both acute otitis ⚫ The risk or severity of pancreatitis. signs or symptoms adequate
penicillinases media, UTIs, bleeding can be increased occur. hydration
and septicemia, when Ceftriaxone is ⚫ Take note of
cephalosporinas pelvic combined with • Renal failure: the
monitor; decrease expiration
es, of Gram- inflammatory Acenocoumarol.
 CLASSIFICAT negative and disease (PID), ABSORPTI EXCRETION dose if drug date in
ION Gram-positive intraabdominal ON accumulation preparation
bacteria. infections, This is primarily eliminated in the occurs. of drug
Cephalosporin meningitis, Ceftriaxone urine (33-67%). The remainder is
antibiotics uncomplicated was eliminated through secretion in the • Chronic hepatic ⚫ Assess and
completely bile and removed from the body via disease or identify
gonorrhea. absorbed the feces. bowel
malnutrition
Surgical following (impaired Vit. K functions for
prophylaxis. IM synthesis or constipation,
administrati storage): monitor diarrhea, and
on with prothrombin time. etc.
mean
maximum • Both hepatic and ⚫ Take the VS
plasma significant renal after the
concentratio impairment: usual administratio
ns occurring max 2g/day. n of the drug
between 2
and 3 hours • Pregnancy ⚫ Instruct and
post-dose. (Cat.B). Nursing determine
mothers. the patient to
report any
• Contraindicated to unusualities
hyperbilirubinemi immediately.
c or premature
⚫ Record the
neonates.
data on the
patient’s
• Concomitant forms and
calcium- report to
containing IV physician for
solutions or any adverse
products in reactions.
neonates.

CLINICAL INSTRUCTOR: JENNY B. ARTIAGA, PHRN, AURN

 POLYTECHNIC COLLEGE OF DAVAO DEL SUR, INC.

MacArthur Highway, Brgy. Kiagot, Digos City, Davao del Sur, Philippines 8002

DRUG STUDY

Name of Patient: Patient X Attending Physician: DR. MALAZA

Age: 10 Sex: MALE Civil Status: SINGLE Diagnosis: DENGUE FEVER
Occupation: NONE Religion: CATHOLIC Chief Complaint: FEVER
Address: ZONE 3, DIGOS CITY, DAVAO DEL SUR

DATE/ ROUTE/ PRECAUTION

TIME BRAND ACTION INDICATION DOSAGE/ DRUG ADVERSE EFFECT CONTRAINDICATIONS NURSING
ORDERE NAME TIME INTERACTION RESPONSIBILITIES
D INTERVA
L
3-11 -Decreases - Paracetamol Blood and lymphatic Contraindications to
04/03/202
fever by a is a mild 500 mg The following system disorders: the use of
4
Biogesic hypo-thalamic analgesic and q4 hours interactions with acetaminophen BEFORE
effect leading antipyretic, Rarely, anaemia, include - Check the body
PRN paracetamol
GENERIC to sweating and is HALF- have been thrombocytopenia,a hypersensitivity to temperature.
NAME and recommended LIFE noted: granulocytosisCardia acetaminophen, - Make sure to observe
vasodilation. and indicated Anticoagulant c disorders: severe hepatic 10 rights of medication
Paraceta- 3-4 hrs
for the drugs (warfarin) impairment, or severe administration.
mol -Inhibits Tachycardia.
treatment of - dosage may active hepatic disease. - Inform client or
pyrogen effect most painful Gastrointestinal watcher that extended-
require
on the and febrile reduction if disorders: - Patients who have release tablets are not
hypothalamic- conditions. paracetamol and Nausea, vomiting; had an allergic to be chewed.
heat regulating anticoagulants reaction to - This drug is not for
centers. redness of rectal
are taken for a paracetamol or any regular use with any
mucus membranes
prolonged other medicines in the form of liver disease.
-Inhibits CNS General disorders past should be noted
period of time.
prostaglandin Paracetamol together with those
 synthesis with absorption is and administration who have liver or DURING
minimal effects increased by site conditions: kidney problems. - Take with food or milk
on peripheral substances that to minimize GI upset.
prostaglandin increase gastric Inj site reactions -Avoid alcohol.
synthesis. emptying, e.g. (e.g. pain, burning -Report any unusualities
- Paracetamol metoclopramide sensation), fatigue, such as cyanosis,
seems to work . peripheral oedema. shortness of breath and
by blocking Investigations: abdominal pain as these
CLASSIF chemical ABSORP EXCRETION are signs of toxicity.
I- messengers in TION Increased -Report paleness,
CATION the brain that Paracetamol is transaminase levels, weakness, and
tell us we have metabolized abnormal breath heartbeat skips
Antipyreti pain. -Parace- extensively in the sounds. -Report abdominal pain,
c Paracetamol tamol is liver and excreted
Metabolism and jaundice, dark urine,
readily in the urine mainly nutrition disorders:
also reduces itchiness or clay-colored
absorbed as inactive
fever by from the glucuronide and stools.
affecting the Hypokalaemia.
gastrointe sulfate
chemical stinal tract conjugates. AFTER
messengers in Skin and
with peak
an area of the plasma subcutaneous tissue
- Monitor CBC, liver and
brain that concentra disorders:
renal functions.
regulates body tions -Assess for fecal occult
occurring Rash, pruritus,
temperature. - Inform physician if
about 30 erythema, urticaria.
Vascular disorders:
there are unusualities
minutes
to 2 hours noted upon re-
after Hypotension and assessmant/evaluation.
ingestion. Hypertension.

CLINICAL INSTRUCTOR: JENNY B. ARTIAGA, PHRN, AURN

 POLYTECHNIC COLLEGE OF DAVAO DEL SUR, INC.

MacArthur Highway, Brgy. Kiagot, Digos City, Davao del Sur, Philippines 8002

DRUG STUDY

Name of Patient: Patient X Attending Physician: DR. MALAZA

Age: 10 Sex: MALE Civil Status: SINGLE Diagnosis: DENGUE FEVER
Occupation: NONE Religion: CATHOLIC Chief Complaint: FEVER
Address: ZONE 3, DIGOS CITY, DAVAO DEL SUR

DATE/ ROUTE/ PRECAUTION

TIME BRAND ACTION INDICATION DOSAGE/ DRUG ADVERSE EFFECT CONTRAINDICATIONS NURSING
ORDERE NAME TIME INTERACTION RESPONSIBILITIES
D INTERVAL

3-11 Immunomax It is also safe to take Do not take more than No changes in kidney • Take the VS of
04/03/202 The process of Forte is a with other and liver functions found
4 supplement Immuno the recommended dose, patient to determine
carboxymethylati medicines. In fact, in patients after CM-
CM- designed to max forte
unless advised by the the baseline data.
on transform β- studies have shown glucan administration and
Glucan support and boost doctor. Possible Side- • Observe the 10
Glucan to CM-
the immune 1tsp. OD that when taken with no effects on heart rate
Glucan doctor-prescribed Effects: Rarely, and blood pressure. rights of drug
system. It is gastrointestinal and
(carboxymethyl- medicine, administration
GENERIC commonly used HALF-
NAME
glucan or to strengthen the Immunomax can allergic reactions. This No contraindications. • Ensure adequate
carboxymethylate LIFE
body's natural help shorten product should not be hydration
d Beta (1,3- defense recovery time and
glucan) into a
given to patients with • Take note of the
mechanisms, lessen occurrence of
Immuno known hypersensitivity
highly soluble making it more 10-12 hrs allergic rhinitis, expiration
max glucan that can be resilient against or allergy to any of its
asthma and upper
Forte readily absorbed infections and components.
respiratory tract
by the body. As a illnesses. By
infections.
promoting
 CLASSIF result, CM-Glucan immune function, ABSORP EXCRETION • Monitor patient
I- triggers and Immunomax TION response to therapy
Forte may help in
CATION enhances
Feces and Urine (improvement in
phagocytosis that maintaining
sets off the entire overall health and condition being
Food well-being. GI Tract
treated).
Supple- immune system
Additionally,
cascade. • Monitor for adverse
ment some
formulations of effects (e.g. flu-like
Immunomax symptoms, GI upset,
Forte may assist CNS changes, bone
the body in
coping with marrow depression).
stress, which can • Evaluate patient
have a positive understanding on
impact on
drug therapy by
immune function.
asking patient to
name the drug, its
indication, and
adverse effects to
watch for.

CLINICAL INSTRUCTOR: JENNY B. ARTIAGA, PHRN, AURN

DISCHARGE PLAN (M.E.T.H.O.D.S.)

Medication

• Instruct the patient to continue prescribed medications.

• Orient the patient about the drugs, their actions, the exact dosage, the frequency, and the route

of administration.

• Instruct the patient to follow the instructions when administering the medication.

• Educate family of the importance of taking the prescribed medicine at the right time and right

frequency.

• Explain the purpose of medication to the patient for further knowledge.

• Emphasize the importance of taking the full course of the medication and for the fast recovery.

• Encourage the patient to take pain relief and antibiotics medications prescribed by the doctor to

lessen discomfort.

• Explain to the patient the side effects and adverse effects of the drugs the patient is taking by

prescribing its manifestation.

Practice deep breathing exercises.

• Emphasize the importance of ambulation and the gradual resume of the patient’s normal daily

activities.

• Encourage to have regular exercise beginning with mild, like walking, stretching and
other forms of activities that would help maintain joint mobility and enhance circulation.

• Encourage to avoid strenuous activities such as heavy lifting. May use isometric exercise.

• Encourage the patient and the family to have a clean environment to avoid acquiring disease that

comes from having contaminated surroundings.

Treatment

• Educate patient the importance of drug compliance.

• Discuss to the patient the complication of the condition because knowledge about the condition

supports learning that will decrease anxiety.

• Promotes rest and relaxation.

• Promote enough sleep in a conducive room temperature.

Out-patient Orders

• Call the doctor if any following occurs:

• Side effects of the drugs taken

• If signs and symptoms persist report to the doctor immediately

Diet

• Instruct patient to eat nutritious food that are high in, vitamins, and minerals such as green leafy

vegetables.

• Instruct patient to avoid liquid intake of soda such as carbonated drinks.

• No dark-colored foods.

• Eat a balanced diet rich in fresh fruits and vegetables.

Significant others

• Advise the family to continue the support in the rehabilitation and restoration of the physical

condition of the patient as well as its psychological aspect.

• Instruct the family to cooperate and to have enough patients in attending the patient’s needs.

• Advise the significant others not to leave the client during medication administration.
 PROGNOSIS

Actual Good Fair Poor Justification

The patient was admitted on March

31, 2024, and had a chief complaint

Duration of fever, vomiting, colds and also a

platelet of 140,000 microliter of

blood.

4 days prior patient was

experiencing fever, vomiting, and

colds, and the patient was promptly

admitted to the Medical Center of

Onset of illness
Digos, Inc. The onset of illness of

the patient was poor since his

condition was getting worse as the

day passed.

The patient was able to provide the

prescribed medicines that were

Compliance of
needed during the occurrence of the
medications
illness and while he was under the

care of the hospital.

The patient is well supported

Family support physically, emotionally, and

financially by her family.

The patient stays in a therapeutic

environment that does promote

Environment
comfort for the patient. The

environment was well-ventilated

 and peaceful which is good for the

patient’s comfort.

Dengue fever can affect individuals

of all ages, and outbreaks can occur

in any population. In some regions,

adults or specific age groups may be

more affected due to local factors

such as occupational exposure,

Age travel patterns, or healthcare

infrastructure. Therefore, while

children may be considered the most

prone age group overall, it's

important for everyone to take

preventive measures against dengue

fever regardless of age.

GOOD 4÷7×100 57.14

FAIR 1÷7×100 14.2

POOR 1÷7×100 14.2

The result reveals a good prognosis for the patient with a percentage of 57.14%. The patient was

admitted for Dengue without warning signs. Before admission, the patient was experiencing high-

grade fever, vomiting, and colds that worsened as days passed by so he was admitted and diagnosed

with Dengue without warning signs and was given medications and IV fluids to address the

symptoms. This all contributes to a good prognosis for the patient is feeling better and able to feel

better having his treatment at the hospital.

EVALUATION

The researchers were extremely appreciative of the chance to participate in this case study.

To learn more about this kind of presentation is truly an honor. This improves critical thinking

abilities, knowledge, and experience in assessing patients in such circumstances, all of which could

be very helpful in becoming a better nurse in the future. Based on his condition, with diagnosis of

Dengue without warning signs.

Dengue fever, a viral illness transmitted by Aedes mosquitoes, presents a spectrum of

manifestations ranging from mild flu-like symptoms to severe hemorrhagic fever. Among its

clinical presentations, dengue without warning signs stands as a less ominous yet significant form

of the disease.

Dengue fever without warning signs represents a milder yet noteworthy manifestation of this

mosquito-borne viral illness. Despite lacking the ominous features of severe dengue, it demands

attention due to its potential to cause significant morbidity and discomfort. Early recognition,

proper diagnosis, and supportive care are paramount in managing dengue without warning signs,

ensuring favorable outcomes for affected individuals. Moreover, public health efforts focusing on

vector control remain essential in curbing the spread of dengue fever and its associated burden on

communities worldwide.
 IMPLICATION OF THE STUDY

Nursing Research

Knowing that every individual patient has different needs it requires different nursing care

mutable for each situation. This case study is a great help for us student nurses who are in the field

of practice in providing nursing care to our patient. This condition of our patient encouraged us to

pursue our research to the paramount nursing care that we can provide for our client and develop

innovative means to respond to its own need. This study able us to improve our knowledge and

skills in nursing care and progress our attitude on how to deal with patient.

Nursing Education

This case study will give everyone who can read it in-depth knowledge on Dengue. It has

sufficient details regarding to the aforementioned condition. These are collected from dependable

sources and the actual circumstances required to describe the condition and the management of its

medical and nursing treatment. The material above will contribute to nursing students' knowledge

as they work to provide correct and appropriate nursing care to a disease they may soon face.

Students opting to pursue nursing careers will also benefit from this education.

Nursing Research

In the field of nursing research, this will have encouraged future nurses to expand their

knowledge and conduct research to fully understand this kind of disease and it will help them to

answer question that bothers on their mind. This study can be used as a tool that can inspire nursing

student as well as any health care provider to conduct further study.

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https://www.google.com/search?q=dengue+symptoms&oq=DENGUE&gs_lcrp=EgZjaHJvbWUqCggCEAA

YsQMYgAQyBwgAEAAYjwIyDAgBEEUYORixAxiABDIKCAIQABixAxiABDIHCAMQABiABDIKCAQQLhixAxiABD

IGCAUQRRg8MgYIBhBFGDwyBggHEEUYPNIBCDM3MTBqMGo5qAIIsAIB&sourceid=chrome&ie=UTF-8

https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue

https://www.cdc.gov/dengue/symptoms/index.html

https://my.clevelandclinic.org/health/diseases/17753-dengue-fever

https://www.unilab.com.ph/articles/what-are-the-basic-symptoms-of-dengue