Actual Findings Normal Findings Analysis
White blood cells 1.4x10^g/L 4.8-10.8x10^g/l Decreased due to inadequate inflammatory defenses to suppress infection and humoral immunity takes place
Red blood cells 1.88x10^12/L 4.7-6.1x10^12/L Decreased due to anemia
Hemoglobin 5.5 g/dL 13-17 g/dL Decreased due to poor oxygen supply
Hematocrit 16.1% 40-52% Decreased due to poor oxygen supply
Platelet count 24x10^3/uL 150-450x10^3/uL Hemolysis
Differential count
Neutrophils 5.5 40-70% Neutropenia
Lymphocytes 91.6 19-48% Increased due to the body’s increased immune system
Eosinophils 0.2 2-8% Decrease due to disease process
Monocytes 2.7 3-9% Decrease
Basophils 0.0 0-5% Normal
Hematology Reports
February 24, 2010
PT
INR- 1.06
Patient-13.6
Control-15.5
%activity-88.5
Thromboplastin Time
Patient (APTT) 32.1
Control 31.6
February 24, 2010
7:03 PM
February 27, 2010
11:08 AM
Actual Findings Normal Findings Analysis
White blood cells 1.3x10^g/L 4.8-10.8x10^g/l Decreased due to inadequate inflammatory defenses to suppress infection and humoral immunity takes place
Red blood cells 1.99x10^12/L 4.7-6.1x10^12/L Decreased due to anemia
Hemoglobin 5.59g/dL 13-17 g/dL Decreased due to poor oxygen supply
Hematocrit 17.4% 40-52% Decreased due to poor oxygen supply
Platelet count 13x10^3/uL 150-450x10^3/uL Hemolysis
Differential count
Neutrophils 7.5 40-70% Neutropenia
Lymphocytes 84.6 19-48% Increased due to the body’s increased immune system
Eosinophils 0.4 2-8% decreased due to disease process
Monocytes 6.9 3-9% Normal
Basophils 0.9 0-5% Normal
Actual Findings Normal Findings Analysis
White blood cells 1.8x10^g/L 4.8-10.8x10^g/l Decreased due to inadequate inflammatory defenses to suppress infection and humoral immunity takes place
Red blood cells 2.25x10^12/L 4.7-6.1x10^12/L Decreased due to anemia
Hemoglobin 6.9g/dL 13-17 g/dL Decreased due to poor oxygen supply
Hematocrit 19.9% 40-52% Decreased due to poor oxygen supply
Platelet count 8x10^3/uL 150-450x10^3/uL Hemolysis
Differential count
Neutrophils 6.4 40-70% Neutropenia
Lymphocytes 85.6 19-48% Increased due to the body’s increased immune system
Eosinophils 0.1 2-8% Decrease due to disease process
Monocytes 7.5 3-9% Normal
Basophils 8.4 0-5% Increase due to inflammatory response
February 27, 2010
11:37 PM
Actual Findings Normal Findings Analysis
White blood cells 1.8x10^g/L 4.8-10.8x10^g/l Decreased due to inadequate inflammatory defenses to suppress infection and humoral immunity takes place
Red blood cells 2.24x10^12/L 4.7-6.1x10^12/L Decreased due to anemia
Hemoglobin 7.5 g/dL 13-17 g/dL Decreased due to poor oxygen supply
Hematocrit 22.7% 40-52% Decreased due to poor oxygen supply
Platelet count 12x10^3/uL 150-450x10^3/uL Hemolysis
Differential count
Neutrophils 6.7 40-70% Neutropenia
Lymphocytes 85.9 19-48% Increased due to the body’s increased immune system
Eosinophils 0.2 2-8% Decreased due to disease process
Monocytes 5.7 3-9% Normal
Basophils 1.5 0-5% Normal
February 28, 2010
12:27 PM
March 1, 2010
5:54 AM
Actual Findings Normal Findings Analysis
White blood cells 2.0x10^g/L 4.8-10.8x10^g/l Decreased due to inadequate inflammatory defenses to suppress infection and humoral immunity takes place
Red blood cells 2.21x10^12/L 4.7-6.1x10^12/L Decreased due to anemia
Hemoglobin 6.8g/dL 13-17 g/dL Decreased due to poor oxygen supply
Hematocrit 19.5% 40-52% Decreased due to poor oxygen supply
Platelet count 12x10^3/uL 150-450x10^3/uL Hemolysis
Differential count
Neutrophils 5.1 40-70% Normal
Lymphocytes 88.8 19-48% Increased due to the body’s increased immune system
Eosinophils 0.1 2-8% Decreased due to disease process
Monocytes 5.1 3-9% Normal
Basophils 0.9 0-5% Normal
Actual Findings Normal Findings Analysis
White blood cells 2.9x10^g/L 4.8-10.8x10^g/l Decreased due to inadequate inflammatory defenses to suppress infection and humoral immunity takes place
Red blood cells 2.081x10^12/L 4.7-6.1x10^12/L Decreased due to anemia
Hemoglobin 6.6g/dL 13-17 g/dL Decreased due to poor oxygen supply
Hematocrit 18.6% 40-52% Decreased due to poor oxygen supply
Platelet count 134x10^3/uL 150-450x10^3/uL Hemolysis
Differential count
Neutrophils 10 40-70% Neutropenia
Lymphocytes 81.3 19-48% Increased due to the body’s increased immune system
Eosinophils 0.3 2-8% Decrease due to disease process
Monocytes 6.1 3-9% Normal
Basophils 2.3 0-5% Normal
March 2, 2010
9:28 PM
Urinalysis
February 26, 2010
Physical
Color - Yellow
Transparency -Hazy
Specific gravity – 1.005
Reaction- 8
Sugar- Negative
Protein- Negative
Microscopic
RBC-3.4
WBC-3.4
Epithelial cells- Few
Bacteria- None
Crystal- Few
Biochemical
Urobilinogen +1
Nitrate (-)
Blood +1
Bilirubin (-)
Ketone (-)
Leukocyte (-)
ANATOMY AND PHYSIOLOGY
BLOOD
Blood is considered the essence of life because the uncontrolled loss of it can result to death. Blood is a type of connective tissue, consisting of cells and cell fragments surrounded by a liquid matrix which circulates through the heart and blood vessels. The cells and cell fragments are formed elements and the liquid is plasma. Blood makes about 8% of total weight of the body.
Functions of Blood:
>transports gases, nutrients, waste products, and hormones
>involve in regulation of homeostasis and the maintenance of PH, body temperature, fluid balance, and electrolyte levels
>protects against diseases and blood loss
PLASMA
Plasma is a pale yellow fluid that accounts for over half of the total blood volume. It consists of 92% water and 8% suspended or dissolved substances such as proteins, ions, nutrients, gases, waste products, and regulatory substances.
Plasma volume remains relatively constant. Normally, water intake through the GIT closely matches water loss through the kidneys, lungs, GIT and skin. The suspended and dissolved substances come from the liver, kidneys, intestines, endocrine glands, and immune tissues as spleen.
FORMED ELEMENTS
Cell Type Description Function
Erythrocytes (RBC) Biconcave disk, no nucleus, 7-8 micrometers in diameter Transport oxygen and carbon dioxide
Leukocytes (WBC):
Neutrophil
Basophil
Eosinophil
Lymphocyte
Monocyte
Spherical cell, nucleus with two or more lobes connected by thin filaments, cytoplasmic granules stain a light pink or reddish purple, 12-15 micrometers in diameter
Spherical cell, nucleus, with two indistinct lobes, cytoplasmic granules stain blue-purple, 10-12 micrometers in diameter
Spherical cell, nucleus often bilobed, cytoplasmic granules satin orange-red or bright red, 10-12 micrometers in diameter
Spherical cell with round nucleus, cytoplasm forms a thin ring around the nucleus, 6-8 micrometers in diameter
Spherical or irregular cell, nucleus round or kidney or horse-shoe shaped, contain more cytoplasm than lymphocyte, 10-15 micrometers in diameter
Phagocytizes microorganism
Releases histamine, which promotes inflammation, and heparin which prevents clot formation
Releases chemical that reduce inflammation, attacks certain worm parasites
Produces antibodies and other chemicals responsible for destroying microorganisms, responsible for allergic reactions, graft rejection, tumor control, and regulation of the immune system
Phagocytic cell in the blood leaves the circulatory system and becomes a macrophage which phagocytises bacteria, dead cells, cell fragments, and debris within tissues
Platelet Cell fragments surrounded by a cell membrane and containing granules, 2-5 micrometers in diameter Forms platelet plugs, release chemicals necessary for blood clotting
PREVENTING BLOOD LOSS
When a blood vessel is damaged, blood can leak into other tissues and interfere with the normal tissue function or blood can be lost from the body. Small amounts of blood from the body can be tolerated but new blood must be produced to replace the loss blood. If large amounts of blood are lost, death can occur.
BLOOD CLOTTING
Platelet plugs alone are not sufficient to close large tears or cults in blood vessels. When a blood vessel is severely damaged, blood clotting or coagulation results in the formation of a clot. A clot is a network of threadlike protein fibers called fibrin, which traps blood cells, platelets and fluids.
The formation of a blood clot depends on a number of proteins found within plasma called clotting factors. Normally the clotting factors are inactive and do not cause clotting. Following injury however, the clotting factors are activated to produce a clot. This is a complex process involving chemical reactions, but it can be summarized in 3 main stages; the chemical reactions can be stated in two ways: just as with platelets, the contact of inactive clotting factors with exposed connective tissue can result in their activation. Chemicals released from injured tissues can also cause activation of clotting factors. After the initial clotting factors are activated, they in turn activate other clotting factors. A series of reactions results in which each clotting factor activates the next clotting factor in the series until the clotting factor prothrombin activator is formed. Prothrombin activator acts on an inactive clotting factor called prothrombin. Prothrombin is converted to its active form called thrombin. Thrombin converts the inactive clotting factor fibrinogen into its active form, fibrin. The fibrin threads form a network which traps blood cells and platelets and forms the clots.
CONTROL OF CLOT FORMATION
Without control, clotting would spread from the point of its initiation throughout the entire circulatory system. To prevent unwanted clotting, the blood contains several anticoagulants which prevent clotting factors from forming clots. Normally there are enough anticoagulants in the blood to prevent clot formation. At the injury site, however, the stimulation for activating clotting factors is very strong. So many clotting factors are activated that the anticoagulants no longer can prevent a clot from forming.
CLOT RETRACTION AND DISSOLUTION
After a clot has formed, it begins to condense into a denser compact structure by a process known as clot retraction. Serum, which is plasma without its clotting factors, is squeezed out of the clot during clot retraction. Consolidation of the clot pulls the edges of the damaged vessels together, helping the stop of the flow of blood, reducing the probability of infection and enhancing healing. The damaged vessel is repaired by the movement of fibroblasts into damaged area and the formation of the new connective tissue. In addition, epithelial cells around the wound divide and fill in the torn area.
The clot is dissolved by a process called fibrinolysis. An inactive plasma protein called plasminogen is converted to its active form, which is called plasmin. Thrombin and other clotting factors activated during clot formation, or tissue plasminogen activator released from surrounding tissues, stimulate the conversion of plasminogen to plasmin. Over a period of a few days the plasmin slowly breaks down the fibrin.
Pathophysiology Dengue Fever
Dengue Fever is caused by one of the four closely related, but antigenically distinct, virus serotypes Dengue type 1, Dengue type 2, Dengue type 3, and Dengue type 4 of the genus Flavivirus and Chikungunya virus. Infection with one of this serotype provides immunity to only that serotype of life, to a person living in a Dengue-endemic area can have more than one Dengue infection during their lifetime. Dengue fever through the four different Dengue serotypes are maintained in the cycle which involves humans and Aedes aegypti or Aedes albopictus mosquito through the transmission of the viruses to humans by the bite of an infected mosquito. The mosquito becomes infected with the Dengue virus when it bites a person who has Dengue and after a week it can transmit the virus while biting a healthy person. Dengue cannot be transmitted or directly spread from person to person. Aedes aegypti is the most common aedes specie which is a domestic, day-biting mosquito that prefers to feed on humans.
INTUBATION PERIOD: Uncertain. Probably 6 days to 10 days
PERIOD OF COMMUNICABILITY: Unknown. Presumed to be on the 1st week of illness when virus is still present in the blood
CLINICAL MANIFESTATIONS:
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
4th to 7th day:
>toxic or hemorrhagic stage --- lowering of temperature, severe abdominal pain, vomiting and frequent bleeding from GIT in the form of melena; unstable BP, narrow pulse pressure and shock; death may occur; vasomotor collapse
7th to 10th day:
>convalescent or recovery stage --- generalized flushing with intervening areas of blanching appetite regained and blood pressure already stable
MODE OF TRANSMISSION:
Dengue viruses are transmitted to humans through the infective bites of female Aedes mosquito. Mosquitoes generally acquire virus while feeding on the blood of an infected person. After virus incubation of 8-10 days, an infected mosquito is capable, during probing and blood feeding of transmitting the virus to susceptible individuals for the rest of its life. Infected female mosquitoes may also transmit the virus to their offspring by transovarial (via the eggs) transmission.
Humans are the main amplifying host of the virus. The virus circulates in the blood of infected humans for two to seven days, at approximately the same time as they have fever. Aedes mosquito may have acquired the virus when they fed on an individual during this period. Dengue cannot be transmitted through person to person mode.
CLASSIFICATION:
1. Severe, frank type
>flushing, sudden high fever, severe hemorrhage, followed by sudden drop of temperature, shock and terminating in recovery or death
2. Moderate
>with high fever but less hemorrhage, no shock present
3. Mild
>with slight fever, with or without petichial hemorrhage but epidemiologically related to typical cases usually discovered in the course of invest or typical cases
GRADING THE SEVERITY OF DENGUE FEVER:
Grade 1:
>fever
>non-specific constitutional symptoms such as anorexia, vomiting and abdominal pain
>absence of spontaneous bleeding
>positive tourniquet test
Grade 2:
>signs and symptoms of Grade 1: plus
>presence of spontaneous bleeding: mucocutaneous, gastrointestinal
Grade 3:
>signs and symptoms of Grade 2 with more severe bleeding: plus
>evidence of circulatory failure: cold, clammy skin, irritability, weak to compressible pulses, narrowing of pulse pressure to 20 mmhg or less, cold extremities, mental confusion
Grade 4:
>signs and symptoms of Grade 3, declared shock, massive bleeding, pulse less and arterial blood Pressure = 1 mmhg (Dengue Syndrome/DS)
SUSCEPTABILITY, RESISTANCE, AND OCCURRENCE:
>all persons are susceptible
>both sexes are equally affected
>age groups predominantly affected are the pre-school age and school age
>adults and infants are not exempted
>peak age affected: 5-9 years old
DF is sporadic throughout the year. Epidemic usually occurs during rainy seasons (June – November). Peak months are September – October. It occurs wherever vector mosquito exists.
DIAGNOSTIC TEST:
Tourniquet test
>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 square just below the cuff, at the antecubital fossa.
>Count the number of petechiae inside the box. A test is positive when 20 or more petechiae per suare are observed.
DENGUE PREVENTION:
There is no vaccine to prevent dengue. Prevention centers on avoiding mosquito bites when traveling to areas where dengue occurs and when in U.S. areas, especially along the Texas-Mexico border, where dengue might occur. Eliminating mosquito breeding sites in these areas is another key prevention measure.
Avoid mosquito bites when traveling in tropical areas:
Use mosquito repellents on skin and clothing.
When outdoors during times that mosquitoes are biting, wear long-sleeved shirts and long pants tucked into socks.
Avoid heavily populated residential areas.
When indoors, stay in air-conditioned or screened areas. Use bednets if sleeping areas are not screened or air-conditioned.
If you have symptoms of dengue, report your travel history to your doctor.
Eliminate mosquito breeding sites in areas where dengue might occur:
Eliminate mosquito breeding sites around homes. Discard items that can collect rain or run-off water, especially old tires.
Regularly change the water in outdoor bird baths and pet and animal water containers.
Personal Data
Name: R.B.A
Age: 34 years old
Address: Gate 10 Area-B Parola Compound, Tondo Manila
Sex: Male
Civil status: Married
Nationality: Filipino
Birthday: September 11, 1975
Birthplace: Manila City
Religion: Roman Catholic
Occupation: Trucking laborer
Date of admission: February 24, 2010
Time of admission: 11:40 AM
Chief complain: fever
Tentative diagnosis: dengue hemorrhagic fever grade III
Final diagnosis: dengue hemorrhagic fever grade III
Admitting Physician: Dra. Coraleah C. Lim
Clinical History
Past medical history
(-) previous hospitalization
(-) allergy to food and drug
(-) dengue
(-) asthma
Family history
(+) Hypertension- mother
(-) Diabetes Mellitus
(-) Cancer
(-) asthma
Occupation and Environment
(+) Canal
History of present illness
Five days PTC, patient had fever undocumented, self medicated with paracetamol and Alaxan affording temporary relief. Four days PTA, still with on and off fever, now associated with nosebleeding and gumbleeding, and throat pain and difficulty of swallowing. Few hours PTC, consulted a nearb hospital, a tourniquet test was done and revealed (+), prompted to seek consult to San Lazaro Hospital.
Physical Examination
Date assessed: February 24, 2010 7:03 PM
General assessment: conscious and coherent
Initial Vital signs: T: 38.6 C P: 117 beats/min R: 23 breaths/min BP: 80/50 mmHg
Head: Normocephalic
Eyes: Anicteric sclera, pink palpebral conjunctiva
ENT :(-) nasal discharge
Neck: stipple neck (-) cervical lymphadenopathy
Heart: adynamic precordiunm , no murmur , normal rate , regular rhythm
Chest: symmetrical chest expansion (-0 retraction
Lungs: clear breath sounds
Abdomen: flat, no tenderness, normoactive bowel sound
Extremities: (+) tourniquet test, full, equal pulse
External genitalia: essentially normal, no discharge
Neurological: No deficit
Tuesday, March 9, 2010
NI
Nursing Implication
Nursing Practice
This case study aims to educate the people about dengue fever. Furthermore, this study will help in the nursing practice by providing information about the proper management and care for patient with dengue fever especially on the prevention of the disease, thus the knowledge that we gain could be applied in clinical settings.
Nursing education
Education plays a vital role in nursing profession. Knowledge that we gain from education will be helpful in actual experience to different hospitals
This knowledge can be inculcated by the nurses through education from schools, hospitals, reference books and informative magazines.
Nursing Research
This study, dengue fever will be helpful in both home and clinical settings. This case study aims to inculcate to people everything about Dengue fever. We are prompting awareness to the people to be able to prevent the development of the disease. We wanted to focus on preventive measures. Thus, this case study will increase awareness about the importance of having a healthy lifestyle and clean environment.
Nursing Practice
This case study aims to educate the people about dengue fever. Furthermore, this study will help in the nursing practice by providing information about the proper management and care for patient with dengue fever especially on the prevention of the disease, thus the knowledge that we gain could be applied in clinical settings.
Nursing education
Education plays a vital role in nursing profession. Knowledge that we gain from education will be helpful in actual experience to different hospitals
This knowledge can be inculcated by the nurses through education from schools, hospitals, reference books and informative magazines.
Nursing Research
This study, dengue fever will be helpful in both home and clinical settings. This case study aims to inculcate to people everything about Dengue fever. We are prompting awareness to the people to be able to prevent the development of the disease. We wanted to focus on preventive measures. Thus, this case study will increase awareness about the importance of having a healthy lifestyle and clean environment.
NCP
Assessment Diagnosis Plan Intervention Rationale Evaluation
Subjective:
“Dumudugo ang ilong ko” as claimed by the patient.
Objective:
•
Weakness and irritability.
•
Restlessness.
T: 38.6 C
P: 117 beats/min
R:23 breaths/min
BP:80/50 mmHg
Injury, risk for hemorrhage related to altered clotting factor.
After 1 hr. Of nursing interventions, the client will be able to demonstrate behaviors that reduce the risk for bleeding.
Independent:
*Assess for signs and symptoms of G.I bleeding. Check for secretions. Observe color and consistency of stools or vomitus.
*Observe for presence of petechiae, ecchymosis, bleeding from one more sites.
*Monitor pulse, Blood pressure.
*Note changes in mentation and level of consciousness.
*Encourage use of soft toothbrush, avoiding straining for stool, and forceful nose blowing.
*Use small needles for injections. Apply pressure to venipuncture sites for longer than usual.
*Recommend avoidance of aspirin containing products.
Collaborative:
*Monitor Hb and Hct and clotting factors.
*The G.I tract (esophagus and rectum) is the most usual source of bleeding of its mucosal fragility.
*Sub-acute disseminated intravascular coagulation (DIC) may develop secondary to altered clotting factors.
*An increase in pulse with decreased Blood pressure can indicate loss of circulating blood volume.
*Changes may indicate cerebral perfusion secondary to hypovolemia, hypoxemia.
Rectal and esophageal vessels are most vulnerable to rupture.
*In the presence of clotting factor disturbances, minimal trauma can cause mucosal bleeding.
*Minimizes damage to tissues, reducing risk for bleeding and hematoma.
*Prolongs coagulation, potentiating risk of hemorrhage.
*Indicators of anemia, active bleeding, or impending complications.
After 1 hr. Of nursing interventions, the client was able to demonstrate behaviors that reduce the risk for bleeding.
Assessment Diagnosis Plan Interventions Rationale Evaluation
Subjective:
“Nilalagnat ako,”as claimed by the patient.
Objective:
T:38.6 C
P: 117 breaths/min
R:23 breaths/min
BP: 80/50 mmHg
Hyperthermia related to direct effect of circulating endotoxins on the hypothalamus altering temperature regulation
To decrease the body temperature and return to normal
*Provide cool/Tepid sponge bath or immersion
*Wrap extremities with cotton blankets
*Maintain bed rest
*Administer antipyretics as ordered
* May help reduce fever be means of heat loss through evaporation and conduction
To minimize shivering
*To reduce metabolic demands and oxygen consumption
* Used to reduce fever by it’s central action on the hypothalamus
After few hours of interventions, the patient body temperature returned to normal range
Assessment Diagnosis Plan Interventions Rationale Evaluation
Subjective:
“Nahihirapan akong lumunok ng pagkain,” as verbalized by the patient.
Objective:
(+) lack of chewing
(+) coughing during a swallow
Impaired swallowing related to decreased strength or excursion of muscle involved in mastication as manifested by lack of chewing and coughing during a swallow
Client will pass food and fluid from mouth to stomach safely.
*Auscultate breath sounds
*Move client to chair for meals, snacks and drinks when possible. If the client is in bed elevate the head of the bed.
*Place food midway in oral cavity, provide medium size bite
*Use a glass with nose cut out when drinking
*Massage the laryngopharyngeal musculature gently
*Provide a consistency of food/fluid that is most easily swallowed.
*Evaluates presence of aspiration
*Reduce risk of regurgitation/aspiration
* To adequately trigger the swallowing reflex
*To avoid posterior head tilting
* To stimulate swallowing
* To decrease pain during swallowing.
After the interventions made, the client was able to swallow food/fluids without difficulty
Subjective:
“Dumudugo ang ilong ko” as claimed by the patient.
Objective:
•
Weakness and irritability.
•
Restlessness.
T: 38.6 C
P: 117 beats/min
R:23 breaths/min
BP:80/50 mmHg
Injury, risk for hemorrhage related to altered clotting factor.
After 1 hr. Of nursing interventions, the client will be able to demonstrate behaviors that reduce the risk for bleeding.
Independent:
*Assess for signs and symptoms of G.I bleeding. Check for secretions. Observe color and consistency of stools or vomitus.
*Observe for presence of petechiae, ecchymosis, bleeding from one more sites.
*Monitor pulse, Blood pressure.
*Note changes in mentation and level of consciousness.
*Encourage use of soft toothbrush, avoiding straining for stool, and forceful nose blowing.
*Use small needles for injections. Apply pressure to venipuncture sites for longer than usual.
*Recommend avoidance of aspirin containing products.
Collaborative:
*Monitor Hb and Hct and clotting factors.
*The G.I tract (esophagus and rectum) is the most usual source of bleeding of its mucosal fragility.
*Sub-acute disseminated intravascular coagulation (DIC) may develop secondary to altered clotting factors.
*An increase in pulse with decreased Blood pressure can indicate loss of circulating blood volume.
*Changes may indicate cerebral perfusion secondary to hypovolemia, hypoxemia.
Rectal and esophageal vessels are most vulnerable to rupture.
*In the presence of clotting factor disturbances, minimal trauma can cause mucosal bleeding.
*Minimizes damage to tissues, reducing risk for bleeding and hematoma.
*Prolongs coagulation, potentiating risk of hemorrhage.
*Indicators of anemia, active bleeding, or impending complications.
After 1 hr. Of nursing interventions, the client was able to demonstrate behaviors that reduce the risk for bleeding.
Assessment Diagnosis Plan Interventions Rationale Evaluation
Subjective:
“Nilalagnat ako,”as claimed by the patient.
Objective:
T:38.6 C
P: 117 breaths/min
R:23 breaths/min
BP: 80/50 mmHg
Hyperthermia related to direct effect of circulating endotoxins on the hypothalamus altering temperature regulation
To decrease the body temperature and return to normal
*Provide cool/Tepid sponge bath or immersion
*Wrap extremities with cotton blankets
*Maintain bed rest
*Administer antipyretics as ordered
* May help reduce fever be means of heat loss through evaporation and conduction
To minimize shivering
*To reduce metabolic demands and oxygen consumption
* Used to reduce fever by it’s central action on the hypothalamus
After few hours of interventions, the patient body temperature returned to normal range
Assessment Diagnosis Plan Interventions Rationale Evaluation
Subjective:
“Nahihirapan akong lumunok ng pagkain,” as verbalized by the patient.
Objective:
(+) lack of chewing
(+) coughing during a swallow
Impaired swallowing related to decreased strength or excursion of muscle involved in mastication as manifested by lack of chewing and coughing during a swallow
Client will pass food and fluid from mouth to stomach safely.
*Auscultate breath sounds
*Move client to chair for meals, snacks and drinks when possible. If the client is in bed elevate the head of the bed.
*Place food midway in oral cavity, provide medium size bite
*Use a glass with nose cut out when drinking
*Massage the laryngopharyngeal musculature gently
*Provide a consistency of food/fluid that is most easily swallowed.
*Evaluates presence of aspiration
*Reduce risk of regurgitation/aspiration
* To adequately trigger the swallowing reflex
*To avoid posterior head tilting
* To stimulate swallowing
* To decrease pain during swallowing.
After the interventions made, the client was able to swallow food/fluids without difficulty
Tuesday, September 1, 2009
DWAD
Narrative report
It was a very hot afternoon of August 9, 2009 when we had our seminar regarding physical assessment, IMCI approach, global challenge in community health development and sexual and reproductive health at the Divine Word Academy, Dagupan City.
I was so excited then, because I know that I will learn a lot form that seminar. At around 10:00 a.m., I with my colleagues went to DWAD. We arrived there so early, so we waited for few hours for the seminar to start.
At exactly 1:30 p.m. the seminar started. The seminar started with a prayer and singing of the national anthem. Mrs. Jane Fernandez introduced the first speaker. The first speaker was Mrs. Cherylina G. Dalilis. She talked about introduction to Integrated Management of Childhood Illnesses (IMCI). The discussion about IMCI was very fun because Ma’am Dalilis was a very good speaker. She imparted important information about the topic and I learned a lot. Aside from IMCI she also discussed about physical assessment. She discussed how to integrate the proper physical assessment.
After the discussion of Ma’am Dalilis, Mrs. Fernandez introduced the next speaker. Prof. Carmen Bolinto was the second speaker. She talked about global challenges in community health development, where she showed some pertinent data about the topic. The discussion was very fun because of data she showed to us. Those data were very informative that gave us hints what was going on the health situations around the globe. On the other hand, she also discussed about sexual and reproductive health. She inculcated important information regarding that topic. Indeed, it was a very fun discussion. After the discussion we sung a song that made us alive and kicking.
When the seminar ended at around 5:00 p.m., happiness was inside my heart because I have learned a lot of information. This seminar made me equipped with the different information that is needed in my chosen career. This seminar served not only that I got certificates but rather the knowledge that I have gained.
It was a very hot afternoon of August 9, 2009 when we had our seminar regarding physical assessment, IMCI approach, global challenge in community health development and sexual and reproductive health at the Divine Word Academy, Dagupan City.
I was so excited then, because I know that I will learn a lot form that seminar. At around 10:00 a.m., I with my colleagues went to DWAD. We arrived there so early, so we waited for few hours for the seminar to start.
At exactly 1:30 p.m. the seminar started. The seminar started with a prayer and singing of the national anthem. Mrs. Jane Fernandez introduced the first speaker. The first speaker was Mrs. Cherylina G. Dalilis. She talked about introduction to Integrated Management of Childhood Illnesses (IMCI). The discussion about IMCI was very fun because Ma’am Dalilis was a very good speaker. She imparted important information about the topic and I learned a lot. Aside from IMCI she also discussed about physical assessment. She discussed how to integrate the proper physical assessment.
After the discussion of Ma’am Dalilis, Mrs. Fernandez introduced the next speaker. Prof. Carmen Bolinto was the second speaker. She talked about global challenges in community health development, where she showed some pertinent data about the topic. The discussion was very fun because of data she showed to us. Those data were very informative that gave us hints what was going on the health situations around the globe. On the other hand, she also discussed about sexual and reproductive health. She inculcated important information regarding that topic. Indeed, it was a very fun discussion. After the discussion we sung a song that made us alive and kicking.
When the seminar ended at around 5:00 p.m., happiness was inside my heart because I have learned a lot of information. This seminar made me equipped with the different information that is needed in my chosen career. This seminar served not only that I got certificates but rather the knowledge that I have gained.
Thursday, August 20, 2009
Till the end
Till the End
The time that we have been together
I realized that I really love you.
Every night I am thinking of you,
that all of my dream s will become true.
No one can take us apart,
because we've shown the best.
No matter what impediments will come,
I know we will survive.
The love that we've shared,
A million sweet memories
that will not surely fade away,
You are the one I truly love.
Just remember, "I'm here,"
No matter what happens.
Don't worry my dear,
"I will love you till the end."
by: Greenerpasture
The time that we have been together
I realized that I really love you.
Every night I am thinking of you,
that all of my dream s will become true.
No one can take us apart,
because we've shown the best.
No matter what impediments will come,
I know we will survive.
The love that we've shared,
A million sweet memories
that will not surely fade away,
You are the one I truly love.
Just remember, "I'm here,"
No matter what happens.
Don't worry my dear,
"I will love you till the end."
by: Greenerpasture
Monday, May 18, 2009
NCP
Assessment
Subjective
“I have difficulty of breathing”, as verbalized by the patient.
“I have headache upon awakening”, as verbalized by the patient.
Objective
Temp. 37.2 degrees Celsius
PR: 146 BPM
RR: 19 breaths/min
BP: 140/90 mmHg
Confusion; restlessness; pale skin; abnormal breathing; nasal flaring; abnormal ABGs/arterial pH as evidenced by hypoxia
Nursing diagnosis
Impaired gas exchange related to inflammatory process, collection of secretions affecting oxygen exchange across alveolar membrane, and hypoventilation possibly evidence by restlessness/change in mentation, dyspnea , tachycardia, pallor and abnormal ABGs/arterial pH evidence of hypoxia
Plan
Client will:
Demonstrate improved ventilation and adequate oxygenation of tissues by ABGs within client’s normal limits and absence of respiratory distress
Participate in treatment regimen(e.g. breathing exercises, effective coughing, use of oxygen)within level of ability/situation
Interventions
*Maintain oxygen administration device as ordered to maintain oxygen saturation at 90% or greater
* For patients who should be ambulatory, provide extension tubing or portable oxygen apparatus.
* Position with proper body alignment for optimal respiratory excursion (if tolerated, head of bed at 45 degrees).
* Routinely check the patient’s position so that he or she does not slide down in bed
* Position patient to facilitate ventilation/perfusion matching. Use upright, high-Fowler’s position whenever possible.
* Pace activities and schedule rest periods to prevent fatigue
* Change patient’s position every 2 hours.
* Encourage deep breathing, using incentive spirometer as indicated
* Encourage or assist with ambulation as indicated
*assist with splinting the chest
*Observe signs of respiratory distress(increased rate/restlessness and pallor)
*Teach the patient appropriate deep breathing and coughing
Rationale
* This provides for adequate oxygenation.
* These promote activity and facilitate more effective ventilation
*This promotes lung expansion and improves air exchange
* This would cause the abdomen to compress the diaphragm, which would cause respiratory embarrassment.
* High-Fowler’s position allows for optimal diaphragm excursion. When patient is positioned on side, the good side should be down
* Even simple activities such as bathing during bed rest can cause fatigue and increase oxygen consumption.
* This facilitates secretion movement and drainage.
* This reduces alveolar collapse.
* This promotes lung expansion, facilitates secretion clearance, and stimulates deep breathing.
*Splinting optimizes deep breathing and coughing efforts.
*These clinical manifestation would be early indicators of hypoxia
*Facilitates adequate air exchange and secretion clearance
Evaluation
Outcome met. The patient demonstrated improved oxygen ventilation and adequate oxygenation. Added to that he participated in treatment regimen for breathing exercise, effective coughing, and use of oxygen
Subjective
“I have difficulty of breathing”, as verbalized by the patient.
“I have headache upon awakening”, as verbalized by the patient.
Objective
Temp. 37.2 degrees Celsius
PR: 146 BPM
RR: 19 breaths/min
BP: 140/90 mmHg
Confusion; restlessness; pale skin; abnormal breathing; nasal flaring; abnormal ABGs/arterial pH as evidenced by hypoxia
Nursing diagnosis
Impaired gas exchange related to inflammatory process, collection of secretions affecting oxygen exchange across alveolar membrane, and hypoventilation possibly evidence by restlessness/change in mentation, dyspnea , tachycardia, pallor and abnormal ABGs/arterial pH evidence of hypoxia
Plan
Client will:
Demonstrate improved ventilation and adequate oxygenation of tissues by ABGs within client’s normal limits and absence of respiratory distress
Participate in treatment regimen(e.g. breathing exercises, effective coughing, use of oxygen)within level of ability/situation
Interventions
*Maintain oxygen administration device as ordered to maintain oxygen saturation at 90% or greater
* For patients who should be ambulatory, provide extension tubing or portable oxygen apparatus.
* Position with proper body alignment for optimal respiratory excursion (if tolerated, head of bed at 45 degrees).
* Routinely check the patient’s position so that he or she does not slide down in bed
* Position patient to facilitate ventilation/perfusion matching. Use upright, high-Fowler’s position whenever possible.
* Pace activities and schedule rest periods to prevent fatigue
* Change patient’s position every 2 hours.
* Encourage deep breathing, using incentive spirometer as indicated
* Encourage or assist with ambulation as indicated
*assist with splinting the chest
*Observe signs of respiratory distress(increased rate/restlessness and pallor)
*Teach the patient appropriate deep breathing and coughing
Rationale
* This provides for adequate oxygenation.
* These promote activity and facilitate more effective ventilation
*This promotes lung expansion and improves air exchange
* This would cause the abdomen to compress the diaphragm, which would cause respiratory embarrassment.
* High-Fowler’s position allows for optimal diaphragm excursion. When patient is positioned on side, the good side should be down
* Even simple activities such as bathing during bed rest can cause fatigue and increase oxygen consumption.
* This facilitates secretion movement and drainage.
* This reduces alveolar collapse.
* This promotes lung expansion, facilitates secretion clearance, and stimulates deep breathing.
*Splinting optimizes deep breathing and coughing efforts.
*These clinical manifestation would be early indicators of hypoxia
*Facilitates adequate air exchange and secretion clearance
Evaluation
Outcome met. The patient demonstrated improved oxygen ventilation and adequate oxygenation. Added to that he participated in treatment regimen for breathing exercise, effective coughing, and use of oxygen
NCP 2
Assessment
Subjective
“I feel weak”, as verbalized by the patient.
“ I am having discomfort and difficulty of breathing”, as verbalized by the patient
Objective
Temp.: 37.2 degrees Celsius
PR: 140 BPM
RR: 22 breathes/min
BP:140/90 mmHg
Development/severing pallor; excessive coughing
Nursing diagnosis
Activity intolerance related to imbalance between oxygen supply and demand, general weakness possibly evidenced by reports of fatigue,dyspnea,and abnormal ital sign response to activity
Plan
Client will:
Report/demonstrate a measurable increase in tolerance to activity with absence of dyspnea and excessive fatigue, and vital signs either normal patient’s acceptable range.
Plan
*Evaluate patient’s response to activity. Note reports of dyspnea, increase weaknesses/fatigue, and changes in vital signs during and after activities.
*Provide a quiet environment and limit visitors during acute phase as indicated. Encourage use of stress management and diversional activities as appropriate.
*Explain importance of rest in treatment plan and necessity for balancing activities with rest. *Establishes patient’s capabilities/needs and facilitates choice of interventions
Rationale
*Reduce stress and excess stimulation, promoting rest.
*Bed rest is maintained during acute phase to decrease metabolic demands, thus conserving energy for healing. Activity intolerance restrictions thereafter are determined by individual patient response to activity and resolution of respiration insufficiency Outcome met. The patient reported and demonstrated a measurable increase in tolerance to activity with absence of dyspnea and excessive fatigue, and vital signs were normal.
Evaluation
Outcome met. The patient reported and demonstrated a measurable increase in tolerance to activity with absence of dyspnea and excessive fatigue, and vital signs were normal.
Subjective
“I feel weak”, as verbalized by the patient.
“ I am having discomfort and difficulty of breathing”, as verbalized by the patient
Objective
Temp.: 37.2 degrees Celsius
PR: 140 BPM
RR: 22 breathes/min
BP:140/90 mmHg
Development/severing pallor; excessive coughing
Nursing diagnosis
Activity intolerance related to imbalance between oxygen supply and demand, general weakness possibly evidenced by reports of fatigue,dyspnea,and abnormal ital sign response to activity
Plan
Client will:
Report/demonstrate a measurable increase in tolerance to activity with absence of dyspnea and excessive fatigue, and vital signs either normal patient’s acceptable range.
Plan
*Evaluate patient’s response to activity. Note reports of dyspnea, increase weaknesses/fatigue, and changes in vital signs during and after activities.
*Provide a quiet environment and limit visitors during acute phase as indicated. Encourage use of stress management and diversional activities as appropriate.
*Explain importance of rest in treatment plan and necessity for balancing activities with rest. *Establishes patient’s capabilities/needs and facilitates choice of interventions
Rationale
*Reduce stress and excess stimulation, promoting rest.
*Bed rest is maintained during acute phase to decrease metabolic demands, thus conserving energy for healing. Activity intolerance restrictions thereafter are determined by individual patient response to activity and resolution of respiration insufficiency Outcome met. The patient reported and demonstrated a measurable increase in tolerance to activity with absence of dyspnea and excessive fatigue, and vital signs were normal.
Evaluation
Outcome met. The patient reported and demonstrated a measurable increase in tolerance to activity with absence of dyspnea and excessive fatigue, and vital signs were normal.
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