ADVENTIST UNIVERSITY OF THE PHILIPPINES

COLLEGE OF NURSING

Case: Patient Corinth Magbanua, 7-year-old female, Filipino, born on August 26, 2013 in Manila. He is the
second child among the four siblings. His mother is the primary care giver while the father is a side car driver.
They live in 2043 Inofil, Tramo, Pasay City, Manila 1300. The patient was brought to the out-patient
department (OPD) by her mother due to fever. Initial diagnosis is Dengue Fever.

The client was given the following treatments:

Paracetamol 250mg/5ml, 7ml every 4 hours for Temperature 37.8°C

History: Three days prior to consult, the patient had a fever with the temperature of 40°C, no consult was
done, but self-medicated with Ibuprofen (Dolan forte 200mg/5ml) syrup every four hours. Two days prior to
consult, with fever but now with associated cough, still no consult was done and continued to self-medicate. A
day prior to admission, still with fever and cough, but now with vomiting every after feeding. Few hours prior
to consult, still with fever, cough, vomiting and now accompanied by abdominal pain. Consult was done.
According to the mother, in case her daughter will be admitted, this will be her first hospitalization. Final
diagnosis is Dengue Hemorrhagic Fever.
Further interview was done and according to the mother, she has family history of diabetes and
hypertension. While the father has no known illness. The mother also added that her daughter has complete
immunization from their barangay health center.

Focus Assessment:
The face and head are symmetrical and round, no evidence of scar and lesions. Both eyes are
coordinated, and eyelids are symmetrical. The patient complains of headache with 5/10 scale. The patient is
warm to touch, with temperature of 38.4°C. The skin is dry, and rashes are present on the lower extremities
and according to her it feels itchy. She complains of abdominal pain with 7/10 pain scale. According to her she
feels weak and needs assistance when going to the toilet. She has no appetite. When vital signs were taken
BP= 90/50, RR=25 bpm, PR=102bpm, and capillary refill is 4 seconds.

Diagnostic/Laboratory Tests:

Complete Blood Count

Hematology Result Normal Values

Blood C Red ell 5.20 4.50-5.40

Hematocrit 0.42 0.38-0.47

Hemoglobin 146 120-160

White Blood Cell L 3.10 5-10

Lymphocytes 23 25-40

Monocytes 8 2-8

Eosinophils 1 1-4

Basophils 1 0-1

Segmenter 67 54-75

Platelet Count 70 150-450

MCV 80 81-99

MCH 28 27-31

MCHL 35 32-36
 ADVENTIST UNIVERSITY OF THE PHILIPPINES COLLEGE OF NURSING

Outpatient Department WORKSHEET

Name of Student: Soriano, Precious Grace; Urbi, Rhen Eirene; Ysit Nikki Joy Section: De la Paz
Date of Duty: November 15, 2020

Instruction: Fill-in the data completely, put N/A for not applicable.

I. DEMOGRAPHIC DATA
Name of Patient: Magbanua, Corinth Age: 7-years-old Sex: F
Address: 2043 Inofil, Tramo, Pasay City, Manila 1300
Civil Status: Single Chief Complaint/s: Fever
Admitting Diagnosis: Dengue Fever Final Diagnosis: Dengue Hemorrhagic Fever

HISTORY OF PRESENT ILLNESS

Three days prior to consult, the patient had a fever with the temperature of 40°C, no consult was done, but
self-medicated with Ibuprofen (Dolan forte 200mg/5ml) syrup every four hours. Two days prior to consult, with
fever but now with associated cough, still no consult was done and continued to self-medicate. A day prior to
admission, still with fever and cough, but now with vomiting every after feeding. Few hours prior to consult,
still with fever, cough, vomiting and now accompanied by abdominal pain.

PAST MEDICAL AND/OR OB HISTORY

No known illness.

FAMILY MEDICAL HISTORY

Father – no known illness, Mother – Diabetes and Hypertension

IMMUNIZATION HISTORY (for pediatric clients)

Complete immunization done in their barangay health center.

II. ASSESSMENT Assess the client (Initial/Focus/General). Use GREEN for Book Picture, RED for Patient’s Manifestations.
 Physical Assessment Book Patient Significance
Picture Manifestations
Skin • Good skin turgor • Good skin turgor Dengue causes flu-like symptoms
• No strong odor should be • No evidence of lesion and lasts for 2-7 days. Dengue
evident, or scar fever usually occurs after an
• lesion free, • warm to touch, with incubation period of 4-10 days
• facial flushing or skin temperature of 38.4°C after the bite of the infected
erythema, • skin is dry mosquito. The patient’s body
• presence of dengue rash, • presence of itchy temperature
• itching, rashes on lower was 38.4 °C.
• fever, extremities
• Capillary refill time CRT >2 • CRT = 4 sec Reference:
sec https://www.who.int/news-
room/q-a-detail/dengue-and-
severe-dengue

Prolonged CRT is a sign of

hypoperfusion that suddenly after
a few days of the febrile phase.

Reference:Clinical and laboratory

signs associated to serious dengue
disease in hospitalized children
Jornal de Pediatria (Versão em
Português), Volume 92, Issue 5,
September–October 2016, Pages
464-471

Head, Eyes, Ears,Nose HEAD • face and head are High Fever (40°C/ 104°F)
• Rounded, smooth skull symmetrical and accompanied by headache and
and Throat
contour, round, no evidence of rash are the common symptom of
• absences of nodules and scar and lesions. Dengue Fever.
masses; • No nodules and
• has systematic facial masses present Reference:
features and movements • No evidence of World Health Organization.
• hair is evenly distributed, alopecia, evenly Dengue and Severe Dengue
with no sign infection and distributed hair, https://www.who.int/news-
dandruff • no pediculosis and room/q-a-detail/dengue-and-
• presence of headache dandruff severe-dengue
• headache with 5/10
EYES scale
• Eyebrows and Eyelashes
are evenly distributed,
• the eyelids symmetrical • eyes are coordinated,
and have no discharge and • eyelids are
no discoloration; symmetrical
• pupils are round, equal in
size normally 3-7 mm in
 diameter;
• conjunctiva pink in color,
the sclera is white in color

EARS
• symmetrical,
• auricle aligned with outer
cantus of eyes,
• not tender;
• no discharge
• able to hear sound in both
ears

NOSE
• Symmetric and straight
• no discharge or flaring,
• uniform color.
• No tenderness and no
lesions

THROAT
• uvula is at the midline
pinkish in color and goes
up when the client is
asked to say “ah”,
• tonsils are not inflamed
Neck • at the midline, straight, • lymph nodes are Normal
• swollen lymph nodes, palpable but non-
• can do range of motion, tender
• trachea is palpable,
thyroid is non-palpable,
Breast • Breasts are flat and • Breasts are flat and Normal
symmetric. symmetric.
• Prepubertal: Elevation
of nipples only
Respiratory • Quiet, rhythmic • Normal breathing Symptoms of dengue fever
respiration, sounds. RR= 25 bpm typically develop between 3 and 14
• normal breathing rate (RR • No use of accessory days after a person is bitten by an
2–10 years: 20–28), muscles when infected mosquito. And this include
• no retraction when breathing some respiratory symptoms, such
breathing • With cough as a cough, sore throat, or nasal
congestion

Reference:
https://www.medicinenet.com/den
gue_fever/article.htm

Cardiovascular • The apical pulse is at the • BP= 90/50, Hypotension and CRT of <3
4th intercostal • PR=102bpm seconds are manifestations of
space (ICS) and into the • CRT = 4 sec compensated shock that can be
right mid-clavicular line life-threatening.
(MCL).
 • no heaves or lifts over the Reference:
apex, World Health Organization.
• no abnormal heart sounds Handbook for clinical management
of dengue. Geneva, 2012.
• BP-ranges are as follows: http://www.wpro.who.int/mvp/do
Systolic cuments/handbook_for_clinical_m
1–7 years = age in years + anagement_of_dengue.pdf
90
Diastolic
6–18 years = age in years
+ 52

• PR 2–10 years: 70–110

bpm
• Capillary refill time CRT >2
sec
Peripheral Vascular UPPER EXTREMETIES • Presence of itchy rash A flat, red rash may appear over
• Equal in size and on lower extremities most of the body 2 to 5 days after
symmetric. the fever starts. A second rash,
• Skin warm and dry to which looks like the measles,
touch, appears later in the disease.
• without edema, bruising, Infected people may have
or lesions. increased skin sensitivity and are
• Radial and brachial pulses very uncomfortable.
2+ and equal bilaterally.
• Epitrochlear nodes An increase in rashes could be an
nonpalpable. indication of decreasing platelet
• Presence of dengue rash count. This would require close
monitoring to prevent any
complication.

Reference:
Centers for Disease Control and
Prevention website. Dengue.
https://www.cdc.gov/dengue/inde
x.html

Gastrointestinal/Abdomen • anorexia, • abdominal pain with When developing into severe

• nausea and vomiting 7/10 pain scale dengue, the critical phase takes
• abdominal pain, mucosal • persistent vomiting place around 3-7 days after the
bleeding, especially • no appetite first sign of illness. Temperature
gastro-intestinal signs of will decrease; this does NOT mean
DHF the person is necessarily
recovering. On the other hand,
special attention needs to be given
to these warning signs as it could
lead to severe dengue:

• Severe abdominal pain

• Persistent vomiting
 Reference:
World Health Organization.
Dengue and Severe Dengue
https://www.who.int/news-
room/q-a-detail/dengue-and-
severe-dengue

Genitourinary • Prepubertal: No • Prepubertal: No Normal

pubic hair; fine pubic hair; fine
vellus hair, vellus hair,
• Oliguria, anuria • Normal urine output

Muskuloskeletal • Upper extremities and • Extremities are Normal

lower extremities symmetric
symmetric, • No lesions, nodules,
• without lesions, nodules, deformities, or
deformities, or swelling. swelling.
• Full ROM. • Full ROM.

Neurologic • Awake, • Awake Dengue-associated myositis is

• Feeling tired, irritability • feels weak and needs common in a younger age group
and restlessness assistance when going range: 3-56 years. Muscle
to the toilet weakness is frequently
accompanied by muscular pain.

Reference:
Dengue-associated neuromuscular
complications
https://neurologyindia.com/article.
asp?issn=0028-
3886;year=2015;volume=63;issue=
4;spage=497;epage=516;aulast=Ga
rg;type=3#:~:text=Dengue%2Dasso
ciated%20myositis%20can%20be%
20of%20varying%20severity%2C%2
0ranging%20from,been%20reporte
d%20along%20with%20myositis.
McLeod, Erik Erikson's Stages of
Psychosocial Development, 2018
https://www.simplypsychology.org
/Erik-Erikson.html
Hernandez, Case Study: Dengue
Fever, February 2014
https://www.slideshare.net/mjher
nandez23/individual-cstudy-
100613-print.
Silbert-Flagg Pillitteri, Maternal &
Child Health Nursing 8th Edition,
2018 – p16993-p1698
III. DEVELOPMENTAL TASK
Task/Crisis According to Sigmund Freud (Psychosexual): Latency phase:

This stage begins at the age of 6 ends when puberty starts to begin. The Oedipus complex was dissolve and set free
resulting in a relatively conflict- free period of development . Most sexual impulses are repressed during the latent stage
, and sexual energy can be sublimated, towards school work , hobbies, and friendship, channeled into developing new
skills and acquiring new knowledge , and play become largely confined to other children of the same gender. Base on
clients experience, the conflict free period of development occurs, because of other factor like being "self-centered
since she had acquire the knowledge through gathering it by her own means the reason he self-medicated. Even if this
is a normal stage they should consult to a psychiatrist for assistance to handle the situation well. In addition, the client
should develop to make a connection to their family.

Reference (APA format): Cherry, K ( March 27, 2020 ). Sigmud Freud Psychosexual Theory Human Developmental

Task/Crisis According to Erik Erickson (Psychosocial): Industry vs. Inferiority:

The patient is in her school-age-level and the patient’s developmental task is to perform a sense of industry vs
inferiority were the child learns to do things well. In this stage is where the patient’s peer group will have bigger impact
that will turn out to be a major source of his/her self-esteem as well as begin to recognize cause-and-effect
relationships. If the child is stimulated and strengthened for his/her initiative, they begin to feel industrious and feel
assured in her ability to achieve goals. If the child cannot develop the specific skill, their impression in society is difficult
then they may develop a sense of Inferiority, doubting his/her own abilities and therefore may not reach his or her
potential. Some failure may be essential that the child can grow some self-effacement. Achievement in this stage will
lead to the quality of competence.

Reference (APA format): (McLeod, Erik Erikson's Stages of Psychosocial Development, 2018), & (Silbert-Flagg Pillitteri,
Maternal & Child Health Nursing 8th Edition, 2018)

IV. LABORATORY/DIAGNOSTIC TEST

LABORATORY/ RESULT NORMAL IMPLICATION

DIAGNOSTIC VALUE
TEST

Complete blood RBC- 5.20 RBC – 4.50– People with DHF will have the regular symptoms of dengue fever
count Hct - 0.42 5.40 for 2 to 7 days. After the fever eases, other symptoms get
Hgb - 146 Hct – 0.38– worse and can cause more severe bleeding; gastrointestinal
WBC – L 0.47 problems like nausea, vomiting, or severe abdominal (belly) pain;
3.10 Hgb – 120 – and respiratory problems like difficulty breathing.
Lymps – 23 160 https://www.hopkinsallchildrens.org/patients-
Monos – 8 WBC – 5–10 families/health-library/healthdocnew/dengue-fever
Eos – 1 Lymphs –
Basos – 1 25–40
Segs – 67 Monos – 2–8
PLT Ct – L Eos– 1–4
70 Basos – 0–1
MCV – 80 Segs– 54-75 Johns, H. All Children’s Hospital, 2020
MCH – 28 PLT Ct– 150–
MCHL - 35 450 The hematocrit level should be monitored at least every 24
MCV – 81–99 hours to facilitate early recognition of dengue hemorrhagic
MCH – 27–31 and every 3-4 hours in severe cases of dengue hemorrhagic
MCHL – 32- fever or dengue shock syndrome.
36
https://pubmed.ncbi.nlm.nih.gov/7786355/

Garcia, S., Et al. Bol Asoc Med P R, Jan- Feb 1995

Platelets contribute to increased vascular

permeability by inflammation dependent release of
IL-1β. A rapid decrease in platelet count,
concomitant with a rising haematocrit, is suggestive
of progression to plasma leakage
https://www.who.int/en/news-room/fact-
sheets/detail/dengue-and-severe-dengue
World Health Organization. Dengue and Severe Dengue

Lymphocytopenia, also referred to as lymphopenia,

occurs when your lymphocyte count in your
bloodstream is lower than normal.

http://www.who.int/mediacentre/factsheets/fs117/en/

World Health Organization. Dengue and Severe

Dengue

Lymphocytes are a kind of white blood cell. They’re

part of your immune system. These essential cells
circulate in blood and lymph fluid.

http://www.who.int/mediacentre/factsheets/fs117/en/
World Health Organization .Dengue and Severe
Dengue
REFERENCES :

Geneve,World Health Organization Clinical Management on Dengue, 2012

dengue-associated neuromuscular complications
World Health Organization. Dengue and Severe Dengue
Mcleod, Erik Erikson's Stages of Psychosocial Development, 2018
Hernandez, Case Study: Dengue Fever, February 2014
Silbert-Flagg Pillitteri, Maternal & Child Health Nursing 8th Edition, 2018 – p16993-p1698
Centers for Disease Control and Prevention website. Dengue.
Sigmud Freud Psychosexual Theory Human Developmental, March 27, 2020
Mcleod,Erik Erikson's Stages of Psychosocial Development, 2018), & (Silbert-Flagg Pillitteri, Maternal & Child Health
Nursing 8th Edition, 2018
Johns, H. All Children’s Hospital, 2020

Garcia, S., Et al. Bol Asoc Med P R, Jan- Feb 1995

World Health Organization. Dengue and Severe Dengue

World Health Organization .Dengue and Severe Dengue

World Health Organization. Dengue amd Severe Dengue, October 14,2019
Jornal de Pediatria (Versão em Português), Volume 92,Issue 5, September–October 2016, Pages 464-
471