Republic of the Philippines

DIVINE WORD COLLEGE OF BANGUED

Bangued, Abra

COLLEGE OF NURSING

A Case study on

DENGUE

(DENGUE W/ WARNING SIGNS)

Presented to:

MISS. RUBY RAMOS RN. MAN

Clinical Instructor

Presented by:

George Mikhail Labuguen

BSN-III
I.INTRODUCTION

A. BACKGROUND OF THE STUDY

Dengue hemorrhagic fever (DHF) is an acute febrile diseases transmitted by mosquitoes,

which occur in the tropics, can be life-threatening, and is caused by four closely related virus
serotypes of the genus Flavivirus, family Flaviviridae. It was identified and named in 1779. It is
also known as breakbone fever, since it can be extremely painful. Unlike malaria, dengue is just
as prevalent in the urban districts of its range as in rural areas. Each serotype is sufficiently
different that there is no cross-protection and epidemics caused by multiple serotypes
(hyperendemicity) can occur. Dengue is transmitted to humans by the Aedes (Stegomyia)
aegypti or more rarely the Aedes albopictus mosquito. The mosquitoes that spread dengue
usually bite at dusk and dawn but may bite at any time during the day, especially indoors, in
shady areas, or when the weather is cloudy.

The disease manifests as fever of sudden onset associated with headache, muscle and joint
pains (myalgias and arthralgias—severe pain that gives it the nickname break-bone fever or
bonecrusher disease), distinctive retro-orbital pain, and rash.

The classic dengue rash is a generalized maculopapular rash with islands of sparing. A

hemorrhagic rash of characteristically bright red pinpoint spots, known as petechiae can occur
later during the illness and is associated with thrombocytopenia. It usually appears first on the
lower limbs and the chest; in some patients, it spreads to cover most of the body. There may also
be severe retro-orbital pain, (a pain from behind the eyes that is distinctive to Dengue infections),
and gastritis with some combination of associated abdominal pain, nausea, vomiting coffee-
grounds-like congealed blood, or severe diarrhea.

A physical examination may reveal:

 Enlarged liver (hepatomegaly)
 Low blood pressure
 Rash
 Red eyes
 Red throat
 Swollen glands
 Weak, rapid pulse
Tests may include:

 Arterial blood gases

 Coagulation studies
 Electrolytes
 Hematocrit
 Liver enzymes
 Platelet count
 Serologic studies (demonstrate antibodies to Dengue viruses)
 Serum studies from samples taken during acute illness and convalescence (increase
in titer to Dengueantigen)
 Tourniquet test (causes petechiae to form below the tourniquet)
 X-ray of the chest (may demonstrate pleural effusion)

Treatment
Because Dengue hemorrhagic fever is caused by a virus for which there is no known cure or
vaccine, the only treatment is to treat the symptoms.

 A transfusion of fresh blood or platelets can correct bleeding problems

 Intravenous (IV) fluids and electrolytes are also used to correct electrolyte imbalances
 Oxygen therapy may be needed to treat abnormally low blood oxygen
 Rehydration with intravenous (IV) fluids is often necessary to treat dehydration
 Supportive care in an intensive care unit/environment

Possible Complications

 Encephalopathy
 Liver damage
 Residual brain damage
 Seizures
 Shock

Prevention
There is no vaccine available to prevent dengue fever. Use personal protection such as full-
coverage clothing, netting, mosquito repellent containing DEET, and if possible, travel during
periods of minimal mosquito activity. Mosquito abatement programs can also reduce the risk of
infection.
MORTALITY AND MORBIDITY

The WHO says some 2.5 billion people, two fifths of the world's population, are now at
risk from dengue and estimates that there may be 50 million cases of dengue infection worldwide
every year. The disease is now endemic in more than 100 countries.

B. RATIONALE FOR CHOOSING THE CASE

The researcher chose this case because the researcher wants to have sufficient knowledge
about Dengue Hemorrhagic Fever; in order to be acquainted with regards to the clinical
manifestations of the condition and its causes, to know the appropriate treatment and diagnostic
procedures that must be done and identify appropriate nursing interventions needed and must be
rendered to the patient experiencing and who may experience such condition; to share and impart
the necessary information that may be helpful in eradicating the occurrence of the condition, and
to be educated about Dengue Hemorrhagic Fever so as to become an effective nurses in the
future.

C. SIGNIFICANCE OF THE STUDY

C.a) To the Patient

This study is significant to the patient because she will acquire information from the
facts shared by the researcher, it will help her to understand her condition and cope up with her
situation as well as to learn and understand the effects of drugs administered to her.

C.b) To the Family

This study will help to determine and be knowledgeable regarding the different measures
that must be done to prevent one from having the condition.

C.c) To the Community

This study will help everyone in the community to be knowledgeable about this illness and
will be able to provide preventive measures in order to avoid this condition.

C.d) To the Student Nurse

For her to know all the appropriate interventions that should be rendered to patients having
this kind of condition, to know all the possible complications, all the procedures that must be
done, the drugs, and the kind of management it requires.
C.d) To the Nursing Education

This study is useful for the students in nursing education for they will obtain relevant
information on the subject which is Dengue Hemorrhagic Fever.

D. SCOPE AND DELIMITATION

This study consists of the information regarding dengue hemorrhagic fever. It contains the
patient’s data, the medical history of the patient, the physical assessment, the medical
management, the nursing care plans needed for this condition, the anatomy and physiology of the
system involved. I wasn’t able to get the result of the urinalysis because it wasn’t in yet.
II.PATIENT’S PROFILE/BIOGRAPHICAL DATA:

Name:
Address:
Age:
Sex:
Civil Status: Single
Religion: Roman Catholic
Nationality: Filipino
Birthday:
Name of Hospital: San Lazaro Hospital
Room and Bed No.: Pedia Dept. / Bed No.
Hospital No.:
Hospital code:
Date of Admission:
Time of Admission:
Admitting Diagnosis: Dengue Fever
Admitting Physician:
Chief Complaints: Fever
III. MEDICAL HISTORY
A. Present History of Illness
Seven days prior to admission the patient developed on and off fever with
associated headache and loss of appetite. Then two days prior to admission the patient is no fever
but still with loss of appetite. One day after, fever occurred again with associated rashes in the
upper and lower extremities. They consulted at MCU wherein CBC with PC was done and when
the result was in it revealed that she has low platelet count that’s why they transferred at San
Lazaro Hospital.

B. Past Medical History

According to the father of the patient, she was fully immunized when she was a
child. She has no allergies on foods and drugs and that she hasn’t encountered any accident yet.
According to him she had experienced all common illnesses such as colds, cough, and fever and
had also experienced primary complex when she was a child that caused her to be hospitalized
way back then and the medication prescribed was Salbutamol.

C. Family History of Illness

According to the father of the patient she is the eldest among the 3 siblings, they
are all girls. Her father told the researcher that her maternal side has a history of hypertension
while her maternal side has no significant hereditary disease and that she is the only member of
the family who has experienced Dengue Hemorrhagic Fever.

D. Socio-Economic History

The father of the patient said that they never considered using herbal drugs. He
said the patient is a Grade V student and loves to play online games right after school, loves to
play outside with their neighbors. The father and mother works as a factory worker.

E. Environmental History

The patient peacefully lives with her family and with the brother of her mother
in an apartment in Caloocan. According to the father they have no complain regarding the place
where they live.
 IV.PHYSICAL ASSESSMENT TOOL

Body Physical Normal findings Actual findings Analysis

part assessment
assessed skill
/examin
ed
Head  Inspectio  Proportional to the size Proportional to the size Normal
n of the body of the body
 Palpatio  Round with prominence Round with prominence Normal
n in the frontal and in the frontal and
occipital area, occipital area,
symmetrical in all planes symmetrical in all
gently curved planes gently curved
Scalp  Inspectio  White, clear, free from Free from lumps, no Presence of
n lumps, no scars, nits, Scars with some visible dandruff related
dandruff and lesions dandruff to poor hygiene
Hair  Inspectio  Black, evenly distributed Black, evenly Normal
n and covers the whole distributed, covers the
scalp, thick shiny, free whole scalp and thick
from split ends
Face  Inspectio  Oblong or oval, Oval shape, facial Normal
n square/heart shaped, expressions are
facial expressions that is dependent on the true
dependent on the true mod or feelings,
mode or true feelings, involuntary muscle
smooth and free from movement
wrinkles, no involuntary
muscle movement
Eyes  Inspectio  Parallel and evenly Parallel and evenly Normal
n placed, symmetrically, placed, symmetrically,
non protruding with non protruding with
amount of secretions, amount of secretions,
both eyes black and clear both eyes black and
clear
Eye  Inspectio  Black, symmetrical, Black, symmetrical, Normal
brows n parallel & thick, raise parallel, thick and raise
and lower eyebrows at and lower eyebrows at
the same time without the same time without
difficulty, evenly difficulty
distributed and parallel
Eyelash  Inspectio  Black evenly distributed Black, evenly Normal
es n and turned outward distributed and turned
outward
Ears  Inspectio  Parallel, symmetrical Proportional to the head, Normal
n proportion to the size of parallel, color is the
 the head, bean shaped, same as the surrounding
color is the same as the area, bean shape, no
surrounding area, clear discharge
Nose  Inspectio  Midline, symmetrical Midline, symmetrical Normal
n patent, no discharge/ patent, no discharge/
flashing flashing
Mouth/  Inspectio  Pinkish, symmetrical, lip Dry Due to
Lips n margin well defined dehydration
 Smooth and moist
Gums  Inspe  Pinkish, smooth, moist, Dark pink in color. No Normal
ction no swelling, no retraction swelling, no retraction
Teeth  Inspe  32 permanent teeth, well Complete teeth, well- Due to poor
ction aligned free from carries aligned, slightly hygiene
of filling to halitosis halitosis with some
carries
Tongue  Inspe  Large/medium, red/pink. Large, red/pink, moist Normal
ction Moist & freely movable and freely movable
Neck  Inspe  Proportional to the size Proportional to the size Normal
ction of the body, symmetrical of the body,
and straight symmetrical and straight
 Palp  No palpable lumps, No palpable lumps, Normal
ation masses or areas of masses or areas of
tenderness tenderness
 Rang  Freely movable without Freely movable without Normal
e of difficulty difficulty
motion
(chin-
chest)
(ear-
shoulder)
Chest  Inspe  Normal bilateral Normal bilateral Normal
ction expansion expansion
No deformities and
 Palp  No deformities and hematoma
ation hematoma
Lung  Ausc  No adventitious breath No adventitious breath Normal
ultation sounds sounds
Abdom  Inspe  Skin is unblemished, no Skin is unblemished, no Normal
en ction scar, color is uniform, scar, color is uniform,
flat, symmetrical slightly distended
movement
 Ausc  There are gurgling Presence of gurgling Normal
ultation sounds, tymphani sounds
predominates because of
presence of air in the
 stomach and intestines
 Perc  Soft abdomen, no Soft abdomen, no Normal
ussion & tenderness, no masses, tenderness, no masses,
palpation no lumps no lumps
Palms  Inspectio  Palms; pinkish, warm Palms are pale Due to decrease
and n Males: thick blood flow
dorsal Females: softer elastic
surface
s
Fingers   Freely movable 5 Freely movable 5 Normal
Inspection fingers fingers
in each hands in each hands

Fingern  Inspectio  Nails are transparent, Nails are pale Due to

ail n smooth and convex with decreased
pink nail beds & white blood flow
tips
Elbow  Inspectio  Performs with relative >Performs with relative Normal
case case
n
 Range of motion bend >Range of motion bend
straight straight
Lower  Inspe Skin color varies (pinkish, Skin color varies Normal
extremi tan, brown) skin is smooth, (brown), fine hair
ction
ties fine hair, evenly distributed, evenly distributed.
Legs muscle
Toes  Inspectio  Freely movable 5 5 fingers in each foot. Poor hygienic
and n fingers Nails are unclean. measure
nails in each foot, sole and
dorsal surface is smooth,
transparent nails with
pink nail beds and white
tips

V. REVIEW OF SYSTEM

Part I
1. General Over Health State
___Weight gain for the past 3 month’s ___Fever
___Weight loss for the past three month’s ___Chills
___Fatigue ___Night sweats
___Weakness or malaise

2. Skin
___History of Skin Diseases (eczema, psoriasis, hives) ___Pigment or color change
___Change in mole ___Excessive dryness
___Excessive moisture ___Pruritus
___Excessive bruising ___Rash
___Lesion

3. Hair
___Recent loss ___Change in texture
Nails
___Change in shape ___Change in color
___Brittleness

4. Head
___Frequent or severe headache ___History of head injury
___Dizziness (Vertigo) ___Syncope (Faintness)

5. Eyes
___Difficulty with vision ___Eye pain
___Double vision (diplopia) ___Redness or swelling
___Watering or discharge ___Glaucoma
___Cataracts ___Wearing glasses or contact lens (specify)
___Loss of vision
6. Ears
___Earaches ___Infections
___Discharge ___Ringing of ears
___Vertigo ___Hearing loss
___Use of hearing aid
7. Nose and Sinuses
___Discharge ___Severe colds
___Sinus pain ___Nose bleeding
___Change in sense of smell ___Nasal Obstruction
___Allergic rhinitis

8. Mouth and throat

___Mouth pain ___Frequent sore throat
___bleeding gums ___Toothache
___Lesion in mouth or tongue ___Difficulty in swallowing
___Hoarseness of voice ___Altered taste
___Tonsillectomy ___Use of dental braces
___Use of dentures, bridges Last dental check-up: Date:________

9.Neck
___Pain ___Limitation of motion
___Lumps or swelling ___Enlarged or tender nodes

10. Breast
___Pain ___Lump
___Nipple discharge ___Nipple retraction
___Rash ___History of breast diseases (specify:
___Any surgery on breasts ___Performs breast self-examination
(Frequency
___Last mammogram (results ___Tenderness, lump, or swelling in the axial
 Part II
1. Respiratory System
___History of lung disease (specify, e.g., asthma, emphysema, bronchitis, pneumonia,
tuberculosis) _________
___Chest pain with breathing
___Wheezing of noisy breathing
___Shortness of breathing
___Cough
___Sputum production; Color_____; Amount_____
___Hemoptysis
___Toxin or pollution exposure
Last Chest X-ray: Date__________

2. Cardiovascular System
___Chest pain
___Palpitation
___Dyspnea:
___on exertion
___on lying
___During the night
___Frequent urination during the night
___Edema
___History of heart Diseases
___Hypertension
___Anemia
Date of last ECG or other heart test, blood test and results

3. Peripheral Vascular System

___Coldness, numbness and tingling, swelling of legs
___Discoloration in hands or feet (bluish red, pallor, mottling)
___Varicose veins
___Pain on the legs on walking and exercise relieved by rest (intermittent claudication)
___History of thrombophlebitis
___Ulcers in the lower extremities

4. Gastrointestinal System
_√__Loss of appetite to eat
___Food intolerance; specify:______________________________________
___Dysphagia
___Odynopagia
___Heartburns
___Indigestion
___Pain associated with eating
___Abdominal pain
___Nausea and vomiting
___History of abdominal disease; specify:_____________________________
___Flatulence
___Constipation
___Diarrhea
___Black stools
___Rectal bleeding
___Hemorrhoids
___Use of antacids
___Use of laxatives

5. Urinary System
___Frequency ___Nocturia
___Urgency ___Dysuria
___Polyuria ___Oliguria
___Hesitancy of training ___Narrowed stream of urine
___Change in color; specify_____ ___Incontinence
___Pollakuria ___Hx of Urinary Disease;
Specify:_________
___Pain in flank, groin, suprapubic, region, or low back pain
___Hx of surgery in the urinary system; specify:___________________________

A. Male Genital system

___Penis or testicular pain ___Sores of lesions
___Penile Discharge ___Lumps
___Hernia ___Performs self-testicular exam
How Frequent? _____________

B. Female Genital System

___Amenorrhea (Absence of menstruation)
___Menorrhagia (Excessive bleeding during menstruation)
___Vaginal itching
___Vaginal discharge (specify characteristics e.g. whitish, cheesy, and foul; yellowish, greenish,
blood tinged) _______
___ Menopausal signs and symptoms (e.g. hot flushes. Emotional liability, ect) specify
_____________
___ Postmenopausal bleeding
Age at menarche period: _______________________________________
Last menstrual period: __________________________________________
Last Gynecologic Check-up date: _____________________________________
Last Pap smear: Date ______________________________________________
Results:_______________________________________________

6. Musculoskeletal System
____ History of arthritis
____History of gout
____Pain, stiffness
____Joint deformity
____Limitation of motion of joints
____Noise with joint motion (Crepitus)
____Muscle pain, cramps
____muscle weakness
____problem with walking
____Back pain
____Stiffness and limitations of motion of muscles
____ History of disc disease. (E.g. slipped disc)
____performs exercise
Specify______________________ how frequent?______________________

____Difficulty with performing ADL Specify_________________________________

____Any mobility aids used; Specify______________________________________

7. Neurologic System
____Hx of seizure disorder ____Hx of stroke
____Hx of fainting and blackouts ____Weakness in any body part; Specify:____
____Tic or tremor ____Paralysis
____Coordinator problems ____Paresthesia
____Memory disorder: specify__ ___Disorientation: specify:________
____Nervousness ___Mood change
____Depression ___Hx oh mental health dysfunction
____Hallucination: Specify:_______

8. Hematologic system
___Bleeding tendency of skin or mucous
Membrane ___Excessive bruising
___Lymph node swelling ___Exposure to toxic agents or radiation
___Blood transfusion ___Reactions to blood transfusion
Specify:____________________
___Hx of blood disorders; Specify:_________________________
9. Endocrine System
___Hx of DM ___Polyuria
___polydypsia ___Polyphagia
___Hx of thyroid dse. ___Intolerance to heat or cold
___Change in skin pigmentation or texture ___Excessive sweating
___Weight gain with loss of appetite to eat ___Weight loss w/ increased appetite
to eat
___abdominal hair distribution ___Nervousness
___Tremors ___Enlarged neck
___Need foe hormone therapy; Specify:________________________
___Need for OHD (name, dose, frequency) _____________________________

VI. PATTERNS OF FUNCTIONING/FUNCTIONSL HEALTH PATTERNS

A.HEALTH PERCEPTION AND HEALTH MANAGEMENT PATTERN

Before hospitalization:
The patient perceived her health in the state of good condition. She values her health a
lot. She maintains her health by practicing proper hygiene and eating nutritious foods.

During hospitalization:
She sees herself as a total ill person because she cannot do anymore the things she
usually does. She relies herself to medical practitioners and her family.

B.NUTRITIONAL-METABOLIC PATTERN

Before hospitalization:
She doesn’t have any allergies on foods and drugs. She eats 3 times a day plus her
snacks after going to school.

During hospitalization:
The patient has loss of appetite and doesn’t want to eat at times. She seldom eats and only
drinks water.

C.ELIMINATION PATTERN

Before hospitalization:
The patient doesn’t have any problem regarding her elimination pattern. She urinates and
passes stool regularly.

During hospitalization:
She has difficulty in passing stool.

D.ACTIVITY-EXERCISE PATTERN

Before hospitalization:
Performs ADL. She plays with her siblings and neighbors often. She love to play online
games

During hospitalization:
She cannot perform all the things she usually does when he was still well. She is only
lying in bed.

E.SLEEP-REST PATTERN

Before hospitalization:
 She sleeps on time and gets enough sleep. Watching the television, playing online games
are her form of rest.

During hospitalization:
She cannot sleep well because of the environment. The fact that she’s not alone in the
room is already a factor for sleep deprivation.

F.COGNITIVE-PERCEPTUAL PATTERN

Before hospitalization:
She is normal in terms of his cognitive abilities. She has good memory. She can easily
comprehend on things. In terms of his perceptual pattern she has no problems with her senses.

During hospitalization:
She was normal as before in her cognitive and perceptual pattern. She responds clearly
and understands.

G.SELF-PERCEPTION – SELF-CONCEPT PATTERN

She sees herself as a God-fearing person. A good daughter to her parents and a good
sister to her siblings.

H.ROLE-RELATIONSHIP PATTERN

Before hospitalization:
She is close with her family. They are 5 in the family. Her father said that she is a
responsible daughter since she is the eldest she guides her sisters. She does well her
responsibilities at home and school.

During hospitalization:
She had less time to bond with their family because of her condition.

I.SEXUALITY-REPRODUCTIVE PATTERN
She said having a boyfriend at her age is still a big No No! She said she’s still young for
such maters.

J.COPING-STRESS TOLERANCE PATTERN

Before hospitalization:
She tells her parents if she feels that there is something wrong with her.

During hospitalization:
She verbalizes her feelings.

K.VALUE-BELIEF PATTERN
 They don’t believe in quack doctors. She s a Roman Catholic and goes t mass often with
her family. She as taught to believe and fear God.

VII. CLINICAL PATHWAY:

ASSESSME CONSULTA HEALTH LABORA INTERVEN INTRAVE MEDCAT DIET

NT TIONS TEACHING TORY TIONS NOUS ION
S FLUID
11-29-10 >Monitor I & >CBC with >PNSSx145>Paraceta >soft diet
>Conscious O every shift PC cc/hr mol 250 except dark
and coherent and record > U/A mg/8ml colored
>symmetrica >Monitor 11-30-10 8ml q 4° foods.
l chest TPR every 4° 11-30-10 >PNSs @ T≥37.8°C
(-)murmur to include BP >ff up U/A 115cc/hr >Sucralfate
>flabby, soft,refer if < 1g/tab 1tab
(+) epigastric90/60 q 6°
tenderness > Watch out
>(-) for bleeding,
cyanosis, (-) hypotension
edema, full and change in
and equal sensorium
pulses
>(+) 11-30-10
petechial
rashes on
upper and
lower
extremities
> (-) bowel
movement
for 1 week.

VIII. LABORATORY:

LABORATORY: Hematology
DATE: November 29, 2010

REQUESTING PHYSICIAN: Dr. Helen Rose A. Minoza, M.D

Component Result Unit Normal Values

Erythrocytes NUMC 4.53 10^12/L 4.60 -6.20

Hemoglobin 12.00 g/dL 12.0-16.0

Hemoglobin 1.86 mmol/L 1.86-2.58

SUBSTC
0.37 .36-.40
Erythrocytes VOLFR
4.1 10^9/L 4.5-11
Leukocytes NUMC
.49 .56
Segmenters
.47 .34
Lymphocytes
.64 .04
Monocytes

Thrombocytes 76 10^9/L 150-400

NUMC

 MCV 81.4 fL 80-96 fL

 MCH 26 pg 27-31 pg
 MCHC 0.33 0.32-0.36

IX. ANATOMY AND PHYSIOLOGY OF SYSTEM/ORGAN INVOLVED\

The circulatory system is made up of the vessels and the muscles that help and
control the flow of the blood around the body. This process is called circulation. The main parts
of the system are the heart, arteries, capillaries and veins.
 As blood begins to circulate, it leaves the heart from the left ventricle and goes into the
aorta. The aorta is the largest artery in the body. The blood leaving the aorta is full of oxygen.
This is important for the cells in the brain and the body to do their work. The oxygen rich blood
travels throughout the body in its system of arteries into the smallest arterioles.

X. PATHOPHYSIOLOGY AND SCHEMATIC DIAGRAM OF THE DISEASE

 Dengue viral infections frequently are not apparent. Classic dengue primarily occurs in
non-immune, non-indigenous adults and children. Symptoms begin after a 5-10 days incubation
period. DHF/DSS usually occurs during a second dengue infection in persons with pre-existing
actively or passively (maternally) acquired immunity to a heterologous dengue virus serotype.
Illness begins abruptly with a minor stage of 2-4 days duration followed by rapid deterioration.
Increased vascular permeability, bleeding, and possible DIC maybe mediated by circulating
dengue antigen-antibody complexes, activation of compliment, and release of vasoactive amines.
In the process of immune elimination of infected, proteases and lymphokines maybe released and
activate complement coagulation cascades and vascular permeability.

Mosquito bite

Virus transmitted and multiplies in the bloodstream

Creates multiple lesions in the bloodstream

Increased capillary fragility

Allows fluid shifting from one compartment to another

Ascites, edema, Hematocencentration

XII. LIST OF NURSING DIAGNOSIS

CUES NURSING DIAGNOSIS JUSTIFICATION

S >”Ang init ng pakiramdam >Hyperthermia related to >For the researcher
 ko”, as verbalized by the presence of circulating toxins, hyperthermia will be the
patient. evidenced by increased body priority because it can cause
temperature (37.8°C), flushed convulsions when it gets off
O>Temp.:37.8°C skin, and warm to touch. hand.
>Flushed skin
>warm to touch

S>”Hindi siya nakakakain ng >>Imbalanced Nutrition: Less >This is the second priority
mabuti kasi palagi siyang than Body Requirements because its improvement
walng gana”, as verbalized by related to inability to ingest cannot be seen in a short span
the Father. food as manifested by weight of time unlike the
loss, pale, weak in appearance, hyperthermia.
O>>weight loss and dry mucous membrane.
>pale
>weak in appearance
>dry mucous membrane

XIII. DISCHARGE PLANNING

Medicines:
>Advised to take medicines prescribed only by the physician.
Exercise:
>Encouraged to have adequate rest and sleep.
Treatment:
>Encouraged to increase oral fluid intake.
Health Teachings:
>Emphasized the importance of proper hygiene.
>Emphasized the importance of good environmental sanitation.
>Encouraged the use of personal protection such as clothing, mosquito repellant,
And netting.
>Encouraged to eat nutritious foods rich in Vit C to boost immune system.
Follow Up:
 >Emphasized routine follow up check up.
>Advised to refer immediately to a physician whenever possible signs and symptoms or
when complications arise.
Diet:
>Encouraged to eat foods rich in Vit. C to help strengthen the immune system.
>Advised to eat nutritious foods.
Spiritual Advice:
>Encouraged to pray that her condition may get better.

XIV. BIBLIOGRAPHY
> Public Health Nursing in the Philippines Book
> Comprehensive Communicable Disease Nursing Handbook by:
Aaron Tuesca Untalan
>Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales by Marilynn
Doenges, Alice Murr