Ospital ng Lungsod ng San Jose Delmonte

NURSING HISTORY
PRESENT MEDICAL HISTORY: Four days prior to admission, the patient had intermittent fever. Patient develops fever 38.5 C at the time of consultation with the doctor. There were no other complaints except abdominal pain. The fever showed signs of improvement in the following days but the abdominal pain continued. Patient developed rashes on both lower extremities.

PAST HEALTH HISTORY: According to the mother of the patient the patient did not yet experienced having serious health problems other than fever, colds and cough. He had no previous hospitalization.

PATHOPHYSIOLOGY

Predisposing Factor Precipitating
(Non Modifiable) (Modifiable)
-Dengue is universal infection -Environmental Condition
-Mosquito carrying dengue virus
(Open space with water)

Mosquito bite

Virus enters. Invade and multiply

Immune response by the body

Contact with susceptible target cell

Protein Cells Cell invasion

B Cell Helper T cell Effector T Cells
Suppressor T cell
Cytokines
Plasma Cell Memory Cell
(IgM) (IgG) Cell death inflammatory response

Antibody Formation

Antigen-antibody complex

Cell injury

Avtivation Hegman Factors Histamine Release

Leukocyte and WBC migrates
to area of inflammation Capillary Permeability Vasodilation

Circulate in Blood Exudation of Plasma Proteins Blood Flow

Hypothalamus–> Body temperature Control System Edema
Rubor Calor
Activate heat production Palor Tumor (redness) (Heat)
(Pain) (Swelling)
Fever Rashes Fever

Abdominal pain, eye pain

DIAGNOSTIC PROCEDURE

Hematology Result Routine Urinalysis
March 2, 2011 March 2, 2011
Color
Yellow
Transparency
Hazy
Reaction
Acidic
Specific Gravity
1.01
Protein
Trace
Sugar
Negative
RBC
None found
Pus Cell
2-3/HPT
Epithelial Cells
+++
Bacteria
++
Mucus threads
++
Amorphus Urates
+++

DRUG STUDY

NAME
GENERIC/BRAND/DOSAGE
INDICATION
CLASSIFICATION
SIDE EFFECTS
CONTRAINDICATION
NURSING CONSIDERATION
Ranitidine Hydrochloride

Zantac

Injection: 25mg/ml
Syrup: 15mg/ml
Tablets: 75mg, 150mg, 300mg.
> Active duodenal and gastric ulcer.
> Maintenance therapy for duodenal or gastric ulcer.
> Gastro esophageal reflux disease.
Anti ulcer drugs
* CNS: headache, malaise, vertigo.
* EENT: blurred vision.
* Hepatic: Jaundice.
* Contraindicated in patients hypersensitivity to drug and those with acute porphyria.
* Use cautiously in patients with hepatic dysfunction. Adjust dosage patients with impaired renal function.
* Assess patient for abdominal pain. Note presence of blood in emesis, stool, or gastric aspirate.
* Drug may be added to total parenteral nutrition solutions.

NAME
GENERIC/BRAND/DOSAGE
INDICATION
CLASSIFICATION
SIDE EFFECTS
CONTRAINDICATION
NURSING CONSIDERATION
Cetirizine hydrochloride

Zyrtec

Oral solution: 5mg/ml
Tablets: 5mg, 10mg.

> Used to treat seasonal rhinitis.
> Used to treat swelling caused by hives.
Antihistamine.
* CNS: somnolence, fatigue, dizziness, headache
* EENT: pharyngitis.
* GI: dry mouth, nausea, vomiting, abdominal distress.
* Contraindicated in patients hypersensitivity to drug or to hydroxyzine and in breast feeding women.
* Use cautiously in patients with renal or hepatic impairment.
* Stop drug 4 days before diagnostic skin testing because antihistamines can prevent reduce or mask positive kin test response.

NAME
GENERIC/BRAND/DOSAGE
INDICATION
CLASSIFICATION
SIDE EFFECTS
CONTRAINDICATION
NURSING CONSIDERATION
Hyoscine Butylbromide

Buscopan

Tablets: 10mg
0.4 mg to 0.8 mg PO
> Spastic states
> To prevent nausea and vomiting
> Delirium, preanesthetic sedation and obstetric amnesia with analgesic.

Anti cholinergic
* CNS: irritability dizziness, delirium, headache
* CV: palpitation, tachycardia, flushing.
* GI: constipation, dry mouth.
* GU: urinary hesitancy, urine retention
SKIN: rash
* Contraindicated in patients with angle-closure glaucoma, obstructive uropathy, asthma, COPD, myasthenia gravis, paralytic ileus , intestinal atony ,&unstable CV.
* Monitor BP for Possible hypotension
* Monitor BP for Possible hypotension
* Be alert for adverse reaction and drug interaction.
* Encourage patient to void. Be alert for adverse reactions and drug interactions.