Pa Tho Physiology of DENGUE Bite of a Virus Carrying Aedes Mosquito

8/4/2019 Pa Tho Physiology of DENGUE Bite of a Virus Carrying Aedes Mosquito

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Thalassemia

Thalassemiaalso called Mediterranean anemiais an inherited blood disorder

characterized by less hemoglobin and fewer red blood cells in your body than normal.

Defects in the genes that make hemoglobin cause thalassemia. Hemoglobin is the

substance in red blood cells that allows the cells to carry oxygen from your lungs tothe other parts of your body. Because of low hemoglobin and a low amount of red

blood cells, thalassemia results in anemia.

If you have a mild form of thalassemia, you may not require any treatment. But, ifyou

have a more severe form, you may need blood transfusions on a regular basis.Although in some

cases severe thalassemia can be life-threatening, milder forms ofthalassemia usually can be

effectively treated.

Although thalassemia causes anemia, don't confuse thalassemia with iron deficiency

anemia. People with thalassemia often have more iron in their bodies than they need.For this reason, if you have thalassemia, don't take iron supplements unless your

doctor recommends it.

Symptoms

Signs and symptoms of thalassemia include:

Fatigue

Weakness

Shortness of breath

Yellow discoloration of the skin (jaundice)

Bone deformities in the face

Slow growth

Protruding abdomen

The signs and symptoms you experience depend on your type and severity of

thalassemia. Some babies show signs and symptoms of thalassemia at birth, whileothers may not develop signs or symptoms until they're about 6 to 12 months old.

Some people who have only one hemoglobin gene affected don't experience any

thalassemia symptoms.


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Causes;

Blood consists of liquid, called plasma, and three types of cells that float within the

plasma:

White blood cells. These blood cells fight infection.

Platelets. These blood cells help your blood clot after a cut.

Red blood cells (erythrocytes). These blood cells carry oxygen from your

lungs, through you

r bloodstream, to your brain and your body's other organs

and tissues. Your body needs a supply of oxygenated blood to function.

Oxygenated blood helps give your body its energy and your skin a healthy

glow.

Red blood cells contain hemoglobina red, iron-rich protein that gives blood its red

color. Hemoglobin enables red blood cells to carry oxygen from your lungs to allparts of your body and to carry carbon dioxide from other parts of your body to your

lungs so that it can be exhaled. Most blood cells, including red blood cells, are

produced regularly in your bone marrowa red, spongy material found within the

cavities of many of your large bones.

Thalassemia disrupts the normal production of hemoglobin and leads to a low level of

hemoglobin and a high rate of red blood cell destruction, causing anemia. When

you're anemic, your blood doesn't have enough red blood cells to carry oxygen to your

tissuesleaving you fatigued.

Thalassemia is caused by defects in the genes that make hemoglobin. The only way to

get thalassemia is to inherit one or more defective hemoglobin genes from your

parents.


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There are two types of thalassemia: alpha and beta, named for the two protein chains

that make up normal hemoglobin. The type of thalassemia you have depends on the

type of defective gene you inherit.

Alpha-thalassemia

Four genes are involved in making the alpha hemoglobin chain. You get two from

each of your parents. If one or more of the alpha hemoglobin genes are defective, you

develop alpha-thalassemia.

The more defective genes you have, the more severe your alpha-thalassemia:

One gene. If only one of your alpha hemoglobin genes is defective, you'll

have no signs or symptoms of thalassemia. But, you're a carrier of the disease

and can pass it on to your children.

Two genes. If you have two defective alpha hemoglobin genes, thalassemia

signs and symptoms are mild. This condition is called alpha-thalassemia

minor.

Three genes. If three of your alpha hemoglobin genes are defective, your

signs and symptoms will be moderate to severe. This condition is also called

hemoglobin H disease.

Four genes. When all four alpha hemoglobin genes are defective, the

condition is called alpha-thalassemia major or hydrops fetalis. It usually

causes a fetus to die before delivery or shortly after birth.

Beta-thalassemia

Two genes are involved in making the beta hemoglobin chain. You get one from each

of your parents. If one or both of the beta hemoglobin genes are defective, you

develop beta-thalassemia.

One gene. If one of your beta hemoglobin genes is defective, you have mild

signs and symptoms. This condition is called beta-thalassemia minor.


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Two genes. If both of your beta hemoglobin genes are defective, your signs

and symptoms will be moderate to severe. This condition is called beta-

thalassemia major or Cooley's anemia. Babies born with two defective beta

hemoglobin genes usually are healthy at birth, but develop signs and

symptoms within the first year of life.

Risk factors

Factors that increase your risk of thalassemia include:

Family history. Thalassemia is an inherited disorder, passed from parents to

children through defective hemoglobin genes.

Ancestry. Thalassemia occurs most often in people of Italian, Greek, Middle

Eastern, southern Asian and African ancestry. Alpha-thalassemia affects

mainly people of Southeast Asian, Chinese and Filipino descent.

When to seek medical advice

Make an appointment with your child's health care provider for an evaluation if he or

she has any of the following signs or symptoms of thalassemia:

Fatigue

Weakness

Shortness of breath

Yellow discoloration of the skin (jaundice)

Bone deformities in the face

Slow growth

Protruding abdomen

Dark urine

Tests and diagnosis

Most children who have moderate to severe cases of thalassemia show signs and

symptoms within their first two years of life. If your doctor suspects your child has

thalassemia, he or she may confirm a diagnosis using blood tests. If your child has


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thalassemia, blood tests may reveal a low level of red blood cells. The red blood cells

may be smaller than normal, pale (a sign of low hemoglobin), varied in size and

shape, and have uneven hemoglobin distributiongiving the cells a bull's-eye

appearance under the microscope.

Blood tests may also be used to measure the amount of iron in your child's blood andto evaluatehis or her hemoglobin. In some cases, a blood test may be used for DNAanalysis to diagnose

thalassemia or to determine if a person is carrying defective


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Dengue hemorrhagic fever

Dengue, the most common arboviral illness transmitted worldwide, is caused by infection

with 1 of the 4 serotypes of dengue virus, family Flaviviridae, genus Flavivirus (single-stranded

no segmented RNA viruses). Dengue is transmitted by mosquitoes of the genusAedes, which are

widely distributed in subtropical and tropical areas of the world, and is classified as a major

global health threat by the World Health Organization (WHO)

Dengue is a mosquito-borne infection that in recent decades

has become a major international public health concern. Dengue is found in tropical and sub-

tropical regions around the world, predominantly in urban and semi-urban areas. Dengue

hemorrhagic fever (DHF), a potentially lethal complication, was first recognized in the 1950s

during dengue epidemics in the Philippines and Thailand. Today DHF affects most Asian

countries and has become a leading cause of hospitalization and death among children in the

region. There are four distinct, but closely related, viruses that cause dengue. Recovery from

infection by one provides lifelong immunity against that virus but confers only partial and

transient protection against subsequent infection by the other three viruses. There is good

evidence that sequential infection increases the risk of developing DHF.

Global burden of dengue

The incidence of dengue has grown dramatically around the world in recent decades.

Some 2.5 billion peopletwo fifths of the world's populationare now at risk from dengue.

WHO currently estimates there may be 50 million dengue infections worldwide every year. In2007 alone, there were more than 890 000 reported cases of dengue in the Americas, of which 26

000 cases were DHF. The disease is now endemic in more than 100 countries in Africa, the

Americas, the Eastern Mediterranean, South-east Asia and the Western Pacific. South-east Asia

and the. Western Pacific is the most seriously affected. Before 1970 only nine countries had

experienced DHF epidemics, a number that had increased more than four-fold by 1995.Not only

is the number of cases increasing as the disease is spreading to new areas,

butexplosive outbreaks are occurring. In 2007, Venezuela reported over 80 000 cases, including

more than 6 000 cases of DHF. Some other statistics:

During epidemics of dengue, infection rates among those who have not been previouslyexposed to the virus are often 40% to 50%, but can reach 80% to 90%.An estimated 500 000

people with DHF require hospitalization each year, a very large proportion of whom are children.

About 2.5% of those affected die. Without proper treatment, DHF fatality rates can exceed 20%.

Wider access to medical care from health providers with knowledge about DHF - physicians and

nurses who recognize its symptoms and know how to treat its effects - can reduce death rates to

less than 1%.


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The spread of dengue is attributed to expanding geographic distribution of the

four dengue viruses and their mosquito vectors, the most important of which is the

predominantly urban species. A rapid rise in urban mosquito populations is bringing ever greater

numbers of people into contact with this vector, especially in areas that are favorable for

mosquito breeding, e.g. where household water storage is common and where solid waste

disposal services are inadequate. Dengue viruses are transmitted to humans through the bites of

infective female mosquitoes. Mosquitoes generally acquire the virus while feeding on the blood

of an infected person. After virus incubation for eight to 10 days, an infected mosquito is

capable, during probing and blood feeding, of transmitting the virus for the rest of its life.

Infected female mosquitoes may also transmit the virus to their offspring by trans ovarial (via the

eggs) transmission, but the role of this in sustaining transmission of the virus to humans has not

yet been defined .Infected humans are the main carriers and multipliers of the virus, serving as a

source of the virus for uninfected mosquitoes. The virus circulates in the blood of infected

humans for two to seven days, at approximately the same time that they have a fever mosquitoes

may acquire the virus when they feed on an individual during this period. Some studies haveshown that monkeys in some parts of the world play a similar role in transmission.

Dengue fever is a severe, flu-like illness that affects infants, young children and adults,

but seldom causes death. The clinical features of dengue fever vary according to the age of the

patient. Infants and young children may have a fever with rash. Older children and adults

may have either a mild fever or the classical incapacitating disease with abrupt onset and high

fever, severe headache, pain behind the eyes, muscle and joint pains, and rash.

Dengue hemorrhagic fever (DHF) is a potentially deadly complication that is characterized

by high fever, often with enlargement of the liver, and in severe cases circulatory failure. The

illness often begins with a sudden rise in temperature accompanied by facial flush and other flu-like symptoms. The fever usually continues for two to seven days and can be as high as 41C,

possibly with convulsions and other complications in moderate DHF cases, all signs and

symptoms abate after the fever subsides. In severe cases, the patient's condition may suddenly

deteriorate after a few days of fever; the temperature drops, followed by signs

of circulatory failure, and the patient may rapidly go into a critical state of shock and die within

12 to 24 hours, or quickly recover following appropriate medical treatment (see below).

There is no specific treatment for dengue fever.

For DHF, medical care by physicians and nurses experienced with the effects and progression of

the complicating hemorrhagic fever can frequently save livesdecreasing mortality ratesfrom more than 20% to less than 1%. With four closely related viruses that can cause the disease,

the vaccine must immunize against all four types to be effective.

There is limited understanding of how the disease typically behaves and how the virus interacts

with the immune system. There is a lack of laboratory animal models available to test immune

responses to potential vaccines. Despite these challenges, two vaccine candidates

have advanced to evaluation in human subjects in countries with endemic disease, and several


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potential vaccines are in earlier stages of development. WHO provides technical advice and

guidance to countries and private partners to support vaccine research and evaluation.

At present, the only method of controlling or preventing dengue virus transmission is to

combat the vector mosquitos .In Asia and the Americas, breeds primarily in man-

made containers like earthenware jars, metal drums and concrete cisterns used for domesticwater storage, as well as discarded plastic food containers, used automobile tires and other items

that collect rainwater. In Africa the mosquito also breeds extensively in natural habitats such as

tree holes, and leaves that gather to form "cups" and catch water

.In recent years,, a secondary dengue vector in Asia, has becomeestablished in the United

States, several Latin American and Caribbean countries, parts of Europe and Africa. The rapid

geographic spread of this species is largely attributed to the international trade in used tires, a

breeding habitat. Vector control is implemented using environmental management and chemical

methods. Proper solid waste disposal and improved water storage practices, including covering

containers to prevent access by egg-laying female mosquitoes are among methods that areencouraged through community-based programs. The application of appropriate insecticides to

larval habitats, particularly those that are useful in households, e.g. water storage vessels,

prevents mosquito breeding for several weeks but must be re-applied periodically. Small,

mosquito-eating fish and copepods (tiny crustaceans) have also been used with some success.

During outbreaks, emergency vector control measures can also include broad application of

insecticides as space sprays using portable or truck-mounted machines or even aircraft. However,

the mosquito-killing effect is transient, variable in its effectiveness because the aerosol droplets

may not penetrate indoors to microhabitats where adult mosquitoes are sequestered, and the

procedure is costly and operationally difficult. Regular

monitoringof the vectors' susceptibility to widely used insecticides is necessary to ensure theappr

opriate choice of chemicals. Active monitoring and surveillance of the natural mosquito

population should accompany control efforts to determine program effectiveness.


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PHYSICAL ASSESSMENT

Date assessed: September 6 2011

General assessment: conscious and coherent

Initial vital signs: T=36.2C, RR=23, BP=90/60, PR=70

Area Assessed Technique Normal Findings Actual Findings Evaluation

Skin

Color Inspection Light brown,tanned skin (vary

according to race)

Light brown skin Normal

Soles and palms Inspection Lighter colored

palms, soles

Lighter colored

palms, soles

Normal

Moisture Inspection/

Palpation

Skin normally dry Skin normally dry Normal

Temperature Palpation Normally warm Normally warm Normal

Texture Palpation Smooth and soft Smooth and soft NormalTurgor Palpation Skin snaps back

immediately

Skin snaps back

immediately

Normal

Skin

appendagesa. Nails Inspection Transparent,

smooth and convex

Transparent,

smooth and convex

Normal

Nail beds Inspection Pinkish Pale Due to

decreased

blood flow

Nail base Inspection Firm Firm Normal

Capillary refill Inspection/

Palpation

White color of nailbed under pressureshould return to

pink within 2-3

seconds

Returns within 2-3seconds

Normal

b. Hair

Distribution Inspection Evenly distributed Evenly distributed Normal

Color Inspection Black Black Normal

Texture Inspection/

Palpation

Smooth Smooth Normal

Eyes

Eyes Inspection Parallel to eachother

Parallel to eachother

Normal

Visual Acuity Inspection

(penlight)

PERRLA- Pupils

equally round reactto light and

accommodation

PERRLA- Pupils

equally round reactto light and

accommodation

Normal

Eyebrows Inspection Symmetrical in

size, extension, hair

Symmetrical in

size, extension, hair

Normal


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texture and

movement

texture and

movement

Eyelashes Inspection Distributed evenly

and curved outward

Distributed evenly

and curved outward

Normal

Eyelids Inspection Same color as the

skin

Blinks involuntarily

and bilaterally up to

20 times per minute

Do not cover the

pupil and the

sclera, lids

normally closesymmetrically

Same color as the

skin

Blinks involuntarily

and bilaterally up to

18 times per minute

Do not cover the

pupil and the sclera,

lids normally close

symmetrically

Normal

Normal

Normal

Conjunctiva Inspection Transparent withlight pink color

Transparent withlight pink color

Normal

Sclera Inspection Color is white Color is white Normal

Cornea Inspection Transparent, shiny Transparent, shiny Normal

Pupils Inspection Black, constrictbriskly

Black, constrictbriskly

Normal

Iris Inspection Clearly visible Clearly visible Normal

Ears

Ear canalopening

Inspection Free of lesions,discharge of

inflammation

Canal walls pink

Free of lesions,discharge of

inflammation

Canal walls pink

Normal

Normal

Hearing Acuity Inspection Client normallyhears words when

whispered

Client normallyhears words when

whispered

Normal

NoseShape, size and

skin color

Inspection Smooth, symmetric

with same color asthe face

Smooth, symmetric

with same color asthe face

Normal

Nares Inspection Oval, symmetric

and withoutdischarge

Oval, symmetric

and withoutdischarge

Normal

Mouth and

PharynxLips Inspection Pink, moist

symmetric

Light pink, dry,

symmetric

Lack of fluid

intake


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Buccal mucosa Inspection Glistening pink soft

moist

Glistening pink soft

moist

Normal

Gums Inspection Slightly pink color,

moist and tightly fit

against each tooth

Slightly pink color,

moist and tightly fit

against each tooth

Normal

Tongue Inspection Moist, slightlyrough on dorsalsurface medium or

dull red

Moist, slightlyrough on dorsalsurface medium or

dull red

Normal

Teeth Inspection Firmly set, shiny Firmly set, shiny

With tooth decay

Normal

Hard and soft

palate

Inspection Hard palate- dome-

shaped

Soft Palate- lightpink

Hard palate- dome-

shaped

Soft Palate- lightpink

Normal

Neck

Symmetry ofneck muscles,

alignment of

trachea

InspectionNeck is slightlyhyper extended,

without masses or

asymmetry

Neck is slightlyhyper extended,

without masses or

asymmetry

Normal

Neck ROM Inspection Neck moves freely,without discomfort

Neck moves freely,without discomfort

Normal

Thyroid gland Palpation Rises freely withswallowing

Rises freely withswallowing

Normal

Thorax andLungs

Auscultation Clear breath sounds Clear breath sounds Normal

Abdomen

Bowel sounds

Inspection

Auscultation

Skin same color

with the rest of thebody

Clicks or gurgling

sounds occur

irregularly andrange from 5-35 per

minute

Skin same color

with the rest of thebody

Clicks or gurgling

sounds occur

irregularly andrange from 20 per

minute

Normal

Normal

Extremities

Symmetry

Skin color

Hair distribution

Inspection

Inspection

Inspection

Symmetrical

Same with the color

of other parts of thebody

Evenly distributed

Symmetrical

Same with the color

of other parts of thebody

Evenly distributed

Normal

Normal

Normal


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Skin

Temperature

Presence of

lesionROM

Palpation

Inspection

Inspection

Warm to touch

No lesions

Moves freelywithout discomfort

Warm to touch

No lesions

Able to move butwith assistance

Normal

Normal

Due to bodyweakness

Neurology

system

Level ofconsciousness

Inspection Fully conscious,respond to

questions quickly,

perceptive of

events

Fully conscious,respond to

questions quickly

perceptive of events

Normal

Behavior andappearance

Inspection Makes eye contactwith examiner,

hyperactive

expresses feelingswith response to the

situation

Makes eye contactwith examiner,

hyperactive

expresses feelingswith response to the

situation

Normal


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ANATOMY AND PHYSIOLOGY OF THE BLOOD

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 aliquid 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, fluidbalance, 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 GITclosely 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 carbondioxide

Leukocytes (WBC):

Neutrophil

Basophil

Spherical cell, nucleus with

two or more lobes connectedby 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


Phagocytizes microorganism

Releases histamine, which

promotes inflammation, andheparin which prevents clot

formation


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Eosinophil

Lymphocyte

Monocyte

Spherical cell, nucleus often

bilobed, cytoplasmic granules

satin orange-red or bright red,

10-12 micrometers in diameter

Spherical cell with roundnucleus, cytoplasm forms athin ring around the nucleus,

6-8 micrometers in diameter

Spherical or irregular cell,nucleus round or kidney or

horse-shoe shaped, contain

more cytoplasm thanlymphocyte, 10-15micrometers in diameter

Releases chemical that reduce

inflammation, attacks certain

worm parasites

Produces antibodies and otherchemicals responsible fordestroying microorganisms,

responsible for allergic

reactions, graft rejection,tumor control, and regulation

of the immune system

Phagocytic cell in the bloodleaves the circulatory system

and becomes a macrophage

which phagocytises bacteria,dead cells, cell fragments, anddebris within tissues

Platelet Cell fragments surrounded by

a cell membrane and

containing granules, 2-5


Forms platelet plugs, release

chemicals necessary for blood

clotting


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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 complexprocess 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 factorswith 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 clottingfactor 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 whichtraps 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 enoughanticoagulants 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 aprocess 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 andenhancing 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.


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The clot is dissolved by a process called fibrinolysis. An inactive plasma protein calledplasminogen 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.


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LABORATORY EXAMINATIONS

Hematology Report

Date: September 6 2011

PARAMETER NORMAL

FINDINGS

ACTUAL FINDINGS ANALYSIS

White Blood Cells 5-10 x 10^g/L 3.9 x 10^g/L Decreased due to

inadequate

inflammatory

defenses to suppress

infection and humoral

immunity takes place

Hemoglobin 120-160g/L 152g/L N0RMAL

Hematocrit 39-54 % 31 % Decreased due to poor

oxygen supply

Segmenters 0.60-0.70 0.73 Increased; indicate

high glucose level in

the blood

Lymphocytes 28-40 42.2

Platelet Count 150-450 x 10^g/L 22x10^g/L Deceased due to

hemolysis


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Hematology Report


PARAMETER NORMAL

FINDINGS



inadequate

inflammatory

defenses to suppress



Hemoglobin 120-160g/L 152g/L

Hematocrit 39-54 % 29 % Decreased due to poor

oxygen supply

Segmenters 0.60-0.70 0.65 Normal

Lymphocytes 28-40 28.6 NORMAL

Platelet Count 150-450 x 10^g/L 45X10^g/L Hemolysis


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Urinalysis Report


PARAMETER NORMAL

FINDINGS


Color Yellow Amber Yellow normal

Transparency Clear clear normal

Reaction 4.5-8 6.5 normal

Specific Gravity 1.005-1.030 1.005 normal

Sugar Negative Negative normal

Protein Negative Negative normal

Squamous Epithelial

Cells

Few Occasional normal

HEMATOLOGY REPORT


PARAMETER NORMALFINDINGS


White Blood Cells 5-10 x 10^g/L 2.7 x 10^g/L Decreased due toinadequate

inflammatory

defenses to suppressinfection and humoral


Hemoglobin 120-160g/L 162g/L Decreased due to poor

oxygen supply

Hematocrit 39-54 % 29 % Decreased due to pooroxygen supply

Segmenters 0.60-0.70 0.68 normal

Lymphocytes 28-40 44 Increased due to the

bodys increasedimmune system

Platelet Count 150-450 x 10^g/L 29x 10^g/L hemolysis


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PARAMETER NORMAL

FINDINGS



inadequate

inflammatorydefenses to suppress



Hemoglobin M: 13.0-18.0 g/dL 10.3 g/dL Decreased due to poor

oxygen supply

Hematocrit 39-54 % 31 % Decreased due to pooroxygen supply

Segmenters 0.60-0.70 0.57 Decreased; indicatelow glucose level in

the blood

Lymphocytes 0.20-0.30 0.43 Increased due to thebodys increased

immune system

Platelet Count 150-450 x 10^g/L 95 x 10^g/dL hemolysis


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OBJECTIVES

General objectives:

To be knowledgeable about the nature of Dengue Fever Syndrome,

management and treatment to be able to render effective nursing care to

the client.

Specific Objectives:

To be familiar with the etiology of the disease

To know the pathophysiology of the disease

To be aware of the signs and symptoms

To know its complications

To be knowledgeable on how to prevent the diseaseTo know the treatment and how to apply it


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PATIENTS PROFILE

Name: VF

Age: 15 years old

Gender: Female

Address: Mallig Isabela

Date of Birth: January 3 1996

Nationality: Filipino

Religion: Roman Catholic

Civil Status: Single

Date of Admission: Sept. 4 2011

Time of admission: 3:00 pm

Physician: Dr. Rema Parallag

Place of Admission: CVMC

Admitting Diagnosis: Dengue hemorrhagic fever 3


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Discharge Planning

Patient's Name:

> VF 15 year-old male patient, who was diagnosed with Dengue

Hemorrhagic Fever.

Diet:

> Encourage nutritious foods like vegetables, meat and fruits.

Medications:

> Give acetaminophen in case the temperatures increases.

> Treatment:

> Increased oral fluid intake.

Health Teaching:

> D- discusses the possible source of infection of the disease.

> E- educate the family/patient on how to eliminate those vectors.

> N- Never stocked water in a container without cover.

> G- Gallon, container and tires must have proper way of disposal.

> U- Use insecticides at home to kill or reduce mosquito.

> E- Encourage the family of the patient to clean the surroundings to destroy the

breeding area.

>Give aerosol to replace fluid in the body.


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PATHOPHYSIOLOGY

Non- predisposing Factor: Predisposing Factor

- Age15y/o immunocompromised

environment

Bite of aedes aegypti mosquito carrying a virus

Virus goes into the circulation

Infects cells & generate cellular response

Initiates destruction of the platelet

Potential for haemorrhage

Stimulates intense inflammatory response

Release of exogenous pyrogens the body releases anti-

Inflammatory

mediators

WBC (Neutrophils & Macrophages) (Histatin, Kinins)


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Release of endogenous pyrogens vascular response

Reset of hypothalamic thermostat Redness & Heat

Fever Headache, Vomiting

Epistaxis, Abdominal

pain

Muscle contract Blood vessels Circulatory CollapseShock

To produce construct to

Additional heat prevent loss of body heat DEATH

SHIVERING CHILLS


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NURSING CARE PLAN

Assessment NursingDiagnosis

Planning NursingIntervention

Rationale Evaluation

Subjective:Mainit po ang katawan koasverbalized by the patient.

v/S takenBP 110/70mmHgTemp. 38.4CRR 26bpmPR 90bpm

- Flushing of skin- Skin warm to touch

Elevated bodytemperaturerelated toincreasepyrogenscirculating inthe body

Within 8 hoursof effectivenursinginterventionpatient bodytemperaturewill bedecrease from38.4- 37.5C

IndependentNursingAction:-Monitoredvital sign

- Monitoredintake andoutput

- Performed

TSB

-Increasedoral fluidintake

- Providedsafe & quiteenvironment

-Informed thepatient aboutpropermanagementof fever

Dependentnursingintervention:- Administeredmedicationsas order byphysicianssuch asParacetamolor any antipyretic drugs.

- Serves atbaseline data.-To know thefluid balanceof the body

- To reducebodytemperature

through theprocess ofconduction- To preventdehydrationand supportcirculatingvolume.- To provideconduciveplace to rest.Inform thepatient about

propermanagementof fever- To be ablefor the patientto know thepropermanagement.

-To elevatethe patientsbodytemperature.

After 8 hours ofrendering effectivnursing interventthe goal wascompletely met aevidenced bypatients bodytemperaturedecreases from38.4-37.5C.Patients skin not

warm to touch.Normal complexiof the skin.


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Assessment Nursing Diagnosis Planning NursingIntervention

Rationale Evaluatio

bjective:asakit ang tiyanas verbalized bypatient.

uarding ofmachacial grimaceain scale of 8/10

Acute pain relatedto clinicalmanifestations ofdenguehemorrhagic fever

Within 8 hours ofeffective nursingintervention patientwill be able to feelless pain on hisabdomen.

.

IndependentNursing Action:-Performed acomprehensiveassessment of pain

- Providednonpharmacologicmanagement likechange of position

& applying warmcompress

- Encourageddivers ionalactivities- rest period

-encouraged pt. todo deep breathingexercises

- To improvequality, frequency &location of pain.

-To alleviate pain.

-To divert hisattentions to thepain- To prevent fatigue

After 8 hours rendering effenursing intervthe goal waspartially met aevidenced byguarding ofstomach andpatients verbapartial relieve

pain.


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Assessment NursingDiagnosis

Planning NursingIntervention

Rationale Evaluation

Subjective:Nangangati akoas verbalized bythe patient

- Redness of theskin- Skin rashes

Risk for impairedskin integrityrelated toitchiness

Within 2hours ofnursingintervention,

patient willdemonstratebehavior inpreventing skinimpairment.

.

IndependentNursing Action:-Monitored vitalsigns

- Provided skinhygiene throughsponge bathing &changing regularly

- Kept bedlinensdry, use non-irritating materials,& keep bedwrinkled free

- Palpated skinlesions for size,shape,consistency,texture & hydration

- Encouragedrepositionschedule for client

-Providedinformation to theclient about the

importance ofregularobservation &effective skin care

- Serves asbaseline data to

determine anydiscrepancies-To maintain skinintegrity at optimallevel.

-To avoid lesions,scratching of skin& harboring ofmicroorganism.

- To assess extentof involvement ofskin impairment.

-To preventfriction that maycause irritation ofthe skin

- To promotewellness bygaining

knowledge ontreatment/ therapy

After 8 hours ofrendering effectivenursing interventiothe goal was

completely met asevidenced bypatientsdemonstration ofbehavior inpreventing skinimpairment.-patient verbalizescomfortability,decrease feeling oitchiness andgradualdisappearance of

rashes.-patients skincolor(pigmentatiobecomes normal(absence ofredness)


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DRUG ACTION INDICATION CONTRAINDICATION ADVERSE

REACTION

NURSING

RESPONSIBILTIES

PATIENT

TEACHING

Dobutamine

Hydrochloride

Stimulateshearts beta1receptors to

increase

myocardial

contractility and

stroke volume.At therapeutic

dosages, drug

increases

cardiac output

by decreasing

peripheral

vascular

resistance,

reducing

ventricular

filling pressure,

and facilitating

AV node

conduction

Increase cardiacoutput in short-tern

treatment of cardiac

decompensation

cause by depressed

contractility, such

as during refractoryheart failure;

adjunctive therapy

in cardiac surgery

Contraindicatedin patients

hypersensitive to

drug or its

components and

in those w/

idiopathichypertrophic

subaortic stenosis

CNS:headache

CV:hypertension,

increasedheart rate

Before startingtherapy, give a

plasma volume

to correct

hypovolemia an

a cardiac

glycoside Continuously

monitor ECG,

blood pressure,

pulmonary

artery wedge

pressure,

cardiac output

and urine

output

Tell patiento report

adverse

reactions

promptly,

especially

laboredbreathing a

drug-induc

headache

Instructpati8ent to

report

discomfort

I.V. inserti

site


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