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I. Introduction
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 ofthe genus Flavivirus and Chikungunya virus. Infection with one of these 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 fourdifferent 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 theDengue 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, vomitingand 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 blanchingappetite regained and blood pressure already stable
MODE OF TRANSMISSION:
Dengue viruses are transmitted to humans through the infective bites of female Aedesmosquito. 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 thevirus when they fed on an individual during this period. Dengue cannot be transmitted
through person to person mode.
CLASSIFICATION:
1. Severe, frank type
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>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)
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 theTexas-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 itemsthat can collect rain or run-off water, especially old tires.
Regularly change the water in outdoor bird baths and pet andanimal water containers.
II. Theoretical Framework
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Florence Nightingale(18201910), considered the founder of educated and scientificnursing and widely known as "The Lady with the Lamp wrote the first nursing notes thatbecame the basis of nursing practice and research. The notes, entitled Notes on Nursing:What it is, What is not(1860), listed some of her theories that have served as foundations of
nursing practice in various settings, including the succeeding conceptual frameworks andtheories in the field ofnursing.[2] Nightingale is considered the first nursing theorist. One of hertheories was the Environmental Theory, which incorporated the restoration of the usual healthstatus of the nurse's clients into the delivery ofhealth careit is still practiced today.She stated in her nursing notes that nursing "is an act of utilizing the environment of thepatient to assist him in his recovery" (Nightingale 1860/1969) , that it involves the nurse'sinitiative to configure environmental settings appropriate for the gradual restoration of thepatient's health, and that external factors associated with the patient's surroundings affect lifeor biologic and physiologic processes, and his development.
http://en.wikipedia.org/wiki/Florence_Nightingalehttp://en.wikipedia.org/wiki/Nursinghttp://en.wikipedia.org/wiki/Conceptual_frameworkhttp://en.wikipedia.org/wiki/Theorieshttp://en.wikipedia.org/wiki/Nursinghttp://en.wikipedia.org/wiki/Nightingale's_environmental_theory#cite_note-1http://en.wikipedia.org/wiki/Health_carehttp://en.wikipedia.org/wiki/Nursinghttp://en.wikipedia.org/wiki/Conceptual_frameworkhttp://en.wikipedia.org/wiki/Theorieshttp://en.wikipedia.org/wiki/Nursinghttp://en.wikipedia.org/wiki/Nightingale's_environmental_theory#cite_note-1http://en.wikipedia.org/wiki/Health_carehttp://en.wikipedia.org/wiki/Florence_Nightingale -
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III. PERSONAL DATA
My patients name is Patient XYZ, He lives in Malabon City, He is 12 years of age, Single andhe is a Roman Catholic, He was born on June 29, 1998. He was admitted at CMC Hospital and
currently at the 6th floor at room 645. Dr R.G Henson is his attending physician and his medical
diagnosis is Dengue fever while the patients chief complain is fever.
IV. MEDICAL HISTORY
4 days prior to admission when the patient started to fever at 38 degrees celsius the paracetamol
was given. 3 days prior to admission the patient was still febrile with an episode of vomiting of
previously ingested food which was shanghai. 2 days prior to admission, there was persistence of fever
and now with cough and colds. Consult with the physician was done.
He had an impurfonate anus since birth. He has no family medical history. He is a grade 6
student in Lourdes school and he indicated that he always drinks mineral water.
His immunization background is complete except for Hepa A and Typhoid. His OPV, DPT,
Hepa B, BCG, Measles, MMR, Varicella are all complete from 1st dose up to 3rd dose except for thebooster.
As for his developmental history he started regard and social smile in his 1-2 months of age.Turned on abdomen, crept, sat aided in his3-4 months of age. Then sat alone, stood aided in his 5-6
months of age. He developed his 1st step, walked, and said words in his 7-8 months while his sentences
and bladder control developed at his 1-2 years of age and his bowel control and first tooth when he was
3 years old.
V. PATTERNS OF FUNCTIONING
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BEFORE
HOSPITALIZATION
DURING
HOSPITALIZATION
INTERPRETATION/
ANALYSIS
Health Perception-
Health Management
pattern.
The patient perceived
his health in the state of
good condition. He
values his health a lot
He sees himself as a
total ill person because
he cannot do anymore
the things he usuallydoes. Like playing with
his siblings. The patient
perceived that he is nothealthy because of his
condition
The patient values his
health by taking
vitamins C everyday
before going to school.
Nutritional- Metabolic
Pattern
The patient eats 3times
a day and with
afternoon snacks aftercoming from school.
His appetite is moderate
and usually depends onthe food being served.
He didn't complain any
difficulty in swallowing.
The patient has less his
appetite and hasn't eaten
a lot. He is on DAT andNDCF.
The patient doesn't have
any problem about his
appetite.
Elimination Pattern He usually Urinates 4-5times a day without
difficulty. The patient
defecates once a day
usually early in themorning before going to
school.
The patient urinates 3-4times a day. The color of
his urine is yellow. The
patient defecates once
every two days.
The patient doesn't anyproblem urinating.
Activity- Exercise
Pattern
He could perform
activities of his daily
living. According to himhe often plays with his
siblings and this serves
as a form of exercise forhim.
His activity was limited
lying on bed.
He is a very active boy
and always plays with
his siblings.
Sleep- Rest Pattern He has the normal 6-8
hours of sleep. He also
has his nap time for 1-2hours a day. Sleeping
and watching the
television are his forms
of rest.
He does not have the
adequate time of sleep
since he is disturbed bythe nurse every now and
then, and also because
of environmental
changes.
Patient sleep is
disturbed when he
arrived at the hospital.
Cognitive- PerceptualPattern
He is normal in terms ofhis cognitive abilities.
He has good memory
and listening skills. In
He was normal asbefore. He responds
appropriately to verbal
and physical stimuli and
Patient doesn't have anyproblem with his skills.
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terms of his perceptual
pattern he has noproblem with with his
senses.
obeys simple
commands.
Self Perception
Self Concept Pattern
He sees himself as a
person with a good
personality. He has beena good friend, brother
and son. He said he has
to be a good person inorder not to hurt others.
He also describes
himself as a typical typeof student and person.
He doesn't have any
changes during
hospitalization.
The patient doesn't have
any problem with his
family, and according tohim he is just a simple
person.
Role RelationshipPattern
He is close with hisfamily. He is also a
responsible student and
knows all his duties as afriend.
He had more times tobond with his family. He
said that it was a nice
feeling to know thatyour family is so
supportive to him.
Patient is happy whenhe discovered that his
family supports him all
the way.
Sexuality Reproductive
Pattern
According to him, He
doesn't think of thethings of the things like
having a girlfriend and
getting married yet. He
is still young for suchmatters.
He doesn't have any
changes duringhospitalization.
Patient doesn't have any
interest with sexuality asof now.
Coping-Stress TolerancePattern
He does not fullyidentify his situations
having stress, but he
always tell his parentswhen something is
wrong
He shares his problemsto his family he
verbalizes his feelings.
Patient is stress free.
Value- Belief Pattern He is a Roman Catholic
devotee. He always goeswith his family even
sunday to go to mass.
He was taught by familyto believe and have fear
of God.
He can't go with his
family for the mass dueto hospitalization.
He is a very religious
person. He does believeand fear of god.
VI. HEMATOLOGY REPORT
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February 15, 2011
LABORATORY
EXAMINATION
RESULTS NORMAL/VALU
ES
ANALYSIS INTERPRETATI
ON
Hemoglobin 136 Female 120 - 150
Male 135 - 160
Normal View of
Hematology is
Normal
Hematocrit 0.41 Female 0.37 0.45Male 0.40 0.48
Normal View of Hematology is
Normal
Erythrocytes 5.33 Female 4.0 5. 0
Male 4.5 5.0
High Loss of blood
plasma, The liquid
component ofblood creates
Relatively high
level of RBC.
MCV 77.3 80 - 96 Low It has irondeficiency due to
blood loss or
parasites.
MCH 25.5 27 - 33 Low It has iron
deficiency due toblood loss or
parasites.
MCHC 33 33 - 36 Normal View of
Hematology is
Normal
Platelets 200 150 - 440 Normal View of Hematology is
Normal
Total WBC 4 5.0 - 10 Low It has an infection
Neutrophils 0.5 0.55 0.65 Low It has low immune
system
Lymphocytes 0.32 0.25 0.40 Normal View of
Hematology is
NormalMonocytes 0.15 0.02 0.06 Normal View of
Hematology is
Normal
Eosinophils 0.01 0.01 0.050 Normal View of
Hematology isNormal
Basophils 0 0 0.005 Normal View of
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Hematology is
Normal
Stabs 0.02 0.01 0.05 Normal View of Hematology is
Normal
VII. PHYSICAL ASSESSMENT
Initial Vital Signs : T- 36.2C , RR:23 bpm , BP: 40/60 mmhg , PR: 70bpm
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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 Normal
Turgor Palpation Skin snaps backimmediately
Skin snaps backimmediately
Normal
Skin
appendages
a. 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 pressure
should return to
pink within 2-3seconds
Returns within 2-3seconds
Normal
b. Hair
Distribution Inspection Evenly distributed Evenly distributed NormalColor Inspection Black Black Normal
Texture Inspection/
Palpation
Smooth Smooth Normal
Eyes
Eyes Inspection Parallel to each
other
Parallel to each
other
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 insize, extension, hair
texture and
movement
Symmetrical insize, extension, hair
texture and
movement
Normal
Eyelashes Inspection Distributed evenly
and curved outward
Distributed evenly
and curved outward
Normal
Eyelids Inspection Same color as the
skin
Same color as the
skin
Normal
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Blinks involuntarily
and bilaterally up to
20 times per minute
Do not cover the
pupil and the
sclera, lidsnormally close
symmetrically
Blinks involuntarily
and bilaterally up to
18 times per minute
Do not cover the
pupil and the sclera,
lids normally closesymmetrically
Normal
Normal
Conjunctiva Inspection Transparent with
light pink color
Transparent with
light pink color
Normal
Sclera Inspection Color is white Color is white Normal
Cornea Inspection Transparent, shiny Transparent, shiny Normal
Pupils Inspection Black, constrict
briskly
Black, constrict
briskly
Normal
Iris Inspection Clearly visible Clearly visible Normal
Ears
Ear canalopening
Inspection Free of lesions,discharge ofinflammation
Canal walls pink
Free of lesions,discharge ofinflammation
Canal walls pink
Normal
Normal
Hearing
Acuity
Inspection Client normally
hears words when
whispered
Client normally
hears words when
whispered
Normal
Nose
Shape, sizeand skin color
Inspection Smooth, symmetricwith same color as
the face
Smooth, symmetricwith same color as
the face
Normal
Nares Inspection Oval, symmetric
and without
discharge
Oval, symmetric
and without
discharge
Normal
Mouth and
Pharynx
Lips Inspection Pink, moistsymmetric
Light pink, dry,symmetric
Lack of fluid intake
Buccalmucosa
Inspection Glistening pink softmoist
Glistening pink softmoist
Normal
Gums Inspection Slightly pink color,
moist and tightly fitagainst each tooth
Slightly pink color,
moist and tightly fitagainst each tooth
Normal
Tongue Inspection Moist, slightlyrough on dorsal
surface medium or
dull red
Moist, slightlyrough on dorsal
surface medium or
dull red
Normal
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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
NeckSymmetry of
neck muscles,
alignment oftrachea
Inspection
Neck is slightly
hyper extended,
without masses orasymmetry
Neck is slightly
hyper extended,
without masses orasymmetry
Normal
Neck ROM Inspection Neck moves freely,
without discomfort
Neck moves freely,
without discomfort
Normal
Thyroid gland Palpation Rises freely with
swallowing
Rises freely with
swallowing
Normal
Thorax and
Lungs
Auscultation Clear breath sounds Clear breath sounds Normal
Abdomen
Bowel sounds
Inspection
Auscultation
Skin same colorwith the rest of thebody
Clicks or gurlingsounds occur
irregularly and
range from 5-35 perminute
Skin same colorwith the rest of thebody
Clicks or gurlingsounds occur
irregularly and
range from 20 perminute
Normal
Normal
Neurology
systemLevel of
consciousness
Inspection Fully conscious,
respond to
questions quickly,perceptive of
events
Fully conscious,
respond to
questions quicklyperceptive of events
Normal
Behavior and
appearance
Inspection Makes eye contact
with examiner,hyperactive
expresses feelings
with response to thesituation
Makes eye contact
with examiner,hyperactive
expresses feelings
with response to thesituation
Normal
VIII. Anatomy and Physiology
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The lymphatic system in vertebrates is a network of conduits that carry a clearfluid called lymph. It also includes the lymphoid tissue through which the lymphtravels. Lymphoid tissue is found in many organs, particularly the lymph nodes,and in the lymphoid follicles associated with the digestive system such as thetonsils. The system also includes all the structures dedicated to the circulation andproduction oflymphocytes, which includes the spleen, thymus, bone marrow andthe lymphoid tissue associated with the digestive system.[1] The lymphatic system
as we know it today was first described independently by Olaus Rudbeck andThomas Bartholin.The blood does not directly come in contact with theparenchymalcells and tissues in the body, but constituents of the blood first exitthe microvascular exchange blood vessels to become interstitial fluid, which comesinto contact with the parenchymal cells of the body. Lymph is the fluid that isformed when interstitial fluid enters the initial lymphatic vessels of the lymphaticsystem. The lymph is then moved along the lymphatic vessel network by eitherintrinsic contractions of the lymphatic vessels or by extrinsic compression of thelymphatic vessels via external tissue forces (e.g. the contractions ofskeletalmuscles).
The lymphatic system has three interrelated functions: it is responsible for theremoval of interstitial fluid from tissues; it absorbs and transports fatty acids and
fats as chyle to the circulatory system; and it transports immune cells to and fromthe lymph nodes. The lymph transports antigen presenting cells (APCs), such asdendritic cells, to the lymph nodes where an immune response is stimulated. Thelymph also carries lymphocytes from the efferent lymphatics exiting the lymphnodes.
The study of lymphatic drainage of various organs is important in diagnosis,prognosis, and treatment of cancer. The lymphatic system, because of its physicalproximity to many tissues of the body, is responsible for carrying cancerous cellsbetween the various parts of the body in a process called metastasis. Theintervening lymph nodes can trap the cancer cells. If they are not successful indestroying the cancer cells the nodes may become sites of secondary tumors.
Diseases and other problems of the lymphatic system can cause swelling and othersymptoms. Problems with the system can impair the body's ability to fightinfections.
http://en.wikipedia.org/wiki/Vertebratehttp://en.wikipedia.org/wiki/Lymphhttp://en.wikipedia.org/wiki/Lymphoid_tissuehttp://en.wikipedia.org/wiki/Organ_(anatomy)http://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Lymphoid_follicleshttp://en.wikipedia.org/wiki/Digestive_systemhttp://en.wikipedia.org/wiki/Tonsilshttp://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/Spleenhttp://en.wikipedia.org/wiki/Thymushttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Digestive_systemhttp://en.wikipedia.org/wiki/Olaus_Rudbeckhttp://en.wikipedia.org/wiki/Thomas_Bartholinhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Parenchymahttp://en.wikipedia.org/wiki/Cell_(biology)http://en.wikipedia.org/wiki/Tissue_(biology)http://en.wikipedia.org/wiki/Interstitial_fluidhttp://en.wikipedia.org/wiki/Parenchymahttp://en.wikipedia.org/wiki/Interstitial_fluidhttp://en.wikipedia.org/wiki/Skeletal_musclehttp://en.wikipedia.org/wiki/Skeletal_musclehttp://en.wikipedia.org/wiki/Fatty_acidshttp://en.wikipedia.org/wiki/Fathttp://en.wikipedia.org/wiki/Chylehttp://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Edemahttp://en.wikipedia.org/wiki/Vertebratehttp://en.wikipedia.org/wiki/Lymphhttp://en.wikipedia.org/wiki/Lymphoid_tissuehttp://en.wikipedia.org/wiki/Organ_(anatomy)http://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Lymphoid_follicleshttp://en.wikipedia.org/wiki/Digestive_systemhttp://en.wikipedia.org/wiki/Tonsilshttp://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/Spleenhttp://en.wikipedia.org/wiki/Thymushttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Digestive_systemhttp://en.wikipedia.org/wiki/Olaus_Rudbeckhttp://en.wikipedia.org/wiki/Thomas_Bartholinhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Parenchymahttp://en.wikipedia.org/wiki/Cell_(biology)http://en.wikipedia.org/wiki/Tissue_(biology)http://en.wikipedia.org/wiki/Interstitial_fluidhttp://en.wikipedia.org/wiki/Parenchymahttp://en.wikipedia.org/wiki/Interstitial_fluidhttp://en.wikipedia.org/wiki/Skeletal_musclehttp://en.wikipedia.org/wiki/Skeletal_musclehttp://en.wikipedia.org/wiki/Fatty_acidshttp://en.wikipedia.org/wiki/Fathttp://en.wikipedia.org/wiki/Chylehttp://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Edema -
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OrganizationThe lymphatic system can be broadly divided into the conducting system and thelymphoid tissue.
The conducting system carries the lymph and consists of tubular vessels thatinclude the lymph capillaries, the lymph vessels, and the right and left thoracicducts.
The lymphoid tissue is primarily involved in immune responses and consists oflymphocytes and other white blood cells enmeshed in connective tissue throughwhich the lymph passes. Regions of the lymphoid tissue that are densely packedwith lymphocytes are known as lymphoid follicles. Lymphoid tissue can either bestructurally well organized as lymph nodes or may consist of loosely organizedlymphoid follicles known as the [[mucosa-associated lymphoid tissue](MALT)].
Formation of lymph
Blood supplies nutrients and important metabolites to the tissues, and collectsback the waste products that they produce, which requires exchange of respectiveconstituents between the blood and tissues. This exchange is not direct, however,and is effected through an intermediary called interstitial fluid or tissue fluid thatthe blood forms. Interstitial fluid (ISF) is the fluid that occupies the spaces betweenthe cells and acts as their immediate environment. As the blood and thesurrounding cells continually add and remove substances from the ISF, itscomposition keeps on changing. Water and solutes can freely pass (diffuse)between the ISF and blood, and thus both are in dynamic equilibrium with eachother; exchange between the two fluids occurs across the walls of small blood
vessels called capillaries.ISF forms at the arterial (coming from the heart) end of the capillaries
because of higher pressure of blood, and most of it returns to its venous ends andvenules; the rest (1020%) enters the lymph capillaries as lymph. Thus, lymphwhen formed is a watery clear liquid with the same composition as the ISF. As itflows through the lymph nodes, however, it comes in contact with blood and tendsto accumulate more cells (particularly lymphocytes) and proteins.
The two primary lymph systems are the thymus gland and the bone marrow,where the immune cells form or mature. The secondary lymph system is made upof encapsulated and unencapsulated diffuse lymphoid tissue. The encapsulatedtissue includes the spleen and the lymph nodes. The unencapsulated tissueincludes the gut-associated lymphoid tissues and the tonsils.
http://en.wikipedia.org/wiki/Lymph_capillarieshttp://en.wikipedia.org/wiki/Lymph_vesselhttp://en.wikipedia.org/wiki/Right_lymph_ducthttp://en.wikipedia.org/wiki/Thoracic_ducthttp://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Nutrientshttp://en.wikipedia.org/wiki/Metabolitehttp://en.wikipedia.org/wiki/Tissue_(biology)http://en.wikipedia.org/wiki/Interstitial_fluidhttp://en.wikipedia.org/wiki/Interstitial_fluidhttp://en.wikipedia.org/wiki/Solutehttp://en.wikipedia.org/wiki/Diffusionhttp://en.wikipedia.org/wiki/Dynamic_equilibriumhttp://en.wikipedia.org/wiki/Capillaryhttp://en.wikipedia.org/wiki/Arteriolehttp://en.wikipedia.org/wiki/Venulehttp://en.wikipedia.org/wiki/Venulehttp://en.wikipedia.org/wiki/Lymph_capillaryhttp://en.wikipedia.org/wiki/Gut-associated_lymphoid_tissuehttp://en.wikipedia.org/wiki/Lymph_capillarieshttp://en.wikipedia.org/wiki/Lymph_vesselhttp://en.wikipedia.org/wiki/Right_lymph_ducthttp://en.wikipedia.org/wiki/Thoracic_ducthttp://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/White_blood_cellhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Nutrientshttp://en.wikipedia.org/wiki/Metabolitehttp://en.wikipedia.org/wiki/Tissue_(biology)http://en.wikipedia.org/wiki/Interstitial_fluidhttp://en.wikipedia.org/wiki/Interstitial_fluidhttp://en.wikipedia.org/wiki/Solutehttp://en.wikipedia.org/wiki/Diffusionhttp://en.wikipedia.org/wiki/Dynamic_equilibriumhttp://en.wikipedia.org/wiki/Capillaryhttp://en.wikipedia.org/wiki/Arteriolehttp://en.wikipedia.org/wiki/Venulehttp://en.wikipedia.org/wiki/Venulehttp://en.wikipedia.org/wiki/Lymph_capillaryhttp://en.wikipedia.org/wiki/Gut-associated_lymphoid_tissue -
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Lymphoid tissue
Lymphoid tissue associated with the lymphatic system is concerned withimmune functions in defending the body against the infections and spread oftumors. It consists of connective tissue with various types of white blood cellsenmeshed in it, most numerous being the lymphocytes.
T The lymphoid tissue may be primary, secondary, or tertiary depending uponthe stage of lymphocyte development and maturation it is involved in. Primary(central) lymphoid tissues serve to generate mature virgin lymphocytes fromimmature progenitor cells. Secondary (peripheral) lymphoid tissues provide aplace where lymphocytes can talk to each other; an environment for antigenfocusing, where lymphocytes can 'study' an antigen and sharpen up the immuneresponse by clonal expansion and affinity maturation; and provide a home forlymphocytes, where they can be available when they are needed.
The thymus and the bone marrow constitute the primary lymphoid tissuesinvolved in the production and early selection of lymphocytes. Secondary lymphoidtissue provides the environment for the foreign or altered native molecules(antigens) to interact with the lymphocytes. It is exemplified by the lymph nodes,and the lymphoid follicles in tonsils, Peyer's patches, spleen, adenoids, skin, etc.that are associated with the mucosa-associated lymphoid tissue (MALT). Thetertiary lymphoid tissue typically contains far fewer lymphocytes, and assumes animmune role only when challenged with antigens that result in inflammation. Itachieves this by importing the lymphocytes from blood and lymph.
Lymph nodes
A lymph node showingafferent and efferentlymphatic vessels
A lymph node is an organized collection of lymphoid tissue, through which thelymph passes on its way to returning to the blood. Lymph nodes are located atintervals along the lymphatic system. Several afferent lymph vessels bring inlymph, which percolates through the substance of the lymph node, and is drainedout by an efferent lymph vessel.
The substance of a lymph node consists of lymphoid follicles in the outer portioncalled the "cortex", which contains the lymphoid follicles, and an inner portioncalled "medulla", which is surrounded by the cortex on all sides except for a portion
http://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Tumorhttp://en.wikipedia.org/wiki/Connective_tissuehttp://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/Thymushttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Clonal_selectionhttp://en.wikipedia.org/wiki/Antigenhttp://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Tonsilhttp://en.wikipedia.org/wiki/Peyer's_patchhttp://en.wikipedia.org/wiki/Spleenhttp://en.wikipedia.org/wiki/Adenoidhttp://en.wikipedia.org/wiki/Skinhttp://en.wikipedia.org/wiki/Mucosa-associated_lymphoid_tissuehttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Afferent_lymph_vesselhttp://en.wikipedia.org/wiki/Afferent_lymph_vesselhttp://en.wikipedia.org/wiki/Efferent_lymph_vesselhttp://en.wikipedia.org/wiki/Lymphatic_vesselhttp://en.wikipedia.org/wiki/Afferent_lymph_vesselhttp://en.wikipedia.org/wiki/Efferent_lymph_vesselhttp://en.wikipedia.org/wiki/Cortex_(anatomy)http://en.wikipedia.org/wiki/Medulla_of_lymph_nodehttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Tumorhttp://en.wikipedia.org/wiki/Connective_tissuehttp://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/Thymushttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Clonal_selectionhttp://en.wikipedia.org/wiki/Antigenhttp://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Tonsilhttp://en.wikipedia.org/wiki/Peyer's_patchhttp://en.wikipedia.org/wiki/Spleenhttp://en.wikipedia.org/wiki/Adenoidhttp://en.wikipedia.org/wiki/Skinhttp://en.wikipedia.org/wiki/Mucosa-associated_lymphoid_tissuehttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Afferent_lymph_vesselhttp://en.wikipedia.org/wiki/Efferent_lymph_vesselhttp://en.wikipedia.org/wiki/Lymphatic_vesselhttp://en.wikipedia.org/wiki/Afferent_lymph_vesselhttp://en.wikipedia.org/wiki/Efferent_lymph_vesselhttp://en.wikipedia.org/wiki/Cortex_(anatomy)http://en.wikipedia.org/wiki/Medulla_of_lymph_node -
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known as the "hilum". The hilum presents as a depression on the surface of thelymph node, which makes the otherwise spherical or ovoid lymph node bean-shaped. The efferent lymph vessel directly emerges from the lymph node here. Thearteries and veins supplying the lymph node with blood enter and exit through thehilum.
Lymph follicles are a dense collection of lymphocytes, the number, size andconfiguration of which change in accordance with the functional state of the lymph
node. For example, the follicles expand significantly upon encountering a foreignantigen. The selection of B cells occurs in the germinal center of the lymph nodes.
Lymph nodes are particularly numerous in the mediastinum in the chest, neck,pelvis, axilla (armpit), inguinal (groin) region, and in association with the bloodvessels of the intestines.
Lymphaticslymphatic system
Tubular vessels transport back lymph to the blood ultimately replacing the volume lostfrom the blood during the formation of the interstitial fluid. These channels are thelymphatic channels or simply called lymphatics.
General structure of LymphaticsThe general structure of lymphatics is based on that ofblood vessels. There
is an inner lining of single flattened cells composed of a type of epithelium that iscalled endothelium, and the cells are called endothelial cells. This layer functionsto mechanically transport fluid and since the basement membrane on which itrests is discontinuous; it leaks easily. The next layer is that ofsmooth muscles thatare arranged in a circular fashion around the endothelium, which by shortening(contracting) or relaxing alter the diameter (caliber) of the lumen. The outermostlayer is the adventitia that consists of fibrous tissue. The general structuredescribed here is seen only in larger lymphatics; smaller lymphatics have fewerlayers. The smallest vessels (lymphatic or lymph capillaries) lack both the muscularlayer and the outer adventitia. As they proceed forward and in their course arejoined by other capillaries, they grow larger and first take on an adventitia, andthen smooth muscles.
The whole lymphatic conducting system broadly consists of two types ofchannelsthe initial lymphatics, the prelymphatics or lymph capillaries thatspecialize in collection of the lymph from the ISF, and the larger lymph vessels thatpropel the lymph forward.
Unlike the cardiovascular system, the lymphatic system is not closed andhas no central pump. Lymph movement occurs despite low pressure due toperistalsis (propulsion of the lymph due to alternate contraction and relaxation ofsmooth muscle), valves, and compression during contraction of adjacent skeletal
http://en.wikipedia.org/wiki/Hilum_of_lymph_nodehttp://en.wikipedia.org/wiki/Mediastinumhttp://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Endotheliumhttp://en.wikipedia.org/wiki/Basement_membranehttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Lumen_(anatomy)http://en.wikipedia.org/wiki/Adventitiahttp://en.wikipedia.org/wiki/Lymph_capillarieshttp://en.wikipedia.org/wiki/Lymph_capillarieshttp://en.wikipedia.org/wiki/Peristalsishttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Hilum_of_lymph_nodehttp://en.wikipedia.org/wiki/Mediastinumhttp://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Endotheliumhttp://en.wikipedia.org/wiki/Basement_membranehttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Lumen_(anatomy)http://en.wikipedia.org/wiki/Adventitiahttp://en.wikipedia.org/wiki/Lymph_capillarieshttp://en.wikipedia.org/wiki/Lymph_capillarieshttp://en.wikipedia.org/wiki/Peristalsishttp://en.wikipedia.org/wiki/Smooth_muscle -
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muscle and arterialpulsation.
Lymph capillaries
Propulsion of lymph through lymph vessel
The lymphatic circulation begins with blind ending (closed at one end) highlypermeable superficial lymph capillaries, formed by endothelial cells with button-likejunctions between them that allow fluid to pass through them when the interstitialpressure is sufficiently high. These button-like junctions consist ofprotein filamentslike platelet endothelial cell adhesion molecule-1 or (PECAM-1). A valve system inplace here prevents the absorbed lymph from leaking back into the ISF. There isanother system of semilunar (semi=half; lunar=related to the Moon) valves thatprevents back-flow of lymph along the lumen of the vessel. Lymph capillaries havemany interconnections (anastomoses) between them and form a very fine network.
Rhythmic contraction of the vessel walls through movements may also helpdraw fluid into the smallest lymphatic vessels, capillaries. If tissue fluid builds upthe tissue will swell; this is called edema. As the circular path through the body'ssystem continues, the fluid is then transported to progressively larger lymphaticvessels culminating in the right lymphatic duct (for lymph from the right upper
body) and the thoracic duct (for the rest of the body); both ducts drain into thecirculatory system at the right and left subclavian veins. The system collaborateswith white blood cells in lymph nodes to protect the body from being infected bycancer cells, fungi, viruses or bacteria. This is known as a secondary circulatorysystem.
Lymph vesselsThe lymph capillaries drain the lymph to larger contractile lymphatics, which
have valves as well as smooth muscle walls. These are called the collectinglymphatics. As the collecting lymph vessel accumulates lymph from more and
http://en.wikipedia.org/wiki/Arterialhttp://en.wikipedia.org/wiki/Pulsehttp://en.wikipedia.org/wiki/Fibrous_proteinhttp://en.wikipedia.org/wiki/CD31http://en.wikipedia.org/wiki/Anastomoseshttp://en.wikipedia.org/wiki/Capillaryhttp://en.wikipedia.org/wiki/Edemahttp://en.wikipedia.org/wiki/Right_lymphatic_ducthttp://en.wikipedia.org/wiki/Thoracic_ducthttp://en.wikipedia.org/wiki/Subclavian_veinhttp://en.wikipedia.org/wiki/Lymphaticshttp://en.wikipedia.org/wiki/Arterialhttp://en.wikipedia.org/wiki/Pulsehttp://en.wikipedia.org/wiki/Fibrous_proteinhttp://en.wikipedia.org/wiki/CD31http://en.wikipedia.org/wiki/Anastomoseshttp://en.wikipedia.org/wiki/Capillaryhttp://en.wikipedia.org/wiki/Edemahttp://en.wikipedia.org/wiki/Right_lymphatic_ducthttp://en.wikipedia.org/wiki/Thoracic_ducthttp://en.wikipedia.org/wiki/Subclavian_veinhttp://en.wikipedia.org/wiki/Lymphatics -
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more lymph capillaries in its course, it becomes larger and is called the afferentlymph vessel as it enters a lymph node. Here the lymph percolates through thelymph node tissue and is removed by the efferent lymph vessel. An efferent lymphvessel may directly drain into one of the (right or thoracic) lymph ducts, or mayempty into another lymph node as its afferent lymph vessel. Both the lymph ductsreturn the lymph to the blood stream by emptying into the subclavian veins
The functional unit of a lymph vessel is known as a lymphangion, which is
the segment between two valves. Since it is contractile, depending upon the ratioof its length to its radius, it can act either like a contractile chamber propelling thefluid ahead, or as a resistance vessel tending to stop the lymph in its place.
IX. PATHOPHYSIOLOGY
Bite of a aedes aegypti mosquito carrying a virus
Virus goes into the circulation
Infects cells & generate cellular response
Initiates destruction of the platelet
Predisposing Factor:Geographical area tropicalislands in the Pacific
Philippines and Asia- Environment
PrecipitatingEnvironmentalconditions (openspaces with water pots,and plants)Mosquito carryingdengue virus
http://en.wikipedia.org/wiki/Afferent_lymph_vesselhttp://en.wikipedia.org/wiki/Afferent_lymph_vesselhttp://en.wikipedia.org/wiki/Efferent_lymph_vesselhttp://en.wikipedia.org/wiki/Right_lymph_ducthttp://en.wikipedia.org/wiki/Thoracic_ducthttp://en.wikipedia.org/wiki/Subclavian_veinhttp://en.wikipedia.org/wiki/Lymphangionhttp://en.wikipedia.org/wiki/Afferent_lymph_vesselhttp://en.wikipedia.org/wiki/Afferent_lymph_vesselhttp://en.wikipedia.org/wiki/Efferent_lymph_vesselhttp://en.wikipedia.org/wiki/Right_lymph_ducthttp://en.wikipedia.org/wiki/Thoracic_ducthttp://en.wikipedia.org/wiki/Subclavian_veinhttp://en.wikipedia.org/wiki/Lymphangion -
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Potential for hemorrhage
Stimulates intense inflammatory response
Release of exogenous pyrogens
WBC (Neutrophils & Macrophages)
Release of endogenous pyrogens
Reset of hypothalamic thermostat
Fever
X. NURSING CARE PLAN
ASSESSMENT
DIAGNOSIS PLANNING IMPLEMENTATION
RATIONALE
EVALUATION
Subjective:Ano baangpwedekong
gawin?asverbalized by thepatientsguardian
READINESSFORENHANCEDKNOWLEDGE: Health
Short Term:
After 4hrs ofNursingIntervention theclient will be
able toverbalizeunderstandingof informationgained.
*Assess clientsperceptions oftheir currenthealth problems
*Determine
motivation/expectations forlearning
*Ascertainpreferredmethods oflearning
*Indicatedeficientknowledgeormisinformation
*To developplan forlearning
*To facilitate
GOALACHIEVED
After 4hrsof Nursing
Intervention theclient hadbeen abletoverbalizeunderstanding ofinformatio
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Objective:The clientmanifeste
d:*cooperative*followsinstructions*active*askingabout thenormalcondition
of hersonshealth
*Provideinformationabout additionallearningresources. Suchas:
-books-magazines-t.v programs
*Review specificdietary changes/retrictions withclient
learningprocess
*Promotesongoing
learning atown pace
*to promotewellness
n gained.
NURSING CARE PLAN
Assessment Nursing Diagnosis Objectives Evaluation
1. Presence of
risk factors ofspecific
diseases
Presence ofbreeding or
resting sites of
vectors of
diseases
Related to possible
occurrence ofdengue as
manifested by
presence of hordesof mosquitoes
Promote avoidance of the
disease through theimplementation of an
effective method
The family must be able to
perform the necessarymethod of maintaining water
cleanliness by covering water
containers
2. Poor home
and
environmentalcondition
Inability to provide
a home
environmentconducive to health
After weeks of session and
health teaching the family
should be able to:
The family will have a
healthy lifestyle giving
importance to healthwellness, conducive and
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maintenance
related to thepresence of
breeding sites and
improper refuse of
trashes.
1. know the importance
of long-term benefitsof investing in health
maintenance, hygiene
and sanitation
2. carry out measure inpreventing cross
infection of illnesses
3. utilize the
community resourcesfor healthcare
4. disseminate
information and be agood role to other
family
5. Learn proper waste
segregation6. Understand the
importance of health
maintenance, hygieneand preventive
measure of the illness
carefree life.
NURSING CARE PLAN
ASSESSMENT NURSINGDIAGNOSIS
OBJECTIVES NURSINGINTERVENTION
S
EVALUATION
Subjective:
Mainitangpakiramdam
ko as verbalizedby the patient.Objective:
- Flushedskin, warmto touch.
Hyperthermiarelated to
dehydration
After 8 hrs. OfnursingInterventions,the patient will
maintain coretemperaturewithin normalrange.
Independent:
Monitorheartrate andrhythm.
Recordallsourcesof fluidloss suchas urine,
After 8 hrs.Of nursingintervention, thepatient was able
maintain coretemperaturewithin normalrange.
Goal was met.
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- Restlessness
- V/S takenas follows:
T: 38.1CP: 70bpmR: 20bpmBP: 90/60mmhg
vomitinganddiarrhea.
Promotesurface
coolingbymeans oftepidspongebath.
Wrapextremities withcotton
blankets.
Collaborative
Administerreplacement fluidsandelectrolytes.
Administerantipyretics orallyorrectallyasprescribed by thephysician.
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XI. DRUG STUDY
Paracetamol Dosage Classification Indication Action Contraindication
NursingConsideration
Tempra 500 mg Nonopiodanalgesicsand
Antipyretics
Mild pain orfever ProduceAnalgesia byblocking pain
impulses by
Inhibitingsynthesis of
prostaglandin
in the CNSor of other
substance
that sensitize
painreceptors to
stimulation.
The drugmay relieve
fever through
central actionin the
hypothalmic
heatregulating
center.
Patients withhypersensitive to drug
Use liquidform forchildren and
patients who
havedifficulty in
swallowing.
-In children,don't exceed
in 24Hrs.
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XII. Discharge Plan
A. Patient's Name: Patient XYZ> A twelve year-old male patient, who was diagnosed with Dengue
Hemorrhagic Fever.
>M- Medication: remind to take prescribed medicine from time to time and the right frequency
>E- Exercise: Instruct to avoid excessive activities that may result to stress
>T- Treatment: Instruct to drink plenty of water or fluids that available at home and eat nutritious diet.
>H- Hygiene: Encourage to continue routinely hygienic care of the patient.
>O- Out Patient Follow Up: Instruct family members to have a checkup or consult physician one awhile to monitor patient condition.
>D- Diet: Give client protein rich foods, Such as meat, Vegetables, and fruits.
B. Health Teaching:
> D- discuss 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 places of mosquito.