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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.
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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.

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