Patients name: Michael Ortiz chief complain: fever on & off x4days Address: 390 capulong St.tondo, Manila diagnosis: Dengue hemorrhagic feverAge: 16 years old pavilion: 7Date of admission: May 7, 2012 Student nurse: Katrina C. Agoc

BRANDNAME: BiogesicGENERIC NAME :ParacetamolDATE OF ORDER:O5-14-12CLASSIFICATION: analgesic DOSAGE & FREQUENCY:

325-650 mg(adult) 650 po(children)

MECHANISM OF ACTION: Produces analgesia by blocking generation of pain impulses. This action is probably caused by inhibition of prostaglandin synthesis; it may also be caused by inhibition of the synthesis or action of other substances those sensitive pain receptors to mechanical or chemical stimulation. It relives fever by central action in the hypothalamic heat-regulating center.

INDICATION: Treat mild pain and fever

CONTRAINDICATION: Contraindicated the patient with

hypersensitivity.ADVERSE REACTIONS:

Hematologic:hemolytic anemia,neutropenia Hepatic:jaundice

NURSING CONSIDERATIONS: Use liquid form for children and patient who

have difficulty swallowing. In children, don’t exceed five doses in 24 hours Once the desired clinical effect is achieved using

repulse, consider tapering to the lowest effective dose

For those not responding adequately when using the repulse consider giving them to total daily dose as a divided dose if a once-daily dosing schedule was followed

Patients name: Melanie Mangaleno chief complain: swelling left arm Address: San Jose, Antipolo City diagnosis: cillulitis Age: 43 Years old pavilion; 2 Date of admission: May 13, 2012 student nurse: Katrina C. Agoc

NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATIONSubjective:“may sugat ang kaliwang kamay ko”as verbalized by the patient.

Objective: (+) chills (+)swelling left arm (+)erythema (+)slight numbness (+)tenderness (+)Pus exudates @

affected arms V/S Taken:BP-110/70 mmHgPR-98 bpmRR-11cpmT-37 C

Impaired skin integrity related to altered clotting factor as manifested by swelling left arm.

After 3 hrs of nursing interventions, the client will be able to demonstrate behaviors that reduce the skin integrity.

DEPENDENT: Advice importance of good

hygiene Emphasize importance of

adequate nutrition and fluid intake

Advice to e elevate the affected arm

INDEPENDENT: Assess skin noted color,

turgor and sensation. Provide and applied wound

dressings carefullyCOLLABORATIVE:

Administer medication per doctors order

Follow up salmonella ELA,done

After 3 hrs nursing interventions the client was able to demonstrate behaviors that reduce the skin integrity.

Patients name: Melanie Mangaleno chief complain: swelling left arm

Address: San Jose, Antipolo City diagnosis: cillulitis

Age: 43 years old pavilion:2

Date of admission: May 13, 2012 student nurse: Katrina C. Agoc

DRUG STUDY

BRAND NAME: AcetaminophenGENERIC NAME: paracetamolDATE OF ORDER: 05-16-12/2:00 PM

CLASSIFICATION: Non narcotic Analgesics & antipyretics

DOSAGE & FREQUENCY: 11 to 10 years old: 480 mg/dose 9 to 10 years old :480 mg/dose 6 to 8 years old: 320mg/dose 4 to 5 years old: 240mg/dose 2 to 3 years old: 160mg/dose 12 to 23 months:120mg/dose 4 to 11 months: 80mg/dose Up to 3 months: 40mg/dose

MECHANISM OF ACTION; Produces analgesia by blocking generation of pain impulses. This

action is probably caused by inhibition of prostaglandin synthesis; it may also be caused by inhibition of the synthesis or action of other substances those sensitive pain receptors to mechanical or chemical stimulation. It relives fever by central action in the hypothalamic heat-regulating center.

INDICATION: Mild pain or fever adults and children over 11 years:225 to 650 mg

P.O or rectally q4 hours; or 1g P.O, qid,prn. CONTRAINDICATION:

Maximum dosage should not exceed 4g daily. Dosage for long term therapy should not exceed 2.6 daily.

ADVERSE REACTIONS: Hepatic: severe liver damage with toxic dose Skin:rash,urticaria

NURSING CONSIDERATIONS: Repeated use is contraindicated in anemia or

renal or hepatic disease Has no significant anti inflammatory effect Warm patient that high doses or unsupervised

chronic use can cause hepatic damage Excessive ingestion of alcoholic beverages may

increase the risk of hepatotoxity Recommend the liquid form of children and

for all patients who have difficulty swallowing

Patients name: Michael Ortiz chief complain: fever & off (4days)Address: 390 capulong st.tondo manila diagnosis: Dengue Hemorrhagic FeverAge: 16 years old pavilion:7Date of admission: may 7 2012 student nurse: Katrina C. Agoc

NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATIONSubjective:“mainit ang pakiramdam ko”as verbalized by the patient.

Objective: Flushed skin, warm to

touch. Body weakness noted Restlessness noted V/S taken:

Bp-120/80mmHgPR-72bpmRR-19cpm

T-38.2 C

Hyperthermia related to dehydration as manifested by flushed skin warm to touch.

After 3 hours of nursing interventions. The patient will maintain core temperature within normal range

Dependent: Emphasized importance

of adequate fluid intake.

Advice to position the patient comfort

Independent: Monitor heart rate and

rhythm Record all sources of

fluid loss such as urine, vomiting and diarrhea

Promote surface cooling by means of tepid sponge bath.

Collaborative: Administer antipyretics

orally as prescribed by the physician

After 3 hrs of nursing interventions, the patient was able maintain core temperature within normal range.

Patients name: Michael Ortiz chief complain: fever on & off x4days Address: 390 capulong St.tondo, Manila diagnosis: Dengue hemorrhagic feverAge: 16 years old pavilion: 7Date of admission: May 7, 2012 Student nurse: Katrina C. Agoc

DRUG STUDY

BRAND NAME: chloramycetin,novochlorocapGENERIC NAME: chlorampenicolDATE OF ADMISSION: 05-15-12/3PM

CLASSIFICATION: Antimicrobial

MECHANISM OF ACTION: Inhibits protein binding to the 50S subunit of

the ribosomeINDICATION:

Hemophilus influenza meningitis, acute salmonella typi infection and meningitis bacteramia or others severe infections caused by sensitive salmonella species, rickettsia lymphogranuloma, psittacosis or various sensitive gram-negative organisms.

NURSING RESPONSIBILITIES: Use cautiously in impaired hepatic or renal

function and with other drugs causing bone marrow depression or blood disorders.

Obtain specimen for culture and sensitivity test before dose. Therapy may begin pending test results

Tell patient to take medications for as long as prescribed. Exactly as directed ,even after he feels better

Patients name: Melanie Mangaleno chief complain: swelling left arm Address: San Jose, Antipolo City diagnosis: cillulitis Age: 43 Years old pavilion; 2 Date of admission: May 13, 2012 student nurse: Katrina C. Agoc

NURSE – PATIENT INTERACTION

STUDENT NURSE PATIENT Magandang hapon po mam Kamusta po pakiramdam niyo mam?

Ano pong nanyari sa kamay niyo mam? Mga ilang arw na po kayo dito mam? Importante po na linisan po yon gilid ng

iyong sugat at uminom kayo ng maraming tubig at kumain ng sapat na nutrisyon,.

Wala pong anuman mam balik nalang po kami maya

Magandang hapon din Medyo masakit pa yon sugat sa kaliwang

kamay ko Nasuagat ng kahoy 4 na araw Salamat Oh sige.

First, I greet. Second, I asked her what she feels and her condition, and lastly before I go ,I integrated some health teachings like importance of good hygiene and importance of adequate nutrition and fluid intake .

Patients name: Michael Ortiz chief complain: fever on & off x4days Address: 390 capulong St.tondo, Manila diagnosis: Dengue hemorrhagic feverAge: 16 years old pavilion: 7Date of admission: May 7, 2012 Student nurse: Katrina C. Agoc

NURSE – PATIENT INTERACTION

STUDENT NURSE PATIENT Good afternoon sir,I’m katrina,UCU student from pangasinan Musta po pakiramdam niyo sir? Ilang araw na po kayong nilalagnat sir? Ano po dahilan at nandito po kayo ngayon sa hospital? Importante sir ang pag inom ng maraming tubig,iwasan niyo

pong kumain ng mga dark colored na pagkain tulad ng chocolate,importante din pong kumain ng masusustansyan pagkain.panatilihin din maghugas ng kamay.

Wala pong anumang balik nalang po kami maya

Good afternoon Mainit ang pakiramdam ko,nilalagnat ako Mga apat na araw na po May dengue ako Maraming salamat

sige

May 7, 2012, I assigned one of the patients Mr. Michael Ortiz. I introduce myself to him, I discovered that patient is diagnosed having dengue., before I go, I integrated some health teaching like importance of adequate fluid intake, avoid eating dark colored food, importance of eating nutritious food and importance of hand washing.

Diagnosis

Both chickenpox (varicella) and shingles (zoster) can usually be diagnosed by symptoms alone. If a diagnosis is still unclear after a physical examination, diagnostic tests may be required.

RULING OUT OTHER DISORDERS

Either variation of the virus may be confused with other disorders.

Ruling out Disorders that Resemble Chickenpox. Chickenpox, particularly in early stages, may be confused with herpes simplex (the disorder more commonly referred to as "herpes"), or

impetigo, insect bites, and scabies.

Ruling out Disorders that Resemble Shingles. The early prodrome stage of shingles can cause severe pain on one side of the lower back, chest, or abdomen before the rash appears. It therefore

may be mistaken for disorders, such as gallstones, that cause acute pain in internal organs.

In the active rash stage, shingles may be confused with herpes simplex, particularly in young adults, if the blisters occur on the buttocks or around the mouth. Herpes simplex, however, does not

usually generate chronic pain.

A diagnosis may be difficult if herpes zoster takes a non-typical course in the face, such as with Bell's palsy or Ramsay Hunt syndrome, or if it affects the eye or causes fever and delirium.

TEST TO IDENTIFY THE VIRUS

In most cases of chickenpox and shingles, the symptoms alone are enough for a health care provider to make a diagnosis. If the symptoms are not straightforward in some patients, such as those

who are immunosuppressed, the doctor performs one or more additional tests to detect the virus itself. The tests usually aim to distinguish between varicella-zoster and herpes simplex viruses.

Virus Culture. A viral culture uses specimens taken from the blister, fluid in the blister, or sometimes spinal fluid. They are sent to a laboratory, where it takes 1 - 14 days to detect the virus in

the preparation made from the specimen. It is also sometimes used in vaccinated patients to determine if a varicella-like infection is caused by a natural virus or by the vaccine. This test is

useful, but it is sometimes difficult to recover the virus from the samples.

Immunofluorescence Assay. Immunofluorescence is a diagnostic technique used to identify antibodies to a specific virus. In the case of herpes zoster, the technique uses ultraviolet rays applied

to a preparation composed of cells taken from the zoster blisters. The specific characteristics of the light as seen through a microscope will identify the presence of the antibodies. This test is

less expensive than a culture, more accurate, and results are faster.

Polymerase Chain Reaction (PCR). Polymerase chain reaction (PCR) techniques use a piece of the DNA of the virus, which is then replicated millions of times until the virus is detectable. This

technique is expensive but is useful for unusual cases, such as identifying infection in the central nervous system.

Related tests: Epstein Barr Virus (EBV); Antibody tests; Cytomegalovirus (CMV)

There are several methods of testing for VZV:

Antibody testing

When you are exposed to VZV, your immune system responds by producing antibodies to the virus. Two types of VZV antibodies may be found in the blood: IgM and IgG. IgM antibodies are the first to be produced by the

body in response to a VZV infection. They are present in most individuals within a week or two after the initial exposure. IgM antibody production rises for a short time period and declines. Eventually, the level ( titer) of VZV

IgM antibody usually falls below detectable levels. Additional IgM may be produced when latent VZV is reactivated. IgG antibodies are produced by the body several weeks after the initial VZV infection to provide long-term

protection. Levels of IgG rise during the active infection, then stabilize as the VZV infection resolves and the virus becomes inactive. Once a person has been exposed to VZV, they will have some measurable amount of VZV

IgG antibody in their blood for the rest of their life. VZV IgG antibody testing can be used, along with IgM testing, to help confirm the presence of a recent or previous VZV infection.

Viral detection

Viral detection involves finding VZV in a blood, fluid, or tissue sample. This can be done either by culturing the virus or by detecting the virus’s genetic material (VZV DNA).

VZV culture—a sample of fluid is collected from a vesicle (the most common sample). It is incubated in a culture of live cells and nutrients to grow and isolate the virus. This test is sensitive and specific, but it takes 2 or

more days to complete. Fresh lesions are the best for this test. Viral shedding decreases over time and can lead to a false negativeresult.

VZV DNA testing–performed to detect VZV genetic material in a patient sample. This method is sensitive. It can identify and quantitate the virus.

Direct Fluorescent Antibody (DFA) – this test visualizes the presence of VZV in the cells taken from the patient’s skin lesion using a special microscope and labeled antibody. It is rapid, but less specific and sensitive

than the VZV culture and DNA testing.

The choice of tests and samples collected depends on the patient, their symptoms, and on the doctor’s clinical findings.

When is it ordered?

VZV antibody tests may be ordered to check immune status and/or to identify a recent infection. VZV culture or DNA tests may be ordered when a newborn or immune-compromised person has been exposed to VZV and is

ill with atypical and/or severe symptoms – to detect an active primary VZV infection in the baby or a primary or reactivated infection in the immune-compromised person.What does the test result mean?

Care must be taken when interpreting the results of VZV testing. The doctor evaluates the results in conjunction with clinical findings. It can sometimes be difficult to distinguish between a latent and active VZV infection. This

is possible for several reasons, including:

A healthy person who has been infected with VZV will continue to harbor the virus after the symptoms disappear. The VZV can reactivate intermittently, often sub-clinically, shedding small amounts of virus into body

fluids but not causing symptoms.

An infant or immune-compromised person may not have a strong antibody response to the VZV infection – their IgMand IgG levels may be lower than expected even though they have an active case of VZV.

The virus may not be present in sufficient number in the particular fluid or tissue tested to be detected.

Antibody detection

If both VZV IgG and IgM are present in a symptomatic person, then it is likely that she has either recently been exposed to VZV for the first time and has chickenpox or that the previous VZV infection has been reactivated

and she has shingles.

If only IgM is present, then the infection may have been very recent. If a newborn has IgM antibodies, then he has acongenital VZV infection. If a person is symptomatic but has low or undetectable levels of IgG and/or IgM, it

may mean that he either has a condition other than VZV or that his immune system is not responding normally – not producing a detectable level of VZV antibody.

Viral detection

If someone is symptomatic and the culture is positive for varicella zoster virus, then the person likely has an active VZV infection. If the culture is negative, then the person’s symptoms may be due to another cause or the

VZV virus is not detectable in the sample tested.

If a test for VZV DNA is positive, then VZV is present. High levels of viral DNA tend to indicate an active infection. Low levels indicate a VZV infection but may not indicate a symptomatic condition. Negative results do not rule

out VZV infection – the virus may be present in very low numbers or may not be present in the body sample tested.

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Patients name: Melanie Mangaleno chief complain: swelling left arm

Address: San Jose, Antipolo City diagnosis: cillulitis

Age: 43 years old pavilion:2

Date of admission: May 13, 2012 student nurse: Katrina C. Agoc