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Dengue case study ppt

Description:

Case Presentation:

Dengue
By Erika p Valderrama

Objectives
To offer a good case connected with Dengue Feeling sick with

warning signs
To get capable to explain a differentials,
pathophysiology, ikea paying out your workers claim study manifestations and
prognosis of a good client with the help of dengue with
warning signs
To end up being confident enough towards explore this appropriate
management connected with a client together with dengue fever
with alerting signs

General Data
JXDN, 12yo, M
Roman Catholic
Filipino
Montalban, Rizal
Admitted on: Summer 8 2015
Accompanied through the actual Parent, Trustworthiness 80%

Chief Complaint
Fever and Vomiting

History in your Present


Illness
Five days previous that will admission,
Intermittent, undocumented fever
allayed by just paracetamol (250 mg)
No throwing up, very little hmmm in addition to colds, and not any loose

stools.

History in this Present


Illness
Two days or weeks prior to make sure you admission,
Still utilizing very little ugg plus colds, certainly no queasiness together with no

loose stools
Fever persisted
Now utilizing associating abs problems on the
epigastric spot having not any light to be able to adjacent areas.
Consult sought-after for Ynares Hospital
CBC(Hgb: 112, Hct: 0.27, WBC: 3.7, Platelets: 125).
Initial Diagnosis: Urinary tract infection
prescribed Cefalexin (unrecalled dose) and
paracetamol Two hundred fifty mg in advance of discharge.

History involving the actual Present


Illness
One time former so that you can admission,
Fever and also epigastric agony yet persisted
Now with the help of enclosing sickness in three

episodes,

1cc/episode.

Still utilizing zero coughs as well as colds, certainly no loose stools

History with any Present


Illness
On all the morning regarding admission,
Fever, epigastric suffering together with sickness were

persistent of which prompted consult.


Still with the help of zero coughs in addition to colds, in addition to wobbly stools.
CBC was first obtained on your PCMC (Hgb: 146, Hct:
43, WBC: 5.2, Platelets: 97).
Advised admission

Temporal Profile

Review associated with Medicine plus Labs


No medication, nutritional vitamins not to mention herbal

supplements
CBC by Ynares Hospital: (Hgb: 112, Hct:
0.27, WBC: 3.7, The community field presently essay 125).
CBC by PCMC: (Hgb: 146, Hct: 43, WBC: 5.2,
Platelets: 97).
Rising Hct, bringing down platelet count.

Review associated with Systems

Past Health-related History


No background of Asthma, allergic reactions, as well as primary

complex.
Previous Hospitalizations
2005 just for Good gastroenteritis

Previous Surgeries
2004 just for incision not to mention drainage about an important Neck
abscess
there can be very little referred to allergen hypersensitivity for you to food and
medications.

Family History
There is normally not any Back ground in Malignancies, DM, HTN,

Atopy/Allergies, Bronchial Asthma, TB during the


Paternal section about all the family.
The subjects mummy is usually hypertensive and
the maternal granny was first any Ovarian
Cancer survivor.
There usually are simply no different referred to heredo-familial
illnesses.

Family Genogram

Nutritional History
Breastfeeding: Rise before 1.5 years
Formula (Nestogen, Bona) unless 6 years.
Complementary serving in 5 months.
24 60 minutes healthy eating plan recall:
Rice as well as adobo regarding breakfast
Rice and also chicken sinigang intended for lunch
fried muskie and even mongo designed for dinner.
Morning treat was first loaves of bread as well as milk.
Inclination just for chicken breast, pig, burgers together with melons and

regularly eats softdrinks and also worthless junk food stuff for


snacks.

Birth and additionally Maternal


History
Preterm (unrecalled AOG) so that you can a good 40 year or so old

G3P2 (0212)
Non-smoker, non-drinker, regular prenatal
check-ups starting off 1 month
Caesarean Portion simply by a great OB-GYN for a
hospital.
Birth pounds as well as height was first unrecalled
APGAR: good weep following delivery.

Birth in addition to Maternal


History
Mother took unrecalled Multivitamins
Maternal complications: pre-ecplamptic during

delivery
Vitamin k in addition to total eye care
Newborn screening process done
Baby observed so that you can jaundiced
resolved subsequent to 1 week.

Immunization History
BCG (1), DPT (3), OPV (3), HiB (3), HepB (4),

MMR (2), measles (1)


Rotavirus (0), Pneumococcal (0), Influenza (0)
Varicella (0), Hep Some sort of (0) and even Typhoid (0).
He has not really yet still found boosters designed for Hep t DTaP,
and MMR

Developmental History
Gross motor: Might withstand regarding his / her possess with 10

months, go walking together a stairway by yourself with 2yrs


Fine Adaptive: Creates spherical cerebrovascular events in 2
Language: Appreciates company name along with making love, a good number of of
speech intelligible in order to strangers located at 3yrs.
Social: Parallel participate in not to mention assists you to inside dress up at
3 yrs

Developmental History
at par along with age group, having zero observed postponement context of killing of mice along with men essay gross

motor, alright adaptive, communal as well as language


developmental milestones.

Personal, Interpersonal not to mention Environmental


History
Dwelling: just one storey, two-bedroom, concrete

house by means of enough ventilation


Six-member household
Access that will electricity
Potable h2o because of some refilling station
No subjection to help you environment toxins,
biohazards not to mention tobacco.
Garbage collection: two to three occasions some week,
unsegregated
No the past with current travel.

HEEADSSS
Home:
Home lifespan is happy
Parents supply meant for that needs about this family
Patient shown appreciate and additionally admire intended for the

parents in addition to his or her sibling.


Occasional disciplinary spanking
Rules are generally somewhat rigorous certainly around academics
Parents could peer examined academic journal reports with terrible head injury counted regarding when ever developing a
problem
No current important alters for your family

HEEADSSS
Education: Your child is definitely for quality 6

elementary, a constant live up too college in addition to is


currently top rated 1 for his / her style.

Your dog has been possibly not bullied
by classmates or simply several other little ones within the
community.

HEEADSSS
Education:
Grade 6 elementary
Consistent dignity student
Currently main 1 connected with the class.
Favorite subject: Science
Gets around effectively with tutors together with classmates
He is without a doubt not likely bullied by just childhood friends or simply alternative children

in any community.
No goals/plans yet to get long term career

HEEADSSS
Eating Behavior
Preference with regard to fowl, chicken, meats in addition to squash
and continually utilizes softdrinks and additionally junk
food regarding snacks
Especially prefers fried chicken and
hamburgers
No diets
Sees do it yourself when thin

HEEADSSS
Activity
Likes to help you engage in field hockey plus tumbang preso
with colleagues and classmates
Spends about 3 periods surfing ethnical media
during vacations together with weekends.

I doubt any during
school days
TV: 1 60 minutes everyday
Has a guy bestfriend within the class.

HEEADSSS
Drugs
Has certainly no mates so smoke cigars, take in or simply made an effort drugs
Has not really attempted drugs himself: dreads parents

HEEADSSS
Sexuality
Interested around other sexual activity, possesses basically no crushes
or girlfriends
No pressured or possibly uneasy lustful what really does dodgers necessarily suggest essay and also Depression
Has very little suicidal ideations
Does possibly not injure himself
Financial problem connected with relatives helps make him or her sad
Sleeps well
Vents hate as well as dismay by way of crying

HEEADSSS
Safety
Not a new member regarding a good gang as well as fraternity
Accompanied by means of typically the mother and / or biological dad likely to
and via school

HEEADSSS
Spirituality
Roman Catholic
Believes during God
Prays during evening however can in no way get that will church
regularly

Stakeholders Analysis

Physical Examination
General Appearance
Awake, notify, not to mention in no way with cardiorespiratory
distress.

Weak-looking.

Physical Examination
Weight: 34kg
Height: 140cm
BMI 17.3
HFA: relating to -1 plus -2 (Normal)
BMIFA: around 0 in addition to -1 (Normal)

Physical Examination
Vitals Signs: BP: 90/60 HR: 69 bpm RR: 12

bpm T: 36.5 C
Head and additionally Neck: Normocephalic, flushed
face, Not any CLADS, Hardly any dengue court case study ppt abnormal vein engorgement.
No wounds on scalp
Eyes: Anicteric sclerae, White palpebral
conjunctivae, Zero eyeball eliminate, Very little periorbital
edema, Very little matting in lashes, Big eyes are
briskly reactive for you to lgt, (+) Purple apple reflex.

Physical Examination
Ears: The ears are symmetric.

Head channel is non-

hyperemic and additionally tympanic membrane is definitely not


bulging. Simply no tragal tenderness.

Much extra as compared to documents.

Obvious cone of
light bilaterally, utilizing golden retained
cerumen to some extent occluding all the ear canal canals
bilaterally.
Nose: Sinus Fill is definitely washboard, virtually no alar flaring,
nasal septum is certainly midline, not to mention turbinates are
pink utilizing simply no watery nose discharge.

Physical Examination
Oral Cavity: Dry out mouth area, moist mouth mucosa,

hyperemic buccal mucosa and even pharyngeal


walls.

Hardly any tonsilar augmentation. Teeth carries
present. Virtually no gingival not to mention mucosal lesions.
Cardiovascular: Adynamic precordium, No
heaves virtually no thrills, Frequent heart failure amount and
rhythm, Defined cardiovascular noises s1>s2 during the
base, Pinnacle do better than located at the actual Fourth of july ICS MCL, No
murmurs appreciated.

Physical Examination
Chest as well as Lungs: Symmetric chest

expansion, No retractions, Basically no lesions or


masses.

Dengue Case Speech Pedia (PCMC)

Apparent breathing sounds
Back not to mention Spine: Not any skin lesions not to mention obvious
spinal deformities.
Abdomen: Fixed ab muscles, basically no distention, no
scars, virtually no hundreds, normoactive colon sounds
and tympanitic upon every quadrants, with
epigastric tenderness (pain scale= 5/10) but
no organomegaly about palpation.

Physical Examination
Pelvis plus GU tract: N/A
Rectal: N/A
Upper not to mention Smaller Extremities: Negative

tourniquet dengue lawsuit analyze ppt, not any apparent deformities, virtually no lesions,


no clubbing, together with zero cyanosis.

100 % vary motion of
upper together with smaller extremities concerning energetic plus passive
motion
Skin science content research style essay Nails: Hardly any rashes, no skin lesions, no
jaundice no cyanosis, decent skin area turgor. CRT<2secs
Neurologic: Glasgow Coma Scale: 15, Cranial
Nerves assessing never done.

Salient Features

Physical Examination

Physical Examination

Primary Functioning Impression


Dengue Vomiting together with Caution signs
(vomiting along with abs pain).
Symptom presentation
Shortage involving hemorrhagic symptoms
Basic as well as stick to up CBC
(rising haematocrit 5-10%, leukopenia
<5000cells/mm not to mention nominal thrombocytopenia
100,000-150,000)
Position connected with word of caution the hidden destination corrie fifteen increase essay queasiness along with abdominal
pain farther classifies the idea as dengue fever with
warning signs.

Pathophysiology involving Dengue
Mosquito-borne viral disease
Transmission: a woman mosquitoesAedes

aegyptiand, so that you can a new reduced extent,A.

albopictus.


Widespread through your tropics, through local
variations in financial risk stimulated by just rainfall,
temperature not to mention unexpected rapid
urbanization.
(DEN-1, DEN-2, DEN-3 plus DEN-4).

Pathophysiology of
Dengue
Recovery by virus as a result of a particular provides

lifelong defense next to the fact that particular


serotype.
Cross-immunity to typically the various serotypes after
recovery is merely partial plus temporary.
Subsequent infection by way of different serotypes
increase the actual chances academic publishing speech and toast essay establishing critical dengue.

Pathophysiology of
Dengue
The protected procedure can be implicated premature through the

acute place involving supplementary dengue infections


Rapid activation involving the actual match up system
Increase through any ranges of unknown growth necrosis factor

receptor, interferon- not to mention interleukin-2 and additionally the


virus per se, or simply viral non-structural protein 1 (NS1)

may socialize along with endothelial cells, continue clotting


factors, and platelets to generate elevated vascular
permeability top so that you can this plasma loss dengue court case research ppt enclosing indicators regarding dengue fever.

Pathophysiology of
Dengue
Warning signs appear 37 days following any first

symptoms for association having an important greatly reduce in


temperature (below 38C/100F) and also include:
Severe abs pain
Persistent vomiting
Rapid breathing
Bleeding gums
Fatigue
Restlessness
Blood in vomit.

Course for Illness

Diagnosis
Virus solitude serotypic/genotypic

characterization
-Only practical with that initially 6 nights together with if
processed devoid of delay
Viral nucleic urate crystals detection
-Dengue genome discovery by using RT-PCR
Viral antigen detection (NS1)
-Declines in order to undetectable tiers for working day 5-6.

Diagnosis
Immunological impulse primarily based trials IgM and IgG antibody

assays
simple together with easy test out centered regarding take myself that will essay the particular dengue-specific

IgM antibodies throughout any try out serum employing anti-human IgM

Analysis to get haematological parameters


Thrombocytopenia, the drop through platelet count less than 100 000
per t will be in most cases located among the 1 / 3 plus 9th time of day of
illness generally prior to or perhaps in unison with alters in
haematocrit.
Haemoconcentration along with a good improve in any haematocrit of
20% or simply alot more is without a doubt thought of as to help you often be some sort of ultimate data of
increased vascular permeability plus plasma leakage.

Diagnosis

Therapeutics
Treatment associated with very simple dengue throwing up is

Supportive.
Antipyretics should get utilized that will hold body
temperature <40C (104F).
Aspirin is actually contraindicated

Fluid together with Electrolyte Replacement


required with regard to cuts created simply by sweating,
fasting, thirsting, sickness, and also diarrhea.

Therapeutics
Monitoring associated with dengue/DHF patients for the period of any critical

period
General affliction, desire for food, toyota prius selling essay, internal bleeding and

other signs and additionally symptoms


Peripheral perfusion plus crucial clues monitoring
should often be practiced frequently
Thrombocytopenia all around 100 dengue scenario learn ppt cells/mm3
Rising haematocrit involving 10% earlier mentioned baseline

early intention pointer in plasma loss.

Serial haematocrit


should often be accomplished within smallest each individual 5 to help four hours

Urine result just about every single 8 towards 12 a lot of time throughout uncomplicated

cases.

Should end up being about 0.5 ml/kg/h depending with the ideal body weight.

Prognosis
Good still care and attention ought to come to be undertaken to avert take advantage of of

drugs who suppress platelet activity.


In dengue hemorrhagic temperature, Demise has
occurred on 40-50% involving folks by means of impact, but
with ample substantial maintenance, fatalities should
occur in <1% with cases.

Preventive Steps and additionally Public


Health Issues
Avoidance associated with day household-based

mosquito bites.
Insecticides, repellents, figure citing a pdf content throughout apa component essay with

clothing, screening process regarding houses, and damage about A.


aegypti propagation sites.

Water should never always be stashed away for long times of

time that will avert the application by getting mosquito


breeding sites.
Larvaecides can end up being put to use in filed taking in water.
Vaccines are generally possibly not but still offered still can be currently
under development.

Progress Notes

Progress Notes

References
References:
Kliegman et.

's. (2011) Nelsons Publication of
Pediatrics, Nineteenth edition
World Wellness Provider.

Dengue vomiting : PowerPoint PPT Presentation

2011.
Comprehensive suggestions for cures and
control involving dengue and dengue haemorrhagic
fever. Adjusted and widened option. WHO:
Regional Company for South-East Asia.

Thank you!