I.

INTRODUCTION

A. Background of the Study

Nursing process is a patient centered, goal oriented method of caring that offers a frame work to the nursing care. The nursing process subsists for every problem that the patient has, and for every factor of patient care, rather than once for each patient. The nurse's evaluation of care will lead to changes in the implementation of the care and the patient's needs are expected to change during their stay in hospital as their health either recovers or deteriorates. Nursing process was used in this case study for a more systematic to care for a client who have diagnosed with DHF or Dengue Hemorrhagic Fever, Grade I. 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 of the 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 four different 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 the Dengue 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, vomiting and 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 blanching appetite regained and blood pressure already stable MODE OF TRANSMISSION:

Dengue viruses are transmitted to humans through the infective bites of female Aedes mosquito. 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 the virus when they fed on an individual during this period. Dengue cannot be transmitted through person to person mode. CLASSIFICATION: 1. Severe, frank type >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) SUSCEPTABILITY, RESISTANCE, AND OCCURRENCE: >all persons are susceptible >both sexes are equally affected

>age groups predominantly affected are the pre-school age and school age >adults and infants are not exempted >peak age affected: 5-9 years old DF is sporadic throughout the year. Epidemic usually occurs during rainy seasons (June November). Peak months are September October. It occurs wherever vector mosquito exists. DIAGNOSTIC TEST: Tourniquet test >Inflate the blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressure for 5 minutes. >Release cuff and make an imaginary 2.5 cm square or 1 inch square just below the cuff, at the antecubital fossa. >Count the number of petechiae inside the box. A test is positive when 20 or more petechiae per suare are observed. Dengue haemorrhagic fever (DHF), a potentially lethal complication, was first recognized in the 1950s during the dengue epidemics in the Philippines and Thailand, but today DHF affects most Asian countries and has become a leading cause of hospitalization and death among children in several of them. Dengue fever is found mostly during and shortly after the rainy season in tropical and subtropical areas of

Africa Southeast Asia and China India Middle East Caribbean and Central and South America Australia and the South and Central Pacific

An epidemic in Hawaii in 2001 is a reminder that many states in the United States are susceptible to dengue epidemics because they harbor the particular types of mosquitoes that transmit it. Worldwide, more than 100 million cases of dengue infection occur each year. This includes 100 to 200 cases reported annually to the Centers for Disease Control and Prevention (CDC), mostly in people who have recently traveled abroad. Many more cases likely go unreported because some health care providers do not recognize the disease. During the last part of the 20th century, many tropical regions of the world saw an increase in dengue cases. Epidemics also occurred more frequently and with more severity. In addition to typical dengue, dengue hemorrhagic fever and dengue shock syndrome also have increased in many parts of the world. In the Philippines there are many diseases illness arising because of environmental changes that may be caused by human activities and geographical conditions. It is considered as one of the tropical country and so disease can spread throughout the country.

One example of these is disease is what we called Dengue Fever and dengue Hemorrhagic Fever (DHF). It is considered as one of the acute febrile diseases caused by one of the four closely related virus serotype of the genus flavivirus. It can be transmitted by Aedes Aegypti mosquito to humans usually attacking during the day. One will experience onset of fever, severe headaches, muscle and joint pains which will give name to Breakbone Fever or Bonecrusher. There are also rashes characterized by bright red petechaie commonly seen on the lowers limbs and on the chest. There may also be gastritis associated to abdominal pain, nausea, vomiting, or diarrhea. Proper attention of health care provider should be given including good assessment, early detection or diagnosis and medications which are essential for total interference of prevention. 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 the Texas- 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 items that can collect rain or run-off water, especially old tires. Regularly change the water in outdoor bird baths and pet and animal water containers

B. OBJECTIVES OF THE STUDY

General Objectives
As a third year nursing students in Siena College Taytay within 8 hours of exposure in the Adolescence Infectious Disease & Tropical Medicine Department , Pavilion III of San Lazaro Hospital aim to acquire the proper attitude, knowledge and skills in providing holistic care to my client in the hospital.

Specific Objectives

Establish rapport and gain the trust and cooperation of the patient and immediate family members. Perform and obtain thorough and complete physical assessment using the assessment techniques following the cephalocaudal approach; obtain complete medical, socio-cultural, and family history related to the patients current health condition. Analyze and prioritize problems based from the gathered pertinent data to come up with the correct nursing diagnoses. Plan the appropriate nursing interventions to address the patients health needs. The interventions should address not only the physical well being of the patient but also his emotional, social, and mental welfare. Implement the planned nursing interventions to meet the desired outcomes and help improve patients condition. Impart useful health teachings to the patient and immediate family members to prevent further development of the patients condition and other related complications, and for the patient to be able to adjust well and continue with her normal life after being discharged from the hospital.

C. SIGNIFICANCE OF THE STUDY

The study will benefit the following: Nursing students This study will serve as a future reference for them. Also, they will increase and enhance their knowledge and deeper understanding about DHF or Dengue Hemorrhagic Fever. This study will also provide them to have an idea of how they could give proper nursing care for their clients with this condition.

Patients This study will help them to know & understand the actual procedures done the whole time they had Dengue. And for them to know what are the risk and what might be the different complications that can be happen to them if the disease is not treated quickly.

Parents This study will serve as a daily guide especially children are prone to this disease. This will provide them the information needed for taking care of the child to avoid this disease.

D. SCOPE AND LIMITATION

The study and assessment have been made at the San Lazaro Hospital in the Adolescence Infectious Disease & Tropical Medicine Department, Pavilion III. It was only limited to one patient who diagnosed with DHF, I in Adolescence Ward bed#306. The conversation for gathering information lasts for 1day (8hrs). The study focuses only to women who had diagnosed with diagnosed with DHF, I.

E. THEORETICAL FRAMEWORK

Lydia Hall Care, Core, Cure Theory Core Care Cure

The theory contains of three independent but interconnected circlesthe core, the care and the cure. According to the theory, the core is the person or patient to whom nursing care is directed and needed. It has been mentioned that the core has goals set by the patient herself and not by any other person, and that these goals need to be achieved. The core, in addition, behaved according to his feelings, and value system. The cure, on the other hand is the attention given to patients by the medical professionals. It has been explicit in stating that the cure circle is shared by the nurse with other health professionals. These are the interventions or actions geared on treating or curing the patient from whatever illness or disease he may be suffering from. Some interventions in relation to this are prescribing pharmacologic therapies and performing diagnostic tests. The highlight however is the care model. This is the part of the model reserved for nurses, and focused on performing that noble task of nurturing the patients, meaning the component of this model is the motherly care provided by nurses, which may include, but is not limited to provision of comfort measures, provision of patient teaching activities and helping the patient meet their needs where help is needed. In relation to Patient JCIC, the patient serves as the core together with the relatives whom nursing care is needed and must be given. The patient sets goal for the relief and this must be achieved according to what the patient feels. On the other hand, the attention the nurses give to the patient serve as the cure. The patient will achieve his goal with the help of all the medical team. Lastly, the care which is the task of the nurses. It focuses on performing the tasks. The nurses will give necessary interventions and actions that gears in treating and curing the patient (core). These three components, the patient, the attention and the care by the nurse should have balance and each one has benefit to one another not to the patient only.

II. NURSING ASSESSMENT

A. PERSONAL DATA
Name Age Sex Birthday Status Religion : JCIC : 14 yrs. old : Male : Oct 8, 1996 : Single : Catholic

Address : 91 Bagong Buhay St. Galas, Quezon City Nationality : Filipino Educational Attainment : Recently Second Yr. High School Student Admission Date : Feb. 12, 2011 Time of admission : 3:16pm Admitting Institution : San Lazaro Hospital

B. Chief Complaint:
JCIC came to the OPD department Saturday with her mother, Feb. 12, 2011 and subsequently complaining of fever. Four days prior to admission, the patient had developed fever associated by epigastric pain, back pain, vomiting about 3 times. The mother of the patient said that no consult was done but Paracetamol, 500mg was given which gave him temporary relief. One day prior to admission mentioned above, signs and symptoms persisted and the patient also develop generalized maculopapular rashes which prompted to consult at this institution and the patient was subsequently admitted for further evaluation and management.

C. IMPRESSION AND DIAGNOSIS:

Impression: Dengue Hemorrhagic Fever Final Diagnosis: Dengue Hemorrhagic Fever, Grade I, as evidenced by nausea, vomiting, aches/pain, generalized maculopapular rashes

D.HISTORY OF PAST ILLNESS:

Theres no any other illness or disease aside from asthma experienced 5 years ago.

E. HISTORY OF PRESENT ILLNESS:

It was on Saturday, Feb. 12, 2011 at around 3:16pm, patient admitted at OPD and was sent to Ward for confinement. She was admitted in San Lazaro Hospital, Adolescence Ward bed#306. VS: BP: 120/80 CR: 86 PR: 102 RR:20

F. FAMILY HISTORY:
The patient said that they are a healthy family. According to the patient, her family has no any history of allergies and hypertension, or even cancer. Complete immunization of the family. No family history of alcohol or substance abuse or of anti-social behavior.

G. PATIENTS CONCEPT HOSPITALIZATION

OF

HEALTH

AND

ILLNESS

AND

JCIC views health as a balance or harmony of mind and body and absence of disease. Illness, for him, refers to any condition that causes pain, dysfunction, distress, social problems, and/or death to the person afflicted, or similar problems for those in contact with the person. He doesnt bother about his health status because hes with her mother and he believes that his illness will be cure with the proper evaluation and management of the health team in the institution.

H. PSYCHOSOCIAL HISTORY

He grew up in Quezon where her biological family lives. Currently, JCIC is living with his parents and together with his 4 siblings in Quezon City. According to her, she spent most of the time watching TV, hang out with friends during weekends & often socializes with his neighbors.

I. PHYSICAL EXAMINATION/ASSESSMENT
Physical examination follows a methodical head to toe format in the Cephalocaudal assessment. This is done systematically using the techniques of inspection, palpation, percussion and auscultation with the use of materials and investments such as the penlight, thermometer, sphygmomanometer, tape measure and stethoscope and also the senses. During the procedure, we made every effort to recognize and respect the patients feelings as well as to provide comfort measures and follow appropriate safety precautions. General Physical Assessment

Date assessed: Feb. 16, 2011 General assessment: conscious, awake and coherent JCIC is a 14 year old male, with a pulse rate of 102 beats per minute, respiratory rate of 20 breathes per minute, temperature of 36.3 C and a BP of 120/80. He is conscious and coherent upon interaction but answers only the questions he is comfortable with. Area Assessed Skin Color Technique Inspection Normal Findings Light brown, tanned skin (vary according to race) Actual Findings Light brown skin, No pallor, no cyanosis, (+)rashes Evaluation Deviation from Normal d/t decreased tissue perfusion & peripheral vasoconstric tion Normal Normal Normal Normal Normal

Soles and palms Moisture Temperature Texture Turgor Skin appendages a. Nails Nail beds Nail base Capillary refill

Inspection Inspection/ Palpation Palpation Palpation Palpation

Lighter colored palms, soles Skin normally dry Normally warm Smooth and soft Skin snaps back immediately Transparent, smooth and convex Pinkish Firm White color of nail bed under pressure should return to pink within 2-3 seconds Evenly distributed Black Smooth Parallel to each

Lighter colored palms, soles Skin normally dry Normally warm Smooth and soft Skin snaps back immediately Transparent, smooth and convex Pale Firm Returns within 23 seconds

Inspection Inspection Inspection Inspection/ Palpation

Normal Due to decreased blood flow Normal Normal

b. Hair Distribution Color Texture Eyes Eyes

Inspection Inspection Inspection/ Palpation Inspection

Evenly distributed Black Smooth Parallel to each

Normal Normal Normal Normal

Visual Acuity

Inspection (penlight) Inspection

Eyebrows

Eyelashes Eyelids

Inspection Inspection

other PERRLA- Pupils equally round react to light and accommodation Symmetrical in size, extension, hair texture and movement Distributed evenly and curved outward Same color as the skin Blinks involuntarily and bilaterally up to 20 times per minute Do not cover the pupil and the sclera, lids normally close symmetrically Transparent with light pink color Color is white Transparent, shiny Black, constrict briskly Clearly visible Free of lesions, discharge of inflammation Canal walls pink Client normally hears words when whispered Smooth, symmetric with same color as the face Oval, symmetric

other PERRLA- Pupils equally round react to light and accommodation Symmetrical in size, extension, hair texture and movement Distributed evenly and curved outward Same color as the skin Blinks involuntarily and bilaterally up to 18 times per minute Do not cover the pupil and the sclera, lids normally close symmetrically Transparent with light pink color Color is white Transparent, shiny Black, constrict briskly Clearly visible Free of lesions, discharge of inflammation Canal walls pink Client normally hears words when whispered Smooth, symmetric with same color as the face Oval, symmetric

Normal

Normal

Normal Normal

Normal

Normal

Conjunctiva Sclera Cornea Pupils Iris Ears Ear canal opening

Inspection Inspection Inspection Inspection Inspection Inspection

Normal Normal Normal Normal Normal Normal

Normal Normal

Hearing Acuity Inspection Nose Shape, size and skin color

Inspection

Normal

Nares

Inspection

and without discharge Mouth and Pharynx Lips Buccal mucosa Gums Inspection Inspection Inspection Pink, moist symmetric Glistening pink soft moist Slightly pink color, moist and tightly fit against each tooth Moist, slightly rough on dorsal surface medium or dull red Firmly set, shiny Hard palatedome-shaped Soft Palate- light pink Neck is slightly hyper extended, without masses or asymmetry Neck moves freely, without discomfort Rises freely with swallowing Clear breath sounds Skin same color with the rest of the body Clicks or gurling sounds occur irregularly and range from 5-35 per minute Extremities Symmetry Skin color Inspection Inspection Symmetrical Same with the color of other parts of the body

and without discharge Light pink, dry, symmetric Glistening pink soft moist Slightly pink color, moist and tightly fit against each tooth Moist, slightly rough on dorsal surface medium or dull red Firmly set, shiny With tooth decay Hard palatedome-shaped Soft Palate- light pink Neck is slightly hyper extended, without masses or asymmetry Neck moves freely, without discomfort Rises freely with swallowing Clear breath sounds Skin same color with the rest of the body Clicks or gurling sounds occur irregularly and range from 20 per minute Symmetrical Same with the color of other parts of the body

Normal

Lack of fluid intake Normal Normal

Tongue

Inspection

Normal Normal Normal

Teeth Hard and soft palate Neck Symmetry of neck muscles, alignment of trachea Neck ROM Thyroid gland Thorax and Lungs Abdomen Bowel sounds

Inspection Inspection

Inspection Inspection Palpation Auscultation Inspection Auscultation

Normal Normal Normal Normal Normal Normal

Normal Normal

Hair distribution Skin Temperature

Inspection Palpation

Evenly distributed Warm to touch

Evenly distributed Warm to touch

Normal Normal Normal

Inspection Presence of lesion ROM Neurology system Level of consciousness No lesions Inspection Moves freely without discomfort Inspection Fully conscious, respond to questions quickly, perceptive of events Makes eye contact with examiner, hyperactive expresses feelings with response to the situation Able to move but with assistance No lesions Due to body weakness

Fully conscious, respond to questions quickly perceptive of events Makes eye contact with examiner, hyperactive expresses feelings with response to the situation

Normal

Behavior and appearance

Inspection

Normal

J. GORDONS 11 FUNCTIONAL HEALTH PATTERN

Pattern 1.Health PerceptionHealth Management Before Patient states that their family goes to a private clinic once theyre sick. All in all, he thinks he is in a healthy state. The patient eats 3 times a day and with afternoon snacks after coming from school. According to the SO of the patient, he eats meat, fish and also vegetables. He Present Patient is concern about his condition right now and thinks that it may be unfavorable to his health. The patient has loss his appetite and hasnt eaten a lot during the first day of his confinement. He is on a DAT (Diet as Tolerated) EDCF (Except Dark Colored Foods). Interpretation Patient cannot function normally anymore like before because of his hospital confinement and condition. Patients nutritional and metabolic status has been changed due to his confinement and also because heneeds further monitoring for lab test

2. NutritionalMetabolic Management

3.Elimination Pattern

doesnt have any allergies on foods and drugs. His appetite is moderate and usually depends on the food being served. He didnt complain any difficulty in swallowing. Bowel: Patient defecates 1-2 times a day, usually morning and in the afternoon. Stool is brown in color and well-formed. Bladder: Patient voids usually 6-8 times a day. Urine is yellow in color. No pain when voiding.

This time he frequently drinks water

To aid in replacing fluid loss/fluid shift

Bowel: Patient defecates once a day but not on a regular basis. He defecate once a day everyday with a formed color brown stool. Bladder: The client urinates 4x a day during his hospitalization with a yellowish color about 100 ml per voiding. Patients activities in the hospital are ambulation, deep breathing and coughing exercise, taking a bath or personal hygiene.

Bowel: There was a slight change in the frequency and amount.

Bladder: There was a change in the frequency and amount.

4.Activity, Leisure, and Recreation Pattern

JCIC has sufficient energy for completing his desired activities, like during playing and doing activities at school. During his spare time he would play outdoor activities with his neighbors. The client has a regular sleeping pattern because of having 8 hrs. of sleep starting from 10pm-6am. He has a continuous sleep and often takes nap in the afternoon after

During patients confinement in the hospital, there is a limitation in her activities of daily living and a disruption in his leisure and recreation pattern.

5.Sleep and Rest Pattern

He can still sleep at least 8hrs in the hospital. Only awakens at the time for his medication.

Patients sleep and rest pattern change when she was admitted.

school. He doesnt have any problem falling asleep. 6.Cognitive Perceptual Pattern Patient is currently a second year high school. He has no difficulty in hearing and on vision. He learned through school and family. HE can read and write. He can speak and be understood by others. He felt good about himself. He considers himself as holistic human being as long as he is healthy and his family is always there. He has a close relationship with his family. They were 3 siblings in their family. He is also a responsible student and knows all his duties as a friend. Patients present condition is not a hindrance to her cognitiveperceptual pattern. No changes/ alterations.

7. SelfPerception / SelfConcept Pattern

8. Role Relationship

9. Sexuality/ Reproductive Pattern

He doesnt think of the things like having a girlfriend & getting married.

During the times of his confinement, he doesnt think that she is a holistic person anymore. However, he is positive that he will be ok after confinement. He said that it was a fine feeling to know that his family is so supportive to him. He learned to value the beauty of having a family that gives you strength and support no matter what. Same

There is a slight change in her selfperception due to present condition.

Normal/ No alterations.

Due to his youthful mind, it is still not his priority in life

10.Coping and Stress Tolerance

He had no big problem in his life, sometimes he experience having fight with his classmates but still they were able to solve it by themselves. The client is a catholic and they believe in God. For their family it is really important to have a connection to God. It really helps every time they are facing a problem and during his stay in the hospital his family is praying for his wellness.

He shares his problems to his family. He verbalizes his feelings. He is positive that he will be able to cope up with current condition. Their family follows a therapeutic regimen and their strong faith to God accounts for his fast recovery.

Patient accepts present condition with a positive attitude.

11.Values- Belief Pattern

Due to his confinement, patient and his family is trusting God that he will be discharge soon and will recover without any complications.

K. LABORATORY EXAMINATIONS
HEMATOLOGY REPORT Date: Feb 12, 2011 PARAMETER White Blood Cells NORMAL FINDINGS 4.8-10.8 ACTUAL FINDINGS 3.46 ANALYSIS Decreased due to inadequate inflammatory defenses to suppress infection and humoral immunity takes place Normal Normal Normal

Hemoglobin Hematocrit Lymphocytes

13-17 40-52 19-70

15-97 48.68 34.9

Platelet Count

150-400 x 10^g/L

71

Decreased; Hemolysis

HEMATOLOGY REPORT Date: Feb 13, 2011 PARAMETER White Blood Cells Hemoglobin Hematocrit Lymphocytes Platelet Count NORMAL FINDINGS 4.8-10.8 13-17 40-52 19-70 150-400 x 10^g/L ACTUAL FINDINGS 6.24 x 10^g/L 14.46 g/L 43.88 53.4 70 ANALYSIS Normal Normal Normal Normal Decreased; Hemolysis

HEMATOLOGY REPORT Date: Feb 14, 2011 PARAMETER White Blood Cells Hemoglobin Hematocrit Lymphocytes Platelet Count NORMAL FINDINGS 4.8-10.8 13-17 40-52 19-70 150-400 x 10^g/L ACTUAL FINDINGS 6.1 14.26 43.44 54.8 114 ANALYSIS Normal Normal Normal Normal Decreased; Hemolysis

III. ANATOMY & PHYSIOLOGY

THE SYSTEMIC CIRCULATION Major arteries (in bright red) and veins (dark red) of the system

 Blood from the aorta passes into a branching system of arteries that lead to all parts of the body. It then flows into a system of capillaries where its exchange functions take place. Function only: to supply materials to and remove materials from the capillaries. Blood from the capillaries flows into venules which are drained by veins. Veins draining the upper portion of the body lead to the superior vena cava. Veins draining the lower part of the body lead to the inferior vena cava. Both empty into the right atrium. BLOOD Blood is a liquid tissue. Suspended in the watery plasma are seven types of cells and cell fragments. red blood cells (RBCs) or erythrocytes platelets or thrombocytes kinds of white blood cells (WBCs) or leukocytes Three kinds of granulocytes neutrophils eosinophils basophils Two kinds of leukocytes without granules in their cytoplasm lymphocytes monocytes FUNCTIONS OF THE BLOOD Blood performs two major functions: transport through the body of oxygen and carbon dioxide food molecules (glucose, lipids, amino acids) ions (e.g., Na+, Ca2+, HCO3) wastes (e.g., urea) hormones heat Defense of the body against infections and other foreign materials. All the WBCs participate in these defenses All the various types of blood cells Are produced in the bone marrow (some 1011 of them each day in an adult human!). Arise from a single type of cell called a multipotent stem cell. These stem cells are very rare (only about one in 10,000 bone marrow cells); are attached (probably by adherens junctions) to osteoblasts lining the inner surface of bone cavities; produce, by mitosis, two kinds of progeny: More stem cells (A mouse that has had all its blood stem cells killed by a lethal dose of radiation can be saved by the injection of a single living stem cell). Cells that begin to differentiate along the paths leading to the various kinds of blood cells

PLASMA Plasma is a pale yellow fluid that accounts for over half of the total blood volume. It consists of 92% water and 8% suspended or dissolved substances such as proteins, ions, nutrients, gases, waste products, and regulatory substances. Plasma volume remains relatively constant. Normally, water intake through the GIT closely matches water loss through the kidneys, lungs, GIT and skin. The suspended and dissolved substances come from the liver, kidneys, intestines, endocrine glands, and immune tissues as spleen. FORMED ELEMENTS
Cell Type Erythrocytes (RBC) Leukocytes (WBC) Neutrophils Spherical cell, nucleus with two or more lobes connected by thin filaments, cytoplasmic granules stain a light pink or reddish purple, 12-15 micrometers in diameter Spherical cell, nucleus, with two indistinct lobes, cytoplasmic granules stain blue-purple, 10-12 micrometers in diameter Spherical cell, nucleus often bilobed, cytoplasmic granules satin orange-red or bright red, 10-12 micrometers in diameter Spherical cell with round nucleus, cytoplasm forms a thin ring around the nucleus, 6-8 micrometers in diameter Phagocytizes microorganism Description Biconcave disk, no nucleus, 78 micrometers in diameter Function Transport oxygen and carbon

Basophils

Releases histamine, which promotes inflammation, and heparin which prevents clot formation

Eosinophils

Releases chemical that reduce inflammation, attacks certain worm parasites

Lymphocyte

Monocyte

Produces antibodies and other chemicals responsible for destroying microorganisms, responsible for allergic reactions, graft rejection, tumor control, and regulation of the immune system Phagocytic cell in the blood leaves the circulatory system

Spherical or irregular cell,

nucleus round or kidney or horse-shoe shaped, contain more cytoplasm than lymphocyte, 10-15 micrometers in diameter

and becomes a macrophage which phagocytises bacteria, dead cells, cell fragments, and debris within tissues

IV.PATHOPHYSIOLOGY

Non Modifiable Factors; age

Modifiable Factors; -environment (sanitation)

Bite of aedes mosquito

Dengue flavi virus mix in the blood circulation

Immune system recognizes the viral invasion; triggers immune response

WBC
Macrophages will release pyrogens that would stimulate the thalamus to body Megakaryocytes desentigrate as core body temp. continue to rise which would result to platelet Platelet count would now decrease the clothing capability hemorrhage Hemorrhage in the micro circulation of the gums (that could cause bleeding gums)