I. Introduction Tuberculosis, sometimes called primary complex, is a disease that affects people across the world.

The World Health Organization (WHO) estimates that 100,000 children die of tuberculosis every year, and Kenyon College in Ohio claims that the disease is responsible for more deaths in young people that any other communicable disease in the world. Most child deaths caused by tuberculosis occur in lowincome areas such as Southeast Asia, but on rare occasions tuberculosis can affect children in North America. Tuberculosis is caused by infection from the bacteria Mycobacterium tuberculosis. It is contracted by inhaling tuberculosis bacilli, the immature form of Mycobacterium tuberculosis, in the air. Tuberculosis bacilli are spread through coughing, sneezing, breathing and talking. Once breathed in, tuberculosis bacilli can sit in the lungs for an extended period of time and may not ever develop into full-blown tuberculosis, as the WHO estimates that only 10 percent of cases develop into the disease. Fewer bacteria sit in the lungs of children infected with the disease, making them less infectious. In the first stage of tuberculosis in a child, the bacteria infect the lungs. At this point, the bacteria may remain latent. In rare cases, the child's immune system may be strong enough at this point to fight the infection,. Four or five months later, in the next stage, the main symptoms of tuberculosis become apparent. These include pneumonia, liquid on the lungs, and collapse of the lungs. More apparent symptoms include weight loss and heavy coughing. There are no apparent symptoms in the final stage, but the bacteria are usually still present in the lungs and may cause another infection. Tuberculosis is difficult to diagnose in children because a lot of the methods used to diagnose the disease, such as chest radiographs, have difficulty distinguishing tuberculosis in a child from other chest and lung infections, such as pneumonia. Testing the sputum coughed up by a child is the most reliable method of diagnosing the disease, but this is complicated by the fact that most children cannot produce the amount of sputum needed for the test. Because of these factors, tuberculosis in children is often diagnosed by identifying the symptoms.

It takes a long time to kill the bacteria that lead to tuberculosis. For this reason, it is important to begin treatment as quickly as possible. The Because children are less infectious than adults, children usually pick up the disease from infected adults. For this reason, early diagnosis and treatment of adults with tuberculosis who are in close contact with children is the best way to try to prevent tuberculosis in those children. BCG immunization is a live virus vaccine developed to combat tuberculosis, and the WHO is 2004 recommended that a single dose of BCG should be given to all infants in countries with a high incidence of tuberculosis, except for infants who are confirmed as HIV-positive. In countries with low incidence of tuberculosis, the WHO stated that BCG vaccinations could be limited to those infants in high-risk groups: "In some low-burden populations, BCG vaccination has been largely replaced by intensified case detection and supervised early treatment." Dengue fever (also known as break-bone fever) is a viral illness transmitted by a type of mosquito. The symptoms of dengue fever usually begin between five and eight days after an infected mosquito bites you. However, you may not have any symptoms at all. Young children with dengue often have a fever with a rash, but other symptoms are minor. These symptoms can also be caused by problems other than dengue fever. If you have any of these symptoms, see your GP and tell him or her where you have travelled to. Dengue fever can sometimes develop into a more serious illness called dengue hemorrhagic fever. You are unlikely to get this condition if you are just visiting areas where the disease is common (eg South-East Asia and India). Children under 15 who live in countries where the dengue fever virus is widespread, and people who are infected more than once with different forms of the virus, are more likely to develop dengue hemorrhagic fever. If you have dengue hemorrhagic fever, you may have bleeding under your skin, from your gums, and from your nose. You may also vomit blood or pass blood in your feces. If you have any of these symptoms, see your GP. In more severe cases of dengue hemorrhagic fever, the condition can suddenly worsen and lead to (dengue shock syndrome). You may develop severe pain in your abdomen (tummy), keep vomiting, feel irritable and your temperature may suddenly drop. Dengue shock syndrome can be life threatening without proper medical treatment. If you have any of these symptoms, you must seek urgent medical attention.

Dengue fever is caused by a type of virus called a flavivirus, which is transmitted by infected female Aedes mosquitoes. You can catch the virus if you are bitten by an infected mosquito. Mosquitoes become infected when they bite an infected person and are able to pass on the virus for the rest of their life (two to three months). There are four different, but closely related forms (serotypes) of the flavivirus that cause dengue fever. Once you have been infected by one form of the virus you're immune against that form for the rest of your life. However, infection with one form of the virus doesn't protect you against catching one of the other three forms. If you're infected a second time, you will be at greater risk of developing dengue hemorrhagic fever. Your GP will ask about your symptoms and examine you. You should tell him or her if you have recently travelled abroad. If your GP suspects you could have dengue fever, he or she may ask you to have a blood test. This is to see whether you have certain antibodies for dengue fever in your blood, and will confirm whether you have the infection. Your GP can also look at your blood tests to see if you have developed dengue hemorrhagic fever or if there is any evidence of another infection such as malaria. Your blood tests will be sent to a laboratory and the results may take several days. If you're severely dehydrated, have severe symptoms of dengue hemorrhagic fever or your symptoms suddenly become worse, you will need to be admitted to hospital. In hospital, you will be given fluids via a drip in your arm to make sure you don't become dehydrated. Most people make a full recovery if they receive appropriate treatment. At present, there are no vaccines that can stop you from being infected by any of the four types of dengue virus. The only way to prevent catching dengue fever is to protect yourself from getting bitten by mosquitoes. Advice for avoiding mosquito bites is as follows. Wear light-colored, loose-fitting, protective clothing that covers as much of your body as possible. Use an insect repellent on areas of your skin that are exposed and on your clothing - especially around loose parts such as collars or cuff. Repellents containing a chemical known as DEET (Ndrug combinations used to cure tuberculosis in adults are used in smaller doses for children and include drugs such as ethambutol, isoniazid, pyrazinamide, rifampicin and streptomycin. Almost 90 percent of the bacteria are killed within the first two weeks of treatment, according to Kenyon College. However, treatment must be continued for six months to kill the remaining 10 percent. If treatment is not continued then there is a high risk of the re-infection., Ndiethylmetatoluamide) are thought to be most effective.

Use plug-in devices, which have insecticides in them, to kill mosquitoes. Sleep under a mosquito net to avoid being bitten at night. Avoid areas where the mosquitoes breed (normally in standing water in domestic containers, around urban areas). You can also remove such sources of water or cover them to prevent access by mosquitoes. It's most important to follow these precautions around dawn and dusk, as this is when the Aedes mosquito is most active. However, it's important to remember that the Aedes mosquito can bite at any time of the day or night, so making sure you always take the necessary precautions can help to reduce your risk of catching dengue fever.

II. Objective General Objective: The general objective of this case study is to gain knowledge, skills and attributes in management of dengue and Koch's disease Specific Objective:

III. Health History III.1 Patient Profile Data

Name: Patient MB Address: 202 Sta. Rita Guiguinto, Bulacan Date Of Birth: November 18, 2007 Sex: Male Race: Filipino Status: Single Religion: Roman Catholic III.2 Chief Complaint Recurrence of fever with accompanying cough and colds III.3 Present Illness Data According to the father of the patient, they noticed the boy having on and off fever for 3 days with cough and colds. The boy was also noted of having no appetite , was having difficulty of breathing as well as body weakness, reasons why patient had vague feeling of discomfort.

III.4

Present Health History

During conversation with patient's father, he recalled and informed us that when the boy was born, he had already weak lungs , that is according to the doctor. They tried to trace their family history but no one has this condition or shall we say they have no knowledge on having a relative with the same disease. The mother stated that during her pregnancy, she did not catch any disease nor engaged in activities that might caused the boy's condition. III.5 Past Personal Health Data According to the boy's father when patient was less than a year old, he was admitted to Bulacan Medical Center for almost a week because of Pneumonia. The child has no history of any other serious illnesses other than fever, cough and cold. III.6 Family Health History The patient mother has a normal condition and so is his father. The patient has baby brother and according to them he is healthy. He is the only member of the family who has this condition. The only diseases they seldom experience are fever, colds which they manage by taking prescribed medicines and home confinement. III.7 Management Data Health

Patient's parents are aware from the time of his birth that he has weaker lungs than normal kids have. They understand that the child should be monitored carefully to conserve his health. Whenever patient is getting weak and having fever they will rush him to nearest hospital. They limit the child's activities like playing to avoid fatigue and excessive perspiration. III.8 Psychosocial Data Observing the patient, we conclude that he is within normal developmental sequence that occurs during toddler period. During confinement, we always see him playing quietly with his toys and sometimes walking around the ward area together with his parents. Whenever we approach him to take vital signs he was so cooperative and exhibits enthusiasm.

III. 9 Home Environment Patient is living with his parents and a baby brother together with his aunt and grandmother. Being with the relatives helps in rearing the children as evidenced by them taking care of the baby brother while the parents are in the hospital taking care of the patient. They all live in a bungalow house having a simple but happy life. They are in good location,where in they can easily access church, school, market and clinics by riding jeepney or tricycle.

Drugs name

Classification

Indication

Contra-indication

Effect in the lymphatic system

Effect in the respiratory

Side-effects i

Nursing responsibilities

Penicillin G

AnTibiotic Drug

indicated for the treatment of severe infections caused by sensitive organisms,

A history of a hypersensitivity (anaphylactic) reaction to any penicillin is a contraindication.

immediate and skipping doses or not completing the full delayed allergic course of therapy may: reactions(fever, (1) decrease the malaise, effectiveness of the urticaria and immediate treatment, pruritus)
and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by Penicillin G sodium or other antibacterial drugs in the future.

Salbutamol Neb

Respiratory Drugs -relief of bronchospasm -chronic bronchitis -emphysema -obstructive pulmonary disease Aminoglycoside -Serious infection cause by susceptible strains. -serious infection when causative

-hypertensive

Dizziness; headache; nausea; nervousness; sinus inflammation; sore or dry throat; tremor; trouble sleeping; vomitin Nausea, vomiting, stomach upset, or loss of appetite may occur.

Patient should wait one full minute after each inhalation to be certain another dose is necessary.

Gentamicin Sulfate

History of hypersensitivity to or toxic reaction with any aminoglycoside antibiotic. Safe use during pregnancy

Determine creatinine clearance and serum drug concentrations at frequent intervals, particularly for patients with impaired renal function, infants (renal immaturity), older adults,

organism are not (category C) or lactation is not known. -unlabeled use: established with clindamycin as alternative Paraacetamol antipyretic Relief for fever and pain associated with many parts of the body
Contraindicated to patients with known hypersensitivity Prolonged daily use increases the risk of upper gastrointestinal problems such as stomach bleeding, ant may cause liver and kidney damage

patients receiving high doses or therapy beyond 10 d, patients with fever or extensive burns, edema, obesity. Do not give children more than 5 doses in 24 h unless prescribed by physician. Do not use this medication without medical direction for: fever persisting longer than 3 d, fever over 39.5 C (103 F), or recurrent fever.

IX. Discharge Planning Medication Instruct patient's mother that the medication is very crucial in patient's full recovery. She should continue giving medications depending on the duration that the doctor ordered for the total recovery of the patient. Exercise Instruct mother to let chid play but it should limited to a short period of time to prevent the occurrence of shortness of breathing. Avoid areas where mosquitoes breed. Treatment Advice of enough sleep and rest Comply with the medication Provide chest physiotherapy to avoid pooling of secretions Encourage to cough so that secretions do not pool and become further infected. Outpatient Department Instruct the need of periodic health care visits to evaluate the extent of drug adherence Diet Increase fluid intake Continue Diet as tolerated. Instruct to increase intake of nutritious foods such as fruits and vegetables Spirituality Advise parent to nourish toddler with Jesus' stories by reading it aloud to the child. Train up a child to the way he should go for when he is old, he shall not depart from it

X. References Books Pilliteri, A(2010). Maternal and Child Health Nursing(6th ed.).Philadelphia.PA:Lippincott Williams & Wilkins Karch,.A(2010). Nursing Drug Guide.Ambler, PA:Lippincott Williams & Wilkins Weber & Kelley(2007).Health Assesment in Nursing(3rd ed.).Phil. Edition:Lippincott Williams & Wilkins

Table of Contents I. Introduction........................................................................................................................................................ II. Objectives.......................................................................................................................................................... III. Health History

III.1
III.2 III.3 III.4 III.5 III.6 III.7 III.8 III.9

Profile Data.................................................................................................................................. Chief Complaint............................................................................................................................ Present Illness Data....................................................................................................................... Present Health Status.................................................................................................................... Past Personal Health Data............................................................................................................. Family Medical Data..................................................................................................................... Health Management Data.............................................................................................................. Psychosocial Data......................................................................................................................... Home Environment.......................................................................................................................

IV. Review of the System IV.1 IV.2 Anatomy and Physiology......................................................................................................................... Pathology.................................................................................................................................................

V. Objective Finding V.1 General Survey............................................................................................................................................... V.2 Vital Signs...................................................................................................................................................... V.3 Physical Examination..................................................................................................................................... VI. Laboratory Result........................................................................................................................................... VII. Drug Study.................................................................................................................................................... VIII. Nursing Care Plan........................................................................................................................................ IX. Discharge Plan................................................................................................................................................ X. References........................................................................................................................................................

La Consolacion University-Philippines Catmon, Malolos, Bulacan SY:2011-2012

A Case Study Of Dengue and Tuberculosis in Children. (Pediatric Ward in Plaridel Emergency Hospital)

Submitted to: Mrs. Luz M. Alhamoui Submitted by: Iris Ann Aransazo Joshua Batan Clarence Angelo Yutuc Michael Angelo Kefi BSN2