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Department of Family & Community Medicine Perpetual Succour Hospital BLEEDING LOVE FAMILY CASE PRESENTATION 1 st  Year Resident Crisbert I. Cualteros, M.D. Postgraduate Interns Alaba, Clevan Teresita Encong, Aubrey Taghoy, Josie Mae Tancongco, Ziphora Tingcang, Marvic Mae Nisnisan, Arvin
Objectives: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Family Profile
THE HOUSE ,[object Object],[object Object],[object Object],bedroom
LIVING AREA
DINING AREA AND KITCHEN ,[object Object],[object Object]
FAMILY LIFE LINE ,[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Economic Profile Total Monthly Income 8,000 – 8,500 PERCENT  ALLOCATION Total Monthly Expenses:  Food: Electricity:  Water:  Medicine:  Miscellaneous: 8,200 4,500 – 5,000 700 400 800-900 1,300 96.5% 53% 8.3% 4.7% 10.5% 16% Savings  300 3.5%
Curaraton-Tundag Family ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prenatal, Natal& Postnatal History: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Past Medical History ,[object Object],[object Object],[object Object],[object Object]
History of Present Illness: ,[object Object],[object Object]
History of Present Illness: ,[object Object],[object Object]
Physical Examination ,[object Object],[object Object],[object Object],[object Object]
Physical Examination ,[object Object],[object Object],[object Object],[object Object]
Physical Examination ,[object Object],[object Object],[object Object],[object Object]
DENGUE HEMORRHAGIC FEVER STAGE 1, GRADE 2  IMPRESSION
On admission: ,[object Object],[object Object],[object Object],[object Object],[object Object]
1 st  Hospital Day 4 TH  Day of Illness ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DAY 4 OF ILLNESS 5/24/09 12mn 5/24/09 6AM WBC 1.88 1.34 HGB 11.3 11.7 HCT 34.4 35.9 PLT 115 80
2 nd  Hospital Day Day 5 of illness ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DAY 5 of ILLNESS 5/25/09  1am  5/25/09 6AM WBC 1.06 1.05 Hct 33.3 29.7 Plt 65,000 75,000
3 rd  – 4 th  Hospital Day Day 6 Illness ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
3 rd  and 4 th  Hospital Day Days 6 and 7 of Illness 5/26/09 5/27/09 12mn 5am 12nn 7pm 6am 12nn 8pm WBC 1.54 1.53 1.66 1.87 2.62 2.72 3.57 Hct 32.8 32.4 32.6 35 34.7 30.8 34.3 Plt 85 60 50 60 85 50 70
5 th  Hospital Day Day 8 of Illness, Day 1 afebrile ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
5 th  Hospital Day Day 8 of Illness, Day 1 afebrile 5/28/09 5am 4pm WBC 3.81 5.33 Hct 34.2 34 Plt 65 60
6 th  Hospital Day Day 9 of Illness, Day 2 afebrile ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
6 th  Hospital Day Day 9 of Illness, Day 2 afebrile 5am 10am WBC 9.35 7.08 Hct 32.5 29.9 Plt 140 140
7th  Hospital Day Day 10 of Illness, Day 3 afebrile ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Graphical Summary of Temperature
FINAL DIAGNOSIS: ,[object Object]
Dengue Hemorrhagic Fever
Introduction: ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Transmission of Dengue virus by  Aedes aegypti
[object Object],[object Object],[object Object]
Aedes aegypti ,[object Object],[object Object],[object Object],[object Object],[object Object]
Vector Control Methods   ,[object Object],[object Object]
Dengue Fever ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
WHO criteria for DHF: ,[object Object],[object Object],[object Object],[object Object]
Objective evidence of plasma leakage: ,[object Object],[object Object],[object Object],[object Object]
Dengue Shock Syndrome   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Warning Signs for Dengue Shock                           
Disease Course ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Positive Tourniquet Test                                                                                                                                                 (+)Torniquet Test: more than 20 petechiae/ sq inch.
Treatment of Dengue Fever   ,[object Object],[object Object],[object Object],[object Object]
Volume Replacement Flow Chart for Patients with DHF Grades I and II
Indications for Hospital Discharge ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Family Assessment Tools
FAMILY CIRCLE Magdalena
Curaraton – Tundag Genogram
[object Object],[object Object],[object Object],[object Object],STRESSFUL EVENT: When Robert John was confined at  PSH due to fever and was diagnosed to have DHF ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
FAMILY APGAR Magdalena Curaraton: Mother APGAR SCORE 7: MODERATELY DYSFUNCTIONAL FAMILY RESOLVE:  I am satisfied with the way my family and I share time together AFFECTION:  I am satisfied with the way my family expresses affection and responds to my emotion such as anger, sorrow and love GROWTH:  I am satisfied that my family accepts and supports my wishes to take on new activities or directions PARTNERSHIP:  I am satisfied with the way my family talks on things with me and shares problems with me. ADAPTATION:  I am satisfied that I can turn to my family for help when something is troubling me. Hardly Ever  (0) Some of the Time (1) Almost always (2)
SCREEM Resource Social adequate Robert John’s family participates in social activities such as family reunions, fiesta celebrations of their relatives residing in the provinces. They also have good relationships with their neighbors, friends and co-workers.  Cultural adequate They have embraced Filipino values and apply these in their everyday life (i.e. showing respect by kissing the hands of elderly).  Religious adequate The family attends mass every Sunday in Capitol Parish and Basilica del Santo Nino. They are aware of religious events in the local community. Economic inadequate Ruben is working as shipper/delivery man of marine products for export and Magdalena is a housewife. Their monthly income is sometimes not enough to provide the basic necessities of the family. Educational adequate Ruben and Magdalena are highschool graduates hence, making them capable of solving problems rationally. Medical adequate When medical problems arise, the family can easily access their private physician to seek consultation for proper medications.
RECOMMENDATIONS ,[object Object],[object Object],[object Object],[object Object]
RECOMMENDATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RECOMMENDATIONS ,[object Object],[object Object],[object Object],[object Object]
RECOMMENDATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object]
RECOMMENDATIONS ,[object Object],[object Object]
FAMILY DIAGNOSIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 

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Family Case: Dengue Hemorrhagic Fever

  • 1. Department of Family & Community Medicine Perpetual Succour Hospital BLEEDING LOVE FAMILY CASE PRESENTATION 1 st Year Resident Crisbert I. Cualteros, M.D. Postgraduate Interns Alaba, Clevan Teresita Encong, Aubrey Taghoy, Josie Mae Tancongco, Ziphora Tingcang, Marvic Mae Nisnisan, Arvin
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  • 12. Economic Profile Total Monthly Income 8,000 – 8,500 PERCENT ALLOCATION Total Monthly Expenses: Food: Electricity: Water: Medicine: Miscellaneous: 8,200 4,500 – 5,000 700 400 800-900 1,300 96.5% 53% 8.3% 4.7% 10.5% 16% Savings 300 3.5%
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  • 25. DENGUE HEMORRHAGIC FEVER STAGE 1, GRADE 2 IMPRESSION
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  • 29. DAY 4 OF ILLNESS 5/24/09 12mn 5/24/09 6AM WBC 1.88 1.34 HGB 11.3 11.7 HCT 34.4 35.9 PLT 115 80
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  • 32. DAY 5 of ILLNESS 5/25/09 1am 5/25/09 6AM WBC 1.06 1.05 Hct 33.3 29.7 Plt 65,000 75,000
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  • 35. 3 rd and 4 th Hospital Day Days 6 and 7 of Illness 5/26/09 5/27/09 12mn 5am 12nn 7pm 6am 12nn 8pm WBC 1.54 1.53 1.66 1.87 2.62 2.72 3.57 Hct 32.8 32.4 32.6 35 34.7 30.8 34.3 Plt 85 60 50 60 85 50 70
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  • 38. 5 th Hospital Day Day 8 of Illness, Day 1 afebrile 5/28/09 5am 4pm WBC 3.81 5.33 Hct 34.2 34 Plt 65 60
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  • 41. 6 th Hospital Day Day 9 of Illness, Day 2 afebrile 5am 10am WBC 9.35 7.08 Hct 32.5 29.9 Plt 140 140
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  • 45. Graphical Summary of Temperature
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  • 50. Transmission of Dengue virus by Aedes aegypti
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  • 58. Warning Signs for Dengue Shock                           
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  • 60. Positive Tourniquet Test                                                                                                                                                 (+)Torniquet Test: more than 20 petechiae/ sq inch.
  • 61.
  • 62. Volume Replacement Flow Chart for Patients with DHF Grades I and II
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  • 68. FAMILY APGAR Magdalena Curaraton: Mother APGAR SCORE 7: MODERATELY DYSFUNCTIONAL FAMILY RESOLVE: I am satisfied with the way my family and I share time together AFFECTION: I am satisfied with the way my family expresses affection and responds to my emotion such as anger, sorrow and love GROWTH: I am satisfied that my family accepts and supports my wishes to take on new activities or directions PARTNERSHIP: I am satisfied with the way my family talks on things with me and shares problems with me. ADAPTATION: I am satisfied that I can turn to my family for help when something is troubling me. Hardly Ever (0) Some of the Time (1) Almost always (2)
  • 69. SCREEM Resource Social adequate Robert John’s family participates in social activities such as family reunions, fiesta celebrations of their relatives residing in the provinces. They also have good relationships with their neighbors, friends and co-workers. Cultural adequate They have embraced Filipino values and apply these in their everyday life (i.e. showing respect by kissing the hands of elderly). Religious adequate The family attends mass every Sunday in Capitol Parish and Basilica del Santo Nino. They are aware of religious events in the local community. Economic inadequate Ruben is working as shipper/delivery man of marine products for export and Magdalena is a housewife. Their monthly income is sometimes not enough to provide the basic necessities of the family. Educational adequate Ruben and Magdalena are highschool graduates hence, making them capable of solving problems rationally. Medical adequate When medical problems arise, the family can easily access their private physician to seek consultation for proper medications.
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Editor's Notes

  1. Neighbors were also helping them watching over Robert John in the hospital and took care of Mary eve