MEDICATION DOSING WHY IS YOUR PATIENT NURSING INDICATIONS/MONITORING HOW DO YOU KNOW THE

-Name (generic and trade) - Current dose/frequency RECEIVING THIS? PARAMETERS MEDICATION IS EFFECTIVE?
-Calculate safe dose -You may have to search the physician
-Drug Class range and max
-Identify any specific instructions noted in Must be measurable.
notes for this. formulary related to monitoring or labs
-Drug route (IV, PO, dose/24hr
Subcutaneous, transdermal, etc)

-Hapacol 250mg -Take 1 packet For relieve fever when fever >38.5, max 4 times/day, Just over 16mg 
(Paracetamol) (250mg)/time every 4h effective
-Oral -Safe dose:
15mg/kg/ 1
take
(=15x15.6kg=
234mg)
-Oresol 245 (NaCl, KCl, Take 4 For electrolyte Drink anytime during the day effective
Natri citrat, glucose) sachet/day, mix compensation
-oral 1 sachet w
200ml water
-siro tamiflu 6mg/ml – Take 7.5ml Influenza A treatment In morning and evening w meals Safe dose: 16-23 kg =
75ml (oseltamivir) (45mg)/time, 2 45mg  effective
-oral times/day

-Tonimer baby spray Spray 2 clear airways In morning, afternoon, night, /

NAME: _ ________________________
DATE: _____________________________
CLINICAL JUDGEMENT/CLINICAL INQUIRY QUESTIONS
 Name: _ _________________

Date: _______________________

CLINICAL JUDGEMENT/ CLINICAL INQUIRY QUESTIONS

1. What is your patient’s admission diagnosis or primary problem?

Influenza A, dengue fever

2. Describe the events leading up to your patient’s admission. What signs and symptoms do you
suspect lead him/her to need medical treatment?

Children have high fever, highest temperature 39-40 degrees C, cough, and fatigue. Patient
examined at Saint Paul hospital for blood test WBC: 5.9G/L; HCT 38%, PLT: 163 G/L, rapid test
results of + Influenza A, +dengue fever. The patient went home and took 1 dose of Tamiflu but still
had a high fever that was difficult to relieve, was very tired, did not vomit, and had no difficulty
breathing  admitted to Vinmec

3. Discuss the pathophysiology behind your patient’s diagnosis. Cite your sources.

- the pathophysiology of influenza A is a complex interplay between viral replication, host

4. Based on your patient’s primary problem, what assessment findings do you expect to see, and
which vital signs and labs should you be following closely to assess disease progression?

- Patients have high fever, tiredness, headache, cough, running nose, poorly eating
- Follow: Fever, pulse and blood pressure; Labs: WBC, HCT, PLT

5. Write an expected outcome statement for your primary diagnosis, ensuring it is measurable
and achievable.
- No fever: axillary 36.5-37.5 degrees C
- Normal HR: 65-100
- Normal BP: 89/46-112/72
- SpO2 98-100%
- HCT <20%
- PLT >100

6. Identify your top 3 nursing interventions to support your outcome statement. Describe if each
intervention will be met, not met, or ongoing by the end of your shift.
- Isolate patient: ongoing
- Monitor the patient's fever and vital signs to promptly administer fever-reducing medication to
prevent the patient from convulsions: ongoing
- Administer medication according to 7 rights to the patient: ongoing
- Rehydrate patients with electrolyte water: ongoing
7. Describe a worst-case scenario for your patient based on their primary diagnosis. What early
signs or symptoms would expect to find in your nursing assessment?

- Convulsions because of high fever  sign: Continuous fever that does not subside for a long
period of 4-6 hours
- Respiratory failure or pneumonia due to severe influenza A signs: Severe cough with thick
phlegm, stuffy nose due to phlegm, difficulty breathing, capillary refill >3s, SpO2 <95%,
increased heart rate, severe fatigue
- dehydration due to dengue fever  dry skin, pale mucous membranes, little urination, much
fatigue

8. What interventions would you anticipate initiating based on the worst-case scenario above?

- Convulsions: ensure safely seizure, not restrain the child. Protect their airway by turning the
child onto their side to clear their airway and prevent choking. Meds: Antipyretics for fever
control, Benzodiazepines or Anticonvulsant for seizure control,
- Respiratory failure or pneumonia: oxygen supply, clear airways (suctioning)
- Dehydration: Rehydrate and replenish electrolytes for patients

9. What changes were made to the plan of care today? What new orders were added? Describe
the rationale for these changes?

Patient continue to use fever reducers, flu medicine and electrolyte replacement. The patient
was instructed to retest for influenza A and dengue fever because of suspected false positives
due to only high fever with no other symptoms.

10. What discharge education and support will your patient and family need? Has anything been
started yet?
- For influenza A: Wear a mask when going out and wash hands regularly. Avoid sending
children to class during times when many classmates are sick with flu or other contact or
droplet infections diseases.
- For dengue fever: use salt spray and close the mosquito net when sleeping for children to
minimize mosquito bites
- Not started educated yet as patient still at hospital

11. How should you adapt your plan of care to support age-appropriate and family-centered care?

- Collaborate with parents in monitoring the child's medical signs as well as implementing
medication and non-medication treatment orders during the day.
- Require family members to always be with the patient to promptly inform medical staff about
the abnormal things related to treatment process.