OBJECTIVES

General

This case presentation aims to identify and determine the general heath problems and needs of the patient with
an admitting diagnosis of Dengue Hemorrhagic Fever. This presentation also intends to help patient promote
health and medical understanding of such condition through the application of the nursing skills.

Specific

• To raise the level of awareness of patient on health problems that she may encounter.
• To facilitate patient in taking necessary actions to solve and prevent the identified problems on her
own.
• To help patient in motivating her to continue the health care provided by the health workers.
• To render nursing care and information to patient through the application of the nursing skills.

OVERVIEW OF THE DISEASE

INTRODUCTION

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

Dengue fever can be caused by any one of four types of dengue virus: DEN-1, DEN-2, DEN-3, and DEN-4. You
can be infected by at least two, if not all four types at different times during your lifetime, but only once by the
same type.

You can get dengue virus infections from the bite of an infected Aedes mosquito. Mosquitoes become infected
when they bite infected humans, and later transmit infection to other people they bite. Two main species of
mosquito, Aedes aegypti and Aedes albopictus, have been responsible for all cases of dengue transmitted in
this country. Dengue is not contagious from person to person.

DEFINITION
Dengue hemorrhagic Fever
Dengue fever also known as break-bone fever is a severe infectious disease characterized
by pain in eyes, head and extremities. The disease is transmitted by the infective bite of
Aedes Aegypti mosquito. Once bitten by the mosquito, it takes 3-14 days to develop the
disease. Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) are the
most serious forms of Dengue that may cause death. Person with dengue hemorrhagic
fever lacks blood clotting process. About 20-30% of people with DHF develop shock which
is known as dengue shock syndrome. Dengue commonly prevails in warm and wet areas of the world.
The disease is commonly spread during the rainy season. It is highly recommended to see a doctor,
once the symptoms of dengue fever are observed.

SIGN AND SYMPTOMS

Symptoms of typical uncomplicated (classic) dengue usually start with fever within 5 to 6 days after you have
been bitten by an infected mosquito and include

• High fever, up to 105 degrees Fahrenheit

• Severe headache
• Retro-orbital (behind the eye) pain
• Severe joint and muscle pain
• Nausea and vomiting
• Rash

The rash may appear over most of your body 3 to 4 days after the fever begins. You may get a second rash later
in the disease. Symptoms of dengue hemorrhagic fever include all of the symptoms of classic dengue plus

• Marked damage to blood and lymph vessels

• Bleeding from the nose, gums, or under the skin, causing purplish bruises

This form of dengue disease can cause death.

Symptoms of dengue shock syndrome-the most severe form of dengue disease-include all of the symptoms of
classic dengue and dengue hemorrhagic fever, plus

• Fluids leaking outside of blood vessels

• Massive bleeding
• Shock (very low blood pressure)

This form of the disease usually occurs in children (sometimes adults) experiencing their second dengue
infection. It is sometimes fatal, especially in children and young adults.
MANAGEMENT AND TREATMENT

Dengue fever can be diagnosed by doing two blood tests, 2 to 3 weeks apart. The tests
can show whether a sample of your blood contains antibodies to the virus. In epidemics, a
health care provider often can diagnose dengue by typical signs and symptoms.

There is no specific treatment for classic dengue fever, and like most people you will
recover completely within 2 weeks. To help with recovery, health care experts recommend

• Getting plenty of bed rest

• Drinking lots of fluids
• Taking medicine to reduce fever

Often health care provider advises people with dengue fever not to take aspirin.
Acetaminophen or other over-the-counter pain-reducing medicines are safe for most
people. For severe dengue symptoms, including shock and coma, early and aggressive
emergency treatment with fluid and electrolyte replacement can be lifesaving.

The best way to prevent dengue fever is to take special precautions to avoid contact with
mosquitoes. Several dengue vaccines are being developed, but none is likely to be
licensed by the Food and Drug Administration in the next few years.

When outdoors in an area where dengue fever has been found

• Use a mosquito repellant containing DEET, picaridin, or oil of lemon eucalyptus

• Dress in protective clothing-long-sleeved shirts, long pants, socks, and shoes

Because Aedes mosquitoes usually bite during the day, be sure to use precautions
especially during early morning hours before daybreak and in the late afternoon before
dark.

Other precautions include

• Keeping unscreened windows and doors closed

• Keeping window and door screens repaired
• Getting rid of areas where mosquitoes breed, such as standing water in flower
pots, containers, birdbaths, discarded tires, etc.

Most people who develop dengue fever recover completely within 2 weeks. Some,
however, may go through several weeks to months of feeling tired and/or depressed.

NURSING HISTORY

CLIENT PROFILE

Room: Silver

Name: Mrs. E.S.R

Address: #78 Brgy. 2, Jones, Isabela

Birthplace: Pampanga

Birthday: October 31, 1974

Age: 34 yrs. old

Status: Married

Nationality: Filipino

Religion: Roman Catholic

Chief complaint: Fever

Admission: September 9, 2009 Time: 8:15pm

Final diagnostic: DHF (dengue hemorrhagic fever)

Discharge: September 13, 2009

PRESENT HEALTH HISTORY

The present health history started 5 days prior to admission. The patient had onset of fever associated with
body malaise and decrease in appetite, no cough, no colds. Tmax 395 retrieved by taking paracetamol. Two
days prior to admission, shu with on & off fever associated with loose watery stool, 2 to 4 episodes. One day
prior to admission, shu with above complaint patient sought consult, CBC was done, patient given ciprofloxacin
& advised to have repeat CBC. Morning prior to admission, CBC had done, PH 197, →135, →82 hence advised
admission. She was admitted last September 9 at around 8:15pm at sanitarium.

PAST HEALTH HISTORY

Prior to hospitalization at sanitarium, she admitted that she has already a record or medical history of being
admitted due to operations, accidents, and diseases. She also says that she has a history in gestational DM but
she denies having an allergies and previous surgery.

FAMILY HEALTH HISTORY

DISEASE FATHER MOTHER

DIABETES MELLITUS - +

CANCER - -

HYPERTENSION - -

ASTHMA - -

11 FUNCTIONAL GORDONS

Health pattern

PHYSICAL ASSESSMENT

GENERAL APPEARANCE: awake, conscious

DATE: September 12, 2009

Body parts Methods Findings interpretation

Head

•scalp Inspection -With dandruff Due for not taking a

bath in 4days.

-normal
-tenderness

Palpation
•Hair Inspection - equally distributed, -normal
straight

-oily hair

-Due for not taking a

bath.
•Face Inspection -symmetrical Normal

Palpation -(+)facial sensation normal

Eyes

•eyebrows Inspection -symmetrical and Normal

aligned
•Eyelids Inspection -able to close Normal

-soft to touch
•eyelashes Inspection -equally distributed normal
•Conjunctiva Inspection -Slightly pale Normal

PERRLA
Ears

•pinna Inspection -Oblong, no lesions Normal

•External canal Inspection -With minimal Normal
cerumen
•Hearing Inspection -Can normal

Hear whispered
word equally in both
ears.
Nose

•external nose Inspection -On the middle of the Normal

eyes

-Normal sense of
smell
Mouth

•lips Inspection -dry lips due to dehydration

•Teeth Inspection
•Gum Inspection -smooth and wet normal
•Tongue Inspection -Normal in size with Normal
sense of taste
•Floor of the mouth Inspection

Neck Inspection -Symmetrical Normal

interiorly and no
swelling
Shoulders Inspection -on the midline normal

-symmetrical
Thorax and lungs Inspection -symmetrical chest Normal
expansion

-no retraction
Heart Auscultation -murmur normal
Abdomen Palpation -(-)tenderness normal

-soft
Musculo skeletal
system

•Upper extremities
 Inspection -(+) edema normal

-symmetrical

-clean fingernails
•Lower extremities Inspection -(-)edema normal

-clean fingernails
Skin inspection -flushed Due to her rashes.

COARSE IN THE WARD

VITAL SIGNS

September 10, 2009

BLOOD PRESSURE BODY RESPIRATORY PULSE RATE (bpm)

(mmHg) TEMPERATURE RATE (cpm)
(degrees
centigrade)

10:00 am 120/80 37.2 21 78

12:00 nn 110/80 36.3 21 72

2:00 pm 110/80 37 22 78

September 12, 2009

BLOOD PRESSURE BODY RESPIRATORY PULSE RATE (bpm)

(mmHg) TEMPERATURE RATE (cpm)
(degrees
centigrade)

6:00 pm 110/80 36.2 18 79

10:00 pm
LABORATORY TEST

SEROLOGY

September 9, 2009 RESULT

ABO group “B”

RH type (+)

HEMATOLOGY

September 10, 2009

CBC (cell blood count) RESULT NORMAL INDICATION

9
WBC 4.3 5-10 x10 /l
lymphocytes 0.53 0.25-0.35

segmenters 0.47 0.50-0.65

platelet count 65 150-400

September 11, 2009

CBC (cell blood count) RESULT NORMAL INDICATION

WBC 10.4 5-10

lymphocytes 0.40 0.25-0.35

platelet count 68 150-400

repeated at 6:00 pm 102 150-400

September 12, 2009

CBC (cell blood count) RESULT NORMAL INDICATION

platelet count 97 150-400

PARASITOLOGY

September 10, 2009

STOOL ROUTINE RESULT

color yellow brown

consistency soft

occult blood (-)

pus cell (-)

mucus trace

PH reaction alkaline

VIEW ANATOMY & PHYSIOLOGY

Etiology: predisposing factors:

Chikungunya Virus environmental factor
(

Phato
Aedes Aegypti
Dengue Virus
(Chikungunya Virus)
IgG adheres to the platelet
(Initiates destruction of the platelet)
Thrombocytopenia
(50,000/mm3 or less)
Increased potential
For hemorrhage
Stimulates intense
Inflammatory response
petechial rash, high fever, headache
(epistaxis, vomiting, conjunctival infection,abdominal pain, shock, death)
DENGUE HEMORRHAGIC FEVER

DISCHARGE PLAN

M – edication

Intake of appropriate vitamin supplement and diuretics to increase protection mechanism of the immune
system and continuous of medications prescribes by the doctor such as cifrofolaxin,

E – conomic

The use of nonpharmacotherapy such as drinking plenty of water will promote increase plasma in blood to
increase immunity and proper hygiene and promotion of cleanliness at home and work area.

T – reatment
Management of such condition would be through hydration and doing control measures to eliminate vector by
promoting cleanliness in the environment through proper disposal of rubber tires, changing of water of lower
vases everyday, destruction of breeding places of mosquito and residual spraying with insecticides.

H – ygiene

Advise to follow proper body hygiene and to maintain cleanliness on surroundings. This would prevent
additional cases of DHF.

O – ut Patient/ Follow-up

Any odd signs such as fever, recurrence of fever,etc. must be immediately reported to the physician.

D – iet

Instruct to eat foods that are low fat, low fiber, non-irritating and non-carbonated

And increase fluid intake.

Risk Factors of Dengue Fever

Dengue fever is primarily caused by a bite of Aedes Aegypti mosquito. It is mainly

caused by any one of the four dengue virus: DEN-1, DEN-2, DEN-3, and DEN-4.
Infection with one virus does not provide protection to the person from other three
viruses. However, the person gets life-long immunity from that particular virus, once
treated. It is a wrong belief that dengue is spread directly from person to person. The
dengue fever can only be transmitted to a healthy individual through mosquito bite.

Prevention of Dengue Fever

Prevention is the only cure for dengue fever. To stop the spread of dengue fever, one
must eradicate the cause of the fever, Aedes mosquito. To prevent the growth and
multiplication of Aedes mosquito, one must take precautions like:

 All water and air-coolers must be thoroughly washed and dried out before reuse.
 One tablespoon of petrol added in cooler water can help in preventing the breeding of
mosquito.
 Overhead and other water tanks should be kept covered or air-tight.
 Unused or broken bottles, pots and tyres should not be left open.
 Accumulation of water in pots, unused utensils or containers must be avoided. People
who are constantly traveling in dengue-prone areas may lower the risk by:
 Wearing insect repellant with DEET.
 Wearing clothes that completely covers the body.
 Keeping the unscreened doors and windows closed.

Dengue fever is caused by any one of four dengue viruses spread by the Aedes aegypti
mosquito. These mosquitoes thrive in and near human habitations where they breed in
even the cleanest water.

Mosquitoes transmit the virus back and forth between humans. When a mosquito bites a
person infected with a dengue virus, the virus enters the mosquito's bloodstream. It then
circulates before settling in the salivary glands. When the infected mosquito then bites
another person, the virus enters that person's bloodstream, where it may cause the serious
illness.

You can become infected with dengue fever more than once. This happens when you're
exposed to a different one of the four dengue viruses than one to which you were
previously exposed. Infection a second time is typically what causes the more severe
form of the disease — dengue hemorrhagic fever.

No specific treatment for dengue fever exists.

If you have a mild form of the disease, your doctor will recommend making sure to
drink enough fluids to avoid dehydration from vomiting and high fever. You can also
take acetaminophen (Tylenol, others) for pain and fever. Avoid aspirin or other
nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and
naproxen sodium (Aleve). These can increase the risk of bleeding complications.

If you have a more severe form of the disease, treatment consists of supportive care in
a hospital. Such care includes intravenous fluids and electrolyte replacement, maintaining
adequate blood pressure and replacing blood loss.

If you have any form of dengue fever, you may also be kept away from mosquitoes, to
avoid transmitting the disease to others.