PAMANTASAN NG LUNGSOD NG MARIKINA COLLEGE OF NURSING

Dengue Fever

In Partial Fulfillment in the Requirements of RLE

Submitted by:

Troy M. Silverio

Dengue is a mosquito-borne infection found in tropical and sub-tropical regions around the world. In recent years, transmission has increased predominantly in urban and semi-urban areas and has become a major international public health concern. Severe dengue (previously known as Dengue Hemorrhagic Fever) was first recognized in the 1950s during dengue epidemics in the Philippines and Thailand. There are four distinct, but closely related, serotypes of the virus that cause dengue (DEN-1, DEN-2, DEN-3 and DEN-4). The incidence of dengue has grown dramatically around the world in recent decades. Over 2.5 billion people over 40% of the world's population are now at risk from dengue. WHO currently estimates there may be 50100 million dengue infections worldwide every year. Transmission The Aedes aegypti mosquito is the primary vector of dengue. The virus is transmitted to humans through the bites of infected female mosquitoes. After virus incubation for 410 days, an infected mosquito is capable of transmitting the virus for the rest of its life. Infected humans are the main carriers and multipliers of the virus, serving as a source of the virus for uninfected mosquitoes. Patients who are already infected with the dengue virus can transmit the infection (for 45 days; maximum 12) via Aedes mosquitoes after their first symptoms appear. The Aedes aegypti mosquito lives in urban habitats and breeds mostly in man-made containers. Unlike other mosquitoes A. aegypti is a daytime feeder; its peak biting periods are early in the morning and in the evening before dusk. Female A. aegypti bites multiple people during each feeding period. Characteristics Dengue fever is a severe, flu-like illness that affects infants, young children and adults, but seldom causes death. Dengue should be suspected when a high fever (40C/ 104F) is accompanied by two of the following symptoms: severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, swollen glands or rash. Symptoms usually last for 27 days, after an incubation period of 410 days after the bite from an infected mosquito. Severe dengue is a potentially deadly complication due to plasma leaking, fluid accumulation, respiratory distress, severe bleeding, or organ impairment. Warning signs occur 37 days after the first symptoms in conjunction with a decrease in temperature (below 38C/ 100F) and include: severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums, fatigue, restlessness, blood in vomit. The next 2448 hours of the critical stage can be lethal; proper medical care is needed to avoid complications and risk of death. Treatment There is no specific treatment for dengue fever.

Biographical Data: Name: J.B.M Age: 22 Address: Banaba San Mateo Rizal Date of Birth: August 15, 1990 Gender: Male Marital Status: Single Nationality: Filipino Religion: Roman Catholic Educational Attainment: Presently in 5th Year College Type of Health Plan: No Phil Health Date and Time of Admission: July 28, 2012 11:25AM Source and Reliability of Information: The Client himself who seems reliable because he can verbalize the discomfort that he feels The clients mother who seems reliable because she is the one who is taking care of the client Clients chart as a secondary source of information

Chief Complaint: Fever accompanied by a stabbing pain in the lower extremities History of Present Illness: Client experience an intermittent fever for 4 consecutive days 4 days prior to admission and it is accompanied by a stabbing pain in the lower extremities when the client is at home. Client did self-medicate and took over-the-counter medicines like Bioflu, Biogesic, and Alaxan. The fever and pain can be relieved but sign and symptoms manifested after several hours. Past Medical History: Client does not have any history of serious childhood illnesses and diseases. Client was never been hospitalized before (until clients chief complaints occur) and never undergone any surgical procedure. According to clients mother, her son had completed his immunization when he was a child because they have a family clinic (private clinic) in SSS. Family Medical History: According to clients mother, she is experiencing an increase of blood pressure and her husband was complaining about joint pain.

Immunization/Exposure to Communicable Disease: According to clients mother, her son had completed his immunization when he was a child because they have a family clinic (private clinic) in SSS. Client verbalized that he has not been expose to any kind of communicable disease. Allergies: Client has no known allergies to food and medications. Home medications/Alternative Medicine: Most of the time, client do self-medication and take over-the-counter medicines like Bioflu, Biogesic, Alaxan, and Neozep whenever he feels sick. Psychosocial History: Client drinks coffee every morning with his breakfast. Client started drinking alcohol when he was 17 years old and until now he drinks alcohol, but moderately and occasionally. Client does not smoke. Developmental Level:
Psychosocial Crisis Later Adolescence 18-22 Years Individual Identity vs. Identity Confusion Central Task Positive Outcome Strong moral identity; Ready for intimate relationships Ego Quality Definition Developmental Task Autonomy from parents; Sex-role identity; Internalized morality; Career choice Early Adulthood 22-34 Years Intimacy vs. Isolation Caregiving Form close relationships and share with others Love Capacity for mutuality that transcends childhood dependency Stable relationships; Child rearing; Work etc

Role experimentation

Fidelity Ability to freely pledge and sustain values and ideologies

Gordons Functional Patterns Before Hospitalization Health Perception/ Health Management Client is confident and satisfied about his health and he considered himself as a healthy person. He does not smoke. He started drinking when he was 17 years old and e only drinks alcohol occasionally and moderately. He does not take any illegal drug. Client does not have any history of chronic childhood illnesses and diseases. According to clients mother, her son had completed his immunization when he was a child because they have a family clinic (private clinic) in SSS. Client was never been hospitalized before (until clients chief complaints occur) and never undergone any surgical procedure. Most of the time, client do selfmedication and take overthe-counter medicines like Bioflu, Biogesic, Alaxan, and Neozep whenever he feels sick. His only exercise is during weekend when he plays basketball because of busy schedule in school. Client has a strong appetite, he eats whatever he wants. He eats 4 times a day including the snacks. His regular diet is composed of rice and meat During Hospitalization Client considered himself as an unhealthy person due to present condition, but he is confident and hopeful that he will easily get better. The patient and his family are compliant to all the doctors order, stating that being in a healthy condition is necessary because he needs to come back to school as a graduating student as soon as possible. Analysis

Nutritional Metabolic

The client loss his appetite due to uncomfortable feeling and he is not use to hospital settings. The client is on DAT diet

An individuals health status greatly affects eating habits and nutritional status

Elimination

with vegetables and fruit. He has no known allergies to food. He does not smoke but drinks alcohol. He consumes 5 to 6 glasses of water per day. He does not have any problem with nausea and vomiting, swallowing, chewing, or indigestion. The clients average voiding pattern is 4 times a day in a moderate amount, light yellow in color, without experiencing discomfort. The client passes out stool once a day in moderate amount, well-formed and brownish in color

except dark color food.

Activity/Exercise

Sleep/Rest

During hospitalization the client voids 3 times a day in moderate amount, light yellow in color, without experiencing any discomfort. He defecates once a day but not every day, in moderate amount, wellformed and yellowishbrown in color Client is able to perform all The client activities activities of daily living were minimized independently. Client likes because of his playing basketball and condition, nevertheless guitar during weekends and the client can perform playing computer games ADLs independently like DOTA. His time and because he feels that energy during weekdays is he have enough energy focused on his studies. to do it and that he believes that hes not too ill. The only leisure of the client is reading his books in engineering. He does not have usual Client complained time of sleep stating that about difficulty of his studies as the reason. sleeping and sleeps for The client do not use any short periods of time forms of sleeping aids and due to pain, fever and is not experiencing sometime due to vital episodes of insomnia and sign taking every hour any other related disorders. that is why sometimes Day time naps are not done he doesnt feel rested. by the client.

Illness that causes pain or physical distress can result in sleep problems. People who are ill require more sleep than normal and the normal rhythm and wakefulness is often disturbed.There is disruption of the sleep-

wake cycle because of the patients disease. Cognitive/Perceptual Client is currently studying and is in his 5th year taking up Civil Engineering in T.I.P. He can read and write and can speak and understand English. Role/Relationship Client is not in a relationship. He has a good relationship with his mother and siblings as well as with his friends in school. Sexual/Reproductive Client is not in a relationship. He is not engaged to sexual activity due to personal reasons. Coping/Stress He hangs out with his Tolerance peers to relax and relieve stress; they usually go out to play basketball or DOTA. He sometimes plays his guitar-based for the samenamed purpose. The clients condition doesnt affect his reading and writing. He can and is understood by others. This hospitalization caused a lot of trouble for his studies due to many absences and lot of lessons missed. Client doesnt perform sexual activities.

Value/Belief

Client is a Roman Catholic. According to him he goes to church rarely because his busy schedule in school.

This recent hospitalization was a traumatic experience for the client for it happening the first time. There have been many changes occurred that made it difficult for him to adjust. Client cannot go to mass due to hospitalization.

Coping is the cognitive and behavioral effort to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person.

Physical Assessment: Body Part Upper Extremities: Left arm Lower Extremities: Left and Right Legs Findings Analysis Bright red rash: Bright red rash has measles-like appearance. The redness may remain dominant in some parts while others may remain unaafected. These rashes may disappear after a few days, only to reappear again. Degradation of skeletal muscle protein

Rash

Rash Muscle pain

Diagnostic/Laboratory Examinations: Examination Platelet Count: July 28 July 29 July 30 July 31 August 1 August 2 Normal Values 150 400X10(cube)g/L 6PM 6AM 6PM 6AM 6PM 6AM 6PM 6AM 6PM 6AM 163 157 160 152 150 162 159 155 150 158 Viral Infections Findings Analysis

URINALYSIS Color Transparency Specific Gravity pH Sugar Protein MICROSCOPIC FINDINGS: RBC Pus Cells Epithilial cells mucus threads Renal Cells Yeast Cells Bacteria Light Yellow Clear 1.005 7.5 Negative Negative 0-1/hpf Rare Few Interpretation

The urinalysis results are within normal reference indicating that urinary functions are also normal.

Medical Diagnosis: Dengue Fever

Anatomy and Physiology: Blood The vital fluid that courses through the body's blood vessels provides the means by which the bodys cells receives vital nutrients and oxygen and dispose of their metabolic waste. As blood flows past the tissue cells, exchanges continually occur between the blood and the tissue cells, so that vital activities can go on continuously. Also called red blood cells or RBCs. Cells that contain hemoglobin, an iron-containing pigment that binds oxygen in order to transport it to the cells of the body. The solid, cellular portion of blood. It consists of erythrocytes, leukocytes, and platelets. The process of forming blood. Also called white blood cells or WBCs. A group of several different types of cells that provide protection against the invasion of bacteria and other foreign material. They are able to leave the blood-stream and search out the foreign invaders (bacteria, virus, and toxins), where they perform phagocytosis. The liquid portion of blood containing 90% water. The remaining 10% consists of plasma proteins (serum albumin, serum globulin, fibrinogen, and prothrombin), inorganic substances (calcium, potassium, and sodium), organic components (glucose, amino acids, cholesterol), and waste products (urea, uric acid, ammonia, and creatinine). Cells responsible for the coagulation of blood. These are also called thrombocytes and contain no hemoglobin. Also called erythrocytes or RBCs. Cells that contain hemoglobin, and iron-containing pigment that binds oxygen in order to transport it to the cells of the body. Blood cell that provides protection against the invasion of bacteria and other foreign material. A protein that is normally found circulating in the bloodstream. It is abnormal for albumin to be in the urine. An organic substance found in plasma. It is used by cells to build proteins.

Erythrocytes

Formed Elements Hematopoiesis Leukocytes

Plasma

Platelets

Red Blood Cell

White Blood Cell Albumin

Amino Acids

Calcium Creatinine Fats Fibrinogen Gamma Globulin Globulins Glucose

Plasma Proteins

Potassium Sodium Urea

Bilirubin

Enucleated Hemoglobin (Hg) Agranulocyte

Granulocyte

Pathogens Basophil Eosinophils

Neutrophil

Monocyte

An inorganic substance found in plasma. It is important for bones, muscles, and nerves. A waste product of muscle metabolism. Lipid molecules transported throughout the body dissolved in the blood. Blood protein that is essential for clotting to take place. Protein component of blood containing antibodies that help to resist infection. One type of protein found dissolved in the plasma. The form of sugar used by the cells of the body to make energy. It is transported to the cells in the blood. Proteins that are found in plasma. Includes serum albumin, serum globulin, fibrinogen, and prothrombin. An inorganic substance found in plasma. It is important for bones and muscles. An inorganic substance found in plasma. A waste product of protein metabolism. It diffuses through the tissues in lymph and is returned to the circulatory system for transport to the kidneys. Waste product produced from destruction of worn-out red blood cells; disposed of by the liver. The loss of a cell's nucleus. Iron-containing pigment of red blood cells that carries oxygen from the lungs to the tissue. Nongranular leukocyte. This is one of the two types of leukocytes found in plasma that are classified as either monocytes or lymphocytes. Granular polymorphonuclear leukocyte. There are three types: neutrophil, eosinophil, and basophil. Disease-bearing organisms. A granulocyte white blood cell that releases histamine and heparin in damaged tissues. A granulocyte white blood cell that destroy parasites and increases during allergic reactions. A granulocyte white blood cell that is important for phagocytosis. It is also the most numerous of the leukocytes. An agranulocyte white blood cell that is

Lymphocytes Agglutinate

Fibrin

Hemostasis Prothrombin Thrombin Thrombocytes

Thromboplastin ABO System Blood Typing

Rh Factor Type A

Type AB

Type B

Type O

Universal Donor

important for phagocytosis. An agranulocyte white blood cell that provides protection through the immune response. Clumping together to form small clusters. Platelets agglutinate to start the clotting process. Whitish protein formed by the action of thrombin and fibrinogen, which is the basis for the clotting of blood. To stop bleeding or the stagnation of the circulating blood. Protein element within the blood that interacts with calcium salts to form thrombin. A clotting enzyme that converts fibrinogen to fibrin Also called platelets. Platelets play a critical part in the blood-clotting process by agglutinating into small clusters and releasing thrombokinase. Substance released by platelets; reacts with prothrombin to form thrombin. The major system of blood typing. The blood of one person is different from another's due to the presence of antigens on the surface of the erythrocytes. The major method of typing blood is the ABO system and includes types A, B, O, and AB. The other major method of typing blood is the Rh factor, consisting of the two types, Rh+ and Rh-. An antigen marker found on erythrocytes of persons with Rh + blood. One of the ABO blood types. A person with type A markers on his or her RBCs. Type A blood will make anti-B antibodies. One of the ABO blood types. A person with both type A and type B markers on his or her RBCs. Since it has both markers, it will not make antibodies against either A or B blood. One of the ABO blood types. A person with type B markers on his or her RBCs. Type B blood will make anti-A antibodies. One of the ABO blood types. A person with no markers on his or her RBCs. Type O blood will not react with anti-A or anti-B antibodies. Therefore, it is considered the universal donor. Type O blood is considered the universal donor.

Universal Recipient

Rh-Negative

Rh-Positive

Since it has no markers on the RBC surface, it will not trigger a reaction with anti-A or anti-B antibodies. A person with type AB blood has no antibodies against the other blood types and therefore, in an emergency, can receive any type of blood. A person with Rh- blood type. The person's RBCs do not have the Rh marker and will make antibodies against Rh + blood. A person with RH + blood type. The person's RBCs have the Rh marker.

Pathophysiology of the Disease: Predisposing Geographical area tropical islands in the Pacific (Philippines) and Asia Precipitating Environmental conditions (open spaces with water pots, plants, and riverside) Mosquito carrying dengue virus Sweaty skin

Aedes aegypti (dengue virus carrier):8-12 days of viral replication on mosquitoes salivary glands

Bite from mosquito (Portal of Entry in the Skin) Allowing dengue virus to be inoculated towards the circulation/blood (Incubation Period: 3-14 days

Virus disseminated rapidly into the blood and stimulates WBCs including B lymphocytes that produces and secretes immunoglobulins (antibodies), and monocytes/macrophges, neutrophils

Antibodies attach to the viral antigens, and then monocytes/macrophages will perform phagocytosis through Fc receptor (FcR) within the cells and dengue virus replicates in the cells

Antibodies attach to the viral antigens, and then monocytes/macrophages will perform phagocytosis through Fc receptor (FcR) within the cells and dengue virus replicates in the cells Entry to the Spleen Recognition of dengue viral antigen on infected monocyte Entry to the Bone marrow

Release of cytokines which consist of vasoactive agents such as interleukins, tumor necrosis factor, urokinase and platelet activating factors which stimulates WBCs and pyrogen release

Dengue

Cellular direct destruction and infection of red bone marrow precursor cells as well as immunological shortened platelet

Thrombocytopenia

Recovery

DISCHARGE PLAN MEDICATION Instruct patient to follow and continue the intake of vitamin B-complex as prescribed by the doctor. ENVIRONMENT Instruct patient to provide clean and peaceful environment. Inform patient to always empty all the stock bottles in their house to eliminate possible breeding grounds of the mosquitoes. Educate patient about the importance of the proper ways of cleaning the surroundings. TREATMENT Instruct patient to provide adequate bed rest to minimize fatigue Avoid all strenuous activity that can make the patient tired. HEALTH TEACHINGS Instruct patients family to prepare foods that are appetizing and nutritious. Educate patient to give emphasis on the importance of proper hygiene. Recommend to patient to wear long comfortable sleeves and long socks to protect against mosquito bites or to apply mosquito repellants. OUT-PATIENT Inform patient to notify the physician if symptoms set in. DIET Inform the patient to prepare nutritious food and provide iron supplement vitamins. SPIRITUALITY Instruct patient and patients family to continue to believe in GOD and always have faith with HIM.