You are on page 1of 18
CASE STUDY OF DENGUE FEVER Submitted by: Cayetano, Jerome L !SN" Submitted to: Norman #im $a%a& C%ini'a% (n)tru'tor I. PATIENT ASSESMENT DATA BASE A. GENERAL DATA 1. Patients Name: T. A. 2. Address: Tayug, Pangasinan 3. Age: 18 years old 4. Sex: Male 5. irt! "ate: S#et. 12, 1$$5 %. &an' in t!e (amily: 2nd )!ild in t!e *amily +. Nationality: (ili#ino 8. ,i-il Status: Single $. "ate o* Admission: (e.. 28, 2/14 1/. 0rder o* Admission: Please admit #atient to Medi)al 1ard, se)ure #atient *or admission and management, monitor 2S , 32( "54&, diagnosti)s ,,, #latelet, urinalysis ,medi)ations are #ara)etamol 5//mg 5 % !ours. 11. Attending P!ysi)ian: "r. Ar5uero 12. (inal "iagnosis: "engue (e-er B. CHIEF COMPLAINT (e-er C. HISTORY OF PRESENT ILLNESS 5 days PT, #atient started as on and o** *e-er o* 4 days asso)iated 1it! !eada)!e and .ody 1ea'ness negati-e )onsultation done. D. PAST HEALTH HISTORY/STATUS A))ording to my #atient, !e is !ad sore eyes and )!i)'en #ox 1!en !e 1as in elementary le-el .6e !as no 'no1n allergies. E. FAMILY ASSESMENT NAM7 &74AT30N A87 S79 0,,:PAT30N 7":,AT30NA4 ATTA3NM7NT N.T (at!er 4/ M (armer 6ig! s)!ool graduate 6.T Mot!er 35 ( 6ouse 1i*e 6ig! s)!ol graduate &.T Sister 22 ( student ,ollege le-el &.T PAT37NT 18 M Student ,ollege le-el A.T rot!er 12 M Student 7lementary le-el F. SYSTEM REVIEW 1. HEALTH PERCEPTION – HEALTH MANAGEMENT PATTERN My #atient;s #er)e#tion o* !ealt! is (ull ,are 3> &e5uires use o* assistan)e 33> &e5uires assistan)e and su#er-isions .y ot!ers 333> &e5uires assistan)e or su#er-isions *rom anot!er and e5ui#ments and de-i)es 32 = "e#endent, doesn;t #arti)i#ate 5. COGNITIVE – PERCEPTUAL PATTERN A))ording to my #atient, !e )ould !ear normal )on-ersation in t!e room. 6e )an see o.?e)ts )learly. 6e doesn;t 1ear eyeglasses or )onta)t lenses. 6e is a.le to *eel 1!en tou)!ed and a.le to rea)t 1!en #ain is in*li)ted. 6e )an taste !is *ood and )an di**erentiate -arious 'inds o* s)ent. 6e )an *ollo1 instru)tions and listens and res#onds to t!e inter-ie1 a##ro#riately. 0. SLEEP- REST PATTERN A))ording to my #atient, #rior to admission, !e slee#s $ = 1/ !ours #er nig!t. 6e !as no slee#ing #ro.lems alt!oug! !e is 1a'ing u# 1!en !e *eels !e needs to urinate. 6e also snores 1!en !e is slee#ing. 6e also slee#s a*ter eating !is lun)!. 1. SELF- PERCEPTION AND SELF- CONCEPT PATTERN My #atient stated t!at !e !el#s !is mot!er in doing some !ouse!old )!ores. ROLE- RELATIONSHIP PATTERN My #atient stated t!at !e is a res#onsi.le son to !is #arents t!at;s 1!y t!ey lo-e !im so mu)!. SEXUALITY- REPRODUCTIVE PATTERN My #atient 1as )ir)um)ised 1!en !e 1as 11 years old. COPING- STRESS TOLERANCE PATTERN My #atient stated !aggard loo'ing 2. a)tual !eig!t and 1eig!t -s. ideal .ody 1eig!t> 3. sym#toms o* distress> #resen)e o* #ain and anxious 4. #osture, gait> 1al's slo1ly 5. a**e)t, mood> #atients loo' anxious and !as a mood s1ing. %. rele-an)e and organiBation o* t!oug!t> )oo#erates and ans1ers 5uestions immediately. B. VITAL SIGNS P> 12/C8/ mm6g &&> 24 P&>82.#m Tem#> 3+.8 , C. REGIONAL EXAM – 2'&&3e IPPA 'e"4-&52e 6air No sign o* !air loss !air, !air is s!iny, no li)e or #arasites seen during ins#e)tion. 6ead No s)ars seen on t!e s)al# during ins#e)tion and .um#s or masses #al#ated (a)e No #im#les *ound. 7yes 7yes do res#ond to lig!t e**e)ti-ely 7ars T!ere is no #resen)e o* dis)!arge u#on ins#e)tion Nose No s1elling, tenderness or masses during #al#ation and no nasal dis)!arge or redness u#on ins#e)tion Mout!Ct!roat T!ere is a tenderness o* my t!roat u#on s1allo1ing *ood Ne)'Clym#! nodes No #resen)e o* s1elling enlargement or tenderness 1!en #al#ated S'in T!ere is a #resen)e o* #ete)!ial ras!es Nails Nails are smoot! )a#illary re*ill is least t!an 3 se)onds T!orax Symmetri)al and *ull ex#ansion o* )!est. 4ung No a.normal sound !eard u#on aus)ultation res#iratory rate is on normal range no signs o* di**i)ulty o* .reat!ing A"4Da)ti-ities o* daily li-ingE ,ardio-as)ular &egular !eart.eat, no .rady)ardia u#on aus)ultation. reast and axilla Symmetri)al s!oulder, no any sign o* ras!es u#on ins#e)tion A.domen :#on aus)ultation 1e did not !ear any gurgling sound, and no masses or #ain *elt .y t!e #atient u#on #al#ation. 7xtremities 6e )an mo-e all extremities. 8enital Patient re*uses to examine. &e)tum and anus Patient re*uses to examine ,ranial ner-es 6is eye *ollo1 my #en #er*e)tly, !e )an !ear )learly *rom .ot! sides o* ear no a.normalities on !is &0M Drandom o* motionE D. DEVELOPMENTAL HISTORY T670&3ST A87 S79 PAT37NT "7S,&7PT30N 7ri' 7ri'son 18 Male 3dentity -s &ole ,on*usion D11>1$ years oldE  At !is age 1e )an see t!at Miss.A.8 is teen age )!ild 1!o start to )!ange .y !is #!ysi)al gro1t! and s!e starting to .uild !is so)ial relations!i# to ot!er not only to !is *amily so as 3 )an see s!e start to intera)t 1it! #eer. II. PERSONAL/SOCIAL HISTORY A. 6A3TSC23,7S aE ,a**eine: 3 )u# o* mil' a day .E Smo'ing: Ne-er )E Al)o!ol: Ne-er dE TeaC?ui)e: Po1dered *ruit drin's i* s!e;s !a-ing a sna)' eE Soda: 0))asionally *E "rugs: 6e ne-er )ommits illegal or #ro!i.ited drugs. . 43(7STF47: Sim#ly li*estyle. ,. S0,3A4 A((343AT30N: A))ording to T. A. !e uses to #lay 1it! !is *riends on t!eir .a)'yard. III. ENVIRONMENTAL HISTORY D4323N8CN73860&600"C,3&,:MSTAN,7SE A))ording to my #atient, !e li-es 1it! !is *amily in a semi>)on)rete !ouse 1it! ade5uate li-ing s#a)e. T!e !ouse is lo)ated a *e1 meters a1ay *rom a lo)al road, o-erloo'ing ri)e *ields *rom t!eir .a)'yard. T!eir 1ater su##ly )omes *rom a 1ater #um#. T!eir toilet is *lus!ed 1it! 1ater. T!eir gar.age is .urned in a #it in t!eir .a)'yard. IV. INTRODUCTION 6RELATED TO THE DISEASE OF THE PATIENT7  "engue *e-er is *ound mostly during and s!ortly a*ter t!e rainy season in tro#i)al and su.tro#i)al areas o*  A*ri)a  Sout!east Asia and ,!ina  3ndia  Middle 7ast  ,ari..ean and ,entral and Sout! Ameri)a  Australia and t!e Sout! and ,entral Pa)i*i) An e#idemi) in 6a1aii in 2//1 is a reminder t!at many states in t!e :nited States are sus)e#ti.le to dengue e#idemi)s .e)ause t!ey !ar.or t!e #arti)ular ty#es o* mos5uitoes t!at transmit it. Gorld1ide, more t!an 1// million )ases o* dengue in*e)tion o))ur ea)! year. T!is in)ludes 1// to 2// )ases re#orted annually to t!e ,enters *or "isease ,ontrol and Pre-entionD,",E, mostly in #eo#le 1!o !a-e re)ently tra-eled a.road. Many more )ases li'ely go unre#orted .e)ause some !ealt! )are #ro-iders do not re)ogniBe t!e disease. "uring t!e last #art o* t!e 2/t! )entury, many tro#i)al regions o* t!e 1orld sa1 an in)rease in dengue )ases. 7#idemi)s also o))urred more *re5uently and 1it! more se-erity. 3n addition to ty#i)al dengue,dengue !emorr!agi) *e-er and dengue s!o)' syndrome also !a-e in)reased in many #arts o* t!e 1orld. "engue *e-er )an .e )aused .y any one o* *our ty#es o* dengue -irus: "7N>1, "7N>2, "7N>3, and "7N>4. Fou )an .e in*e)ted .y at least t1o, i* not all *our ty#es at di**erent times during your li*etime, .ut only on)e .y t!e same ty#e. Fou )an get dengue -irus in*e)tions *rom t!e .ite o* an in*e)ted Aedes mos5uito. Mos5uitoes .e)ome in*e)ted 1!en t!ey .ite in*e)ted !umans, and later transmit in*e)tion to ot!er #eo#le t!ey .ite. T1o main s#e)ies o* mos5uito, Aedesaegy#ti and Aedesal.o#i)tus, !a-e .een res#onsi.le *or all )ases o* dengue transmitted in t!is )ountry. "engue is not )ontagious *rom #erson to #erson. Sym#toms o* ty#i)al un)om#li)ated D)lassi)E dengue usually start 1it! *e-er 1it!in 5 to % days a*ter you !a-e .een .itten .y an in*e)ted mos5uito and in)lude  6ig! *e-er, u# to 1/5 degrees (a!ren!eit  Se-ere !eada)!e  &etro>or.ital D.e!ind t!e eyeE #ain  Se-ere ?oint and mus)le #ain  Nausea and -omiting  &as! T!e ras! may a##ear o-er most o* your .ody 3 to 4 days a*ter t!e *e-er .egins. Fou may get a se)ond ras! later in t!e disease. Sym#toms o* dengue !emorr!agi) *e-er in)lude all o* t!e sym#toms o* )lassi) dengue #lus  Mar'ed damage to .lood and lym#! -essels  leeding *rom t!e nose, gums, or under t!e s'in, )ausing #ur#lis! .ruises T!is *orm o* dengue disease )an )ause deat!. Sym#toms o* dengue s!o)' syndrome>t!e most se-ere *orm o* dengue disease>in)lude all o* t!e sym#toms o* )lassi) dengue and dengue !emorr!agi) *e-er, #lus  (luids lea'ing outside o* .lood -essels  Massi-e .leeding  S!o)' D-ery lo1 .lood #ressureE T!is *orm o* t!e disease usually o))urs in )!ildren Dsometimes adultsE ex#erien)ing t!eir se)ond dengue in*e)tion. 3t is sometimes *atal, es#e)ially in )!ildren and young adults. V. ANATOMY AND PHYSIOLOGY T!e 3mmune System  A se)ond line o* de*ense is !oused1it!in t!e .ody: a *inely tuned immune system t!at re)ogniBes and destroys *oreign su.stan)es and organisms t!at enter t!e .ody. T!e immune system )andistinguis! .et1een t!e .odyHs o1n tissues and outside su.stan)es )alled antigens. T!is allo1s )ells o* t!e immune army to identi*y and destroy only t!ose enemy antigens. T!e a.ility to identi*y an antigen also #ermits t!e immune system to Iremem.erI antigens t!e .ody !as .een ex#osed to in t!e #astJ so t!at t!e .ody )an mount a.ettor and *aster immune res#onse t!e next time any o* t!ese antigens a##ear. T!e immune system also in)ludes ot!er #roteins and )!emi)als t!at assist anti.odies and T )ells in t!eir 1or'. Among t!em are )!emi)als t!at alert #!ago)ytes to t!e site o* t!e in*e)tion. T!e )om#lement system, a grou# o* #roteins t!at normally *loat *reely in t!e .lood, mo-e to1ard in*e)tions, 1!ere t!ey )om.ine to !el# destroy mi)roorganisms and *oreign #arti)les. T!ey do t!is .y )!anging t!e sur*a)e o* .a)teria or ot!er mi)roorganisms, )ausing t!em to die. VII. PATHO-PHYSIOLOGY 6IN DIAGRAM7 Pre-disposing factor: Precipitating factors: -Environmental Condition (open spaces w/ water pols and plants) -mosquito carrying dengue virus -sweaty skin Bite of a virus carrying aedes mosquito eadiness and itc!iness in area "osquito in#ects $uid to victims% skin &irus enters 'lood stream (nfects all and generate cellular response (nitiates immune response ()timulate release of cytokine) Cytokines destroys mem'rane and cell wall (&iral antigens found in monocytes) *engue (nfection VII. LABORATORY AND DIAGNOSTIC EXAMINATION U$&-#(,&, &outine Mi)ros)o#i) ,olor yello1 Pus)ell />2 Trans#aren)y Tur.id &, &ea)tion A)idi) a)teria (e1 S#e)i*i) gra. 1./25 7#it!elial)ell sugar Negati-e Mu)us #rotein Negati-e T!reads He+#'))/( &esults N.2.S3 :N3TS &, )ount 4.3 4./4>5 6emoglo.in D!g.E 12+ 14/>18/gCl G.) )ount /.4 5>1/ Platelet ,ount )ount 42 12/> 4// Segmenters .5$ /.5/>/.+/ 4ym#!o)ytes .33 /.2/>.4/ Mono)ytes /.8 /./>/.+ +ever (ncrease vascular permea'ility ,!rom'ocytopenia Peticial rus! Positive (-) tourniquet test 7osino#!ils 2.// /./>//+ 6emato)rit .3$ /.3+>/.4+ VIII. DRUG STUDY 8eneri) Name: Para)etamol rand Name: Tylenol ,lassi*i)ation: Non>nar)oti) analgesi), Anti#yreti) "osage: 5//mg 3ndi)ation: tem#orarily relie* o* #ain and dis)om*ort *rom !eada)!e, *e-er, )old, *lu, minor mus)ular a)!es. Me)!anism o* a)tion ,ontraindi)ations Ad-erse e**e)t Side e**e)ts Nursing )onsideraton  "e)reases *e-er .y a !y#ot!alami) e**e)t leading to s1eating and -asodilation  3n!i.its #yrogen e**e)t on t!e !y#ot!alami)>!eat>regulating )enters  3n!i.its ,NS #rostaglandin synt!esis 1it! minimal e**e)ts on #eri#!eral #rostaglandin synt !esis  &enal 3nsu**i)ien )y  Anemia  4i-er toxi)ity D!e#ato )yte ne)rosi sE may o))ur 1it! doses not *ar .eyond  Minimal 83 u#set.  Met!emoglo.inemia  6emolyti) Anemia  Neutro#enia  T!rom.o)yto#enia  Pan)yto#enia  4eu'o#enia  :rti)aria  ,NS stimulation  6y#ogly)emi) )oma  Aaundi)e  "o not ex)eed 4gmC24!r. in adults and +5mgC'gCday in )!ildren.  "o not ta'e *or K5days *or #ain in )!ildren, 1/ days *or #ain  "oes not )ause ul)eration o* t!e 83 tra)t and )auses no anti)oagulant a)tion. la.eled dosing.  3* 3 or more al)o!oli ) drin's #er day is )onsum ed, )onsult a #!ysi)ia n #rior use.  8lissitis  "ro1siness  4i-er "amage in adults, or more t!an 3 days *or *e-er in adults.  7xtended> &elease ta.lets are not to .e )!e1ed.  Monitor ,,, li-er and renal. IX. NURSING CARE PLAN ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION Su.?e)ti-e: < mainit ang #a'iramdam 'o@ 0.?e)ti-es:  Tem#>38.3 ,  Garm to tou)!  Teary eyes  (lus!ed s'in  G, 5>25 x 1/ $C4  3n)rease in G, 6y#ert!ermia related to .a)terial in*e)tion A*ter 2 !ours o* rendering o* nursing inter-entions t!e #atient 1ill maintain t!e )ore tem#erature *rom 38.3 , to 3+.2 ,.  Monitor -ital signs  Pro-ide te#id s#onge .at!. "o not use al)o!ol  &emo-es ex)ess )lot!ing and )o-ers  Promote a 1ell -entilated area to  Ser-es as a .aseline data  TS !el#s in lo1ering t!e tem#erature and al)o!ol )ools t!e s'in ra#idly, )ausing s!i-ering, in)reases meta.oli) rate and .ody tem#erature.  To de)rease 1armt! and in)rease e-a#orati-e )ooling.  To #romote )lear *lo1 o*  80A4 M7T. A*ter 4 !ours o* rendering o* nursing inter-ention s t!e #atient maintained t!e )ore tem#eratur e *rom 38.3 , to 3+.5 ,. #atient  Ad-ise #atient to in)rease *luid inta'e as indi)ated  Maintain .ed rest  Administer anti#yreti)s as ordered .y t!e #!ysi)ian air in t!e #atient;s area. 0ne 1ay #romoting o* !eat loss.  Additional *luids !el# #re-ent ele-ated tem#erature asso)iated 1it! de!ydration.  To meet in)rease meta.oli) demand. XIII. O-/)&-/ #88$#&,#  0n t!e *irst day o* admission #atients assessed 1it! *e.rile 38.8 , and *re5uen)y urination, s'in dryness and !eada)!e. G!en rendered nursing inter-entions li'e TS e-ery !our and 1it! t!e used o* anti#yreti)s and analgesi)s D#ara)etamolE as #res)ri.ed .y t!e do)tor t!e #atient )ore tem#erature de)reased *rom 38.8 , to 3+.3 , and 1it! a #ain s)ale *rom 8 to 2, t!en maintained *luid -olume.  3n t!e se)ond day o* admissions most o* t!e inter-entions are e**e)ti-e as e-iden)e .y t!e -er.aliBation o* t!e #atient, !e )an slee# more t!an 4 !ours.  T!ird day o* admission no signs o* #ain and still t!ere is urinary *re5uen)y. No signs o* !y#ert!ermia or anyt!ing else. 3t only 1aiting *or t!e #latelet )ount to in)rease. XIV. D&,"4#$/e P#- 64e#'4 'e#"4&-/7  3n)reased *luid inta'e.  ,lean t!e surroundings.  Ad-ise #atient to eat more nutritious *ood.  Ad-ise to ta'e -itamins.  Ad-i)e #atient to re#ort immediately i* any signs and sym#toms o))ur.  6a-e a )!e)'u# at least on)e a mont!.