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Dengue Hemorrhagic Fever: Saint Michael's College of Laguna School of Nursing & Midwifery
Dengue Hemorrhagic Fever: Saint Michael's College of Laguna School of Nursing & Midwifery
A case study on
Dengue
Hemorrhagic Fever
Submitted By
AÑABIEZA, Babyrlene P.
Date of Rotation
July 19-21, 26-28, 2010
INTRODUCTION
GOAL
Causative agent
It is caused by four antigenically related but distinct serotypes of the dengue virus DEN-
1, DEN-2, DEN-3 and DEN-4.
Mode of transmission
A strain of Arbovirus caused Dengue Hemorrhagic Fever and transmitted by the Aedes
aegypti mosquito.
Incubation Period
There is an incubation period of 3-14 days (usually about 4-7).
* Grade I: fever + Herman's sign (flushes and redness of skin with lighter color at the
center of the rash)
* Grade II: Grade I symptoms + bleeding (epistaxis or nosebleeding, gingival bleeding,
hematemesis or upper gastrointestinal bleeding; e.g: vomiting of blood), and melena or
dark stool.
* Grade III: Grade II + Circulatory Collapse (hypotension, cold clammy skin and weak
pulse)
* Grade IV: Grade III + Shock.
Diagnostic Tests
1. Complete blood count to detect elevated white blood cell count, decreased platelet
count (thrombocytopenia), and increased hematocrit.
2. Blood test for antibodies.
3. Ask the client about a history of travel to tropical or subtropical areas.
• Fatigue ,Tiredness ,Dengue hemorrhagic fever - this can cause several serious
complications(Bleeding ,Shock, Very low blood pressure ,Death)
Medical Management
Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to
treat it. For typical dengue, the treatment is purely concerned with relief of the symptoms
(symptomatic). Rest and fluid intake for adequate hydration is important. Aspirin and
nonsteroidal anti-inflammatory drugs should only be taken under a doctor's supervision
because of the possibility of worsening hemorrhagic complications. Acetaminophen
(Tylenol) and codeine may be given for severe headache and for the joint and muscle
pain (myalgia).
Management
Do not give Aspirin because it contains at antiplatelet property which prmotes bleeding.
Treatment is solely supportive and includes:
* Fluids.
* Analgesics (not aspirin) for fever and muscles aches.
* Replacement of plasma or plasma expanders.
Independent:
Close monitoring of vital signs in critical period (between days 2 to day 7
of fever) is critical.
Increased oral fluid intake is recommended to prevent dehydration.
Treatment is purely concerned with relief of the symptoms (symptomatic).
Dependent:
Because dengue is caused by a virus, there is no specific medicine or
antibiotic to treat it.
Aspirin and nonsteroidal anti-inflammatory drugs should be avoided as
these drugs may worsen the bleeding tendency associated with some of
these infections.
Acetaminophen (Tylenol) and codeine may be given for severe headache
and for the joint and muscle pain (myalgia).
(DHF) Oxygen and sedatives may be administered.
Collaborative:
A platelet transfusion is indicated in rare cases if the platelet level drops
significantly (below 20,000) or if there are significant bleeding.
The presence of melena or blood in the stool may indicate internal
gastrointestinal bleeding requiring platelet and/or red blood cell
transfusion.
PATIENT’S PROFILE
Name: Miss X
Age: 22
Gender: Female
Address: 141 Sitio Salvacion Tunasan Muntinlupa City
Date of Birth: September 9, 1987
Place of Birth: Muntinlupa City
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Single
Occupation: Toshiba Employee
Date of Admission:
Time of admission:
Physician:
Place of Admission: Biñan Doctors Hospital
Admitting Diagnosis: Dengue Fever Syndrome
According to Miss X, she eats vegetables and fish instead she prefers
eating hotdogs. Furthermore she has no vices except for computer
games. After working hours, she goes directly at home to relax.
C. HISTORY OF ILLNESS
• During the mid of, Miss X, started experiencing fever that persist only at night.
As a remedy her mom gave her Paracetamol to lower her body temperature.
Except from fever she’s also experiencing abdominal pain, headache and
general flushing of the skin with on and off vomiting.
As the above signs and symptoms persists, her parent decided to bring
her to the hospital.
THEORETICAL FRAMEWORK
Application Theory:
The case of CJS can be correlated with the theory of Nightingale wherein,
the environment of the patient is a factor leading to recovery. Having a clean,
well ventilated and quite environment is important in. With a nurturing
environment, the body could repair itself.
PHYSICAL ASSESSMENT
(Normal Findings Actual Findings Rationale)
SCALP
Distribution of hair Inspection Evenly distributed No inflammation, Normal
Lesions Inspection No inflammation, lumps Normal
Other findings Inspection lumps or masses or masses Normal
FACE
Skin color Inspection Light to deep brown Pinkish Due to fever
Texture Inspection Smooth Symmetric facial Normal
Facial movement Inspection Symmetric facial Symmetric facial Normal
movement movement
EYES
External structure Inspection Evenly distributed
Eyebrows Inspection Evenly distributed, Pink conjunctiva Normal
Eyelashes Inspection Evenly distributed, curved outward Evenly distributed Normal
Eyelids Inspection Evenly distributed Normal
EARS Same as facial color Symmetric to head
Color Inspection Symmetrical at the No discharges and
Symmetry Inspection level of the eyes inflammation Normal
Shape and size Inspection corner Normal Normal
Symmetric to head Normal
No discharges and
inflammation
Same as facial color
MOUTH Symmetric
Lips Inspection Pink Symmetric
Symmetry Inspection Moist Pink Normal
Moisture Inspection Dry Normal
D/t poor
TONGUE Positioned at the nutrition
Position Inspection center can move Central position
Color Inspection freely Dull red Normal
Texture Inspection Dull red Smooth Normal
Mobility Inspection Smooth Can move freely Normal
Lesions Inspection Can move freely No lesions or Normal
No lesions or inflammation Normal
inflammation
NECK Head centered
Position Inspection Symmetrical Head centered
Symmetry Inspection Smooth movements Symmetrical Normal
Range of movements Inspection without discomfort Smooth Normal
Palpation Symmetric and at movements Normal
midline position without discomfort Normal
Symmetric and at
midline position
Normal Normal
GORDON’S 11 FUNCTIONAL HEALTH PATTERN
The tissues of the lymphatic system include the spleen. The spleen serves as a reservoir
for blood, releasing additional blood into the circulatory system as needed. It is also
involved with destruction of old cells and other substances by phagocytosis. The
lymphatic system is also responsible for collecting nutrients that the digestive system has
extracted from our foods, and is a very important part of the immune system. We will
cover the lymphatic system in detail in the lesson on the immune system.
Background
Results
Conclusion
Reference: Halstead SB, O'Rourke EJ, Allinson AC: Dengue virus and
mononuclear phagocytes. II. Identity of blood and tissue leukocytes supporting in
vitro infection.
Brand name/ Classification Action Indication Adverse Effect Contraindication Nursing
Generic name consideration
Acetaminophen Nonopoiod Produce Symptomatic Rash, nausea, Hypersensitivity. Patients with
(Paracetamol) analgesics and analgesia relief of pain and vomiting, blood Patients alcoholic liver
anti pyretics by blocking fever. Relief of dyscrasias , disease.
pain headache, anemia, analgesic Impaired liver
impulses by toothachge, back nephropathy , or kidney
inhibitinfg pain, nephrotoxicity , function
synthesis of dysmenorrheal, hypersensitivity
prostaglandi myalgias,neuralg reactions
n in the ias, etc.
CNS or of Analgesics and
other anti pyretic for
substances patients
that hypersensitive to
sensitize aspirin
pain
receptors to
stimulation.
Brand name/ Classification Action Indication Adverse Effect Contraindication Nursing
Generic name consideration
Generic Name: Classificatio . Inhibits > Drugs that >Assess pt for
Ciprofloxacin n: bacterial > Infections of > Drugs that inhibit previous
Anti- DNA the resp. tract, inhibit peristalsis. sensitivity
Brand Name: infectives gyrase thus middle peristalsis. Infants and reaction
Pharex preventing ear,paranasal Infants and children, >Assess pt for
Ciprofloxacin replication sinuses, eyes, children, growing any s/s of
in kidneys, urinary growing adolescents. infection
susceptible tract adolescents. Pregnancy and before &
bacteria Pregnancy and lactation during
lactation treatment
>Assess for
adverse
reactions
>assess pt. &
family’s
knowledge of
drug therapy
Brand name/ Classification Action Indication Adverse Effect Contraindication Nursing
Generic name consideration
Generic Name: Classificatio .
n
Brand Name:
ASSESSMENT NURSING SCIENTIFIC PLANNING INTERVENTION RATIONALE EVALUATIO
DIAGNOSIS EXPLAINATION N
Subjective: Acute pain .This is due to With in 30 Independent: Goal Partially
“Masakit ang related to Entry of pathogens minutes and for met,
tiyan ko” as inflammatory in circulation the whole >monitor v/s > To determine After 30 hour
verbalized by the response as leading to release of period of duty alteration in present of nursing care
patient. evidenced by anti-inflammatory the patient will condition the patient
verbalization
Objective: of patient “
mediators and as a be free from >Instructed to >Helps relieving was able to
>C pain scale of masakit po vascular response it pain from 7/10 deep breathing pain reduced pain
7/10 tiyan ko” pain cause increase in to 1/10 excersise felt from 7/10
>grimace noted scale of 7/10, capillary >Encourage to >To divert attention to 5/10 as
>irritable grimace & permeability have Diversional from and reduce evidenced
>weakness noted irritability leading to activities like pain felt verbalization
Characteristic: hyperemia and watching t.v. of the patient
Stabbing, cellular exudation, >Place patient in >To provide
shooting pain swelling and pain a comfortable comfort
Onset: position
“pasumpong
>Encourage to >To have energy
sumpong po eh”
as verbalized by
have adequate
patient bed rest
Location: >Provided > Helps in relieving
No exact therapeutic touch pain
Location” sa
buong tiyan poh Dependent:
as verbalization
Duration: 2-3 >Administered
minutes Ranitidine as
Exacerbations: ordered
Gets worst when
pressure is
applied in the
stomach
Radiation:
Radiates in the
whole abdomen
Relief: “ kapag
iniipit ko tiyan ko
nwawala minsan
sakit”
↓
Bite of aedes aegypti mosquito carrying a virus
↓
Virus goes into the circulation
↓
Infects cells & generate cellular response
↓
Initiates destruction of the platelet
↓
↑ Potential for hemorrhage
↓
Stimulates intense inflammatory response
▼ ▼
Release of exogenous pyrogens body releases anti-
↓ inflammatory mediators
↑ WBC (Neutrophils & Macrophages) (Histatin, Kinins)
↓ ↓
Release of endogenous pyrogens Vascular response
↓ ↓
Reset of hypothalamic thermostat Redness & Heat
↓ ↓
Fever Headache, Vomiting
▼ ▼ Epistaxis, Abdominal pain
Muscle contract Blood vessels Circulatory Collapse Shock
To produce construct to ↓
Additional heat prevent loss of body heat DEATH
↓ ↓
SHIVERING CHILLS
Discharge Planning
A. Patient's Name:
> C.J.S a thirteen year-old male patient, who was diagnosed with Dengue
Hemorrhagic Fever.
B. Diet:
> Encourage nutritious foods like vegetables, meat and fruits.
C. Medications:
> Give acetaminophen in case the temperatures increases.
> Give oresol to replace fluid in the body.
D. Treatment:
> Increased oral fluid intake.
E. Health Teaching:
> D- discuss the possible source of infection of the disease.
> E- educate the family/patient on how to eliminate those vectors.
> N- Never stocked water in a container without cover.
> G- Gallon, container and tires must have proper way of disposal.
> U- Use insecticides at home to kill or reduce mosquito.
> E- Encourage the family of the patient to clean the surroundings to destroy the
breeding places of mosquito.