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A case study on
Dengue
Hemorrhagic Fever
Submitted By
AÑABIEZA, Babyrlene P.
Date of Rotation
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.
Characteristics of an Aedes aegypti mosquito:
1. Daybiting
2. Low-flying
4. In urban area
Incubation Period
There is an incubation period of 3-14 days (usually about 4-
7).
Signs and Symptoms
1. Rapid deterioration Deterioration occurs after 2–5 days of the typical symptoms
of
dengue fever
2. Irritability Associated with rapid deterioration
3. Restlessness Associated with rapid deterioration
4. Low blood pressure Related to hemorrhage
5. Weak and rapid pulse Related to hemorrhage
6. Petechial rash Related to hemorrhage
* 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)
Diagnostic
* Grade IV:Tests
Grade III + Shock.
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.
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
It was according to the patient that she wasn't been hospitalized yet not
until when she was diagnosed with Dengue Fever Syndrome. Before that
diagnosis, she was already experiencing fever and her mom gives her a
Paracetamol for remedy.
According to her grandmother the only disease that the family has
genetically is Diabetes Mellitus and no other diseases noted.
Miss X is the daughter of Mr. and Mrs. SJ. CJS is currently working at
Toshiba as an employee at Sta. Rosa Citys.
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.
According to the patient the environment that the family has an open
drainage, wherein big rats and cockroaches can be seen. The house is
cleaned by her mother and grandmother. It was described by the patient that
there are parts of their house that is deprived from light.
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
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 NonopoiodProduce Symptomatic Rash, nausea,Hypersensitivity. Patients with
(Paracetamol) analgesics and analgesia relief of pain and vomiting, bloodPatients alcoholic liver
anti pyreticsby 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 After 30 hour
>monitor v/s > To determine
verbalized by the response as leading to release ofperiod of duty of nursing care
alteration in present
patient. evidenced by anti-inflammatory the patient will the patient
verbalization condition
mediators and as a be free from was able to
of patient “ >Instructed to >Helps relieving
Objective: vascular response it pain from 7/10 reduced pain
masakit po deep breathing pain
>C pain scale of cause increase in to 1/10 felt from 7/10
tiyan ko” pain capillary excersise to 5/10 as
7/10 scale of 7/10,
>grimace noted permeability >Encourage to >To divert attentionevidenced
grimace & have Diversional verbalization
>irritable leading to from and reduce
irritability activities like
>weakness noted hyperemia and pain felt of the patient
Characteristic: cellular exudation, watching t.v.
Stabbing, swelling and pain >Place patient in
shooting pain a comfortable >To provide
Onset: position comfort
“pasumpong >Encourage to
sumpong po eh” have adequate >To have energy
as verbalized by bed rest
patient >Provided
Location: therapeutic touch
No exact > Helps in relieving
Location” sa pain
buong tiyan poh
as verbalization
Duration: 2-3 Dependent:
minutes
Exacerbations: >Administered
Gets worst when Ranitidine as
pressure is ordered
applied in the
stomach
Radiation:
Radiates in the
whole abdomen
Relief: “ kapag
iniipit ko tiyan ko
nwawala minsan
sakit”
>skinwarm to
Elevated Entry of pathogens Within 30-1 Independent:
touch body in the systemic hour of nursing Goal met,
>flushed skin temperature circulation leading intervention & >To promote> RenderedAfter 45
>temp. 38 related to to regulation of for the whole Surface cooling and minutes ofsponge bath
>c dry lips presence of toxins in the body period of duty allow heat tonursing care,
infection or and release of the patient releasethe patient
inflammatory pyrogens causig temperature will >To replace fluid>Encourage totemperature
response as stimulation of decrease with in increase oral fluid loss due to bodydecrease from
evidenced hypothalamus the normal heatintake38C to 36.8 as
by temp- 38, leading to increase range from 38 to >Promote Surface >To release heatevidenced by
flushed and of thermoregulation 37 C through evaporation normal tempcooling, loosen
warm skin to and increase in clothing, and cool and conductionand absence
touch body tempertature environmentof flushing and
>To reduce>Encouraged tocool skin
metabolic demandhave adequate
and regain energybed rest
Dependent:
>To decrease>Administer
temperature andParacetamol as
support circulatingordered
volume and tissue
perfusion
PATHOPHYSIOLOGY
↓
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 contractBlood vessels
To produceconstruct to Circulatory Collapse Shock
Additional heatprevent loss of body heat ↓
↓↓ DEATH
SHIVERINGCHILLS
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.