CHAPTER I

INTRODUCTION

Dengue Fever, a benign syndrome caused by several arthropod-borne viruses, is

characterized by biphasic fever, myalgia or arthralgia, rash, leucopenia, and lymphadenopathy.

Epidemics were common in temperate areas of the Americas, Europe, Australia, and Asia

until early in the 20th century. Dengue fever and dengue-like disease are now epidemic in tropical

Asia, the South Pacific Islands, Northern Australia, tropical Africa, the Caribbean, and Central

and South America. Dengue fever occurs frequently among travelers.

Dengue viruses are transmitted by mosquitoes of Stegomyia family. Aedes aegypti, a

daytime biting mosquito, is the principal vector and all four virus types been recovered from it.

In most tropical areas Aedes aegypti is highly urbanized, breeding in water stored for drinking or

bathing or in rain water collected in any container.

Insufficient pathologic material has been obtained from virologically confirmed cases of

dengue fever to permit a comprehensive description. Fatalities are rare with Chikungunya and

West Nile Infections; those recorded have been ascribed to viral encephalitis, hemorrhage or

febrile convulsions. Manifestations vary with age from patient to patient. In infants and young

children the disease may be undifferentiated or characterized by a 1- to 5- day fever, pharyngeal

inflammation, rhinitis, and mild cough.

Pancytopenia may occur on the 3rd-4th days of illness; neutropenia may persist or reappear

during the latter stage of the disease and may continue into convalescence. White cell counts as
1
low as 2,000/mm3 have been recorded. Platelets rarely fall below 100,000 cells/mm3 Venous

clotting, bleeding and prothrombin times, and plasma fibrinogen values are within normal

values.

Treatment is supportive. Bed rest is advised during the febrile period. Antipyretics or

cold sponging should be used to keep body temperature below 40 ̊C (104 ̊F). Analgesics or mild

sedation may be required to control pain. Because of its effects on hemostasis, aspirin should not

be used. Fluid and electrolyte replacement is required when there are deficits caused by

sweating, fasting, thirsting, vomiting or diarrhea.

Primary infections with dengue fever and dengue-like diseases are usually self –limited

and benign. Fluid and electrolyte losses, hyperpyrexia and febrile convulsions are the most

frequent complications in infants and young children. The prognosis may be adversely affected

by passively acquired antibody or by prior infection with a closely related virus. (Behrman,

Kliegman and Arvin, Nelson Texbook of Pediatrics 15th edition, W.B. Saunders,2003)

Purpose and Objectives

This study aims to present the different nursing care for a pediatric client with Dengue

Fever Syndrome. Specifically, this study seeks to achieve the following objectives:

1. Identify factors that led to the development of the problem.

2
 2. Explain the relationship of factors leading to the development of the problem.

3. Discuss the relevant interventions that were utilized to resolve problems.

4. Describe the effectiveness of the responses towards the intervention.

Significance of the Study

The conducted study tries to offer the appropriate nursing care for a pediatric client with

Dengue Fever Syndrome. With the results found in this case, this would benefit the following:

To the patient, as the primary recipient of care, the findings of this study will help in

the improvement of the patient’s condition and that he can be taken care of

appropriately and adequately through the proper utilization of the nursing process

done by the researcher to formulate the most appropriate nursing interventions in

addressing both the actual and potential problems of the client.

To the Parents and Family Member, This study will give them background about

patient’s condition. They will be provided with sufficient knowledge, making them

prepared on the changes that will occur and information about what is happening in

the patient’s body, what to do and what not to do.

To the Health Care Team, The findings and new information in the study will further

increase their awareness regarding a child with dengue fever syndrome. This will also

help them deliver continuous quality nursing care to clients of the same condition.

3
 To the Clinical Instructors, this will serve as an instrument in guiding the student

nurse on how to handle a pediatric patient with dengue fever syndrome and will serve

as a partial individual evaluation of what the students have learned in the clinical

area. This will also show the student’s capabilities and weaknesses that needs

improvement.

To the Future Researchers, this will serve as a, preliminary research material and a

recommendation for the development of a better plan of care for the practice of the

similar condition. This will also help in improving the interventions that should be

given to a pediatric patient.

Scope and Limitations

This research utilizes the Retrospective B type of study which focuses on providing

appropriate care to an adult client with Dengue Fever Syndrome. The researcher was assigned to

a twenty one year-old girl from the 17th and 18th of December 2010, from 0600 to 1400H at the

7th floor wing in a tertiary hospital in Makati City.

4
 This case study is about the utilization of the nursing process in rendering appropriate

care to K.D.S., a twenty one year-old girl. In order for the client to meet her needs, routine care

was given.

The data gathered and presented in this study were gathered through observation and

existing records in the client’s chart. The scope of the study would be from the time the

researcher assigned with the client until the last day with the client. Limitations of the study

includes the limited time of handling the patient so problems encountered by the patient after the

shift were not identified. And the difficulty of choosing the patients because of the researcher

was shadowing the charge nurse during that week.

Background of the Study

The study was conducted at a tertiary level hospital in the city of Makati. The hospital

bears the legacy of being a “hospital with a heart”. The hospital’s mission is “With patient

wellness in mind, we provide high-quality health care services through integrated specialty

centers operated by highly qualified physicians and nurses, as well as technical and management

5
staffs, who are sustained by well-developed research, and training programs and enabled by

state-of- the- art professional equipment and specialized tools”.

The hospital’s vision is “To be an internationally recognized medical center dedicated to

excellence in healthcare”. The core values of the hospital are “We hold dear our people and their

well-being. We are guided by the principles of professionalism, integrity, fairness, accountability

and transparency, and by the spirit of compassion. Our compassion for excellence is our bond.”

Currently the hospital is in the process of being accredited by the Joint Commission

International. JCI accreditation means that we meet global standards of safe, efficient, low-cost

and ethical medical practice. The hospital caters services on anesthesiology, dentistry,

dermatology, emergency medicines, laboratories, medicine, neurosciences, nuclear medicines,

obstetrics and gynecology, ophthalmology, orthopedics, orthorhinolaryngology (ENT),

pediatrics, physical medicine and rehabilitation, radiology, surgery, operating theaters, intensive

care units (ICU), and telemetry.

Specifically, the study was conducted at the 7th floor of the said tertiary hospital. The

common nursing activities includes vital signs taking, documentation, giving and receiving

endorsements, accurate input and output, performance of Nasogastric Tube (NGT) feeding,

Capillary Blood Glucose (CBG) monitoring, oxygen administration, suctioning, heplock

removal, skin testing, Central Venous Pressure (CVP) reading, Colostomy care and medicine

administration.

The researcher chose the patient for the case due to the possible development of problems and

awareness that will improve the researchers’ knowledge and skills.

6
 CHAPTER II

REVIEW OF RELATED LITERATURE

BOOKS:

Definition

1. Dionesa Mondejar-Navales, RN, MAed. Handbook of Common Communicable and

Infectious Diseases. 2006. C & E Publishing, Inc.

Dengue fever is an acute febrile disease caused by infection with one of the serotypes of

dengue virus which is transmitted by mosquito genus Aedes. It refers to a benign form of disease
7
with systemic symptoms, fever, and often rash associated with pain behind the eyes, the joints,

and bones.

2. Compilation of Communicable diseases in Nursing by San Lazaro hospital, Philippines.

Dengue Fever is a tropical disease otherwise known as Philippines, Thai or Singapore

hemorrhagic fever. It is an acute infectious disease characterized by severe pain behind the eye

and in joints and bones and accompanied by an initial erythema and terminal rash, occasionally

this condition is also called Acute Infectious Thrombocytopenic Purpura.

Epidemiology

1. National League of Philippine Government Nurses. Public Health Nursing in the

Philippines. 2007.

The morbidity rate of dengue fever in 2003 is much lower at 13 cases per 100,000

population compared to the highest ever recorded rate of 60.9 per 100,000 in 1998. The sudden

increases in the incidence of dengue in 1993, 1998 and 2001 were expected because of the

cyclical nature of the disease. The reason dengue remains a threat to public health despite low

incidences reported in recent years. Dengue cases usually peaks in the months of July to

November and lowest during the month of February to April.

2. World Distribution of Dengue, (2007) retrieved by National Institute of allergy and

infectious diseases

Dengue fever is an infectious disease carried by mosquitoes and caused by any of four

related dengue viruses. This disease used to be called "break-bone" fever because it sometimes

8
causes severe joint and muscle pain that feels like bones are breaking, hence the name. Health

experts have known about dengue fever for more than 200 years.

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

An epidemic in Hawaii in 2001 is a reminder that many locations in the United States are

susceptible to dengue epidemics because they harbor the particular types of mosquitoes that

transmit dengue virus.

Worldwide, 50 to 100 million cases of dengue infection occur each year. This includes

100 to 200 cases in the United States, mostly in people who have recently traveled abroad. Many

more cases likely go unreported because some health care providers do not recognize the disease.

During the last part of the 20th century, many tropical regions of the world saw an

increase in dengue cases. Epidemics also occurred more frequently and with more severity. In

addition to typical dengue, dengue hemorrhagic fever (DHF) and dengue shock syndrome also

have increased in many parts of the world. Globally, there are an estimated several hundred

thousand cases of DHF per year.

9
 In 2005, dengue was the most important mosquito-borne viral disease affecting humans .

There is currently a worldwide pandemic of dengue fever. Dengue is making its comeback most

notably in Central and South America, with Dengue in Argentina becoming a growing concern.

The reasons for this may include:

• Deteriorating public-health facilities and lack of expensive active surveillance programs

• More people living in cities under squalid conditions where mosquitoes can breed

• Increased air travel, allowing infected people to introduce the disease to mosquitoes at

their destination

• Ineffective mosquito control compared with past decades

Etiologic agent

1. Dionesa Mondejar-Navales, RN, MAed. Handbook of Common Communicable and

Infectious Diseases. 2006. C & E Publishing, Inc.

According to Navales, etiologic agents of the disease are Flaviviruses 1, 2, 3, 4, a family

of Togaviridae viruses which contain single strand RNA. Arboviruses group B is also one of the

agents.

Mode of Transmission and Incubation Period

1. Dionesa Mondejar-Navales, RN, MAed. Handbook of Common Communicable and

Infectious Diseases. 2006. C & E Publishing, Inc.

10
 Dengue is transmitted by bite of an infected mosquito, principally by Aedes aegypti.

Aedes aegypti is a day-biting mosquito (they appear two hours after sunrise and two hours before

sunset). They breeds on stagnant water. The mosquito has limited and low-flying movement

which is characterized having fine white dots at the base of the wings and with white bands on

the legs. Aedes albopictus may also contribute to the transmission of dengue virus in rural areas.

Other contributory mosquitos include: Aedes polynensis and Aedes scutellaris simplex.

The incubation period is three to fourteen days, commonly seven to ten days. Patients are

usually infective to mosquito from a day before the febrile period to the end of it. The mosquito

becomes infective from day 8 to 12 after the blood meal and remains infective all throughout

life.

Pathogenesis, Pathology, Signs and Symptoms

1. Dionesa Mondejar-Navales, RN, MAed. Handbook of Common Communicable and

Infectious Diseases. 2006. C & E Publishing, Inc.

Infectious virus is deposited in the skin by the vector and initial replication occurs at the

site of infection and in local lymphatic tissues. Within a few days, viremia occurs, lasting until

the 4th or 5th day after onset of symptoms. Evidence indicates that macrophages are the principal

site of replication. At the site of petechial rash, non-specific changes are noted which include

endothelial swelling, perivascular edema, and extravasation of blood. There is marked increase

in vascular permeability, hypotension, hemoconcentration, thrombocytopenia, with increased

platelet agglutinability, and or moderate disseminated intravascular coagulation. The most

11
serious pathophysiological abnormality is hypovolemic shock resulting from increased

permeability of vascular endothelium and loss of plasma from the intravascular space.

Clinical manifestation includes prodromal symptoms which is characterized by malaise

and anorexia up to 12 hours, fevers and chills accompanied by severe frontal headache, ocular

pain, myalgia with severe backache, and athralgia. Nausea and vomiting may experience. Fever

is non-remitting and persists for three to seven days. Rash is more prominent on the extremities

and the trunk. It may involve the face in some isolated cases. Petechiae usually appears near the

end of the febrile period and most common on the lower extremities.

Diagnostic Tests

1. Dionesa Mondejar-Navales, RN, MAed. Handbook of Common Communicable and

Infectious Diseases. 2006. C & E Publishing, Inc.

Tourniquet test is done to diagnose the disease. In this screening test, the arm vein is

occluded for about five minutes to detect capillary fragility. A decreased platelet count

(<150,000) will be a confirmatory test. Hemoconcentration or an increase of at least 20 percent

in hematoccrit or steady rise in hematocrit is reviewed. Occult blood and hemoglobin

determination is done.

12
Treatment Modalities

1. Dionesa Mondejar-Navales, RN, MAed. Handbook of Common Communicable and

Infectious Diseases. 2006. C & E Publishing, Inc.

There is no effective antiviral therapy for dengue fever. Treatment is entirely

symptomatic. Analgesic drugs other than aspirin maybe required for relief of headache, ocular

pain, and myalgia.

Nursing Responsibilities

1. Dionesa Mondejar-Navales, RN, MAed. Handbook of Common Communicable and

Infectious Diseases. 2006. C & E Publishing, Inc.

a) Patient should be kept in mosquito-free environment to avoid further transmission of

infection.

b) Keep patient at rest during bleeding episodes

c) Vital signs must be promptly monitored

d) For nose bleeding, maintain patient’s position in elevated trunk, apply ice bag to the

bridge of the nose and to the forehead.

e) Observe signs of shock, such as slow pulse, cold clammy skin, prostration, and fall of

blood pressure.

f) Restore blood volume by putting the patient in Trendelenberg position to provide greater

blood volume to the head part.

13
Prevention and Control

The best way to prevent dengue virus infection is to take special precautions to avoid

being bitten by 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 repellent 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 take 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.

INTERNET:

Journals:

Diagnosis

14
 Your health care provider can diagnose dengue fever 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.

http://www3.niaid.nih.gov/topics/DengueFever/Understanding/Diagnosis.htm

Treatment

There is no specific treatment for classic dengue fever, and most people recover 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

Centers for Disease Control and Prevention advise 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.

http://www3.niaid.nih.gov/topics/DengueFever/Understanding/Diagnosis.htm

Modified Mosquitoes Could Save People from Dengue Fever

Dengue’s common name, break bone fever, speaks of the misery caused by this

mosquito-borne illness. Annually, about 100 million people worldwide are stricken with fever,

15
headache, and "bone-breaking" joint pain characteristic of dengue, and more than 20,000 die of

its most severe form.

Dengue cases can be reduced through mosquito control techniques such as eliminating

mosquito breeding sites and applying pesticides, but these efforts alone cannot completely break

the cycle of disease, notes NIAID grantee Carol Blair, Ph.D., of Colorado State University

(CSU). Breaking the cycle of disease, she says, requires either creating a vaccine against dengue

virus, which has proved difficult, or finding a way to keep mosquitoes from becoming infected in

the first place.

Dr. Blair and her colleagues, including Ken Olson, Ph.D., of CSU, and Anthony James,

Ph.D., of the University of California, Irvine, began their attempts to build a dengue-resistant

mosquito more than a decade ago, soon after the discovery of RNA interference (RNAi). RNAi

is viral defense mechanism known to occur in plants, insects, and higher animals as well. To

harness RNAi’s potential to make dengue-resistant mosquitoes, the scientists had to clear three

hurdles: get RNAi to work at the right time (immediately after the insects become infected), in

the right place (midgut cells), and in the right amount (quantities of a naturally occurring double-

stranded form of viral RNA had to be boosted to allow mosquitoes to develop significant

resistance to dengue infection.)

Recently, they succeeded. Steady-handed researchers injected thousands of mosquito

eggs with cloned dengue virus genes that had been manipulated to trigger RNAi at the right time,

place, and amount. The resulting genetically modified mosquitoes not only were highly resistant

to dengue virus infection, they also appeared to pass this characteristic on to succeeding

generations.
16
 Dr. Blair and her colleagues are continuing their efforts to build dengue-resistant

mosquitoes by developing a better understanding of how dengue virus evades the destructive

effects of RNAi in wild mosquitoes. Dr. Blair says the ongoing research will benefit from the

newly available genomic sequence of Aedes aegypti, the mosquito species that carries both

dengue and yellow fever viruses, a recent advance also supported by NIAID

http://www3.niaid.nih.gov/topics/DengueFever/Research/Prevention/modSkeetersDengue.h

tm

CHAPTER III

CLIENT PRESENTATION

This is a case of Ms. K.DS., a 21 year old female college graduate who was diagnosed

with Dengue Fever Syndrome. She was admitted last December 16, 2010.

17
 Her chief complaint was: fever. Patient’s chart stated that 8 days prior to admission,

patient started to experience fever (Tmax 39C) with myalgia. Patient took Paracetamol 500

mg/tab which gave temporar relief. Two days prior to admission, there was persistence of fever

so consult was done with a physician where CBC was done and showed platelet count of

120,000, urinalysis showed UTI and was prescribed with Amoxiclav. Due to these results,

admission of the patient was done.

The patient had a past history of mumps. She was not hospitalized ever since. There were

no known allergies. Her age of onset of menstruation was 13 yrs old with no specific frequency

and lasts for 4-5 days with moderate amount. She has family history of Diabetes Mellitus and

Hypertension.

The patient has no passive or regular exercise. She has no sleeping difficulties and a

regular pattern of elimination. She loves eating chicken and pasta and has a regular meal pattern.

She has no special diet.

CHAPTER IV

ANALYSIS AND INTERPRETATION

Nursing Diagnosis 1: Altered thermoregulation related to present condition as evidenced

by temperature of 37.9°C

18
“Altered thermoregulation: Hyperthermia is the body temperature elevated above normal range.”

(Doengges, 2008)

Fever, or pyrexia, describes an elevation in body temperature that is caused by a

cytokine-induced upward displacement of the set point of the hypothalamic thermoregulatory

center. Fever is resolved or “broken” when the condition that caused the increase in the set point

is removed. Fevers that are regulated by the hypothalamus usually do not rise above 41°C,

suggesting a built-in thermostatic safety mechanism. Temperatures above that level are usually

the result of superimposed activity, such as convulsions, hyperthermic states, or direct

impairment of the temperature control sytem.

The patient skin was warm to touch with temperature of 37.9°C, oral intake of 6 glasses

of water/8 hours, UO: 3x, BM: 0x and antipyretic medication. These cues led to the discovery of

the problem so the following interventions were carried out: monitored vital signs every 4 hours,

especially temperature, performed tepid sponge bath, encouraged increase fluid intake to at least

2500ml per day, observed standard precautions such as hand washing, gloving and masking

when in contact with the patient and provided appropriate medicines at the right time and as

ordered.

Due to the interventions performed, the goal of the problem was fully met by the student

nurses.

Nursing Diagnosis 2: Risk for injury: bleeding related to insufficient clotting factors

19
 Bleeding occurs as a result of decrease in the number of circulating platelets or impaired

platelet function. Platelets are small blood components that form a plug in the blood vessel wall

or the formation of thrombi that stops bleeding. Platelets also produce a variety of substances

that stimulate the production of a blood clot. The depletion of platelet must be relatively severe

(10,000 to 20,000/mL, which is severely low compared to the normal values: 150,000 to

400,000) before hemorrhagic tendencies or spontaneous bleeding become evident.

Thrombocytopenia, decrease in number of circulating platelet, one factor that contributes to this

is the premature destruction of platelets caused by antibodies produced against the platelet,

another is the excessive consumption which leads to deficiency. Without thrombocytes, there

will be no platelet plug and blood escapes to the injured blood vessel.

The patient exhibited the following cues which led to the identification of the problem:

stable vital signs, intake of 6 glasses for 8 hours, urinary output of 3x and 0x bowel movement,

no signs of bleeding were evident, with good skin turgor and rapid capillary refill.

Monitored vital signs every 4 hours, monitored intake and output every shift, assessed for

signs of bleeding and dehydration, instructed to avoid dark colored foods, prevented scratching

of rashes, encouraged oral fluid intake and citrus fruits, observed sterile technique and observed

for anaphylactic reaction to medications. The goal of the nursing diagnosis was fully met.

Nursing Diagnosis 3: Risk for fluid volume deficit related to increased vascular

permeability

20
“Risk for fluid volume deficit is being at risk for experiencing vascular, cellular or intracellular

dehydration.” (Doengges, 2008)

When blood vessels are injured, the body releases chemical mediators as a defensive

response such as histamine, kinins, bradykinin and prostaglandin. As a result, generalized

vasodilatation occurs as to facilitate the inflammatory process. The blood vessels dilate,

stretching and thinning their capillary walls and making these walls more permeable. There is an

imbalance between the hydrostatic pressure (the maintained pressure that pushes blood out of the

vessels) and the osmotic pressure (based on the concentration of plasma proteins) and more

plasma proteins escape the blood vessels than normal. Because of the increased vascular

permeability, the body may not receive the proper amount of fluids and electrolytes needed as

they may escape circulation from intravascular to interstitial space prematurely.

During the 1st day of handling the patient, these cues were noted by the researcher: stable

vital signs, intake of 6 glasses of water for 8 hours, UO: 3x, BM: 0x, no signs of dehydration and

no signs of bleeding.

The interventions done were the following: monitored vital signs, monitored fluid intake

and output, monitored and regulated intravenous fluid infusion, assessed for signs of

dehydration: decreased or absent tearing, dry mucous membrane and loss of skin turgor. The

goal of the problem was then partially met by the researchers.

21
Nursing Diagnosis 4: Risk for secondary infection related to compromised immune system

“Risk for infection is being at increased risk for being invaded by pathogenic organisms.”

(Doengges, 2008)

Most patients who develop dengue hemorrhagic fever or dengue shock syndrome have

had prior infection with one or more dengue serotypes. In individuals with low levels of

neutralizing antibodies, nonneutralizing antibodies to one dengue serotype, when bound by

macrophage and monocyte Fc receptors, have been proposed to result in increased viral entry

and replication and increased cytokine production and complement activation. This phenomenon

is called antibody-dependent enhancement.

Some researchers suggest T-cell immunopathology may play a role, with increased T-cell

activation and apoptosis. Increased concentrations of interferon have been recorded 1-2 days

following fever onset during symptomatic secondary dengue infections.

The researchers observed that the patient has had many visitors inside her room. In

addition to that the patient was febrile for a time with altered blood chemistry that poses a risk

for immunologic complications. The interventions done were the following: monitored vital

signs every 4 hours, monitored for any signs of infection such as swelling, redness, observed

standard precautions such as hand washing, gloving and masking when in contact with the

patient, changed the linens every morning and as needed and emphasize the importance of daily

22
hygiene practices and as ordered, monitored laboratory results including WBC, platelet count,

monocyte count, serum levels of Ig and blood cultures.

The performance of these interventions has led the researchers to meet, although

partially, the goal of the nursing diagnosis.

REFERENCES:

Carlson Mattson Porth 2005, Pathophysiology: Concepts of Altered Health States 7th Edition

www.emedicine.medscape.com

CHAPTER V

SUMMARY OF FINDINGS

I. Factors that led to the development of the problem

The researcher found out that the factors that led to the development of dengue

hemorrhagic fever are the following:

 Lifestyle

o Passive or no regular exercise

 Environment

23
 o Rainy season

o Lives in a tropical country

II. Interrelationship of factors identified

Based on the summary of findings, lifestyle and environment greatly contributed

to the development of the disease of the patient.

Curative care was implemented to alleviate actual problems; while promotive,

preventive and rehabilitative care was provided to present possible unnecessary

complications brought about by the said factors.

III.Relevant nursing interventions rendered

Nursing Diagnosis 1: Altered thermoregulation: Hyperthermia related to present

condition as evidenced by temperature of 37.9°C

a. monitored vital signs every 4 hours, especially temperature

b. performed tepid sponge bath

c. encouraged increase fluid intake to at least 2500ml per day

24
 d. observed standard precautions such as hand washing, gloving and masking when

in contact with the patient

e. provided appropriate medicines at the right time and as ordered.

Nursing Diagnosis 2: Risk for injury: bleeding related to insufficient clotting factors

a. monitored vital signs every 4 hours

b. monitored intake and output every shift

c. assessed for signs of bleeding and dehydration

d. instructed to avoid dark colored foods,

e. prevented scratching of rashes

f. encouraged oral fluid intake and citrus fruits

g. observed sterile technique and observed for anaphylactic reaction to medications

Nursing Diagnosis 3: Risk for fluid volume deficit related to increased vascular

permeability

a. monitored vital signs

b. monitored fluid intake and output

c. monitored and regulated intravenous fluid infusion

d. assessed for signs of dehydration: decreased or absent tearing, dry mucous membrane

and loss of skin turgor and encouraged to increase oral intake (2000 ml/day)

25
 Nursing Diagnosis 4: Risk for secondary infection related to compromised immune

system

a. monitored vital signs every 4 hours

b. monitored for any signs of infection such as swelling, redness

c. observed standard precautions such as hand washing, gloving and masking when in

contact with the patient

d. changed the linens every morning and as needed

e. emphasized the importance of daily hygiene practices

f. as ordered, monitored laboratory results including WBC, platelet count, monocyte

count, serum levels of Ig and blood cultures

IV. Evaluation

The problems in which the goals were fully met were:

1. Nursing Diagnosis 1: Altered thermoregulation: Hyperthermia related to present

condition as evidenced by temperature of 37.9°C

2. Nursing Diagnosis 2: Risk for injury: bleeding related to insufficient clotting

factors

The problems in which the goals were partially met were:

26
 1. Nursing Diagnosis 3: Risk for fluid volume deficit related to increased vascular

permeability

2. Nursing Diagnosis 4: Risk for secondary infection related to compromised

immune system

CHAPTER V

CONCLUSION AND RECOMMENDATION

CONCLUSION

Based on the summary of findings, lifestyle and environment greatly contributed

to the development of the disease of the patient.

Curative care was implemented to alleviate actual problems; while promotive, preventive

and rehabilitative care was provided to present possible unnecessary complications brought

about by the said factors.

RECOMMENDATION

To the patient’s significant others, knowledge regarding proper care which will allow

them to be more of a support system through competent advices, reminders and even

psychological and emotional support.

To the health care providers, to continue providing care thorough assessment and

documentation of the findings, close monitoring and proper health education.

To the Clinical instructor, for use of this case study as a guide and reference for future

27
students.

To the future researchers, maximize available knowledge and resources to meet all

objectives and goals of care, to even possibly contribute better and effective interventions.

28
BIBLIOGRAPHY

Books:

1. Behrman, Kleigman and Arvin (2003). Nelson Textbook of Pediatrics. 15th Edition, W.B

Saunders

2. Mondejar-Navales, Dionesa (2006). Handbook of Common Communicable Diseases.

C&E Publishing Inc.

3. San Lazaro Hospital, Philippines. Compilation of Communicable Diseases in Nursing.

4. National League of Philippine Government Nurses (2007). Public Health Nursing in the

Philippines.

5. World Distribution of Dengue. (2007) retrieved by National Institute of Allergy and

Infectious Diseases

6. Porth, Carlson Mattson (2005). Pathophysiology: Concepts of Altered Health States. 7th

Edition

Internet (Journals):

1. http://www.niaid.nih.gov/topics/DengueFever/Understanding/Diagnosis.htm

2. http://www.niaid.nih.gov/topics/DengueFever/Research/Prevention/modSkeetersDengue.

htm

3. http://emedicine.medscape.com/

Records:

1. Patient’s medical chart

29