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Dengue

Dengue

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Published by Chrizl Joy

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Published by: Chrizl Joy on Jul 25, 2011
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Introduction
Dengue fever is an acute febrile infectious disease, caused by all four serotypes (1, 2, 3 or 4) of a virus from genus Flavivirus, called dengue virus. It¶s the most prevalent flavivirus infection of humans, with a worldwide distribution in the tropics and warm areas of the temperate zone corresponding to that of the principal vector, Aedesaegypti. When simultaneous or sequential introduction of two or more serotypes occurs in the same area, there may be an increased number of cases with worse clinical presentation (dengue hemorrhagic fever). The term µhemorrhagic¶ is imprecise, because what characterizes this form of the disease is not the presence of hemorrhagic manifestations, but the abrupt increase of capillary permeability, with diffuse capillary leakage of plasma, hemoconcentration and, in some cases, with nonhemorrhagic hypovolemic shock (dengue shock syndrome). Incubation period: 3 - 6 days; some cases may reach 15 days. Dengue Fever: Symptoms begin with the abrupt onset of high fever, severe malaise, headache, retro-orbital pain, myalgia (lumbosacral pain, also involving legs), frequently accompanied by sore throat, nausea, vomiting, epygastric pain and diarrhea. In children, sore throat and abdominal pain are predominant. Defervescence occurs between days 3 and 8, usually followed by minor hemorrhagic phenomena (petechiae, purpura, epistaxis) and the onset of a maculopapular or morbilliform, sometimes pruritic rash on the trunk , with a centrifugal spread involving limbs, face, palms and soles. Some cases may advance with severe gastrointestinal bleeding and shock. Thus, the presence of hemorrhagic manifestations is not exclusively for µdengue hemorrhagic fever¶. Dengue Hemorrhagic Fever (DHF): The early phase of illness is indistinguishable from dengue fever. After 2 - 5 days, however (defervescence period), a few cases in the first infection, in contrast with a significant number of cases after reinfection by another serotype may present with thrombocytopenia (< 100.000 /mm3) and hemoconcetration, the first usually preceeding the second. Hemorrhagic manifestations may or may not occur; the spleen is not palpable, but hepatic enlargement and tenderness is a sign of bad prognosis. Other manifestations include pleural effusion and hypoalbuminemia, encephalopathy with normal cerebrospinal fluid. Diffuse cappilary leakage of plasma is responsible for the hemoconcentration. In the presence of hemoconcentration and thrombocytopenia, the pacientis considered to be seized by dengue hemorrhagic fever and classified according to the following World Health Organization classification:

5 cm square or 1 inch square just bellow the cuff. Declared shock. narrowing of the pulse pressure (< 20 mmHg).thrombocytopenia + hemoconcentration. Grade II . patient pulseless and with arterial blood pressure = 0 mmHg (dengue shock syndrome .thrombocytopenia + hemoconcentration. .Grade I . Grade III . Last August 11. A test is positive when 20 or more petichae per square are observed. Grade IV . Diagnostic Test: Torniquet test y y y Inflate the blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressure for 5 mins. cold extremities. Absence of spontaneous bleeding.thrombocytopenia + hemoconcentration. Recovery is rapid and without sequelae. Hemodynamic instability: filiform pulse. Count the number of petichae inside the box. mentalconffusion. 2010. at the antecubitalfossa.thrombocytopenia + hemoconcentration.Presence of spontaneous bleeding. This patient has became my topic for this case study. The case-fatality of DHF/DSS is 10% or higher if untreated. I encountered a patient with such kind of disease. With supportive treatment. fewer than 1% of such cases succumb. Release cuff and make an imaginary 2.DSS).

Patient¶s Profile Name Age Gender Address Date of Birth Occupation Nationality Civil Status Religion : : : : : : : : : Patient 1 20 years old Female Boni. III.II. This case study aims to promote health and medical understanding about Dengue Hemorrhagic Fever. 1990 N/A Filipino Single Catholic Fever August 8. Mandaluyong City January 21. This case study will help me understand the disease process of dengue fever. Objectives: y y y y This case study aims to identify and determine the general health problems and needs of a patient with a Dengue Hemorrhagic Fever. 2010 Rizal Medical Center Chief Complaint : Date Admitted : Hospital : . This study will help me orient myself the appropriate nursing interventions in managing Dengue Hemorrhagic Fever.

2010. She had no previous hospitalization V. colds and cough. Physical Examination . the patient had not yet experienced serious health problems other than fever.IV. According to the mother of the patient during the first day of the fever the patient took Paracetamol. On the third day the patient still had the symptoms. Nursing History: Three days prior to admission the patient had fever and lost her appetite. Past Medical History: According to the guardian of the patient. The patient now consult the physician and was ordered to perform CBC test and torniquet test and was determined to be suffering from dengue. The patient then was admitted to Rizal Medical Center on August 15.

discharge and inflammation Client normally responds when asked Smooth. 2010 General Assessment: Conscious and coherent Initial vital signs: T=36.Date Assessed: August 11. and w/o discharge Neurology Level of Fully Conscious Consciousness Behavior and Expressess feelings when asked and Appearance in certain situations VI-VII Anatomy Physiology And Pathophysiology Normal Normal .2c RR=20 BP=110/80 PR=70 Area Assessed Findings skin w/ petichae on arms Color Moisture Texture Turgor Nail beds Capillary refill Eyes Visual acuity Eyebrows Eyelashes Eyelids Ears Hearing acuity Nose Comes back within 2-3 seconds Skin normal moisture Smooth and soft Skin snaps back immediately Pale Evaluation Due to +torniquet test Normal Normal Normal Due to decreased blood flow Normal Normal Normal Normal Normal Normal Normal Normal PERRLA Symmetrical Evenly distributed Same color of skin and blinks 2o times per minute Free of lesions. symmetrical.

and heparin w/c prevents clot formation Release chemical that reduce inflammation. consisting of cell fragments surrounded by a liquid matix which circulates through the heart and blood vesseles. attacks certain worm parasites Produces antibodies and other chemicals responsible for destroying microorganism Phagocytic cell in the blood leaves the circulatory systemand become macrophage w/c phagocytises bacteria.Blood Blood is considered the essence of life because the uncontrolled loss of it can result to death. fluid balance and electrolyte levels  protects against diseases and blood loss Formed Elements: Erythrocytes (RBC) Transport oxygen and carbon dioxide Leukocyte (WBC) >Neutrophil >Basophil Phagocytizes microorganism Release histamine. a contagious disease transmitted by the Aedesaegypti mosquito. The cells and cell fragments are formed elements and the liquid is plasma. dead cells. Dengue fever. which promotes inflammation. body temperature. release chemicals necessary for blood clotting. cell fragments and debris within tissue >Eosinophil - >Lympocytes >Monocyte - Platelet Forms platelet plugs. Functions of blood:  transports gases. infects between 50 million and 100 million people worldwide each year. nutrients. Blood is a type of connective tissue. Also known as breakbone or . Blood makes about 8% of total weight of the body. waste products and hormones  involves in regulation of homeostasis and maintenance of PH.

DHF or dengue shock syndrome. Medical Management . the more severe dengue hemorrhagic fever (DHF) or dengue shock syndrome. which require hospitalization. A small minority of cases of dengue fever develop into severe forms of the fever. Melena/Blood in stools. Transmission of Dengue Fever Dengue fever is transmitted only through an infected mosquito or by contact with the blood of someone who is actively infected with one of the four viruses responsible for the fever. Hematuria. Infection with one of these viruses generally provides immunity from dengue fever for as much as a year after the illness. Hematemesis.000/mm3 Elevated haematocrit (hemoconcentration) > 20% the average value for the age VIII. dengue fever is found in the tropical and subtropical regions of the world.dandy fever. Bruises. Dengue Haemorrhagic Fever (DHF) Clinical description Possibly more frequent in children and young adults Similar onset as Dengue Fever Complications usually start when fever subsides Facial flush Epigastric and abdominal pain Hepatomegaly Haemorrhagic tendencies Petechiae. Exposure to the flavivirus that causes dengue fever results in one of three pathophysiologies: dengue fever. Epistaxis. Gingival bleeding Positive tourniquet test Haematology laboratory tests Platelet count < 100.

All patients regarded as Grade IV. care must be taken not to induce pulmonary edema with continued intravenous fluid administration. chronic obstructive pulmonary diseases . Criteria For Home Observation: y y y All cases of dengue fever with no need of intravascular fluids replacement. Once the patient is stabilized and capillary leakage stops and resorption of extravasated fluid begins. Patients regarded as Grade II without response to OFRT. Patients regarded as Grade I capable of receiving oral fluids replacement therapy (OFRT). Criteria For Short-Duration Admission In Hospital (12 . IX. Laboratory Exams .No specific treatment of dengue is available.24 hours): y y y y y All cases of dengue fever that need intravascular fluids replacement. Patients regarded as Grade I without response to OFRT. Patients regarded as Grade I or II with predisposing factors to develop severe forms of presentation (asthma. C. Criteria For Long-Duration Admission In Hospital (> 24 hours): y y Patients with no response to fluids replacement therapy after short-duration admission. alergies. Patients regarded as Grade I or II with hepatic tenderness. All patients regarded as Grade III.) Patients regarded as Grade II or III with important bleedings. Early institution of supportive treatment (fluids replacement and correction of electrolyte imbalances) is the key to management of patients with dengue in all its forms. anorexia. replacement of intravascular volume with lactated Ringer¶s solution or isotonic saline . since high fever. y y Intensive monitoring of vital signs and markers of hemoconcentration. vomiting and cappilary leakage result in some degree of dehidration. and O2 therapy is life-saving in patients with DSS. Patients regarded as Grade II capable of receiving OFRT and without important bleedings. correction of metabolic acidosis. diabetes mellitus.. B. A..

Laboratory Findings: >Total White Blood Cells Count: In case of dengue.68 0. meningoencephalitis. Lab Report: Date: August 11. when it¶s not possible to know the previous value of hematocrit.30 150-450 x 10^g/dL Actual Findings 5 x 10^g/l 10 g/dL 30 % 0.) must be considered.0 g/dL 39-54 % 0.0-18. measles.32 18 x 10^g/dL Lab Report: Date: August 12.000 /mm3): Total platelets count must be obtained in every patient with symptoms suggestive of dengue for three or more days of presentation. 2010 . Leptospirosis. this test will reveal leukopenia. rubella.70 0.60-0.20-0. we must regard as significantly elevated the results > 45%. pielonephritis etc. 2010 Parameter White Blood Cells Hemoglobin Hematocrit Segmenters Lymphocytes Platelet Count Normal Findings 5-19 x 10^g/l M: 13. The presence of leukocytosis and neutrophilia excludes the possibility of dengue and bacterial infections (leptospirosis. meningococcemia and septicemy may also course with thrombocytopenia. it¶s necessary the presence of hemoconcentration (hematocrit elevated by > 20%). >Hematocrit (micro-hematocrit): According to the definition of DHF. >Thrombocytopenia (< 100. septicemy.

Parameter White Blood Cells Hemoglobin Hematocrit Segmenters Lymphocytes Platelet Count Normal Findings 5-19 x 10^g/l M: 13. Leukopenia.60-0.0 g/dL 39-54 % 0. Urticaria Contraindications: y Contraindicated in pt.32 33 x 10^g/dL X. The drug may relieve fever through central action in the hypothalamic heat regulating center. Neutropenia. be aware of this when calculating daily dose y Use liquid for for children and patients who have difficulty in swallowing y In children do not exceed five doses in 24 hours y Patient Teaching: y Tell parents to consult prescriber before giving drug to children younger than age 2 . Adverse Reactions: y Hematologic: Hemolytic Anemia.68 0.70 0.0-18.20-0. Drug Study: Paracetamol Dosage: 250 mg/5ml q4 RTC Classification:Nonpioid Analgesics & Antipyretics Indication: Mild pain or fever Action: Produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in the CNS or other substances that sensitize pain receptors to stimulation.30 150-450 x 10^g/dL Actual Findings 5 x 10^g/l 10 g/dL 30 % 0. with long term alcohol use because therapeutic doses cause hepatotoxicity in these patients y Nursing Considerations: y ALERT: Many OTC and prescription products contain acetaminophen. hypersensitive to drug y Use cautiously in pt. Panyctopenia y Hepatic: Jaundice y Metabolic: Hypoglycemia y Skin: Rash.

wheezing. furry tongue. Excessive alcohol use may increase the risk of liver damage. nonspecific hepatitis y GU ± nephritis y Hematologic ± Rash. causing death Adverse Reactions: y CNS ± Lethargy. sore mouth. or other allergens Use cautiously with renal disorders and lactation Nursing considerations: y Culture infected area prior to treatment.y y Advice pt. helicobacter pylori infections in combination with other agents. seizures y G. do not stop because you feel better y This antibiotic is specific for this problem and should not be used to self treat the other infections XI. enterocolitis. continuation for 10 full days is recommended y Use corticosteroids or antihistamine for skin reactions Patient Teachings: y Take this drug around the clock y Take the full course of theraphy. gastritis. urge them to consult prescriber if giving to children for longer than 5 days or adults for longer than 10 days ALERT: Warn patient that high doses or unsupervised long term use can cause liver damage. Amoxicillin Dosage: 375mg TID Antibiotic Classification: Indication: Infections due to susceptible strains. reculture area if response is not expected y Give in oral preparations only.I ± Glossitis. vaginitis Contraindications: Contraindicated with allergy to cephalosporin¶s or penicillin¶s. hallucinations. anaphylaxis y Others ± Superinfections: oral and rectal monoliasis.or parents that drug is only for short term use. nausea. diarrhea (bloody). Stomatitis. amoxicillin is not affected by food y Continue theraphy for at least 2 days after sign of infection have disappeared. post exposure prophylaxis against bacillusantharicis. Chlamydia trochomatis in pregnancy Action: Bactericidal ± Inhibits synthesis of bacterial cell wall. fever. Nursing Care Plan . vomiting. pseudomembranous colitis.

Assessment Subjective: ´dumudugoangilongnganak koµ as verbalized by the mother Objective: Weakness and irritability Restlessness V/s taken and recorded as follows T:38 PR:55 RR:20 BP:110/80 Diagnosis Risk for hemorrhag e related to altered clotting factor Planning After 1 hour of nursing intervention s.activ e bleeding or impending complications Monitor HB and Hct and clotting factore . the client will be able to demonstrate behaviors that reduce the risk for bleeding Intervention Assess for signs of G. eccymosis.I. hypoxemia Indicators of aneamia. Check for secretions. tract is the most usual source of bleeding of its mucosal fragility Evaluation After 1 hour of nursing intervention s. bleeding from one more sites Monitor pulse and blood pressure Rationale The G. bleeding. Observe color and consistency of stools or vomitus Observe for presence of petechiae. the client was able to demostrate behaviors that reduce the risk for bleeding May develop because of altered clotting factor Note changes in mentation and level of consciousne ss An increase in pulse and decrease in blood pressure can indicate loss of circulating blood volume Changes may indicate cerebral perfusion secondary to hypovolemia.I.

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