OBJECTIVES

General

This case presentation aims to identify and determine the general heath problems and needs of the patient with an admitting diagnosis of Dengue Hemorrhagic Fever. This presentation also intends to help patient promote health and medical understanding of such condition through the application of the nursing skills.

Specific

• • • •

To raise the level of awareness of patient on health problems that she may encounter. To facilitate patient in taking necessary actions to solve and prevent the identified problems on her own. To help patient in motivating her to continue the health care provided by the health workers. To render nursing care and information to patient through the application of the nursing skills.

OVERVIEW OF THE DISEASE

INTRODUCTION

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

Dengue fever can be caused by any one of four types of dengue virus: DEN-1, DEN-2, DEN-3, and DEN-4. You can be infected by at least two, if not all four types at different times during your lifetime, but only once by the same type.

You can get dengue virus infections from the bite of an infected Aedes mosquito. Mosquitoes become infected when they bite infected humans, and later transmit infection to other people they bite. Two main species of mosquito, Aedes aegypti and Aedes albopictus, have been responsible for all cases of dengue transmitted in this country. Dengue is not contagious from person to person.

DEFINITION

Dengue hemorrhagic Fever
Dengue fever also known as break-bone fever is a severe infectious disease characterized by pain in eyes, head and extremities. The disease is transmitted by the infective bite of Aedes Aegypti mosquito. Once bitten by the mosquito, it takes 3-14 days to develop the disease. Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) are the most serious forms of Dengue that may cause death. Person with dengue hemorrhagic fever lacks blood clotting process. About 20-30% of people with DHF develop shock which is known as dengue shock syndrome. Dengue commonly prevails in warm and wet areas of the world. The disease is commonly spread during the rainy season. It is highly recommended to see a doctor, once the symptoms of dengue fever are observed.

SIGN AND SYMPTOMS

Symptoms of typical uncomplicated (classic) dengue usually start with fever within 5 to 6 days after you have been bitten by an infected mosquito and include

• • • • • •

High fever, up to 105 degrees Fahrenheit Severe headache Retro-orbital (behind the eye) pain Severe joint and muscle pain Nausea and vomiting Rash

The rash may appear over most of your body 3 to 4 days after the fever begins. You may get a second rash later in the disease. Symptoms of dengue hemorrhagic fever include all of the symptoms of classic dengue plus

• •

Marked damage to blood and lymph vessels Bleeding from the nose, gums, or under the skin, causing purplish bruises

This form of dengue disease can cause death.

Symptoms of dengue shock syndrome-the most severe form of dengue disease-include all of the symptoms of classic dengue and dengue hemorrhagic fever, plus

• • •

Fluids leaking outside of blood vessels Massive bleeding Shock (very low blood pressure)

This form of the disease usually occurs in children (sometimes adults) experiencing their second dengue infection. It is sometimes fatal, especially in children and young adults.

MANAGEMENT AND TREATMENT

Dengue fever can be diagnosed 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. There is no specific treatment for classic dengue fever, and like most people you will recover completely 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

Often health care provider advises 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. The best way to prevent dengue fever is to take special precautions to avoid contact with 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 repellant 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 use 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.

Most people who develop dengue fever recover completely within 2 weeks. Some, however, may go through several weeks to months of feeling tired and/or depressed.
NURSING HISTORY

CLIENT PROFILE

Room: Silver

Name: Mrs. E.S.R

Address: #78 Brgy. 2, Jones, Isabela

Birthplace: Pampanga

Birthday: October 31, 1974

Age: 34 yrs. old

Status: Married

Nationality: Filipino

Religion: Roman Catholic

Chief complaint: Fever

Admission: September 9, 2009

Time: 8:15pm

Final diagnostic: DHF (dengue hemorrhagic fever)

Discharge: September 13, 2009

PRESENT HEALTH HISTORY

The present health history started 5 days prior to admission. The patient had onset of fever associated with body malaise and decrease in appetite, no cough, no colds. Tmax 395 retrieved by taking paracetamol. Two days prior to admission, shu with on & off fever associated with loose watery stool, 2 to 4 episodes. One day prior to admission, shu with above complaint patient sought consult, CBC was done, patient given ciprofloxacin & advised to have repeat CBC. Morning prior to admission, CBC had done, PH 197, →135, →82 hence advised admission. She was admitted last September 9 at around 8:15pm at sanitarium.

PAST HEALTH HISTORY

Prior to hospitalization at sanitarium, she admitted that she has already a record or medical history of being admitted due to operations, accidents, and diseases. She also says that she has a history in gestational DM but she denies having an allergies and previous surgery.

FAMILY HEALTH HISTORY

DISEASE

FATHER

MOTHER

DIABETES MELLITUS CANCER HYPERTENSION ASTHMA

-

+ -

11 FUNCTIONAL GORDONS

Health pattern

PHYSICAL ASSESSMENT

GENERAL APPEARANCE: awake, conscious

DATE: September 12, 2009
Body parts Head •scalp Methods Findings interpretation

Inspection

-With dandruff

Due for not taking a bath in 4days. -normal

-tenderness Palpation Inspection

•Hair

- equally distributed, straight -oily hair

-normal

•Face

Inspection

-symmetrical

-Due for not taking a bath. Normal

Palpation Eyes •eyebrows •Eyelids Inspection Inspection

-(+)facial sensation

normal

-symmetrical and aligned -able to close -soft to touch -equally distributed

Normal Normal

•eyelashes

Inspection

normal

•Conjunctiva

Inspection

-Slightly pale

Normal

PERRLA Ears •pinna •External canal •Hearing Inspection Inspection Inspection -Oblong, no lesions -With minimal cerumen -Can Hear whispered word equally in both ears. Nose •external nose Inspection -On the middle of the eyes -Normal sense of smell Mouth •lips •Teeth •Gum •Tongue •Floor of the mouth Inspection Inspection Inspection Inspection Inspection -dry lips -smooth and wet -Normal in size with sense of taste due to dehydration normal Normal Normal Normal Normal normal

Neck Shoulders

Inspection Inspection

-Symmetrical interiorly and no swelling -on the midline -symmetrical -symmetrical chest expansion -no retraction -murmur -(-)tenderness -soft

Normal normal

Thorax and lungs

Inspection

Normal

Heart Abdomen

Auscultation Palpation

normal normal

Musculo skeletal system •Upper extremities

Inspection

-(+) edema -symmetrical -clean fingernails -(-)edema -clean fingernails -flushed

normal

•Lower extremities

Inspection

normal

Skin

inspection

Due to her rashes.

COARSE IN THE WARD

VITAL SIGNS

September 10, 2009

BLOOD PRESSURE (mmHg)

BODY TEMPERATURE (degrees centigrade)

RESPIRATORY RATE (cpm)

PULSE RATE (bpm)

10:00 am 12:00 nn 2:00 pm

120/80 110/80 110/80

37.2 36.3 37

21 21 22

78 72 78

September 12, 2009

BLOOD PRESSURE (mmHg)

BODY TEMPERATURE (degrees centigrade)

RESPIRATORY RATE (cpm)

PULSE RATE (bpm)

6:00 pm 10:00 pm

110/80

36.2

18

79

LABORATORY TEST

SEROLOGY

September 9, 2009 ABO group RH type

RESULT “B” (+)

HEMATOLOGY

September 10, 2009

CBC (cell blood count) WBC lymphocytes segmenters platelet count

RESULT 4.3 0.53 0.47 65

NORMAL 9 5-10 x10 0.25-0.35 0.50-0.65 150-400

INDICATION

/l

September 11, 2009

CBC (cell blood count) WBC lymphocytes platelet count repeated at 6:00 pm

RESULT 10.4 0.40 68 102

NORMAL 5-10 0.25-0.35 150-400 150-400

INDICATION

September 12, 2009

CBC (cell blood count) platelet count

RESULT 97

NORMAL 150-400

INDICATION

PARASITOLOGY

September 10, 2009

STOOL ROUTINE

RESULT

color consistency occult blood pus cell mucus PH reaction

yellow brown soft (-) (-) trace alkaline

VIEW ANATOMY & PHYSIOLOGY

Etiology:

predisposing factors:

Chikungunya Virus

environmental factor (

Phato Aedes Aegypti Dengue Virus (Chikungunya Virus) IgG adheres to the platelet (Initiates destruction of the platelet) Thrombocytopenia (50,000/mm3 or less) Increased potential For hemorrhage Stimulates intense Inflammatory response petechial rash, high fever, headache (epistaxis, vomiting, conjunctival infection,abdominal pain, shock, death) DENGUE HEMORRHAGIC FEVER

DISCHARGE PLAN

M – edication

Intake of appropriate vitamin supplement and diuretics to increase protection mechanism of the immune system and continuous of medications prescribes by the doctor such as cifrofolaxin,

E – conomic

The use of nonpharmacotherapy such as drinking plenty of water will promote increase plasma in blood to increase immunity and proper hygiene and promotion of cleanliness at home and work area.

T – reatment

Management of such condition would be through hydration and doing control measures to eliminate vector by promoting cleanliness in the environment through proper disposal of rubber tires, changing of water of lower vases everyday, destruction of breeding places of mosquito and residual spraying with insecticides.

H – ygiene

Advise to follow proper body hygiene and to maintain cleanliness on surroundings. This would prevent additional cases of DHF.

O – ut Patient/ Follow-up

Any odd signs such as fever, recurrence of fever,etc. must be immediately reported to the physician.

D – iet

Instruct to eat foods that are low fat, low fiber, non-irritating and non-carbonated

And increase fluid intake.

Risk Factors of Dengue Fever
Dengue fever is primarily caused by a bite of Aedes Aegypti mosquito. It is mainly caused by any one of the four dengue virus: DEN-1, DEN-2, DEN-3, and DEN-4. Infection with one virus does not provide protection to the person from other three viruses. However, the person gets life-long immunity from that particular virus, once treated. It is a wrong belief that dengue is spread directly from person to person. The dengue fever can only be transmitted to a healthy individual through mosquito bite.

Prevention of Dengue Fever
Prevention is the only cure for dengue fever. To stop the spread of dengue fever, one must eradicate the cause of the fever, Aedes mosquito. To prevent the growth and multiplication of Aedes mosquito, one must take precautions like:  All water and air-coolers must be thoroughly washed and dried out before reuse.  One tablespoon of petrol added in cooler water can help in preventing the breeding of mosquito.

 Overhead and other water tanks should be kept covered or air-tight.  Unused or broken bottles, pots and tyres should not be left open.  Accumulation of water in pots, unused utensils or containers must be avoided. People who are constantly traveling in dengue-prone areas may lower the risk by:  Wearing insect repellant with DEET.  Wearing clothes that completely covers the body.  Keeping the unscreened doors and windows closed. Dengue fever is caused by any one of four dengue viruses spread by the Aedes aegypti mosquito. These mosquitoes thrive in and near human habitations where they breed in even the cleanest water. Mosquitoes transmit the virus back and forth between humans. When a mosquito bites a person infected with a dengue virus, the virus enters the mosquito's bloodstream. It then circulates before settling in the salivary glands. When the infected mosquito then bites another person, the virus enters that person's bloodstream, where it may cause the serious illness. You can become infected with dengue fever more than once. This happens when you're exposed to a different one of the four dengue viruses than one to which you were previously exposed. Infection a second time is typically what causes the more severe form of the disease — dengue hemorrhagic fever.

No specific treatment for dengue fever exists. If you have a mild form of the disease, your doctor will recommend making sure to drink enough fluids to avoid dehydration from vomiting and high fever. You can also take acetaminophen (Tylenol, others) for pain and fever. Avoid aspirin or other nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve). These can increase the risk of bleeding complications. If you have a more severe form of the disease, treatment consists of supportive care in a hospital. Such care includes intravenous fluids and electrolyte replacement, maintaining adequate blood pressure and replacing blood loss. If you have any form of dengue fever, you may also be kept away from mosquitoes, to avoid transmitting the disease to others.

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