CASE PRESENTATION: DENGUE FEVER

I. INTRODUCTION
Patient J.E. is 12 yrs. old from Banan, Rizal was admitted to Rizal Provincial Hospital due
to abdominal pain, cough and fever. The patient was diagnose with Dengue Fever with Upper
respiratory infection. Dengue Fever
II. OBJECTIVES
GENERAL OBJECTIVES

We are presenting a case of Dengue Hemorrhagic fever to be able to be able to review the
Components and functions of the blood, Pathophysiology Dengue fever of and its medical and
nursing management.

SPECIFIC OBJECTIVES:
Review the Components and functions of the blood
To know and understand the Pathophysiology of  Dengue fever
To be able to review the importance of Diagnostic and Laboratory examinations
To be able to know what are the medications needed by a patient who had Dengue fever
To be able to practice Physical Assessment
To prioritized the problems obtained from the patient who had Dengue fever
To be able to formulate a Nursing process as a framework in making a comprehensive
Nursing Care Plan to the patient who had Dengue fever
To be able to impart knowledge by means of health teaching to the patient and the family
for continuous care at home.

III. BIOGRAPHIC DATA

I. Personal Data:
Name: J.E.
Sex: M
Age: 12
Date of Birth: 09/07/98
Address: Banan, Rizal
Religion: Roman Catholic
Status: Single
Nationality: Filipino
Room/Bed No.: 9B
Chief Complaint: Abdominal pain, cough, fever
Attending Physician: Dr. Zafra
Diagnosis: Dengue fever with Upper respiratory infections

IV. NURSING HISTORY

PAST ILLNESS HISTORY:
 1 day prior to admission the patient experienced abdominal pain, cough and fever.
 The patient was hospitalized at age of 4 because of convulsion
PRESENT ILNESS HISTORY:
 January 13, 2011, the patient was admitted to Rizal Provincial Hospital with chief
complaint of abdominal pain, cough and fever. The patient had undergone Hematology
tests: hgt, hgb, pt. count as ordered by his attending physician. He was started with
Plain lactated ringer’s solution of 1L to run for 10 hours.

FAMILY HISTORY:

V. PHYSICAL ASSESMENT:
General assessment:
During assessment, the patient was lying on bed. Patient is awake, conscious and coherent. He
is calm. Patient had already done sponge bath, oral hygiene and was dress appropriately.

Skin:
He has a flushed skin and it is warmth to touch. Petichiae is present all over the body. Skin
elasticity returns faster after being tenden between the thumb and finger. Hair color is black,
thin and fine textured and evenly distributed on the scalp. He has temperature of 38.0 degree
celcius.
Head: Head is symmetrical, rounded smooth skull contour positioned at midline and erect
with no lumps or ridges. Facial movements are symmetrical and patient is able to perform
different kinds of facial expression effortlessly and without any obstruction
Eyes: Eyebrows are symmetrically aligned with equal movement without presence of flakes,
scars and lesions.
Ears: The color of the patient’s ear is the same with his facial skin. The left and the right pinna
are symmetrical and are aligned with the inner canthus of the eye. There is no foul smelling,
serous or purulent discharges notes. The earlobe is elongated. The patient was able to hear
normal voice tones
Nose: the nose is symmetric, straight and uniform on color and has discharges due to colds
and no flaring noted. Nasal septum is intact and in with line
Mouth: The lip is moist and red in color. The teeth are complete and whitish in color. With no
mouth sores noted.
Neck: Unpalpable lymph nodes and with rashes

Abdomen: Flat, rounded, symmetric movement, no tenderness. Rashes are also noted
Extremities: Full & equal pulses, no deformities and with presence of rashes

VI. DRUG STUDY

GENERIC/ DOSAGE/ CLASS INDICATION CONTRAIN SIDE EFFECTS NURSING

TRADE NAME FREQUENCY DICATION RESPONSIBILITIES
CEFALEXIN 500mg 1 cap Anti-infective Respiratory Contraindic CNS:  Use
q8 drugs tract ated in dizziness, cautiousl
infections patients headache, y in
hypersensit fatigue, patients
ive to agitation, hypersen
cephalospo confusion, sitive to
rins hallucinations penicillin
GI:  Ask
pseudomemb patient
ranous colitis, about
nausea, past
anorexia, reaction
vomiting, to
diarrhea, cephalos
gastritis, phorins
glossitis, before
dyspepsia, giving
abdominal first dose
pain, anal  Tell
pruritus, patient to
tenasmus, take all
oral the drug
candidiasis, exactly
genital as
pruritus, prescribe
candidiasis, d even
vaginitis, after he
interstitial feels
nephritis better
HEMATOLO  Instruct
GIC: patient to
neutropenia, take drug
eusonophilia, with food
anemia, or milk to
thrombocytop lessen GI
enia discomfo
MUSCULOS rt
KELETAL:
arthritis,
arthralgia,
joint pain
SKIN:
maculopapula
 r and
erhythematou
s
OTHER:
hypersensitivi
ty reactions,
serum
sickness,
anaphylaxis
Paracetamol 500mg 1 Non- Mild pain Contrain HEMATOL  Use
tab q4 Narcotic or fever dicated OGIC: cautiou
PRN Analgesics in hemolytic sly with
and patients anemia, patient
Antipyreti hypersen neutropeni with
cs sitive to a, history
the drugs leukopenia of
, chronic
pancytope alcohol
nia use
HEPATIC:
liver
damage,
jaundice
METABOLI
C:
hypoglyce
mia
SKIN: rash,
urticarial
CETIRIZINE 1 tab OD Anti- Chronic Contrain CNS:  Use
for histamine urticaria dicated somnolenc cautiou
itchiness to e, fatigue, sly in
patient dizziness, patient
hypersen headache s with
sitive to EENT: renal or
drugs or pharyngitis liver
to GI: dry impair
hydroxyzi mouth, ment
ne nausea,  Discon
vomiting, tinue
abdominal drug 4
distress days
before
patient
underg
oes
 diagnos
tic skin
test

LABORATORY/DIAGNOSTICS

Jan 14, 2011 12nn

Normal Values Interpretation
Hematology
Hemoglobin 128.0
Hematocrit 0.38
Platelet 210

Jan 14, 2011 7am

Hemoglobin 136.0
Hematocrit 0.40
Platelet 204

VI. GORDON’S FUNCTIONAL PATTERN

Health Perception/Health Management Pattern

The mother of our client perceived health as one of the most important things to
consider in life. “Paano ka makakapagtrabaho at makakapagisip kung hindi ka malusog at
kung may sakit ka hindi lang ikaw pati ang pamilya mo ay maaapektuhan rin” she said. The
mother rated the health of her son as 6, 1 being the lowest and 10 being the highest. The client
verbalized “6 siguro kasi may lagnat pa siya at inuubo”. The mother verbalized that “ Akala
naming dahil sa ubot at sipon kung bakit siya nilagnat yun pala dahil sa dengue na”. The
mother stated that stagnant water nearby there house is the reason for acquiring the disease.
She reminds her son that healthy lifestyle like eating nutritious food is the key for a healthy
body. When asked about the past illness of her son she said that her son was hospitalized at
the age of 4 because of convulsion. “Mahina ang baga ng anak ko kasi madalas ito magkasipon
at ubo” she said. The patient doesn’t have breathing problems. The patient has complain of
itchiness.

ANALYSIS:
Nutritional-Metabolic Pattern

The mother of our client said that her son usually eats meat during his hospitalization
except dark colored food as advised by the doctor. “Wala naman problema sa pagkain ang
anak ko, ganado pa rin siya kahit may sakit” she said. Her son eats three times a day.“Mahina
uminom ang anak ko kung hindi mo pa babantayan di pa siya iinom ng tubig” she added.

ANALYSIS:
Maintaining a nutritious diet is important in clients with chronic disease,(Medical-Surgical Nursing by Black
and Hawk 7th edition p.1748, 7th ed.) 

Elimination Pattern

The patient usually defecates 2 times a day during hospitalization as verbalized by

the mother. She describes the stool of her son as brown and the urine as yellow and odorless.
“Madalas umihi ang anak ko nakaIV kasa siya at lagi ko pinapainom ng apple juice” she said.
Her son urinates more than eight times every day.

ANALYSIS:
Most people have individual patterns of bowel elimination involving frequency, timing and considerations,
position and place. Although many adults pass one stool each day, other healthy people have more frequent or
less frequent bowel movements. Some people have a bowel movement two or three times a week; others two or
three times a day.(Fundamentals of Nursing by taylor, et al.,  p. 1292,1340, 7th ed.)

Activity-Exercise Pattern

When asked about the daily activities of her son during hospitalization she said “ Higa at upo
lang ginagawa niya dito.” Her son’s hobby is playing saxophone. “Namimiss niya nga ang
pagtutugtog ng saxophone” the mother said.

ANALYSIS:
A regular program of moderate exercise is recommended for adults. Exercise also helps maintain bone
calcification and muscle tone throughout the body, reduce muscle tension and muscle pain. (Medical Surgical
Nursing by Brunner, p.654, 10th ed.)

Sleep-Rest Pattern

The client usually sleeps at 9pm and wakes up at 8am before he was hospitalized. “Ngayon
puro tulog lang ginagawa niya dito sa hospital” the mother verbalized. “Nagigising lang siya
kapag umiihi” she added.

ANALYSIS:
Rest and sleep are essential for health. People who are ill frequently require more sleep than usual.
(Fundamentals of Nursing by Kozier, et al.,  p 1114, 7th ed.)
Middle-aged adults generally maintain the sleep pattern established at a younger age. They usually sleep 6-8
hours per night. (Fundamentals of Nursing by Barbara Kozier, Pp.1116)

     
Coping/Stress Tolerance Pattern

The patient is not irritated during the assessment. “Nakakapagadjust naman siya sa
pagkaospital niya” the mother said

ANALYSIS:
Normal coping stress patterns refers to the client’s adaptive response in challenging life events. (Nursing
Diagnosis and Intervention by: G. McFarland and E. McFarlane Pp. 16).
Ineffective coping is a state in which an individual experiences an inability to manage internal or environmental
stressors adequately due to inadequate resources (physical, psychological, and behavioral). (Handbook of
Nursing Diagnosis by: Lynda Juall Carpenito, Pp.15)

Role-Ralationship

The mother said “Close and anak ko sa mga kapatid niya.”. The client has 2 siblings
and she is the second child. The patient was supported by his family. “yung bunso namin ay
nagdadasal pa na gumaling ang kuya niya” the mother said.

ANALYSIS:

Once someone has accepted certain gender roles and "Gender differences" as expected socialized
behavioral norm, their "Behavior trait” become part of their perceived "Responsibilities”. Influential roles
in gender relationships on a personal and social level to the individual's own socializing role or "Self-
concept".

Cognitive Perceptual

The mother stated that her son doesn’t have any problem in hearing and reading. The patient
is at sixth grade.

ANALYSIS:
Normal cognitive perceptual pattern refers to the ability of the client to perceive, understand, remember and
make decisions about information from the external and internal environment. (Nursing Diagnosis and
Intervention by: G. McFarland and E. McFarlane Pp. 15)

          
Values and Belief
The patient is Born again. “Every Sunday kami nagsisimba” the mother said. “Wala na kaming
pinaniniwalaang iba kundi and diyos lang” she added.
ANALYSIS:
Normal value belief pattern includes beliefs and values that guide a person’s choices and lifestyle.  (Nursing
Diagnosis and Intervention by: G. McFarland and E. McFarlane Pp. 16)
Spiritual Distress is a state in which an individual experiences a disturbance in his belief or value system that is
the source of his strength and hope. (Handbook of Nursing Diagnosis by: Lynda Juall Carpenito, Pp.72)

VII. COMPONENTS AND FUNCTION OF THE BLOOD

VIII. ECOLOGIC MODEL

Host: Patient

Agent: Aedes Aegypti

Environment: Poor environmental sanitation

The predisposing factors together with their components are as follows:

HOST

E AGENT
Interpretation

We have chosen the lever ecologic model because it is used to show the relationship between the
host, agent, and environment. It is also used to determine if there is an imbalance among the three pre-
disposing factors or there is one that contributes more than the other, which may lead to an occurrence of the
disease.

Dengue fever could occur in all ages and regarding the gender. And the aedes aegypti is the main causative
agent of the disease. Poor environmental sanitation may contribute to the occurrence of the disease.
IX. PATOPHYSIOLOGY

X. PROBLEM IDENTIFICATION
Cues Identified Problems

Objective: Elevated body temperature related to illness

Temperature: 38.0 degree celcius

Skin is warm to touch

Flushed skin

Presence of rashes

Subjective: The mother rated the health of her

son as 6, 1 being the lowest and 10 being the
highest. The client verbalized “6 siguro kasi
may lagnat pa siya at inuubo”.

Risk for deficient fluid volume realted to

increased body temperature
Temperature: 38.0 degree celcius

The mother rated the health of her son as 6, 1

being the lowest and 10 being the highest. The
client verbalized “6 siguro kasi may lagnat pa
siya at inuubo”.

Presence of petechiae all over the body Risk for impared skin integrity related to
hyperthermia
The patient has complain of itchiness.
XI. PRIORITIZATION

Problem Rank Justification

Elevated body temperature 1 This is an actual problem of the

related to illness patient and needs immediate
intervention. Having an
elevated body temperature can
lead to complication.

Risk for deficient fluid 2 This is a potential problem and

volume realted to doesn’t need immediate
increased body intervention. It can be
temperature prevented by adequate fluid
intake

Risk for impared skin This is a potential problem and

integrity related to doesn’t need immediate
hyperthermia 3 intervention. It can be solved if
existing problems are solved.

XII. NURSING CARE PLAN

NURSING ANALYSI GOAL AND NURSING RATIONALE EVALUATION

PROBLEM S OBJECTIVES INTERVENTIONS
After 3 hours of
Elevated body Body GOAL: nursing
temperature temperat After 3 hours of intervention
related to ure nursing the client
elevate intervention the decreased
illness above client will be able temperature
normal to decrease body
Objective: range temperature

Temperature:3 Objectives:
8.0 degree
After 5 minutes of
celcius nursing Discuss to the mother
intervention the ways to reduce body
Skin is warm to mother will be able temperature.
touch to gain knowledge
about how to
Flushed skin reduce
temperature
Presence of
rashes Discuss the
After 5 minutes of importance of increase To prevent
nursing fluid intake dehydration and
Subjective: The intervention the support circulating
mother rated mother will be able volume and tissue
the health of to enumerate 3 perfussion(Nanda page
her son as 6, 1 ways on how to 385)
being the reduce body
lowest and 10 temperature
Discuss the
being the
importance of tepid It helps to decrease
highest. The sponge bathe body temperature by
client evaporation and
verbalized “6 conduction
siguro kasi may (Nanda 386)
lagnat pa siya Discuss the
at inuubo effectiveness of local Groin and axilla are
ice packs areas of high blood
flow (Nanda page 386)

Discuss the Reduces metabolic

importance of bedrest demands and oxygen
consumption (nanda
page 386)

Discuss the
importance of Anti-pyretic helps in
administering anti- lowering body
pyretics as prescribed temperature ( Kee and
by the doctor Hayes)

XIII. DISCHARGE PLAN 

Home Care
MEDICATIONS 
 Take medication exactly as directed. Don’t skip doses. Continue taking antibiotics as
directed until they are all gone—even if you start to feel better.

 EXERCISE / ACTIVITY
 Deep Breathing Exercises
 Light Activities
 Tepid Sponge bath
  Drink lots of fluids

TREATMENTS 
 Advice to take medications as prescribed
 Emphasize the importance of proper hygiene and cleaning
 Advice to drink lots of fluids
 Advice to not eat dark colored foods

HEALTH TEACHING
 Encourage and explain to the patient that it is important to maintain proper hygiene to
prevent further infection.
 Instruct to increase fluid intake of the patient.      
 On Diet as tolerated, except for dark colored foods
 Deep breathing excercises     

PATIENT FOLLOW UP 

 Regular consultation to the physician can be factor for recovery and to assess and
monitor the patient’s condition. 

 DIET
 Diet as tolerated, meaning, the patient can eat everything until he can. But he needs to
not eat dark colored foods. Diet plays a big role in fast recovery so that, instruct the
patient to take nutritious food such as green leafy vegetables and fruits.

XIIII. TEACHING PLAN

NURSING RATIONALE CONTENT RESOURCES

INTERVE
NTIONS

Date:
01/15/2011
Time: 9:00am
Setting: Room
9B of Payward,
Rizal Provincial
Hospital

Money: none
Material:
Manpower: