CLINICAL ANALYSIS

I. Overview
Dengue hemorrhagic fever is a more severe form of a viral illness. Symptoms include
headache, fever, rash, and evidence of bleeding (hemorrhage) in the body. This form of dengue
fever can be life-threatening and can progress to the most severe form of the illness, dengue
shock syndrome. This chapter reviews the etiology, epidemiology, diagnosis, pathophysiology,
transmissions, manifestations, diagnosis, treatment, and prevention of dengue.

Many people experience no signs or symptoms of a dengue infection. When symptoms

do occur, they may be mistaken for other illnesses — such as the flu — and usually begin four
to 10 days after you are bitten by an infected mosquito.

Dengue fever causes a high fever — 104 F (40 C) — and any of the following signs and
symptoms:

● Headache
● Muscle, bone or joint pain
● Nausea
● Vomiting
 ● Pain behind the eyes
● Swollen glands
● Rash

Most people recover within a week or so. In some cases, symptoms worsen and can
become life-threatening. This is called severe dengue, dengue hemorrhagic fever or dengue
shock syndrome.

Severe dengue happens when your blood vessels become damaged and leaky. And the
number of clot-forming cells (platelets) in your bloodstream drops. This can lead to shock,
internal bleeding, organ failure and even death.

Warning signs of severe dengue fever which is a life-threatening emergency — can

develop quickly. The warning signs usually begin the first day or two after your fever goes away,
and may include:

● Severe stomach pain

● Persistent vomiting
● Bleeding from your gums or nose
● Blood in your urine, stools or vomit
● Bleeding under the skin, which might look like bruising
● Difficult or rapid breathing
● Fatigue
● Irritability or restlessness

You have a greater risk of developing dengue fever or a more severe form of the disease
if:

● You live or travel in tropical areas. Being in tropical and subtropical areas
increases your risk of exposure to the virus that causes dengue fever. Especially
high-risk areas include Southeast Asia, the western Pacific islands, Latin America
and Africa.
 ● You have had dengue fever in the past. Previous infection with a dengue fever
virus increases your risk of severe symptoms if you get dengue fever again.

Complications (DHF)

a. Metabolic acidosis

b. Hyperkalemia

c. Tissue anoxia

d. Hemorrhage into the CNS or adrenal glands

e. Uterine bleeding may occur

f. Myocarditis
 II. PATIENT’S PROFILE

Name: Elena Gilbert

Age: 17y/o
Birth date: December 24, 2002
Sex: Female
Address: Bulacan, Bulacan
Nationality: Filipino
Civil status: Single
Religion: Catholic
Admitting date: September 10, 2021
Chief complaint/s: Severe headache, epistaxis and body malaise
Admitting diagnosis: Dengue Hemorrhagic Fever
Attending Physician: Dr. Pediatrician
 III. MEDICAL HISTORY

A. Past Medical History

According to the patient, she had experienced cough, fever, cold and chickenpox before. She
doesn't have any allergies to food or any medications. She has no history of hospitalization or any
surgery before but seeks medical advice to clinics in their barangay and other clinics to the nearby
towns.

B. Present Medical History

The patient is a 17 y/o female, prior to admission the patient was experiencing fever, loss of
appetite and epistaxis so the family decided to take him to the hospital.

C. Socio- economic Status

Upon interviewing the patient it was stated that the patient is the only child living with her
mother and his father is an OFW in Dubai. It was also stated that the patient is very active and plays a lot
outside.
IV. ANATOMY AND PHYSIOLOGY

Platelet

A tiny, disc-shaped piece of cell that is found in the blood and spleen. Platelets are
pieces of very large cells in the bone marrow called megakaryocytes. Platelets circulate in blood
plasma and are primarily involved in hemostasis (stopping the flow of blood during injury), by
causing the formation of blood clots, also known as coagulation. The adhesive surface proteins
of platelets allow them to accumulate on the fibrin mesh at an injury site to form a platelet plug
that clots the blood. The complex process of wound repair can only begin once the clot has
stopped bleeding.

Bone Marrow

Bone marrow is a spongy substance found in the center of the bones. It manufactures
bone marrow stem cells and other substances, which in turn produce blood cells. Each type of
blood cell made by the bone marrow has an important job. Red blood cells carry oxygen to
tissues in the body
V. PATHOPHYSIOLOGY (in flow chart)

Complication:

Dengue shock syndrome. Common symptoms in impending shock include abdominal pain, vomiting,
and restlessness.
VI. DIAGNOSTIC TESTS
A. Laboratory
B. Radiologic Test

Laboratory Test Result Clinical Significance

Blood Type O -Blood type is important

when it comes to having
blood transfusion.

Hgb 14 -It helps in detecting and

evaluating blood loss.

Hct 42.1 -The hct level should be

monitored to facilitate early
recognition of dengue
hemorrhagic fever.

Rbc 4.1 -It diagnoses blood related

conditions.

Lymphocyte 23 -It helps the immune system

to fight off the infection.

Neutrophil 64 -Neutrophils have a crucial

role in the pathogenesis of
dengue virus infection.

Monocyte 02 -To evaluate because dengue

can increase the monocytes
of the patient.

Platelet 16 -To know if the patient needs

to receive platelet
transfusion to prevent the
possibility of internal
bleeding.

VII. MEDICAL MANAGEMENT

Name of Drug Dosage/ Route Action Adverse/ Side Effects Nursing Consideration
 Thought to produce
Generic Name: Dosage: 250mg analgesia by CNS: Agitation (IV), I. Consider reducing
inhibiting anxiety, fatigue, daily dose and
Paracetamol prostaglandin and headache, insomnia, increasing dosing
other substances pyrexia. intervals in patients
Brand Name: Route: IV that sensitize pain
with hepatic or renal
receptors. Drugs may CV: HTN,
Acetaminophen impairment.
relieve fever through
hypotension,
central action in the
(APAP, Paracetamol) peripheral edema, PATIENT/ GUARDIAN
hypothalamic heat-
regulating center. periorbital edema, TEACHING
Therapeutic class:
analgesics tachycardia (IV).
I. Tell guardians to
Pharmacological GI: Nausea, consult prescriber
class: Para- vomiting, abdominal before giving drugs to
aminophenol pain, diarrhea, children younger than
derivatives constipation (IV). age 2.

GU: oliguria (IV). II. Advise guardians

that the drug is only for
HEMATOLOGIC: short-term use; urge
hemolytic anemia, them to consult
leukopenia, prescriber if giving to
neutropenia, infants for longer than 3
pancytopenia, days, children for longer
anemia. than 5 days, or adults
longer than 10 days.
HEPATIC: jaundice.
III. Caution guardian to
METABOLIC:
contact health care
hypoalbuminemia
provider if signs and
(IV), hypoglycemia,
symptoms of liver
hypokalemia,
damage (illogical
hypervolemia,
thinking, severe
hypomagnesemia,
dyspepsia, jaundice,
hypophosphatemia
inability to eat,
(IV).
weakness) occur.
RESPIRATORY:
Abnormal breath
sounds, dyspnea,
hypoxia, atelectasis,
pleural effusion,
pulmonary edema,
stridor, wheezing
NURSING CARE PLAN (NCP)

Assessment Background Nursing Planning Nursing Rationale Evaluation

Knowledge Diagnosis Interventio
n
 -Monitor -It measures Goals for the
- Risk for the vital the basic patient are
Subjective: - Acquired - The
bleeding signs. function of achieved as
“Sobrang sakit ng mosquito bite patient will
related to the body. It evidenced by:
ulo ko, para decreased maintain -Administer
possible allows the
akong platelet causing fluid the given
impaired clinician to
nanghihina” as hemorrhage medicines
liver - The see what’s
verbalized by the (bleeding) and and - Free of signs
patient will going on
patient. hyperthermia. function. analgesics. of bleeding.
be febrile inside the
objective: and free -Instruct body.
from other the patient
- High body -It helps to - Verbalized
signs of to increase
temperature. lessen the understandin
infection. the fluid
pain and g on specific
- Red spots intake to
- Pain will improve the interventions
appear on skin, promote
be relieved health of
epistaxis. hydration. in preventing
or the patient.
fever
Vital signs taken controlled. -Give
-To regulate
as follow: knowledge
body
about the
BP: 100/70 temperature
disease.
and improve
PR: 98 bpm overall
RR: 19 bpm wellness.

T: 38.9C -To prevent

worsening
O2 sat: 98% of the
disease.

Comments and suggestions_____________________________________

Clinical Instructor_________________________________