DENGUE

HEMORRHAGIC
FEVER

CASE SIMULATION BY GROUP 8 CLUSTER A

TABLE OF
CONTENTS
I INTRODUCTION
II. KARDEX
III. IV FLOW RATE AND
DRUG COMPUTATIONS
IV. NURSING CARE PLAN
V. DRUG STUDY
VI. DISCHARGE PLAN
VII. FDAR
CASE SCENARIO
You are the receiving ward nurse. An ER nurse endorses a newly admitted patient.
Endorsing to you Patient LB, 21 years old, female, under the service of Dr. C. Guzman.
Patient is admitted with chief complaints of on and off fever, body malaise skin rashes and
headache for 2 days. Patient is admitted with initial diagnosis of DHF.
The following are the admitting orders:
Please admit to ROC under the service
of Dr. C. Guzman
- Secure consent for admission and management
- TPR every shift and record please
- Diet: DAT EDCF
- IVF: D5LRS 1L +1 amp Ascorbic Acid x 8 hours
- IVF to follow: D5LRS 1L + 1 amp Ascorbic Acid x 10 hours
- Labs: CBC with APC daily, Na, K, Creatinine, Dengue NS1, PTPA, APTT, CT, BT, Rapid
Antigen Test, Rapid Antibody Test, CXR PA
- Meds: Famotidine 20mg IV every 12 hours
- OMX capsule BID
- Isoprinosine tab every 6 hours
- Cefuroxime 750mg IV ( ) ANST
- Paracetamol 500mg/tab every 4 hours for T >/= to 37.9 C
- Paracetamol 300mg IV every 4 hours for T >/= to 38.9 C
- V/S monitoring every 2 hours
- I and O every shift and record pls.
- WOF signs of bleeding
- Refer accordingly
Physical assessment done with the following results:
- V/S: T 38.5C, PR - 88bpm, RR - 20cpm, BP - 100/70mmHg
- With skin rashes
- Patient complains of headache with pain scale of 6
I. ABOUT THE DISEASE
Dengue (also known as Breakbone Fever, Hemorrhagic Fever, Dandy Fever, Infectious
Thrombocytopenic Purpura). Some patients with dengue fever go on to develop dengue hemorrhagic
fever, a severe and sometimes fatal form of the disease. Dengue fever is an acute febrile disease caused
by infection of one of the four serotypes of dengue virus, which is a Flavivirus, a genus of single-stranded
non segmented RNA virus. It is a mosquito-borne disease caused by the genus Aedes (transmitted by
day-biting mosquitoes - Aedes aegypti - that breed in stagnant water. It has white dots at the base of its
wings, with white bands on the legs. Incubation period of three to ten days. Dengue hemorrhagic fever
is a fatal manifestation of the dengue virus that manifests with bleeding diathesis and hypovolemic
shock. These viruses are related to the viruses that cause the West Nile infection and yellow fever.

Symptoms, which usually begin 4 to 6 days after infection and may last to up to 10 days, include
high fever, severe headaches, damage to lymph and blood vessels, bleeding, enlargement of the liver,
and circulatory system failure.

There are many ways to prevent dengue fever but there are no vaccines available yet. Here are
some ways - Avoid crowded places (Stay away from heavily populated residential areas), mosquito
repellents (use mosquito repellents that are mild for the skin, even indoors), proper clothing (when
outdoors, wear long-sleeved shirts and long pants tucked into socks), mosquito-free environment (make
sure window and door screens are secure and free of holes or use mosquito nets), stagnant water
(empty or cover bottles, cans, and any containers with stagnant water as these can become breeding
places of mosquitoes)

Laboratory criteria for the diagnosis of dengue virus may include 1 of the following:

• Dengue virus isolation. Isolation of the dengue virus from serum, plasma, leukocytes, or autopsy
samples.

• Immunoglobulin titers. Demonstration of a fourfold or greater change in reciprocal

immunoglobulin or IgM antibody titers to one or more dengue virus antigens in paired serum
samples.

• Immunohistochemistry. Demonstration of the dengue virus antigen in autopsy tissue via

immunohistochemistry or immunofluorescence.

• Polymerase chain reaction. Detection of viral genomic sequences in autopsy tissue, serum, or
cerebrospinal fluid samples via PCR.

• Complete blood count. In DHF, there may be the presence of increases hematocrit level
secondary to plasma extravasation and/or third-space fluid loss.

• Decreased platelet count. This test confirms dengue.

• Guaiac test. Guaiac testing for occult blood in the stool should be performed on all patients
suspected of dengue virus infection.
STATISTICS
PHILIPPINES
During epidemiological week 49 of 2022, a total of 473 dengue cases were reported.
The number of cases is 71% lower compared to the same period in 2021 (n=1,633). From 1
January to 10 December 2022 (week 49), there have been 216,927 dengue cases and 706
deaths (CFR 0.3%), which is 187% higher compared to the 75,529 cases reported in the
same period in 2021. Of the 216,927 reported dengue cases 591 cases were confirmed via
PCR. The most prevalent dengue serotype was DEN-1 (360.6%), followed by DEN-2
(135.2%)

TUGUEGARAO CITY
Tuguegarao City, Cagayan – Cagayan’s Provincial Government has reported a record-high
1,396 Dengue cases in July, the highest figure logged in 2022 so far.
According to the Provincial Epidemiology Surveillance Unit (PESU) on Tuesday, August 2,
the month of July has been flagged to have topped the figures, close to June’s 1,313; May
with 565; April with 253; March with 139; February with 80; and January with 79. In
PESU’s cumulative count of Dengue cases, the densely populated city of Tuguegarao has the
highest with 410; followed by Gattaran with 335; Baggao with 293; Solana with 281; Tuao
with 276; Lasam with 270; Piat with 195; Aparri with 192; Alcala with 184; Pamplona with
141; Ballesteros with 135; Abulug with 113; and Lal-lo with 107. Dengue-related deaths in
the province have also reached 6, with 4 casualties noted in May, 1 each in July and March,
from Tuguegarao City and the towns of Iguig, Solana, Baggao, Gattaran and Lasam. In the
first two days of August, there had been 5 Dengue cases logged so far. With the rainy
season in play, the provincial government has warned of rising cases of the mosquito-borne
disease due to its breeding habits in stagnant water. The Provincial Government has also
reminded all residents to prevent the accumulation of stagnant water, clean up
surroundings and practice safety protocols against mosquito bites.
II. KARDEX
III. IV FLOW RATE COMPUTATION

DRUG COMPUTATION
 IV. NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective:  Hyperthermia After 2 hours -Monitor patient’s - note progress and changes Goal met:
related to of appropriate vital signs of condition
-Headache for After 2 hours
presence of nursing
2 days -provide tepid -enhance heat loss by of
pyrogens in intervention
sponge bath evaporation and conduction appropriate
-Body malaise the blood the patient’s
nursing
stream as temperature -promote bed rest -to reduce metabolic
  intervention
manifested by will return to demands and oxygen
the patient’s
Objective: a temperature normal range. consumption
temperature
of 38.5˚C
-V/S: T is decreased
-advice client fluid -to replenish fluid loss
38.5˚C, to 36.5˚C.
intake
PR - 88bpm,
-encourage the client - to provide sense of
RR - 20cpm, to wear thin clothes comfort and increase the
that absorb sweats evaporation heat
BP -
100/70mmHg -adjust room -promote regulation and
temperature ventilation
-Skin rashes
according to client’s
  request

  -monitor lab results -to identify underlying

problems
 

  -Administered anti- -for heat reduction

pyretics drugs as
 
ordered
  - To check for complete
- Coordinates with
Medical Technologist blood count
for Patient Lab
Result

 
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Objective: Impaired skin After 2 hours - Evaluated patient’s - The greatest risk Goal was
Skin rashes integrity of nursing ability to move factor in skin met
related to intervention breakdown is
inflammatory the patient immobility After 2 hours
response as will be able to of nursing
evidence by verbalize -Performed routine - Systemic infection intervention
skin rashes healing of skin skin inspections, can identify the patient
lesions describing improvement or will be able
without observed changes changes for timely to verbalize
complication intervention healing of
skin lesion
- Maintained and - To reduce the risk without
instructed good skin of dermal trauma, complication
hygiene and self-care improve circulation
as well in her and promote comfort
surroundings

- Recommended - To reduce risk of

keeping nails short dermal injury when
severe itching is
present
- Educated patient’s - To maintain skin
and caregivers about integrity enhances
proper skin care their sense of self-
efficacy and
prevents skin
breakdown
- Used pillows or
foam wedges to keep - These measures
bony prominence reduced shearing
from direct contact forces on the skin
with each other

-Suggested use of
- To decrease
ice, colloidal bath,
irritable itching
lotion
 V. DRUG STUDY

Name of Drug Generic Name:

Famotidine
Brand Name:
Pepsid

Classification H2-receptor antagonist or h2-blockers, gastrointestinal agents.

Action Famotidine works on H2 receptors and blocks the actions of histamine.

Indication Famotidine is indicated in pediatric and adult patients (with the bodyweight of 40 kg and
above) for the management of active duodenal ulcer (DU), active gastric ulcer, symptomatic
non-erosive gastroesophageal reflux disease (GERD), and erosive esophagitis due to GERD,
diagnosed by biopsy.

Contraindicatio Famotidine is contraindicated for use by patients with serious hypersensitivity to famotidine
n itself or any component of the formulation.

Adverse CNS: Headache, dizziness, paresthesia, depression, anxiety, somnolence, insomnia, fever,
Reaction seizures in renal disease
CV: Dysrhythmias, QT prolongation (impaired renal functioning)
EENT: Taste change, tinnitus, orbital edema
GI: Constipation, nausea, vomiting, anorexia, cramps, abnormal hepatic enzymes, diarrhea
INTEG: Rash, toxic epidermal necrolysis, Stevens-Johnson syndrome
MS: Myalgia, arthralgia
RESP: Pneumonia

Nursing  Observe the 10Rs of drug administration

Responsibility
 Assess heart rate, ECG, and heart sounds, especially during exercise. Report any rhythm
disturbances or symptoms of increased arrhythmias, including palpitations, chest
discomfort, shortness of breath, fainting, and fatigue/weakness.

 Report signs of agranulocytosis and neutropenia (fever, sore throat, mucosal lesions,
signs of infection, bruising), aplastic anemia (unusual fatigue, weakness), or
thrombocytopenia (bruising, bleeding gums, nose bleeds).

 Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness

in the throat or chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus,
urticaria). Notify physician or nursing staff immediately if these reactions occur.

Name of Drug Generic Name:

 Cefuroxime
Brand Name:
Ceftin, Zenacef

Classification Cephalosporin antibiotics

Action Cefuroxime is a bactericidal agent that acts by inhibition of bacterial cell wall synthesis.

Indication For the treatment of many different types of bacterial infections such as bronchitis, sinusitis,
tonsillitis, ear infections, skin infections, gonorrhea, and urinary tract infections.

Contraindicatio Hypersensitivity to penicillin and contraindicated in patients with cephalosporin

n hypersensitivity or cephamycin hypersensitivity.
 

Adverse CNS: Dizziness, headache, seizures

Reaction
GI: Diarrhea, nausea, vomiting, anorexia, CDAD HEMA: Leukopenia, thrombocytopenia,
agranulocytosis, neutropenia, eosinophilia, hemolytic anemia
INTEG: Rash, urticaria, dermatitis, Stevens-Johnson syndrome, IV site reactions.
SYST: Anaphylaxis, serum sickness, superinfection

Nursing  Observe the 10Rs of drug administration 

Responsibility
 Watch for seizures; notify physician immediately if patient develops or increases
seizure activity.

 Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever,

pus, or mucus in stools, and other severe or prolonged GI problems (nausea, vomiting,
heartburn). Notify physician or nursing staff immediately of these signs.

 Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms

(tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash,
pruritus, urticaria). Notify physician or nursing staff immediately if these reactions
occur.

Name of Drug Generic Name:

 Isoprinosine/Inosine Pranobex
Brand Name:
Canada, Imunovir

Classification Immunomodu-latory antiviral drug

Action Stimulates cell-mediated immune processes to viral infections

Indication Isoprinosine used for the treatment of various infections such as herpes
simplex, Genital warts, sclerosing panencephalitis.

Contraindication Isoprinosine should not be used in those cases where there is a known
hypersensitivity to product components or in
cases where the patient is presently suffering from gout or elevated uric
acid blood levels.

Adverse Reaction CNS: adverse effects that may be related to possible effects of dopamine
levels in the brain, like light-headedness, dizziness, insomnia.
CV: orthostatic hypotension
GU: urinary retention

Nursing Responsibility  Observe the 10Rs of drug administration.

 Administer drug as prescribed as soon after exposure to the virus

is possible to enhance effectiveness and decrease the risk of
complications due to viral infection.

 Instruct the patient about the appropriate dosage scheduling

regimen.

 Educate client on drug therapy to promote understanding and

compliance.

 Assess for the mentioned cautions and contraindications to

prevent any untoward complications.

 Perform a thorough physical assessment (other medications taken,

orientation and reflexes, vital signs to establish baseline data
before drug therapy begins, to determine effectiveness of therapy,
and to evaluate for occurrence of any adverse effects associated
with drug therapy.
Name of Drug Generic Name:
OMX capsule
Brand Name:
 

Classification Proton pump inhibitors (PPIs).

Action OMX capsule works by reducing the amount of acid in the stomach which
helps in relief of acid related indigestion and heartburn.

Indication used in treating heartburn and chest pain due to stomach acid reflux disease
in which acidic content from the stomach comes up to food pipe and mouth. It
is also used for the treatment of ulcers of the stomach, intestine and
inflammation and erosion of food pipe due to stomach acid.

Contraindication 1.If you are allergic to omeprazole or any other ingredients of Omx Capsule.
2.If you have an allergic reaction to any medicines that are proton pump
inhibitors (PPI) such as Esomeprazole, Pantoprazole, Rabeprazole and
Lansoprazole.
3.If you are taking nelfinavir, used to treat HIV infection.

Adverse Reaction CNS: Headache, dizziness, vertigo, insomnia.

Skin: Rash.
GI: Diarrhea, abdominal pain, nausea, vomiting.
Respiratory: Upper respiratory infections

Nursing Responsibility  Observe the 10Rs of drug administration.

 Monitor patient response to the drug (relief of GI symptoms caused

by hyperacidity, healing of erosive GI lesions).

 Monitor for adverse effects (GI effects, CNS changes, dermatological

effects, respiratory effects).

 Monitor the effectiveness of comfort and safety measures and

compliance with the regimen.
Name of Drug Generic Name:
Ascorbic Acid
Brand Name:
Vital C

Classification Vitamins

Action Increases protection mechanisms of the immune system, thus supporting

wound healing

Indication 1.Vitamin C is indicated to treat and prevent scurvy.

2.Scurvy develops 1 to 3 months after initiating a vitamin C
deficient diet. Individuals may complain of lethargy, fatigue, malaise, emotional
lability, arthralgias, weight loss, anorexia, and diarrhea
3.Vitamin C is a watersoluble vitamin, antioxidant, and essential cofactor for
collagen biosynthesis, carnitine and catecholamine metabolism, and dietary
iron absorption.

Contraindication 1.Use of sodium ascorbate in patients on sodium restriction.

2.Use of calcium ascorbate on patient receiving digitalis.

Adverse Reaction GI: nausea, vomiting, heartburn, diarrhea

HEMO: acute hemolytic anemia
CNS: Headache (high doses)
Urogenital: Urethritis, dysuria, crystalluria
Others: mild soreness, dizziness, faintness with rapid IV administration

Nursing Responsibility  Observe the 10 R’s of drug administration

 Secure doctors order

 Do handwashing

 Assess patient’s condition

 Give medication on right timing

 Inform patient about the possible side effects of the drugs

 Instruct the patient to be cautious of the contraindication of the drugs

 Return the medication ticket on the right box for the next timing

 Do the charting or the document

Name of Drug Generic Name:
Paracetamol IV
Brand Name:
 

Classification Anilide preparations

Action To relieve pain

Indication It is recommended to use a suitable oral rectal analgesic treatment as soon as

practicable

Contraindication 1.Severe hepatocellular insufficiency

2.When oral or rectal route available
3.Known sensitivity to paracetamol

Adverse Reaction CNS: Headache, vomiting and Constipation

GI: Diarrhea, abdominal pain, nausea, vomiting, constipation and enlarged
abdomen.
Hematologic: Anemia, postoperative hemorrhage

Nursing Responsibility  Observe 10R’s or drug administration

 Verify any medication order and make sure it’s complete. The order
should include the drug name, dosage, frequency, and route of
administration. If any element is missing, check with the practitioner.

 Check the patient’s medical record for an allergy or contraindications

and notify the practitioner.

 Prepare medications for one patient about their medications. Encourage

them speak up if something seems amiss
Name of Drug Generic Name:
Paracetamol/Acetaminophen
Brand Name:
Tylenol, Mapap, Panadol

Classification Analgesic, anti-pyretic drugs

Action Has central analgesic effect that is mediated through activation

of descending serotonergic pathways.
A commonly used medicine that can help treat pain and
reduce a high temperature.

Indication Control of pain due to headache, and dysmenorrhea, it used to

reduce a high temperature(fever)

Contraindication Conditions with caloric undernutrition, acute liver failure,

liver problems, a condition where the body is unable to
maintain adequate blood flow called shock, acetaminophen
overdose, acute inflammation of the liver due to hepatitis C
virus.

Adverse Reaction CNS: Headache

GI: Hepatic toxicity and failure, jaundice
GU: Acute kidney failure, renal tubular necrosis

Nursing Responsibility  Routinely monitor the effectiveness of acetaminophen

by assessing pain levels and fever reduction.

 Observe 10R’s or drug administration

 Instruct the patient to report abdominal pain, jaundice,

dark urine, itchiness, or clay-colored stools.

 Educate client on drug therapy to promote

understanding and compliance.

 educate the patients on the safe use of paracetamol

containing products and the risk of overdose

 Make sure patients are aware they must not exceed the
recommended dose.
VI. DISCHARGE PLAN

NURSING ORDERS DISCHARGE INSTRUCTIONS

MEDICATION - Advise the client to take prescribed medication. Provide an adequate

instruction on the importance of taking medication as prescribed. Include a
written reminder on the time and frequency of the medication

EXERCISE - Advise to perform range of motions and repetitive body movement.

 
- Instruct to avoid doing activities that can result stress

TREATMENT - instruct the client to increase fluid intake

 
-Advise patient to have enough bed rest

HYGIENE - Doing personal hygiene like brushing teeth using soft toothbrush to avoid
reduce risk of injury to oral mucosa, trimming nails, proper hand washing
and taking bath every day.
 
- clean beddings and room for controlled environment

OUT-PATIENT - Encourage patient to comply with the recommended medical and laboratory
follow-ups.
 
- Advise the client to go back immediately when unusual signs and symptoms
are felt.
 
- Educate patient on the use of mosquito nets and insecticides

DIET - Advise the patient to eat healthy foods and drink a lot of water.
 
-Encourage patient to eat foods rich in vitamin K such as green leafy
vegetables.

SPIRITUAL - Encourage the patient to always pray to God for good health and guidance
VII. FDAR

DATE/HOUR FOCUS PROGRESS NOTES

01/10/2023-12:00PM Hyperthermia DATA:

- Complains of On & Off fever
- Warm to touch
- body malaise
- skin rashes
- Headache for 2 days (pain scale of 6/10)
- V/S: T: 38.5°c, PR: 88bpm, RR: 20cpm, BP:
100/70mmHg
 

ACTION:
- Monitor Vital Signs
- Administer 500mg Paracetamol q4h as per doctor’s
order.
- Perform Tepid sponge bath
- encourage enough fluid intake
- encourage enough rest
 

RESPONSE:
- Temperature decreased from 38.5°c to 37°c.