CASE STUDY

SECTION 24
What is DENGUE?
A virus called dengue (also known as break-bone fever) is transmitted from
mosquitoes to humans. In tropical and subtropical regions, it is more prevalent. The
majority of dengue patients experience no symptoms. However, the most typical
symptoms for those who do include rash, nausea, body aches, headaches, and high
fever. Dengue can be lethal in severe situations. Since there is currently no specific
treatment for dengue, it is managed with pain medication.
Statistics
Globally, 2.5 to 3 billion individuals live in approximately 112 countries
that experience dengue transmission.
Annually, approximately 50-100 million individuals are infected.
Dengue fever has a mortality rate of less than 1%.
When treated, DHF has a mortality rate of 2-5%, but when left untreated,
the mortality rate is as high as 50%.
Statistics
Based on the DOH's latest epidemic-prone disease case
surveillance report, 72,333 dengue cases were recorded from
January to June 17, 2023, which is 14 percent higher than the
63,526 in 2022. There were also 249 deaths due to dengue in the
Philippines last year.
Significance of the Study
This study aims to determine whether dengue fever has the potential to
contribute valuable insights, information, and solutions to address the
challenges posed by this infectious disease.

The study will be beneficial to all and will improve their current awareness
with regards to dengue.
01 ASSESSMENT
About the Patient
Name: Anthonie Kharol Lacre Calledo
Age: 13 years old
Sex: Male
Room #: 414 (STATION 2, SABAL HOSPITAL)
Address: Cugman, Cagayan de Oro City
Religion: Baptist
Date of Admission: January 07, 2024
Date of Discharge: January 11, 2024
Chief Complaint
High Fever (4 days)

History of Present Illness

Headache, Body Malaise, and Chest pain

Past Medical History

Admitted @Sabal Hospital, when he was 1 year old, due to vomiting
Physical Examination
HEAD EARS
Shape and size of skull: Normal External ear: Normal in appearance
Scalp: No abnormalities, no lesions Tympanic membrane: Intact
Face: Pale Hearing problem: No complaints of hearing loss
EYES
Vision: Clear
MOUTH & PHARYNX
Eyebrow and eyelid: No swelling or redness
Eyeball: Normal Mouth: Dryness and peeling Lips due to dehydration
Conjunctiva: slight redness and fever.
Sclera: White no signs of jaundice Teeth : Clean, no cavities noted
Cornea and Iris: Clear, No signs of inflammation Tongue: Dryness
Pupil (accommodation): Equal and reactive to light Throat & pharynx: Redness
Lens: Clear
Physical Examination
ABDOMEN
Inspection: No possible abnormalities
Auscultation: Normal Bowel Sounds in all Quadrants
Palpation: Tenderness in Right Upper Quadrant
Percussion: Tympanic sound throughout the abdomen,
no dullness.
NECK
Thyroid gland: No enlargement or nodules
Lymph node: Normal
Range of motion: Full range of motion, no pain on
movement
CHEST
Breath sounds: Murmurs bilaterally.
Lungs: Some wheezing or crackles.
Heart: Irregular rate and rhythm, murmurs
present.
NOSE
Nose: No discharge and swelling
External nares: normal in appearance
Nostrils: clear, no obstruction
Diagnostics & Procedures
COMPLETE BLOOD COUNT (CBC)
-provides information about cells in your blood, including red blood cells, white blood
cells and platelets. It helps to assess severity of the infection.

SPECIFIC INDICATION
-patient with dengue may show a decrease in platelet count, which is a common
characteristics of dengue fever monitoring platelet levels is crucial in managing dengue
patient assess the risk of bleeding complication.
Diagnostics & Procedures
RESULTS
Date ordered Date done Values obtained Normal values

Platelet - 140,000 - Low WBC - 4,500-11,000

January 7, 2024 January 7, 2024 Platelet - 150,000-450,00
WBC -2,630 - Low
Platelet - 118,000 - Low WBC - 4,500-11,000
January 8, 2024 January 8, 2024 WBC -2,190 Low Platelet - 150,000-450,00
Neutrophils - 470 - Low Neutrophils - 2,500-7,000

Platelet - 118,000 - Low WBC - 4,500-11,000

January 9, 2024 January 9, 2024 WBC -2,190 - Low Platelet - 150,000-450,00
Neutrophils - 290 - Low Neutrophils - 2,500-7,000
Platelet - 122,000 - Low Platelet - 150,000-450,00
January 10, 2024 January 10, 2024 Neutrophils - 190 - Low Neutrophils - 250-700
Eosinophils - 80 - HIgh Eosinophils - 30-35

January 11, 2024 January 11, 2024 Neutrophils - 230 Low Neutrophils - 250-700
Eosinophils - 80 - High Eosinophils - 30-35
ANATOMY & PHYSIOLOGY

BONE
MARROW
ANATOMY
ANATOMY & PHYSIOLOGY
LIVER ANATOMY
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
02 PLANNING
List of Prioritized Nursing Diagnosis
-Hyperthermia related to the disease process of dengue fever as
evidenced by temperature of 38.
-Fluid volume deficit related to increased fluid loss secondary by fever
as evidenced by patients verbalization of thirst.

-Risk for Infection related to decreased platelet count and altered

immune response due to dengue fever.
-Fluid volume deficit related to increased fluid loss secondary by fever as
evidenced by patients verbalization of thirst.
Cues Plan of Care
Subjective Short term – after 4 hours
of nursing interventions,
the patient will maintain
Patient verbalizes “ ma
adequate fluid volume at
giuhaw kayo ko ma”
functional level as
evidenced by adequate
urine output, stable vital
signs, moist mucous
membrane and good skin
turgor.
Objective
Decresed urine output
Dry skin
Long term – after 24 hours
Dry mucous membrane of nursing interventions,
Weakness the patient will exhibit no
Temp of 38C further episodes of
dehydration
Intervention
Independent
Monitor vital signs
Monitor intake and output
Assess patient’s hydration
status
Encourage adequate fluid
intake
Provide cool environment
Offer oral fluids
Provide nutritionally balanced
diet
Educate patient’s family on
the importance of maintaining
a proper hydration and
nutrition status regularly.
Dependent
Administer IV as prescribed by
physician
Replace electrolytes as
ordered
-Hyperthermia related to the disease process of dengue fever as evidenced by
temperature of 38.
Cues Plan of Care Intervention

Subjective Short term Independent

After 4 hours of
patients Monitor patient’s temperature
nursing degree and pattern
verbalizes “ma interventions, the Provide tepid sponge baths
init kayo ako patient will maintain Offer fluids to maintain
hydration
lawas” core temperature Ensure comfortable
within normal range environment to conclude rest
Provide cool environment
Objective Loosen or remove excess
Long term clothing or covers
Flushed skin After 24 hours of
Restlessness nursing Dependent

interventions, the
Temp of 38C Administer antipyretic
patient will be free medication as prescribed
of complications Infuse intravenous cooled
saline as ordered.
-Risk for Infection related to decreased platelet count and altered immune
response due to dengue fever.
Cues Plan of Care Intervention
Independent
Subjective Short term
The client will Monitor and report any signs and
symptoms of infection.
patient complaint of maintain or restore
Instruct clients to perform hand
chills, fever, and body defenses hygiene when handling food or
aches eating.
Encourage increased fluid intake
Long term Encourage coughing and deep
The client will breathing exercises and frequent
position changes.
remain free of
Encourage sleep and rest
Objective
infection, as Limit visitors and reinforce the
Temp of 38C evidenced by reporting of signs of infection.
Encourage vaccination against
decreased platelet normal vital signs dengue
count and the absence of Encourage strict adherence to
prescribed antibiotic
signs and symptoms
of infection. Dependent
.
Administer antiviral as prescribed
by physician.
03 IMPLEMENTATION
Paracetamol
Nursing Responsibilities/
Indication Mechanism of Action Contraindication Effects
Patient Teaching

Used to reduce Works by Individuals with Side Effect Educate the patient on
the correct dosage
fever and relieve inhibiting the liver disease or a
Nausea (625g/1tab) and

mild to moderate production of history of allergic frequency (every 4 hours

Vomiting as prescribe by their
pain, which can prostaglandins in reactions to
Skin rash/ Itching healthcare provider.
be helpful in the brain, which acetaminophen Highlight the importance

managing the help to reduce should avoid of not exceeding the

recommended dosage to
symptoms of fever and block using biogesic. avoid liver damage.

dengue fever, pain signals. It’s also Advise the patient to

important to Adverse Effect monitor for side effects
including and And report any adverse
body aches avoid exceeding Liver failure reaction promptly.
the Liver damage Educating the patient to
avoid any alcohol
recommended consumption while taking
dosage to the medicine.
prevent potential
liver damage.
Cetirizine
Nursing Responsibilities/
Indication Mechanism of Action Contraindication Effects
Patient Teaching

Indicated for the Cetirizine, a Contraindicated Side Effect Emphasize the

importance of adherence
metabolite of in those patients drowsiness,
relief of to the prescribed dosage
hydroxyzine, is an with a known fatigue, and schedule.
symptoms Educate the patient about
antihistamine; its hypersensitivity tired feeling,
associated with the correct dosage and
principal effects to it or any of its dizziness, frequency of the
seasonal allergic
are mediated via ingredients or dry mouth, medicine
rhinitis caused by Advise patients about the
selective inhibition hydroxyzine. sore throat,
allergens such as potential for drowsiness
of peripheral H1 cough, and recommend avoiding
ragweed, grass activities requiring mental
receptors. It also nausea,
and tree pollens alertness until they know
possesses some constipation, or
in adults and how the medication
mast cell stabilizing headache. affects them.
children 2 years Encourage the patient to
of age and above. properties.
Adverse Effect adequate fluid intake to
Somnolence help manage potential dry
mouth as aside effect.
Headache Instruct the patient to
Dizziness report any sign of severe
affect of the medicine .
Dry mouth
Nifedipine
Nursing Responsibilities/
Indication Mechanism of Action Contraindication Effects
Patient Teaching

Indicated to treat Inhibits the entry Known Side Effect Educate the patient about
the dosage and frequency
of calcium ions by hypersensitivity Headaches
vasospastic of the medicine.
blocking these reaction to Dizziness Monitoring the patients
angina and Blood pressure regularly
voltage-dependent nifedipine and Flushing
chronic stable while taking nifedipine
L-type calcium pregnancy. Swollen ankles and report any
angina.
channels in Constipation significance changes to
their healthcare provider.
vascular smooth Dropping blood Instruct the patient to
muscle and pressure change position slowly,
especially from lying to
myocardial cells.
standing ,to avoid sudden
drops in blood pressure.
Advise patient to avoid
Adverse Effect consuming grapefruit or
Irregular it’s twice in taking
nifedipine.as it can
heartbeat interact and lead to
Heart failure potentially harmful effect.

Allergic reaction
04 EVALUATION
Evaluation of the Actual Nursing problem
-Fluid volume deficit related to increased fluid loss secondary by fever as evidenced by patients
verbalization of thirst.
Short term – after 4 hours of nursing interventions, the patient has maintained adequate fluid volume at functional level as evidenced by adequate urine output,
stable vital signs, moist mucous membrane and good skin turgor
Long term – after 24 hours of nursing interventions, the patient has exhibit no further episodes of dehydration

-Hyperthermia related to the disease process of dengue fever as evidenced by

temperature of 38.
Short term- After 4 hours of nursing interventions, the patient has maintained core temperature within normal range
Long term- After 24 hours of nursing interventions, the patient is now free of complications

-Risk for Infection related to decreased platelet count and altered immune response due to
dengue fever.
Short term - The client has maintained or restore defenses
Long term - The client remained free of infection, as evidenced by normal vital signs and the absence of signs and symptoms of infection.
Planning Instructions
M -Nefidipine, Cetirizine & Paracetamol.
E -Exercise (Dandasana or Staff Pose).
T -No specific treatment, just supportive care.
H -Avoid crowded places, use repellant, and proper clothing.
O -Monitor Signs and Symptoms.
D -Foods that can boost immunity and increase platelet count.