Dengue Group Case Pres

Evolve.
Adapt.
Overcome.
CEFI is now ready.
DENGUE FEBRILE SYNDROME

COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
FOREWORD
Nursing was never an easy course, you will be bombarded with different
cases that will truly enhance your knowledge and skills in the profession.
Polycystic ovarian syndrome is one of the common endocrine disorders in
women of childbearing age. This case study contains information useful in
the development and advancement of science. All are based on statistics,
researches, studies, and books conducted and written by different medical
specialists.
Thus, this paper functions to disseminate information and knowledge
with my co-nursing students. Also, to perform better interventions as a nurse
in the future. This will be useful for future researchers conducting similar
studies, hoping that they will be able to improve and deepen the study.
COLLEGE OF NURSING
DEDICATION
To my co-nursing students, I hope this study would be useful in improving your
respective cases as you will be able to deepen this study.
To my professor, for motivating and giving us hard tasks that serve as challenges; for
enhancing our skills and for guiding us throughout the study by helping us improve its
contents.
To my family and friends, for their utmost support and love. Without them, I am
demotivated to continue anything now.
To science, for existing and evolving day by day. Your works and advancement make a
person who he is today; for developing life-saving treatments to human beings.
Lastly, to Almighty God, for reminding me that He is always by my side giving me
strength, knowledge, wisdom, and peace of mind that I need every day.
COLLEGE OF NURSING
OBJECTIVES
At the end of the study, the students will be able to identify not only the disease
process and clinical manifestations of Dengue Febrile Syndrome but also the
interventions necessary.
Specific Objectives:
By the end of this case study, we will be able to:
 Understand Dengue Febrile Syndrome

 Identify the Laboratory and Diagnostic Result
 Discuss the pathophysiology of Dengue
 Discuss the medical management of Dengue
 Discuss the nursing care plan for patient with Dengue
 Provide a comprehensive discharge plan for the patient to achieve optimum health
management even after discharge.
COLLEGE OF NURSING
OVERVIEW OF THE DISEASE
Dengue Febrile Syndrome is an acute mosquito born viral

infection from the bite of a female Aedes Aegypti. It is sometimes
referred as breakbone fever or dandy fever because patients often
have contortions due to severe muscle, bone, and joint pain they
experience. Everyone is prone to dengue but immunocompromised
are at higher risk.
Dengue cases are more common in tropical areas, with local
variations in risk influenced by rainfall, temperature, relative
humidity. Poor hygiene and environment are also factors
contributing to the disease. If dengue fever was failed to address, it
may develop into dengue hemorrhagic fever and dengue shock
syndrome. Currently, there is no direct treatment for the disease, so
symptomatic treatment is given.
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Sign and Symptoms

The symptoms can develop only after 6 to 10 days after bitten by an infected mosquito.
 The patient might feel week with  extreme headaches

high fever(high, about 104 F-105 F),
for 3-7 days
 Multiple rashes and
 Severe joint and muscle pain
wounds on the skin.
 Diarrhea, vomiting and Loss of  Gum and nose

appetite. bleedings.
Others:
 A sudden drop in blood
 Pain behind the eyes. pressure
 Swollen Glands
COLLEGE OF NURSING
PATIENT’S DATA
INFORMATION Date: September 4, 2021 Bed No. 439
Name: Patient D Age: 7 y/o
Birthdate: April 17, 2014 Religion: Roman Catholic
Address: Akap Village Red-V Little Baguio II Brgy. Ibabang Dupay Lucena City, Quezon
Province
Weight: 22 kg Civil Status: Single
Height: 3’11 ft
CHIEF COMPLAINT: “Ilang araw na pong nilalagnat at nagsusuka ang anak ko. Sobrang sakit din
daw po ng ulo.” as verbalized by the mother
DIAGNOSIS: Dengue Febrile Syndrome
Attending Physician: Dra. Rein Vergara

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PHYSICAL ASSESSMENT
General examination Other observations:
• General Condition: Severely ill • Facial Grimace
• State of consciousness: Compos mentis • Facial and skin flushing
• Vital Signs: • Warm to touch (indicate high fever)
BP- 80/60 mmHg • (+) Headache
PR- 110 cpm • (+) Abdominal pain
RR- 28 bpm • (+) Muscle pain
T - 38.6 °C • (+) Joint pain
WT- 22 kg. • (+) Thirst
HT- 3'11 ft. • (+) Nausea
• (-) Diarrhea
Mental Status
• Lethargy
• Restlessness
• Irritability
COLLEGE OF NURSING
ASSESSMENT FINDINGS INTERPRETATION

Body Build,
Height and Appropriate for age NORMAL SKIN
Weight
Uniformity of
Posture and distorted body positions Flushed Red ABNORMAL
ABNORMAL Skin Color
Gait (due to pain)
Skin
Body and Dry Skin ABNORMAL
No body and breath odors NORMAL Moisture
Breath Odor
Skin Warm to touch - Beyond
Signs of ABNORMAL
Distress is Present ABNORMAL Temperature normal range
Distress
Attitude Uncooperative ABNORMAL
Affect or Not appropriate to the
ABNORMAL
Mood Situation
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EYES AND VISION

Evenly Distributed, Symmetrical,
Eyebrows Skin Intact NORMAL
Skin Intact, No Discharges, No

Eyelids NORMAL
Discoloration, Symmetrical
SKULL AND FACE
Equally Distributed, Slightly
Rounded and symmetrical, Eyelashes NORMAL
Head NORMAL curved outward
Smooth Skull Contour
Conjunctiv With red sore conjunctival ABNORMA
a suffusion L
Lacrimal
No Edema or Tearing NORMAL
Gland
Cornea Transparent, Shiny, Smooth & NORMAL

Blinks when cornea is touched
Black Color, Smooth Border
Pupils PERRLA, Equally round and NORMAL
reactive to light
Visual
Acuity Clear NORMAL
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NECK AND MUSCUSKELETAL

Shape and Symmetrical NORMAL
EARS AND HEARING Symmetry
Color is uniform, symmetric, Spinal Deformities Vertically Aligned NORMAL
Auricles mobile, Firm pinna recoils when NORMAL
folded Symmetrical with Head
Centered, no mass palpated,
Response to Neck Muscles without lessions, no NORMAL
Normal Voice Can hear Normal Voice Tone NORMAL enlargement of lymp nodes
Tone and pain
Coordinated, Smooth,
Head Movement Movement with no discomfort, NORMAL
Equal Strength
NOSE AND SINUSES
Muscle Weak and pain in muscles ABNORMAL
Nares No discharge and swelling NORMAL ( Severe myalgias)
No Deformities, No swelling or
Lining of Nose Nasal Septum in Midline NORMAL Bones Tenderness NORMAL
Joints Join paint ABNORMAL

Cannot perform ROM due to
Range of Motion pain
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OTHERS
MOUTH
Chest and lungs No adventitious sounds NORMAL
Lips and Buccal Dry mucus membrane
ABNORMAL
Mucosa and pale lips Abdominal pain or
Abdomen ABNORMAL
tenderness
Teeth and
Complete NORMAL GIT Loss of appetite ABNORMAL
Gums
In Midline, Freely Renal and
Tongue NORMAL
Moveable, Pink Urologic Decrease in Urine output ABNORMAL
changes
Palates and Light Pink, No Discharges, NORMAL
Uvula, Tonsils Present Gag Reflex Cardiovascular
None NORMAL
Changes
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PAST MEDICAL HISTORY

Past Medical History
• Previous Hospitalization: none Diet
• No allergies • Irregular meal/eating due to lack of
• No medical problem appetite
• No medication use • Not enough fluid intake
• Refuse highly color foods
Past Surgical History
• None Sleep pattern
• Average of 4-5 hours
Family History
• Not contributory (sleeplessness due to pain felt
cause by dengue)
Life Style Recreational/Hobbies
• Poor personal hygiene • No recreational activities due to lack of
• Lack of knowledge about tolerance
sanitation of environment
COLLEGE OF NURSING
HISTORY OF PRESENT ILLNESS

3 days before admission
(+) fever 38.7C
(+) vomiting
(+) loss of appetite
(+) headache 7/10 continuous, bilateral, frontoparietal area, throbbing,
non-radiating
(+) muscle and joint pains
(-) colds, (-) cough, (-) dysuria, (-) flank pain, (-) nose/ gum bleed
Self-medicated with paracetamol (Tempra) syrup 10 mL q4h which
relieved pain temporarily and fever subsided to 37.9C
COLLEGE OF NURSING
HISTORY OF PRESENT ILLNESS

2 days before admission
- Still with symptoms from yesterday
- Temperature still not within normal range
- Fever was relieved temporarily by paracetamol (Tempra) 10mL q4h
Few hours before admission

- Still with symptoms from yesterday
- Persistent fever impelled the patient to seek consult from the doctor,
leading to admission in the institution.
COLLEGE OF NURSING
LABORATORY AND DIAGNOSTIC RESULTS

Test Description
Dengue NS1 RDT Requested between 1-5 days of illness
Use to detect dengue virus antigen during early phase of acute dengue
infection
Dengue IgM/IgG Requested beyond five days of illness
Use to detect dengue antibodies during acute late stage of dengue
infection (IgM) and to determine previous infection (IgG)
May give false positive result due to antibodies induced by dengue vaccine
May cross react with other arboviral diseases such as Chikungunya and
Zika
Polymerase Chain Reaction One of the gold standard laboratory tests to confirm dengue virus.
(PCR) Molecular based test confirmatory test
Available only in dengue sub-national and national reference laboratories
Complete Blood Count Look for trend of decreasing WBC, decreasing platelet and increasing
hematocrit
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LABORATORY AND DIAGNOSTIC RESULTS

Examination Normal Values Actual Findings
Hematology Report
WBC 5.0-10.0x10⁹/L 3.0
RBC 4.2-5.6x10¹²/L 4.8
Hemoglobin 140-180g/L 130
Hematocrit 0.37-0.47 0.41
Platelet 150-400x10⁹/L 125
WBC Differential Count
Segmenters 0.40-0.60 0.85
Lymphocytes 0.20-0.40 0.13
Monocytes 0.02-0.05 0.02
COLLEGE OF NURSING
Physician: Dr. Rein Vergara September 4, 2021

Examination Normal Values Actual Findings Significance
Hematology Report
WBC 5.0-10.0x10⁹/L 3.0 Decreased due to inadequate inflammatory response
defense to suppress infection and anti-body mediated
immunity take place
RBC 4.2-5.6x10¹²/L 4.8 Normal
Hemoglobin 140-180g/L 130 Decreased Hgb results in RBC destruction or
infiltration of bone marrow with infectious cell
Hematocrit 0.37-0.47 0.41 Normal
Platelet 150-400x10⁹/L 125 The infected platelet cells tend to destroy normal
platelets
Segmenters 0.40-0.60 0.85 Increased due to infection.
Lymphocytes 0.20-0.40 0.13 Decreased due to illness, humoral response to take
place
Monocytes 0.02-0.05 0.02 Normal
COLLEGE OF NURSING
Physician: Dr. Rein Vergara September 4, 2021 6:00 pm

CBC with Platelet
Hemoglobin 125-160g/ dl 120 Decreased Hgb results in RBC destruction or infiltration of
bone marrow with infectious cell
Hematocrit 0.38-0.54 0.37 Decreased Hct results in RBC destruction or infiltration of
bone marrow with infectious cell
WBC 4.5-10.0x⁹/L 1.70 Decreased due to inadequate inflammatory response
immunity take place
RBC 4.2-6.2x10¹²/L 4.20 Normal
WBC Differential
Count
Segmenters 0.46-0.66 0.33 Decreased due to inadequate protection in an ongoing
infection because it acts as phagocytes and first to arrive in
infected site.
Lymphocytes 0.20-0.40 0.18 Decreased due to illness, humoral response to take place
Platelet 150-400x10⁹/L 128 The infected platelet cells tend to destroy normal platelets
COLLEGE OF NURSING
Physician: Dr. Rein Vergara September 5, 2021 8:00 am

Hematology Report
WBC 5.0-10.0x10⁹/L 2.5 Decreased due to inadequate inflammatory response
immunity take place
RBC 4.2-5.6x10¹²/L 5.0 Normal
Hemoglobin 140-180g/L 130 Decreased Hgb results in RBC destruction or
infiltration of bone marrow with infectious cell
Platelet 150-400x10⁹/L 130 The infected platelet cells tend to destroy normal
platelets
Segmenters 0.40-0.60 0.38 Decreased due to inadequate protection in an ongoing
infection because it acts as phagocytes and first to
arrive in infected site.
Lymphocytes 0.20-0.40 0.62 Increased immune response fighting infection
COLLEGE OF NURSING
Physician: Dr. Rein Vergara September 6, 2021

CBC with Platelet
Hemoglobin 125-160g/ dl 130 Normal
WBC 4.5-10.0x⁹/L 1.80 Decreased due to inadequate inflammatory response
immunity take place
RBC 4.2-6.2x10¹²/L 4.55 Normal

WBC Differential
Count
Segmenters 0.46-0.66 0.48 Normal

Lymphocytes 0.20-0.40 0.58 Increased immune response fighting infection
Platelet 150-400x10⁹/L 148 The infected platelet cells tend to destroy normal platelets
COLLEGE OF NURSING
Urinalysis
Urinalysis Normal Findings Actual Findings Interpretation
Color Normal urine is a transparent solution ranging from Yellow Normal
colorless to amber but is usually a pale yellow.
Transparency The turbidity of the urine sample is clear, slightly cloud, Clear Normal
cloudy, opaque. Normally, fresh urine is slightly cloudy.
Specific Gravity Normal urine density or values vary between 1.003– 1.005 Normal
1.035 (g·cm−3)
pH The pH of urine can vary (6)Acidic Acidic pH helps in 20 (6) Acidic Acidic pH helps in preventing
between 4.6 and 8, with neutral (7) being norm bacterial growth
WBC 0.2/HPF 1-2/HPF Normal
RBC 0.2/HPF 0-3/HPF May be due to bladder
problem
Bacteria Absent Few Presence of Infection
Epithelial Cells Absent Few Possible contamination of
specimen
COLLEGE OF NURSING
Physician: Dr. Rein Vergara September 7, 2021 6:00 pm

CBC with Platelet
Hemoglobin 125-160g/ dl 145 Normal
WBC 4.5-10.0x⁹/L 4.61 Normal
RBC 4.2-6.2x10¹²/L 6.0 Normal

WBC Differential
Count
Segmenters 0.46-0.66 0.50 Normal

Lymphocytes 0.20-0.40 0.39 Normal
Platelet 150-400x10⁹/L 155 Normal
COLLEGE OF NURSING
Urinalysis
Urinalysis Normal Findings Actual Findings Interpretation
Color Normal urine is a transparent solution ranging from Yellow Normal
colorless to amber but is usually a pale yellow.
Transparency The turbidity of the urine sample is clear, slightly cloud, Slightly turbid Normal
cloudy, opaque. Normally, fresh urine is slightly cloudy.
Specific Gravity Normal urine density or values vary between 1.003– 1.030 Normal
1.035 (g·cm−3)
pH The pH of urine can vary (6)Acidic Acidic pH helps in 20 (6) Acidic Acidic pH helps in preventing
between 4.6 and 8, with neutral (7) being norm bacterial growth
WBC 0.2/HPF 1-2/HPF Normal
RBC 0.2/HPF 0-3/HPF May be due to bladder
problem
Bacteria Absent Moderate Presence of Infection
Epithelial Cells Absent Few Possible contamination of
specimen
COLLEGE OF NURSING
Serology Result Form
Sample used: Whole Blood

Patient’s Result Interpretation
IgM IgG
TYPHIDOT
IgM IgG
Dengue IgM/IgG ✓POSITIVE POSITIVE LATE PRIMARY/ EARLY SECONDARY
DENGUE INFECTION
Dengue NS1 ANTIGEN NEGATIVE
COLLEGE OF NURSING
COLLEGE OF NURSING
ANATOMY & PHYSIOLOGY

The Immune System A second line of defense is housed
within the body: a finely tuned immune system that
recognizes and destroys foreign substances and organisms
that enter the body. The immune system can distinguish
between the body's own tissues and outside substances
called antigens. This allows cells of the immune army to
identify and destroy only those enemy antigens. The
ability to identify an antigen also permits the immune
system to "remember" antigens the body has been
exposed to in Interpretation: Platelets rapidly drops more
lower than normal range which would risk for bleeding
tendency and coagulation problems or hemolysis.
COLLEGE OF NURSING
COLLEGE
Calayan OF NURSING
Educational Foundation, Inc.
Lymphocytes is lower than normal range which might need help in fighting against nfection. .
Indicates decrease immune system Segmenters indicates high glucose level in the blood. WBC
a decrease value indicates inadequate inflammatory defenses to suppress infection and
humoral immunity takes place. 15 the past; so that the body can mount a better and faster
immune response the next time any of these antigens appear.
The immune system also includes other proteins and chemicals that assist
antibodies and T cells in their work. Among them are chemicals that alert
phagocytes to the site of the infection. The complement system, a group of
proteins that normally float freely in the blood, move toward infections, where
they combine to help destroy microorganisms and foreign particles. They do this
by changing the surface of bacteria or other microorganisms, causing them to
die.
COLLEGE OF NURSING
COLLEGE
Calayan OF NURSING
Educational Foundation, Inc.
Components of the Immune System:
1. Lymphoid Structures
 Spleen
- Composed of red and white pulp, acts somewhat like a filter.
- The red pulp is the site where old and injured red blood cells are
destroyed.
- The white pulp contains concentrations of lymphocytes.
 Lymph Nodes
- Are distributed throughout the body
- Are connected by lymph channels and capillaries, which remove
foreign material from the lymph before it enters the bloodstream.
2. Immune Cells – Lymphocytes

a. B lymphocytes (or B cells) - produce immunoglobulins.
b. T lymphocytes (or T cells) - help control the immune response and
destroy foreign antigens directly.
c. Plasma Cells - are white blood cells that produce large volumes of
antibodies.
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3. Tissues – The remaining lymphoid tissues, such as the tonsils and

adenoids and other.
 Mucoid Lymphatic Tissue – contain immune cells that defend the
body’s mucosal surfaces against microorganisms.
Types of Immune Defense:
a. Innate or Nonspecific Immunity
- Also termed as the person’s natural resistance, and are the most
basic and primary of all defenses in the body. (skin, mucus
membranes, phagocytic activity)
4. Immune Cells – Lymphocytes

d. B lymphocytes (or B cells) - produce immunoglobulins.
17
e. T lymphocytes (or T cells) - help control the immune response and
destroy foreign antigens directly.
f. Plasma Cells - are white blood cells that produce large volumes of
antibodies.
5. Tissues – The remaining lymphoid tissues, such as the tonsils and

adenoids and other.
 Mucoid Lymphatic Tissue – contain immune cells that defend the
body’s mucosal surfaces against microorganisms.
COLLEGE OF NURSING
PATHOPHYSIOLOGY
COLLEGE OF NURSING
MEDICAL MANAGEMENT
The management of Dengue Fever is actually simple as long as it
is detected early. Currently, there is no cure for dengue fever but
it can be managed through:
• Oral rehydration therapy. Recommended for patients with

moderate dehydration caused by high fever and vomiting.
• IV fluids. IVF administration is indicated for patients with
dehydration.
• Oral fluids. Increase in oral fluids is also helpful.
COLLEGE OF NURSING
• Acetaminophen. May be used to treat fever and relieve

other symptoms.
• Avoid aspirins. Aspirin can thin the blood.
• Avoid nonstreroidal anti-inflammatory drugs (NSAIDs)
they increase the risk for hemorrhage.
Evolve.
Adapt.
Overcome.
CEFI is now ready.
COURSE IN THE WARD

COLLEGE OF NURSING
Date Doctor’s Order Rationale Nursing Responsibilities

Day 1 Admit to ward Admission will help to monitor client’s condition.  Admit the patient as ordered
September 4  Prepare and filled out necessary documents
 Obtain health history taking
Secure Consent Informed consent is the patient’s autonomous  Explain the laboratory test and medications that
decision about whether to undergo a procedure the patient will undergo
Vital Signs every To monitor deviation from normal values  Monitor vital signs every shift, recorded and
Shift reported immediately any deviations
Obtain weight To assess the loss of weight from the day of  Take patient’s weight daily.
admission to day of discharge.
DFA but avoid highly Dark colored food may alter the color of the  Educate the patient on what food should be
colored food stool of the patient. avoided
Intake and Output Accurate intake and output are necessary for  Monitor and record the input and output every
every Shift determining fluid replacement needs and shift
reducing risk of fluid overload and reflects
circulating fluid shifts
Perform TSB To help reduce fever • Teach SO to perform tepid sponge bath on
patient.
Encourage increased To replenish lost electrolytes and fluids through • Encourage patient and SO to guide the patient in
fluid intake vomiting. increasing fluid intakes but more on clear fluids.
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Therapeutic: D5LR is a hypertonic solution that  Verified doctor’s order

IVF: D5LR 1Lx 12 hours given to prevent dehydration.  Regulate at 83 gtts/min and put on
IV tag
Laboratory:  Verified doctor’s order
1. CBC (Complete Blood  CBC is done to test if there is  Inform the patient about the
Count) blood loss procedure
2. Platelet Count monitoring  Filled out necessary forms
q6h  Dysfunction of platelets  Inform the laboratory department
is implicated in prothrombotic about the test
complications associated with  Followed up result and attach it to
severe cases of dengue patient’s chart
Medications:  Observe 14 rights of medication

1. Ascorbic Acid (Ceelin  To increase protection administration
chewables) 100 mg OD mechanism of the immune  Check physician’s order
2. Paracetamol Tempra syrup system and resistance to  Repeat the name of the patient
10 ml q4h infection.  Explain the medication to the
3. Metoclopramide 1 ampule  To reduce fever and relieve other patient
IV Q8 symptoms such as muscle pain.
 To prevent nausea and vomiting.
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Day 2 Vital Signs every Shift To monitor deviation from normal values  Monitor vital signs every shift,
September 5 recorded and reported immediately
any deviations.
 Perform TSB if necesarry
DFA but avoid highly Dark colored food may alter the color of  Educate the patient on what food
colored food the stool of the patient. should be avoided
Maintain Bed rest To reduce metabolic demands and oxygen  Provide clean and safe bed.
consumption.  Provide a well ventilated room.
 Pull the rails up.
 Provide comfort and access cool air.
Intake and Output Accurate intake and output are necessary  Monitor and record the input and
every Shift for determining fluid replacement needs output every shift
and reducing risk of fluid overload and
reflects circulating fluid shifts.
Refer to dietician For further evaluation and suggestion  Referred and endorsed accordingly.
regarding food partialities and nutritional
assistance.
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Refer to Pediatrician Refer for further assessment and  Referred and endorsed accordingly.
treatment
Therapeutic: D5LR is a hypertonic solution that given to  Verified doctor’s order
IVF: D5LR 1Lx 12 hours prevent dehydration.  Regulate at 83 gtts/min and put on IV tag
1. CBC (Complete  CBC is done to test if there is blood  Inform the patient about the procedure
Blood Count) loss  Filled out necessary forms
2. Platelet Count  Dysfunction of platelets is implicated  Inform the laboratory department about the
monitoring q6h in prothrombotic complications test
associated with severe cases of  Followed up result and attach it to patient’s
dengue chart

1. Ascorbic Acid (Ceelin  To increase protection mechanism of administration
chewables) 100 mg the immune system and resistance to  Check physician’s order
OD infection.  Repeat the name of the patient
2. Paracetamol Tempra  To reduce fever and relieve other  Explain the medication to the patient
syrup 10 ml q4h symptoms such as muscle pain.
3. Metoclopramide 1  To prevent nausea and vomiting.
ampule IV Q8

COLLEGE OF NURSING

Day 3 Vital Signs every Shift To monitor deviation from normal  Monitor vital signs every shift, recorded and
Septemb values reported immediately any deviations.
er 6  Perform TSB if necesarry
DFA but avoid highly Dark colored food may alter the  Educate the patient on what food should be
colored food color of the stool of the patient. avoided

Monitor Hb and Hct Indicators of anemia, active  Monitor, recorded and reported
and clotting factors bleeding or impending immediately any deviations.
complication.
Intake and Output Accurate intake and output are  Monitor and record the input and output
every Shift necessary for determining fluid every shift
replacement needs and reducing
risk of fluid overload and reflects
circulating fluid shifts.
Maintain Bed rest To reduce metabolic demands and  Provide clean and safe bed.
oxygen consumption.  Provide a well ventilated room.
COLLEGE OF NURSING

IVF: D5LR 1Lx 12 hours given to prevent dehydration.  Regulate at 83 gtts/min and put
on IV tag
1. CBC (Complete Blood  CBC is done to test if there is blood  Inform the patient about the
Count) loss procedure
2. Platelet Count monitoring  Dysfunction of platelets  Filled out necessary forms
q6h is implicated in prothrombotic  Inform the laboratory department
complications associated with about the test
severe cases of dengue  Followed up result and attach it to
patient’s chart

1. Ascorbic Acid (Ceelin  To increase protection mechanism administration
chewables) 100 mg OD of the immune system and  Check physician’s order
2. Paracetamol Tempra syrup resistance to infection.  Repeat the name of the patient
10 ml q4h  To reduce fever and relieve other  Explain the medication to the
3. Metoclopramide 1 ampule symptoms such as muscle pain. patient
IV Q8  To prevent nausea and vomiting.

COLLEGE OF NURSING

Day 4 Vital Signs every Shift To monitor deviation from normal  Monitor vital signs every shift, recorded
September values and reported immediately any deviations.
7  Perform TSB if necesarry
DFA but avoid highly Dark colored food may alter the  Educate the patient on what food should
colored food color of the stool of the patient. be avoided

Monitor Hb and Hct and Indicators of anemia, active bleeding  Monitor, recorded and reported
clotting factors or impending complication. immediately any deviations.
Intake and Output every Accurate intake and output are  Monitor and record the input and output
Shift necessary for determining fluid every shift
replacement needs and reducing risk
of fluid overload and reflects
circulating fluid shifts.
Maintain Bed rest To reduce metabolic demands and  Provide clean and safe bed.
oxygen consumption.  Provide a well ventilated room.
COLLEGE OF NURSING

IVF: D5LR 1Lx 12 hours given to prevent dehydration.  Regulate at 83 gtts/min and put
on IV tag
1. CBC (Complete Blood Count)  CBC is done to test if there is blood  Inform the patient about the
2. Platelet Count monitoring q6h loss procedure
 Filled out necessary forms
 Dysfunction of platelets  Inform the laboratory department
is implicated in prothrombotic about the test
complications associated with  Followed up result and attach it to
severe cases of dengue patient’s chart

1. Ascorbic Acid (Ceelin  To increase protection mechanism administration
chewables) 100 mg OD of the immune system and  Check physician’s order
2. Paracetamol Tempra syrup 10 resistance to infection.  Repeat the name of the patient
ml q4h PRN  To reduce fever and relieve other  Explain the medication to the
3. Metoclopramide 1 ampule IV symptoms such as muscle pain. patient
Q8 PRN  To prevent nausea and vomiting.

COLLEGE OF NURSING
Day 5 May go home  Provide written and verbal instructions at the

September 8 patient/family's level of understanding.
 Provide verbal and written information on what
signs and symptoms to observe and when to call
the physician
 Document all discharge teaching on discharge
instruction sheet and nurse’s notes
Home Meds: To increase  Explain the medication to the patient

1. Ascorbic Acid protection
(Ceelin mechanism of the
chewables) 100 immune system
mg OD and resistance to
infection
Evolve.
Adapt.
Overcome.
CEFI is now ready.
NURSING CARE PLAN

COLLEGE OF NURSING
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: Altered body SHORT TERM: INDEPENDENT: After 4 hours of nursing
“Ilang araw na temperature After 4 hours of  Establish rapport.  To attain trust and intervention goals and
pong nilalagnat related to the appropriate nursing cooperative of the patient. objectives was met as
ang anak ko” as process of intervention the  Monitor vital signs at least
 To establish a baseline evidenced by:
verbalized by the dengue virus patient will every 4 hours. data.  The patient’s body
mother. infection as  Display stabilized  Remove excessive clothing,  To regulate the temperature lowered to
evidenced by temperature within blankets and linens and temperature of the 37.5 C
OBJECTIVE: increase in body the normal range. adjust the room temp. environment and make it  Skin is cool and absence
 Temp: 38.6C temperature  Obtain PR and RR more comfortable for the of flushing.
 RR: 28 cpm higher than in normal range. patient.  The patient, together
 PR: 110 bpm normal range.  Perform tepid sponge bath.  To facilitate the body in with her significant
 BP: 80/60 cooling down and to other understand the
mmHg provide comport. causes of the disease
 Lethargic  Monitor platelet count  To look for low platelet and is ready to practice
 Skin warm to every 6 hours. count typical of the later specific interventions to
touch stages of the illness and to prevent hyperthermia.
 Flushed skin detect the decrease in
 Restlessness hemoglobin, hematocrit,
 Irritability and red blood cell.

COLLEGE OF NURSING
• Encourage client to • Water regulates body

increase fluid intake. temperature.
• Instruct the patient to • To avoid confusion on the
avoid highly colored food. color of vomit, urine and
stool.
• Instruct the patient how • To avoid transmission of
to perform handwashing. the bacteria.

DEPENDENT:
• Administer paracetamol • To alleviate the fever of
as prescribed by the the patient.
physician.

COLLABORATIVE:
• Refer to dietician. • For further evaluation
and suggestion regarding
food partialities and
nutritional assistance.
• Monitor and coordinate • To monitor any deviations
the laboratory results in results.
COLLEGE OF NURSING

Subjective: “ Imbalanced Short term: •Assess the weight of the •Provides baseline data The goal was met
Nagsusuka at Nutrition: Less After 6 hrs of nursing client about the client after nursing
nanghihina ang than body intervention, the patient •Identify situations the client •To decrease the possibility intervention the
katawan ng anak ko requirements will verbalize and perceived as “nauseatic” of nausea episodes upon patient was able to
wala parin siyang related to demonstrate selection of situation meal verbalize
gana kumain” nausea, foods or meals that will •Determine client’s nutritional •To assess the usual food understanding and
verbalized by the vomiting, achieve a cessation of history. that she eats demonstrate
mother of patient. dehydration and weight loss. Should also •Determine the client’s •Psychological factors selection of meals
no appetite as report adequacy of attitude towards eating. towards eating may that helps in
Objective: manifested by energy level affect one person’s achieving cessation of
•Small Body frame weight loss appetite and to weight loss and the
•Weak looking know the client’s patient has no sign of
•Pale eating habits. dehydration and had
•Nausea and •Encourage increase fluid •For hydration decrease episode of
Vomiting intake providing appealing nausea and vomiting
•Restlessness liquids and she will gain at
•Slight dehydration •Ensure proper IVF regulation •To ensure that there is least 5% of ideal body
upon skin turgor adequate hydration weight.
test
Weight: 21.5kg
COLLEGE OF NURSING
•Educate the client •Education provides

regarding the sample information
importance of eating that the client may not be
healthy foods and it’s benefits aware of, hence leading to
to his body. the kind of eating habits
she is following.
•Encourage the client to •To provide
maintain the intake of nourishment to the client
the healthy foods that keeps healthy.
needed by his body to
achieve ideal body weight.

Dependent:
•Administer pharmaceutical •To established nutritional
agents, as indicated: Vitamins plans
and antiemetic
Collaborative:
•Ask dieticians for further •Dieticians have a broader
evaluation and suggestions knowledge of the
regarding food partialities and nutritional value of foods
nutritional assistance. and may be useful in
evaluating specific ethnic
or cultural foods.
COLLEGE OF NURSING

Subjective : Acute Pain Short: INDEPENDENT After 6 hours of
“sabi po ng anak ko related to After 6-8hrs of nursing •Monitor vital signs • Alteration from normal nursing intervention
masakit po ang pathological intervention the patient maybe signs of infection. goals and objectives
kanya ulo at will be able to: •Observation of the patient's • Indicates the need for was met as evidenced
kasukasuhan nya ” disease process
as evidenced by level of pain (scale, intervention and also by:
as the mother • Report pain is relieved/ frequency, duration). the signs of the
verbalized guarding controlled, with the • No facial grimace
development /
behavior and pain scale of 2/10 from
resolution of • Able to verbalize”
Objective: facial grimace. 7/10 hindi na po
• Irritability complications.
•Observe for nonverbal • Some patients may deny masyadong
• Guarding behavior • Patient's pain be masakit ang ulo
• Facial grimace reduced and indicators of pain: moaning, the existence of pain.
• Weakness disappeared. guarding, crying, facial These behaviors can ko at kasukasuhan
• Pain scale 7/10 grimace. help with proper ko po”
• Maintain relaxed body evaluation of pain. • rated pain as 2 in
Vital signs : posture •Provide a quiet and • A comfortable the scale of 1-10
• BP-80/40 mmHg comfortable environment environment will help Stable vital signs:
• PR- 130 cpm and comfort measures the process of BP: 90/60 mmHg
• RR- 29 bpm relaxation. PR: 130 cpm
• T - 38.7 °C • Give proper entertainment • Refocused attention ;
• WT- 22 kg. T:37.3 C
activities. improve the ability to RR: 29 bpm
• HT- 3'11 ft. cope with pain.
COLLEGE OF NURSING
• Involve family in • Family will help the

nursing care. healing process by
training the patient
relaxation.
• Teach the patient • Relaxation pain will
relaxation move to other
techniques. things.
DEPENDENT
• Give analgesics as • Provide pain relief.
ordered by the
physician
Evolve.
Adapt.
Overcome.
CEFI is now ready.
DRUG STUDY
COLLEGE OF NURSING
THERAPEUTIC ACTION CONTRAINDICATION TOXICITY INTERVENTIONS SAFE DOSE

Paracetamol • central analgesic • Hypersensitivity to • liver • Do not exceed the recommended • 15 mg/kg per dose,
Generic Name: effect that is Acetaminophen damage dosage to a maximum of 1
Calpol mediated • Severe hepatic • stomach • Consult physician if needed for g per dose, every
through impairment pain children < 3 yr if needed for longer four to six hours,
Brand Name: activation of • Severe active • loss of than 10 days; if continued fever, severe with a maximum of
Dymadon descending hepatic disease. appetite or recurrent pain occurs (possible 60 mg/kg daily,
serotonergic serious illness). without exceeding 4
Drug class: pathways.
Acetaminophen • Avoid using multiple preparations g daily
• inhibition of containing acetaminophen. Carefully
prostaglandin check all OTC products.
(PG) synthesis or • Avoid using multiple preparations
through an containing acetaminophen. Carefully
active check all OTC products.
metabolite • Discontinue drug if hypersensitivity
influencing reactions occur.
cannabinoid • Treatment of overdose: Monitor serum
receptors. levels regularly, N-acetylcysteine
should be available as a specific
antidote; basic life support measures
may be necessary.
COLLEGE OF NURSING
THERAPEUTIC ACTION CONTRAINDIC TOXICITY INTERVENTIONS SAFE DOSE

ATION
Metoclopramid • blocking a natural • patients with •restlessness • Monitor BP carefully • 0.1-2
e substance pheochromo fatigue during IV administration. mg/kg 1
Generic Name: (dopamine). cytoma •diarrhea • Monitor for Ampule
Reglan • speeds up stomach • Gastrointesti extrapyramidal IV q6-
emptying and nal bleeding reactions, and consult 8hr PRN
Brand Name: movement of the physician if they occur.
Reglan upper intestines.
• Assess for
• Increases peristalsis gastrointestinal
Drug class: without stimulating
Antiemetic secretions. complaints, such as
Agents, • Enhances response to nausea, vomiting and
Prokinetic acetylcholine of tissue constipation.
Agents in the upper
gastrointestinal tract,
which results in
contraction of gastric
muscle.
COLLEGE OF NURSING
THERAPEUTIC ACTION CONTRAINDICATION TOXICITY INTERVENTIONS SAFE DOSE
Ascorbic Acid • increase • blood • Negative • Lab tests: Periodic Hct & Hgb, serum • 25-100
Generic Name: protection disorders stool electrolytes. mg/day
Ascorbic mechanism thalassemia guaiac • Monitor for S&S of acute hemolytic
Acid/Ascorbate of the G6PD effects anemia, sickle cell crisis.
Sodium immune deficiency • nausea • Take large doses of vitamin C in
Brand Name: system and
Cenolate, resistance sickle cell and divided amounts because the body
disease diarrhea uses only what is needed at a
Vitamin C to
Drug class: infection. hemochromat particular time and excretes the rest
Vitamins, Water- osis in urine.
Soluble • Megadoses can interfere with
absorption of vitamin B12.
• Note: Vitamin C increases the
absorption of iron when taken at the
same time as iron-rich foods.
COLLEGE OF NURSING
COLLEGE OF NURSING
M •
DISCHARGE PLAN
Advice the family/relatives to continue the prescribed home medications to ensure optimum recovery.
Medicine • Ascorbic Acid 100mg Ceelin Chewables
E • Encourage the Parents to clean surroundings.
Environment • Provide a clean environment.
• Advised patient/ Parents to cover water barrels and other storage for water.
• Avoid dark places and heavily polluted areas.
• Do not stock water without cover to avoid mosquito breeding and emptying containers or water.
T • Instruct the parents to increase fluid intake.
Treatment • Instruct patient or parents to have complete bed rest.
H • Advise to put on insect repellants.
Health • Use screens or mosquito nets when sleeping.
Teaching • People can prevent mosquito bites by wearing clothing that fully covers the skin.
• Maintain good hygiene by daily taking a bath.
O • Instruct patient to continue follow-up check up to the doctor.
Outpatient • Instruct the parents to report immediately to health care provider if these symptoms occur: high fever,
referral severe headache, Pain behind the eye, severe joint and muscle, nausea and vomiting and rash.
D • Drink a lot of water, at least 8-10 glasses of water a day.
Diet • Eat healthy foods such as (fruits, vegetables, and meat).
• Instruct the patient to eat foods rich in iron like green leafy vegetable and organ meats.
COLLEGE OF NURSING
PROGNOSIS
The prognosis for dengue is commonly good. For patient D, she

recovered after 1 week of admission in the hospital. Currently,
there is no specific medicine to cure dengue. Symptomatic
treatments are used in the hospital. For most cases, patients, they
make full recoveries which is similar to the case of Patient D.
However, if left untreated it may turn severe and lead to internal
bleeding and organ damage. In some cases, severe dengue leads to
death.
COLLEGE OF NURSING
REFERENCES
https://byjus.com/biology/dengue/
https://www.slideshare.net/noomnumgentlegirl/case-study-dengue-fever-15463675
www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue
https://www.slideshare.net/rozymea/dengue-hemorrhagic-fever-case-study
https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue
https://www.slideshare.net/mjhernandez23/individual-cstudy-100613-print
https://youtu.be/CtaVL3d2vqA
https://image.slidesharecdn.com/individualcstudy10-140205075317-
phpapp02/95/case-study-dengue-fver-18-638.jpg?cb=1391586881
https://youtu.be/b3DsPDyPnv8
https://www.medicines.org.uk/emc/product/1561/smpc#gref
https://www.ncbi.nlm.nih.gov/books/NBK252/
https://byjus.com/biology/dengue/
https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue
https://www.scribd.com/document/126492677/Dengue-Case-Study
file:///C:/Users/Acer/Downloads/individualcstudy10-140205075317-phpapp02.pdf
https://ncp-blog.blogspot.com/2015/01/ncp-for-acute-pain-related-to-dengue.html
https://www.nursebuff.com/nursing-care-plan-for-pain/
https://www.scribd.com/doc/20629006/NCP-Acute-Pain
Evolve.
Adapt.
Overcome.
CEFI is now ready.
THANK YOU! 
COLLEGE OF NURSING
ASSIGNED PARTS
• Arellano, Ark Aaron – Drug Study
• Cadacio, Everly May – Medical Management
• Gagolinan, Harvey – Anatomy and Physiology
• Mataragnon, Rainelle Kaye – Pathophysiology and Course in the Ward
• Niegas, Eunice Ida Marie – NCP (Imbalanced Nutrition)
• Rodelas, Rhea Mae – Overview of the Disease, Physical Assessment, Past Medical
History
• Saguno,Gleisy – Course in the Ward and Discharge Plan
• Soliman, Ezekiel Daniel – NCP (Altered body temperature)
• Sumilang, Nina Mae – Objectives, History of Present Illness, Laboratory and
Diagnostic Results, Prognosis
• Villena, Faith Anne – NCP (Acute pain)

Dengue Group Case Pres

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Dengue Group Case Pres

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Evolve.

DENGUE FEBRILE SYNDROME

 Understand Dengue Febrile Syndrome

OVERVIEW OF THE DISEASE

Dengue Febrile Syndrome is an acute mosquito born viral

Sign and Symptoms

 The patient might feel week with  extreme headaches

 Diarrhea, vomiting and Loss of  Gum and nose

Attending Physician: Dra. Rein Vergara

ASSESSMENT FINDINGS INTERPRETATION

EYES AND VISION

Skin Intact, No Discharges, No

Cornea Transparent, Shiny, Smooth & NORMAL

NECK AND MUSCUSKELETAL

Joints Join paint ABNORMAL

PAST MEDICAL HISTORY

HISTORY OF PRESENT ILLNESS

HISTORY OF PRESENT ILLNESS

Few hours before admission

LABORATORY AND DIAGNOSTIC RESULTS

LABORATORY AND DIAGNOSTIC RESULTS

Physician: Dr. Rein Vergara September 4, 2021

Physician: Dr. Rein Vergara September 4, 2021 6:00 pm

Physician: Dr. Rein Vergara September 5, 2021 8:00 am

Physician: Dr. Rein Vergara September 6, 2021

RBC 4.2-6.2x10¹²/L 4.55 Normal

Segmenters 0.46-0.66 0.48 Normal

Physician: Dr. Rein Vergara September 7, 2021 6:00 pm

RBC 4.2-6.2x10¹²/L 6.0 Normal

Segmenters 0.46-0.66 0.50 Normal

Serology Result Form

Sample used: Whole Blood

ANATOMY & PHYSIOLOGY

Components of the Immune System:

2. Immune Cells – Lymphocytes

3. Tissues – The remaining lymphoid tissues, such as the tonsils and

4. Immune Cells – Lymphocytes

5. Tissues – The remaining lymphoid tissues, such as the tonsils and

• Oral rehydration therapy. Recommended for patients with

• Acetaminophen. May be used to treat fever and relieve

COURSE IN THE WARD

Date Doctor’s Order Rationale Nursing Responsibilities

Therapeutic: D5LR is a hypertonic solution that  Verified doctor’s order

Medications:  Observe 14 rights of medication

Date Doctor’s Order Rationale Nursing Responsibilities

Medications:  Observe 14 rights of medication

Date Doctor’s Order Rationale Nursing Responsibilities

Therapeutic: D5LR is a hypertonic solution that  Verified doctor’s order

Medications:  Observe 14 rights of medication

Date Doctor’s Order Rationale Nursing Responsibilities

Therapeutic: D5LR is a hypertonic solution that  Verified doctor’s order

Medications:  Observe 14 rights of medication

Day 5 May go home  Provide written and verbal instructions at the

Home Meds: To increase  Explain the medication to the patient

NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

• Encourage client to • Water regulates body

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

•Educate the client •Education provides

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

• Involve family in • Family will help the

THERAPEUTIC ACTION CONTRAINDICATION TOXICITY INTERVENTIONS SAFE DOSE

THERAPEUTIC ACTION CONTRAINDIC TOXICITY INTERVENTIONS SAFE DOSE