Introduction

Dengue is a mosquito-borne infection that in recent decades has become a major international public health concern. Dengue is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas.

Dengue hemorrhagic fever (DHF), a potentially lethal complication, was first recognized in the 1950s during dengue epidemics in the Philippines and Thailand. Today DHF affects most Asian countries and has become a leading cause of hospitalization and death among children in the region.

There are four distinct, but closely related, viruses that cause dengue. Recovery from infection by one provides lifelong immunity against that virus but confers only partial and transient protection against subsequent infection by the other three viruses. There is good evidence that sequential infection increases the risk of developing DHF.

Dengue hemorrhagic fever is a leading cause of serious illness and death among children in some Asian countries. There is no specific treatment for dengue, but appropriate medical care frequently saves the lives of patients with the more serious dengue hemorrhagic fever. The only way to prevent dengue virus transmission is to combat the disease-carrying mosquitoes.

GOAL

To be knowledgeable about the nature of Dengue Fever Syndrome, management and treatment to be able to render effective nursing care to the client.

PATIENT’S PROFILE

Name: Mr. XAge: 4 years oldGender: MaleAddress:

Date of Birth: August 31, 2005Place of Birth: ManilaNationality: FilipinoReligion: Roman CatholicCivil Status: SingleDate of Admission: April 26, 2010Time of admission: 1:58 a.m.

Physician: Dr. Roberto Ibañez Place of Admission: Pavilion 8 – San Lazaro Hospital

Admitting Diagnosis: Dengue Fever Stage 1

a.1 CHIEF COMPLAIN

The patient mother complains of high grade fever and vomiting with abdominal epigastric pain.

a.2 PRESENT ILLNESS

Four days prior to confinement Fever highest temperature 39.5 degree Celcius. Tempra 5ml every 4 hours was taken for 3 days which provide relief of symptoms. Three days prior to confinement, vomiting, undigested food approximately 3 spoons 3 x a day accompanied by abdominal pain epigastric, no cough, colds and diarrhea. Persistence of symptoms hence consult (+) weakness.

a.3 PAST MEDICAL YEARS

According to mother her son had Tonsillitis last April 21, 2010, and given medication of Amoxicillin 5ml every six hours for three days improved.

a.4 FAMILY HISTORY

According to mother no family member had same symptom

THEORETICAL FRAMEWORK

Patient X, is at the stage of preschool, was diagnosed of having Dengue Fever Syndrome (DFS) Stage. The case of patient X can be correlated with the theory of Florence Nightingale

Application Theory:

The case of patient X can be correlated with the theory of Nightingale wherein, the environment of the patient is a factor leading to recovery. Having a clean, well ventilated and quite environment is important in. With a nurturing environment, the body could repair itself.

PHYSICAL ASSESMENT

BODY PART METHOD USED

FINDNGS ANALYSIS

HEAD

Hair

Scalp

Face

Inspection With short black hair evenly distributed

(-) Seborrhea

Symmetrical

Normal.

Normal

Normal

SKIN Inspection Healthy young smooth skin

Normal

EYES

Eyebrow

Inspection Symmetrically

aligned Normal

Eyelashes

Conjunctiva

With normal distribution

With no presence of abnormalities

Normal

Normal

EARS Inspection Symmetrically

aligned

With earwax but no discharges

Normal

Normal

NOSE Inspection Symmetrically aligned

Normal

MOUTH

Lips Inspection Pale Abnormal. It is pale

Teeth

Tongue

With tooth decay

Tongue at midline

due to fever.

Normal

Normal

NECK Inspection Palpation

No enlargement of thyroid gland

Supple neck

Normal

Normal

SHOULDER AND BACK

Inspection Level shoulder

Normal

CHEST AND LUNGS

Inspection No crackles or sign

of abnormalities

Normal

HEART Auscultation No murmurs Normal

ABDOMEN InspectionPalpation

Flat, soft, nontender

Normal

PATHOPHYSIOLOGY

Bite of a aedes aegypti mosquito carrying a virus

Virus goes into the circulation

Infects cells & generate cellular response

Initiates destruction of the platelet

↑ Potential for hemorrhage

Stimulates intense inflammatory response Release of exogenous pyrogens The body releases anti-inflammatory

mediators(Histatin, Kinins)

↑ WBC (Neutrophils & Macrophages) Release of endogenous pyrogens Vascular response

Reset of hypothalamic thermostat Redness & Heat Fever Headache, Vomiting Epistaxis, Abdominal pain Muscle contract Blood vessels Circulatory Collapse Shock To produce construct to

Predisposing Factor:-Immuno compromised - Environment

Non- predisposing Factor:- Age:4 y/o- Male

Additional heat prevent loss of body heat DEATH SHIVERING CHILLS

HEMATOLOGY EXAMINATION

April 25, 2010

10:35pm

Laboratory Test Results Normal ValueHemoglobin 172 137-175 g/lHematocrit 0.51 0.40-0.51%

RBC 6.48 4.63-6.08MCV 79.02 80-96 FLMCH 26.5 27.5-33.2 Fg

MCHC 33.6 32.3-36.5%RDW 15.90 9.0-14.5%WBC 15.19 4.23-10.04

DIFFERENTIAL COUNT

Laboratory test Results Normal ValuePolys 0.31 0.55-0.65%

Lymphocytes 0.60 0.25-0.35Monocytes 0.09 0.02-0.10Eosinopils 0.00 0.02-0.04Basophils 0.00 0.00-0.01Platelets 56 150-450

HEMATOLOGY EXAMINATION

April 26, 2010

Blood Components Results Normal ValueWBC 12.5 4.8-10.8

RBC 4.66 4.7-6.1Hemoglobin 11.89 g/l 15-17Hematocrit 34.96 40-52

MCV 75 Fl 82-98MCH 25.54pg 28-33

MCHCPlatelets

34g/l29

33-36150-400

Neutrophils 35.30% 40-70Lymphocytes 50.10% 17.48Monocytes 9.70% 2-8Eosinophils 0.60% 3-9Basophils 4.30 0-5.000

SUMMARY

Patient X prior to confinement visit La Mesa Eco Park with his family to have a picnic. He complained to his mother that he was bitten by a mosquito in his back. After several days he suffered from high grade fever, about 39.5 ˚C. His parents gave him Tempra 5ml every four hours to relieve the symptoms, but another problem arises, he vomited undigested foods for three days accompanied by abdominal pain.

He was then confined in San Lazaro Hospital on April 26, 2010 with an admitting diagnosis of Dengue Hemorrhagic Fever Stage 1. During the course of his confinement he was transferred to ICU on the date of April 27, 2010. After two days, he was then again returned to the regular dengue ward seeking continual care to improve his condition.

RECOMMENDATION

We recommend that the patient increases his compliance to care and therapeutic regimen.

Improve patient’s nutritional status and promote proper hygiene. For the family members, to always clean their environment, and avoid places

with incidence of Dengue Fever. Use lotions with mosquito repellant effect before living their home. Use mosquito nets during sleeping hours. Do not let children play on those places prone to the possible habitats of such

vector. Eliminate vectors by changing water and scrubbing sides of lower vases once a

week.

Destroying breeding places of mosquito by cleaning the surroundings and keeping the water containers covered.

Avoid too many hanging clothes inside the house.

Conclusion

Hemoptysis and pulmonary hemorrhages are rare complications of DHF. Only one other case of DHF with such a presentation exists in the literature. Pathologic sections of the lung tissue showed diffuse hemorrhage completely filling the alveolar spaces as well as a diffuse alveolar damage-like reaction pattern along the surface of the alveolar septa. The patient failed to develop either a significant coagulopathy or thrombocytopenia, both of which are often seen in DHF and are thought to result in spontaneous hemorrhage. These findings may suggest that vascular permeability, platelet dysfunction, or other factors may play an important role in DHF-related hemorrhage.

 Discharge Planning

A. Patient's Name:Patient X is a 4 year-old male patient, who was diagnosed with Dengue

Hemorrhagic Fever Stage 1.

B. Diet:> Encourage nutritious foods like vegetables, meat and fruits.

C. Medications:> Give acetaminophen in case the temperatures increases.> Give oresol to replace fluid in the body.

D. Treatment:> Increased oral fluid intake.

E. Health Teaching:> D- discuss the possible source of infection of the disease to the mother.> E- educate the family/patient on how to eliminate those vectors.> N- Never stocked water in a container without cover.> G- Gallon, container and tires must have proper way of disposal.> U- Use insecticides at home to kill or reduce mosquito.> E- Encourage the family of the patient to clean the surroundings to destroy the

breeding places of mosquito.

MEDICATIONS

DRUG ACTION INDICATION CONTRAINDICATION ADVERSE REACTIONS

NURSING CONSIDERATIONS

Generic Name:Paracetamol

Brand Name:Biogesic

Classification:AnalgesicAnti-pyretic

Dosage:250g/5ml q4 PRN for fever

Paracetamol exhibits analgesic action by peripheral blockage of pain impulse generation. It produces antipyresis by inhibiting the hypothalamic heat-regulating centre. Its weak anti-inflammatory activity is related to inhibition of prostaglandin synthesis in the CNS.

Relief of fever, minor aches & pains.

Anemia, cardiac & pulmonary disease. Hepatic or severe renal disease.

Allergic skin reactions & GI disturbances

Renal or hepatic impairment; alcohol-dependent patients; G6PD deficiency.

DRUG ACTION INDICATION CONTRAINDICATION ADVERSE REACTIONS

NURSING CONSIDERATIONS

Generic Name:Amoxicillin

Brand Name:Amoxil,

Classification:CephalosporinsAntibiotic

Dosage:250g/5ml, 5 ml

q8 P.O.

Amoxicillin is a semisynthetic aminopenicillin of the β-lactam group of antibiotics. It has a broad spectrum of antibacterial activity against many gram-positive and gram-negative microorganisms, acting through the inhibition of biosynthesis of cell wall mucopeptide. It is rapidly bactericidal and possesses the safety profile of penicillin.

used to treat infections due to organisms that are susceptible to the effects of amoxicillin. Common infections that amoxicillin is used for include infections of the middle ear, tonsils, throat, larynx (laryngitis), bronchi (bronchitis), lungs (pneumonia), urinary tract, and skin. It also is used to treat gonorrhea.

Hypersensitivity to penicillins & other β-lactams.

Nausea, vomiting, diarrhea, rash, pruritus, urticaria.

Hypersensitivity to cephalosporins. Renal or hepatic impairment. Avoid prolonged use. Maintain adequate fluid intake esp w/ high doses. Pregnancy.

DRUG ACTION INDICATION CONTRAINDICATION ADVERSE REACTIONS

NURSING CONSIDERATIONS

Generic Name:Furosemide

Brand Name:Lasix

Classification:Loop Diuretics

Dosage:10mg

Rapid-acting potent sulfonamide “loop” diuretic and antihypertensive with pharmacologic effects and uses almost identical to those of ethacrynic acid. Exact mode of action not clearly defined; decreases renal vascular resistance and may increase renal blood flow.

Controlling high blood pressure

Treating water retention (edema) due to several causes, including congestive heart failure, cirrhosis, and kidney failure (renal failure).

Anuria; hepatic coma & precoma; severe hypokalemia &/or hyponatremia; hypovolemia w/ or w/o hypotension. Hypersensitivity to sulfonamides.

- dry mouth, thirst, nausea, vomiting;

- feeling weak, drowsy, restless, or light-headed;

- fast or uneven heartbeat;

- muscle pain or weakness;

- urinating less than usual or not at all;

- easy bruising or bleeding, unusual weakness;

- a red, blistering, peeling skin rash

Hypotension, latent or manifest DM, gout, obstruction of urinary passages; hepatic cirrhosis w/ concomitant renal insufficiency; hypoproteinemia; premature infant. Pregnancy, lactation

ASSESSMENT DIAGNOSIS PLANNNING INTERVENTION / RATIONALE EVALUATION

Subjective:

“ Nilalagnat ang anak ko”, as verabalized by the mother.

Objective:

Warm to touch With flushed skin Increase in body

temperature above normal range 38.5˚C

Hyperthermia related to illness as

manifested by increase in body

temperature above normal range

After 4 hours of nursing intervention

the patient’s temperature will

subside within normal range

Monitored vital signs especially the temperature. / To evaluate patient’s condition

Rendered TSB / to reduce body heat

Advised to wear loose clothing / to promote comfort

Advised to increase oral fluid intake / for good body hydration

Administered anti-pyretic drugs as per doctors order / to lower body temperature

Many bed rest to reduce metabolic demands/ Oxygen consumption

After 4 hours of nursing intervention the patient’s

temperature subsided within normal range 37˚C

NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION/ RATIONALE EVALUATION

Subjective:

“ Walang ganang kumain ang anak ko” as verbalized by the mother.

Objective:

Inadequate food intake less than recommended daily allowance

Perceived inability to ingest food

Lack of interests towards eating

Refused food offered

Imbalanced nutrition: less

than body requirements

related to inability to digest or

absorb nutrients because present

condition

At the end of the shift the patient will be able to:

Show interest towards eating

Ingest foods that he can tolerate

Request foods that he want to eat

Provided foods that are requested by the patients to stimulate the patient’s desire to eat

Administered the prescribed amount of food to provide patient with needed nutrition

Used flavoring agents such as sugars to enhance food satisfaction and stimulate appetite.

Promoted pleasant, relaxing environment, including socialization when possible to enhance intake.

Administered pharmaceutical agents as per doctor’s order to stimulate appetite.

At the end of the shift the patient was able to:

Showed interest towards eating

Ingested foods that he can tolerate

Requested foods that he want to eat

UNIVERSITY OF BATANGAS

COLLEGE OF NURSING AND MIDWIFERY

CASE STUDY

(DENGUE HEMORRHAGIC FEVER)

PREPARED BY:

Ilagan Kristine Layka

Maderazo Fe Amor

Marzan kristy

Olano Alberth Crisyne

Pasia Jesus

Perez Joey

PREPARED FOR:

Mrs. Maricel Gamas