Dengue Laboratory Details

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Dengue Hemorrhagic Fever(A Case Analysis) Page 1

Chapter 1

INTRODUCTION

Dengue fever, also known as break-bone fever, is an infectious tropical

disease caused by infection of the dengue virus. It is a mosquito borne of single

positive stranded RNA virus from the family Flaviviridae. It refers to a benign

form of disease with symptoms including fever, headache, muscle pain, joint

pains, pain behind the eyes, and skin rash that is similar to measles. In some

cases the disease develops into a life-threatening Dengue Hemorrhagic Fever

(DHF). It is a severe and sometimes fatal manifestation of the dengue virusinfection characterized by bleeding, low levels of blood platelets, and

hypovolemic shock.

Dengue is transmitted by mosquito Genus Aedes, principally female

Aedes Egypti. Other Aedes species that transmit the disease include: Aedes

Albopictus, Aedes Polynesiensis, and Aedes Scutellaris. There are four types of

dengue fever viruses that cause dengue fever worldwide. A person infected with

one type of dengue will only be immune to that type. Humans and primates arethe primary host of the virus, and infection can be acquired by a single bite. A

female mosquito becomes infective about eight to twelve days after a blood meal

from a person infected with dengue and becomes infected itself with the virus in

cells lining its gut, and remains infective throughout its life. During this period,

the virus spreads to other tissues including the mosquitos salivary glands and is

subsequently released into its saliva. The patients are usually infective from a

day before the febrile period to the end of it.

The mosquito has fine white dots at the base of its wings with white bands

on its legs. It is a day-biting and low-flying mosquito that appears between two

hours after sunrise and two hours before sunset. It usually remains one hundred

meters of where they hatched. Breeding places include any clear stagnant water

along and around the premises of the household.


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The incubation period (the time between the exposure and the onset of

symptoms) is three to fourteen days but most often four to ten days. It is more

common in young children between four to nine years old. Both sexes can be

affected. It is more frequent during rainy season. Dengue fever is more prevalent

in urban communities. It is life-threatening to people with chronic diseases such

as diabetes and asthma. Children often experience symptoms similar to common

cold and gastroenteritis (vomiting and diarrhea) but are more susceptible to the

severe complications.

In this case analysis, the researchers had sought information about a 44

year old client whose case is Dengue Hemorrhagic Fever. Upon gathering of

data, no rights have been bypassed and all precautions have been foreseen so it

would not harm the said client.

Herewith the researchers made a plan of care for the benefit of the client.

The care consists of a holistic approach so that recovery would be maximized in

a short period of time and wellness would be available in no time.

This case covers all the conditions of what the client had experienced and

it is limited only to the case and anything concerning it. With the help of God, this

case study has been made possible.


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Chapter 2

HEALTH HISTORY

A. Biographical Data

Patient X is 44 years old, married and was born on June 16, 1967 in

Palauig, Zambales. She is a Methodist. Her permanent residency is in Tubo-

tubo South, Santa Cruz Zambales with her husband and their four kids. She

works as a server in a canteen at Mariveles Bataan.

B. Present Health History

Three days prior to admission, Patient X had a fever early in the morning

and vomited twice. She sought consultation at the Santa Cruz Hospital for her

high grade fever. The doctor wanted to monitor her platelet because she was

suspected of Dengue. Her platelet result was 138.

Second days prior to admission, Patient X still had a high grade fever and

vomited two more times. Her platelet result was 147.

Prior to admission, Patient X complained of having pain in the stomach

and vomiting. Her platelet dropped to 99 and the doctor referred her immediately

to President Ramon Magsaysay Memorial Hospital. She was admitted on

September 1st, 2011 on 1:35 pm. Her admitting diagnosis was Dengue without

early warning signs

C. Past Health History

Patient X had vaccinations for BCG, DPT, Hepatitis B, and Tetanus

Toxoid. She had the measles at age of 6 and the chickenpox when she was 8.

She has no known allergies to drugs but she is allergic to bagoong, as

manifested by rashes. Her last menstrual period was on August 31, 2011. She


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has four children that were all normal deliveries.After the birth of her last child,

shes been getting a recurrent urinary tract infection.

She never had any serious accidents requiring hospitalizations and except

for this present condition she never had the need to be hospitalized for an illness.

D. Family Health History

Patient X is the eighth child out of nine. She has no known family history

of Diabetes Mellitus and Hypertension. Her father died when she was 28 years

old due to hydrothorax. He was an avid smoker and had a history of asthma and

high blood. Her mother is still alive at the age of 78, and has a history of stroke

and anemia. She was also an avid smoker for 62 years. She doesnt know if

any of her siblings have any health complications.

All of her four children are well and updated in their immunizations (BCG,

DPT, OPV, Hepatitis B, and Measles).

E. Psychosocial Health History

Patient X owns a house in Santa Cruz. Its a cemented house, with

two rooms and one bathroom. All her children reside with them and are

financially dependent.

Patient X also rents a room with her husband in Mareveles Bataan. The

boarding house is located in an area where the houses are overcrowded and

there arelots of plants and trees. She works as a server in a canteen seven days

a week and this is the first time that she got time off from work in the last three

months.

Patient X states that she and her husband dont drink alcohol or smoke

cigarettes. She goes to work daily and does household chores. She doesnt go

out much and socialize, but she does like to sing karaoke when she can.

Since the age of 16, she had a bad incident where she almost choked on

a tablet. Ever since then, she would let nature take its course whenever she got


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a fever, cough or colds. She is also scared of going to the doctor. If it wasnt for

her daughter forcing her to go, she would never have gone to get a consultation

on her own.

F. Dietary Health History

Patient X was vomiting on the day of her admission. She felt weak and

had poor appetite. But on any other normal day she likes to eat 2 cups of rice, 5

pieces of tuyo, coffee, a glass of water and banana for breakfast. She doesnt

have snacks between breakfast and lunch. At lunch time, she likes to eat 2 cups

of rice, a bowl of baboy sinigang, a glass of water and a soft drink. For her

afternoon snack, she eats 2 pieces of bread, cup of coffee and glass of water.

For dinner, she likes to eat 2 cups of rice, diningding and a glass of water.

Patient X doesnt drink enough water daily. At the most, she drinks only

four cups of water a day as opposed to 12 cups thats recommended daily. She

tries to balance what she eats by eating a serving of vegetables and fruit at least

once a day.


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Chapter 3

PHYSICAL ASSESSMENT

Generalappearance

Technique NormalActual

findingsInter-

pretation

Body built,height, weightin relation toclients age,lifestyle andhealth

Posture andgait, standing,sitting andwalking

Overallhygiene andgrooming

Body andbreath odor

Patientsattitude

Patients mood

Quality,quantity andorganization ofspeech

Inspection Proportionatevaries with ageand lifestyle

Relaxed, erectposture andcoordinatedmovement

Clean and neat

No body odor or

minor odorrelated to workor exercise; nobreath odor

Cooperative andable to followinstruction

Appropriate

according tosituation

Understandable,moderate pace,clear tone andexhibits thoughtassociation

Build slightlyfat

Able to sit andwalk

Fair hygiene

No body odor

Slightlycooperative

Irritable

Moderatepace and soft

Normal

Normal

Normal

Normal

Normal

Due to

environmentchanges

Normal


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DATE: September 02, 2011TIME: 8:30 am

WEIGHT: 62 kg

HEIGHT: 54

BODY MASS INDEX: 24.34

Weight Status Body Mass Index

Underweight < 18.5

Normal Weight18.5 24.9

Overweight25 29.9

Obesity30 - 40

Procedure Normal Vitals signs Interpretation

Blood Pressure


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Body part Technique NormalActual

FindingsInter-

pretation

SKIN

Skin color Inspection Varies fromlight to deepbrown,generallyuniform exceptin areasexposed to thesun

With presenceof petechiae inthe antecubitalarea

Due to rupturesof tiny capillaries

Skinmoisture

Palpation Moist skin Dry skin Due to fluid loss

Skin

Tempe-rature

Palpation Within normal

rangeT-36.5-37.5

Warm to touch

T-38.0 C

Due to excessive

sweating andvomiting

Skin turgor Palpation When pinchedskin springsback toprevious state

Skin springsback to previousstateimmediately

Normal

HEADScalp Inspection Lighter in color

Moist/Oily(-) Lice, anddandruff

Oily hair, no liceor dandruff

Normal

Hair Inspection Black orbrownEvenlydistributedThick or thin

Black and thinhair Normal

FACE

Eyes

Inspection Shape maybeoval androunded

Color dependson race

usually blackor brownEvenly placein lineNot protruding

Oval shape

Black andevenly placed in

line

Normal

Normal

Conjunctiva Inspection Meetscompletelywhen the eyes

Reddish in color Due toinflammationbehind the eyes


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are closedTransparentwith light pinkin color

Pupils Inspection Dilates when

looking atdistant objectConstrictwhen lookingat near object

Reacts to light Normal

Sclera Inspection Color is white(-) yellowishdiscoloration

Pinkish in color Due toinflammationbehind the eyes

EARS Inspection

Palpation

Earlobes arebean shaped,parallel and

symmetricalSome color asthe skin

No lesions,discharge ortenderness

Light brown incolor

No discharge orcerumen

Normal

Normal

NOSE Inspection Same color asthe face andskinIn the midline

No discharge

Light brown incolor andwithout anydischarge or

bleeding

Normal

MOUTH

Lips Inspection Pink and moist Dry lips Due to lack offluid intake

Gums Inspection Pinkish color,moist andtightly fitagainst eachtoothNo gumsbleeding

Slightly pink andno gumsbleeding

Normal

Teeth Inspection Firmly set andshiny white toyellowish color

Whitish in colorand all her teethare real exceptfor the twocentral incisorswhich aredentures

Normal


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Tongue Inspection Moist andslightly roughin the surface

Able to movefreely andwithoutpresence of coldsores

Normal

NECK Inspection

Palpation

Straight andmidline

Withoutmasses

Neck movesfreely withoutdiscomfort

Normal

BREAST Inspection

Palpation

Whenoverlying thebreast shouldbe overNipples arerounded,

averted samesized andequal in color(-) Dischargefrom thenipple

(-)tenderness(-) masses

Breast are evenand nodischarge fromthe nipple

Normal

ABDOMEN Inspection

Palpation

Color of skin isuniform

Contourmaybe flat orrounded

(-)Tenderness

Skin is uniformin color

No tenderness

Normal

Normal

EXTREMITIES Inspection Bothextremitiesequal in sizedhas equalcontraction

Presence ofpetechiae in theupperextremities

Due to rupture oftiny capillaries

LUNGS and

THORAX

Auscultation Clear breath

soundsQuite,effortlessrespiration

Quite and clear

breath sounds

Normal

MUSCOSKELETAL

Muscle size Inspection Equal in size Moves freely Normal


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Deformities

Palpation

Inspection

on the bothside of thebody

(-)tenderness

No deformitiesand bonecontractures

and nodeformities andtenderness


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Chapter 4

LABORATORY FINDINGS

A.HEMATOLOGY

Date: 09/01/11

Time: 1:15 pm

Test Normal Value Result Indication/InterpretationHematocrit 35-50% 48 NORMAL

Hemoglobin 11.0-16.5 g/dL 16.0 NORMAL

Leukocyte Count 4.5-11x109/L 5.6 NORMAL

Differential Count

Neutrophils 0.45-0.73% .72 NORMAL

Lymphocytes .20-.35% .28 NORMAL

Platelet Count 150-450% 112

DECREASED: May

indicate decreased

platelet production,

increased platelet

destruction.


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B.HEMATOLOGY

Date: 09/01/11

Time: 8:00pm

Test Normal Value Result Indication/Interpretation

White blood cells 4.5-11x10 /mm 5.2 10 /mm NORMAL

Red Blood cells 3.80-

5.80106/mm3

4.50 106/mm3 NORMAL

Hemoglobin 11-16.5 g/dl 12.5g/dl NORMAL

Hematocrit 35-50% 37.0% NORMAL

Platelet count 150-450% 93 DECREASED: May

indicate decreased


increased platelet

destruction

PCT .100-.500 .186 L% NORMAL

Mean

Corpuscular

Volume (MCV)

80-97 82 um NORMAL

Mean corpuscular

Hemoglobin

(MCH)

26.5-33.5 27.7pg NORMAL

Mean

Corpuscular

Hemoglobin

Concentration

(MCHC)

31.5-35 g/dl 33.7g/dl NORMAL

RDW 10-15% 14.0% NORMAL


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MPV 6.5-11 um3 7.8um3 NORMAL

PDW 10-18% 10.9% NORMAL

Differential Count

Lymphocyte 17-48% 29.1% NORMAL

Monocytes 4-10% 11.4% ELEVATED: May

indicateinfection that may

cause monocytosis

C. HEMATOLOGY

Date: 9/01/11

Time: 4:00am


White blood cells 3.5-10x10 /mm 4.2x10 /mm NORMAL

Red Blood cells 3.80-5.80 4.41 NORMAL

Hemoglobin 11-16.5g/dl 12.3g/dl NORMAL

Hematocrit 35-50% 36.1% NORMAL

Platelet count 150-450 L

103/mm

3

90 L

103/mm

3

DECREASED: : May

indicate decreased


increased platelet

destruction.

PCT .100-.500% .168 L% NORMAL

Mean Corpuscular

Volume (MCV)

80-97 um 82 um NORMAL

Mean corpuscular

Hemoglobin(MCH)

26.5-33.5 pg 27.8 pg NORMAL


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Mean Corpuscular

Hemoglobin

Concentration

(MCHC)

31.5-35 g/dl 34.0 g/dl NORMAL

RDW 10-15% 14.1% NORMAL

MPV 6.5-11 um3

7.5 um3

NORMAL

PDW 10-18% 8.6 L % DECREASED: May

indicate a variation in

platelet size which can be

sign of an active platelet

release.

Differential Count

Lymphocyte 17-48% 27.6% NORMAL

Monocytes 4-10% 17.1% ELEVATED: May indicate

infection that may cause

monocytosis.


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D.URINALYSIS

Date: 9/01/11

Time: 12:00pm

Macroscopic

Examination

Normal

FindingsResult Indication/Interpretation

Color Amber Yellow Orange Abnormal: May indicate

concentrated urine due to

dehydration, fever, bile,

excess bilirubin.

Transparency Turbid NORMAL

Microscopic

Examination

Red Blood Cells 5hpf Many NORMAL: May indicate

hematuria.

Pus Cells 0-8% 3-5% NORMAL

Epithelial Cells


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E.SEROLOGY

Date: 09/02/11

Time: 2:00 pm

Test Result Indication/ Interpretation

IgM Negative (-) NORMAL

IgG Negative (-) NORMAL

F. HEMATOLOGY

Date: 09/02/11

Time: 12:00pm


Hematocrit 35-50% 38% NORMAL

Hemoglobin 11.0-16.5 g/L 11.5 g/L NORMAL

Leukocyte Count 4.5-11x10 /L 4.0 x10 /L DECREASED: The body

is fighting infection

Differential Count

Neutrophils 0.45-0.73 0.57 NORMAL

Lymphocytes .20-.35 0.72 Elevated: May indicate

an active viral infection.

Eosinophils 0.00-0.04 0.01 NORMAL

Platelet Count 150-450 x10 /L 93 x10 /L DECREASED: : May

indicate decreased



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increased platelet

destruction.

G. HEMATOLOGY

Date: 09/02/11

Time: 10:00 pm



Hemoglobin 11.0-16.5 g/L 11.5g/L NORMAL

Leukocyte Count 4.5-11x109/L 9.5 x109/L NORMAL

Differential Count


Lymphocytes .20-.35 0.78 ELEVATED: May indicate

an active viral infection

and exhausted immune

system.

Platelet Count 150-450 x10 /L 93 x10 /L DECREASED: May

indicate decreased


increased platelet

destruction.


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H. HEMATOLOGY

Date: 09/03/11

Time: 4:00am


PROTIME(PT) 14.9-18.5

seconds

11.6 seconds DECREASED: May

indicate reduction in

clotting ability of the

blood.

% Activity 75-130% 124.9% NORMAL

INR 1.0 0.83 NORMAL

Activated Partial

Thromboplastin

Time (a PTT)

25-43 seconds 53.3 seconds ELEVATED: Increased in

clotting factor depletion

and circulating

coagulation.

I. HEMATOLOGY

Date: 09/03/11

Time: 6:00 am




Leukocyte Count 4.5-11 x10 /L 10.37 x10 /L NORMAL

Differential Count


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Lymphocytes .20-.35 0.54 ELEVATED: May indicate

an active viral infection.

Platelet Count 150-450 x109/L 95 x10

9/L DECREASED: May

indicate decreased


increased platelet

destruction.

J. HEMATOLOGY

Date: 09/04/11

Time: 6:00 am




Leukocyte Count 4.5-11 x109/L 10.5 x109/L NORMAL

Differential Count

Neutrophils 0.45-0.73 . 53 NORMAL

Lymphocytes .20-.35 .28 NORMAL

Platelet Count 150-450 x10 /L 125 x10 /L DECREASED: May

indicate decreased


increased platelet

destruction.


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Chapter 5

ANATOMY AND PHYSIOLOGY


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BLOOD

Humans can't live without blood. Without blood, the body's organs couldn't

get the oxygen and nutrients they need to survive. We couldn't keep warm or

cool off, fight infections, or get rid of our own waste products. Without enough

blood, we'd weaken and die.

Here are the basics about the mysterious, life-sustaining fluid called blood.

Blood Basics

Two types of blood vessels carry blood throughout our bodies:

1. Arteries carry oxygenated blood (blood that has received oxygen from the

lungs) from the heart to the rest of the body.

2. Blood then travels through veins back to the heart and lungs, where it

receives more oxygen.

As the heart beats, you can feel blood traveling through the body at pulse

points like the neck and the wrist where large, blood-filled arteries run close

to the surface of the skin.

The blood that flows through this network of veins and arteries is whole

blood, which contains three types of blood cells:

1. red blood cells (RBCs)

2. white blood cells (WBCs)

3. platelets

In babies and young kids, blood cells are made within the bone marrow

(the soft tissue inside of bones) of many bones throughout the body. But, as kids

get older, blood cells are made mostly in the bone marrow of the vertebrae (thebones of the spine), ribs, pelvis, skull, sternum (the breastbone), and parts of the

humerus (the upper arm bone) and femur (the thigh bone).

The cells travel through the circulatory system suspended in a yellowish

fluid called plasma, which is 92% water and contains nutrients, proteins,


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hormones, and waste products. Whole blood is a mixture of blood cells and

plasma.

Red Blood Cells

Red blood cells (also called erythrocytes) are shaped like slightly

indented, flattened disks. RBCs contain the iron-rich protein hemoglobin. Blood

gets its bright red color when hemoglobin picks up oxygen in the lungs. As the

blood travels through the body, the hemoglobin releases oxygen to the tissues.

The body contains more RBCs than any other type of cell, and each has a

life span of about 4 months. Each day, the body produces new RBCs to replace

those that die or are lost from the body.

White Blood Cells

White blood cells (also called leukocytes) are a key part of the body's

system for defending itself against infection. They can move in and out of the

bloodstream to reach affected tissues. Blood contains far fewer WBCs than red

blood cells, although the body can increase WBC production to fight infection.

There are several types of WBCs, and their life spans vary from a few days to

months. New cells are constantly being formed in the bone marrow.

Several different parts of blood are involved in fighting infection. Whiteblood cells called granulocytes and lymphocytes travel along the walls of blood

vessels. They fight germs such as bacteria and viruses and may also attempt to

destroy cells that have become infected or have changed into cancer cells.

Certain types of WBCs produce antibodies, special proteins that recognize

foreign materials and help the body destroy or neutralize them. The white cell

count (the number of cells in a given amount of blood) in someone with an

infection often is higher than usual because more WBCs are being produced or

are entering the bloodstream to battle the infection.

After the body has been challenged by some infections, lymphocytes

"remember" how to make the specific antibodies that will quickly attack the same

germ if it enters the body again.


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Platelets

Platelets (also called thrombocytes) are tiny oval-shaped cells made in the

bone marrow. They help in the clotting process. When a blood vessel breaks,

platelets gather in the area and help seal off the leak. Platelets survive only about

9 days in the bloodstream and are constantly being replaced by new cells.

Important proteins called clotting factors are critical to the clotting process.

Although platelets alone can plug small blood vessel leaks and temporarily stop

or slow bleeding, the action of clotting factors is needed to produce a strong,

stable clot.

Platelets and clotting factors work together to form solid lumps to seal

leaks, wounds, cuts, and scratches and to prevent bleeding inside and on the

surfaces of our bodies. The process of clotting is like a puzzle with interlocking

parts. When the last part is in place, the clot happens but if even one piece is

missing, the final pieces can't come together.

The body may not be able to repair itself through clotting alone, if large

blood vessels are severed (or cut). In these cases, dressings or stitches are used

to help control bleeding.

Nutrients in the Blood

Blood contains other important substances, such as nutrients from food

that has been processed by the digestive system. Blood also carries hormones

released by the endocrine glands and carries them to the body parts that need

them.

Blood is essential for good health because the body depends on a steady

supply of fuel and oxygen to reach its billions of cells. Even the heart couldn't

survive without blood flowing through the vessels that bring nourishment to its

muscular walls.

Blood also carries carbon dioxide and other waste materials to the lungs,

kidneys, and digestive system to be removed from the body.

Blood cells and some of the special proteins blood contains can be

replaced or supplemented by giving a person blood from someone else via a


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transfusion. In addition to receiving whole-blood transfusions, people can also

receive transfusions of a particular component of blood, such as platelets, RBCs,

or a clotting factor. When someone donates blood, the whole blood can be

separated into its different parts to be used in this way.


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( C )

Composition of whole blood

Component Function

PLASMA

Water Dissolves and transports molecules,blood cells, and heat

Electrolytes Normal extracellular fluid ioncomposition essential for vital cellularactivities

Nutrients Used for energy production, growth,and maintenance of cells

Wastes Travel to sites of excretion

ProteinsAlbumins: Transports lipidsGlobulins: Transports ions, hormones, and lipids

Fibrinogen: Essential component of clotting system

Formed Elements

Red blood cells Transports oxygen and carbon dioxide

White blood cells

Granulocytes

Nuetrophils Engulf debris and pathogensEosinophils Engulf items coated in antibodiesBasophils Stimulate inflammation on tissues by

releasing histminesAgranulocytes

Monocytes Engulf debris and pathogensLymphocytes Immune defense against pathogens,

toxins, and foreign substances

Platelets Participate in clotting response

Documents

Dengue Laboratory Details