Dr.

Jose Reyes Memorial Medical Center

Rizal Avenue, Santa Cruz, Metro Manila

__________________________
DENGUE HEMORRHAGIC FEVER
__________________________

Case Presentation
Submitted by:
Mr. Vandie P. Magallanes, RN

In Partial Fulfillment of the Requirement

Nurse I Applicant

INTRODUCTION
We live in our world today where everything seems to be in a fast face.
As it is, we cannot deny that things change over or in a certain period of
time. New technologies were being invented, clothes for fashion, jewelries,
luxuries mode of entertainment, etc. Its just like having a new mode of
socialization, cultures, beliefs, perceptions, adaptation to life and environment.
With all of these, one aspect of human being which are greatly affected and the
one which we have to be most concern of would be in the side of our heath and
well being.
In the Philippines there are many diseases illness arising because of
environmental changes that may be caused by human activities and
geographical conditions. It is considered as one of the tropical country and so
disease can spread through out the country.
One example of these is disease is what we called Dengue Fever and
dengue Hemorrhagic Fever (DHF). It is considered as one of the acute febrile
diseases caused by one of the four closely related virus serotype of the genus
flavivirus. It can be transmitted by Aedes Aegypti mosquito to humans usually
attacking during the day. One will experience onset of fever, severe headaches,
muscle and joint pains which will give name to Breakbone Fever or Bonecrusher.
There are also rashes characterized by bright red petechaie commonly seen on
the lowers limbs and on the chest. There may also be gastritis associated to
abdominal pain, nausea, vomiting, or diarrhea. Proper attention of health care
provider should be given including good assessment, early detection or diagnosis
and medications which are essential for total interference of prevention.

GOAL
General 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.

Specific Goal:

To be familiar with the etiology of the disease

To know the pathophysiology of the disease
To be aware of the signs and symptoms
To know its complications
To be knowledgeable on how to prevent the disease
To know the treatment and how to apply it
To know the diagnostic exam

PATIENTS PROFILE

Name: GNB
Age: 22
Gender: Male

Address: 1935 Tuntungin Putho, Los Banos Laguna

Date of Birth: November 22, 1993
Place of Birth: Calamba, Laguna
Nationality: Filipino
Religion: Baptist
Civil Status: Single
Occupation: Accountant
Date of Admission: May 23, 2016
Time of admission: 7:11 am
Physician: Dr. Marc Anthony G. Donguines
Place of Admission: Dr. Jose Reyes Memorial Medical Center
Admitting Diagnosis: Dengue Fever Syndrome

NURSING HISTORY

CHIEF COMPLAIN:
The patient complains of abdominal pain, headache, periorbital pain, fever
and general flushing of skin with on and off vomiting.

PRESENT ILLNESS
Two days prior to admission, the patient had an intermittent fever
associated with myalgia, abdominal pain, headache, periorbital pain with
vomiting episodes (2x) of previously ingested food. A few hours prior to
admission still the above sign and symptoms remain but already have (-)
vomiting with accompanying chills and was diagnosed with Dengue fever.
PAST MEDICAL YEARS
It was according to the patient that he wasn't been hospitalized yet not
until when he was diagnosed with Dengue Fever. Before that diagnosis,
he was already experiencing fever and his mom gives him a Paracetamol
for remedy.
FAMILY HISTORY
According to patient the only disease that the family has genetically is
Hypertension on both sides and no other diseases noted.
SOCIAL HISTORY
GNB is the son of Mr. and Mrs. Galido. GNB is currently working as an
Accountant at Jollibee World Wide Services at Pasig.
His father works as a Housekeeping at DJRMMC while his mother is a
housewife. He is living with his father in a dorm near his father workplace.
Hence, he visits his mother and siblings every weekends in Calamba,
Laguna.
ENVIRONMENTAL HISTORY
According to the patient the environment that the family has an open
drainage, wherein big rats and cockroaches can be seen. The house is
cleaned by his father. It was described by the patient that there are parts
of their house that is deprived from light.

HISTORY OF ILLNESS
During the mid of May, GNB and his family went to Lucban Quezon
to visit the sister of her mother and for the pahiyas festival. After a week he
started experiencing fever that persist only at night. As a remedy his mother gave
him Paracetamol to lower his body temperature. Except from fever hes also
experiencing abdominal pain, headache, periorbital pain with vomiting episodes
of previously ingested food.
As the above signs and symptoms persists, his parent decided to
bring him to the hospital.
Upon the physical assessment and after several diagnostic
procedures that the patient had undergone, he was diagnosed with T/c Dengue
Fever with warning signs and was admitted under the service of Dr. Marc
Anthony Donguines.

PHYSICAL EXAMINATION
PHYSICAL ASSESSMENT
Received Patient on bed awake conscious and coherent
With IVF PNSS 1000ml at 450 cc level and regulated at 180cc/hr
I. LINEAR MEASUREMENT
Height: 54
Weight : 61kgs.
PHYSICAL ASSESSMENT
NAME: GNB
DATE OF ASSESSMENT: May 23, 2016
VITAL SIGNS:
BP: 100/70 mmHg PR: 93bpm
RR: 20bpm Temp: 38.8C
General Appearance: Received on moderate high back rest, conscious and
coherent. Pale and has general flushing with rashes
Area assessed Technique
Used
Normal Findings Actual Findings Rationale

GORDONS 11 FUNCTIONAL HEALTH PATTERN

FUNCTION
Nutrition

Elimination

BEFORE
HOSPITALIZATION
Eats 3x a day
He loves to
eat bread &
processed
foods such as
hotdog,
tocino,
longanisa,
and others.
He doesnt eat
vegetables
and fish
Seldom drinks
water

Sleeping

CognitivePerceptual

He is able to
urinate &
defecate
normally
everyday by
himself
He doesnt
have any
problem on
his elimination
Defecates
usually early
in the morning
before going
to school
Has a regular
sleeping
pattern
Normal sleep
is 6-8 hrs. per
day but he
naps for 1-2
hrs in the
afternoon
Has a normal
cognitive

DURING
HOSPITALIZATION
Mostly eat
bread

INTERPRETATION

The Doctor ordered

DAT diet to the
patient except dark
colored food

This time he
frequently
drinks water
He can still
urinate &
defecate by
himself even
without an
assistance

To replace fluid loss

His condition doesnt

affected his
elimination pattern

Disturbed
sleeping
pattern

Due to adherence to
time of medication &
vital signs monitoring

He is
responsive &

Portraying
cooperativeness

Pattern

Self- PerceptionSelf concept

Role
Relationship
Pattern

SexualityReproductive
Pattern

Coping Stress &

Tolerance Pattern

Activity-Exercise
Pattern

Value-Belief
Pattern

perception
Can
comprehend
well
He responds
appropriately
to verbal &
physical
stimuli
Perceived
himself as a
good friend,
brother & son.

can
communicate
well

This time he
perceives
himself as an
approachable
person
This time his
role as a
patient is not
fully met

Due to his ability to

establish good
rapport to other
people

Due to his condition,

he is not aware of
performing his real
role in this field.

Same

Due to his youthful

mind, it is still not his
priority in life

At his age, he still

has a playful mind &
he doesnt mind the
stressors in life.
He only focuses on
simple things.

He was able
to do his
responsibilitie
s as a son &
brother
He doesnt
think of the
things like
having a
girlfriend &
getting
married.
He doesnt
fully identifies
his stressors.

Same

His daily
routine on
playing
computer. His
daily activities
were limited in
waking up in
the morning to
attend his
class & after
that going to
computer
shop.
He is a
Catholic

He interacts
with his
grandmother &
other people
around him
Cooperates
well to the
doctor &
nurses.

Due to their culture

preferences &

parents influence
Health Perception
Health Management
Pattern

He
perceived
his health
in the state
of good
condition

He thinks
that he is
not healthy

Due to his illness

HEMATOLOGY
EXAMINATION
RBC COUNT
WBC COUNT
HEMOGLOBIN

HEMATOCRIT

DIFFERENTIAL
COUNT
SEGMENTERS
LYMPHOCYTES
MONOCYTES
EOSINOPHIL
BASOPHIL
CLOTTING TIME
BLEEDING TIME
BLOOD TYPE
ESR
STAB
PLATELETS

REFERENCE
VALUE
4-6X10 / L
5-10X10g/L
Male: 140170gms/ L
Female: 120140gms/L
Male:0.430.54
Female:
0.37-0.45
12

0.55-0.65
0.25-0.35
0.02-0.06
0.01-0.03
0.01-1.0
--------------------------------------------------150-400x103
g/L

EXAM
RESULTS
Aug. 24,2009
5.1
3.0
155

INTERPRETATION
Aug. 26, 2009
4.7
2.4
138

Within normal range

0.47

0.42

Within normal range

0.57
0.43
--------------------------------------------------------------------------------172

0.40
0.60

166

Within normal range

Within normal range

Brand name/
Generic name
Acetaminophen
(Paracetamol)

Classification

Action

Nonopoiod
Produce
analgesics and analgesia
anti pyretics
by blocking
pain
impulses by
inhibitinfg
synthesis of
prostaglandi
n in the
CNS or of
other
substances
that
sensitize
pain
receptors to
stimulation.

Indication
Symptomatic
relief of pain and
fever. Relief of
headache,
toothachge, back
pain,
dysmenorrheal,
myalgias,neuralg
ias, etc.
Analgesics and
anti pyretic for
patients
hypersensitive to
aspirin

Adverse Effect

Contraindication

Rash, nausea,
Hypersensitivity.
vomiting, blood
Patients
dyscrasias ,
anemia, analgesic
nephropathy ,
nephrotoxicity ,
hypersensitivity
reactions

Nursing
consideration
Patients with
alcoholic liver
disease.
Impaired liver
or kidney
function

Assessment

Nursing Diagnosis

Subjective:
Nangangati ako as
verbalized by the
patient

Risk for impaired

skin integrity related
to

Objective:
V/S taken: Aug
24,2009 as of 4pm
BP 100/70mmHg
Temp. 36.5C
RR 22 bpm
PR 76bpm
- Redness of the
skin
- Skin rashes

Planning
Short Term Goal:
Within 2hours of
nursing intervention,
patient will
demonstrate
behavior in
preventing skin
impairment.
Long Term Goal:
After period of
hospitalization, the
patient will be able
to understand and
apply treatment/ or
therapy, regimen to
the skin impairment.

Nursing
Intervention
Independent
Nursing Action:
-Monitor vital signs
- Provide skin
hygiene through
sponge bathing &
changing regularly

Rationale

- Serves as baseline
data to determine
any discrepancies
-To maintain skin
integrity at optimal
level.

- Keep bed clothes

dry, use nonirritating materials, &
keep bed wrinkled
free

-To avoid lesions,

scratching of skin &
harboring of
microorganism.

- Palpate skin
lesions for size,
shape, consistency,
texture & hydration

- To assess extent of
involvement of skin
impairment.

- Encourage
reposition schedule
for client

-To prevent friction

that may cause
irritation of the skin

-Provide information
to the client about
the importance of
regular observation
& effective skin care

- To promote
wellness by gaining
knowledge on
treatment/ therapy

Evaluation
After 8 hours of
rendering effective
nursing intervention
the goal was
completely met as
evidenced by
patients
demonstration of
behavior in
preventing skin
impairment.
-patient verbalizes
comfortability,
decrease feeling of
itchiness and
gradual
disappearance of
rashes.
-patients skin
color(pigmentation)
becomes normal
(absence of
redness)

Assessment

Nursing Diagnosis

Subjective:
Masakit ang tiyan
ko as verbalized by
the patient.

Acute pain related to

clinical
manifestations of
dengue hemorrhagic
fever

Objective:
V/S taken: Aug
24,2009 as of 4pm
BP 110/70mmHg
Temp. 35.5C
RR 30bpm
PR 67bpm
- Guarding of
stomach
- Facial grimace
- Pain scale of 8

Planning
Short Term Goal:
Within 8 hours of
effective nursing
intervention patient
will be able to feel
less pain on his
abdomen.
Long Term Goal:
After period of
hospitalization, the
patient will be able
to maintain a relax
and calm abdomen.

Nursing
Intervention
Independent
Nursing Action:
-Perform a
comprehensive
assessment of pain
- Provide
nonpharmacologic
management like
change of position &
applying warm
compress
- Encourage divers
ional activities
- Encourage rest
period
Dependent nursing
intervention:
- Administer
medications as
order by physicians
such s gastroflora

Rationale

- To improve quality,
frequency & location
of pain.
-To alleviate pain.

-To divert his

attentions to the
pain
- To prevent fatigue

- To alleviate pain.

Evaluation
After 8 hours of
rendering effective
nursing intervention
the goal was
partially met as
evidenced by less
guarding of stomach
and patients
verbalize partial
relieve of pain.

Assessment

Nursing Diagnosis

Subjective:
Mainit po ang
katawan koas
verbalized by the
patient.

Elevated body
temperature related
to

Objective:
V/S taken: Aug
25,2009 as of 6pm
BP 110/70mmHg
Temp. 38.6C
RR 30bpm
PR 67bpm
- Flushing of skin
- Skin warm to touch

Planning
Short Term Goal:
Within 8 hours of
effective nursing
intervention patient
body temperature
will be decrease
from 38.6- 37.5C

Nursing
Intervention
Independent
Nursing Action:
-Monitor vital sign
- Monitor intake and
output
- Perform TSB

Long Term Goal:

After period of
hospitalization, the
patient will be able
to know the proper
management of
hyperthermia

-Increase oral fluid

intake
- Provide safe &
quite environment
-Inform the patient
about proper
management of
fever
Dependent nursing
intervention:
- Administer
medications as
order by physicians
such as
Paracetamol or any
anti pyretic drugs.

Rationale

- Serves at baseline
data.
-To know the fluid
balance of the body
- To reduce body
temperature through
the process of
conduction
- To prevent
dehydration and
support circulating
volume.
- To provide
conducive place to
rest .Inform the
patient about proper
management of
fever
- To be able for the
patient to know the
proper
management.
-To elevate the
patients body
temperature.

Evaluation
After 8 hours of
rendering effective
nursing intervention
the goal was
completely met as
evidenced by
patients body
temperature
decreases from
38.6-37.5C.
Patients skin not
warm to touch.
Normal complexion
of the skin.

PATHOPHYSIOLOGY
Predisposing Factor:
-Immuno
compromised
- Environment

Non- predisposing
Factor:
- Age:13 y/o
- Male

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
WBC (Neutrophils & Macrophages)
(Histatin, Kinins)

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

Additional heat
prevent loss of body heat
DEATH

SHIVERING
CHILLS

Discharge Planning
A. Patient's Name:
> C.J.S a thirteen year-old male patient, who was diagnosed with Dengue
Hemorrhagic Fever.
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.
> 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.