l.

Introduction

Dengue fever (dengue hemorrhagic fever DHF ) is an

acute febrile diseases which occur in the tropics, can be life-
threatening, and are caused by four closely related virus serotypes of
the genus Flavivirus, family Flavivirdae. It is also known
as breakbone fever, since it can be extremely painful.

Dengue is found in tropical and sub-tropical regions around the

world, predominantly in urban and semi-urban areas.

The incidence of dengue has grown dramatically around the

world in recent decades. Some 2.5 billion people – two fifths of the
world's population – are now at risk from dengue. WHO currently
estimates there may be 50 million dengue infections worldwide every
year.

In 2007 alone, there were more than 890 000 reported cases of
dengue in the Americas, of which 26 000 cases were DHF.

The disease is now endemic in more than 100 countries in Africa,

the Americas, the Eastern Mediterranean, South-east Asia and the
Western Pacific. South-east Asia and the Western Pacific are the most
seriously affected. Before 1970 only nine countries had experienced
DHF epidemics, a number that had increased more than four-fold by
1995.

Not only is the number of cases increasing as the disease is

spreading to new areas, but explosive outbreaks are occurring. In
2007, Venezuela reported over 80 000 cases, including more than 6
000 cases of DHF.

• During epidemics of dengue, infection rates among those who

have not been previously exposed to the virus are often 40% to
50%, but can reach 80% to 90%.
• An estimated 500 000 people with DHF require hospitalization
each year, a very large proportion of whom are children. About
2.5% of those affected die.
• Without proper treatment, DHF fatality rates can exceed 20%.
Wider access to medical care from health providers with
knowledge about DHF - physicians and nurses who recognize its
symptoms and know how to treat its effects - can reduce death
rates to less than 1%.
 II. Personal Data

Name: Mr. HEY

Address: Quezon City
Age: 19 y/o
Sex: Male
Civil Status: Single
Religion: Roman Catholic
Birth date: 02/19/91
Birth place: Manila
Room No: 745A
Hospital No: 330641

Attending Physician: Dr. Encarma

Medical Diagnosis: Dengue Fever Syndrome

Chief Complaint: Fever

III. History of Present Illness

3 days PTA, pt. had remittent fever (highest temp. of 40.7 C)

accompanied by chills, decreased appetite, general body weakness
and headache

Pt. self medicated with Paracetamol 500mg/tab every 2 hours

which proved slight relief of signs and symptoms.

1 day PTA, pt. had episodes of loose watery stools. Pt. also noted
appearances of petechial rashes on left extremity.

IV. Past Medical History

(+) HPN

V. Family History
 (+) Heart Disease – Grandmother (Mother Side)
(+) Increase BP – Mother Side
(+) Diabetes Mellitus – Father Side
(+) Cancer – Leukemia (Uncle in Mother Side)

VI. Social History

• Previous smoker – stopped 2 months ago.

• Used to consume 1 ppd (HS days)
• 3 sticks per day for 5 years
• Occasional alcoholic beverage drinker

VII. Patterns of Functioning

FUNCTION BEFORE DURING INTERPRETATION

HOSPITALIZATI HOSPITALIZATI
ON ON
Health • He perceived • He thinks • Due to his illness
Perception – his health in that he is not
Health the state of healthy
Management good
Pattern condition
Nutrition • Eats 3x a • He is • Because of the
day restricted in diet, he cannot eat
• Loves to eat eating dark certain food that he
any kinds of colored wants.
food. foods.
• Drinks water
frequently
Elimination • He is able to • He can still • His condition
urinate & urinate & doesn’t affected his
defecate defecate by elimination pattern
normally himself even • Urinates more
everyday by without an because of the
himself assistance increase in oral
• He doesn’t fluid intake
have any
problem on
his
elimination
Sleeping • Has a regular • Still sleeps 6- • He can still
sleeping 8 hours and manage to sleep
pattern gets a nap well.
 • Normal sleep more
is 6-8 hrs. frequently
per day but even there is
he naps for a nurse
1-2 hrs in the checking his
afternoon VS.
Cognitive- • Can • He is • His condition
Perceptual comprehend responsive & doesn’t affect his
Pattern well, can cognitive and
responds communicat perception pattern.
appropriately e well
to verbal &
physical
stimuli.
Self- Perception- • Perceived • He still • Due to his good
Self concept himself as a percieves relationship with
good, loving himself as a his loved ones.
friend and good, loving
son to his friend and
parents. son to his
parents.
Role • He was able • This time his • Because of his
Relationship to do his role as a condition, he
Pattern responsibiliti patient is not cannot do his role
es as a son & fully met as a family
brother member and as a
stuent.
Sexuality- • The patient • Same • Their relationship
Reproductive has a has been stronger
Pattern beautiful because of the
girlfriend. support that his
girlfriend gave him.
Coping Stress & • Cramming, • This time, he • The patient didn’t
Tolerance Noise. is able to have a problem
Pattern relax fully with relaxing
because of because there are
the good, no stressors.
calm and
quiet
environment
of the
hospital
Activity-Exercise • He do chores • His form of • The patient’s
Pattern in their exercise activity-exercise
house inside the pattern somehow
whenever he hospital is by decreased because
has the time. walking of his condition, his
 • He around the actions is limited.
sometimes ward.
jog around
their village.
Value-Belief • He is a • The patient • His relationship to
Pattern Roman still prays God didn’t change.
Catholic while he is
• He goes to staying in
Church every the hospital
Sundays

Vlll. Laboratory / Diagnostic Examinations

Laboratory Results Normal Values Analysis /
Examination Interpretation
Urinalysis WBC – 1-2 (0 – 4 / hpf) Increase
Bacteria - few Presence of Bacteria
Dengue Antigen (+) Positive in Dengue

lX. Physical Examination

• Conscious, Coherent, Not in Distress

• (+) Rashes both Upper and Lower Extremities
• (+) Dry lips
• flabby abdomen, soft and non-tender normoactive bowel sounds

X. Pathophysiology
Non- predisposing
Predisposing Factor: Factor:
- Environment - Age:19 y/o
- Male

↓
Bite of an 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

Xl. Nursing Diagnosis

Assessm Diagnosi Planning Interventi Rationale Evaluatio

ent s on n
Subjectiv Elevated Short Independ After 8
e: body Term Goal: ent: - Serves at hours of
“Mainit po temperat -Monitor baseline rendering
ang ure Within 8 vital sign data. effective
katawan related to hours of nursing
ko”as infection effective - Monitor -To know interventi
verbalized nursing intake and the fluid on the
by the intervention output balance of goal was
patient. patient the body completel
body - Perform y met as
temperatur TSB - To reduce evidenced
e will be body by
Objectiv decrease temperature patient’s
e: from 38.6- through the body
V/S taken: 37.8˚C process of temperatu
conduction re
BP: decreases
120/80 Long Term -Increase - To prevent from 38.6-
mmHg Goal: oral fluid dehydration 37.8˚C.
intake and support Patient’s
Temp. – After period circulating skin not
38.6˚C of volume. warm to
hospitalizati touch.
 RR – 20 on, the - To provide Normal
bpm patient will - Provide conducive complexio
be able to safe & place to rest. n of the
PR – 67 know the quite skin.
bpm proper environme - To be able
manageme nt for the
- Skin nt of patient to
warm to hyperthermi -Inform the know the
touch a patient proper
about managemen
proper t
managem
ent of
fever
– To
maintain the
Depende temperature
nt: of the
- patient
Administer within
medication normal
s as order range by
by using
physicians pharmacolog
such as ical
Paracetam measures
ol or any
anti –
pyretic
drugs.

Xll. Drug Study

Brand Classificatio Action Indicatio Advers Contraindica Nursing

Name / n n e tions Responsibil
Generic Effect ities
Name
Amlodipin Antihypertensi Inhibits For Headac Hypersensitivi Monitor BP
e ves the managem he, ty to Norvasc and pulse
(Norvasc) transport ent of dizzines before
of calcium HPN, s, therapy.
into Angina nausea
myocardia Pectoris Assess
l and location,
vascular duration,
 smooth intensity
muscle and
cells, precipitating
resulting factors of
in pt’s angina
inhibition pain.
of
excitation
–
contractio
n coupling
and
subsequen
t
contractio
n

Brand Classificati Action Indicatio Advers Contraindica Nursing

Name / on n e tions Responsibil
Generic Effect ities
Name
Ranitidine H2 Receptor Inhibits Maintenan Headac Hypersensitivi Asses pf for
(Zantac) Blocker gastric acid ce of he, ty to abdominal
Antagonist secretion Peptic blurred Ranitidine pain
disease vision
active
duodenal
and
gastric
ulcer

Brand Classificati Action Indicatio Advers Contraindica Nursing

Name / on n e tions Responsibil
Generic Effect ities
Name
Butamirate Anti tussive Supresses For Dizzine Hypersensitivi Asses cough
Citrate the cough Active ss, ty to drug type and
(Sinecod reflex cough. nausea frequency
Forte) and
vomitin Monitor
g adverse
reactions

Assess sleep
pattern
Brand Classificati Action Indicatio Advers Contraindica Nursing
Name / on n e tions Responsibil
Generic Effect ities
Name
Co – Antibiotics Amoxicillin For URTI , Diarrhe Hypersensitivi Instruct pt to
Amoxiclav inhibits LRTI a, ty to drug report any
(Augmentin transpeptid nausea hypersensiti
) ase, vity to drug
preventing
cross-linking
of bacterial
cell wall and
leading to
cell death

Brand Classificatio Action Indicatio Advers Contraindica Nursing

Name / n n e tions Responsibil
Generic Effect ities
Name
Bactidol Oral Protection Minor Lesions and Instruct pt
Antiseptic against oral sore ulcerations of not to
bacteria throat, oral / buccal swallow the
and fungal halitosis, mucosa medication
infection to gen. oral
give fast hygiene. Caution the
relief from pt that the
sore throat solution may
and mouth be too harsh
ulcers. to taste

Assess for
any lesions
in the mouth
of the pt.
CASE STUDY

Carl Masangcay
Secion lII-3
Group 3

Submitted to: Mam Amlog