DENGUE FEVER

A Case Presentation
Presented to the Faculty of St. Luke’s College of Nursing

In Partial Fulfillment of the Requirements

In Related Learning Experience for the
Degree of Bachelor of Science in Nursing

Submitted by:
2NU01
Quiaño, Elijah R.

April 2019
 TABLE OF CONTENTS
I. Objectives
A. General
B. Specific
II. Introduction
III. Patient’s Profile
A. Demographic Data
B. Chief Complaint
C. History of Present Illness
D. History of Past Illness
E. History of Family Illness
F. Social History
G. Allergies
H. Assessment
1. Physical Assessment
2. Gordon’s Functional Health Pattern
IV. Anatomy and Physiology
V. Pathophysiology
VI. Diagnostic Procedures and Laboratory Examinations
VII. Drug Study
VIII. Nursing Theory
IX. Nursing Care Management
X. Discharge Plan
I. Objectives

General Objectives

● This case study aims to develop the application of critical and analytical thinking in the

nursing practice.

● To be able to apply critical skills with a patient with Dengue

● To be able to analyze common signs and symptoms of a patient with Dengue

● To be able to synthesize possible ways to avoid Dengue from the patient’s experience

Specific Objectives

● To practice safe and quality nursing care by formulating Nursing Care Plans

● To give health education by performing health teaching with the patient and his family

● To practice legal and ethico-moral responsibility by documenting care rendered to the

patient

● For personal and professional development.

● Promotion of quality nursing service.

● To apply research findings in nursing practice

● To improve record management by maintaining accurate and updated documentation

of patient care

● To practice therapeutic communication with the client.

● To establish collaborative relationship with colleagues and other members of the health

team for the health plan

Introduction

Dengue is a mosquito-borne viral disease that has rapidly spread in all regions according

to the WHO. The Dengue virus is spread by female mosquitoes (Aedes aegypti). They can also

transmit chikungunya, yellow fever and the Zika infection.

Dengue fever is a severe, flu-like illness and seldom causes deaths. Dengue should be

suspected when a patient has a forty degree Celsius and is accompanied with severe headache,

pain behind the eyes, muscle and joint pain, nausea, vomiting, swollen glands or rash.

Symptoms usually last for two to seven days. There is a vaccine present for dengue, the

Dengvaxia, although it is for people who had Dengue prior to the vaccine.

Latest data from the DOH-Epidemiology Bureau showed that from January 1 to

November 17 this year, 179,540 dengue fever cases were reported and recorded nationwide,

more than the 135,166 cases in the first 11 months of 2017.

Patient’s Profile
A. Demographic Data of the Patient
Name: J.L.C.
Age: 16Y9M16D
Sex: Male
Address: B 29 Ampalaya st Tumana Marikina City Metro Manila
Civil Status: Single
Occupation: N/A
Nationality: Filipino
Religion: Christian
Date and Time of Admission: 03/25/2019 ; 5:20AM
Admitting Diagnosis: Dengue fever with warning signs
B.Chief Complaint
Fever, Abdominal pain
C.History of Present illness
Patient was said to have noted on and off fever (His highest recorded temp 38.5 oC) with on and
off abdominal and joint pain. No vomiting and no bleeding noted. Patient has not consulted a
doctor. Patient has stated that “wala po akong tini-take na gamot “. When brought to the
hospital he stated that “Pagpunta po sa hospital bukod po sa dalawa sumakit po ng sobra ulo
ko.” Patient states “Hindi pa po ako nagkakaDengue” also followed by “Hindi pa po ako
nahohospital , ngayong pa lang po”
D.History of Family Illness
Father: (+) htn. He states that “High blood lang po meron ang pamilya naming eh, sa side po ni
erpat”
E. Social History
Patient is an out of school youth. He finished up to grade six due to family problems that he did
not want to disclose. He has a history of Marijuana use, he has stopped using it for 2 years
prior to the hospitalization. Patient was reluctant and did not want to answer any questions
regarding his family, although he did state that he used to drink and smoke with some of his
family members; he did not disclose who those family members were. During his stay with his
family he used to smoke every day, around 5 sticks an average while he leisured outside of their
home for around 6 hours.
The patient wants to keep the reason as to why he was in DSWD in confidentiality. However in
the patient’s chart the patient is accused of murder 3 months ago and is under investigation
thus his custody with the DSWD. He states that his stay with the DSWD was pleasant; He states
their meals were rationed and distributed among the times of 8AM 12 NN and 6PM. His diet
during the stay with the DSWD, according to him, made him maintain a good diet that the
rations composed of rice, meat and vegies. He also states that he drinks water regularly during
the stay with the DSWD. According to him their time of sleep was at 7PM and they sleep until
6AM. He states that he has no trouble sleeping. He made no enemy among with the fellow
children living there. He was not able to smoke anymore when he moved into the DSWD.
F. Allergies
Patient has stated that he’s NKA. There is also no drug allergy noted when tested.
H. Assessment

GENERAL APPEARANCE: Patient states that he is fine.

Although he also states that there is
pain and is avoiding moving the
painful areas (upper back and knees).

VITAL SIGNS: Hospital day: April 3, 2019

PR: 93 PR: 97
RR: 20 RR: 20
T : 38.0* T : 38.2*
BP: 130/20* BP: 140/20*

SKIN: Skin appears to be normal. There are

no signs of edema. Although his
there are small spots on his skin. He
states that they were always there

LYMPH NODES: There is slight swelling and is

palpable.
HEAD: Head appears to be normal.
Although there is limited ROM of the
head.

EYES: Eyes are responsive to light. Eyes are

able to follow objects. Pupils are
equal and round. PERRLA

EARS: Ears are normal no signs of

deformities. Amount of wax is
normal and is expected

NOSE: No nasal flaring observed. Breath

sounds appear to be normal on both
sides.

MOUTH: Lips are slightly dry. Mouth shows no

signs of ulcers. Teeth appear to be
normal. The tongue is responsive to
taste and movement. Mouth is pink
without lesions

THROAT: Swallowing is present and normal.

NECK: Neck has limited ROM due to pain.

Skin integrity appears to be normal.
The carotid artery can be easily seen
palpating.

BACK: Normal with no discoloration, small

spots are visible in the lower back.
There is pain on the upper back. VAS
3/10

THORAX: Breathing sounds are normal. There

are no lesions.

LUNGS: Clear breath sounds, no retractions.

BREAST: Breast are round, almost

symmetrical and normal

HEART: Normal bpm. Heart sound is

abnormally very loud.
ABDOMEN: Abdomen has no lesions. It is flabby
with normal active bowel sounds.

EXTREMITIES: Joints are responsive. Pulses can

easily be located due to the
palpitation

MUSCULOSKELETAL: Joints in upper extremities are

normal and responsive. There is pain
in the knee joint VAS 7/10 when
standing. Patient states that “bibigay
po ang tuhod kapag nakatayo”. No
swelling is present. Moving the
patella would show no pain. There is
no pain upon squeezing and moving
the patella side to side.

NEUROLOGIC: Responsive to questioning. Answers

are related to the question. Patient is
alert and response time are normal

2. Gordon’s Functional Health Pattern

Date: April 3, 2019
Temperature: 38.2 Route: Auxiliary
Pulse Rate: 97 Site: Radial
Respiration Rate: 20

GORDON’S FUNCTIONAL HEALTH PATTERN

Before Hospitalization During Hospitalization

Health Perception and Management

He states that “Hindi ko priority yung He states that “Nagbago na pananaw

kalusugan ko. Wala naman akong ko. Kailangan kong pangalagaan ang
nararamdaman na masakit. Hindi rin katawan ko. Nakakatakot
ako nagpapacheck up”. magkasakit.”
 Nutritional and Metabolic

Patient states “Yung DSWD na bahala He states that “Importante pala na i-

sa diet ko. Okay lang naman, parang monitor yung diet. Lalo na yung
balanse naman eh” tubig.”

Elimination

Patient states that “Normal naman Patient states that “Eh ngayon, ang
kapag umihi ako, mga 4 na beses pag ihi ko 3 beses nalang, minsan 4.
isang araw. Tapos sa pagdumi, mga Tapos pagdumi ko normal parin
isa.” naman, isang beses kada araw”

Activity and Exercise

Patient states that “Hindi ako Patient states that “Ganun parin,
masyado nageexrcise eh, mahilig lang cellphone lang ako lagi eh. Wala rin
ako mag cellphone. Yun lang” naman akong magagawa kasi nandito
ako”

Sleep and Rest

Patient states that “Sa DSWD Patient states that “nakakatulog

natutulog kami ng 7PM-6AM, wala naman ako ng 6AM-7PM parin pero
naman akong hirap matulog. Kapag nagigising talaga ako sa gabi para
nagpapahinga, wala nakahilata lang umihi. Isang beses kada araw yan.”
naman ako kadalasan.”

Cognitive - Perception

Patient states that “maayos naman Patient responded when asked

pananaw ko dati eh. Hindi man ako
ganon katalino.”
whether he understood why he was in
a hospital and if he understood the
questions. He responded with
“Naiintindihan ko naman kung bakit
ako nandito at ang mga tanong mo.”

Role and Relationship

Patient refuses to share about his He states that “minsan binibista ako
family. However he states that “sa ng tita ko at nang lola ko. Itong
DSWD marami naman akong nagging kasama ko trop ako. Naiintindihan ko
kaibigan. Walang kuya-kuya doon eh, naman na pasyente ako dito at
lahat pantay pantay tapos kailangan kong gumaling”
magkakasundo naman kaming lahat”

Coping Stress Tolerance

Patient states that “malakas ako Patient states that “wala na akong
magyosi dati kapag nastress ako, magawa eh, umiiwas na rin ako sa
minsan nakakaisang kaha ako. Pero yosi kaya puro cellphone nalang ako”
tumigil naman na ako, nakalimutan ko
lang kung kalian pero matagal tagal
narin.”

Value - Belief Pattern

Patient states that “wala masyado Patient states that “Pangangalagaan

akong pinaggagastusan eh. Hindi
naman ako ma-materyal na tao. Hindi
ko rin naman masyado
pinapahalagahan kalusugan ko. Siguro
yung sakin lang yung kasiyahan.”
ko na sarili ko, lalo na diet. Tapos
siguro mageexercise rin ako
paminsanminsan. Importante eh,
ayaw ko na ma-ospital ulit”
IV. Anatomy and Physiology
The circulatory system in humans is a network of blood vessels through which the heart
pumps the blood and keeps the blood in circulation. The circulation system provides blood to
each cell in the body. The circulatory system comprises of two subsystems; the cardiovascular
system and the lymphatic system. The cardiovascular system consists of the heart, blood and
the blood vessels in the form of arteries and veins. The lymphatic system consists of the lymph
vessels, lymphatic nodes and lymph. There are two categories of blood vessels; the arteries and
veins. The arteries carry the oxygenated blood from the heart to the rest of the body where it
distributes the oxygen and nutrients. The veins carry the deoxygenated blood from the body
organs back to the heart. The heart pushes the deoxygenated blood to the lungs, where the
blood exchanges the carbon dioxide with fresh oxygen and is returned to the heart for
recirculation to the body organs. When the blood reaches the intestines, it collects nutrients for
distribution and discards the waste collected from the body cells to the intestines. The blood
carries the oxygen and the nutrients to the tissues of the body where it exchanges them with
carbon dioxide and waste from the cells. Waste like toxins are released into the kidneys.
Another important role of blood is to carry the white blood platelets that have the capacity to
fight germs and contain diseases to the infection areas. Therefore, blood helps the immune
system of the body.
VI. Diagnostic Procedure and Laboratory Examination
Hematology 4/2/2019
TEST RESULTS REFERENCE VALUES INTERPRETATIONS

WBC Count 17.76 -10^3/uL* 5-10

RBC Count 3.00 -10^6/uL* M: 4.6 - 6.2

F: 4.2 - 5.2

Hemoglobin 9.3 -g/dL* M: 14.0 - 18.0

F: 12.0 - 16.0

Hematocrit 28. -%* M: 40.0 - 54.0

F: 35.0 - 47.0

MCV 88.2 -fl 80.0 - 100.0

MCH 31.6 -pg 27.0 - 32.0

MCHC 35.8 -g/dL 32.0 - 36.0

Platelet count 616 10^3/uL* 150 - 450

Segmenters(%) 89.3 -%* 40.0 - 60.0

Lymphocytes(%) 8.7 -%* 20.0 - 40.0

Monocyte(%) 0.9 -%* 2.0 - 8.0

Eosinophil(%) 0.5 -%* 1.0 - 6.0

Basophil(%) 0.6 -%* 0.1 - 1.0

Double checked. Please correlate clinically

Microbiology Final Report

Specimen source URINE Interpretation
Final Report NEGATIVE AFTER 48 HOURS OF
INCUBATION

Microbiology Preliminary Report

Specimen source: BLOOD W/O ARD Interpretation
Preliminary report: NEGATIVE AFTER 3 DAYS OF
INCUBATION
VIII. Nursing Theory
14 Functions of Nursing Care
Virginia Henderson
The 14 components
 Breathe normally.
 Eat and drink adequately.
 Eliminate body wastes.
 Move and maintain desirable postures.
 Sleep and rest.
 Select suitable clothes-dress and undress.
 Maintain body temperature within normal range by adjusting clothing and modifying
environment
 Keep the body clean and well groomed and protect the integument
 Avoid dangers in the environment and avoid injuring others.
 Communicate with others in expressing emotions, needs, fears, or opinions.
 Worship according to one’s faith.
 Work in such a way that there is a sense of accomplishment.
 Play or participate in various forms of recreation.
 Learn, discover, or satisfy the curiosity that leads to normal development and health
and use the available health facilities.

This is chosen for this case due to the specifity and sensitivity of the patient. The
patient has been smoking for a long time, according to them although would not say for how
long. Also, this was chosen because the theory focuses not only on the individual but also their
environment, especially since the patient may only have limited access to the outside.
 XI. Discharge Plan

Environment

1. Instructed patient to stay in calm, quiet environment

2. Home environment must be free from slipping or accident hazards

3. If pain on the knee or back is still felt. Repositioning and ambulation devices should

be provided and within their range of motion.

Treatment

1. Informed patient to have a follow-up check up after 1- 2 weeks

2. Patient is informed to not skip medications

Health Teachings

1. Informed patient to avoid lifting heavy objects

2. Instructed patient to increase intake of fluids and green leafy vegetables

3. Encourage exercise

Observable Signs and Symptoms

1. Observe for electrolyte imbalances

2. Instructed patient to report to physician any signs of infection

Diet

1. Encouraged client to increase intake of fiber to avoid constipation

2. Instructed to increase fluid intake

3. Instructed to increase intake of nutritious foods such as fruits and vegetables

4. Encourage patient to take in more vitamin C