CASE STUDY

OF
DENGUE FEVER
Submitted by:
Cayetano, Jerome L
!SN"
Submitted to:
Norman #im $a%a&
C%ini'a% (n)tru'tor
I. PATIENT ASSESMENT DATA BASE
A. GENERAL DATA
1. Patients Name: T. A.
2. Address: Tayug, Pangasinan
3. Age: 18 years old
4. Sex: Male
5. irt! "ate: S#et. 12, 1$$5
%. &an' in t!e (amily: 2nd )!ild in t!e *amily
+. Nationality: (ili#ino
8. ,i-il Status: Single
$. "ate o* Admission: (e.. 28, 2/14
1/. 0rder o* Admission: Please admit #atient to Medi)al 1ard, se)ure #atient *or admission and
management, monitor 2S , 32( "54&, diagnosti)s ,,, #latelet, urinalysis ,medi)ations are
#ara)etamol 5//mg 5 % !ours.
11. Attending P!ysi)ian: "r. Ar5uero
12. (inal "iagnosis: "engue (e-er
B. CHIEF COMPLAINT
(e-er
C. HISTORY OF PRESENT ILLNESS
5 days PT, #atient started as on and o** *e-er o* 4 days asso)iated 1it! !eada)!e and .ody 1ea'ness
negati-e )onsultation done.
D. PAST HEALTH HISTORY/STATUS
A))ording to my #atient, !e is !ad sore eyes and )!i)'en #ox 1!en !e 1as in elementary le-el .6e !as no
'no1n allergies.
E. FAMILY ASSESMENT
NAM7 &74AT30N A87 S79 0,,:PAT30N 7":,AT30NA4
ATTA3NM7NT
N.T (at!er 4/ M (armer 6ig! s)!ool
graduate
6.T Mot!er 35 ( 6ouse 1i*e 6ig! s)!ol graduate
&.T Sister 22 ( student ,ollege le-el
&.T PAT37NT 18 M Student ,ollege le-el
A.T rot!er 12 M Student 7lementary le-el
F. SYSTEM REVIEW
1. HEALTH PERCEPTION HEALTH MANAGEMENT PATTERN
My #atient;s #er)e#tion o* !ealt! is <ma.uti, 1alang sa'it; and !e #er)ei-es illness as <meroong sa'it;
2. NUTRITIONAL METABOLIC PATTERN
Prior to admission, a))ording to my #atient !is regular diet is meat and -egeta.les. 3n !is .rea'*ast !e eats 2)u#s o* ri)e and
egg or dried *is! or noodles. 3n !is lun)! !e eats 2 = 3 )u#s o* ri)! 1it! meat or -egeta.les. And in !is dinner !e eats 2)u#s o* ri)e
1it! meat or -egeta.les. 6e also eats in .et1een meals su)! as yema, turon, or .i.ing'a. 6e drin's + = 8 glasses #er day.
3. ELIMINATION PATTERN
Prior to admission, a))ording to my #atient !e urinates 8 = 1/ times #er day in)luding in .et1een slee#s. 6e des)ri.ed !is
urine as sometimes )lear and sometimes dar' yello1 in )olor. 6e also de*e)ates 1 = 2 times #er day. 6e des)ri.es !is stool as
sometimes *ormed and sometimes 1atery.
4. ACTIVITY- EXERCISE PATTERN-Se! "#$e #%&&'(
P$&)$ ') #*+&,,&)-. / (eeding / "ressing / 8rooming
/ at!ing / Toileting / ,oo'ing
/ ed mo.ility / 6ome maintenan)e
Le/e-*.
/> (ull ,are
3> &e5uires use o* assistan)e
33> &e5uires assistan)e and su#er-isions .y ot!ers
333> &e5uires assistan)e or su#er-isions *rom anot!er and e5ui#ments and de-i)es
32 = "e#endent, doesn;t #arti)i#ate
5. COGNITIVE PERCEPTUAL PATTERN
A))ording to my #atient, !e )ould !ear normal )on-ersation in t!e room. 6e )an see o.?e)ts )learly. 6e doesn;t 1ear
eyeglasses or )onta)t lenses. 6e is a.le to *eel 1!en tou)!ed and a.le to rea)t 1!en #ain is in*li)ted. 6e )an taste !is *ood and )an
di**erentiate -arious 'inds o* s)ent. 6e )an *ollo1 instru)tions and listens and res#onds to t!e inter-ie1 a##ro#riately.
0. SLEEP- REST PATTERN
A))ording to my #atient, #rior to admission, !e slee#s $ = 1/ !ours #er nig!t. 6e !as no slee#ing #ro.lems alt!oug! !e is
1a'ing u# 1!en !e *eels !e needs to urinate. 6e also snores 1!en !e is slee#ing. 6e also slee#s a*ter eating !is lun)!.
1. SELF- PERCEPTION AND SELF- CONCEPT PATTERN
My #atient stated t!at !e !el#s !is mot!er in doing some !ouse!old )!ores.
ROLE- RELATIONSHIP PATTERN
My #atient stated t!at !e is a res#onsi.le son to !is #arents t!at;s 1!y t!ey lo-e !im so mu)!.
SEXUALITY- REPRODUCTIVE PATTERN
My #atient 1as )ir)um)ised 1!en !e 1as 11 years old.

COPING- STRESS TOLERANCE PATTERN
My #atient stated <na!i!ira#an a'o #ag may #ro.lema 'ami lalo na sa #era, 'aya nananalangin nalang 'ami sa diyos #ara
!indi ma1alan ng #agasa.@
VALUE- BELIEF PATTERN
My )lient is &oman ,at!oli), !e .elie-es in 80" and Aesus. A))ording to !im !e is religiously a)ti-e.
I. PHYSICAL ASSESSMENT
A. GENERAL SURVEY
1. o-erall a##earan)e and grooming > !aggard loo'ing
2. a)tual !eig!t and 1eig!t -s. ideal .ody 1eig!t>
3. sym#toms o* distress> #resen)e o* #ain and anxious
4. #osture, gait> 1al's slo1ly
5. a**e)t, mood> #atients loo' anxious and !as a mood s1ing.
%. rele-an)e and organiBation o* t!oug!t> )oo#erates and ans1ers 5uestions immediately.
B. VITAL SIGNS
P> 12/C8/ mm6g
&&> 24
P&>82.#m
Tem#> 3+.8 ,
C. REGIONAL EXAM 2'&&3e IPPA 'e"4-&52e
6air No sign o* !air loss !air, !air is s!iny, no li)e or #arasites seen
during ins#e)tion.
6ead No s)ars seen on t!e s)al# during ins#e)tion and .um#s or
masses #al#ated
(a)e No #im#les *ound.
7yes 7yes do res#ond to lig!t e**e)ti-ely
7ars T!ere is no #resen)e o* dis)!arge u#on ins#e)tion
Nose No s1elling, tenderness or masses during #al#ation and no nasal
dis)!arge or redness u#on ins#e)tion
Mout!Ct!roat T!ere is a tenderness o* my t!roat u#on s1allo1ing *ood
Ne)'Clym#! nodes No #resen)e o* s1elling enlargement or tenderness 1!en
#al#ated
S'in T!ere is a #resen)e o* #ete)!ial ras!es
Nails Nails are smoot! )a#illary re*ill is least t!an 3 se)onds
T!orax Symmetri)al and *ull ex#ansion o* )!est.
4ung No a.normal sound !eard u#on aus)ultation res#iratory rate is
on normal range no signs o* di**i)ulty o* .reat!ing A"4Da)ti-ities
o* daily li-ingE
,ardio-as)ular &egular !eart.eat, no .rady)ardia u#on aus)ultation.
reast and axilla Symmetri)al s!oulder, no any sign o* ras!es u#on ins#e)tion
A.domen :#on aus)ultation 1e did not !ear any gurgling sound, and no
masses or #ain *elt .y t!e #atient u#on #al#ation.
7xtremities 6e )an mo-e all extremities.
8enital Patient re*uses to examine.
&e)tum and anus Patient re*uses to examine
,ranial ner-es 6is eye *ollo1 my #en #er*e)tly, !e )an !ear )learly *rom .ot!
sides o* ear no a.normalities on !is &0M Drandom o* motionE
D. DEVELOPMENTAL HISTORY
T670&3ST A87 S79 PAT37NT "7S,&7PT30N
7ri' 7ri'son 18 Male 3dentity -s &ole ,on*usion
D11>1$ years oldE
At !is age 1e )an see
t!at Miss.A.8 is teen
age )!ild 1!o start to
)!ange .y !is #!ysi)al
gro1t! and s!e starting
to .uild !is so)ial
relations!i# to ot!er not
only to !is *amily so as 3
)an see s!e start to
intera)t 1it! #eer.
II. PERSONAL/SOCIAL HISTORY
A. 6A3TSC23,7S
aE ,a**eine: 3 )u# o* mil' a day
.E Smo'ing: Ne-er
)E Al)o!ol: Ne-er
dE TeaC?ui)e: Po1dered *ruit drin's i* s!e;s !a-ing a sna)'
eE Soda: 0))asionally
*E "rugs: 6e ne-er )ommits illegal or #ro!i.ited drugs.
. 43(7STF47: Sim#ly li*estyle.
,. S0,3A4 A((343AT30N: A))ording to T. A. !e uses to #lay 1it! !is *riends on t!eir .a)'yard.
III. ENVIRONMENTAL HISTORY D4323N8CN73860&600"C,3&,:MSTAN,7SE
A))ording to my #atient, !e li-es 1it! !is *amily in a semi>)on)rete !ouse 1it! ade5uate li-ing s#a)e. T!e !ouse is lo)ated a
*e1 meters a1ay *rom a lo)al road, o-erloo'ing ri)e *ields *rom t!eir .a)'yard. T!eir 1ater su##ly )omes *rom a 1ater #um#. T!eir
toilet is *lus!ed 1it! 1ater. T!eir gar.age is .urned in a #it in t!eir .a)'yard.
IV. INTRODUCTION 6RELATED TO THE DISEASE OF THE PATIENT7
"engue *e-er is *ound mostly during and s!ortly a*ter t!e rainy season in tro#i)al and su.tro#i)al areas o*
A*ri)a
Sout!east Asia and ,!ina
3ndia
Middle 7ast
,ari..ean and ,entral and Sout! Ameri)a
Australia and t!e Sout! and ,entral Pa)i*i)
An e#idemi) in 6a1aii in 2//1 is a reminder t!at many states in t!e :nited States are sus)e#ti.le to dengue e#idemi)s .e)ause t!ey
!ar.or t!e #arti)ular ty#es o* mos5uitoes t!at transmit it. Gorld1ide, more t!an 1// million )ases o* dengue in*e)tion o))ur ea)!
year. T!is in)ludes 1// to 2// )ases re#orted annually to t!e ,enters *or "isease ,ontrol and Pre-entionD,",E, mostly in #eo#le
1!o !a-e re)ently tra-eled a.road. Many more )ases li'ely go unre#orted .e)ause some !ealt! )are #ro-iders do not re)ogniBe t!e
disease. "uring t!e last #art o* t!e 2/t! )entury, many tro#i)al regions o* t!e 1orld sa1 an in)rease in dengue )ases. 7#idemi)s also
o))urred more *re5uently and 1it! more se-erity. 3n addition to ty#i)al dengue,dengue !emorr!agi) *e-er and dengue s!o)'
syndrome also !a-e in)reased in many #arts o* t!e 1orld.
"engue *e-er )an .e )aused .y any one o* *our ty#es o* dengue -irus: "7N>1, "7N>2, "7N>3, and "7N>4. Fou )an .e in*e)ted .y at
least t1o, i* not all *our ty#es at di**erent times during your li*etime, .ut only on)e .y t!e same ty#e.
Fou )an get dengue -irus in*e)tions *rom t!e .ite o* an in*e)ted Aedes mos5uito. Mos5uitoes .e)ome in*e)ted 1!en t!ey .ite
in*e)ted !umans, and later transmit in*e)tion to ot!er #eo#le t!ey .ite. T1o main s#e)ies o* mos5uito, Aedesaegy#ti and
Aedesal.o#i)tus, !a-e .een res#onsi.le *or all )ases o* dengue transmitted in t!is )ountry. "engue is not )ontagious *rom #erson to
#erson.
Sym#toms o* ty#i)al un)om#li)ated D)lassi)E dengue usually start 1it! *e-er 1it!in 5 to % days a*ter you !a-e .een .itten .y an
in*e)ted mos5uito and in)lude
6ig! *e-er, u# to 1/5 degrees (a!ren!eit
Se-ere !eada)!e
&etro>or.ital D.e!ind t!e eyeE #ain
Se-ere ?oint and mus)le #ain
Nausea and -omiting
&as!
T!e ras! may a##ear o-er most o* your .ody 3 to 4 days a*ter t!e *e-er .egins. Fou may get a se)ond ras! later in t!e disease.
Sym#toms o* dengue !emorr!agi) *e-er in)lude all o* t!e sym#toms o* )lassi) dengue #lus
Mar'ed damage to .lood and lym#! -essels
leeding *rom t!e nose, gums, or under t!e s'in, )ausing #ur#lis! .ruises
T!is *orm o* dengue disease )an )ause deat!.
Sym#toms o* dengue s!o)' syndrome>t!e most se-ere *orm o* dengue disease>in)lude all o* t!e sym#toms o* )lassi) dengue
and dengue !emorr!agi) *e-er, #lus
(luids lea'ing outside o* .lood -essels
Massi-e .leeding
S!o)' D-ery lo1 .lood #ressureE
T!is *orm o* t!e disease usually o))urs in )!ildren Dsometimes adultsE ex#erien)ing t!eir se)ond dengue in*e)tion. 3t is sometimes
*atal, es#e)ially in )!ildren and young adults.
V. ANATOMY AND PHYSIOLOGY
T!e 3mmune System
A se)ond line o* de*ense is !oused1it!in t!e .ody: a *inely tuned immune system t!at re)ogniBes and destroys *oreign su.stan)es and
organisms t!at enter t!e .ody. T!e immune system )andistinguis! .et1een t!e .odyHs o1n tissues and outside su.stan)es )alled
antigens. T!is allo1s )ells o* t!e immune army to identi*y and destroy only t!ose enemy antigens. T!e a.ility to identi*y an antigen also
#ermits t!e immune system to Iremem.erI antigens t!e .ody !as .een ex#osed to in t!e #astJ so t!at t!e .ody )an mount a.ettor and
*aster immune res#onse t!e next time any o* t!ese antigens a##ear. T!e immune system also in)ludes ot!er #roteins and )!emi)als
t!at assist anti.odies and T )ells in t!eir 1or'. Among t!em are )!emi)als t!at alert #!ago)ytes to t!e site o* t!e in*e)tion. T!e
)om#lement system, a grou# o* #roteins t!at normally *loat *reely in t!e .lood, mo-e to1ard in*e)tions, 1!ere t!ey )om.ine to !el#
destroy mi)roorganisms and *oreign #arti)les. T!ey do t!is .y )!anging t!e sur*a)e o* .a)teria or ot!er mi)roorganisms, )ausing t!em
to die.
VII. PATHO-PHYSIOLOGY
6IN DIAGRAM7
Pre-disposing
factor:
Precipitating factors:
-Environmental Condition (open
spaces w/ water pols and plants)
-mosquito carrying dengue virus
-sweaty skin
Bite of a virus carrying aedes
mosquito
eadiness and itc!iness in
area
"osquito in#ects $uid to victims%
skin
&irus enters 'lood stream
(nfects all and generate cellular
response
(nitiates immune response
()timulate release of cytokine)
Cytokines destroys mem'rane and cell
wall
(&iral antigens found in monocytes)
*engue (nfection
VII. LABORATORY AND DIAGNOSTIC EXAMINATION
U$&-#(,&,
&outine Mi)ros)o#i)
,olor yello1 Pus)ell />2
Trans#aren)y Tur.id &,
&ea)tion A)idi) a)teria (e1
S#e)i*i) gra. 1./25 7#it!elial)ell
sugar Negati-e Mu)us
#rotein Negati-e T!reads
He+#'))/(
&esults N.2.S3 :N3TS
&, )ount 4.3 4./4>5
6emoglo.in D!g.E 12+ 14/>18/gCl
G.) )ount /.4 5>1/
Platelet ,ount )ount 42 12/> 4//
Segmenters .5$ /.5/>/.+/
4ym#!o)ytes .33 /.2/>.4/
Mono)ytes /.8 /./>/.+
+ever
(ncrease vascular
permea'ility
,!rom'ocytopenia
Peticial rus!
Positive (-)
tourniquet test
7osino#!ils 2.// /./>//+
6emato)rit .3$ /.3+>/.4+
VIII. DRUG STUDY
8eneri) Name: Para)etamol
rand Name: Tylenol
,lassi*i)ation: Non>nar)oti) analgesi), Anti#yreti)
"osage: 5//mg
3ndi)ation: tem#orarily relie* o* #ain and dis)om*ort *rom !eada)!e, *e-er, )old, *lu, minor mus)ular a)!es.
Me)!anism o* a)tion ,ontraindi)ations Ad-erse e**e)t Side e**e)ts Nursing
)onsideraton
"e)reases *e-er .y a
!y#ot!alami) e**e)t leading to
s1eating and -asodilation
3n!i.its #yrogen e**e)t on t!e
!y#ot!alami)>!eat>regulating
)enters
3n!i.its
,NS #rostaglandin synt!esis
1it! minimal e**e)ts on
#eri#!eral #rostaglandin synt
!esis
&enal
3nsu**i)ien
)y
Anemia
4i-er
toxi)ity
D!e#ato
)yte
ne)rosi
sE may
o))ur
1it!
doses
not *ar
.eyond
Minimal 83 u#set.
Met!emoglo.inemia
6emolyti) Anemia
Neutro#enia
T!rom.o)yto#enia
Pan)yto#enia
4eu'o#enia
:rti)aria
,NS stimulation
6y#ogly)emi) )oma
Aaundi)e
"o not
ex)eed
4gmC24!r. in
adults and
+5mgC'gCday
in )!ildren.
"o not ta'e
*or K5days
*or #ain in
)!ildren, 1/
days *or #ain
"oes not )ause ul)eration o*
t!e 83 tra)t and )auses no
anti)oagulant a)tion.
la.eled
dosing.
3* 3 or
more
al)o!oli
) drin's
#er day
is
)onsum
ed,
)onsult
a
#!ysi)ia
n #rior
use.
8lissitis
"ro1siness
4i-er "amage
in adults, or
more t!an 3
days *or *e-er
in adults.
7xtended>
&elease
ta.lets are
not to .e
)!e1ed.
Monitor ,,,
li-er and
renal.
IX. NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Su.?e)ti-e:
< mainit ang #a'iramdam
'o@
0.?e)ti-es:
Tem#>38.3 ,
Garm to tou)!
Teary eyes
(lus!ed s'in
G, 5>25 x 1/
$C4
3n)rease in G,
6y#ert!ermia
related to
.a)terial
in*e)tion
A*ter 2 !ours o*
rendering o*
nursing
inter-entions t!e
#atient 1ill
maintain t!e
)ore
tem#erature
*rom 38.3 , to
3+.2 ,.
Monitor -ital
signs
Pro-ide te#id
s#onge .at!.
"o not use
al)o!ol
&emo-es
ex)ess
)lot!ing and
)o-ers
Promote a
1ell -entilated
area to
Ser-es as a
.aseline data
TS !el#s in
lo1ering t!e
tem#erature
and al)o!ol
)ools t!e
s'in ra#idly,
)ausing
s!i-ering,
in)reases
meta.oli)
rate and
.ody
tem#erature.
To de)rease
1armt! and
in)rease
e-a#orati-e
)ooling.
To #romote
)lear *lo1 o*
80A4
M7T. A*ter
4 !ours o*
rendering
o* nursing
inter-ention
s t!e
#atient
maintained
t!e )ore
tem#eratur
e *rom 38.3
, to 3+.5
,.
#atient
Ad-ise #atient
to in)rease
*luid inta'e as
indi)ated
Maintain .ed
rest
Administer
anti#yreti)s
as ordered .y
t!e #!ysi)ian
air in t!e
#atient;s
area. 0ne
1ay
#romoting o*
!eat loss.
Additional
*luids !el#
#re-ent
ele-ated
tem#erature
asso)iated
1it!
de!ydration.
To meet
in)rease
meta.oli)
demand.
XIII. O-/)&-/ #88$#&,#
0n t!e *irst day o* admission #atients assessed 1it! *e.rile 38.8 , and *re5uen)y urination, s'in dryness and !eada)!e.
G!en rendered nursing inter-entions li'e TS e-ery !our and 1it! t!e used o* anti#yreti)s and analgesi)s D#ara)etamolE as
#res)ri.ed .y t!e do)tor t!e #atient )ore tem#erature de)reased *rom 38.8 , to 3+.3 , and 1it! a #ain s)ale *rom 8 to 2, t!en
maintained *luid -olume.
3n t!e se)ond day o* admissions most o* t!e inter-entions are e**e)ti-e as e-iden)e .y t!e -er.aliBation o* t!e #atient, !e )an
slee# more t!an 4 !ours.
T!ird day o* admission no signs o* #ain and still t!ere is urinary *re5uen)y. No signs o* !y#ert!ermia or anyt!ing else. 3t only
1aiting *or t!e #latelet )ount to in)rease.
XIV. D&,"4#$/e P#- 64e#'4 'e#"4&-/7
3n)reased *luid inta'e.
,lean t!e surroundings.
Ad-ise #atient to eat more nutritious *ood.
Ad-ise to ta'e -itamins.
Ad-i)e #atient to re#ort immediately i* any signs and sym#toms o))ur.
6a-e a )!e)'u# at least on)e a mont!.