Pamantasan ng Lungsod ng Marikina

J.P. Rizal St. Concepcion Uno, Marikina City

__________________________

DENGUE HEMORRHAGIC FEVER

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A Group Case Study

Submitted to:
Mr. Ryan E. Aliwalas, RN

In Partial Fulfillment
of the Requirement for the Course
NCM 101
RLE

H-Vill Hospital

Submitted by:
Gomez, Richerylle C.
Gutierrez, Floren Angelie V.
Hernandez, Richelle Joy T.
Hussin, Johanna Fariza T.
Ison, Sheila May H.
Javier, Jayson R.
Jayme, Carolyn Eleanor F.
Labide, Prima Encar T.
Ladjahasan, Irish Princess A.
Lagumbay Joanne B.
Lardillo, Catherine A.
Lomocso, Jamielyn Kate B.

GROUP 7
AUGUST 2009
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. It’s 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

 PATIENT’S PROFILE

Name: CJS
Age: 13 years old
Gender: Male
Address: # 32 Natividad St. Malanday San Mateo, Rizal
Date of Birth: October 24, 1995
Place of Birth: Marikina
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Single
Occupation: N/A
Date of Admission: August 24, 2009
Time of admission: 9:00 pm
Physician: Dra. Del Valle
Place of Admission: H-Vill Hospital
Admitting Diagnosis: Dengue Fever Syndrome
a.1 CHIEF COMPLAIN
• The patient complains of abdominal pain, headache, fever and general
flushing of skin with on and off vomiting.

a.2 PRESENT ILLNESS

• Four days prior to admission, the patient had an intermittent fever
associated with abdominal pain, headache, and general flushing of the
skin with on and off vomiting. 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 Syndrome.

a.3 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 Syndrome. Before that
diagnosis, he was already experiencing fever and his mom gives him a
Paracetamol for remedy.

a.4 FAMILY HISTORY

• According to his grandmother the only disease that the family has
genetically is Diabetes Mellitus and no other diseases noted.

a.5 SOCIAL HISTORY

• CJS is the son of Mr. and Mrs. SJ. CJS is currently on the secondary level
of education at Roosevelt College at Malanday, Marikina City, near their
place.
• His father works as a seaman while his mother is a housewife; his
grandmother is also living with them. Hence, his grandmother and his
mother were the ones responsible in all the household chores.
 According to CJS, he eats vegetables and fish instead he prefers
eating hotdogs. Furthermore he has no other vices except for computer
games. After school hours, he goes directly to the computer shop together
with his brother and friends.

a.6 ENVIRONMENTAL HISTORY

• According to the patient the environment that the family have has an open
drainage, wherein big rats and cockroaches can be seen. The house is
cleaned by his mother and grandmother. It was described by the patient
that there are parts of their house that is deprived from light.
•

C. HISTORY OF ILLNESS
• During the mid of August, CJS, started experiencing fever that persist only
at night. As a remedy his mom gave him Paracetamol to lower his body
temperature. Except from fever he’s also experiencing abdominal pain,
headache and general flushing of the skin with on and off vomiting.

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 Dengue Fever
Syndrome (DFS) and was admitted under the service of Dra. Del Valle.
THEORETICAL FRAMEWORK

CJS, is at the stage of puberty, was diagnosed of having Dengue Fever

Syndrome (DFS).At the clinical check-up, the physician was able to identify some
clinical signs of it and was referred to Dra. Del Valle. The case of CJS can be
correlated with the theory of Florence Nightingale

Application Theory:

The case of CJS can be correlated with the theory of Nightingale wherein,
the environment of the patient is a factor leading to recovery. Having a clean,
well ventilated and quite environment is important in. With a nurturing
environment, the body could repair itself.
PHYSICAL EXAMINATION

PHYSICAL ASSESSMENT

1. Received Patient on bed awake conscious and coherent

2. With IVF D5LR 1000ml at 450 cc level and regulated at 25gtts/min.

I. LINEAR MEASUREMENT

1. Height: 5’4’’
2. Weight : 51kgs.
 PHYSICAL ASSESSMENT
NAME: CJS
DATE OF ASSESSMENT: August 24, 2009
VITAL SIGNS:
BP: 10070 mmHg PR: 76bpm
RR: 22bpm Temp: 36.5˚C

General Appearance: Received lying on bed, conscious and coherent. Pale and has general flushing with rashes
Area assessed Technique
Used
Normal Findings Actual Findings Rationale

Area Assessed Method Used Normal Findings Actual Findings Rationale

SKIN
Color and Inspection Light to deep brown General flushing Decrease WBC
pigmentation in the body

Lesions Inspection No lesions, scars or inflammation No lesions, but Normal

Texture Palpation Smooth presence of scars Normal
Moisture Palpation Moist Smooth Normal
Temperature Palpation The skin springs back to its previous Moist Normal
Mobility and turgor Palpation state after being pinched The skin springs Normal
back
to its previous state
after being pinched
NAILS
Nail bed color Inspection Pink Pale Decrease RBC
Shape Inspection Convex Convex in the body
Lesions Inspection No inflammation of No inflammation of Normal
Thickness Palpation the skin around the nail the Normal
capillary refill Palpation Firm skin around the nail Normal
 Firm Normal
Normal capillary (less than 3secs)
refill

HEAD
Size Inspection Proportion to the body Proportion to the Normal
Symmetry Inspection and the skull is body Normal
rounded and smooth and the skull is
Symmetrical rounded
and smooth
HAIR Symmetrical Normal
Color Inspection Black No nits/lice present Normal
Texture Inspection Curly hair, straight Normal
Other findings Inspection No nits/lice present

SCALP
Distribution of hair Inspection Evenly distributed No inflammation, Normal
Lesions Inspection No inflammation, lumps Normal
Other findings Inspection lumps or masses or masses Normal

FACE
Skin color Inspection Light to deep brown Pinkish Due to fever
Texture Inspection Smooth Symmetric facial Normal
Facial movement Inspection Symmetric facial Symmetric facial Normal
movement movement

EYES
External structure Inspection Evenly distributed
Eyebrows Inspection Evenly distributed, Pink conjunctiva Normal
Eyelashes Inspection Evenly distributed, curved outward Evenly distributed Normal
Eyelids Inspection Evenly distributed Normal

EARS Same as facial color Symmetric to head

Color Inspection Symmetrical at the No discharges and
Symmetry Inspection level of the eyes inflammation Normal
Shape and size Inspection corner Normal Normal
Symmetric to head Normal
No discharges and
inflammation
Same as facial color

NOSE Same with facial color Same with facial

Color Inspection Symmetric color
Shape Inspection No discharges Symmetric Normal
Discharges Inspection No discharges Normal
Normal

MOUTH Symmetric
Lips Inspection Pink Symmetric
Symmetry Inspection Moist Pink Normal
Moisture Inspection Dry Normal
D/t poor
TONGUE Positioned at the nutrition
Position Inspection center can move Central position
Color Inspection freely Dull red Normal
Texture Inspection Dull red Smooth Normal
Mobility Inspection Smooth Can move freely Normal
Lesions Inspection Can move freely No lesions or Normal
No lesions or inflammation Normal
inflammation

NECK Head centered

Position Inspection Symmetrical Head centered
Symmetry Inspection Smooth movements Symmetrical Normal
Range of movements Inspection without discomfort Smooth Normal
Palpation Symmetric and at movements Normal
midline position without discomfort Normal
Symmetric and at
midline position

UPPER AND LOWER

EXTREMITIES Equal size
Size Inspection Symmetrical
Symmetry Inspection Evenly distributed Equal size Normal
Distribution of hair Inspection Light to deep brown Symmetrical Normal
Skin color Inspection No lesions, Evenly distributed Normal
Lesions Inspection deformities or Light to deep brown Normal
inflammation No lesions, Due to
deformities or disease
Temperature Inspection Normal inflammation

Normal Normal
 GORDON’S 11 FUNCTIONAL HEALTH PATTERN

BEFORE DURING INTERPRETATION

FUNCTION HOSPITALIZATION HOSPITALIZATION
Nutrition • Eats 3x a day • Mostly eat • The Doctor ordered
• He loves to bread DAT diet to the
eat bread & patient except dark
processed colored food
foods such as
hotdog,
tocino,
longanisa,
and others.
• He doesn’t eat
vegetables
and fish
• Seldom drinks • This time he • To replace fluid loss
water frequently
drinks water
Elimination • He is able to • He can still • His condition doesn’t
urinate & urinate & affected his
defecate defecate by elimination pattern
normally himself even
everyday by without an
himself assistance
• He doesn’t
have any
problem on
his elimination
• Defecates
usually early
in the morning
before going
to school
Sleeping • Has a regular • Disturbed • Due to adherence to
sleeping sleeping time of medication &
pattern pattern vital signs monitoring
• Normal sleep
is 6-8 hrs. per
day but he
naps for 1-2
hrs in the
afternoon
Cognitive- • Has a normal • He is • Portraying
Perceptual cognitive responsive & cooperativeness
Pattern perception can
 • Can communicate
comprehend well
well
• He responds
appropriately
to verbal &
physical
stimuli
Self- Perception- • Perceived • This time he • Due to his ability to
Self concept himself as a perceives establish good
good friend, himself as an rapport to other
brother & son. approachable people
person
Role Relationship • He was able • This time his • Due to his condition,
Pattern to do his role as a he is not aware of
responsibilitie patient is not performing his real
s as a son & fully met role in this field.
brother
Sexuality- • He doesn’t • Same • Due to his youthful
Reproductive think of the mind, it is still not his
Pattern things like priority in life
having a
girlfriend &
getting
married.
Coping Stress & • He doesn’t • Same • At his age, he still
Tolerance Pattern fully identifies has a playful mind &
his stressors. he doesn’t mind the
stressors in life.
Activity-Exercise • His daily • He interacts • He only focuses on
Pattern routine on with his simple things.
playing grandmother
computer. His & other
daily activities people around
were limited in him
waking up in • Cooperates
the morning to well to the
attend his doctor &
class & after nurses.
that going to
computer
shop.
Value-Belief • He is a • Due to their culture
Pattern Catholic preferences &
parent’s influence
Health Perception – • He • He thinks • Due to his illness
Health Management perceived that he is
Pattern his health not healthy
in the state
of good
condition
 HEMATOLOGY

EXAMINATION REFERENCE EXAM INTERPRETATION

VALUE RESULTS
Aug. 24,2009 Aug. 26, 2009
RBC COUNT 4-6X10 / L
12
5.1 4.7 Within normal range
WBC COUNT 5-10X10g/L 3.0 2.4
HEMOGLOBIN Male: 140- 155 138 Within normal range
170gms/ L
Female: 120-
140gms/L
HEMATOCRIT Male:0.43- 0.47 0.42 Within normal range
0.54
Female:
0.37-0.45
DIFFERENTIAL
COUNT
SEGMENTERS 0.55-0.65 0.57 0.40
LYMPHOCYTES 0.25-0.35 0.43 0.60
MONOCYTES 0.02-0.06 -----------
EOSINOPHIL 0.01-0.03 -----------
BASOPHIL 0.01-1.0 -----------
CLOTTING TIME ----------- -----------
BLEEDING TIME ----------- -----------
BLOOD TYPE ----------- -----------
ESR ----------- -----------
STAB ----------- -----------
PLATELETS 150-400x103 172 166 Within normal range
g/L
 Brand name/ Classification Action Indication Adverse Effect Contraindication Nursing
Generic name consideration
Acetaminophen Nonopoiod Produce Symptomatic Rash, nausea, Hypersensitivity. Patients with
(Paracetamol) analgesics and analgesia relief of pain and vomiting, blood Patients alcoholic liver
anti pyretics by blocking fever. Relief of dyscrasias , disease.
pain headache, anemia, analgesic Impaired liver
impulses by toothachge, back nephropathy , or kidney
inhibitinfg pain, nephrotoxicity , function
synthesis of dysmenorrheal, hypersensitivity
prostaglandi myalgias,neuralg reactions
n in the ias, etc.
CNS or of Analgesics and
other anti pyretic for
substances patients
that hypersensitive to
sensitize aspirin
pain
receptors to
stimulation.
 Assessment Nursing Diagnosis Planning Nursing Rationale Evaluation
Intervention
Subjective: Risk for impaired Short Term Goal: Independent After 8 hours of
“Nangangati ako” as skin integrity related Nursing Action: rendering effective
verbalized by the to Within 2hours of -Monitor vital signs - Serves as baseline nursing intervention
patient nursing intervention, data to determine the goal was
patient will any discrepancies completely met as
Objective: demonstrate - Provide skin -To maintain skin evidenced by
V/S taken: Aug behavior in hygiene through integrity at optimal patient’s
24,2009 as of 4pm preventing skin sponge bathing & level. demonstration of
impairment. changing regularly behavior in
BP – 100/70mmHg preventing skin
Temp. – 36.5˚C Long Term Goal: - Keep bed clothes -To avoid lesions, impairment.
RR – 22 bpm dry, use non- scratching of skin & -patient verbalizes
PR – 76bpm After period of irritating materials, & harboring of comfortability,
hospitalization, the keep bed wrinkled microorganism. decrease feeling of
- Redness of the patient will be able free itchiness and
skin to understand and gradual
- Skin rashes apply treatment/ or - Palpate skin - To assess extent disappearance of
therapy, regimen to lesions for size, of involvement of rashes.
the skin impairment. shape, consistency, skin impairment. -patient’s skin
texture & hydration color(pigmentation)
becomes normal
- Encourage -To prevent friction (absence of
reposition schedule that may cause redness)
for client irritation of the skin

-Provide information - To promote

to the client about wellness by gaining
the importance of knowledge on
regular observation treatment/ therapy
& effective skin care

Assessment Nursing Diagnosis Planning Nursing Rationale Evaluation

Intervention
Subjective: Acute pain related to Short Term Goal: Independent After 8 hours of
“Masakit ang tiyan clinical Nursing Action: rendering effective
ko” as verbalized by manifestations of Within 8 hours of -Perform a - To improve quality, nursing intervention
the patient. dengue hemorrhagic effective nursing comprehensive frequency & location the goal was
fever intervention patient assessment of pain of pain. partially met as
will be able to feel evidenced by less
Objective: less pain on his - Provide -To alleviate pain. guarding of stomach
V/S taken: Aug abdomen. nonpharmacologic and patient’s
24,2009 as of 4pm management like verbalize partial
change of position & relieve of pain.
 Assessment Nursing Planning Nursing Rationale Evaluation
Diagnosis Intervention
Subjective: Elevated body Short Term Goal: Independent After 8 hours of
“Mainit po ang temperature Nursing Action: rendering effective
katawan ko”as related to Within 8 hours of -Monitor vital sign - Serves at nursing
verbalized by the effective nursing baseline data. intervention the
patient. intervention - Monitor intake -To know the fluid goal was
patient body and output balance of the completely met as
temperature will body evidenced by
be decrease from - Perform TSB patient’s body
Objective: 38.6- 37.5˚C - To reduce body temperature
V/S taken: Aug temperature decreases from
25,2009 as of through the 38.6-37.5˚C.
6pm Long Term Goal: -Increase oral fluid process of Patient’s skin not
intake conduction warm to touch.
BP – After period of - To prevent Normal
110/70mmHg hospitalization, the dehydration and complexion of the
Temp. – 38.6˚C patient will be able - Provide safe & support circulating skin.
RR – 30bpm to know the proper quite environment volume.
PR – 67bpm management of - To provide
hyperthermia -Inform the patient conducive place to
- Flushing of skin about proper rest .Inform the
- Skin warm to management of patient about
touch fever proper
management of
Dependent fever
nursing - To be able for
intervention: the patient to
- Administer know the proper
medications as management.
order by
physicians such
as Paracetamol or -To elevate the
any anti –pyretic patient’s body
drugs. temperature.

PATHOPHYSIOLOGY

Predisposing Factor: Non- predisposing

-Immuno Factor:
compromised - Age:13 y/o
- Environment - 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.