I.

INTRODUCTION The Department of Health said that 62,503 cases of the mosquito-borne illness have

been reported in the Philippines from January 1 to August 21, up nearly 90 percent from the same period last year. The death toll was also up from 350 in the same period last year. The department said the number of dengue cases in the country started to rise in May and peaked last month at the onset of the rainy season. Disease experts are now closely monitoring several barangays across the country for cases of dengue outbreak. In line with this, the group decided to conduct a class regarding measles to raise the awareness of the residents of Barangay Sapa Libutad, Angeles City. II. CONTENT

What is dengue? Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. strikes people with low levels of immunity. Because it is caused by one of four serotypes of virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that particular serotype to which the patient was exposed. Dengue goes by other names, including "breakbone" or "dandy fever." Victims of dengue often have contortions due to the intense joint and muscle pain, hence the name breakbone fever. Slaves in the West Indies who contracted dengue were said to have dandy fever because of their postures and gait. Dengue hemorrhagic fever is a more severe form of the viral illness. Manifestations include headache, fever, rash, and evidence of hemorrhage in the body. Petechiae (small red or purple blisters under the skin), bleeding in the nose or gums, black stools, or easy bruising are all possible signs of hemorrhage. This form of dengue fever can be life-threatening and can progress to the most severe form of the illness, dengue shock syndrome. Agent and Vector Dengue viruses (DEN) types 1, 2, 3, 4, which are classified as flaviviridae, are principally transmitted from human to human through the bites of the Aedes aegypti mosquitoes. The femle mosquito bites the infected human during the day and can transmit the virus to another host immediately or after 8 to 10 days of incubation within the salivary gland of the mosquito. The mosquito host remains infected for life.

Incubation Period After an individual is bitten by an infective mosquito, the virus undergoes an incubation period of 3 to 14 days. Symptoms Signs and symptoms of dengue fever vary, depending on the form and severity of the disease. Dengue fever With the mild form of the disease, you may experience some or all of these signs and symptoms:
y y

High fever, up to 105 F (40.6 C) A rash over most of your body, which may subside after a couple of days and then reappear Severe headache, backache or both Pain behind your eyes Severe joint and muscle pain Nausea and vomiting

y y y y

Sign and symptoms usually begin about four to seven days after being bitten by a mosquito carrying a dengue virus. Mild dengue fever rarely causes death, and your symptoms will usually subside within a week after starting.

Dengue hemorrhagic fever More-severe forms of the disease usually begin the same way as the mild form (dengue fever) then become worse after several days.

Dengue hemorrhagic fever a more severe form of the disease than initial dengue fever can cause signs and symptoms of dengue fever plus:
y y y y y

Significant damage to your blood and lymph vessels A decrease in the number of blood cells that help your blood clot (platelets) Bleeding from the nose and mouth Bleeding under the skin, which gives the appearance of bruising Death

Dengue shock syndrome Dengue shock syndrome the most severe form of the disease may cause signs and symptoms of mild dengue fever plus:
y y

Severe abdominal pain Frequent vomiting

y y y y y

Disorientation Fluid (plasma) leakage from blood vessels Heavy bleeding A sudden drop in blood pressure (shock) Death

Severe signs and symptoms may appear after your fever has improved. In a small number of cases, people with a severe form of the disease die of it. Modern supportive hospital care decreases this risk. Diagnostic Test - Torniquet Test (Rumpel Leads Test) Inflate the blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressure for 5 minutes. Release cuff and make an imaginary 2.5 cm, square or 1 inch square just below the cuff, at the antecubital fossa. Count the number of petechiae inside the box. A test is (+) when 20 or more petechiae per 2.5 cm square or 1 inch square are observed.

How is it treated? For a mild form of the disease:

y y

Drinking plenty of fluids to avoid dehydration from vomiting and high fever. Taking acetaminophen (Tylenol, others) to alleviate pain and reduce fever. Don't take aspirin or other nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve, others). These can increase the risk of bleeding complications.

For a more severe form of the disease, treatment consists of:

y y y y

Supportive care in a hospital Intravenous (IV) fluid and electrolyte replacement Blood pressure monitoring Transfusion to replace blood loss

Methods of Prevention and Control The prevention of dengue is directed at community and personal mosquito control in endemic areas. - Cover water drums and water pails at all times to prevent mosquitoes from breeding. - Replace water in flower vases once a week. - Clean all water containers once a week. Scrub the sides well to remove eggs of mosquitoes sticking to the sides.

- Clean gutters of leaves and debris so that rain water will not collect as breeding places of mosquitoes. - Old tires used as roof support should be punctured or cut to avoid accumulation of water. - Collect and dispose all unusable tin cans, jars, bottles and other items that can collect and hold water. - To prevent mosquito bites, wear long pants and long sleeves. - For personal protection, use mosquito repellant sprays that contain DEET when visiting places where dengue is endemic. - Limiting exposure to mosquitoes by avoiding standing water and staying indoors two hours after sunrise and before sunset will help. Public Health Nursing Responsibilities Since there is no known immunization agent against Dengue, nursing efforts should be directed toward the immediate control of its cause by knowing the nature of the disease and its causation. The following are important:  Report immediately to the Municipal Health Office if there is any known case outbreak  Refer immediately to the nearest hospital, if there are cases that exhibit symptoms of hemorrhage from any part of the body  Conduct a strong health education program directed towards environmental sanitation particularly destruction of all known breeding places of mosquitoes  Assist in the diagnosis based on the signs and symptoms. For those with no signs of hemorrhage, the nurse may perform the tourniquet test.  Conduct epidemiologic investigations as means of contacting families, case finding and as well as community health education.

Nursing Care Any disease or condition associated with hemorrhage is enough to cause alarm. Immediate control of hemorrhage and close observation of the patient for vital signs leading to shock are the nurses primary concern. Nursing measures are directed towards the symptoms as they occur but immediate medical attention must be sought. 1. For hemorrhage keep the patient ate rest during bleeding episodes. For nose bleeding, maintain an elevated position of trunk and promote vasoconstriction in nasal mucosal membrane through an ice bag over the forehead. For melena, place ice bag over the abdomen. Avoid unnecessary movement, If transfusion is given, support patient during therapy. Observe signs of deterioration (shock) such as low pulse, cold clammy perspiration, prostration. 2. For shock Prevention is the best treatment. Dorsal recumbent position facilitates circulation.

 Adequate preparation of the patient, mentally, and physically prevents occurrence of shock.  Provision of warmth through lightweight covers (overheating causes vasodilation which aggravates bleeding). 3. Diet low fat, low fiber, non-irritating, non-carbonated. Noodle soup may be given. III. LESSON PLAN

A. Learners Our expected learners are the selected residents of Barangay Sapa Libutad, Angeles CIty. (Refer to the appendices for the list of learners) B. Topic The topic to be discussed is about dengue, which is a disease caused by a family of viruses that are transmitted by mosquitoes.. C. Objectives  Student-centered After 40 minutes of discussion, the student nurses will be able to: y y y y y Establish rapport to the participants of Chat Session Teach learners about measles Provide basic knowledge on how dengue is prevented and its signs & symptoms Increase the learners awareness on how measles is transmitted Realize the importance of giving health teachings especially in the community

 Client- centered After 40 minutes of discussion, the participants will be able to: y y y Acknowledge the purpose of the class Participate well in the said session Understand the given health teachings by the student nurses as shown by the participants ability to answer questions given by student nurses at the end of the class D. Method of Teaching The method of teaching would be in a form of classroom type discussion wherein the group will act as instructors and the learners as the students. There will be use of visual aids like Manila paper to guide the learners. E. Materials y y Manila paper Markers

CONTENT TO BE TAUGHT

TEACHER-LEARNER ACTIVITIES

EVALUATION OF PERFORMANCE of  Question and Answer

I.

INTRODUCTION The Department of

 Presentation visual aids  Discussion

Health said that 62,503 cases of the mosquito-borne illness have been reported in the Philippines from January 1 to August 21, up nearly 90 percent from the same period last year. The death toll was also up from 350 in the same period last year. The department said the number of dengue cases in the country started to rise in May and peaked last month at the onset of the rainy season. Disease experts are

now closely monitoring several barangays across the country for cases of dengue outbreak. In line with this, the group decided to conduct a class regarding measles to raise the awareness of the residents of Barangay Sapa Libutad. II. CONCEPT Dengue viruses (DEN) types 1, 2, 3, 4, which are classified as are transmitted flaviviridae, principally  Presentation visual aids  Discussion of  Question and Answer

Agent and Vector -

from human to human through the bites of the Aedes mosquitoes. aegypti

Incubation Period After an individual is bitten by an infective mosquito, the days. Methods of Prevention and Control - Cover water drums and water pails at all times to prevent mosquitoes from breeding. - Replace water in flower vases once a week. - Clean all water containers once a week. Scrub the sides well to remove eggs of mosquitoes sticking to the sides. - Clean gutters of leaves and debris so that rain water will not collect as breeding places of mosquitoes. - Old tires used as roof support should be punctured or cut to avoid accumulation of water. - Collect and dispose all unusable tin cans, jars, bottles and other items that can collect and hold water. - To prevent mosquito bites, wear long pants and long virus undergoes an incubation period of 3 to 14

sleeves. - For personal protection, use mosquito repellant sprays that contain DEET when visiting places where dengue is endemic. Diagnostic Test - Torniquet Test (Rumpel Leads Test) III. SUMMARY  Discussion  Question and Answer Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. Symptoms such as headache, fever, exhaustion, severe joint and rash. muscle The pain, swollen (the glands (lymphadenopathy), and presence "dengue triad") of fever, rash, and headache (and other pains) is particularly characteristic of dengue fever. Because dengue fever is

caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is purely concerned with relief of the symptoms (symptomatic). The acute phase of the illness with fever and myalgias lasts about one to two weeks. Dengue hemorrhagic fever

(DHF) is a specific syndrome

that tends to affect children under 10 years of age. It causes abdominal (bleeding), pain, and hemorrhage

circulatory collapse (shock). The prevention of dengue fever requires control or eradication of the mosquitoes carrying the virus that causes dengue.

IV.

SUMMARY It was a bright, sunny day as the group headed their way to Barangay Sapa Libutad

Function Hall, to conduct their Chat Session. The group was hoping for the Chat Session to go smoothly as planned, and with Gods grace the class went on well. The group was able to achieve their objectives at the end of the class. V. EVALUATION  Student-centered After 40 minutes of discussion, the student nurses were able to: y y y y y Establish rapport to the participants of Chat Session Teach learners about measles Provide basic knowledge on how dengue is prevented and its signs & symptoms Increase the learners awareness on how measles is transmitted Realize the importance of giving health teachings especially in the community

 Client- centered After 40 minutes of discussion, the participants were able to: y y y Acknowledge the purpose of the class Participate well in the said session Understand the given health teachings by the student nurses as shown by the participants ability to answer questions given by student nurses at the end of the class VI. BIBLIOGRAPHY

NLPGNI (2007).Public Health Nursing in the Philippines.National League of Philippine Government Nurses, Philippines Mayo Clinic (September 30, 2009). Dengue Fever. Retrieved September 13,2010, from http://www.mayoclinic.com/health/denguefever/D/DSECTION=symptoms DOH (2006). Dengue. Retrieved September 13, 2010, from http://www.doh.gov.ph/healthadvisories/dengue/

VII.

APPENDICES

Angeles University Foundation Angeles City COLLEGE OF NURSING

LESSON PLAN:

Dengue Fever
Submitted to: Pamela Rose Sotto, RN Submitted by: Edmarr Bautista Alpha Patricia Cabacungan Karla Camille De Leon Kathleen Dungca Geneva Lumabi Liezel Magsombol Mervin Mandani Jan Yor Marmeto Kim Romero Bianca Margarita Tizon BSNiii-2/ Group 5