What is dengue fever?

Dengue viruses are transmitted to humans through the bites of infective female Aedes
mosquitoes.Mosquitoes generally acquire the virus while feeding on the blood of an infected person.
After virusincubation for 8-10 days, an infected mosquito is capable, during probing and blood feeding,
oftransmitting the virus, to susceptible individuals for the rest of its life. Infected female mosquitoes
mayalso transmit the virus to their offspring by transovarial (via the eggs) transmission, but the role of
thisin sustaining transmission of virus to humans has not yet been delineated.

Humans are the main amplifying host of the virus, although studies have shown that in some
parts ofthe world monkeys may become infected and perhaps serve as a source of virus for
uninfected mosquitoes. The virus circulates in the blood of infected humans for two to seven
days, atapproximately the same time as they have fever; Aedes mosquitoes may acquire the virus
when theyfeed on an individual during this period.

Characteristics
Dengue fever is a severe, flu-like illness that affects infants, young children and adults, but
seldomcauses death.

The clinical features of dengue fever vary according to the age of the patient. Infants and youngchildren
may have a non-specific febrile illness with rash. Older children and adults may have either amild febrile
syndrome or the classical incapacitating disease with abrupt onset and high fever, severeheadache, pain
behind the eyes, muscle and joint pains, and rash.

How is edngue contracted?

The virus is contracted from the bite of a striped Aedes aegypti mosquito that has previously bitten an
infected person. The mosquito flourishes during rainy seasons but can breed in water-filled flower pots,
plastic bags, and cans year-round. One mosquito bite can inflict the disease.

The virus is not contagious and cannot be spread directly from person to person. There must be a person-
to-mosquito-to-another-person pathway.

What are the signs and symptoms of dengue?

After being bitten by a mosquito carrying the virus, the incubation period ranges from three to 15 (usually
five to eight) days before the signs and symptoms of dengue appear. Dengue starts with chills, headache,
pain upon moving the eyes, and low backache. Painful aching in the legs and joints occurs during the first
hours of illness. The temperature rises quickly as high as 104° F (40° C), with relative low heart rate
(bradycardia) and low blood pressure (hypotension). The eyes become reddened. A flushing or pale pink
rash comes over the face and then disappears. The glands (lymph nodes) in the neck and groin are often
swollen.
Fever and other signs of dengue last for two to four days, followed by rapid drop in temperature
(defervescence) with profuse sweating. This precedes a period with normal temperature and a sense of
well-being that lasts about a day. A second rapid rise in temperature follows. A characteristic rash appears
along with the fever and spreads from the extremities to cover the entire body except the face. The palms
and soles may be bright red and swollen.

How is dengue fever treated?

Because dengue is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical
dengue, the treatment is purely concerned with relief of the symptoms (symptomatic). Rest and fluid
intake for adequate hydration is important. Aspirin and nonsteroidal anti-inflammatory drugs should be
avoided. Acetaminophen (Tylenol) and codeine may be given for severe headache and for the joint and
muscle pain (myalgia).

OBJECTIVES

General

This case presentation aims to identify and determine the general heath problems and needs of the patient
with an admitting diagnosis of Dengue Hemorrhagic Fever, Type 1. This presentation also intends to help
patient promote health and medical understanding of such condition through the application of the
nursing skills.

Specific

 To raise the level of awareness of patient on health problems that she may encounter.
 To facilitate patient in taking necessary actions to solve and prevent the identified problems on
her own.
 To help patient in motivating her to continue the health care provided by the health workers.
 To render nursing care and information to patient through the application of the nursing skills.

Dengue fever is an infectious disease carried by mosquitoes and caused by any of four related dengue
viruses. This disease used to be called “break-bone” fever because it sometimes causes severe joint and
muscle pain that feels like bones are breaking, hence the name. Health experts have known about dengue
fever for more than 200 years.

INTRODUCTION

Dengue fever is found mostly during and shortly after the rainy season in tropical and subtropical areas of

 Africa
 Southeast Asia and China
 India
 Middle East
 Caribbean and Central and South America
  Australia and the South and Central Pacific

An epidemic in Hawaii in 2001 is a reminder that many states in the United States are susceptible to
dengue epidemics because they harbor the particular types of mosquitoes that transmit it. Worldwide,
more than 100 million cases of dengue infection occur each year. This includes 100 to 200 cases reported
annually to the Centers for Disease Control and Prevention (CDC), mostly in people who have recently
traveled abroad. Many more cases likely go unreported because some health care providers do not
recognize the disease. During the last part of the 20th century, many tropical regions of the world saw an
increase in dengue cases. Epidemics also occurred more frequently and with more severity. In addition to
typical dengue, dengue hemorrhagic fever and dengue shock syndrome also have increased in many parts
of the world.

Dengue fever can be caused by any one of four types of dengue virus: DEN-1, DEN-2, DEN-3, and DEN-
4. You can be infected by at least two, if not all four types at different times during your lifetime, but only
once by the same type.

You can get dengue virus infections from the bite of an infected Aedes mosquito. Mosquitoes become
infected when they bite infected humans, and later transmit infection to other people they bite. Two main
species of mosquito, Aedes aegypti and Aedes albopictus, have been responsible for all cases of dengue
transmitted in this country. Dengue is not contagious from person to person.

Symptoms of typical uncomplicated (classic) dengue usually start with fever within 5 to 6 days after you
have been bitten by an infected mosquito and include

 High fever, up to 105 degrees Fahrenheit

 Severe headache
 Retro-orbital (behind the eye) pain
 Severe joint and muscle pain
 Nausea and vomiting
 Rash

The rash may appear over most of your body 3 to 4 days after the fever begins. You may get a second
rash later in the disease. Symptoms of dengue hemorrhagic fever include all of the symptoms of classic
dengue plus

 Marked damage to blood and lymph vessels

 Bleeding from the nose, gums, or under the skin, causing purplish bruises

This form of dengue disease can cause death.

Symptoms of dengue shock syndrome-the most severe form of dengue disease-include all of the
symptoms of classic dengue and dengue hemorrhagic fever, plus

 Fluids leaking outside of blood vessels

 Massive bleeding
 Shock (very low blood pressure)

This form of the disease usually occurs in children (sometimes adults) experiencing their second dengue
infection. It is sometimes fatal, especially in children and young adults.
 PARACETAMOL
Dosage: 250 mg/5ml q 4° RTC
Classification: Nonopioid Analgesics & Antipyretics
Indication: Mild pain or fever

Action: Produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in the CNS or of
other substances that sensitize pain receptors to stimulation. The drug may relieve fever through central
action in the hypothalamic heat-regulating center.

Adverse Reactions:
Hematologic: Hemolytic Anemia, Neutropenia, Leukopenia, Pancytopenia
Hepatic: Jaundice
Metabolic: Hypoglycemia
Skin: Rash, Urticaria

Contraindications:
 Contraindicated in patients hypersensitive to drug.
 Use cautiously in patients with long-term alcohol use because therapeutics doses
cause hepatotoxicity in these patients.
Nx Considerations:
 ALERT: Many OTC and prescription products contain acetaminophen; be aware of
this when calculating total daily dose.
 Use liquid form for children and patients who have difficulty in swallowing.
 In children, don’t exceed five doses in 24 hours.
Patient Teaching:
 Tell parents to consult prescriber before giving drug to children younger than age 2.
 Advise patient or parents that drug is only for short-term use; urge them to consult
prescriber if giving to children for longer than 5 days or adults for longer than 10
days.
 ALERT: Advise patient or caregiver that many OTC products contain acetaminophen,
which should be counted when calculating total daily dose.
 Tell patient not to use for marked fever (temperature higher than 103.1°F [39.5°C]),
fever persisting longer than 3 days, or recurrent fever unless directed by prescriber.
 ALERT: Warn patient that high doses or unsupervised long-term use can cause liver
damage. Excessive alcohol use may increase the risk of liver damage. Caution long-
term alcoholics to limit acetaminophen intake to 2g/day or less.
 Tell breast-feeding woman that acetaminophen appears in breast milk in low levels
(less than 1% of dose). Drug may be used safely if therapy is short-term and doesn’t
exceed recommended doses.
Interactions
o
Drug-Drug

- Barbiturates, Carbamazepine, Hydantoins, Rifampin, Sulfinpyrazone: high doses or long-term use of these
drugs may reduce therapeutic effects and enhance hepatotoxic effects of acetaminophen. Avoid using
together.

- Lamotrigine: may decrease lamotrigine level. Monitor patient for therapeutic effects.
- Warfarin: may increase hypoprothrombinemic effects with long-term use with high
doses of acetaminophen. Monitor INR closely.
- Zidovudine: may decrease zidovudine effects. Monitor patient closely.
o
Drug-Herd
- Watercress: may inhibit oxidative metabolism of acetaminophen. Discourage use
together.
o
Drug-Food
- Caffeine: may enhance analgesic effects of acetaminophen. Products may combine
caffeine and acetaminophen for therapeutic advantage

Florence Nightingale (1820–1910), considered the founder of educated and scientific nursing and
widely known as "The Lady with the Lamp"[1], wrote the first nursing notes that became the basis of
nursing practice and research. The notes, entitled Notes on Nursing: What it is, What is not (1860),
listed some of her theories that have served as foundations of nursing practice in various settings,
including the succeeding conceptual frameworks and theories in the field of nursing.[2] Nightingale
is considered the first nursing theorist. One of her theories was the Environmental Theory, which
incorporated the restoration of the usual health status of the nurse's clients into the delivery of
health care—it is still practiced today. Environmental effects

She stated in her nursing notes that nursing "is an act of utilizing the environment of the patient
to assist him in his recovery" (Nightingale 1860/1969),[3], that it involves the nurse's initiative to
configure environmental settings appropriate for the gradual restoration of the patient's health.

[edit] Environmental factors affecting health

Adequate ventilation has also been regarded as a factor contributing to changes of the patient's process
of illness recovery

Defined in her environmental theory are the following factors present in the patient's
environment:

 Pure or fresh air

 Pure water
 Sufficient food supplies
 Efficient drainage
 Cleanliness
 Light (especially direct sunlight)[4]

Any deficiency in one or more of these factors could lead to impaired functioning of life
processes or diminished health status.[5]

[edit] Provision of care by environment

The factors posed great significance during Nightingale's time, when health institutions had poor
sanitation, and health workers had little education and training and were frequently incompetent
and unreliable in attending to the needs of the patients. Also emphasized in her environmental
theory is the provision of a quiet or noise-free and warm environment, attending to patient's
dietary needs by assessment, documentation of time of food intake, and evaluating its effects on
the patient.[6]

Nightingale's theory was shown to be applicable during the Crimean War when she, along with
other nurses she had trained, took care of injured soldiers by attending to their immediate needs,
when communicable diseases and rapid spread of infections were rampant in this early period in
the development of disease-capable medicines. The practice of environment configuration
according to patient's health or disease condition is still applied today, in such cases as patients
infected with Clostridium tetani (suffering from tetanus), who need minimal noise to calm them
and a quiet environment to prevent seizure-causing stimulus