Don Mariano Marcos Memorial State University

South, La Union Campus

COLLEGE OF COMMUNITY HEALTH AND ALLIED MEDICAL SCIENCES
Agoo, La Union

DENGUE HEMORRHAGIC FEVER

PREPARED BY:
Corpuz, Rachel Ann S.
Estalilla, Sherdela Joy P.
Lasin, Jessica Maica B.
Loquias, Paula Richie B.
S.Y.2018-2019
INTRODUCTION
Dengue is a mosquito home disease caused by one of four
closely related dengue viruses (DENV -1,-2,-3,-4). Infection with one
serotype of DENV provides immunity to that serotype for life, but
provides no long-term immunity to other serotypes. Thus, a person can
be infected as many as four times, once with each serotype.
Dengue hemorrhagic fever, also known as Severe Dengue, was
first recognized in 1950s during dengue epidemics in the Philippines
and Thailand. Today, severe dengue affects most Asian and Latin
American countries and has become a leading cause of hospitalization
and death among children in these regions. Typical cases of DHF are
characterized by for major clinical manifestations; high fever,
hemorrhagic phenomena, and often, hepatomegaly and circulatory
failure.
Infected humans are the main carriers and multipliers of the
virus, serving as a source of the virus for uninfected mosquitoes.
Patients who are already infected with the dengue virus can transmit
the infection (4-5 days, maximum) via Aedes mosquitoes after their
first symptoms appear.
Mode of Transmission
1. Bite of infected mosquito, principally the Aedes Aegypti
a. Aedes aegypti, is a day biting mosquito
b. It breaks in areas of stagnant water
c. It has limited, low flying movement
d. It has a fine whole dots at the base of the wings and white
bands on the legs.
2. Aedes Albopictus may contribute to the transmission of the
dengue virus in rural areas
3. Other contributory mosquitoes:
a. Aedes polynensis
b. Aedes scutellaris simplex
Incubation Period
The incubation period is 3 to 14 days; commonly 7 to 10 days.
Period of Communicability
1. Patients are usually infective to the mosquito from a day before
the febrile period to the end of it.
2. The mosquito becomes infective from day 8 to 12 after the
blood meal and remains infective throughout its life.
Sources of Infection
1. Infected persons – the virus is present in the blood of patients
during the acute phase of the disease and will become a
reservoir of the virus, sucked by mosquitoes, which may then
transmit the disease.
 2. Stagnant water – any stagnant water in the household and its c. Tissue anoxia
premises are usual breeding places of these mosquitoes. d. Hemorrhage into the CNS or adrenal glands
e. Uterine bleeding may occur
Dengue Hemorrhagic Fever (DHF)
f. Myocarditis
This severe form of dengue virus infection is manifested by 3. Severe Manifestations
fever, hemorrhagic diathesis, hepatomegaly and hypovolemic shock. Dengue encelophalopathy is manifested by increasing
restlessness, apprehension or anxiety, disturbed
Classification According to Severity: sensorium, convulsions, spacity , and hyporeflexia.
1. Grade 1 Vaccine
There is fever accompanied with non-specific
constitutional symptoms and the only hemorrhagic Dengvaxia, world’s first dengue vaccine was approved in
manifestations is positive (+) in the tourniquet test. Mexico. The Federal Commission for the Protection against Sanitary
2. Grade 2 Risks has approved Dengvaxia, tetravalent dengue vaccine, for the
All signs of Grade 1, plus spontaneous bleeding from the prevention of disease caused by all four dengue virus serotype in
nose, gums and GIT are present. preadolescents, adolescents and adults, 9 to 45 years of age living in
3. Grade 3 endemic areas.
There is the presence of circulatory failure, as manifested
It took the multinational pharmaceutical company Sanofi
by weak pulse, narrow pulse pressure, hypotension, cold,
Pasteur more than 20 years to develop the vaccine with clinical trials in
clammy skin, and restlessness.
five Asian and five Latin American countries where dengue is endemic.
4. Grade 4
There is profound shock, and undetectable blood The vaccine was launched in the Philippines since it was the
pressure and pulse. only country where all three phases of the clinical development were
conducted.
Complications
Health authorities said the vaccine will have side effects,
1. Dengue Fever
including fever, headache, muscle pain, weakness, redness, and
a. Epistaxis menorrhagia
swelling.
b. Gastrointestinal bleeding
c. Concomitant gastrointestinal disorder (peptic ulcer) The DOH also said that the medical breakthrough is no excuse
2. DHF to stop the fight against dengue. Communities should work towards
a. Metabolic acidosis prevention by clearing possible mosquito breeding sites.
b. Hyperkalemia
 Health secretary Janette Garin said the agency would get a Member states in 3 WHO regions regularly report the annual
discounted price for the vaccine that would be used in the vaccination number of cases. In 2010, nearly 2.4 million cases were reported.
program starting March. Although the full global burden of the disease is uncertain, the initiation
of activities to record all dengue cases partly explains the sharp
The DOH will begin the vaccinating Grade 4 students in public
increase in the number of cases reported in recent years.
schools in Metro Manila and in Southern and Central Luzon. The
vaccine will be given in three doses, with six month intervals. Other features of the disease include its epidemiological
patterns, including hyper-endemicity of multiple dengue virus serotypes
It will give the vaccine to over a million students this year but the
in many countries and the aiming impact on both human health and the
health department is planning to hold a nationwide vaccination.
global and national economies.
B. Statistics
Cases across the America, South-East Asia and Western
Local Pacific exceeded 1.2 million in 2008 and over 3 million in 2013.
Recently the number of reported cases has continued to increase. In
The number of dengue cases in the country spiked from around 2013, 2.35 million cases of dengue were reported in the America
120,000 in 2014 to over 200,000 in 2015. alone, of which 37 687 cases were of sever dengue.
Despite the sharp increase in dengue cases, the Department of
Health said there was no corresponding increase in the number of
deaths--- with 598 in 2015 compared to 465 in 2014.
The DOH estimated that some 220 Filipinos a day may be
infected by the disease.
International
The incidence of dengue has grown dramatically around the
world in recent decades. The actual number of dengue cases are
underreported and many cases are misclassified. One recent estimate
indicates 390 million dengue infections per year, of which 96 million
manifest clinically. Another study, of the prevalence of dengue,
estimates that 3900 million people, in 128 countries, are at risk of
infection with dengue viruses.
GENERAL OBJECTIVES  The family of the patient will be able to understand the his
condition and have knowledge regarding the action that they
We, the student nurses which affiliated on the Medical Ward II of
might perform if signs and symptoms of the disease reoccur.
the Ilocos Training and Regional Medical Center (MWII-ITRMC) 7-3 shift
 Encourage his family to participate in rendering therapeutic care
will be able to expound and incorporate all the ideas and knowledge
to the patient by noting the advises of the doctor.
gained from the nursing approach in providing valid and outmost care
related with the patient’s condtiton which is Dengue Hemorrhagic fever. Student-centered Objectives
SPECIFIC OBJECTIVES
 The purpose of doing this case study is to allow students read
Patient-centered objectives: and understand the disease and be able to conduct health
teaching to patients.
 To collect information through thorough assessment and be
 The students will be able to think and apply possible nursing
able to conduct health teaching to raise the level of awareness
interventions for signs and symptom associated with the
of the patient on his health condition which includes the
disease.
discussion of the disease process and its management.
 Counsel the patient in taking necessary actions to manage the
existing condition for faster recovery.
 Lessen patient’s discomfort caused by the disease and
diagnostic procedures done.
 Encourage the patient to be participative in his treatment
process and let him realize the importance of taking his
medications on time.

Family-centered objectives
PATIENT’S PROFILE Admitting Diagnosis: Systemic Viral Infection, To Consider Dengue
Name: Patient Nike Fever without Warning Signs

Age: 22 years old Final Diagnosis: Dengue Hemorrhagic Fever

Address: San Fernando, City La Union Admitting Physician: Christel Marie D. Seno M.D

Sex: Male Date and Time of Admission: September 30, 2018 at 2:45pm

Height: 5’ 5” Date and Time of Assessment:

Weight: 58 kgs. October 1, 2018 at 9:00 Am To 12:00 Pm (Physical

Assessment and Interview) And
Civil status: Single
October 2, 2018 at 10:00 To 12:00 Pm (Continuation of the
Race: Asian
Interview)
Nationality: Filipino

Culture: Ilocano

Religious affiliation: Catholic

Educational attainment: High School Graduate

Birthday: November 11, 1995

Birthplace: San Antonio, Aringay, La Union

Occupation: Merchandizer

Chief Complaint: On and Off Fever

PRESENT HEALTH HISTORY
Two days prior to his admission, patient Nike started to
complain about his on and off high fever ranging from 38 - 39 ° C with
associated symptoms like abdominal pain, headache, dizziness, loose
of appetite, sudden body weakness with muscle and joint pain, taking
only Biogesic at home. He was admitted at Caba, District Hospital on
September 28, 2018 at around 7:00 in the evening as a suspected
dengue case. He was transferred to the Emergency Room of the Ilocos
Training and Regional Medical Center on September 30, 2018 at 2:46
in the afternoon. He was seen and examined by Dr. Castillo with an
admitting diagnosis of Systemic Viral Infection, To Consider Dengue
Fever without Warning Signs. The doctor ordered a shift in his IVF;
from D5 LRS to PLRS in 1L volume for 8 hours. Patient was requested
for Chest X-Ray Examination. Laboratory tests exams were requested
(Complete Blood Count with Platelet Count, Sodium and Potassium,
Blood Urea Nitrogen and Creatinine) and was ordered a diet as
tolerated except for dark colored foods and was endorsed to the
Medical Ward 2 at 3:15 pm.
PAST HEALTH HISTORY
During the interview, Patient Nike stated that he had received
complete immunizations such as BCG and others. He also stated that
we was never been hospitalized since then. He suffered common
illnesses such as fever, cough, common colds and sometimes flu. He
never went to a hospital for a check-up and only takes over the counter
drugs such as Paracetamol, Neozep, Tuseran and Bioflu. He takes
multivitamins and sometimes drink extracted fruit juices such as
calamansi and lemon juice.
FAMILY HEALTH HISTORY
Patient Nike is the eldest son among the three siblings. His father
had already died since he was 9 years old because of vehicular
accident. His mother is already 55 years old and have complaints of
back pain. His grandfather died due to lung cancer and his grandmother
suffers from arthritis and hypertension. His mother told us that they have
family health histories of hypertension and that his uncle suffers from a
prostate problem.
The families usually suffer from fever, cough, cold, diarrhea and
headache. The signs and symptoms were managed with OTC (Over The
Counter) drugs, like Biogesic for fever, Tuseran for cough, Neozep for
colds and Bioflu for fever and common cold. They also use medicinal
plants such as oregano for cough, bayabas for fever and herba buena
for headache. They drink fruit extracted juices like calamansi and lemon.
The family tries to treat these illnesses on their own. But for serious
illness they cannot further treat themselves. They seek consultation from
a physician.
SOCIAL HEALTH HISTORY
Patient Nike smokes 4 sticks of Marlboro Red a day and drinks a
bottle of 500 ml Red Horse beer twice a month with his friends. His live
in partner told us that he sometimes sleep late at night because of
playing online and video games. He loves playing basketball together
with his friends and baby sits his four month old baby after work. He is
a family oriented man had good relationships towards his partner’s
relatives.
 GENOGRAM

82 + + +

+ + +
62 59 58 55

22 20 19 LEGEND:

Shape:

Male Deceased

Female Arthritis

Color:
4 2 4mos Hypertension
mos.
Healthy
4
Lung Cancer

Prostate problem

Vehicular accident
COURSE OF CONFINEMENT
September 30, 2018
2:46 pm
3-11 shift
A 22 years old male patient was transferred from Caba, District
Hospital to the Emergency Room of the Ilocos Training and Regional
Medical Center at 2:46 in the afternoon. He was endorsed by the 7-3
shift to the 3-11 shift of on duty staff nurses. His chief complaint was
the on and off fever. He had an IVF of D5 LRS at 1L volume for 8
hours and with a blood pressure of 110/80 mm hg, pulse rate of 77
beats per minute, respiratory rate of 21 breaths per minute,
temperature of 37.4 degrees Celsius, and SPO2 of 98% as his initial
vital signs. Patient was seen and examined by Doctor Castillo and he
ordered to change the IVF from D5 LRS to PLRS in 1L volume for 8
hours. Patient was requested for Chest X-Ray Examination. Laboratory
tests exams were requested (Complete Blood Count with Platelet
Count, Sodium and Potassium, Blood Urea Nitrogen and Creatinine)
and was ordered a diet as tolerated except for dark colored foods and
was endorsed to the Medical Ward 2 at 3:15 pm.
3:30 PM
3-11 shift
Patient was transferred to Medical Ward II with an ongoing IVF
of PLRS for 8 hours at left metacarpal vein which is infusing well.
Patient was transferred comfortably at room B, Bed 6, right side
corner. Dr. Garcia ordered a Paracetamol of 500 mg per tablet to be
taken orally every 4 hours for onsets of fever greater than or equal to
37.8 ֯ C, 300 mg of Paracetamol via Intravenous route every 4 hours if
fever is greater than or equal to 38.2 ֯ C and Omeprazole of 40 mg of
capsule once a day before breakfast. Patient’s vital signs were
monitored every 2 hours with Oxygen saturation, input and output were
monitored every shift as ordered by the physician. Patient was advised
to take rest and to report fever. Laboratory exams (Complete Blood
Count with Platelet Count, Sodium and Potassium Blood Urea Nitrogen
and Creatinine) done.
9:00 pm
Dr. Abaya ordered to hold Omeprazole 40 mg of capsule, and to
monitor patient’s vital signs every two hours, input and output every
shift and to watch out for hypotension, fever and bleeding.
11pm-7am
Paracetamol was administered at 12 midnight because of fever
at
38.4 ֯ C. Vital signs were still monitored every 2 hours and input and
output every shift.
October 1, 2018
7-3 Shift
Dr. Abaya ordered a diet as tolerated except dark colored foods
and request for a Complete Blood Count and platelet count on October
2 at 3 am. Vital signs were monitored every two hours, medications
were administered and input and output every shift as ordered by the
physician. Patient is advised to increase oral fluid intake and to report
signs of bleeding.
3-11 shift
Patient is not in distress and afebrile with the same IVF of PLRS
for 8 hours at left metacarpal vein which is infusing well. Vital signs
were still monitored every two hours, input and output every shift and
to report any signs of bleeding.

11-7 shift
3 am
Complete blood count done. Patient’s platelet count decreased
from 69 x 10^9/L to 39 x 10^9/L. Medications were still given, vital
signs, input and output were monitored and recorded.
October 2, 2018
7-3 shift

Patient was ordered a diet as tolerated except dark colored

foods. Patient’s vital signs were taken and recorded and to still watch
out for bleeding. Patient is not in distress and afebrile. Patient was
informed to report any hardening felt in his abdomen and if there is
dysentery seen.
13 AREAS OF ASSESSMENTS
1. PSYCHOSOCIAL STATUS
Patient Nike is 22 years old, male, single and was born on
November 11, 1995 in San Antonio Aringay, La Union. He is now
residing in San Fernando City, La Union with his 3 sons and live in
partner. He is a Filipino with a strong faith in the Roman Catholic
religious point of view. Patient Nike is a high school graduate
working as a Merchandiser to support his family. They live in a two
storey concrete house with a flush type toilet system. The kitchen
and living room are located at the first floor and their bed rooms are
located at the second floor. The source of water for bathing, washing
of clothes and dishes come from a water pump. They use mineral
water bought from a refilling station for both brushing and drinking
purposes. They lived in a compound together with the relatives of
his live in partner located along the highway. The house is
surrounded with small potted plants with a drainage along the road.
He is the oldest among the 3 children. He said that they have a
harmonious family member relationship at home and that they
resolve problems by talking and listening to each other.
2. MENTAL AND EMOTIONAL STATUS
He is very responsive upon interaction. He is well-oriented
about the time, date, and place where he was. Patient was able to
read words shown to him like the words written “Aphrodite” and
“Hermes”. He was able to read a paragraph and tell us the message.
He thoroughly understand his health condition and told us that the
disease was “Nakakamatay, delikadong sakit”. He takes his
medications on time and understands the importance of these
medications. He is still afraid about his condition but believes that
he will be able regain his strength. He believes that doctors are
knowledgeable and that they can help him manage and recover from
this illness.
3. ENVIRONMENTAL STATUS
A. Safety Factors
The patient’s range of motion was assessed through
instruction and performance. Patient Nike was able to bend his
shoulders apart and move his shoulders laterally and medially as
well as rotate his shoulder in the same manner.
Patient’s lower extremities can be flexed and extended.
Movement through full range of motion can be done easily but the
patient feels dizzy.
B. Infection control
 Patient Nike and his family know that through proper hand
washing, using of alcohol and hand sanitizers and using face masks
they can protect and avoid the transmission of pathogens.
C. Environmental Effects on Illness
Before the patient was hospitalized, he sleep late at night and
travels to places because of his work and sometimes play online and
video games in his tablet.
4. Sensory Status
A. Visual status
We asked the patient to sit on his bed and read the word
“Aphrodite” written in big letters and “Hermes” written in a smaller
size at a distance of 2 to 3 meters approximately and he can read it
clearly. He doesn’t use eyeglasses nor contact lenses. With the use
of a penlight, we observed that his pupils constrict when light passes
and dilates afterwards. Dark eye bags are noted and patient’s eyes
looks sleepy. He blinks when the corneal touch was done. His pupils
were equally round and normal in size. His sclera was white in color,
conjunctiva was pale and his eyes were symmetrically moving when
he was instructed to follow the penlight in different positions. His
eyebrows and eyelashes are equally distributed.
B. Auditory Status
For auditory assessment, the voice whisper test was used.
He was instructed to repeat the words whispered to him. In his right
ear we whispered the word “bouquet” and he was able to repeat it
while in his left ear we whispered the word “brighter” and he stated
the word “lighter”. His ears are symmetrical and no earwax or
discharge seen. Upon palpation, there were no nodules and lumps
felt.
C. Olfactory Status
The patient’s nose is in midline of the face and is symmetrical.
There is no obstruction or secretion seen. The patient’s olfactory
status was normal because he was able to recognize the smell of
perfume, alcohol, coffee and alcohol. He did not report any pain
when his sinuses were percussed.
D. Gustatory Status
We examined his sense of taste using a variety of foods
which tastes salty, bitter, and sweet and such as candy, cornick and
toasted garlic. We instructed him to close his eyes and tell us what
food was given to him to taste. The patient’s gustatory status was
normal because he was able to differentiate each taste and tell us
what that food is. His oral mucous are moist and his lips were pink
and moist as well. His teeth are white in color and he said that his
molar teeth in the right side was removed. There are no lumps seen.
E. Tactile Status
We examined his sense of touch by instructing him to close
his eyes and tell what he feels, if it soft or rough and dull or sharp.
We stroke a cotton ball in his face and he told us that it was soft and
we let him hold piece of cloth and he told us that it was rough. We
let him hold the tip of a pen and he said that it was sharp and the top
part was dull. He looks pale but his skin turgor was normal.
5. Motor status
4/5 4/5
4/5 4/5
Patient’s gait was assessed using the head to toe method.
He was able to stand on his own and balance himself during the
assessment. He complains of slight dizziness when moving from one
place to another. He has a slight difficulty in moving in between
positions. He was able to flex, extend, adduct and abduct his
shoulders and legs.
6. Nutritional Status
Before the hospitalization, the patient usually refers to eat
meat and vegetables. He eats 3 times a day and sometimes taking
snack in between meals. He drinks 1000 to 1500 ml of water per
day.
Upon admission, he was ordered a diet as tolerated except
or dark colored foods. He eats porridge (lugaw) and fruits like apples
and bananas. He was advised to increase his oral fluid intake up to
4L daily.
7. Elimination Status
Before hospitalization Patient usually defecate one to two
times a day. Since admission his defecation is still once or twice
daily. He describes it as green in color, well-formed and with strong
odor.
8. Fluid and electrolytes Status
Before Hospitalization, he usually drinks 6 to 8 glasses of
water a day and urinates regularly.
 Since admission, he drinks up to 4L of water as advised by
his physician. Patient has an ongoing IVF of PLRS x 1L for 8 hours
regulated at 31 to 32 gtts/min. His skin turgor is normal and he has
moist mouth and mucous membranes. The patient’s capillary refill is
within 1 to 2 seconds.
9. Circulatory Status
The patient had a cardiac rate ranges from 70 to 93 beats
per minute. The patient was in semi fowler’s position. His capillary
refill is in normal state. His systolic blood pressure ranges from
120 to 100 mm hg and his diastolic blood pressure ranges from
70-80 mm hg. His nails are pale in color so with his lips and skin.
He has a urine output of 3200 ml during the shift.
10. Respiratory Status
There was no flaring observed and no respiratory
accessory used. His respiratory status rate ranges from 20 to 23
breaths per minute. The patient smokes 4 sticks per day. In his
chest x-ray exam there are reticulohazed opacities seen in the
right paracardiac area with an impression of pneumonia, right.
11. Temperature Status
The patient was warm to touch on his extremities. His body
temperature is taken per axilla ranging from 36.8 ֯ C to 38.4 ֯ C.
The patient had warm extremities and the room is well ventilated.
12. Integumentary Status
The patient had a pale and fair skin color with rashes on
his both lower extremities. There was no clubbing of nails
observed. There is evenness of hair growth over the scalp and
there is no presence of infection.
13. Rest and Comfort Status
Prior to hospitalization he sleeps 7 hours at night and
seldom taking naps during the day time because of his work. He
is comfortable at his bed at home.
During his stay in the hospital, he sleeps 5 hours a day.
“Natutulog ako mula 11pm hanggang 4am. “Minsan maingay at
mainit kasi dito sa ospital” as verbalized by the patient, he is not
using any aid for him to sleep. He is lying on the hospital bed that
suits for his rest and comfort.
ANATOMY AND PHYSIOLOGY Lymphoid cell line
Can develop into lymphocytes. Lymphocytes are another type of
white blood cells also called leukocytes. Lymphocytes help fight
infection and destroy abnormal cells.
Myeloid Cell Line
Can develop into red blood cells, platelets and some type of
white blood cells. Red blood cells carry oxygen to all tissues of the
body. Platelets form clots in damaged blood vessels to stop bleeding.
Myeloid stem cells develop into 2 different types of white blood
cells, called granulocytes and monocytes. These white blood cells
destroy bacteria and other foreign invaders and help to fight infection.
Blood
Functions
Blood is made up of liquid (called plasma) and solid cells. Blood
The main function of blood is to carry nutrients, gases, waste
cells are made in bone marrow. Bone marrow is the soft, spongy
products, cells and hormones. Each type of blood cell has a specific
substance in the center of bones.
job
Structure
1. Red blood cells carry oxygen from the lungs to the rest of the
In adults, the most active bone marrow is found in the pelvic body. They also carry carbon dioxide from the body to the lungs
bone, shoulder bones, back bones, ribs, breast bone and skull. so it can be breathed out.
Immature blood cells in the bone marrow are called stem cells. Stem 2. Platelets from blood clots in damaged vessels to stop bleeding
cells can also be found in smaller amounts in the bloodstream. These 3. White blood cells help prevent and fight infection by destroying
are called peripheral blood stem cells. bacteria, viruses and other foreign cells or substances.

All our blood cells develop from stem cells. The process of Types of White Blood cells
blood cell development is called hematopoiesis. In the earliest stage of
White blood cells are the cells that help the body fight infection.
blood cell development, stem cells begin to develop either along the
There are a number of different types and sub-types of white blood
lymphoid cell line or the myeloid cell line. In both cell lines, the stem
cells which each have different roles to play.
cells become blasts, which are still immature cells.
The three major types of white blood cells are:
 1. Granulocytes 1. Dendritic cells are antigen-presenting cells which are able to
2. Monocytes mark out cells that are antigens that need to be destroyed by
3. Lymphocytes lymphocytes.
2. Macrophages are phagocyte cells which are larger and live
Granulocytes
longer than neutrophils. Macrophages are also able to act as
There are three different forms of granulocytes: antigen-presenting cells.

1. Neutrophils Lymphocytes
2. Eosinophils
Lymphocytes are cells which help to regulate the body’s
3. Basophils
immune system
Granulocytes are pathogens, that are able to ingest foreign cells
The main type of lymphocytes are:
such as bacteria, viruses, and other parasites.
1. B Lymphocytes (B cells)
Granulocytes are cells that have granules of enzymes which
2. T Lymphocytes (T cells)
help to digest the invading microbes. Granulocytes account for about
3. Natural killer cells
60% of our white blood cells
Neutrophils are by far the most prevalent of these cells. Each
neutrophil cell can ingest up to between around 5 and 20 bacteria in its
lifetime.
Eosinophils are involved in allergic reactions and can attack
multicellular parasites such as worms.
Basophils are also involved in allergic reactions and are able to
release histamine, which helps to trigger inflammation, and heparin,
which prevents blood from clotting.
Monocytes
Monocytes can develop into two types of cell:
LABORATORY RESULTS AND INTERPRETATION
Name: Mr. Nike Laboratory Accession No: 18-1965
Birthdate: 11-1-95 Age: 22 Sex: Male Hospital No.: 18-5918 Ward: Med
Requesting Physician Date Received: SEP-30-2018 Time: 3:50 pm
INFECTIOUS DISEASES
Assay Result Method Interpretation
Dengue NS1 Antigen Positive Immunochromatography Positive Dengue NS1 antigen is a
laboratory confirmation of dengue in
people
Dengue DOT IgG Negative Immunochromatography Negative tests for IgM and/or IgG
IgM Negative antibodies may mean that the individual
tested does not have a dengue infection
and symptoms are due to another
cause, or that the level of antibody may
be too low to measure. The person may
still have a dengue infection – it may just
be that it is too soon after initial
exposure to the virus to produce a
detectable level of antibody.
Name: Mr. Big
Department: MED 2 Lab Control No: 1804976
Date of Birth: 11-NOV-1995 Date Requested: 02-OCT-2018
Gender: Male Age: 22 Run Time: 02-OCT-2018, 04:37 AM
HEMATOLOGY RESULT
PARAMETER RESULT UNIT REF. RANGE INTERPRETATION
WBC 2.6 X 10^9/L 4.0 - 10.0 Dengue virus, the main cause of dengue fever induces bone
marrow suppression. Since bone marrow is the manufacturing
centre of blood cells its suppression causes deficiency of blood
cells leading to low white blood cell count.
Differential Count
Neutrophils 40.8 % 55.0 - 65.0 Neutropenia is a blood condition characterized by low levels of
neutrophils, which are white blood cells that protect your body from
infections. Without enough neutrophils, your body can’t fight off
bacteria. Having neutropenia increases your risk of many types of
infection.
Lymphocytes 38.8 % 25.0 - 35.0 Lymphocytosis, or a high lymphocyte count, is common if there is
an infection
Monocytes 18.0 % 3.0 - 6.0 The condition of having high monocyte levels is known as
monocytosis. This most commonly occurs during and after chronic
inflammation or infection.
Eosinophil 1.6 % 2.0 - 4.0 Dengue virus, the main cause of dengue fever induces bone
marrow suppression. Since bone marrow is the manufacturing
centre of blood cells its suppression causes deficiency of blood
cells leading to low eosinophil count.
Basophils 0.8 % 0.0 - 1.0 Normal
Erythrocytes 5.4 X 10^12/L 4.5 - 6.2 Normal
Hemoglobin 153 g/L 130 - 180 Normal
Hematocrit 0.46 0.40 - 0.54 Normal
MCV 84.1 fL 80.0 - 100.0 Normal
MCH 28.3 Pg 27.0 - 34.0 Normal
MCHC 336 g/L 310 - 370 Normal
RDW-CV 0.013 % 0.110 - 0.160 Indicates anemia.
RDW-SD 38.6 fL 35.0 – 56.0 Normal
PLATELET 39 X10^9/L 150 - 450 Dengue virus, the main cause of dengue fever induces bone
COUNT marrow suppression. Since bone marrow is the manufacturing
Name: Mr. Nike Age: 22 Sex:
centre of Male
blood cells its suppression causes deficiencyWard: MED
of blood
Test Result Reference
cells leading to low platelet Value
count. Interpretation
Anaemia and spontaneous
Sodium Na (+) 138.9 mmol/L 135 – 148are
severe bleeding mmol/L
the other resultant factors of boneNormal
marrow
Potassium K (+) 4.73 mmol/L 3.50
suppression – 5.30 mmol/L Normal
Chloride
MPV Cl (-) 10.4 fL mmol/L
6.5 - 12.0 Normal 96 – 107 mmol/L
Ionized
PDW Calcium 11.8 9.0 – 17.0
mmol/L Normal 1.120 – 1.320 mmol/L
PCT 0.04 mL/L 1.08 – 2.82
IG# %
NRBC# %
Name: Mr. Big
Department: ER-MED Lab Control No: 1804710
Date of Birth: 11-NOV-1995 Date Requested: 30-SEP-2018
Gender: Male Age: 22 Run Time: 30-SEP-2018, 04:15 PM
HEMATOLOGY RESULT
PARAMETER RESULT UNIT REF. RANGE INTERPRETATION
WBC 2.3 X 10^9/L 4.0 - 10.0 Dengue virus, the main cause of dengue fever induces bone marrow
suppression. Since bone marrow is the manufacturing centre of blood
cells its suppression causes deficiency of blood cells leading to low
white blood cell count.
Differential Count
Neutrophils 71.7 % 55.0 - 65.0 Having a high percentage of neutrophils in your blood is called
neutrophilia. This is a sign that your body has an infection.
Lymphocytes 20.4 % 25.0 - 35.0 Dengue virus, the main cause of dengue fever induces bone marrow
suppression. Since bone marrow is the manufacturing centre of blood
cells its suppression causes deficiency of blood cells leading to low
lymphocyte count.
Monocytes 7.5 % 3.0 - 6.0 The condition of having high monocyte levels is known as
monocytosis. This most commonly occurs during and after chronic
inflammation or infection.
Eosinophil 0.0 % 2.0 - 4.0 Dengue virus, the main cause of dengue fever induces bone marrow
suppression. Since bone marrow is the manufacturing centre of blood
cells its suppression causes deficiency of blood cells leading to low
eosinophil count.
Basophils 0.4 % 0.0 - 1.0 Normal
Erythrocytes 5.3 X 10^12/L 4.5 - 6.2 Normal
Hemoglobin 120 g/L 130 - 180 Indicates anemia
Hematocrit 0.45 0.40 - 0.54 Normal
MCV 85.1 fL 80.0 - 100.0 Normal
MCH 24.6 Pg 27.0 - 34.0 A low mean corpuscular hemoglobin concentration (MCHC) shows that
someone's red blood cells do not have enough hemoglobin.
Hemoglobin is an iron-rich protein, and a lack of it may indicate
anemia.
MCHC 336 g/L 310 - 370 Normal
RDW-CV 0.013 % 0.110 - 0.160 Indicates anemia.
RDW-SD 39.6 fL 35.0 – 56.0 Normal
PLATELET 69 X10^9/L 150 - 450 Dengue virus, the main cause of dengue fever induces bone marrow
COUNT suppression. Since bone marrow is the manufacturing centre of blood
cells its suppression causes deficiency of blood cells leading to low
platelet count. Anaemia and spontaneous severe bleeding are the
other resultant factors of bone marrow suppression
MPV 10.9 fL 6.5 - 12.0 Normal
PDW 12.8 9.0 – 17.0 Normal
PCT 0.08 mL/L 1.08 – 2.82
IG# 0.0 %
NRBC# 0.0 %
GENERAL PATHOPHYSIOLOGY

Predisposing Factors Precipitating Factors

 Geographical area-tropical island in the  Environmental conditions (open spaces with water,
Pacific (Philippines) flood)
 Dengue Outbreaks

Aedes Mosquito
(Carrier of Dengue Virus)

Bite from mosquito to skin (Portal of Entry)

Virus will circulate in the blood

Infection primarily targets reticulo

endothelial system (blood, bone marrow
lymph nodes)

Production of immune mediators Release of cytokines

Activation of immune response Stimulate WBC and Pyrogens

Viral replication and Destructive actions of the virus or bone Fever

Cellular destruction marrow precursor cells

Muscle Weakness

Thrombocytopenia Lymphopenia Leukopenia

 Capillary fragility Petechiae

Epistaxis

GI Bleeding

Melena

Release of Histamine Capillary Permiability

Plasma Leakage
Leakage Leakage

DENGUE HEMORRAHGIC
FEVER
SPECIFIC PATHOPHYSIOLOGY

Predisposing Factors Precipitating Factors

 Geographical area-tropical island in the  Environmental conditions (open spaces with water)
Pacific (Philippines)  Travels to places because of his work as a merchandizer

Aedes Mosquito
(Carrier of Dengue Virus)

Bite from mosquito to skin (Portal of Entry)

Virus will circulate in the blood

Infection primarily targets reticulo

endothelial system (blood, bone marrow
lymph nodes)

Production of immune mediators Release of cytokines

Activation of immune response Stimulate WBC and Pyrogens

Viral replication and Destructive actions of the virus or bone Fever

Cellular destruction marrow precursor cells

Hyperthermia
Muscle Weakness

Activity Intolerance
Thrombocytopenia Lymphopenia Leukopenia

Risk for injury

 Capillary fragility Petechiae

Risk for bleeding

Release of Histamine Capillary Permiability

Disturbed sleeping
pattern

Plasma Leakage
Leakage Leakage

DENGUE HEMORRAHGIC
FEVER
LIST OF PRIORITIZATION OF DIAGNOSIS

 Hyperthermia related to presence of arbovirus in patient’s body causing release of Pyrogens.

 Activity Intolerance r/t Muscle weakness 2° to Decreased hemoglobin level
 Disturbed Sleeping Patterns related to interruptions for therapeutics, monitoring and other generated awakening
 Risk for injury related to abnormal blood profile as evidenced by decrease platelet count and hemoglobin.
 Risk for bleeding related to Decreased Platelet Count as evidenced by Lab Results

NURSING PROBLEMS ASSESSMENT AIRWAY ; ACTUAL/POTENTIAL OVERT/ COVERT MASLOW’S

BREATHING ; HEIRARCHY OF
CIRCULATION NEEDS

Hyperthermia related to Subjective: Circulation Actual Overt Physiological need

presence of arbovirus in “Pabalik balik tong
patient’s body causing release lagnat ko, hindi
of Pyrogens. bumababa” as
verbalized by the
patient

Objective:
 Temp. of
38.4
 Warm to
touch
 Weak in
appearance
 Pale skin
Activity Intolerance SUBJECTIVE: Circulation Actual Overt Safety and security
r/t Muscle weakness 2° to
Decreased hemoglobin level “Agkakapsuttak
ken, marigatanak
aggunay” as
verbalized by the
patient.

OBJECTIVE:

 Weak in
appearance
 With pale
skin and
conjunctiva
 Looks thin in
appearance
 Dec. Hgb,
Level:
12.9g/dl

Disturbed Sleeping Patterns Subjective: Circulation Actual Overt Physiological

related to interruptions for “Paputol-putol yung needs
therapeutics, monitoring and tulog naming dito
other generated awakening kasi maya’t-maya
and excessive stimulation may pumapasok na
(noise and lighting). tao eh” as
verbalized by
patient Nike

Objective:
  Presence of
eye bags
 Weakness
and
restlessness
 Taking nap
where there
is chance or
if there is a
free time
 Yawning

Risk for injury related to Subjective: Circulation Potential Overt/Covert Safety and Secutiry
abnormal blood profile as “Medyo nahihilo
evidenced by decrease platelet ako, ” as verbalized
count and hemoglobin. by the patient

Objective:
 Weak in
appearance
 Pale skin
 Platelet
count of 39 x
10^9/L
 Hemoglobin
of 120 g/L
 Mean
corpuscular
hemoglobin
of 24.6 Pg
  Petechiae in
lower
extremities

Risk for bleeding related to Subjective: Circulation Potential Overt/Covert Safety and security
Decreased Platelet Count as “Ma’am pinagbawal
evidenced by Lab Results akong
magtoothbrush ni
Dok at palagi ko
daw pong titignan
ung tae ko kung
may dugo” as
verbalized by the
patient.

Objective:
 Petechiae in
lower
extremities
 Abdominal
pain
 Weak in
appearance
 ASSESSMENT EXPLANATION OF THE OBJECTIVE INTERVENTIONS RATIONALE EVALUATION
PROBLEM
Subjective: Aedes Mosquito
Short Term Goal:  Monitor  Serves as Goal met. After 2
“Pabalik balik tong (Carrier of Dengue Virus) After 2 hours of patient’s vital baseline data hours of nursing
lagnat ko, hindi nursing signs for future intervention, the
bumababa” as interventions, the comparison patient’s core
verbalized by the patient Bite from mosquito to skin patient will be able  Note  Assess for temperature had
(Portal of Entry) to: chronological causative/contr decreased from
Objective: 1. Manifest and ibuting factor 38.4 to 37.5.
 Temp. of 38.4 reduction of development
 Warm to touch Virus will circulate in core al age of the  To assess
 Weak in the blood temperature patient degree of
appearance from 38.4 C hyperthermia
 Pale skin Infection primarily targets
to 37.5 C  Note
reticulo endothelial presence/abs
system (blood, bone ence of  Facilitates heat
marrow lymph nodes) sweating through
Nursing diagnosis: conduction
Hyperthermia related to  Initiate tepid and
presence of arbovirus in Production of immune mediators sponge bath evaporation
patient’s body causing
release of Pyrogens.  Promote  Facilitates heat
Release of cytokines surface loss by
cooling radiation
through
Stimulate WBC and Pyrogens undressing or
removing
extra linens.
 To promote
Fever
heat loss and
hydration
  Encourage
adequate
fluid intake  To reduce
metabolic
consumption
 Encourage and oxygen
adequate bed demands
rest
 To promote
wellness
 Instruct
patient and
significant
others to
report signs
and
symptoms of
hyperthermia
like flushed
skin,  To relieve high
increasing temperature by
respiratory inhibiting the
rate and body synthesis of
temperature. prostaglandin.
Collaborative:
 Administer
paracetamol
as prescribed
by the
physician

NURSING CARE PLAN:

 ASSESSMENT EXPLANATION OF THE OBJECTIVE INTERVENTIONS RATIONALE EVALUATION
PROBLEM
Subjective: Aedes Mosquito
Short Term Goal:  Establish  To gain Short Term Goal:
“Medyo nahihilo ako, ” (Carrier of Dengue Virus) After 30 minutes of rapport. patient’s Goal met. After 30
as verbalized by the health teaching, the trust and minutes of health
patient patient will be able to cooperation. teaching, the patient
Bite from mosquito to skin understand the understand the
(Portal of Entry) individual factors that  Monitor and  For baseline individual factors that
Objective: contribute to the record vital data. contribute to the
 Weak in possibility of injury signs. possibility of injury
appearance Virus will circulate in such as his low platelet such as his low
 Pale skin the blood count and dizziness,  Assess  Aggressive platelet count and
 Platelet count of and modify the mood, and dizziness and modify
39 x 10^9/L environment such as coping, impulsive the environment such
Infection primarily targets
(October 2, reticulo endothelial system
keeping those self- abilities and behavior as keeping those self-
2018, 4:37 am) (blood, bone marrow lymph inflicting objects and personality indicates inflicting objects and
 Hemoglobin of nodes) putting up the side rails styles self-harm to putting up the side
120 g/L at all times as the patient. rails at all times as
(September 30, Production of indicated to enhance indicated to enhance
2018, 4:15 pm) immune mediators safety.  Observe for  Observing safety.
 Mean presence of those signs
corpuscular Activation of Long Term Goal: petechiae, will help to Long Term Goal:
hemoglobin of immune response Throughout his ecchymosis, reduce the Goal met. The patient
24.6 Pg hospitalization, the bleeding risk for injury was free from any
(September 30, patient will be free of from one to the other injury throughout his
2018, 4:15 pm) injury. more sites. parts of the hospitalization.
Destructive actions of the
 Petechiae in virus or bone marrow
body.
lower precursor cells
 Maintain
extremities bed in a
lowest
Thrombocytopenia position with
Nursing diagnosis: wheels  Ensuring the
Risk for injury related locked. patient’s
to dizziness. safety.
 Advise
significant
others that  To prevent
those self- further injury
inflicting to the
materials patient.
such as
(utensils,
knife, and
syringes)
should be
keep.

 Encourage  Leaving the

the patient
significant unattended
others not may
to leave the increase
patient anxiety to
unattended. the patient.
ASSESSMENT EXPLANATION OF THE OBJECTIVE INTERVENTIONS RATIONALE EVALUATION
PROBLEM
Subjective: Aedes Mosquito Short Term Goal:  Assess patient’s  Different levels of Short Term Goal:
“Ma’am natatakot po (Carrier of Dengue Virus) After 10-30 minutes level of anxiety. anxiety will affect Goal met. After 10-30
ako kc mababa ung of nursing the coping minutes of nursing
platelet count ko?” as intervention, the mechanism of the intervention, the client
verbalized by the Bite from mosquito to skin
client will appear client. appeared more
patient. (Portal of Entry)
more relaxed and  To identify physical relaxed and was able
be able to know responses to know and practice
some techniques  Monitor vital signs. associated with some techniques on
Objective: on how to lessen both medical and how to lessen the
 German Rashes Virus will circulate in the anxiety such as emotional anxiety such as deep
in lower the blood deep breathing conditions breathing exercises
extremities exercises and  Acknowledge  Acknowledgement and promotion of
 Weak in promotion of sleep. awareness of of the patient’s sleep.
Infection primarily targets
appearance patient’s anxiety. feelings validates
reticulo endothelial system
 Agitated Long Term Goal: the feelings and Long Term Goal:
(blood, bone marrow lymph
 Platelet count nodes)
Throughout communicates Goal met. Throughout
of 39 x 10^9/L hospitalization the acceptance of hospitalization the
patient’s anxiety will those feelings. patient’s anxiety was
(October 2, Production of
2018, 4:37 am)
be reduced to a  Instruct to do deep  To help client relax. reduced to a
immune mediators manageable level. manageable level.
breathing
 Increased
exercise.
perspiration  Provide accurate  Helps the client to
Activation of
immune response information about identify what is
Nursing diagnosis: the situation. reality based.
Anxiety related to
 Establish a  To avoid a
actual/perceived threat
Destructive actions of the therapeutic contagious
to health as evidenced
virus or bone marrow relationship, effect/transmission
by agitated appearance
precursor cells conveying of anxiety. The
secondary to low
empathy and health care
platelet count.
unconditional provider can
Thrombocytopenia positive reward ad transmit his or her
maintain a calm own anxiety to the
manner while hypersensitive
interacting with patient.
patient.
 Establish a  An ongoing
working relationship
relationship with establishes a basis
the patient through for comfort in
continuity of care. communicating
anxious feelings.
 Review results of  This factors may
diagnostic tests point to
(e.g., drug screens physiological
, cardiac testing, sources of anxiety.
complete blood
count, and
chemistry panel).
 Administer  To reduce level of
medications (anti- anxiety.
anxiety
agents/sedatives),
as ordered.
 ASSESSMENT EXPLANATION OF THE OBJECTIVE INTERVENTIONS RATIONALE EVALUATION
PROBLEM
Subjective: Aedes Mosquito
Short Term  Assess sleep  High percentage After two days of nursing
“Paputol-putol yung (Carrier of Dengue Virus) Goal: pattern of sleep intervention the patient
tulog naming dito kasi After the 2 days disturbances disturbances was able to display
maya’t-maya may of nursing that are can affect the improvement in sleeping
pumapasok na tao eh” Bite from mosquito to skin intervention, the associated recovery of the pattern as evidenced by:
as verbalized by (Portal of Entry) patient will be with the patient.
patient Nike able to verbalize environment.  The patient
that he feels  To determine verbalized “medyo
Objective: Virus will circulate in rested and the  Observe and usual sleeping nakakatulog at
 Presence of the blood presence of eye obtain pattern and to nakakapagpahinga
eye bags bags decreases. feedbacks compare if there na ako ng maayos
 Weakness and Infection primarily targets
regarding on are any kumpara sa dati”.
restlessness reticulo endothelial system the usual improvements  The patient does
 Taking nap (blood, bone marrow lymph Long term goal: sleeping on the sleeping not look weak and
where there is nodes) Throughout pattern, pattern of the restlessness
chance or if hospitalization bedtime patient. compare to the
there is a free Production of the patient will routine and past.
time for about immune mediators verbalize that the usual  The presence of
an hour his sleeping number of eye bags have
 Yawning Activation of pattern hours of  To avoid minimized or have
 Vital signs immune response improves and sleep and disturbances gone.
monitoring absence of rest. during sleep,  Decrease of the
every 2 hours restlessness and also usual yawning.
 5 hours of Release of Histamine noted.  Do as much maximize the
sleep care as sleep and rest Long term goal:
possible of the client. Goal partially met. The
Capillary Permiabiity
without patient verbalizes that his
Nursing diagnosis: waking up sleeping pattern improves
Disturbed Sleeping the client and but not as the same
Disturbed sleeping
Patterns related to pattern
do as much  For the patient before his hospitalization.
interruptions for care as to have an
therapeutics, possible understanding
monitoring and other while the of the
generated awakening client is still importance of
and excessive awake. care being done
stimulation (noise and to him and to
lighting). minimize the
 Explain complaints.
necessary of
disturbances
for
monitoring
vital signs
and care
when
hospitalized.
 ASSESSMENT EXPLANATION OF THE OUTCOME NURSING RATIONALE EVALUATION
PROBLEM INTERVENTION
SUBJECTIVE: Aedes Mosquito Short Term Goal: Independent Mgt. Short Term
(Carrier of Dengue Virus) After 30 minutes of
“Nahihilo ako” as nursing intervention,  Assess  Influences After 30 minutes of
verbalized by the the patient will use patients ability choice of nursing intervention,
patient. Bite from mosquito to skin the identified to perform intervention GOAL was met as
(Portal of Entry) techniques to ADLs noting or needed evidence by:
OBJECTIVE: enhance activity reports of assistance
intolerance such as weakness, Patient being
 Weak in Virus will circulate in practicing the active fatigue and cooperative in active
appearance the blood range of motion difficulty in range of motion
 With pale skin and exercises and deep accomplishing exercises and
palpebral breathing exercises. task identifies the
Infection primarily targets
conjunctiva reticulo endothelial system effectiveness of deep
 Looks thin in (blood, bone marrow lymph Long Term Goal:  Promote  Mild/modera breathing exercises.
appearance nodes) Throughout independence te activities
 Hemoglobin of hospitalization, the in self-care and Long Term:
120 g/L Production of patient will activities as improved Goal met.Throughout
(September 30, immune mediators demonstrate a tolerated self-esteem hospitalization, the
2018, 4:15 pm) decrease in are patient will
 20- 23 breaths per Activation of physiological signs of  Encourage promoted demonstrate a
minute immune response intolerance as alternating decrease in
evidenced by normal activity with physiological signs of
hemoglobin level. rest  Minimized intolerance as
Nursing Diagnosis: exhaustion evidenced by normal
Destructive actions of the
Activity Intolerance virus or bone marrow and helps hemoglobin level at
r/t dizziness 2° to precursor cells balance 153 g/L(October 2,
Decreased oxygen 2018,4:37 am).
hemoglobin level  Encourage supply and
Viral replication and deep breathing demand
Cell destruction exercises
  Promotes
Muscle Weakness
relaxation,
relieves
tension and
stress and
promote
 Explain effective
importance of exchange of
be rest in gases
treatment
 Bed rest is
maintained
 Monitor to decrease
laboratory metabolic
results like demands
Hgb and Hct thus
conserving
energy
 To identify
the extent of
deficiency
and foe
better.
DRUG STUDY
DRUG NAME DOSAGE/ MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
FREQUENCY/ ACTION EFFECTS CONSIDERATIONS
ROUTE
Generic Name: 40 mg , 1 Suppresses Treatment Contraindicated with  Weakness  Inform patient
Omeprazole capsule once a gastric secretion and hypersensitivity to  Dizziness and significant
Brand Name: day before by inhibiting prevention of omeprazole or its  Headache others about the
Losec (CAN), breakfast hydrogen; hyper components  Fatigue reason why drug
Prisolec, characterized as secretions of  Abdominal is given.
Prisolec OTC, gastric pump stomach acid. pain  Monitor for
Zegerid (with inhibitor.  Acid diarrhea and
sodium regurgitation abdominal pain.
bicarbonate)  Constipation  Take the drug
 Diarrhea before meals.
Drug
 Flatulence  Report severe
Classification: headache,
Anti-secretory  Nausea
 Vomiting worsening of
drug symptoms, fever,
Proton inhibitor  Rush
chills.
pump  Itching
 Inform the patient
and significant
others that he
may experience
this adverse
effects; dizziness,
headache,
nausea, vomiting,
diarrhea.
 DRUG NAME DOSAGE/ MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
FREQUENCY ACTION EFFECTS CONSIDERATIONS
/ROUTE
Generic Name: 500 mg, 1 tab  Inhibits the  For fever  Hypersensitivity  Skin rashes  Assess patient for
Paracetamol every 4 hours synthesis of  Urticaria fever, note presence
PRN for fever prostaglandin  Hypoglyce of associated signs
Brand Name: greater than that may serve mia (diaphoresis,
Acetaminophen or equal to as mediators of  Leukopenia tachycardia, and
37.8 ֯ C pain and fever. malaise.
 Be aware that long
300 mg, IV term use can cause
every 4 hours liver damage.
for fever  Assess for allergic
greater than reactions
or equal to
38.2 ֯ C
DISEASE ENTITY
Dengue Hemorrhagic Fever
Overview
Dengue fever is a common mosquito-borne illness in many tropical and
subtropical countries. One study estimated that 50 million infections
occur every year. Symptoms can be mild and include:
 fever
 rash
 muscle and joint pain
Mosquitoes become infected with the dengue virus when they bite
infected people, and then spread it when they bite another person.
Most cases of the dengue virus are caused when a mosquito bites
someone, but you can get the virus if you are exposed to infected
blood.
Dengue virus rarely causes death. However, the infection can progress
into a more serious condition known as severe dengue or dengue
hemorrhagic fever.
Symptoms of dengue hemorrhagic fever include:
 bleeding under the skin
 frequent vomiting
 abdominal pain
The more severe symptoms of dengue hemorrhagic fever often
develop after you start to recover from the dengue virus.
What Causes Dengue Hemorrhagic Fever?
Dengue hemorrhagic fever can occur when someone is bitten by a
mosquito or exposed to blood infected with the dengue virus. Infected
mosquitoes are the most common causes.
There are four different types of the dengue virus. Once you are
infected with one of the viruses, you develop immunity to that virus for
the rest of your life. However, this immunity will not protect you from
the other viruses. It is possible to be infected with all four different
types of the dengue virus in your lifetime.
Repeated exposure to the dengue virus can make it more likely that
you will develop dengue hemorrhagic fever.
Who Is at High Risk for Dengue Hemorrhagic Fever?
Living in or traveling to Southeast Asia, South and Central America,
sub-Saharan Africa, and parts of the Caribbean can increase your risk
of contracting the dengue virus. Other people at higher risk include:
 infants and small children
 pregnant women (the virus may be passed from mother to fetus)
 older adults
 those with compromised immune systems
What Are the Symptoms of Dengue Hemorrhagic Fever?
Symptoms of the dengue virus generally include:
 mild, moderate, or high fever
 headaches
 nausea
 vomiting
 pain in the muscles, bones, or joints
 rashes on the skin
You may feel like you are recovering from dengue fever, and then
suddenly develop new and severe symptoms. These could be
symptoms of dengue hemorrhagic fever. Call your doctor if you begin
to experience:
 restlessness
 acute, or sudden, fever
 severe abdominal pain
 bleeding or bruising under the skin
 cold or clammy skin
 nosebleeds
 large decrease in blood pressure (shock)
How Is Dengue Hemorrhagic Fever Diagnosed?
Doctors will usually diagnose the type of dengue virus and then begin
to look for signs of dengue hemorrhagic fever. Your doctor may do the
following:
 check your blood pressure
 examine your skin, eyes, and glands
 perform blood tests and coagulation studies
 take a chest X-ray
In addition to performing these tests, your doctor may ask you
questions about your personal and family medical history. Your doctor
may ask about your lifestyle and recent travels. They may also try to
rule out other conditions, like malaria, that are common in tropical
regions.
Treatment for Dengue Hemorrhagic Fever
The goal of treatment is to manage symptoms and keep the infection
from becoming more severe. Severe cases may need emergency
treatments such as:
 hydration with intravenous (IV) fluids
 over-the-counter or prescription drugs to manage pain
 electrolyte therapy
 blood transfusions
 careful monitoring of blood pressure
 oxygen therapy
 skilled nursing observation
All of these methods are aimed at controlling and alleviating your
symptoms while helping your body heal naturally. Doctors will continue
to monitor your body’s response. Severe dengue fever is often more
difficult to treat because the symptoms are worse and appear at a
faster rate.
Complications from Dengue Hemorrhagic Fever
Complications from severe or acute dengue hemorrhagic fever may
include:
 seizures
 brain damage
 blood clots
 damage to the liver and lungs Dengue fever is not common in the United States, but travelers to
areas of dengue epidemics can be at a high risk of infection. It’s
 heart damage important to talk to your doctor about any international travel plans,
 shock and to be aware of any diseases in the area you’re traveling to.
The CDC keeps an up-to-date health map to show areas that have
 death recent reports of dengue infection. Call a doctor right away if you
Prompt treatment can help prevent complications. become ill with any dengue symptoms.

What Is the Long-Term Outlook? How Can I Prevent Dengue Hemorrhagic Fever?

The outlook for dengue hemorrhagic fever depends on how early the
condition is detected. People who receive care in the early stages of
dengue infection will often recover — according to the Mayo Clinic, this
usually happens within a week.
Researchers are working on a vaccine to prevent dengue fever.
However, it is currently unavailable. The best way to prevent dengue
fever is to protect yourself from being bitten by mosquitos. Wear
clothing that covers your arms and legs. Use mosquito netting and
mosquito repellent when traveling in the tropics.
 REFERENCES

 American Association for Clinical Chemistry. (2018). Dengue Fever Testing. (Retrieved from: https://labtestsonline.org/tests/dengue-fever-
testing on November 25, 2018, 2:17 pm)

 Medical News Today. (2017). What's to know about low MCHC in blood tests?. Biggers, Alana. (Retrieved from:
https://www.medicalnewstoday.com/articles/319613.php on November 25, 2018, 1:19 pm)

 Karen, Amy M.
LIPPINCOTT’S Nursing Drug Guide

 Healthline Media. (2015). Dengue Hemorrhagic Fever. Laflamme, Mark R. M.D. (Retrieved from: https://www.healthline.com/health/dengue-
hemorrhagic-fever on November 25, 2018, 10 :53 am)