CASE PRESENTATION

ON
DENGUE FEVER
Apego, Rez
Gavino, Allyne
Sevilla, Kyle
 NURSING HEALTH HISTORY
BACKGROUND PROFILE
Patient A, male, 18 years old, a baptized Roman Catholic was born full
term on August 26, 1996 via normal spontaneous vaginal delivery NSVD
assisted by a midwife and is living in Libertad, Butuan City. Patient stands 5’4 ft
tall. He has brown complexion, black, shiny, curly hair, thin lips, and small
slanted eyes.
During the conduct of the interview, the students were able to talk with
the mother of Patient A and extracted important details as to the pregnancy
period of patient’s mother such as prenatal check-up and possible
complications and found out that the mother receive all necessary care.
Patient A is living with his mother together with his sibling. His father is an
Overseas Filipino Worker and is out of the country at this moment.
INFANCY AND TODDLERHOOD
When asked to relay information about the infancy stage of Patient A
such as his immunizations and history of illnesses during this certain period, the
mother claimed that this is the first time that the patient was hospitalized.
“Karon ra gyud na siya na-ospital Ma’am”. As further narrated by the mother
Patient A received all necessary vaccination during his infancy.
Patient A was sent to daycare at the age of 4 until 6. This was the time
when he was learning alphabets, basic objects and initiating social interaction
with children of his age. “Mao ra man to, dula dula, basa basa, inana ra. Mao
lang man akong madumduman.”, he added. Patient said that he has vague
flashback of events during this period.
• PRESCHOOL TO ELEMENTARY PERIOD
• At the age 6, patient entered elementary education as Grade 1 pupil in a
private school in Butuan City. All throughout those elementary years, he used
to have more girl friends than boy friend’s as his school buddies. Back then,
he was shy, reserved and timid unlike other boys of his age who were
hyperactive and aggressive. “Maghilum rako”. Patient had no problems with
his academics and excelled more in extracurricular activities.

• FOOD AND ALLERGIES

• Patient has no known allergic reactions to any kind of foods and eats
anything that is being served in the table. “Bisan unsa ra man maam.
Mukaon kog maskin unsa.” he stated. He has no specific food restrictions
and preferences and follows no certain diet or meal plan.
• His usual daily consumption composes of rice, vegetables, fish and meat. He
eats 3 meals a day and never skips one of them. Patient also loves fruits like
mango and banana.
• Patient takes of vitamin supplements. He also has no known
hypersensitivity reactions to any drugs.

• USUAL ELIMINATION PATTERN

• Patient A used to urinate daily at least 4 to 5 times a day. He has no
fixed time as to when as he stated, “Maskin unsang orasa man, basta
kadaadlaw gyud ko makaihi. Kusog man pod ko muinom og tubig.” When
asked for the amount of urine, he responded, “Dili kaayo nako mabana-
bana. Basta normal.” He defecated once in every other day and had no
problems with his bowel pattern. Moreover, patient said that he had not
encountered any elimination problems or discomfort before.
• SLEEP PATTERN
• Patient A had no time set as to when he sleeps.“Depende man, hantod sa
mahuman ang himuonon. Pinakasayo na ang alas noybe.” He woke up around
7am. Though there are times when he sleeps really late at night until 2am to finish his
task, he still woke up at the same time in the morning. Patient reported to have
encountered no sleeping problems at all before even he had been sleeping very
late most of the time.
• ADOLESENCE
• High School
• Patient A went to high school at the age of 12. It was this time when patient
experienced certain physical changes. According to him, he started getting chubby
when he reached first year high school. Pimples started to appear all over his face
and back and he was sometimes teased for his appearance.
• As patient reached 2nd year, he claimed to have started developing feelings for his
female classmate. Patient did not have any other vices such as drinking liquors with
friends as he verbalized, “Dili man pod ko ganahan gyud maam bisan hantod
karon, gainom man sila mga amigo nako pero ako dili.”.
• Patient graduated at the age of 16 with awards.
• ONSET OF ILLNESS
• Three days prior to admission, patient and his family decided to admit
him. On December 3, patient A, accompanied by his mother, sought
medical help at MJ Santos Hospital and was received at Emergency Room
with chief complaint of fever and abdominal pain. They arrived at 11:00 am
with the admitting diagnosis of dengue vital signs upon admission were as
follows:
• T= 38.6 C PR=96 bpm R= 24 cpm BP= 90/70 mmHg
• abdominal girth = 45cm Weight= 80.9 kg
THEY WERE UNDER THE SERVICE OF DR. G WITH THE INITIAL
ORDERS GIVEN:

DOCTOR’S ORDER

12-03-14 TPR q hr
I and O q shift
NPO
Lab:
-Complete Blood Count -Urine Analysis
-refer CBC

Meds:
-aeknil (acetaminophen)
-paracetamol
-cefuroxime 1.5 g IV/IM q8hr
HEMATOLOGY REPORT
Date: January 03, 2014

PARAMETER NORMAL ACTUAL ANALYSIS

FINDINGS FINDINGS
White Blood 5-10 x 10^g/L 3.9 x 10^g/L Decreased due
Cells to inadequate
inflammatory
defenses to
suppress
infection and
humoral
immunity takes
place
Hemoglobin M: 13.0-18.0 g/dL 10.2 g/dL Decreased due
to poor oxygen
supply
Hematocrit 39-54 % 31 % Decreased due
to poor oxygen
supply
Segmenters 0.60-0.70 0.73 Increased;
indicate high
glucose level in
the blood
Lymphocytes 0.20-0.30 0.27 normal
Platelet Count 150-450 x 10^g/L 85 x 10^g/dL Decreased,
increases risk for
bleeding
HEMATOLOGY REPORT
Date: January 03, 2014, AM
ABO/ Rh Type: O Rh positive

PARAMETER NORMAL ACTUAL FINDINGS ANALYSIS

FINDINGS
White Blood Cells 5-10 x 10^g/L 2.9 x 10^g/L Decreased due to
inadequate
inflammatory
defenses to
suppress infection
and humoral
immunity takes
place
Hemoglobin M: 13.0-18.0 g/dL 9.5 g/dL Decreased due to
poor oxygen
supply
Hematocrit 39-54 % 29 % Decreased due to
poor oxygen
supply
Segmenters 0.60-0.70 0.65 Normal
Lymphocytes 0.20-0.30 0.35 Increased due to
the body’s
increased immune
system
Platelet Count 150-450 x 10^g/L 90 x 10^g/dL Decreased,
increases risk for
bleeding
HEMATOLOGY REPORT
Date: January 04, 2014, PM

PARAMETER NORMAL ACTUAL FINDINGS ANALYSIS

FINDINGS
White Blood Cells 5-10 x 10^g/L 2.7 x 10^g/L Decreased due to
inadequate
inflammatory
defenses to
suppress infection
and humoral
immunity takes
place
Hemoglobin M: 13.0-18.0 g/dL 9.5 g/dL Decreased due to
poor oxygen
supply
Hematocrit 39-54 % 29 % Decreased due to
poor oxygen
supply
Segmenters 0.60-0.70 0.68 normal
Lymphocytes 0.20-0.30 0.32 Increased due to
the body’s
increased immune
system
Platelet Count 150-450 x 10^g/L 87 x 10^g/dL Decreased,
increases risk for
bleeding
HEMATOLOGY REPORT
Date: January 5, 2014, AM

PARAMETER NORMAL ACTUAL FINDINGS ANALYSIS

FINDINGS
White Blood Cells 5-10 x 10^g/L 3 x 10^g/L Decreased due to
inadequate
inflammatory
defenses to
suppress infection
and humoral
immunity takes
place
Hemoglobin M: 13.0-18.0 g/dL 9.7 g/dL Decreased due to
poor oxygen
supply
Hematocrit 39-54 % 29 % Decreased due to
poor oxygen
supply
Segmenters 0.60-0.70 0.69 normal
Lymphocytes 0.20-0.30 0.36 Increased due to
the body’s
increased immune
system
Platelet Count 150-450 x 10^g/L 80 x 10^g/dL Decreased,
increases risk for
bleeding
HEMATOLOGY REPORT
Date: January 5 , 2014, PM

PARAMETER NORMAL FINDINGS ACTUAL FINDINGS ANALYSIS

White Blood Cells 5-10 x 10^g/L 4.8 x 10^g/L Decreased due to
inadequate
inflammatory
defenses to suppress
infection and
humoral immunity
takes place

Hemoglobin M: 13.0-18.0 g/dL 10.3 g/dL Decreased due to

poor oxygen supply

Hematocrit 39-54 % 31 % Decreased due to

poor oxygen supply

Segmenters 0.60-0.70 0.57 Decreased; indicate

low glucose level in
the blood

Lymphocytes 0.20-0.30 0.43 Increased due to the

body’s increased
immune system

Platelet Count 150-450 x 10^g/L 95 x 10^g/dL Decreased,

increases risk for
bleeding
12-06-14 -DAT
-V/S q hour
-Repeat CBC refer
-Refer Dizziness
-D5LR 1 L at 30 gtts/min
- For ECG refer results
HEMATOLOGY REPORT
Date: January 06, 2014 AM

PARAMETER NORMAL FINDINGS ACTUAL FINDINGS ANALYSIS

White Blood Cells 5-10 x 10^g/L 5 x 10^g/L Normal

Hemoglobin M: 13.0-18.0 g/dL 10 g/dL Decreased due to
poor oxygen supply

Hematocrit 39-54 % 30 % Decreased due to

poor oxygen supply

Segmenters 0.60-0.70 0.68 Normal

Lymphocytes 0.20-0.30 0.32 Increased due to the
body’s increased
immune system

Platelet Count 150-450 x 10^g/L 85 x 10^g/dL Decreased, increases

risk for bleeding
On December 07, 2014 at 8am, the student nurse started to handle patient A
in the Floor 2 station, room 203 and received patient lying on bed without IVF,
with heplock on the left metacarpal vein, conscious and coherent with the
initial vital signs taken and recorded as follows:
T= 36.9 c P= 95 bpm R= 28 cpm BP= 110/80 mmHg
Weight= 89 kg
Patient complained of body weakness as he verbalized, “luya ko.” Upon
oberservation, patient was pale and weak looking. The student nurse
identified effective nursing interventions to address the problem.

Problem identified:
- Risk for Bleeding related to altered clotting factor
- Hyperthermia related to inappropriate clotting factor as evidenced by
decrease in platelet count
-Risk for Fluid Volume Deficit related to related to decreased blood volume
secondary to altered platelet production.
FECALYSIS REPORT
Date: January 04, 2014
Bacteria: Occasional
Occult Blood: Negative
Remarks: No ova/intestinal parasite seen

PARAMETER NORMAL FINDINGS ACTUAL FINDINGS ANALYSIS

Physical Properties
Color Yellow Brown Due to the presence
of bacteria

Consistency Semi-formed Loose Due to presence of

bacteria
12-07-14 -for 2D echo at 2pm December 08, 2014
-I and O q shift
-BP q 2 hours
-D5LR 1L at 35 gtts/min
-Still for Stool Exam
• On the second day December 08, 2013 the student nurse handled and
received the patient lying on bed in a semi-fowler’s position, awake and
coherent, with D5LR 1L at 780 cc at left metacarpal vein with the initial vital
signs as follows:
• T= 37.4 C P= 44 pbm R= 25 cpm
• BP= 100/80 mmHg Weight= 88 kg
• Upon initial interaction with the patient on that day, patient complained
of decreased appetite as he stated, “Gamay ra gyud na akong gikaon.
Feeling nako busog na dayon ko.
•
• The following nursing problems were identified:
• -Imbalanced Nutrition: Less than Body Requirements related to inability to
process and absorb nutrients
• -Anxiety related to upcoming 2D echo
12-08-14 -Repeat ECG for AM
-I and O q shift
-BP q 2 hours
-D5LR 1L at 35 gtts/min
-Still for Stool Exam
3:30
2d echo done
• On December 9 2014, the student nurse handled and received patient lying
on bed with two pillows at the head and back portion, awake and coherent
with D5LR 1L at the level of 310cc at left metacarpal vein, dry and intact.
•
• Patient A was ordered may go home by his physician with home
medications and specific instructions on diet given. Hospital bills were settled
as soon as possible by the family members right away. On Novermber 20,
hospital bills were all settled. Patient A, accompanied by his mother, was
discharged ambulatory with the final diagnosis of dengue.
•
• Problems Identified:
• Ineffective Tissue Perfusion r/t Decreased hemoglobin concentration
12-09-14 -If Stable Vital Signs pt. may go home
Meds:
1. Cefuroxime 500 mg 3 times a day
 Patient A was ordered may go home by his
physician with home medications and specific
instructions on diet given. Hospital bills were
settled as soon as possible by the family
members right away. On December 10, 2014
hospital bills were all settled. Patient A,
accompanied by his mother, was discharged
ambulatory with the final diagnosis of dengue.
 Name of Drug Classification Mechanism of Indication Contraindicatio Side Effects Nursing
of Drug Action ns Responsibilitie
s
Generic Name: Therapeutic:  Bactericida Infections due o Contrai o CNS: l
l; to susceptible ndicate ethargy o Continu
Amoxicillin Antibiotic
interferes strains; d with , e
trihydrate
with DNA helicobacter allergy halluci therapy
(Amoxycillin) pylori to the nations as
replication
Pregnancy infections in drug, , indicat
Availability: Category C , repair,
combination pregnan seizure ed for
transcripti
with other cy, s conditi
Tablets—400 on, and agents; post- lactati o GI: gl on
mg; injection— recombinati exposure on; ossitis being
400 mg in
on in prophylaxis prolong , treated
250 mL
susceptible against ed QT stomati .
gram- bacillus interva tis, o Adminis
negative anthracis; l, hypo gastrit ter
and gram- Chlamydia kalemia is, oral
positive trachomatis in . sore drug 4
pregnancy o Use mouth, hr
bacteria,
cautiou furry before
preventing
sly tongue or at
cell
with (black least 8
reproductio
hepatic hairy), hr
n and dysfunc nausea, after
leading to tion, vomitin antacid
cell death. seizure g, s
s. diarrhe
a
(bloody), WARNING:
enterocoli Discont
tis,pseudo inue
membran drug and
ous colitis, monitor
nonspecifi
ECG if
c hepatitis
Hematolo palpitat
gic: ane ions or
mia, dizzines
thromboc s
ytopenia, occurs.
leucopeni
a,
neutropen
ia,
prolonged
bleeding
time
 Name of Drug Classification of Drug Mechanism of Action Indication Contraindications Side Effects Nursing Responsibilities

Generic Name: Therapeutic: : Produce analgesia by Mild pain or fever  Contraindicated in patients Hematologic: Hemolytic Anemia, Advise patient or parents that drug is
blocking pain impulses by hypersensitive to drug. Neutropenia, Leukopenia, only for short-term use; urge them to
Paracetamol Analgesics & inhibiting synthesis of  Use cautiously in patients with Pancytopenia consult prescriber if giving to
Antipyretics prostaglandin in the CNS long-term alcohol use because Hepatic: Jaundice children for longer than 5 days or
Availability: or of other substances therapeutics doses cause Metabolic: Hypoglycemia adults for longer than 10 days.
that sensitize pain hepatotoxicity in these patients. Skin: Rash, Urticaria  ALERT: Advise patient or
Tablets—400 mg; injection— receptors to stimulation. caregiver that many OTC
400 mg in 250 mL The drug may relieve products contain
fever through central acetaminophen, which
action in the should be counted when
hypothalamic heat- calculating total daily dose.
regulating center.  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.
 NCP
Assessment Diagnosis Planning Intervention Rationale Evaluation
Risk for hemorrhage related -After 3 hours of nursing -Assess the signs and symptoms of GI -The GI tract is the most usual -After 3 hours of nursing
to altered clotting factor interventions, the client will bleeding. Check for secretions. source of bleeding of its interventions, the client is able to
be able to demonstrate Observe color and consistency of mucosal fragility demonstrate behaviors that
Objective: behaviors that reduce the stools or vomitus. reduce the risk of bleeding.
-Weakness and irritability risk of bleeding. -Observe for presence of petichiae,
-Restlessness ecchymosis, bleeding from one
-V/S taken as follows: more sites -Sub-acute disseminated
T- 38.1 C -Monitor pulse, BP intravascular coagulation may
P- 102 bpm develop secondary to altered
R- 22 cpm clotting factor.
BP- 90/60 mmHg -an increase in pulse with
-Note changes in level of decrease BP can indicate loss
consciousness. of circulating blood volume.
-Changes may indicate
-Encourage use of soft toothbrush. cerebral perfusion problems.
Avoid straining in stool, and forceful -Minimal trauma can cause
nose blowing. mucosal bleeding
-Use small needles for injections.
Apply pressure to venipuncture sites
for longer than usual. -Minimize damage to tissues,
reduce risk for bleeding and
hematoma.
 Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective: Ineffective Tissue Perfusion r/t -After 4 hours of nursing -Encourage patient to take iron -To help elevate hemoglobin and After 4 hours of nursing
-Dizziness Decreased hemoglobin intervention, the client will be supplements and eat foods rich in hematocrit levels intervention, the client is able
-Abdominal pain concentration able to demonstrate different iron. -To promote circulation and venous to demonstrate different ways
-Muscle weakness ways to improve blood -Elevate head of bed to about 10 drainage. to improve blood oxygenation
oxygenation and circulation. degrees. -To avoid increased oxygen and circulation.
-Discourage strenuous activities. demand.

-Provide health teaching regarding -To help client understand his health
DHF and Typhoid Ilietis condition.
Objective: -Provide health teaching on drugs
-Pallor being taken. -To maintain compliance to meds.
-Hemoglobin = 63 g/L 1.
-Hematocrit = 0.19 L/L -Serve as basis for any alteration in
-Monitor vital signs. system functions.

- Enhances venous return.

- Encourage early ambulation

when possible. -Aids in establishing blood
replacement needs & monitoring
-Monitor lab studies ( Hb,Hct, RBC effectiveness of therapy.
count)
 Assessment Diagnosis Planning Interventions Rationale Evaluation

Risk Factors: Risk for deficient fluid volume related to Short Term: Independent: Short term:
decreased blood volume secondary to
altered platelet production.
 Decreased platelet count = 85,000 After 1 hr. of nursing interventions, the client will  Note possible conditions like fluid loss and limited  These conditions may lead to fluid deficits. Goal Met.
be able to demonstrate behaviors that reduce intake.  To ensure accurate picture of fluid status.
the risk of decreased fluid volume as  Monitor I&O  Water loss can directly affect the body system.
.
manifested by:  Monitor VS changes. (e.g. h20 blood volume blood supply to the
(e.g. orthostatic hypotension, tachycardia, fever) brain = hypotension; an increase in pulse with
decrease BP can indicate loss of circulating blood  Increased oral fluid intake.
volume.)  Enumerate ways to prevent bleeding

 Increased oral fluid intake.

 Enumerate ways to prevent  The GI tract is the most usual source of bleeding of
bleeding. its mucosal fragility

 Assess the signs and symptoms of GI bleeding. Check

 Sub-acute disseminated intravascular coagulation
for secretions. Observe color and consistency of stools
may develop secondary to altered clotting factor.
or vomitus.

 Minimal trauma can cause mucosal bleeding

 Observe for presence of petichiae, ecchymosis,
bleeding from one more sites
 Aids in establishing blood replacement needs &
monitoring effectiveness of therapy.

 Encourage use of soft toothbrush. Avoid straining in  Juices or soda are more concentrated and has
stool, and forceful nose blowing. lesser water content.

 Monitor lab studies ( Hb,Hct, RBC count, platelet, PTT,  Adds water in the diet without overwhelming the
APTT) client with bulk of drinking water.

 Encourage water for thirst instead of juices or soda.

 To replenish fluid volume for severe dehydration

 Promote intake of high-water content foods (e.g.

popsicles, gelatin, eggnog, watermelon)

Collaborative:

 Provide/ assist in giving supplemental fluids as indicated

(e.g. parenteral, enteral)