Wesleyan University- Philippines

Mabini Extension, Cabanatuan City

Case Study
RLE: DENGUE HEMORRHAGIC FEVER

Submitted by:
Jenilyn Faye M. Orpilla
(Bsn4-4 Group 3a)

Submitted To:

Clinical Instructor

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 TABLE OF CONTENTS

I. Patient’s History................................................................................................................................ 3
II. Diagnosis............................................................................................................................................. 3
III. Chief Complain ………........................................................................................................................ 3
IV. Dengue Hemorrhagic Fever Definition………………..................................................................... 3
V. Intubation Period………...................................................................................................................... 3
VI. Period of Communicability ............................................................................................................. 3
VII. Clinical Manifestations ………………………....………....................................................................... 3
VIII. Mode of Transmission................................................................................................................... 4
IX. Grading of severity............................................................................................................................ 4
X. Classification........................................................................................................................................ 4
XI. Pathophysiology ................................................................................................................................ 5
XII. Susceptability, Resistance, and Occurrence ............................................................................... 5
XIII. Diagnostic Procedures………………............................................................................................... 5
XIV. Medical Management......................................................................................................................6
XV. nursing management....................................................................................................................... 6
XVI. Outlook (Prognosis) ……………...................................................................................................... 6
XVII. Possible Complications................................................................................................................. 6
XVIII. Dengue Prevention .............................................................................................................. 7
XIX. References................................................................................................................................ 7

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 PATIENT HISTORY
Name: A.R.M.
Age: 5 years old
Gender: Female
Birth date: April 14, 2009
Address: Villa Opelia, Cabanatuan City, N.E.
Educational Level: Preparatory
Race: Tagalog, Filipino
Religion: Roman Catholic
Source of Information: mother

Date of Admission: August 29, 2013 ; 12:50 a.m.

DIAGNOSIS: Dengue Hemorrhagic Fever t/c Upper Respiratory Tract Infection

CHIEF COMPLAIN:
5 days prior to admission, the patient developed fever associated with occational cogh, no
headache and no abdominal pain.
2 days prior to admission, fever lysed. Platelet count: 221; (+) cough
1 day prior to admission, Platelet count: 192; today platelet count: 169 hence advised
admission.

DENGUE HEMORRHAGIC FEVER CASE STUDY

DENGUE FEVER is caused by one of the four closely related, but antigenically distinct, virus serotypes
Dengue type 1, Dengue type 2, Dengue type 3, and Dengue type 4 of the genus Flavivirus and
Chikungunya virus. Infection with one of these serotype provides immunity toonly that serotype of life,
to a person living in a Dengue-endemic area can have more than oneDengue infection during their
lifetime. Dengue fever through the four different Dengue serotypesare maintained in the cycle which
involves humans and Aedes aegypti or Aedes albopictus mosquito through the transmission of the
viruses to humans by the bite of an infected mosquito.The mosquito becomes infected with the Dengue
virus when it bites a person who has Dengue and after a week it can transmit the virus while biting a
healthy person. Dengue cannot be transmitted or directly spread from person to person. Aedes aegypti
is the most common aedes specie which is a domestic, day-biting mosquito that prefers to feed on
humans.

INTUBATION PERIOD: Uncertain. Probably 6 days to 10 days

PERIOD OF COMMUNICABILITY: Unknown. Presumed to be on the 1st week of illness when virus is
still present in the blood

CLINICAL MANIFESTATIONS:
First 4 days:
>febrile or invasive stage --- starts abruptly as high fever, abdominal pain and headache; later
flushing which may be accompanied by vomiting, conjunctival infection and epistaxis

4th to 7th day:

>toxic or hemorrhagic stage --- lowering of temperature, severe abdominal pain, vomiting and
frequent bleeding from GIT in the form of melena; unstable BP, narrow pulse pressure and
shock; death may occur; vasomotor collapse
7th to 10th day:

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 >convalescent or recovery stage --- generalized flushing with intervening areas of blanching
appetite regained and blood pressure already stable

MODE OF TRANSMISSION:
Dengue viruses are transmitted to humans through the infective bites of female Aedes mosquito.
Mosquitoes generally acquire virus while feeding on the blood of an infected person. After virus
incubation of 8-10 days, an infected mosquito is capable, during probing and blood feeding of
transmitting the virus to susceptible individuals for the rest of its life. Infected female mosquitoes may
also transmit the virus to their offspring by trans ovarial (via the eggs) transmission

Humans are the main amplifying host of the virus. The virus circulates in the blood of infected
humans for two to seven days, at approximately the same time as they have fever. Aedes mosquito may
have acquired the virus when they fed on an individual during this period. Dengue cannot be
transmitted through person to person mode.CLASSIFICATION:1.Severe, frank type>flushing, sudden
high fever, severe hemorrhage, followed by sudden drop of temperature, shock and terminating in
recovery or death2.Moderate>with high fever but less hemorrhage, no shock present3.Mild>with
slight fever, with or without petichial hemorrhage but epidemiologically related to typical cases
usually discovered in the course of invest or typical cases

GRADING THE SEVERITY (Signs and Symptoms) OF DENGUE FEVER:

Grade 1:
>fever
>non-specific constitutional symptoms such as anorexia, vomiting and abdominal pain
>absence of spontaneous bleeding>positive tourniquet test
Grade 2:
>signs and symptoms of Grade 1: plus
>presence of spontaneous bleeding: mucocutaneous, gastrointestinal
Grade 3:
>signs and symptoms of Grade 2 with more severe bleeding: plus
>evidence of circulatory failure: cold, clammy skin, irritability, weak to compressible pulses,
narrowing of pulse pressure to 20 mm hg or less, cold extremities, mental confusion
Grade 4:
>signs and symptoms of Grade 3, declared shock, massive bleeding, pulse less and arterial
blood Pressure = 1 mm hg (Dengue Syndrome/DS)

CLASSIFICATION:
1.Severe, frank type
>flushing, sudden high fever, severe hemorrhage, followed by sudden drop of
temperature, shock and terminating in recovery or death
2.Moderate
>with high fever but less hemorrhage, no shock present
3.Mild
>with slight fever, with or without petichial hemorrhage but epidemiologically related
to typical cases usually discovered in the course of invest or typical cases

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 DHF PATHOPYSIOLOGY

SUSCEPTABILITY, RESISTANCE, AND OCCURRENCE:

>all persons are susceptible
>both sexes are equally affected
>age groups predominantly affected are the pre-school age and school age
>adults and infants are not exempted>peak age affected: 5-9 years old
DF is sporadic throughout the year. Epidemic usually occurs during rainy seasons (June –
November). Peak months are September – October. It occurs wherever vector mosquito exists.

DIAGNOSTIC PROCEDURES:
Exams,Tests and Laboratory Test
A physical examination may reveal:  Weak, rapid pulse
 Enlarged liver (hepatomegaly) Tests may include:
 Low blood pressure  Arterial blood gases
 Rash  Coagulation studies
 Red eyes  Electrolytes
 Red throat  Hematocrit
 Swollen glands  Liver enzymes
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  Platelet count
 Serologic studies (demonstrate
antibodies to Dengue viruses)
 Serum studies from samples taken during
acute illness and convalescence (increase
in titer to Dengue antigen)
 Tourniquet test (causes petechiae to form
below the tourniquet)
 X-ray of the chest (may demonstrate
pleural effusion)
 nucleic acid detection by PCR,
 viral antigen detection or specifica
ntibodies (serology).

MEDICAL MANAGEMENT
There are no specific treatments for dengue fever. Treatment depends on the symptoms, varying
from oral rehydration therapy at home with close follow-up, to hospital admission with administration
of intravenous fluids and/or blood transfusionA decision for hospital admission is typically based on
the presence of the "warning signs" listed in the table above, especially in those with preexisting health
conditions.
Intravenous hydration is usually only needed for one or two days. The rate of fluid administration is
titrated to a urinary output of 0.5–1 mL/kg/hr, stable vital signs and normalization of hematocrit.
Invasive medical procedures such as nasogastric intubation, intramuscular injections and arterial
punctures are avoided, in view of the bleeding risk. Paracetamol (acetaminophen) is used for fever and
discomfort while NSAIDs such as ibuprofen and aspirin are avoided as they might aggravate the risk of
bleeding. Blood transfusion is initiated early in patients presenting with unstable vital signs in the face
of a decreasing hematocrit, rather than waiting for the hemoglobin concentration to decrease to some
predetermined "transfusion trigger" level. Packed red blood cells or whole blood are recommended,
while platelets and fresh frozen plasma are usually not.
During the recovery phase intravenous fluids are discontinued to prevent a state of fluid overload. If
fluid overload occurs and vital signs are stable, stopping further fluid may be all that is needed. If a
person is outside of the critical phase, a loop diuretic such as furosemide may be used to eliminate
excess fluid from the circulation.

NURSING MANAGEMENT
Nursing management of dengue fever is non-specific and supportive, consisting of pain relief and oral
and/or intravenous administration of fluids. Dengue patient care requires vigilant medical monitoring
for warning signs of the potentially fatal vascular permeability of dengue hemorrhagic fever (DHF) and
life-threatening circulatory failure defining dengue shock syndrome (DSS).

OUTLOOK (PROGNOSIS)
With early and aggressive care, most patients recover from dengue hemorrhagic fever. However, half
of untreated patients who go into shock do not survive
POSSIBLE COMPLICATIONS
 Encephalopathy
 Liver damage
 Residual brain damage
 Damage to brain due to bleeding or prolonged shock

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  Inflammation of the heart muscles (Myocarditis)
 Seizures
 Shock

DENGUE PREVENTION:
There is no vaccine to prevent dengue. Prevention centers on avoiding mosquito bites when
traveling to areas where dengue occurs and when in U.S. areas, especially along the Texas-
Mexico border, where dengue might occur. Eliminating mosquito breeding sites in these areas is
another key prevention measure.

 Avoid mosquito bites when traveling in tropical areas:

 Use mosquito repellents on skin and clothing.
 When outdoors during times that mosquitoes are biting, wear long-sleeved shirts and
long pants tucked into socks.
 Avoid heavily populated residential areas.
 When indoors, stay in air-conditioned or screened areas. Use bed nets if sleeping
areas are not screened or air-conditioned.
 If you have symptoms of dengue, report your travel history to your doctor.

 Eliminate mosquito breeding sites in areas where dengue might occur:

 Eliminate mosquito breeding sites around homes. Discard items that can collect rain
or run-off water, especially old tires.
 Regularly change the water in outdoor bird baths and pet and animal water
containers

References:
 About Dengue Fever & Nursing Management |
eHow.com http://www.ehow.com/about_4618289_dengue-fever-nursing-
management.html#ixzz208FyF9Id
 http://www.scribd.com/doc/18479720/Case-Study-Dengue