CASE PRESENTATION: DENGUE FEVER

I. INTRODUCTION
Patient J.E. is 12 yrs. old from Banan, Rizal was admitted to Rizal
Provincial Hospital due to abdominal pain, cough and fever. The patient was
diagnose with Dengue Fever with Upper respiratory infection. Dengue Fever
II. OBJECTIVES
GENERAL OBJECTIVES

We are presenting a case of Dengue Hemorrhagic fever to be able to be able to

review the Components and functions of the blood, Pathophysiology Dengue
fever of and its medical and nursing management.

SPECIFIC OBJECTIVES:
Review the Components and functions of the blood
To know and understand the Pathophysiology of Dengue fever
To be able to review the importance of Diagnostic and Laboratory
examinations
To be able to know what are the medications needed by a patient who had
Dengue fever
To be able to practice Physical Assessment
To prioritized the problems obtained from the patient who had Dengue
fever
To be able to formulate a Nursing process as a framework in making a
comprehensive Nursing Care Plan to the patient who had Dengue fever
To be able to impart knowledge by means of health teaching to the patient
and the family for continuous care at home.

III. BIOGRAPHIC DATA

I. Personal Data:
Name: J.E.
Sex: M
Age: 12
Date of Birth: 09/07/98
Address: Banan, Rizal
Religion: Roman Catholic
Status: Single
Nationality: Filipino
Room/Bed No.: 9B
Chief Complaint: Abdominal pain, cough, fever
Attending Physician: Dr. Zafra
Diagnosis: Dengue fever with Upper respiratory infections

IV. NURSING HISTORY

PAST ILLNESS HISTORY:
• 1 day prior to admission the patient experienced abdominal pain, cough
and fever.
• The patient was hospitalized at age of 4 because of convulsion
PRESENT ILNESS HISTORY:
• January 13, 2011, the patient was admitted to Rizal Provincial Hospital
with chief complaint of abdominal pain, cough and fever. The patient had
undergone Hematology tests: hgt, hgb, pt. count as ordered by his
attending physician. He was started with Plain lactated ringer’s solution
of 1L to run for 10 hours.

FAMILY HISTORY:

V. PHYSICAL ASSESMENT:
General assessment:
During assessment, the patient was lying on bed. Patient is awake, conscious
and coherent. He is calm. Patient had already done sponge bath, oral hygiene
and was dress appropriately.

Skin:
He has a flushed skin and it is warmth to touch. Petichiae is present all over the
body. Skin elasticity returns faster after being tenden between the thumb and
finger. Hair color is black, thin and fine textured and evenly distributed on the
scalp. He has temperature of 38.0 degree celcius.
Head: Head is symmetrical, rounded smooth skull contour positioned at midline
and erect with no lumps or ridges. Facial movements are symmetrical and
patient is able to perform different kinds of facial expression effortlessly and
without any obstruction
Eyes: Eyebrows are symmetrically aligned with equal movement without
presence of flakes, scars and lesions.
Ears: The color of the patient’s ear is the same with his facial skin. The left and
the right pinna are symmetrical and are aligned with the inner canthus of the
eye. There is no foul smelling, serous or purulent discharges notes. The earlobe
is elongated. The patient was able to hear normal voice tones
Nose: the nose is symmetric, straight and uniform on color and has discharges
due to colds and no flaring noted. Nasal septum is intact and in with line
Mouth: The lip is moist and red in color. The teeth are complete and whitish in
color. With no mouth sores noted.
Neck: Unpalpable lymph nodes and with rashes

Abdomen: Flat, rounded, symmetric movement, no tenderness. Rashes are also noted
Extremities: Full & equal pulses, no deformities and with presence of rashes

VI. DRUG STUDY

GENERIC/ DOSAGE/ CLASS INDICATI CONTRA SIDE NURSING

TRADE FREQUE ON INDICAT EFFECTS RESPONSIBI
NAME NCY ION LITIES
CEFALEXIN 500mg 1 cap Anti-infective Respiratory Contraindic CNS: • Use
q8 drugs tract ated in dizziness, cautiousl
infections patients headache, y in
hypersensit fatigue, patients
ive to agitation, hypersen
cephalospo confusion, sitive to
rins hallucinations penicillin
GI: • Ask
pseudomemb patient
ranous colitis, about
nausea, past
anorexia, reaction
vomiting, to
diarrhea, cephalos
gastritis, phorins
glossitis, before
dyspepsia, giving
abdominal first dose
pain, anal • Tell
pruritus, patient to
tenasmus, take all
oral the drug
candidiasis, exactly
genital as
pruritus, prescribe
candidiasis, d even
vaginitis, after he
interstitial feels
nephritis better
HEMATOLO
 GIC: • Instruct
neutropenia, patient to
eusonophilia, take drug
anemia, with food
thrombocytop or milk to
enia lessen GI
MUSCULOS discomfo
KELETAL: rt
arthritis,
arthralgia,
joint pain
SKIN:
maculopapula
r and
erhythematou
s
OTHER:
hypersensitivi
ty reactions,
serum
sickness,
anaphylaxis
Paracetam 500mg Non- Mild Contrai HEMATO • Use
ol 1 tab q4 Narcotic pain or ndicate LOGIC: cautio
PRN Analgesi fever d in hemolyti usly
cs and patient c with
Antipyre s anemia, patien
tics hypers neutrope t with
ensitiv nia, histor
e to the leukopen y of
drugs ia, chroni
pancytop c
enia alcoh
HEPATIC: ol use
liver
damage,
jaundice
METABO
LIC:
hypoglyc
emia
SKIN:
rash,
urticarial
CETIRIZINE 1 tab Anti- Chronic Contrai CNS: • Use
OD for histami urticaria ndicate somnole cautio
itchines ne d to nce, usly
s patient fatigue, in
hypers dizziness patien
ensitive , ts
to headach with
 drugs e renal
or to EENT: or
hydrox pharyngi liver
yzine tis impair
GI: dry ment
mouth, • Disco
nausea, ntinue
vomiting, drug
abdomin 4
al days
distress before
patien
t
under
goes
diagn
ostic
skin
test

LABORATORY/DIAGNOSTICS

Jan 14, 2011 12nn

Normal Values
Interpretation
Hematology
Hemoglobin 128.0
Hematocrit 0.38
Platelet 210

Jan 14, 2011 7am

Hemoglobin 136.0
Hematocrit 0.40
Platelet 204
VI. GORDON’S FUNCTIONAL PATTERN

Health Perception/Health Management Pattern

The mother of our client perceived health as one of the most important
things to consider in life. “Paano ka makakapagtrabaho at makakapagisip kung
hindi ka malusog at kung may sakit ka hindi lang ikaw pati ang pamilya mo ay
maaapektuhan rin” she said. The mother rated the health of her son as 6, 1
being the lowest and 10 being the highest. The client verbalized “6 siguro kasi
may lagnat pa siya at inuubo”. The mother verbalized that “ Akala naming
dahil sa ubot at sipon kung bakit siya nilagnat yun pala dahil sa dengue na”.
The mother stated that stagnant water nearby there house is the reason for
acquiring the disease. She reminds her son that healthy lifestyle like eating
nutritious food is the key for a healthy body. When asked about the past illness
of her son she said that her son was hospitalized at the age of 4 because of
convulsion. “Mahina ang baga ng anak ko kasi madalas ito magkasipon at ubo”
she said. The patient doesn’t have breathing problems. The patient has
complain of itchiness.

ANALYSIS:

Nutritional-Metabolic Pattern

The mother of our client said that her son usually eats meat during his
hospitalization except dark colored food as advised by the doctor. “Wala
naman problema sa pagkain ang anak ko, ganado pa rin siya kahit may sakit”
she said. Her son eats three times a day.“Mahina uminom ang anak ko kung
hindi mo pa babantayan di pa siya iinom ng tubig” she added.

ANALYSIS:

Maintaining a nutritious diet is important in clients with chronic disease,(Medical-Surgical Nursing by Black
and Hawk 7th edition p.1748, 7th ed.)

Elimination Pattern

The patient usually defecates 2 times a day during hospitalization as

verbalized by the mother. She describes the stool of her son as brown and the
urine as yellow and odorless. “Madalas umihi ang anak ko nakaIV kasa siya at
lagi ko pinapainom ng apple juice” she said. Her son urinates more than eight
times every day.

ANALYSIS:
Most people have individual patterns of bowel elimination involving frequency, timing and
considerations, position and place. Although many adults pass one stool each day, other
healthy people have more frequent or less frequent bowel movements. Some people have a
bowel movement two or three times a week; others two or three times a day.(Fundamentals of
Nursing by taylor, et al., p. 1292,1340, 7th ed.)

Activity-Exercise Pattern

When asked about the daily activities of her son during hospitalization she said
“ Higa at upo lang ginagawa niya dito.” Her son’s hobby is playing saxophone.
“Namimiss niya nga ang pagtutugtog ng saxophone” the mother said.

ANALYSIS:
A regular program of moderate exercise is recommended for adults. Exercise also helps
maintain bone calcification and muscle tone throughout the body, reduce muscle tension and
muscle pain. (Medical Surgical Nursing by Brunner, p.654, 10th ed.)

Sleep-Rest Pattern

The client usually sleeps at 9pm and wakes up at 8am before he was
hospitalized. “Ngayon puro tulog lang ginagawa niya dito sa hospital” the
mother verbalized. “Nagigising lang siya kapag umiihi” she added.

ANALYSIS:
Rest and sleep are essential for health. People who are ill frequently require more sleep than
usual. (Fundamentals of Nursing by Kozier, et al., p 1114, 7th ed.)
Middle-aged adults generally maintain the sleep pattern established at a younger age. They
usually sleep 6-8 hours per night. (Fundamentals of Nursing by Barbara Kozier, Pp.1116)

Coping/Stress Tolerance Pattern

The patient is not irritated during the assessment. “Nakakapagadjust

naman siya sa pagkaospital niya” the mother said

ANALYSIS:
Normal coping stress patterns refers to the client’s adaptive response in challenging life
events. (Nursing Diagnosis and Intervention by: G. McFarland and E. McFarlane Pp. 16).
Ineffective coping is a state in which an individual experiences an inability to manage internal
or environmental stressors adequately due to inadequate resources (physical, psychological,
and behavioral). (Handbook of Nursing Diagnosis by: Lynda Juall Carpenito, Pp.15)

Role-Ralationship

The mother said “Close and anak ko sa mga kapatid niya.”. The client
has 2 siblings and she is the second child. The patient was supported by his
family. “yung bunso namin ay nagdadasal pa na gumaling ang kuya niya” the
mother said.

ANALYSIS:

Once someone has accepted certain gender roles and "Gender differences" as expected socialized
behavioral norm, their "Behavior trait” become part of their perceived "Responsibilities”. Influential roles
in gender relationships on a personal and social level to the individual's own socializing role or "Self-
concept".

Cognitive Perceptual

The mother stated that her son doesn’t have any problem in hearing and
reading. The patient is at sixth grade.

ANALYSIS:
Normal cognitive perceptual pattern refers to the ability of the client to perceive, understand,
remember and make decisions about information from the external and internal
environment. (Nursing Diagnosis and Intervention by: G. McFarland and E. McFarlane Pp. 15)

Values and Belief

The patient is Born again. “Every Sunday kami nagsisimba” the mother said.
“Wala na kaming pinaniniwalaang iba kundi and diyos lang” she added.

ANALYSIS:
Normal value belief pattern includes beliefs and values that guide a person’s choices and
lifestyle. (Nursing Diagnosis and Intervention by: G. McFarland and E. McFarlane Pp. 16)
Spiritual Distress is a state in which an individual experiences a disturbance in his belief or
value system that is the source of his strength and hope. (Handbook of Nursing Diagnosis by:
Lynda Juall Carpenito, Pp.72)

VII. COMPONENTS AND FUNCTION OF THE BLOOD

VIII. ECOLOGIC MODEL

 Host: Patient

Agent: Aedes Aegypti

Environment: Poor environmental sanitation

The predisposing factors together with their components are as follows:

HOST

E AGENT
Interpretation

We have chosen the lever ecologic model because it is used to show the relationship between the
host, agent, and environment. It is also used to determine if there is an imbalance among the three pre-
disposing factors or there is one that contributes more than the other, which may lead to an occurrence of the
disease.

Dengue fever could occur in all ages and regarding the gender. And the aedes aegypti is the main causative
agent of the disease. Poor environmental sanitation may contribute to the occurrence of the disease.

IX. PATOPHYSIOLOGY

X. PROBLEM IDENTIFICATION
Cues Identified Problems
Objective: Elevated body temperature related to
illness
Temperature: 38.0 degree celcius

Skin is warm to touch

Flushed skin

Presence of rashes

Subjective: The mother rated the

health of her son as 6, 1 being the
lowest and 10 being the highest. The
client verbalized “6 siguro kasi may
lagnat pa siya at inuubo”.

Risk for deficient fluid volume

realted to increased body
Temperature: 38.0 degree celcius temperature
The mother rated the health of her
son as 6, 1 being the lowest and 10
being the highest. The client
verbalized “6 siguro kasi may lagnat
pa siya at inuubo”.

Presence of petechiae all over the Risk for impared skin integrity
body related to hyperthermia

The patient has complain of

itchiness.

XI. PRIORITIZATION

Problem Rank Justification

Elevated body 1 This is an actual problem

temperature related to of the patient and needs
illness immediate intervention.
Having an elevated body
temperature can lead to
 complication.

Risk for deficient fluid 2 This is a potential

volume realted to problem and doesn’t
increased body need immediate
temperature intervention. It can be
prevented by adequate
fluid intake

Risk for impared skin This is a potential

integrity related to problem and doesn’t
hyperthermia 3 need immediate
intervention. It can be
solved if existing
problems are solved.

XII. NURSING CARE PLAN

NURSING ANALY GOAL AND NURSING RATIONALE EVALUATIO

PROBLEM SIS OBJECTIVES INTERVENTIONS N
After 3 hours
Elevated Body GOAL: of nursing
body temper After 3 hours of intervention
temperatur ature nursing the client
e related to elevate intervention the decreased
above client will be temperature
illness
normal able to decrease
range body
Objective: temperature

Temperatur Objectives:
e:38.0
degree After 5 minutes Discuss to the
of nursing mother ways to
celcius intervention the reduce body
mother will be temperature.
Skin is able to gain
warm to knowledge
touch about how to
reduce
Flushed skin temperature
Discuss the To prevent
importance of dehydration and
Presence of
After 5 minutes increase fluid support circulating
rashes of nursing intake volume and tissue
intervention the perfussion(Nanda
Subjective: mother will be page 385)
The mother able to
rated the enumerate 3
health of ways on how to
her son as reduce body It helps to decrease
temperature Discuss the body temperature
6, 1 being
importance of tepid by evaporation and
the lowest sponge bathe conduction
and 10 (Nanda 386)
being the
highest. The Groin and axilla are
client Discuss the areas of high blood
verbalized effectiveness of flow (Nanda page
“6 siguro local ice packs 386)
kasi may
lagnat pa
Reduces metabolic
siya at
Discuss the demands and
inuubo importance of oxygen
bedrest consumption
(nanda page 386)

Discuss the Anti-pyretic helps

importance of in lowering body
administering anti- temperature ( Kee
pyretics as and Hayes)
prescribed by the
doctor

XIII. DISCHARGE PLAN

Home Care
MEDICATIONS
• Take medication exactly as directed. Don’t skip doses. Continue taking
antibiotics as directed until they are all gone—even if you start to feel
better.

EXERCISE / ACTIVITY
•Deep Breathing Exercises
•Light Activities
•Tepid Sponge bath
•Drink lots of fluids
 TREATMENTS
• Advice to take medications as prescribed
• Emphasize the importance of proper hygiene and cleaning
• Advice to drink lots of fluids
• Advice to not eat dark colored foods

HEALTH TEACHING
• Encourage and explain to the patient that it is important to maintain
proper hygiene to prevent further infection.
• Instruct to increase fluid intake of the patient.
• On Diet as tolerated, except for dark colored foods
• Deep breathing excercises

PATIENT FOLLOW UP
• Regular consultation to the physician can be factor for recovery and
to assess and monitor the patient’s condition.

DIET
• Diet as tolerated, meaning, the patient can eat everything until he can.
But he needs to not eat dark colored foods. Diet plays a big role in fast
recovery so that, instruct the patient to take nutritious food such as
green leafy vegetables and fruits.

XIIII. TEACHING PLAN

NURSIN RATIONALE CONTENT RESOURCES

G
INTERV
ENTION
S

Date:
01/15/2011
Time:
9:00am
Setting:
Room 9B of
Payward,
Rizal
Provincial
Hospital
Money: none
Material:
Manpower: