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A Case Study on DENGUE FEVER

Presenters: Tissa Carrin De Belen, R.N. Patricia Ladores, R.N.


Objectives A. General Objective: This case study aims to provide a complete understanding of Dengue Fever, its symptoms, management and prevention.

B. Specific Objectives: 1. to build rapport with the patient and his guardians. 2. to assess the client holistically and identify his health needs. 3. to define Dengue Fever and explain its progression. 4. to enumerate and explain the diagnosis, management and prevention of Dengue Fever. 5. to differentiate between Dengue fever, Dengue Hemorrhagic Fever and Dengue Shock Syndrome.


Introduction A virus transmitted by the Aedes mosquito causes Dengue Fever, a sporadically epidemic disease of warmer climates. The term "dengue" is a Spanish attempt at the Swahili phrase "ki denga pepo", meaning "cramp-like seizure caused by an evil spirit". It emerged during a Caribbean outbreak in 1827-1828. Outbreaks resembling dengue fever have been reported throughout history. The first case report dates back from 1789 and is attributed to Benjamin Rush, who coined the term "breakbone fever" (because of the symptoms of myalgia and arthralgia). The viral etiology and the transmission by mosquitoes were only deciphered in the 20th century. The socioeconomic impact of World War II resulted in increased spread globally. Dengue is the most common arthropod-borne viral (Arboviral) illness in humans. It is caused by infection with 1 of the 4 serotypes of dengue virus, which is a Flavivirus (a genus of single-stranded nonsegmented RNA viruses). Recovery from infection by one serotype provides lifelong immunity against that serotype but confers only partial and transient protection against subsequent infection by the other three. Several serotypes can be in circulation during an epidemic. In the Philippines, epidemic usually occur during the rainy seasons June to November with peak months September and October. Age group predominantly affected are the preschool and school age which peaks at 5 to 9 years. Immunization against Dengue Fever has not yet been introduced thus, nurses should have a clear background of the disease nature and etiology and help in its control thru health education and case finding.


Case Study Proper General Data Name: Christopher John Protacio Age: 10 years old Address: Blk. 7 Lot 1 Phase 8 Parklane Subd. Gen. Trias, Cavite Sex: Male Religion: Catholic Nationality: Filipino Occupation: Student Educational attainment: currently on Grade 3 Date/Time of Admission: February 14, 2012 / 1:45 am Admission Diagnosis: Dengue Fever with Warning Signs Date/Time of Discharge: February 17, 2012 / 3:10 pm Final Diagnosis: Dengue Fever with Warning Signs i. Neurologic Assessment Vital Signs: BP: 90/60 mmHg T: 36.4C PR: 74 bpm RR: 24 cpm CN I: can identify aroma CN II: 2-3 mm pupils equally round, reactive to light and accommodation CN III: intact extraocular eye movement CN IV: intact extraocular eye movement CN V: can identify deep and light sensations CN VI: intact extraocular eye movement CN VII: no facial assymmetry CN VIII: intact hearing CN IX: positive gag reflex CN X: positive good gag reflex CN XI: can shrug shoulders and turn head against resistance CN XII: can protrude tongue at midline and side to side ii. Physical Assessment Head: hair thick and evenly distributed, dandruff present, skull size falls within normal limits Eyes: pink palpebral conjunctiva, anicteric sclera, no periorbital edema

Ears: symmetrical, size and shape bigger than normal, no drainage or discomfort Face: no edema present, symmetrical facial movements Nose and Throat: nostrils are symmetrical, normally red nasal mucosa with no drainage, no evidence of swelling or other obstruction Mouth: lips are dark red and dry, teeth present: 25, no sores or ulcers noted, presence of dental caries Neck: no palpable mass noted Skin: skin color uniform, good skin turgor, dry Upper extremities: no swelling or enlargements noted, warm to touch, nail beds pink and nails unclean, good capillary refill Lower extremities: no swelling or deformities noted, legs, knees and feet bilaterally symmetrical, skin color normal with few scars noted on both legs, warm to touch, nail beds pink and nails clean Chest: symmetrical chest expansion Abdomen: abdominal skin color is lighter than extremities, smooth, flat, umbilicus centrally located and shallow, normo-active bowel sounds, no scars or pigmentation noted Genito-urinary: good urinary output Heart: no murmurs heard on auscultation Lungs: clear breath sounds C. History of Present Illness: 5 days prior to admission, patient had undocumented fever and started to develop body malaise. No cough, no rashes, no bleeding noted. No consultation done. Paracetamol was given with afforded temporary relief. Few hours prior to admission, patient was afebrile but still complained of body malaise and with loss of appetite. No nosebleeding noted. This prompted consult at SLH, hence the admission.

D. Past Medical History: (+) measles, (+) chicken pox, (+) primary complex which resolved after compliance to 6 months Anti-Kochs treatment, with complete immunization record, (-) allergies, (-) history of accidents/injuries E. Personal and Social History: Patient belongs to a nuclear family. His father works as a security guard in Pasig City and his mother is a plain housewife. He has 3 siblings and is second to the eldest. The family is presently renting a house in Cavite. The patient is currently a grade 3 student in a public school near their home. He enjoys playing basketball with his schoolmates during his leisure time. F. Family History: (+) Diabetes father side (+) Cancer mother side

H. Course in the Ward: Day 1 Patient consulted at San Lazaro Hospital with chief complaint of fever. Upon assessment, he was ordered for admission and was hooked to IVF PLR 1 L to run for 4 hours after which patient will be re-assessed. His diet excluded dash, colored and acidic foods. The following diagnostic tests were ordered: CBC with platelet count, CXR PA-L, PT, PTT, blood typing AST/ALT, and urinalysis. Medications given were Paracetamol 250mg/ml, 5 ml, q4 for T >37.8C and Paracetamol 300mg/IV, 1.6 ml, q4 for T >38.3C, Ascorbic acid + Zinc syrup, 10 ml, OD. Day 2 Patient reported epigastric pain with pain scale of 5 out of 10 but no signs of active bleeding. CBC with PC was ordered and encouraged to increase oral fluid intake. Day 3 There was no epigastric pain and active bleeding reported and patient was afebrile. CBC with PC was ordered. Day 4 Patient with stable vital signs was ordered may go home. His follow up check up at San Lazaro Hospital will be on February 27, 2012 at 1 pm.

L. Health Education There is no vaccine to protect against Dengue. Dengue prevention and control solely depends on effective vector control measures. Dengue feveris typically a self-limiting disease and is rarely fatal. There are no specifi treatment for Dengue Fever. Supportive care with analgesics, judicious rest is usually sufficient. M. Discharge Plan Patient was ordered for discharge on February 17, 2012 by Dra. Saya. M- EDICATIONS Home medication for the client consist of taking Ascorbic Acid + Zinc Syrup, 10mL, once daily. E- NVIRONMENT The primary method of controlling A. aegypti is by eliminating its habitats. Reduce open collections of water by coverin, emptying and cleaning of domestic water storage containers on a weekly basis. Disposing of solid wastes properly and removing artificial man-made habitats. T- REATMENTS Not applicable Instructed patient to drink 8 to 10 glasses of water daily. H- EALTH TEACHING fluid replacement, and bed

Avoid mosquito bites by using mosquito repellants, wearing clothing that fully covers the skin and using mosquito net while resting.

O- UTPATIENT REFERRAL Patients follow up check up at San Lazaro Hospital is scheduled on February 27, 2012 at 1:00 pm. If they are unable to come back on the said date, they may opt to have their check up done in the nearest local health center. D- IET There is no specific diet recommended for the patient as long as he can tolerate it well.

V. References Amy M. Karch, Focus on Nursing Pharmacology, 2nd ed. (Lippincott Williams and Wilkins, 2003) Community Health Nursing in the Philippines (DOH) Compilation of Communicable Diseases in Nursing Grolier International Encyclopedia www.wikipedia.org www.doh.gov.ph www.nursingcribs.com www.dengue.lcc.ufmg.br