Objectives: 1 .

To identifies and determines the general health problems and needs of the patient with an admitting And diagnosis of Dengue Hemorrhagic Fever 2. To raise the level of awareness of patient on health problems that she/he may encounter. 3. To facilitate patient in taking necessary action to solve and prevent the identified problems on her own. 4. To help patient in motivating her continue the health care provided by the health workers. 5. To render nursing care and information to patient through the application of the nursing skill.

Introduction:

Dengue fever is an infectious disease carried by mosquitoes and caused by any of four related dengue viruses. This disease used to called break bone fever because it sometimes causes serve joint and muscle pain that feels like bones are breaking. Health experts have known about dengue fever for more than 200 years. An acute febrile infection of sudden onset with clinical manifestations of three stages: First 4 days- Febrile or invasive stage starts abruptly at high fever, abdominal pain and headache; later flushing which may accompanied by vomiting, conjunctival infection and epistaxis. 4th to 7th days- toxic or hemorrhagic stage- lowering of temperature, severe abdominal pain, vomiting and frequent bleeding from gastrointestinal tract in the form of hematemesis or melena. Unstable B.P., narrow pulse temperature and shock. Death may occur. Tourniquet test which may be positive on third day may become negative due to low or vasomotor collapse. 7th to 10th days- convalescent or recovery stage- generalized flushing with interventing areas of blanching appetite regained and blood pressure already stable

Etiologic Agent: Dengue Virus Type 1,2,3,4 and Chikungunya virus

Source of infection: Immediate source is a vector mosquito, the Aedes Aegypti or the common household mosquito. The infected person.

Mode of Transmission: Mosquito bite (Aedes Aegypti) Incubation period: Uncertain. Probably 6 days to one week. Period of Communicability: Unknown Presumed to be on the 1st week of illness when virus is still present in the blood. Susceptibility, Resistance and Occurrence: All persons are susceptible. Both sexes are equally affected. Age groups predominantly affected are the preschool age and school age. Adults and infants are not exempted. Peak age affected 5-9 years old. Sporadic throughout the year. Epidemic usually occurs during the rainy seasons June-November. Peak months are September and October. Occurs wherever mosquito exist. Susceptibility is universal. Acquired immunity may be temporary but usually permanent.

PATIENTS DATA

Patients Name: Mr. D.S. Case number: 204205 Date Admitted: 7/18/12 Time: 2:46 am Address: Tarlac Date of birth: 5/13/94 Place of birth: Tarlac Religion: Roman Catholic Age: 18 Civil Status: Single

Gender: male Chief Complaints: Fever Physician: Dra. Biswelan Ward: Pedia

NURSING ASSESSMENT

Present Health History 5 days prior to admission, the patient started to have fever with loss of appetite, nausea, abdominal pain, bleeding noted, no consult done. Self medication of paracetamol. Past health History: 1 Childhood illness: no measles, mumps, chickenpox 2. Immunizations: complete

3. Major illness: none 4. Current medication: paracetamol, 5. Allergies: none Family Health History

No hereditary disease can be attributed on both parents.

System Review 1. Healh Percepion-

2. Nutritional- Metabolic Pattern He likes to eat meat.. hes favorite food is sinigang na baboy.. Usual Daily Menu; Food- vegetables, meat Water- juice, plain water Beverages- soda Elimination pattern Color; brown Odor: foul Consistency: Laxatives: none Bladder: Color: yellow Odor: aromatic Alteration if any: none Self Care ability

O-feeding O-cooking

o-dressing o-bed mobility

o-grooming o-home maintainace

0-bathing o-others

o-toileting

Cognitive perceptual Sleep test Self- perception and self concept pattern Role- relationship pattern Sexuality- reproductive pattern Coping-stress pattern Value-belief pattern REVIEW OF ANATOMY AND PHYSIOLOGY

Blood is considered the essence of life because the uncontrolled loss of it can result to death. Blood is a type of connective tissue, consisting of Cells and cell fragments surrounded by a liquid matrix which circulates through the heart and blood vessels. The cells and the cell fragments are Formed elements and the liquid is plasma. Blood makes about 8% of total weight of the body.

Functions of Blood Transports gases, nutrients, waste products, and hormones

 Involve in regulation of homeostasis and the maintenance of PH, body temperature, fluid balance, and electrolyte levels. Protects against diseases and blood loss PLASMA a. Plasma is a pale yellow fluid that accounts for over half of the total blood volume. It consists of 92% water and 8% suspended or dissolved Substances such as proteins, ions, Nutrients, gases, waste products, and regulatory substances. b. Plasma volume remains relatively constant. Normally, water intake through the GIT closely matches water loss through the kidneys, lungs, GIT and skin. The suspended and dissolved substances come from the liver, kidneys, intestines, endocrine glands, and immune spleen tissues PREVENTING BLOOD LOSS When a blood vessel is damage, blood can leak into other tissues and interfere with the normal tissue function or blood can be lost from the body. Small amounts of blood from the body can be tolerated but new blood must be produced to replace the loss blood. If large amounts of blood are lost death can occur. Pathophysiology Predisposing Precipitating -Geographical area= tropical islands in the with water pots and plants -Open spaces

Pacific(Philippines) and Asia Immunocompromise -Sweaty skin

Aedes Aegypti: 8-12 days of viral replication on mosquitos salivary glands

Bite from mosquito (Portal of entry in the skin)

Allowing Dengue virus to be inoculated towards the blood (Incubation Period: 3-14 days)

Virus disseminated rapidly into the blood and stimulates WBCs including b lymphocytes that produces and secretes immunoglobins (Antibodies) and monocytes, macrophages and neutrophils

Antibodies attach to the viral antigen or infected monocytes and phagocytes

Release of cytokines with consist of vaso active agents such as interleukins, tumor necrosis factor, urokinase and platel Factors with stimulates WBC And pyrogen release

Dengue Fever

Control Measures: Eliminate vector by: Changing water and scrubbing sides of lower vases once a week. Destroy breeding places of mosquito by cleaning surroundings proper disposal of rubber tires, empty bottles and cans. Keep water containers covered. Avoid too many hanging clothes inside the house. Residual spraying with insecticides.

Nursing care: Any disease or condition associated with hemorrhage is enough cause for alarm. Immediate control of hemorrhage and close observation of the patient for vital signs leading to shock are the nurses primary concern. Nursing measure are directed towards the symptoms as they occur but immediate attention must be sought: For hemorrhage keep the patient at rest during bleeding episode. For nose bleeding, maintain an elevated position of trunk and promote vasoconstriction in nasal mucosa membrane through an ice bag over the forehead. For melena, ice bagover the abdomen. Avoid unnecessary movement. If transfusion is given, support the patient during the therapy. Observe signs of deterioration (shock) such as low pulse, cold clammy perspiration, prostration. For shock Prevention is the best treatment. Dorsal recumbent position facilitates circulation. Adequate preparation of the patient, mentally and physically prevents occurrence of shock.

Provision of warmth through lightweight covers (overheating causes vasodilation which aggravates bleeding). Diet low fat, low fiber, non-irritating, non-carbonated. Noodle soup may be given.

ASSESSMENT RATIONALE INTERVENTION

NURSING EVALUATION DIAGNOSIS

PLANNING

NURSING

Subjective: Monitor Vital Serve as mainit po ang Signs baseline datarendering Katawan ko sa effective nursing effective nursing Verbalized by the intervention the patient balance goal was met.

Elevated body temperature related to normal response of body to the Infection

Short term goal: After 8 hours of Within 8 hours of

intervention patientMonitor intake To monitor the body temperature and output fluid

will lessenOf the body. Patient body Objective:To reduce the temperature Bp=100/70 mmhg Perform TSB body temperaturedecreases from Temp.=38.6c through the process RR=30bpm of conduction. 38.6c-37.5c.

PR=67bpm Increase oral Fluid intakeTo be able for the Patient to know -flushing of skin Inform the patient the proper

To prevent dehydration

-skin warm to touch about proper management management of fever.

ASSESSMENT

NURSING

PLANNING DIAGNOSIS

NURSING

RATIONALEEVALUATION INTERVENTION

Subjective: To assist in Nurse ang sakit ng evaluating ulo ko as verbalized Impact of pain by the patient. on clients life. Provide comfort

Acute pain related Goal was met to decreased blood the patient flow as manifested verbalized by guarding relieve of pain behaviour, facial To allow non-

-After four hours of nursing Intervention the patient will be able to verbalize relieve

Ask client to rate pain from 0-1 scale.

Objective: such -Facial grimace as repositioning -Palmar and facial the patient in a Pallor comfortable -cluthches head and position and assumes fetal providing a hot position or cold. compress Provide calm and quit environment.

grimace and pallor. pharmacologic pain relief and promote good circulation to the brain and decreased Vasoconstriction. To decrease environmental factors which Contribute to headache.

Of pain.

Measures

ASSESSMENT RATIONALE INTERVENTION

NURSING EVALUATION DIAGNOSIS

PLANNING

NURSING

Subjective: teaching wala po akong alam or information Signs and sa sakit koas dengue fever. verbalized by the headache patient. -nausea .pallor Objective:Instructed dengue fever. Temp.=36c avoid drinking

Knowledge deficit to have ideas related to lack of nursing interregarding to ideas/knowledge patient have regarding to To know what fever. they are going to do if they

-After 8 hours of After 8 hours of nurs ing intervention Watch

Health out for

vention the the patient should have ideas and ideas knowledge to regarding to dengue fever to symptoms like knowledge regarding

RR=24bpm or eating dark -asking questions colored foods -looking at me like -listening attentively-chocolate -red meat -soft drinks -ice tea To distinguish whether the stool are normal or with blood.

MEDICATION CONTRAINDICATION

INDICATION NURSING RESPONSIBILITY

CLASSIFICATION

Generic Name: Symptomatic relief of Contraindicated inUse liquid from for -paracetamol pain and fever patients hyper-sensitive children and To drug. Patients who have

Anti-pyretic

Brand Name: Use cautiously in difficulty swallowing. -biogesic patients with long term Alcohol use because In children, dont

Dosage:therapeutic doses cause exceed five doses -Adults and hepatotoxicity in these in 24 hours.

Children 500-100mg patients. Orally every 4-6 hours Hematologic :haemolytic Anemia, neutropenia, Leukopenia Pancytopenia. Hepatic: jaundiceterm use can be Metabolic: cause liver damage. Hypoglycemia, Skin: rash, urticaria Warn patient that high doses or Unsupervised long

CASE STUDY

OF

DENGUE

FEVER

Submitted to: Ms Alyssa Ashley D. Malag, RN -Clinical InstructorSubmitted by: Manuel, Mae Ann Joy Martinez, Julie Pearl