Community Health Nursing RLE

Leadership and Management

Date of Exposure: December 5, 2016 to December 13, 2016
Day: MTWTH Time: 7:00 am to 3:00 pm
Name:
Date of Exposure: December 8, 2016
Staff Nursing Worksheet: # 1
Concept: Planning
Topic: Dengue Prevention: Dengue puksain ng wagas para lamok ay lumayas
Goal: The participants will fully understand the importance of Dengue Prevention
OBJECTIVES

CONTENT
OUTLINE

METHO
D

TIME
ALLOTMEN
T

RESOURCE
S

EVALUATION

After 30 minutes of
student nurse client
interaction, the client
will be able to:
1.) Define the causes
*Signs
and Lecture
of dengue.
Symptoms of
Dengue
2.) Emphasize the
signs and
symptoms of
dengue fever.

I.

Student-centered

* Signs and
Symptoms of
Dengue

Manila Paper

|_ 20 mins

Scotch Tape

Pentel Pen

Laptop
Speaker

3.) Return
Demonstrate
measures to repel
dengue
(protective
lotion, vitamins)
4.) Appreciate the
importance of
effectively
avoiding them.
5.) 1.To assess the
understanding of
Dengue fever
among
community
people.
6.) 2.To promote

EVALUATION

* Preventive
Measures

After 40 minutes of discussion, the

student nurses were able to:

Establish rapport to the

participants of Chat
Session

Teach learners about

measles

Provide basic
knowledge on how
dengue is prevented and
its signs & symptoms

Increase the learners

awareness on how
measles is transmitted

Realize the importance

of giving health
teachings especially in
the community

|_ 30 mins.

* Appreciation
|_ 10 mins.

Client- centered
After 40 minutes of discussion, the
participants were able to:

awareness of
Dengue fever
among the
community
people.
7.) 3.To provide
vital information
regarding
Dengue fever
8.)
a. causes
9.)
b.signs
and symptoms
10.)
11.)

*Preventive Measures
- Environmental sanitation
- Clean out areas in the house that are usually found to be wet and secure those places.
- Vitamins
- Vitamin C
- Repellants
- Lotions with mosquito repelling action

Acknowledge the
purpose of the class

Participate well in the

said session

Understand the given

health teachings by the
student nurses as shown
by the participants
ability to answer
questions given by
student nurses at the
end of the class

- Timing
- The highest biting time intensity is about 2 hours after sunrise and before sunset
- Clothing
- Full sleeved T-shirts, Pants
RLE group 3 BSN 3a
Community

Teaching plan
Dengue fever:
Heath Education

Treatment

Hygiene

Rehydration
with intravenous (IV)
fluids is often
necessary to treat
dehydration

Supportive care
in an intensive care
unit/environment

A transfusion of
fresh blood or
platelets can correct
bleeding problems

Intravenous (IV)
fluids and electrolytes
are also used to
correct electrolyte
imbalances
Oxygen therapy
may be needed to treat
abnormally low blood
oxygen
Administration
of medications as
ordered

Keep a sanitary
environment one that
would not allow
microorganisms to
burgeon and cause
infection or
complications. Also an
environment that
would promote healing
or conjucive in
restoring health of the
patient.
Bathe daily to prevent
invasion of
microorganisms. If
unable to do so, make
sure to clean your body
with wet cloth and
change your clothes
everyday with clean
and neat one.
Maintain good oral
hygiene.
Instruct parents to
clean the surroundings
and spray insecticides.
Instruct the parents to
close the container
when they collect
water.

Outpatient

Diet

Instruct patient to have a Normally, Physicians and

follow up check up
Clinical Dietitians would
consultation and regular
suggest patients to continue
check ups.
Normal Diet or Diet as
Tolerated regime. This is to
foster the wasting of
Instruct the patient about
nutrient which the patient
the proper way to take an
unconsciously loses during
oral temperature at home.
his/her sickness.

Instruct client to have

enough rest and avoid
heavy or strenuous
activity.

Instruct patient to avoid

drinking alcoholic
beverages for a few
weeks (especially while
taking medications).

Emphasize the
importance of increased
fluid intake.

Discuss the proper use of

antipyretics and
antibiotics.

Teach signs and

symptoms that require
immediate medical
attention.

Instruct client to follow

compliance to
medication.

A No Dark Colored Food

Diet (NDCF) or
Hemoglobin free diet is also
advice to patients which
will undergo fecalysis exam
to determine Blood Occult
in the stools. A meat free
diet is given for three (3)
days prior to stool collection
Highly colored foods, dark

green leafy vegetables and

Iron supplements are
avoided as these tend to
interfere with the test.
Foods that are safe to eat on
NDCF diet regime.
* Cheese
* Milk
* Eggs
* Non-Leafy Vegetables
* Refined Cereals
* Fruits and Fruit Juices

Dengue Fever
An acute infectious disease manifested initially with fever that caused by the Flavi virus and the first confirmed Dengue epidemic was
reported from Philippines in 1953-1954.
Transmission
Aedes aegypti or the common household mosquito are the transmitter of the disease, is a day-biting
mosquito which lays eggs in clear and stagnant water found in flower vases, cans, rain barrels, old rubber
tires, etc. The adult mosquitoes rest in dark places of the house.
Mosquito Bite

Diagnosis

Tests may include the following blood tests:

Antibody teststo see if your body is producing substances that fight the dengue fever viruses

Reverse transcriptase polymerase chain reaction test (RT-PCR)to determine the presence and quantity of virus present in the
bloodstream

20 or more petechiae that form within a 2.5-cm diameter circle by tourniquet test

Signs and Symptoms

Signs and Symptoms

First 4 days: febrile or invasive stage

-

Sudden onset of high fever

Abdominal pain

Joint & muscle pain

Headache

Vomiting

Conjunctival infection / pain behind the eyes

Epistaxis

Loss of appetite and Weakness

4th 7th days: toxic or hemorrhagic stage

-

Lowering of temperature

Skin rashes - maculopapular rash or red tiny spots on the skin called petechiae

Severe abdominal pain

Vomiting

Hematemesis and melena

Unstable BP

7th 10th day: convalescent or recovery stage

-

Generalized flushing with intervening areas of blanching appetite regained and blood pressure already stable.

Management: no medications available that can provide a cure. Treatment addresses the symptoms and it also attempts to avoid
potential complications.
Dengue fever:

Symptomatic and supportive treatment.

Bed rest during acute febrile illness.

Avoidance of antipyretics or aspirin because of gastritis and bleeding. Paracetamol may be given.

Analgesics / mild sedation for pain such as headache.

For vomiting and sweating, oral fluids and electrolytes must be supplemented

IV fluids if necessary.

Monitoring of patient is required till he becomes afebrile, has normal platelet count and normal hematocrit.

Prevention of DHF by early recognition of plasma leakage by frequent estimation of hematocrit (> 20% in normal values) and
platelet count < 50,000/mm3 would cause Dengue Hemorrhagic Fever.

Check for low BP and for Narrow pulse pressure (< 20 mm Hg)

Prevention and Control

Cover water drums and water pails at all times to prevent mosquitoes from breeding.

Replace water in flower vases once a week.

Clean all water containers once a week. Scrub the sides well to remove eggs of mosquitoes sticking to the sides.

Clean gutters of leaves and debris so that rain water will not collect as breeding places of mosquitoes.

Old tires used as roof support should be punctured or cut to avoid accumulation of water.

Collect and dispose all unusable tin cans, jars, bottles and other items that can collect and hold water.

Insect repellents, screen the window and bed mosquito net

Wear long-sleeved shirts and pants. Also wear socks and shoes, and apply insect repellents on your skin and your clothing
whenever going out in infected area.

I.

INTRODUCTION

The Department of Health said that 62,503 cases of the mosquito-borne illness have been reported in the Philippines from
January 1 to August 21, up nearly 90 percent from the same period last year. The death toll was also up from 350 in the same period
last year.
The department said the number of dengue cases in the country started to rise in May and peaked last month at the onset of the
rainy season.
Disease experts are now closely monitoring several barangays across the country for cases of dengue outbreak.
In line with this, the group decided to conduct a class regarding measles to raise the awareness of the residents of Barangay
Sapa Libutad, Angeles City.
II.

CONTENT

What is dengue?
Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. strikes people with low levels of
immunity. Because it is caused by one of four serotypes of virus, it is possible to get dengue fever multiple times. However, an attack
of dengue produces immunity for a lifetime to that particular serotype to which the patient was exposed.
Dengue goes by other names, including "breakbone" or "dandy fever." Victims of dengue often have contortions due to the
intense joint and muscle pain, hence the name breakbone fever. Slaves in the West Indies who contracted dengue were said to have
dandy fever because of their postures and gait.
Dengue hemorrhagic fever is a more severe form of the viral illness. Manifestations include headache, fever, rash, and
evidence of hemorrhage in the body. Petechiae (small red or purple blisters under the skin), bleeding in the nose or gums, black stools,
or easy bruising are all possible signs of hemorrhage. This form of dengue fever can be life-threatening and can progress to the most
severe form of the illness, dengue shock syndrome.

Agent and Vector

Dengue viruses (DEN) types 1, 2, 3, 4, which are classified as flaviviridae, are principally transmitted from human to human
through the bites of the Aedes aegypti mosquitoes. The femle mosquito bites the infected human during the day and can transmit the
virus to another host immediately or after 8 to 10 days of incubation within the salivary gland of the mosquito. The mosquito host
remains infected for life.
Incubation Period
After an individual is bitten by an infective mosquito, the virus undergoes an incubation period of 3 to 14 days.
Symptoms
Signs and symptoms of dengue fever vary, depending on the form and severity of the disease.

Dengue fever
With the mild form of the disease, you may experience some or all of these signs and symptoms:

High fever, up to 105 F (40.6 C)

A rash over most of your body, which may subside after a couple of days and then reappear

Severe headache, backache or both

Pain behind your eyes

Severe joint and muscle pain

Nausea and vomiting

Sign and symptoms usually begin about four to seven days after being bitten by a mosquito carrying a dengue virus. Mild dengue
fever rarely causes death, and your symptoms will usually subside within a week after starting.
-

Dengue hemorrhagic fever

More-severe forms of the disease usually begin the same way as the mild form (dengue fever) then become worse after several
days.

Dengue hemorrhagic fever a more severe form of the disease than initial dengue fever can cause signs and symptoms of dengue
fever plus:

Significant damage to your blood and lymph vessels

A decrease in the number of blood cells that help your blood clot (platelets)

Bleeding from the nose and mouth

Bleeding under the skin, which gives the appearance of bruising

Death

Dengue shock syndrome Dengue shock syndrome the most severe form of the disease may cause signs and symptoms of
mild dengue fever plus:

Severe abdominal pain

Frequent vomiting

Disorientation

Fluid (plasma) leakage from blood vessels

Heavy bleeding

A sudden drop in blood pressure (shock)

Death

Severe signs and symptoms may appear after your fever has improved. In a small number of cases, people with a severe form of the
disease die of it. Modern supportive hospital care decreases this risk.
Diagnostic Test
- Torniquet Test (Rumpel Leads Test)
- Inflate the blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressure for 5 minutes.
- Release cuff and make an imaginary 2.5 cm, square or 1 inch square just below the cuff, at the antecubital fossa.
- Count the number of petechiae inside the box.
- A test is (+) when 20 or more petechiae per 2.5 cm square or 1 inch square are observed.
How is it treated?
For a mild form of the disease:
Drinking plenty of fluids to avoid dehydration from vomiting and high fever.

Taking acetaminophen (Tylenol, others) to alleviate pain and reduce fever. Don't take aspirin or other nonsteroidal antiinflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve, others). These can increase the
risk of bleeding complications.

For a more severe form of the disease, treatment consists of:

Supportive care in a hospital

Intravenous (IV) fluid and electrolyte replacement

Blood pressure monitoring

Transfusion to replace blood loss

Methods of Prevention and Control

The prevention of dengue is directed at community and personal mosquito control in endemic areas.
Cover water drums and water pails at all times to prevent mosquitoes from breeding.
Replace water in flower vases once a week.
Clean all water containers once a week. Scrub the sides well to remove eggs of mosquitoes sticking to the sides.
Clean gutters of leaves and debris so that rain water will not collect as breeding places of mosquitoes.
Old tires used as roof support should be punctured or cut to avoid accumulation of water.
Collect and dispose all unusable tin cans, jars, bottles and other items that can collect and hold water.
To prevent mosquito bites, wear long pants and long sleeves.
For personal protection, use mosquito repellant sprays that contain DEET when visiting places where dengue is endemic.
II.

BIBLIOGRAPHY
NLPGNI (2007).Public Health Nursing in the Philippines.National League of Philippine Government Nurses, Philippines
Mayo Clinic (September 30, 2009). Dengue Fever. Retrieved September 13,2010, from
http://www.mayoclinic.com/health/denguefever/D/DSECTION=symptoms
DOH (2006). Dengue. Retrieved September 13, 2010, from http://www.doh.gov.ph/healthadvisories/dengue/