I.

Introduction
Dengue fever is a disease caused by a family of viruses transmitted by infected
mosquitoes. It is an acute illness of sudden onset that usually follows a benign
course with symptoms such as headache, fever, exhaustion, severe muscle
and joint pain, swollen lymph nodes (lymphadenopathy), and rash. The
presence of fever, itchy rash, and headache (the "dengue triad") is
characteristic of dengue. Other signs of dengue fever include bleeding gums,
severe pain behind the eyes (retro-orbital), and red palms and soles.
Dengue (pronounced DENG-gay) can affect anyone but tends to be more severe
in people with compromised immune systems. Because one of five serotypes of
the dengue virus causes dengue fever, it is possible to get dengue fever multiple
times. However, an attack of dengue produces immunity for a lifetime to that
particular viral dengue serotype to which the patient was exposed.
Dengue goes by other names, including "breakbone fever" or "dandy fever."
Victims of dengue often have contortions due to the intense pain in the joints,
muscles, and bones, 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. Symptoms
include headache, fever, rash, and evidence of bleeding (hemorrhage) in the
body. Petechiae (small red spots or purple splotches or 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.

II. Objective

I. General objectives
This case study aims to come up with in-depth understanding and will be able
to obtain knowledge, develop attitudes towards the care of a patient with
Dengue fever and to improve skills in providing a holistic and comprehensive
plan of nursing care and for all the aspects that contribute to and affect the
condition of patients with the said situation.
II. Specific Objectives
a. Knowledge:

 To define Dengue fever

 To be able to know the pathophysiological basis of the

Dengue fever
 To determine the signs and symptoms on the current health
history and other manifestations of the patient.

 To know the laboratory and diagnostic tests the patient had

undergone
b. Skills:
 To make and decide on different nursing care plans.

 Demonstrate communication skills in educating clients with

Dengue fever and their significant others

 To better understand the medication given to the patient.

  To explain to the patient the cause or reason of having
Dengue fever, laboratory examination, and drug
administration.
c. Attitude:
 To formulate a discharge plan and prognosis for the
continuous health care even at home and recommendation
for future further researches

 To organize patient’s data to establish good background

information.
 Identify therapeutic methods in caring for a client with
Dengue fever

III. Nursing Health History

A. Biographic Data
• Therese
• 7 years old
• Female
B. Chief Complaint
• On and off fever, headache, and muscle joint pain
C. History of Present Illness
• No stated data
D. Past Medical History
• No stated data
E. Family History of Illness
• No stated data
F. Lifestyle
• No stated data
G. Social History
• No stated data
H. Psychological Data
• No stated data

IV. Physical Examination

A. Vital Signs
o Temperature- 38.9°C

o Blood pressure- 90/60 mmHg

o Pulse rate- 115bpm

o Respiratory Rate- 24 breaths per minute

o Weight - 25kg

o
 B. Overall Assessment
• Head eyes & Vision / Ear & Hearing/ Nose & Smelling / Mouth &
Taste/ Neck
Head
- No stated data.
Eyes
-No stated data.
Ears
-No stated data
Nose
- No stated data
Mouth
-No stated data.
Nervous System/ Neurologic function
• Mental status- No stated data
Respiratory System
• Respiratory rate 24 breaths per minute
Sounds during breathing – no stated data
• Speech ability- no stated data
Chest and the Heart
• Blood Pressure- 90/60 mmHg
• Breath Sounds- no stated data
• Heart Sound- No crackles and no rales upon auscultation
Digestive system
• Palpation- No stated data
Genitourinary system
• Stool- No stated data
Reproductive System
• No stated data
Musculoskeletal system
• Skin color - has cold and clammy skin
Integumentary System
 Petechial Rash appears on the left upper arm, on the tourniquet site.
V. Pathophysiology
 Precipitating
Predisposing
Environmental conditions (open spaces with water pots
Geographical area- tropical islands in and plants )
the pacific (Philippines) and Asia.
Immunocompromise

Aedes aegypti ( dengue virus carrier) :

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 to

circulation/ blood ( Incubation Period : 3- 14days)

Virus disseminated rapidly into the blood and stimulates white

blood cells including B lymphocytes that produces and secretes
immunoglobulins ( antibodies ),and monocytes/ macrophages,
neutrophils

Antibodies attached to the viral antigens and

then monocytes macrophages will perform
phagocytosis through Fc receptor within the
cells and dengue virus replicates in the cells

Entry to the bone

Entry to the spleen marrow
Recognition of dengue viral antigen on
infected monocyte.

Release of cytokines vasoactive agents such as interleukins,

tumor necrosis factor, urokinase and platelet activating factor
which stimulates white blood cells and pyrogen release.

Part of the Flavivirus family, the DENGUE dengue virus is a 50 nm virion

with three structural and seven nonstructural proteins, a lipid
envelope, and a 10.7 kb capped positive sense single strand of
ribonucleic acid. Infections are asymptomatic in up to 75% of infected
humans. 
Dengue fever is a virus transmitted by the bite of a female Aedes mosquito
(Aedes aegypti and Aedes albopictus) carrying dengue virus. The infection is
caused by one of four dengue viruses (DENV 1-4). These mosquitos also spread
Zika, chikungunya and other viruses.
Once an individual is bit by an infected mosquito, the mosquito transmits the
virus to that individual. The individual then becomes a carrier of the virus and
the virus multiplies inside them. The virus circulates inside the blood of the
infected person for 2-7 days during which time they become a source of the
virus for uninfected mosquitos and can transmit the infection to another
individual via Aedes mosquitos.
When an individual recovers from the infection by one dengue virus, they
become immune against that particular type of virus but can be infected by
any of the other dengue virus types.

VI. Diagnostic and Laboratory

Laboratory Results Revealed:

Platelet Count- 100 x10(9)/L
Hg- 12 g/L
Hct- 40%
WBC – 8 x10(9)/L
Chest X-ray- Normal Lungs
Dengue NS Antigen- Positive
Elisa (Igm) IgG Test-Igm- Negative
IgG - Negative

On the 6thday
Platelet- 200 x10(9)/L.
Serology Test: Elisa (Igm) IgM Test-Positive
IgGTest-Positive
VII. Drug Study

Drug Classificati Indications Side effects Special Nursing

Name on & and and Adverse Precaution Responsibi
Mechanism Contradiction Effects s lities
of Action s
Generic Classificati Indications:
Side effects: Do not Before:
Name: on: Used because
Hypotension connect Obtain
Plain Isotonic it has little to flexible history of
NSS Intravenou no effect on
Adverse plastic the
s the tissues
Effects: containers patient’s
Brand Classificati and make the
 Febrile of intravenou fluid and
Name: on person feel response s solutions in electrolyte
0.9% hydrated  Injection series status
Sodium Action/s: preventing at the connections. before
Choride hypovolemic site of Such use therapy
Solution Normal shock or injection could result in and
Saline is a hypotension.
 Venous air embolism  reassess
Dosage: sterile, thrombo due regularly.
500ml nonpyrogen Contraindica sis or to residual air
ic solution tions: phlebetis being drawn Before
Route: for fluid  Heart extendin from one giving the
Right and failure g from container bottle,
metacar electrolyte  Pulmonar the site before check for
pal vein replenishm y Edema of administratio the correct
ent.  Renal injection n of the fluid patient to
Freque It contains Impairme  Extravas from a be
nt secondary
ncy & noantimicr ation administer
 Sodium container is
Timing: obial  hypervol ed.
Retension completed.
Q 8hrs agents emia
Pressurizing
Check for
intravenous
the correct
solutions
contained in fluid to be
flexible given
plastic
containers to During:
increase flow Upon
rates can inserting
result in air the
embolism if chamber
the residual to another,
air in the make sure
container is that it is
not fully inserted
evacuated well.
prior to
administratio Be alert of
n. fluid
overload.
Use of a
vented Check the
intravenou patients
s comfort.
administrat
ion set with After:
the vent in Infuse the
the open IV well to
position its
could prescribed
result in rate.
air
embolism. Check for
Vented the
intravenou presence
s of bubbles
administrat in the IV.
ion sets
with the
vent in the
open
position
should not
be used
with
flexible
plastic
containers.
 Drug Classificat Indications Side effects Special Nursing
Name ion & and and Precautions Responsibi
Mechanis Contradiction Adverse lities
m of s Effects
Action
Generic Classifica Indications: Side Consult a  If there
Name: tion: Paracetamol effects: Doctor: If is
Tempra analgesic- (TEMPRA) is Generally, fever fever,
antipyretic useful for side effects persists assess
Brand drug reducing to more than 3 patient’
Name: Action/s: fever and for acetamino days (72 s fever
Paraceta Thought the phen hours) or if or
mol to produce temporary (paracetam pain pain:
Dosage: analgesia relief of ol) are continues type of
125 mg by  minor aches, mild, for more pain,
syrup blocking pains and though than 5 days locatio
7.5 ml generation discomfort hematologi in children n,
of  pain associated cal and 10 days intesns
Route: impulses, with the reactions in adults, ity,
P. O  probably  common have been consult the duratio
Q. by colds or flu, reported. doctor. n,
Frequen inhibiting  inoculations Skin As with any temper
cy & prostaglan or rashes and drug, if the ature,
Timing: din vaccinations. other patient is and
Q 4hrs synthesis in It is also allergic pregnant or diapho
nursing a
prn for the CNS or valuable in reactions resis.
baby, seek
fever the reducing occur
the advice of
synthesis pain occasionall  Tell
a health
or action of following y. patient
professional
other subst tonsillectomy not to
before using
ances that and Adverse use for
this product.
sensitize adenoidecto Effects: If rashes or marke
pain my. Hematolic: any swelling d fever
receptors Contraindic Hemolytica develops, ( highe
to ations: e mia, stop the use r than
mechanical Paracetamol neutropeni of 39.5 c).
or chemical is a, acetaminoph Fever
stimulatio contraindicat leukopenia en persisti
n. It is ed in patients , (paracetamol ng
thought to with known pancytope ) longer
relieve hypersensitiv nia. immediately than 3
fever by ity to and consult days,
central acetaminoph Hepatic: with the or
action in en liver doctor. recurre
the (paracetamol) damage, Signs and nt fever
hypothalam . Patients jaundice symptoms unless
ic heat- with anemia, do not directe
regulating cardiac, Metabolic: improve or d by
center pulmonary, hypoglyce new signs prescri
renal and/or mia develop. ber.
liver diseases
must consult Skin: rash,  Avoid
first with uticaria giving
their patient
physician aspirin
before taking or
this drug. aspirin
These - like
patients analge
must also sics
avoid becaus
prolonged e it
use of inhibit
acetaminoph s
en platelet
(paracetamol) aggreg
. ation.

 Teach
client
warnin
g signs
that
needs
immedi
ate
attenti
on of
the
physici
an.

 Evalua
te
therap
eutic
effects.
 VIII. Nursing Process

Assessmen Diagnosis Planning Inference Implementation Rationale Evaluation

t
Subjective: Altered body After 2 Body Independent:- Heat loss by After 4 hours
Cold and temperature hours of temperature Provide tepid means of of nursing
clammy skin. related to nursing elevated sponge bath evaporation intervention
Looks weak infection as intervention above and goals and
and pale. evidence by client will normal -Promote surface conduction.- objectives
raised in be able to level that is cooling by means Heat loss by was met as
body maintain usually of undressing means of evidenced
temperature. core caused by radiation by:-
Objective: temperature several - Provide cool and
Temp. 38.9 with factors environment conduction- Body
PR. – 115 normal related to Heat loss by temperature
bpm range as illness. As -Maintain bed rest means of lowered to
RR – 24 bpm evidence inoculation or minimize convection 37degree
BP – 90/60 by: body occurs, movement - To reduce celcius.
mmHg temperature proliferatio metabolic
WT.- 25 kgs is lowered n of virus Discuss importance demands of
to 37 follows and of adequate fluid oxygen
degrees once the intake particularly consumptio
Celsius. virus starts to the parents. n
to grow in - To prevent
number, it Strictly monitor dehydration
will soon temperature -To know if
reach it the
pathogenic patient’s
level that Temperature
will result went down
into pyrexia to the
or fever as a normal
defense After 4
mechanism hours of
of the body. nursing
intervention
goals and
objectives
was met as
evidenced
by:-Body
temperature
lowered to
37degree
celcius.
Assessmen Diagnosis Planning Inference Implementation Rationale Evaluation
t
Subjective: Fluid After 3 1. Monitor vital signs Aid the patient if Oral fluid After 3 hours
Volume hours of every 3 hours / more he or she is unable replacement is of nursing
-Weak. Deficit nursing often. to eat without indicated for intervention
-Heat or related to interventio Rationale: Vital sign assistance, and mild fluid goals and
Active n the help identify encourage the deficit and is a objectives
fever.
Fluid Loss patient will fluctuations in family or SO to cost-effective was met as
-Headache. be able to intravascular fluid assist with method for evidenced
replenish feedings, as replacement by:
-Anorexia, fluid 2. Observation necessary. treatment.
nausea, thirst, volume and of capillary refill. Good skin
painful will be able Rationale: Indications If patient can Dehydrated turgor and
to show adequacy of tolerate oral fluids, patients may good
swallowing.
signs of peripheral circulation.give what oral be weak and capillary
-Heartburn. hydration. fluids patient unable to meet refill –
3. Observations intake prefers. Provide prescribed indication of
-Pain in the and output. Note the fluid and straw at intake good
muscles and color of urine / bedside within easy independently peripheral
joints. concentration, reach. Provide . circulation
specific gravity. fresh water and a
straw. Fluid deficit
can cause a
Insert and IV dry, sticky
Objective: catheter to have IV mouth.
Temp. 38.9 access. Attention to
PR. – 115 mouth care
bpm promotes
RR – 24 bpm interest in
BP – 90/60 drinking and
mmHg reduces
WT.- 25 kgs discomfort of
dry mucous
membranes.

Parenteral
fluid
replacement is
indicated to
prevent or
treat
hypovolemic
complications.
IX. Discharge Plan
Medicines:
 Acetaminophen decreases pain and fever. It is available without a doctor's
order. Ask how much to take and how often to take it. Follow directions. Read
the labels of all other medicines you are using to see if they also contain
acetaminophen, or ask your doctor or pharmacist. Acetaminophen can cause
liver damage if not taken correctly. Do not use more than 4 grams (4,000
milligrams) total of acetaminophen in one day.
 Take your medicine as directed. Contact your healthcare provider if you think
your medicine is not helping or if you have side effects. Tell him of her if you are
allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you
take. Include the amounts, and when and why you take them. Bring the list or
the pill bottles to follow-up visits. Carry your medicine list with you in case of
an emergency.

Manage your symptoms:

 Do not take NSAIDs or aspirin. These medicines can increase your risk for
bleeding.
 Drink plenty of fluids to prevent dehydration. You are at risk for dehydration if
you have a fever, are vomiting, or have diarrhea. Ask how much liquid to drink
each day and which liquids are best for you. You may need to drink an oral
rehydration solution (ORS). This is a drink that contains the right amount of
salt, sugar, and minerals in water. It is the best oral liquid for replacing your
body fluids. Ask your healthcare provider where you can get an ORS. An ORS
can be given in small amounts (about 1 teaspoon at a time) if you or your child
is vomiting. If you or your child vomits, wait 30 minutes and try again. Ask
healthcare providers how much ORS you or your child needs.
 Rest as directed. Ask your healthcare provider when you can return to your
normal activities.

Call your doctor if:

 Your symptoms do not improve within 3 days.
 You are pregnant or think you are pregnant.
 You have questions or concerns about your condition or care.

Seek care immediately

For any of the following warning signs that your infection is getting worse:
 Your heart is beating faster than usual.
 You urinate less than usual or not at all.
 You feel confused or anxious.
 Your skin is pale and feels cold or clammy.
 You have bruises or small red or purple dots on your skin.
 You feel weak, dizzy, or faint.
 You have severe abdominal pain.
 You cannot stop vomiting or you vomit blood.
 You have blood in your bowel movements or your bowel movements look like
tar.
 You have irregular or heavy menstrual bleeding.

STRATEGIES

Enhanced 4S Strategy
S - earch and Destroy

S - eek Early Consultation

S - elf Protection Measures

S - ay yes to fogging only during outbreaks