Part III.

Nursing Care Plan

Assessment Diagnosis Goals Intervention Evaluation

Subjective Cues: Dengue Hemorrhagic Short term goal: Preventive: A stable
I have blood coming Fever After one hour the -Inhibit the use of blood- increased on
out of my nose. And I patient manifested thinning medicines such as Platelet count
am having fever and Nursing Diagnosis: behavior of avoiding aspirin and monitor for was achieved.
joint pains, and loss of Bleeding related to injuries to prevent bleeding tendencies such as Relieved signs
appetite altered clotting factors bleeeding and there will GI bleeding and symptoms
be no more presence of such as fever
epistaxis or any other -taking measure to promote and joint pains.
Objective Cues: form of bleeding patient’s safety, including Manisfested
-Weakness removal of sharp materials good hydration
-Rashes Long term goal: that may injure patient status The
-Platelet count: 100 The patient develop overall condition
-Joint pains undertsanding the -applying TSB to keep patient of the Patient
-black tarry stool disease process and thermoregulated was improved.
finds ways on
preventing contact to -Recommend use of soft
the disease. toothbrush to reduce risk of
injury to the oral mucosa.

-Administering NSAIDS as
prescribed

-watch out for danger signs

such as: decrease level of
consciousness, hypotension,
signs of shock, eye pain,
board-like abdomen, and
perfuse bleeding

Curative:
-Administration of medications
to relieve symptoms and to
increased patient’s immune
system

-applying cold compress on

area of the nose to constrict
vessels and stop the bleeding

-Hydration through IV therapy,

to prevent shock.

-Introduce Oral fluids

Rehabilitative:
-Introduce foods rich in
Vitamins to boost immune
syste

-Foods rich in vitamin K

should be recommended to
promote blood clotting
-Watch out for bleeding
tendencies

-Maintain good hydration

-Monitor Hgb, hct, platelet

count , and other clotting
factors
 Part II. Pathophysiology

Precipitating Factors:
Tropical Environment near rivers or near
Predisposing Factors:
possible breeding grounds of mosquito
Both males and females
Aedes Aegypti

Joint pains due

Bite of Aedes Aegypti mosquito carrying virus to infiltration
Death

Activation of immune Plasma leakage

Replication of virus in the blood circulation
response

Increase
Thrombocytopenia: Initiation of thrombocytosis brought by capillary
PC of 100 Release of
viremia permeability
pyrogens

Fluidshift and rash

Disseminated Altered clotting factor: increased
Fever:rick
tempfor Loss of
Activation
intravascular of inflammatory response
disease Decreased
hemorrhage and shock
of 38.5 appetite
Increased
neutrophils and
Hemorrhagic shock/DSS Lymphocytes
Edema
WBC
Risk factors

Factors that put you at greater risk of developing dengue fever or a more severe form of
the disease include:
Precipitating Factor: Living or traveling in tropical areas. Being in tropical and
subtropical areas increases your risk of exposure to the virus that causes dengue fever.
Especially high-risk areas are Southeast Asia, the western Pacific islands, Latin America
and the Caribbean.
Predisposing Factor: Prior infection with a dengue fever virus. Previous infection
with a dengue fever virus increases your risk of having severe symptoms if you're
infected again.

Signs and symptoms:

rapid, weak pulse and narrow pulse pressure (≤20 mmHg [2.7 kPa]) or (2) hypotension
for age, restlessness, and cold, clammy skin. Patients with dengue can rapidly progress
into Dengue Shock Syndrome, which, if not treated correctly, can lead to severe
complications and death.

Preventive measures:
Stay in air-conditioned or well-screened housing, Wear protective clothing, Use
moquito repellent and reduce mosquito habitat

Medical, Surgical, pharmacological management

Maintaining hydration should be stressed out. Monitoring for warning signs of severe
dengue and initiating early appropriate treatment are key to preventing complications
such as prolonged shock. Successful management of DHF and DSS includes judicious
and timely IV fluid replacement therapy with isotonic solutions and frequent
reassessment of the patient’s hemodynamic status and vital signs during the critical
phase. Health care providers should learn to recognize this disease at an early stage.
To manage pain and fever, patients should be given acetaminophen. Aspirin and non-
steroidal, anti-inflammatory medications may aggravate the bleeding tendency
associated with some dengue infections and, in children, can be associated with the
development
of Reyes syndrome.

Nursing management

Tell patients to drink plenty of fluids and get plenty of rest. It is necessary to administer
antipyretics to control their temperature. Children with dengue are at risk for febrile
seizures during the febrile phase of illness. Warn patients to avoid aspirin and other
non-steroidal, anti-inflammatory medications because they increase the risk of
hemorrhage. Monitor your patients’ hydration status during the febrile phase of illness.
Educate patients and parents about the signs of dehydration and have them monitor
their urine output. If patients cannot tolerate fluids orally, they may need IV fluids.
Assess hemodynamic status frequently by checking the patient’s heart rate, capillary
refill, pulse pressure, blood pressure, and urine output.Perform hemodynamic
assessments, baseline hematocrit testing, and platelet counts. Continue to monitor your
patients closely during defervescence. The critical phase of dengue begins with
defervescence and lasts 24–48 hours.

Complications

If severe, dengue fever can damage the lungs, liver or heart. Blood pressure can drop
to dangerous levels, causing shock and, in some cases, death.

References:

https://www.cdc.gov/dengue/resources/denguedhf-information-for-health-care-
practitioners_2009.pdf

https://www.mayoclinic.org/diseases-conditions/dengue-fever/symptoms-causes/syc-
20353078

https://www.doh.gov.ph/sites/default/files/statistics/2019_Monthly_Dengue_Report
%20_N1.pdf

https://nurseslabs.com/dengue-hemorrhagic-fever/

https://www.medscape.com/answers/215840-43482/what-is-the-global-incidence-of-
dengue
Part I. Introduction

Introduction:

Dengue (DENG-gey) fever is a mosquito-borne disease that occurs in tropical and

subtropical areas of the world. Mild dengue fever causes a high fever, rash, and muscle
and joint pain. A severe form of dengue fever, also called dengue hemorrhagic fever,
can cause severe bleeding, a sudden drop in blood pressure (shock) and death.

Millions of cases of dengue infection occur worldwide each year. Dengue fever is most
common in Southeast Asia and the western Pacific islands, but the disease has been
increasing rapidly in Latin America and the Caribbean.

Statistics Local:

A total of 12431cases were reported nationwide from January 1 to 26 of 2019. This is

according to the department of Health is higher compared to the numbers on the same
period last year. The regions with the highest percent increase in the number of the
reported cases for this year compared to last year were region X, VII, XI, IX,
MIMAROPA, CARAGA, and region XII. Age of suspect cases range from less than 1
month old to 98 years old. Majority of the cases were male. Most of the cases belonged
to 5-9 years age group.

Statistics International:

Dengue is a reportable disease in the United States; known or suspected cases should
be reported to public health authorities.
• Globally, 2.5 to 3 billion individuals live in approximately 112 countries that
experience dengue transmission.
• Annually, approximately 50-100 million individuals are infected.
• Dengue fever has a mortality rate of less than 1%.
• When treated, DHF has a mortality rate of 2-5%, but when left untreated, the
mortality rate is as high as 50%.
• Dengue fever may occur at any age but is more common among children.
Assessment Diagnosis Goals Intervention Evaluation
Subjective Cues: Dengue Hemorrhagic Short term goal Preventive: A stable white
I am having fever and Fever After one hour the -Inhibit the use of blood- blood cell count
joint pains, and loss of patients tempreature thinning medicines such as was achieved
appetite Nursing Diagnosis: will decrease from 38.5 aspirin and suggested
Hyperthermia related to to 37.5 c increased
infection -Monitor for bleeding immune system
Objective Cues: tendencies such as GI and decreased
-Weakness Long term goal: bleeding viral infection
-Temp: 38.5 c There will be no signs .the patient was
-Joint pains of infection and the -taking measure to promote relieved of signs
temperature of the patient’s safety, including and symptoms
patient will be stable. removal of sharp materials such as fever
that may injure patient and joint pains.
Manisfested by
-applying TSB to keep patient good hydration
thermoregulated status .The
overall condition
-Administering NSAIDS as of the Patient
prescribed was improved.

-watch out for danger signs

such as: decrease level of
consciusness, hypotension,
signs of shock, eye pain,
board-like abdomen, and
perfuse bleeding

-Educate Patient to clean or

empty water containers that
re prone to be a breeding
ground of dengue-carrying
mosquitos.

Curative:
-Administration of medications
to relieve symptoms and to
increased patient’s immune
system

-Hydration through IV therapy,

to prevent shock.

-Introduce Oral fluids

-administer paracetamol as
ordered by the physician

Rehabilitative:
-Introduce foods rich in
Vitamins to boost immune
system

-Bed rest

-Maintain good hydration

-Monitor WBC count and

signs of infection and also
monitor possible source of
infection
Assessment Diagnosis Goals Intervention Evaluation

Subjective Cues: Dengue Short term goal Preventive: Displayed

My mouth is dry and Hemorrhagic Fever Maintain fluid -monitor hgb, hct, pc laboratory
I have headache volume at a count. results within
Nursing Diagnosis: functional level normal range
Deficient fluid -Place the patient in for individuals.
Objective Cues: volume related to Trendelenburg position to
Dry mucosa vascular leakage. Long term goal: restore blood volume to I&O and fluid
Flushing Maintained fluid the head. are balance.
Poor skin turgor volume at a
Cracked lips functional level. Pat lips with dump cloth to
No signs of
prevent cracking of lips or
fluid volume
provide lip balm
deficit
-watch out for danger
signs such as: decrease
level of consciusness,
hypotension, signs of
shock, eye pain, board-like
abdomen, and perfuse
bleeding

Advised to avoid caffeine

and alcohol as indicated to
reduce effects of diuresis

Curative:

-Hydration through IV
therapy, to prevent shock.

-Introduce Oral fluids

-administer paracetamol
as ordered by the
physician

Rehabilitative:
-Bed rest

-Maintain good hydration

Measure blood pressure

as indicated.

Maintain patency of
vascular access for fluid
administration or blood
replacement as indicated.
 MAKATI MEDICAL CENTER

Nursing Education Research and Development

Nurse Residency Probationary Program- Batch 54

Assignment

DENGUE HEMORRAHAGIC FEVER

A CASE STUDY

Prepared by
Sharmaine Camille M. De Leon
July 15 2019