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

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
Environmental conditions (open spaces with water pots
Predisposing and plants )
Immunocompromise
Geographical area- tropical islands in Mosquito carrying dengue virus so
the pacific (Philippines) and Asia. Sweaty skin

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 spleen Entry to the bone

Recognition of dengue viral antigen on
marrow
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.

DENGUE
Part of the Flavivirus family, the 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 Name Classificati Indications Side effects Special Precautions Nurs
on & and and Adverse Responsi
Mechanis Contradictio Effects
m of ns
Action
Generic Classificat Indications: Side Do not connect flexible plastic Before:
Name: ion: Used effects: containers Obtain his
of intravenous solutions in series
Plain NSS Isotonic because it Hypotensio connections. Such use could result the patient
Intravenou has little to n in air embolism due to residual air and electro
Brand s no effect on being drawn from one container status befo
Name: Classificati the tissues Adverse before administration of the fluid therapy an
from a secondary container is
0.9% on and make Effects: completed. Pressurizing
reassess re
Sodium the person Febrile intravenous solutions contained in
Choride Action/s: feel hydrated response flexible plastic containers to Before givi
Solution preventing increase flow rates can result in bottle, che
Normal hypovolemic Injection at air embolism if the residual air in the correct
the container is not fully
Dosage: Saline is a shock or the site of evacuated prior to administration. to be
500ml sterile, hypotension. injection administer
nonpyroge Use of a vented intravenous
Route: nic Contraindic Venous administration set with the Check for
Right solution ations: thrombosis vent in the open position correct flui
 Heart could result in air
metacarpal for fluid or phlebetis given
failure embolism. Vented
vein and extending intravenous administration
electrolyte  Pulmona from the sets with the vent in the During:
Frequency replenish ry site of open position should not be Upon inser
& Timing: ment. Edema injection used with flexible plastic chamber to
 Renal containers.
Q 8hrs It contains another, m
noantimicr Impairm Extravasati sure that i
obial ent on inserted w
agents  Sodium
Retensio hypervolemi Be alert of
n a overload.

Check the
patients co

After:
Infuse the
to its presc
rate.

Check for
presence o
bubbles in
 Drug Classifica Indications and Side effects Special Nursing
Name tion & Contradictions and Adverse Precautions Responsibil
Mechanis Effects
m of
Action
Generic Classifica Indications: Side effects: Consult a Doctor: If If there is fev
Name: tion: Paracetamol Generally, side fever persists more assess patien
than 3 days (72
Tempra (TEMPRA) is effects to hours) or if pain fever or pain:
analgesic- useful for acetaminophe continues for more of pain, locat
Brand antipyreti reducing fever n than 5 days in intesnsity,
Name: c drug and for the (paracetamol) children and 10 days duration,
Action/s: temporary relief in adults, consult the
Paraceta are mild, doctor.
temperature,
mol Thought of minor aches, though As with any drug, if diaphoresis.
Dosage: to produc pains and hematological the patient is
125 mg e discomfort reactions have pregnant or nursing Tell patient n
syrup analgesia associated with been reported. a baby, seek the use for mark
by  advice of a health
7.5 ml the common Skin rashes professional before fever ( higher
blocking colds or flu, and other using this product. 39.5 c). Fever
Route: generation inoculations or allergic If rashes or any persisting lon
P. O of  pain vaccinations. It reactions swelling develops, than 3 days,
impulses, is also valuable stop the use of
Q. occur recurrent fev
acetaminophen
Frequen  probably  in reducing pain occasionally. unless direct
(paracetamol)
cy & by following immediately and prescriber.
Timing: inhibiting  tonsillectomy Adverse consult with the
Q 4hrs prostagla and Effects: doctor. Avoid giving
ndin Signs and symptoms
prn for adenoidectomy. Hematolic: do not improve or patient aspir
fever synthesis Contraindicatio Hemolyticae new signs develop. aspirin- like
in the CNS ns: mia, analgesics
or the Paracetamol is neutropenia, because it in
synthesis contraindicated leukopenia, platelet
or action of in patients with pancytopenia. aggregation.
other subs known
tances that hypersensitivity Hepatic: liver Teach client
sensitize to damage, warning sign
pain acetaminophen jaundice needs immed
receptors (paracetamol). attention of t
to Patients with Metabolic: physician.
mechanica anemia, cardiac, hypoglycemia
l pulmonary, renal Evaluate
or chemica and/or liver Skin: rash, therapeutic
l diseases must uticaria effects.
stimulatio consult first with
n. It is their physician
thought to before taking
relieve this drug. These
fever by patients must
central also avoid
action in prolonged use of
the acetaminophen
hypothala (paracetamol).
mic heat-
regulating
center
 VIII. Nursing Process
Assessmen Diagnosis Planning Inference Implementation Rationale Evaluation
t
Subjective: Altered After 2 Body Independent:- Heat loss by After 4 hours
Cold and body hours of temperature Provide tepid means of of nursing
clammy skin. temperature nursing elevated sponge bath evaporation intervention
Looks weak related to intervention above and goals and
and pale. infection as client will normal -Promote surface conduction.- objectives
evidence by be able to level that is cooling by means Heat loss by was met as
raised in maintain usually of undressing means of evidenced
body core caused by radiation and by:-
Objective: temperature. temperature several - Provide cool conduction-
Temp. 38.9 with factors environment Heat loss by Body
PR. – 115 normal related to means of temperature
bpm range as illness. As -Maintain bed rest convection lowered to
RR – 24 bpm evidence inoculation or minimize - To reduce 37degree
BP – 90/60 by: body occurs, movement metabolic celcius.
mmHg temperature proliferatio demands of
WT.- 25 kgs is lowered n of virus Discuss importance oxygen
to 37 follows and of adequate fluid consumption
degrees once the intake particularly - To prevent
Celsius. virus starts to the parents. dehydration
to grow in -To know if
number, it Strictly monitor the
will soon temperature patient’s
reach it Temperature
pathogenic went down
level that to the
will result normal After
into pyrexia 4 hours of
or fever as a nursing
defense intervention
mechanism goals and
of the body. 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
Rationale: Vital sign help
-Heat or related to interventio identify fluctuations in assistance, and mild fluid goals and
Active n the intravascular fluid encourage the deficit and is a objectives
fever.
Fluid Loss patient will family or SO to cost-effective was met as
be able to 2. Observation assist with method for evidenced
-Headache. of capillary refill.
replenish Rationale: Indications
feedings, as replacement by:
-Anorexia, fluid adequacy of peripheral necessary. treatment.
nausea, thirst, volume and circulation. Good skin
painful will be able If patient can Dehydrated turgor and
to show 3. Observations intake and tolerate oral fluids, patients may good
swallowing. output. Note the color of
signs of urine / concentration,
give what oral be weak and capillary
-Heartburn. hydration. specific gravity. fluids patient unable to meet refill –
prefers. Provide prescribed indication of
-Pain in the fluid and straw at intake good
muscles and bedside within easy independently peripheral
joints. reach. Provide . circulation
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