BACHELOR OF SCIENCE IN NURSING:

NCMB312 – COMMUNICABLE DISEASE NURSING

RLE MODULE RLE UNIT WEEK
3 12 14

Dengue Fever

 Read course and laboratory unit objectives

 Read study guide prior to class attendance
 Read required learning resources; refer to course unit terminologies for jargons
 Participate in weekly discussion board (Canvas)
 Answer and submit course unit tasks

At the end of this unit, the students are expected to:

General Objective:

This case study aims to broaden the students’ knowledge regarding dengue fever, and it is
designed to develop and enhance the skills and attitude in the application of different nursing
processes and management of the patient with dengue fever.

Specific Objectives:

1. To be able to acquire knowledge regarding dengue fever, its background and epidemiology
through research.
2. To recognize the contributing risk factors and signs and symptoms associated in the
development of Dengue Fever.
3. To understand the anatomical and physiological structures involved together with its
pathophysiology.
4. To formulate a comprehensive nursing care plan in the care for the patient with Dengue
Fever.
5. To acquire the knowledge on the role of drug therapy and medical and nursing
management.
6. To learn the nursing implications and prioritize responsibilities to improve patient’s condition.
7. To provide recommendations to ensure the continuity of the nursing care management
8. To provide health teaching about dengue fever.

Navales, Dionesia M. (2010). Handbook of Common Communicable and Infectious Disease, C

and E Publishing, Inc. QC.

GROUP TASK:
1. The class will be divided into groups depending upon the number of students.
2. Each group will discuss among themselves the case scenario provided.
3. Each group should make their PowerPoint for presentation.
4. Each group should present their case in a synchronous session via zoom class for 30
minutes.
4. Each group should submit their manuscript and PowerPoint through email at
ganicolas@fatima.edu.ph or Canvas upload.
5. Students presentation will be graded with the use of a Rubric.

CLINICAL SCENARIO:

NURSING HEALTH HISTORY

A. Patient’s Profile
Name: C.B.D.
Gender: Female
Age: 24 years old
Birth date: August 13, 1995
Birth place: Pangasinan
Civil Status: Single
Address: Parañaque City
Nationality: Filipino
Religion: Roman Catholic
Educational Attainment: High School Graduate
Date of Admission: September 21, 2020
Time of Admission: 03:00 AM
Admitting Diagnosis: Dengue with Warning Signs
Chief Complaint: Rashes

History of Present Illness:

4 days prior to consultation, patient had intermittent, undocumented fever accompanied by
body malaise, joint pain, nausea, and headache. Patient self-medicated Paracetamol and no
consult was done. The next day, symptoms persisted which prompted consult at local hospital
where patient was given unrecalled medications and was advised to return if problems occur.

Few hours after, above symptoms are now associated with generalized distribution of rashes,
hence referral to San Lazaro Hospital after being diagnosed with Dengue Fever.

History of Past Illness:

The patient has been hospitalized at the age of 16 years old due to urinary tract infection but
no other medical illnesses reported.

Family History:
The patient’s family history has hypertension in her mother side but there are no other medical
illnesses indicated.

Social and Personal History:

The patient occasionally drinks alcohol but does not smoke and denied using drugs.

GENERAL SURVEY
September 21, 2020 6:00 AM

VITAL SIGNS FINDINGS INTERPRETATION

Temperature 38.4 High
Pulse Rate 81 bpm Normal
Oxygen Saturation 98% Normal
Respiratory Rate 24 cpm Normal
Blood Pressure 100/80 mmHg Normal
PHYSICAL ASSESSMENT
HEAD
o Normocephalic
o No lesions
o Headache (5/10)
EYES
o Pupils are equally round and reactive to light and accommodation
o Anicteric sclera
o Pinkish palpebral conjunctiva
EARS
o Align symmetrically within corner of the eyes
o With slight cerumen
o No tenderness
o No discharges
o No swelling/redness
NOSE
o Patent nares
o No tenderness
o No swelling
o No discharges
o No bleeding
o Septum is in the midline, symmetrical nasolabial fold
MOUTH, THROAT, and NECK
o Lips are not dry
o Tongue is at the midline and pinkish
o Uvula is in the midline
o Tonsils not enlarged
o No palpable nodules
o No gums bleeding noted
CHEST
o Symmetrical chest expansion
o No retraction
o No difficulty of breathing noted
HEART
o No murmur
o Regular rhythm
ABDOMEN
o Soft and non-tender
o No pulsatile masses
o No guarding behavior
 o Normal bowel sounds
o (+) abdominal pain (7/10)
EXTREMITIES UPPER:
o No edema
o No cyanosis
o LR IV x 125cc/hr at left arm
LOWER:
o No edema
o No cyanosis
o Weakness on both legs when lifted
o Joint pain on the right leg (pain scale: 6/10)
SKIN
o Hot to touch (Temperature: 38.4)
o Petechial rashes on the abdomen and upper & lower extremities with itchiness

Admission Order:

The patient was admitted on September 21, 2020 at 3:00 am with a chief complaint of rashes
in the body and was admitted to female ward of San Lazaro Hospital, hooked to PLR 1L at 125
cc/hr. Admit to:
Diet: avoid darkly colored foods (for monitoring of melena)
Vital signs: Every 4 hours and watch out for any signs of bleeding and hypotension
IVF to follow: PLR (3X) X 8 hours, D5NM X 8 hours, D5 NSS or D5 LR for shock
Diagnostics: CBC with platelet count, Torniquet test, Dengue Ig IM, PT PTT, Urinalysis, CXR
(pneumonia and pleural effusion)
Monitor: Platelet count every 12 – 24 hours
Therapeutics: Medical Management
1. Supportive: Hydration
2. Medications: Omeprazole 40 mg TIV, Cetirizine HCL 10mg tab, PO, OD. and ORS
sachet in 250 ml water.
3. Watch out for complication
a. If there is frank, uncontrolled bleeding, fresh whole blood is indicated
b. If PT and PTT are prolonged and with thrombocytopenia, fresh frozen plasma
transfusion is indicated
c. If there is disseminated intravascular coagulation, platelet transfusion is indicated
d. In the absence of bleeding, there is no need to administer platelet transfusion even if
platelet count is low
Course in the Ward
Day 1: Patient C.B.D was admitted at San Lazaro Hospital at 3:00 am, with a diagnosis of
dengue. Patient exhibited fever, abdominal pain, joint pain, and headache with a complaint of
rashes; vital signs are BP: 100/80 mmHg, T- 38.4°C, PR- 81 bpm, RR- 24 cpm. Then, patient
was hooked to Lactated Ringer’s at 125cc/hr while an order for complete blood count, rinalysis,
clinical chemistry, chest x-ray, and dengue was done together with a diet as tolerated except
dark colored foods with strict aspiration. Medications are given: Omeprazole 40 mg TIV and
ORS sachet in 250 ml water. Patient is strictly monitor for any signs of narrow pulse pressure;
hypotension. At 6:00, patient was admitted into the female ward and in at 10 am complaint of
skin itchiness related to rashes and was given Cetirizine HCL 10mg tab, PO, OD. The next
day, patient is encouraged to increase fluid intake and order for repeat CBC.

Day 2: At exactly 7:00am, patient received with petechial rashes, lying down hooked in IV
Lactated Ringer’s that runs 125 cc/hr at left arm and vital signs were done with normal result
except temperature of 39.5°C. She sustained an order of repeat CBC and was done at
midnight. An interview was started and identified top three priority nursing care plan:
hyperthermia, impaired comfort, and risk for bleeding. The results of Platelet Count with normal
of 150-400 – Upon admission (50) Day 1 (36) Day 2 (41) and Serological Test Result September
21, 2020 result of Dengue Duo (RAPID ICT) ICT/LOT # QDE3018007 NS1: POSITIVE IgM: POSITIVE IgG:
POSITIVE.

COURSE TASKS:

1. Make an Anatomy and Physiology of Dengue Fever.

2. Conceptualize the pathophysiological alterations distinct to the case.

 Establish the pathophysiological triad of Host – Agent – Environment specific to the
case.
 Trace the pathophysiological changes and highlight problems that are
experienced by the client.
 Connect the pertinent nursing care and medical – surgical management to the
various signs and symptoms presented by the client.

Host Agent Environment

 Assessments found in  Etiologic agent  Predisposing factors present
the host contributing to in the host contributing to
the development of the the development of the
disease disease
 Disease Process
 Concise and brief flow of the pathophysiologic changes

3. Make a drug study with 6 columns.

3.1. Generic name, brand name if any, classification, dosage, frequency, route of
administration
3.2. Mechanism of action
3.3. Indications and drug rationale (why the drug is being given to patient
3.4. Contraindication
3.5. Common side effects
3.6. Nursing considerations while taking the drug.

4. Make at least two nursing care plan based on your assessment that needs to prioritize.

5. Make a recommendation based on a METHODS formal in simplest way.

Date Completed:
Date Submitted:

Links:
www.cdc.gov
www.doh.gov.ph
http://caro.doh.gov.ph/infectious-diseases/
www.who.org
Can access to YouTube, Google and other electronic communicable disease nursing books
available