CASE STUDY # 3

DENGUE FEVER

NCM 109 RLE (GROUP 3)

MARJORY ANN S. GORRICETA

CLINICAL INSTRUCTOR

NIKKI KIM M. LIM

STUDENT

BSN 2-F
SECTION & YEAR LEVEL

ILOILO DOCTORS’ COLLEGE

BACHELOR OF SCIENCE IN NURSING

S.Y 2021-2022
I. INTRODUCTION

This case study will mainly focus on Dengue fever

Dengue (DENG-gey) fever is a mosquito-borne illness that occurs in tropical and subtropical areas
of the world. Mild dengue fever causes a high fever and flu-like symptoms. The severe form of dengue
fever, also called dengue hemorrhagic fever, can cause serious 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, the western Pacific islands, Latin America and Africa. But the disease has been
spreading to new areas, including local outbreaks in Europe and southern parts of the United States.

Researchers are working on dengue fever vaccines. For now, in areas where dengue fever is
common, the best ways to prevent infection are to avoid being bitten by mosquitoes and to take steps
to reduce the mosquito population.

Most people recover within a week or so. In some cases, symptoms worsen and can become life-
threatening. This is called severe dengue, dengue hemorrhagic fever or dengue shock syndrome.

Severe dengue happens when your blood vessels become damaged and leaky. And the number of
clot-forming cells (platelets) in your bloodstream drops. This can lead to shock, internal bleeding, organ
failure and even death. Philippines: In 2021 and as of 13 November 2021, 66 655 cases, including 237
deaths, have been reported. This is an increase of 5 485 cases and 21 deaths since 23 October 2021

Dengue is a virus, so there is no specific treatment or cure. However, intervention can help,
depending on how severe the disease is. For milder forms, treatment includes: Preventing dehydration:
A high fever and vomiting can dehydrate the body.. 
II. OBJECTIVES

General Objective:

At the end of this study, we will be able to apply proper knowledge, skills, and attitude to:

 To prevent further complications

 To provide proper care and intervention
 To provide basic health education to mother or guardian of the child

Specific Objective:

At the end of this case study, we will be able to:

Knowledge:

 Provide after care for the child

 Provide awareness and preventive measures to the disease
 Provide knowledge regarding the disease

Skills:

 Formulate an appropriate nursing care plan according to the needs of the client.
 Implement a nursing care plan in managing the client’s needs and complains
using the nursing process.
 Continually checking up on their [Child’s] conditions, providing medications and
regularly asking after their health
 Document correctly the client’s condition, nursing interventions and evaluation.

Attitude:

 Actively participate in conducting the case study.

 Recognize client’s needs using a holistic approach.
 Maintain confidentiality regarding patient records/information.
 Display outmost confidence in managing client’s care.
 III. NURSING HEALTH HISTORY

CURRENT STATUS:

She came in the Emergency Room per wheelchair accompanied by her mother, with the chief
complaints of on and off fever, headache, abdominal pain and muscle joint pain for 3 days prior to admission.
Seen and examined by Dr. Analy, a Pedia Resident on Duty.

LIFESTYLE:

They lived in a slum area, with presence of stagnant water and unclean environment. Her mother is
taking care of her. Her father is a driver in a private company.
 IV. PHYSICAL EXAMINATION

Biographic Data

Name: Andrea

Age: 6 year old

Gender: female

Marital Status: Single

Religion: N/A

Attending Physician: Dr. Analy

Final Diagnosis: Dengue fever

Vital Signs

Temperature: 38.9 C

Pulse rate: 110 bpm

Respiratory rate: 25 cpm

O2 saturation: 96 percent

Blood pressure: 90/60 mmhg

Weight: 25kgs

Physical assessment findings

Her findings revealed: No crackles, no rales upon auscultation. Tourniquet test positive. Petechial rash
appears on the left upper arm, on the tourniquet site. Andrea has a cold and clammy skin. She looks weak and
pale. She had a complete Immunization.
 I. ANATOMY AND PHYSIOLOGY

when your blood vessels become damaged and leaky. And the number of clot-forming cells (platelets) in your
bloodstream drops. This can lead to shock, internal bleeding, organ failure and even death. Warning signs of
severe dengue fever — which is a life-threatening emergency — can develop quickly.

A flat, red rash may appear over most of the body 2 to 5 days after the
fever starts. A second rash, which looks like the measles, appears later in
the disease. Infected people may have increased skin sensitivity and are
very uncomfortable. Rash in dengue fever is a maculopapular or macular
confluent rash over the face, thorax, and flexor surfaces, with islands of
skin sparing. The rash typically begins on day 3 and persists 2-3 days. Fever
typically abates with the cessation of viremia.
II. DIAGNOSTIC AND LABORATORY

CBC Laboratory Results Revealed: on admission result

Chest X-ray- Normal Lungs

Dengue NS1 Antigen- Positive

Elisa (Igm) IgG Test-Igm- Positive

IgG - Negative
 III. PATHOPYSIOLOGY

Predisposing factors:
Precipitating factors:
1. Age
2. Host response 1. Environment and lifestyle
3. Nutritional status 2. High pollution
4. History of other 3. Uncovered water reservoir
complications 4. Humidity and climate

Bite of Aedes Aegypti

Virus penetrates the skin

Virus infects and replicates inside the Langerhans cell (immunity if the skin)

Langerhans cells release interferons (to limit spread of infection)

Infected langerhans cells go to the lymphatic system to make the immune system alert

Then goes to circulation

 Results in viremia - high levels of virus in the bloodstream

Activation of immune response - increases lymphycyte

Decreases neutrophils and white blood cells

Release of pyrogen Increased blood pressure in vessels

fever rashes

dehydration Abdominal pain headache Muscle and joint pain

IV. RUG STUDY

Name of Indication Contraindication Mechanism Side and adverse Nursing Responsibilities

Drug of Action effects
prescriptio Hypersensitivity It itching, hives, -Do not administer
IVF of n to raises swelling of the unless solution is clear
PNSS medicine any of the intravascular face, puffy eyes, and container is
used to components. osmotic coughing, undamaged.
Route of treat the pressure and sneezing, sore
Administr symptoms provides throat, difficulty -Caution must be
ation: of fluid, breathing, fever, exercised in the
electrolyte electrolytes and injection site administration of
IV
and fluid and calories reactions parenteral fluids,
Dosage imbalance for energy or (infection, especially those
and site: used as a replenishmen swelling, containing sodium
source of t of any fluid redness). ions to patients receiving
500 ml at water and loss corticosteroids or
125cc via electrolyte corticotrophin. Solution
soluset s. containing acetate
sarted at should be used with
the left caution as excess
metacarpa administration may
l vein. result in
metabolic alkalosis.

-Solution containing
dextrose should be used
with caution in patients
with known subclinical or
overt diabetes
mellitus.

-Discard unused
portion. In very low birth
weight infants, excessive
or rapid administration
of dextrose injection may
result in increased serum
osmolality and possible
intracerebral
hemorrhage.

-Properly label the IV

Fluid

-Observe aseptic
technique when
changing IV fluid

-apply 10 rights of
medication
Name of Indication Contraindic Mechanism Side and Nursing Responsibilities
Drug ation of Action adverse
effects
Generic Paracetamo Paracetamol Side Do not administer unless solution
caloric
Name: l is a mild has a central effects: is clear and
undernutriti
analgesic analgesic container is undamaged.
on low fever
Paracetamo and effect that is
l antipyretic, mediated thr with
acute liver
and is ough nausea,
failure - Check that the patient is not
Route of recommend activation of stomach
taking any other medication
Administra ed for the descending pain, and
liver containing paracetamol.
tion: treatment serotonergic loss of
problems
of most pathways. appetite;
Oral painful and Debate exists dark urine, - For children who may refuse
severe renal
febrile impairment about its clay- medicine off a spoon try using a
Dosage and colored
conditions, primary site medicine syringe to squirt liquid
Frequency: stools; or.
for a condition of action, slowly into the side of the child’s
example, where the which may jaundice mouth or use soluble paracetamol
250mg/
headache body is be inhibition (yellowing mixed with a drink.
5mlsyrup; 5
including mi unable to of of the skin
ml q 4 hrs
graine, maintain prostaglandin or eyes).
PRN for - Some children may be happy to
toothache, adequate (PG)
fever. take one paracetamol product but
neuralgia, blood flow synthesis or dislike the taste of another.
colds and called shock through an
Adverse
influenza, active
acetaminop Effect: - Evaluate therapeutic response.
sore throat, metabolite
backache, hen influencing
rheumatic overdose cannabinoid -apply 10 rights of medication
pain and receptors.
 dysmenorrh
acute
oea.
inflammatio
n of the liver
due to
hepatitis C
virus

Name of Indication Contraindica Mechanism Side and Nursing Responsibilities

Drug tion of Action adverse
effects
Generic It relieves Ranitidine headache If patient have high fever or have
stomach abdominal
Name: symptoms is a had antibiotic induced diarrhea
cancer pain
such as competitive for more than 2 days don’t let
agitation
Ranitidine stomach p porphyria inhibitor of patient take this drug
hair loss
ain. histamine confusion
Brand Ranitidine liver H2-receptors. constipatio
problems Apply 10 rights of medication
name: belongs to The n
a class of reversible diarrhea
decreased
Zantac drugs inhibition of dizziness
kidney
known as function H2-receptors hypersensiti
Route of vity
H2 in gastric
reaction
Administra blockers. parietal cells nausea
tion: results in a vomiting
reduction in anemia
Oral both gastric necrotizing i
acid volume nflammatio
Dosage and n of
and
Frequency: the small
concentratio
intestine an
50mg/ n. It works by d colon in fe
2ml/amp; decreasing tus or
Q8H; the amount newborn
1mg/kilo as of acid your
recommend stomach
ed dose makes.
V. NURSING CARE PLAN

Assessment Nursing Planning Nursing Rationale Evaluation

Diagnosis Intervention
Short-term: Independent: Goals Met as
Chief Hyperthermia - heat loss by evidenced
complaint: due -after the -provide tepid means of by:
inappropriate nursing sponge bath evaporation
on and off clotting factors intervention, and conduction Andrea was
fever, secondary to the patient will -provide cool observed to
headache, environment -heat loss by
dengue fever be able to be more
abdominal means of
evidenced by: demonstrate active and no
pain and -monitor convection
on and off fever, comfort, have fever noted.
muscle joint cold and her fluids temperature. Above IVF
- to know if
pain for 3 days clammy skin, balanced, skin condition has consumed
prior to -maintain bedrest
PR- 110 bpm, will be able to improved or and
admission. with strong return to its discontinued.
encourage/educate not
pulses upon original state parents about She was
Objectives: - to reduce
palpation, and vital signs increased oral fluid metabolic discharged
Temp. 38.9°C will return to intake per
Andrea has a demand on
muscle joint safe levels wheelchair
cold and oxygen
pain and low accompanied
clammy skin. consumption
platelet count by mother in
She looks weak
-to prevent an improved
and pale. Long term:
dehydration condition.
*Vital signs- OPD follow
Scientific -The mother of
O2 saturation- up after 1
rationale: the patient will
96% week.
be able to
PR- 110 bpm - Hyperthermia understand and
RR- 25 cpm
T- 38.9 C occurs overcome the Dependent:
BP- 90/60 when your body issue of her
mmhg absorbs or child *Give
generates more medication
heat than it can as prescribed
*Lab. Result release. A by the doctor used to treat
human's normal or physician the symptoms
CBC body of electrolyte
temperature is and fluid
Platelet Count- about 98.6 replenisher
degrees IVF of D5 0.3 NaCl
100 x10(9)/L
Hg- 12 g/L Fahrenheit
Hct- 40% (37C). Any body recommended
WBC – 8 temperature for the
x10(9)/L above 100 treatment of
Paracetamol
degrees most painful
Fahrenheit (38C) and febrile
is too warm. conditions
Diagnostic test Hyperthermia is
It relieves
usually the
Chest X-ray- symptoms such
result of
Normal Lungs as
overexertion in
Ranitidine stomach pain.
Dengue NS1 hot, humid
Antigen- conditions.
Positive

Elisa (Igm) IgG

Test-Igm-
Positive

IgG - Negative
Assessment Nursing Planning Nursing Rationale Evaluation
Diagnosis Intervention
Short-term: Independent: Goals Met as
Chief Pain related to evidenced by:
complaint: Abdominal pain -after the -assess the
-to identify the
and severe nursing clients pain Andrea was
on and off fever, headache due to intensity, onset,
intervention, the scale and observed to
headache, duration and
dengue fever patient will be perception be more
abdominal pain quality of pain
able to active and
and muscle joint demonstrate -encourage -pain is highly with
pain for 3 days comfort verbal report subjective and improved
prior to Scientific regarding during & after appetite. She
to identify the
admission. rationale: abdominal pain interventions was
effectiveness of
interventions discharged
Objectives: - “In dengue, -teach client or per
people focus clients parents -to divert the
wheelchair
Andrea has a mostly on fall in Long term: divertional child’s attention
accompanied
cold and platelet count. activities for from pain
by mother in
clammy skin. But, the real -The mother of their daughter
-to allow proper an improved
She looks weak warning sign is the patient will
oxygen supply condition.
and pale. abdominal be able to -teach
in the body, OPD follow
discomfort or understand and breathing
*Vital signs- clients tend to up after 1
pain. It overcome the exercises
O2 saturation- stop breathing week.
is reflective of issue of her child
96% during pain
capillary leak –
PR- 110 bpm escape of blood
RR- 25 cpm plasma through
T- 38.9 C minute blood
BP- 90/60 vessels called the
mmhg capillaries –
 which can
*Lab. Result damage the
organs. Dependent:
CBC
*Give
medication
Platelet Count-
as prescribed
100 x10(9)/L
by the doctor
Hg- 12 g/L
or physician
Hct- 40%
WBC – 8
x10(9)/L
IVF of D5 0.3
NaCl used to treat
the symptoms
Diagnostic test of electrolyte
Chest X-ray- and fluid
Normal Lungs Paracetamol replenisher

Dengue NS1 recommended

Antigen- for the
Positive treatment of
most painful
Elisa (Igm) IgG
and febrile
Test-Igm- Ranitidine
conditions
Positive
It relieves
IgG - Negative
symptoms such
as
stomach pain.
 V. DISCHARGE PLAN/HEALTH TEACHING

Health Teachings

Health teachings will focus on follow up or home care for the mother of the patient to follow as well as
preventive measures.

Preventive measures

1. Reduce Mosquito Habitat:

The mosquitoes which breed dengue thrive in stagnant water containing objects like tires, plastic covers,
flower pots, pet’s water bowls, etc. Reducing the habitat available for these mosquitoes (by getting rid of
stagnant water to breed) can help prevent dengue.

2. Stay in well-screened houses:

Ensure that the windows are closed properly or the door screens do not contain any holes. This would
eliminate the chances of any mosquitoes entering the house.

3. Use Mosquito Repellents:

Using mosquito repellents, especially in tropical areas with high populations and crowds, can help repel
mosquitoes from biting you. Apply mosquito repellent creams on your body when travelling to tropical
destinations and even when you are indoors.

4. Wear Protective Clothing:

In order to avoid being bitten by mosquitoes, one can go for long-sleeved clothes and full pants with socks &
covered shoes. It is advisable to go for this kind of protective clothing specifically in dengue-infested areas.

5. Sleep Under Mosquito-net:

Sleeping under the mosquito net can provide you and your children a double layer of protection from being
bitten by mosquitoes.   
 Home care

Manage dengue:

 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.
 On Low Fat, Low Fiber, Non-Irritating, Non-Carbonated Diet, No dark colored foods.

Watch for warning signs

Although the fever has gone away, the next phase of dengue can be dangerous for some people. Warning
signs generally begin in the 24-48 hours after the fever has gone away.

About 1 in 20 people with dengue will develop severe dengue. Severe dengue requires hospitalization and can
be life threatening.

If you or a family member develop any of the following warning signs, go to an urgent care clinic or the
emergency room immediately:

 Stomach or belly pain, tenderness

 Vomiting (at least 3 times in 24 hours)
 Bleeding from the nose or gums
 Vomiting blood, or blood in the stool
 Feeling tired, restless, or irritable
 Cold clammy skin
 Difficulty breathing
Questions:

1. What is Dengue Fever?

Dengue fever is a tropical disease caused by a virus carried by mosquitoes. The virus can cause fever,
headaches, rashes, and pain throughout the body. Most cases of dengue fever are mild and go away on their
own after about a week.

2. What are the signs and symptoms of Dengue?

 Mild symptoms of dengue can be confused with other illnesses that cause fever, aches and pains, or a
rash.

The most common symptom of dengue is fever with any of the following:

 Nausea, vomiting
 Rash
 Aches and pains (eye pain, typically behind the eyes, muscle, joint, or bone pain)
 Any warning sign
Symptoms of dengue typically last 2–7 days. Most people will recover after about a week.

3. What is the meaning of Incubation period, mode of transmission, communicability period and prognosis.

A. INCUBATION PERIOD the period between the infection of an individual by a pathogen and the
manifestation of the illness or disease it causes.

B. MODE OF TRANSMISSION is the route or method of transfer by which the infectious microorganism

moves or is carried from one place to another to reach the new host. The modes (means) of transmission are:
Contact (direct and/or indirect), Droplet, Airborne, Vector and Common Vehicle.

C. COMMUNICABILITY PERIOD The time during which an infectious agent may be transferred directly
or indirectly from an infected person to another person,
 D. PROGNOSIS medical term for predicting the likely or expected development of a disease, including
whether the signs and symptoms will improve or worsen or remain stable over time;

4. What is the mode of transmission, and prognosis of Dengue fever?

MODE OF TRANSMISSION: transmitted to humans through the bites of infective female Aedes
mosquitoes. When a patient suffering from dengue fever is bitten by a vector mosquito, the mosquito is
infected and it may spread the disease by biting other people.

PROGNOSIS: The prognosis for dengue is usually good. The worst symptoms of the illness typically last
1 to 2 weeks, and most patients will fully recover within several additional weeks. Typical dengue infection is
fatal in less than 1% of cases; however, the more severe dengue hemorrhagic fever is fatal in 2.5% of cases.

5. Lists down its Predisposing & Precipitating factors.

PREDISPOSING FACTORS: host response, age, history of other comlications and nutritional status

PRECIPITATING FACTORS: environment, high pollution, uncovered water containers, climate and
humidity

6. What are the Stages of Dengue Fever.

ebrile Phase

 Fever typically lasts 2–7 days and can be biphasic.

 Other signs and symptoms may include severe headache; retro-orbital eye pain; muscle, joint, and
bone pain; macular or maculopapular rash; and minor hemorrhagic manifestations including petechia,
ecchymosis, purpura, epistaxis, bleeding gums, hematuria, or a positive tourniquet test result.
 Some patients have injected oropharynx and facial erythema in the first 24–48 hours after onset.

Critical Phase

 The critical phase of dengue begins at defervescence and typically lasts 24–48 hours.
 Most patients clinically improve during this phase, but those with substantial plasma leakage can,
within a few hours, develop severe dengue as a result of a marked increase in vascular permeability.
 Initially, physiologic compensatory mechanisms maintain adequate circulation, which narrows pulse
pressure as diastolic blood pressure increases.
 Patients with severe plasma leakage may have pleural effusions, ascites, hypoproteinemia, or
hemoconcentration.
 Patients may appear to be well despite early signs of shock. However, once hypotension develops,
systolic blood pressure rapidly declines, and irreversible shock and death may ensue despite
resuscitation.
  Patients can also develop severe hemorrhagic manifestations, including hematemesis, bloody stool, or
menorrhagia, especially if they have been in prolonged shock. Uncommon manifestations include
hepatitis, myocarditis, pancreatitis, and encephalitis.
Convalescent Phase

 As plasma leakage subsides, the patient enters the convalescent phase and begins to reabsorb
extravasated intravenous fluids and pleural and abdominal effusions.
 As a patient’s well-being improves, hemodynamic status stabilizes (although he or she may manifest
bradycardia), and diuresis ensues. The patient’s hematocrit stabilizes or may fall because of the
dilutional effect of the reabsorbed fluid, and the white cell count usually starts to rise, followed by a
recovery of platelet count.
 The convalescent-phase rash may desquamate and be pruritic.
Laboratory findings commonly include leukopenia, thrombocytopenia, hyponatremia, elevated aspartate
aminotransferase and alanine aminotransferase, and a normal erythrocyte sedimentation rate.

7. What are the nursing responsibilities in patient with dengue?

 Blood pressure monitoring. Measure blood pressure as indicated.

 Monitoring pain. Note client report of pain in specific areas, whether pain is increasing, diffused, or
localized.
 Vascular access. Maintain patency of vascular access for fluid administration or blood replacement as
indicated.
 Medication regimen. There must be a periodic review of the medication regimen of the client to
identify medications that might exacerbate bleeding problems.
 Fluid replacement. Establish 24-hour fluid replacement needs.

8. Using the Elisa test , when can you say that the above laboratory test is Positive.

A change in color from light green to purple indicates a positive result.

9. Give the medication and treatment for patient with Dengue.

Based on case study: IVF of PNSS 500ml @ 125cc via soluset started at the left metacarpal vein,
Paracetamol 250mg/5ml syrup; 5 ml q 4 hrs PRN for fever. Ranitidine 50mg/2ml/amp; Q8H; 1mg/kilo as
recommended dose

10. Make at least 2 NCP & its corresponding Nursing Interventions.

Assessment Nursing Planning Nursing Rationale Evaluation

Diagnosis Intervention
Short-term: Independent: Goals Met as
Chief Hyperthermia - heat loss by evidenced
complaint: due -after the -provide tepid means of
 evaporation by:
on and off inappropriate nursing sponge bath and conduction
fever, clotting factors intervention, Andrea was
-provide cool -heat loss by
headache, secondary to the patient will observed to
environment means of
abdominal dengue fever be able to be more
convection
pain and evidenced by: demonstrate active and no
muscle joint on and off fever, comfort, have -monitor fever noted.
- to know if
pain for 3 dayscold and her fluids temperature. Above IVF
condition has
prior to clammy skin, balanced, skin improved or consumed
-maintain bedrest
admission. PR- 110 bpm, will be able to not and
with strong return to its encourage/educate discontinued.
Objectives: - to reduce
pulses upon original state parents about She was
metabolic
palpation, and vital signs increased oral fluid discharged
Andrea has a demand on
Temp. 38.9°C will return to intake per
cold and oxygen
muscle joint safe levels wheelchair
clammy skin. consumption
pain and low accompanied
She looks weak platelet count by mother in
-to prevent
and pale. an improved
dehydration
Long term: condition.
*Vital signs-
OPD follow
O2 saturation- Scientific -The mother of
up after 1
96% rationale: the patient will
week.
PR- 110 bpm be able to
RR- 25 cpm - Hyperthermia understand and Dependent:
T- 38.9 C occurs overcome the
BP- 90/60 when your body issue of her *Give
mmhg absorbs or child medication
generates more as prescribed
heat than it can by the doctor
*Lab. Result release. A or physician
used to treat
human's normal
the symptoms
CBC body
of electrolyte
temperature is
IVF of D5 0.3 NaCl and fluid
Platelet Count- about 98.6
replenisher
100 x10(9)/L degrees
Hg- 12 g/L Fahrenheit
Hct- 40% (37C). Any body recommended
WBC – 8 temperature for the
Paracetamol
x10(9)/L above 100 treatment of
degrees most painful
Fahrenheit (38C) and febrile
is too warm. conditions
Diagnostic test Hyperthermia is
Chest X-ray- It relieves
Normal Lungs usually the symptoms such
result of Ranitidine as
Dengue NS1 overexertion in stomach pain.
Antigen- hot, humid
Positive conditions.
Elisa (Igm) IgG
Test-Igm-
Positive

IgG - Negative

Assessment Nursing Planning Nursing Rationale Evaluation

Diagnosis Intervention
Short-term: Independent: Goals Met as
Chief Pain related to evidenced by:
complaint: Abdominal pain -after the -assess the
-to identify the
and severe nursing clients pain Andrea was
on and off fever, headache due to intensity, onset,
intervention, the scale and observed to
headache, duration and
dengue fever patient will be perception be more
abdominal pain quality of pain
able to active and
and muscle joint demonstrate -encourage -pain is highly with
pain for 3 days comfort verbal report subjective and improved
prior to Scientific regarding during & after appetite. She
to identify the
admission. rationale: abdominal pain interventions was
effectiveness of
interventions discharged
Objectives: - “In dengue, -teach client or per
people focus clients parents -to divert the
wheelchair
Andrea has a mostly on fall in Long term: divertional child’s attention
accompanied
cold and platelet count. activities for from pain
by mother in
clammy skin. But, the real -The mother of their daughter
-to allow proper an improved
She looks weak warning sign is the patient will
oxygen supply condition.
and pale. abdominal be able to -teach
in the body, OPD follow
discomfort or understand and breathing
*Vital signs- clients tend to up after 1
pain. It overcome the exercises
O2 saturation- stop breathing week.
is reflective of issue of her child
96% during pain
capillary leak –
PR- 110 bpm escape of blood
RR- 25 cpm plasma through
 T- 38.9 C
BP- 90/60 minute blood
mmhg vessels called the
capillaries –
which can
*Lab. Result damage the
organs.
Dependent:
CBC
*Give
Platelet Count- medication
100 x10(9)/L as prescribed
Hg- 12 g/L by the doctor
Hct- 40% or physician
WBC – 8
x10(9)/L

IVF of D5 0.3 used to treat

NaCl the symptoms
Diagnostic test of electrolyte
Chest X-ray- and fluid
Normal Lungs replenisher
Paracetamol
Dengue NS1 recommended
Antigen- for the
Positive treatment of
most painful
Elisa (Igm) IgG and febrile
Test-Igm- conditions
Ranitidine
Positive
It relieves
IgG - Negative symptoms such
as
stomach pain.

11. What are the prevention and health teachings of to patient with Dengue Fever.

HEALTH TEACHING: this will mainly focus of preventive measure (including environment), home care
and diet (what will the parents do for their child without medical supervision and foods that are good and
foods to avoid), warning signs (when will the parents know when to call a doctor)
 PREVENTIVE MEASURES: such as the use of protective clothing and materials (socks, mosquito net),
mosquito repellents (lotion/spray), and reducing breeding sites of mosquitos (cleaning canals and covering
stagnant water source)

12. The patient weighs 25kg, with a recommended of 1mg/kilo/dose, how much Ranitidine will you give to the
patient?

Ranitidine 50mg/2ml/amp; Q8H; 1mg/kilo as recommended dose

50mg/2ml = 25 mg/ml

25 kg X 1 mg / 25 kg = 1ml

Reference:

https://www.mayoclinic.org/diseases-conditions/dengue-fever/symptoms-causes/syc-
20353078#:~:text=Dengue%20(DENG%2Dgey)%20fever,fever%20and%20flu%2Dlike%20symptoms.

https://www.ecdc.europa.eu/en/dengue-monthly#:~:text=Philippines%3A%20In%202021%20and%20as,no
%20deaths%20have%20been%20reported.

https://www.rxlist.com/consumer_ranitidine_zantac/drugs-condition.htm

https://pharmeasy.in/blog/5-ways-to-avoid-dengue-fever/

https://www.cdc.gov/dengue/symptoms/family.html

https://www.drugs.com/cg/dengue-discharge-care.html