CASE STUDY : DENGUE FEVER

I. Introduction

R.K.G.M is a 27 years old from Lapu-Lapu Santa Cruz Marinduque. He was born on July
30,1994 and is a Roman Catholic . During his admission, he was diagnosed with Dengue Fever.
Dengue Fever is a viral infection transmitted to humans through the bite of mosquitoes. The
primary vectors that transmit the disease are Aedes aegypti mosquitoes and, to a lesser extent.
Albopictus (WHO,2022). High fever, headache, muscle, bone or joint pain, nausea and vomiting
may be present on the patient as well as rash and swollen glands.

Later on he was also diagnosed on having Urinary tract infection, he was positive on
having Urinary tract infection (UTI). UTI is an infection in any parts of the urinary system-
kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract- the bladder
and the urethra. And last July 12, 2022 at 6:00 pm, he was taken into the hospital due to fever
and vomiting several times for five (5) days. The symptoms he was complaining was
characterized of having Dengue fever and later on diagnosed with Urinary tract infection through
his laboratory test- urinalysis.

II. Anatomy and Physiology

Blood is the “river of life” that surges within us. It transports everything that must be carried from
one place to another within the body- nutrients, wastes (headed for elimination from the body)
and body heat through blood vessels. Long before modern medicine, blood was viewed as
magical, because when it drained from the body, life departed as well.

Functions of the Blood

Blood is unique; it is the only fluid tissue in the body.

● Carrier of gases, nutrients, and waste products.

● Clot formation
● Transport of processed molecules.
● Protection against foreign substances
● Transport of regulatory molecules
● Maintenance of body temperature
● pH and osmosis regulation
Physical Characteristics and Volume

Blood is a sticky, opaque fluid with a characteristic metallic taste.

● Color. Depending on the amount of oxygen it is carrying, the color of blood varies from
scarlet (oxygen-rich) to a dull red (oxygen-poor).
● Weight. Blood is heavier than water and about five times thicker, or more viscous,
largely because of its formed elements.
● pH. Blood is slightly alkaline, with a pH between 7.35 and 7.45.
● Temperature. Its temperature (38 degrees Celsius, or 100.4 degrees Fahrenheit) is
always slightly higher than body temperature.

Components of Blood

● Plasma- which is approximately 90 percent water, is the liquid part of the blood.
● Erythrocytes, or red blood cells- function primarily to ferry oxygen in blood to all cells
of the body.
● Hemoglobin- an iron bearing protein, transports the bulk of oxygen that is carried in the
blood.
● Leukocytes, or white blood cells- are far less numerous than red blood cells, they are
crucial to body defense against disease.
● Granulocytes- are granule-containing WBCs; they have lobed nuclei, which typically
consist of several rounded nuclear areas connected by thin strands of nuclear material,
and includes neutrophils, eosinophils, and basophils.
● Agranulocytes- The second group of WBCs, the agranulocytes, lack visible cytoplasmic
granules; their nuclei are closer to the norm- that is, they are spherical; they are
spherical, oval, or kidney-shaped; and they include lymphocytes and monocytes.
● Lymphocytes. Lymphocytes have a large, dark purple nucleus that occupies most of
the cell volume; they tend to take up residence in lymphatic tissues, where they play an
important role in the immune response.
● Monocytes. Monocytes are the largest of the WBCs; when they migrate into the tissues,
they transform into macrophages with huge appetites; macrophages are very important
in fighting chronic infections.
● Platelets- are not cells in the strict sense; they are fragments of bizarre multinucleate
cells called megakaryocytes, which pinch off thousands of anucleate platelet “pieces”
that quickly seal themselves off from surrounding fluids; platelets are needed for the
clotting process that occurs in plasma when blood vessels are ruptured or broken.

● Lymphocytes. Lymphocytes have a large, dark purple nucleus that occupies most of
the cell volume; they tend to take up residence in lymphatic tissues, where they play an
important role in the immune response.
 ● Monocytes. Monocytes are the largest of the WBCs; when they migrate into the tissues,
they transform into macrophages with huge appetites; macrophages are very important
in fighting chronic infections.
● Platelets- are not cells in the strict sense; they are fragments of bizarre multinucleate
cells called megakaryocytes, which pinch off thousands of anucleate platelet “pieces”
that quickly seal themselves off from surrounding fluids; platelets are needed for the
clotting process that occurs in plasma when blood vessels are ruptured or broken.

Urinary System

The urinary system's function is to filter blood and create urine as a waste by-product.
The organs of the urinary system include the kidneys, renal pelvis, ureters, bladder and
urethra.

The body takes nutrients from food and converts them to energy. After the body has
taken the food components that it needs, waste products are left behind in the bowel and in the
blood.

- The kidney and urinary systems help the body to eliminate liquid waste called urea,
and to keep chemicals, such as potassium and sodium, and water in balance.
- Urea is produced when foods containing protein, such as meat, poultry, and certain
vegetables, are broken down in the body.Urea is carried in the bloodstream to the
kidneys, where it is removed along with water and other wastes in the form of urine.

Important functions of the kidneys include blood pressure regulation and the production
of erythropoietin, which controls red blood cell production in the bone marrow. Kidneys also
regulate the acid-base balance and conserve fluids.

Kidney and urinary system parts and their functions

Two kidneys: This pair of purplish-brown organs is located below the ribs toward the middle of
the back. Their function is to

● Remove waste products and drugs from the body

● Balance the body's fluids
● Release hormones to regulate blood pressure
● Control production of red blood cells

The kidneys remove urea from the blood through tiny filtering units called nephrons. Each
nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small
tube called a renal tubule. Urea, together with water and other waste substances, forms the
urine as it passes through the nephrons and down the renal tubules of the kidney.
● Two ureters- These narrow tubes carry urine from the kidneys to the bladder.
● Bladder- This triangle-shaped, hollow organ is located in the lower abdomen. It is held
in place by ligaments that are attached to other organs and the pelvic bones.
● Two sphincter muscles -These circular muscles help keep urine from leaking by
closing tightly like a rubber band around the opening of the bladder.
● Urethra- This tube allows urine to pass outside the body. The brain signals the bladder
muscles to tighten, which squeezes urine out of the bladder. At the same time, the brain
signals the sphincter muscles to relax to let urine exit the bladder through the urethra.
When all the signals occur in the correct order, normal urination occurs.

III. Pathophysiology
 Environmental Conditiom

Bite of Aedes Aegypti

The virus penetrates to the skin

The virus infects and replicates inside the Langerhans cell

Immunity of the skin

Langerhans cells release interferons [to limit the spread of infection]

Infected Langerhans cells go to the lymphatic systems to make the immune systems alerts

Then goes to the circulation

Results in viremia- high levels of virus in the blood stream

Activation of immune response- increases lymphocytes

 Decreases neutrophils and white blood cells

Release of pyrogen causes fever and increased blood pressure in vessels-causes rashes

Dengue

Ascension to the kidney

Epithelial damage by bacteria toxins & protease

 Bacterial multiplication and immune system subversion

Neutrophil infiltration

Biofilm formation

Colonization & invasion of bladder, mediated by pili & adhesins

Inflammatory response in the bladder and fibrinogen accumulation in the catheter

Colonization of the urethra and migration to the bladder

Contamination of the periureteral area with a uropathogen from the gut

 IV. Patient's Profile

V. Nursing Care Plan

VI. Laboratory Results

VII. Drug Study

VIII. Discharge Planning

IX. Health Education

 III. Pathophysiology

Bite of Aedes Aegypti

The virus penetrates to the skin

The virus infects and replicates inside the Langerhans cell

Immunity of the skin

Langerhans cells release interferons [to limit the spread of infection]

Infected Langerhans cells go to the lymphatic systems to make the immune systems alerts

Then goes to the circulation

 Results in viremia- high levels of virus in the blood stream

Activation of immune response- increases lymphocytes

Decreases neutrophils and white blood cells

Release of pyrogen causes fever and increased blood pressure in vessels-causes rashes

Dengue

Ascension to the kidney

 Epithelial damage by bacteria toxins & protease

Bacterial multiplication and immune system subversion

Neutrophil infiltration

Biofilm formation

Colonization & invasion of bladder, mediated by pili & adhesins

Inflammatory response in the bladder and fibrinogen accumulation in the catheter

 Colonization of the urethra and migration to the bladder

Contamination of the periureteral area with a uropathogen from the gut

IV. Patient's Profile

V. Nursing Care Plan

VI. Laboratory Results

VII. Drug Study

VIII. Discharge Planning

IX. Health Education