GOAL

General Goal:

To be knowledgeable about the nature of Dengue Fever Syndrome, management and treatment to be able to render effective nursing care to the client.

Specific Goal:

To be familiar with the etiology of the disease To know the pathophysiology of the disease To be aware of the signs and symptoms To know its complications To be knowledgeable on how to prevent the disease To know the treatment and how to apply it To know the diagnostic exam

PATIENTS PROFILE

Name: P.R Age: 13 years old Gender: Female Address: # 32 Natividad St. Malanday Dasmarinas Cavite Date of Birth: October 24, 1995 Place of Birth: Cavite Nationality: Filipino Religion: Roman Catholic Civil Status: Single Occupation: N/A Date of Admission: August 24, 2009 Time of admission: 9:00 pm Physician: Dra. Amores Place of Admission: St. Paul Hospital Cavite Admitting Diagnosis: Dengue Hemorrhagic Fever

CHIEF COMPLAIN The patient complains of abdominal pain, headache, fever and general flushing of skin with on and off vomiting.

PRESENT ILLNESS Four days prior to admission, the patient had an intermittent fever associated with abdominal pain, headache, and general flushing of the skin with on and off vomiting. A few hours prior to admission still the above sign and symptoms remain but already have (-) vomiting with accompanying chills and was diagnosed with Dengue Hemorrhagic fever.

PAST MEDICAL YEARS

It was according to the patient that she wasn't been hospitalized yet not until when he was diagnosed with Dengue Hemorrhagic fever. Before that diagnosis, she was already experiencing fever and her mom gives her a Paracetamol for remedy.

Allergies Patient has no known allergies FAMILY HISTORY According to the mother the only disease that the family has genetically is Diabetes Mellitus and no other diseases noted.

ENVIRONMENTAL HISTORY According to the patient the environment that the family have has an open drainage, wherein big rats and cockroaches can be seen. The house is cleaned by his mother and grandmother. It was described by the patient that there are parts of their house that is deprived from light.

C. HISTORY OF ILLNESS Feb 6th of 2014 ,R.P, started experiencing fever that persist only at night. As a remedy her mom gave him Paracetamol to lower her body temperature. Except from fever shes also experiencing abdominal pain, headache and general flushing of the skin with on and off vomiting.

As the above signs and symptoms persists, his parent decided to bring him to the hospital.

Upon the physical assessment and after several diagnostic procedures that the patient had undergone, he was diagnosed with Dengue Hemmorhagic Fever)and was admitted under the service of Dra. Amores.

THEORETICAL FRAMEWORK

CJS, is at the stage of puberty, was diagnosed of having Dengue Fever Syndrome (DFS).At the clinical check-up, the physician was able to identify some clinical signs of it and was referred to Dra. Del Valle. The case of CJS can be correlated with the theory of Florence Nightingale

Application Theory:

The case of CJS can be correlated with the theory of Nightingale wherein, the environment of the patient is a factor leading to recovery. Having a clean, well ventilated and quite environment is important in. With a nurturing environment, the body could repair itself.

ETIOLOGY Dengue infection is caused by dengue virus (DENV), which is a single-stranded RNA virus (approximately 11 kilobases long) with an icosahedral nucleocapsid and covered by a lipid envelope. The virus is in the family Flaviviridae, genus Flavivirus, and the type-specific virus is yellow fever. The dengue virus has 4 related but antigenically distinct serotypes: DENV-1, DENV-2, DENV-3, and DENV4. Genetic studies of sylvatic strains suggest that the 4 serotypes evolved from a common ancestor in primate populations approximately 1000 years ago and that all 4 separately emerged into a human urban transmission cycle 500 years ago in either Asia or Africa. Albert Sabin speciated these viruses in 1944. Each serotype is known to have several different genotypes. Viral genotype and serotype, and the sequence of infection with different serotypes, appear to affect disease severity. Living in endemic areas of the tropics (or warm, moist climates such as the southern United States) where the vector mosquito thrives is an important risk factor for infection. Poorly planned urbanization combined with explosive global population growth brings the mosquito and the human host into close proximity. Increased air travel easily transports infectious diseases between populations.

SIGNS AND SYMPTOMS According to patient

According to Book
Symptoms, which usually begin four to six days after infection and last for up to 10 days, may include: Sudden, high fever Severe headaches Pain behind the eyes Severe joint and muscle pain Nausea Vomiting Skin rash, which appears three to four days after the onset of fever Mild bleeding (such a nose bleed, bleeding gums, or easy bruising)

abdominal pain headache Fever general flushing of skin on and off vomiting.

HEMATOLOGY

EXAMINATION

REFERENCE VALUE 4-6X1012/ L 5-10X10g/L Male: 140170gms/ L Female: 120140gms/L Male:0.430.54 Female: 0.37-0.45

EXAM RESULTS
Feb 11,2014 Feb12,2014

INTERPRETATION Feb13,2024 4.7 Within normal range 2.4 138 Within normal range

RBC COUNT WBC COUNT HEMOGLOBIN

5.1 3.0 155

4.7 2.4 138

HEMATOCRIT

0.47

0.42

0.42

Within normal range

DIFFERENTIAL COUNT SEGMENTERS LYMPHOCYTES MONOCYTES EOSINOPHIL BASOPHIL CLOTTING TIME BLEEDING TIME BLOOD TYPE ESR STAB PLATELETS

0.55-0.65 0.25-0.35 0.02-0.06 0.01-0.03 0.01-1.0 --------------------------------------------------150-400x103 g/L

0.57 0.43 --------------------------------------------------------------------------------50

0.40 0.60

0.40 0.60

68

82

Abnormal

thrombocytopenia

URINALYSIS

Results Color Transparency ph Protein Specific Gravity Bilirubin Urobilinogen Nitrite Blood Ketones Glucose Pus cells Yellow Hazy 6.0 (-) 1.030 (-) Normal (-) (-) (-) (-) 5-10 hpf

Normal Yellow Clear 5.0 9.0 (-) 1.005 to 1.065 (-) Normal (-) (-) (-) (-) Negative

Analysis and Interpretation Normal Abnormal Normal Normal Normal Normal Normal Normal Normal Normal Normal Abnormal

DISCHARGE PLAN M edication Intake of appropriate vitamin supplement and diuretics to increase protection mechanism of the immune system and decreases renal vascular resistance and may increase renal blood flow, respectively. E xercise and environment Exercise at least 3x a week 30 mins a day for stronger body. The use of nonpharmacotherapy such as drinking plenty of water will promote increase plasma in blood to increase immunity and hydration, proper hygiene and promotion of cleanliness at home and work area. T reatment Management of such condition would be through hydration and doing control measures to eliminate vector by promoting cleanliness in the environment through proper disposal of rubber tires, changing of water of lower vases once a week, destruction of breeding places of mosquito and residual spraying with insecticides. H ealth teaching Advise support people to follow proper body hygiene for the client and to maintain cleanliness on surroundings. In addition, encourage to apply lotion having mosquito repellant property. This would prevent additional cases of DHF. O ut Patient/ Follow-up Any odd signs such as fever, petechiae, recurrence of fever,etc. must be immediately reported to the physician. D iet Instruct to eat foods that are low fat, low fiber, non-irritating and non-carbonated. S pirituality Encourage to pray.