COMMUNICABLE DISEASES IN NURSING

AZORES, MAE ANN A. September 17, 2010

BSN 4A1-4 Dr. Alfredo Ed Talosig, RN
DENGUE/DANDY/BREAKBONE FEVER

INTRODUCTION

Dengue fever is an infectious disease carried by mosquitoes and caused by any of four related dengue viruses. This disease used to be called “break-
bone” fever because it sometimes causes severe joint and muscle pain that feels like bones are breaking, hence the name. Health experts have known
about dengue fever for more than 200 years.

Dengue fever can be caused by any one of four types of dengue virus: DEN-1, DEN-2, DEN-3, and DEN-4. You can be infected by at least two, if
not all four types at different times during your lifetime, but only once by the same type.

You can get dengue virus infections from the bite of an infected Aedes mosquito. Mosquitoes become infected when they bite infected humans, and
later transmit infection to other people they bite. Two main species of mosquito, Aedes aegypti and Aedes albopictus, have been responsible for all
cases of dengue transmitted in this country. Dengue is not contagious from person to person.

Symptoms of typical uncomplicated (classic) dengue usually start with fever within 5 to 6 days after you have been bitten by an infected mosquito
and include

• High fever, up to 105 degrees Fahrenheit

• Severe headache
• Retro-orbital (behind the eye) pain
• Severe joint and muscle pain
• Nausea and vomiting
• Rash

The rash may appear over most of your body 3 to 4 days after the fever begins. You may get a second rash later in the disease. Symptoms of dengue
hemorrhagic fever include all of the symptoms of classic dengue plus

• Marked damage to blood and lymph vessels

• Bleeding from the nose, gums, or under the skin, causing purplish bruises

This form of dengue disease can cause death.

Symptoms of dengue shock syndrome-the most severe form of dengue disease-include all of the symptoms of classic dengue and dengue
hemorrhagic fever, plus

• Fluids leaking outside of blood vessels

• Massive bleeding
• Shock (very low blood pressure)

This form of the disease usually occurs in children (sometimes adults) experiencing their second dengue infection. It is sometimes fatal, especially in
children and young adults.
CASE:

The present health history started 8 days ago prior to admission. Patient Y, 18 years old female, had a sudden onset of headache; no
medication and consultation to the doctor was done. Few days prior to admission, the patient had high grade fever at 42°C accompanied with
throbbing headache, joint pains and nausea. She self-medicated with equaline 1000mg TID and afforded temporary relief. Due to persistence of the
said signs and symptoms, the patient seeks consultation and hence admitted at East Avenue Medical Center with Dr. T as attending physician. The
patient is positive in tourniquet test and Herman’s sign. She was admitted last September 12 at around 12:30 am. On September 15 at 11:25pm, she
was transferred from Ward I to Female Surgical Ward.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION

Subjective: Hyperthermia r/t After 30 mins of nursing Dependent: GOAL PARTIALLY MET:
*Throbbing headache increased metabolic intervention, the patient’s 1. Administer antipyretics as
*joint paints rate body temperature will be ordered.—Lowers body After 30 minutes of nursing
*nausea decreased from 42°C to temperature. intervention, the client’s
*persistence of ssx even atleast 39°C body temperature decreased
with equaline therapy Independent: from 42- 40°C.
1.Encourage tepid sponge bath.—
Objective: Nonpharmacologic measure to
*Fever-42 ‘C decrease body temperature through
*Tourniquet test – reveals conduction.
>20 petechial formation
*(+) Herman’s Sign 2. Encourage client to drink plenty
of water.-- will promote increase
plasma in blood to increase
immunity. Also to prevent
dehydration.

3. Encourage intake of Vitamin C or

fruits and vegetables that are rich in
vitamin C—To increase capillary
resistance.

4. Limit physical activities.—They

can further increase metabolic
demands.
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 – conomic

The use of nonpharmacotherapy such as drinking plenty of water will promote increase plasma in blood to increase immunity and 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 – ygiene

Advise to follow proper body hygiene and to maintain cleanliness on surroundings. 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.
EVALUATION

CONCLUSION

The patient in this study had undergone supportive and symptomatic management. She was admitted last September 12, and was transferred from
Ward 1 to the Female Medical Ward last September 15.

Proper nursing care such as water therapy and administration of prescribed drugs were done to promote comfort and repression of symptoms.
Hygiene was also strictly implemented to avoid risk for further infection. Nursing assistance was also given to help him in his activities of daily
living.

Health teaching is a very important role on the part of the nurses. This is of great significance to the knowledge deficit of patients regarding health
and illness.

Recommendation

Strict compliance to the medical treatment, health teachings and medical check-up is advised. With proper nutrition and conformity to the
medications & therapy, recovery would be easier and faster.