INTRODUCTION Dengue Fever is caused by one of the four closely related, but antigenically distinct, virus serotypes Dengue

type 1, Dengue type 2, Dengue type 3, and Dengue type 4 of the genus Flavivirus and Chikungunya virus. Infection with one of these serotype provides immunity to only that serotype of life, to a person living in a Dengueendemic area can have more than one Dengue infection during their lifetime. Dengue fever through the four different Dengue serotypes are maintained in the cycle which involves humans and Aedes aegypti or Aedes albopictus mosquito through the transmission of the viruses to humans by the bite of an infected mosquito. The mosquito becomes infected with the Dengue virus when it bites a person who has Dengue and after a week it can transmit the virus while biting a healthy person. Dengue cannot be transmitted or directly spread from person to person. Aedes aegypti is the most common aedes specie which is a domestic, day-biting mosquito that prefers to feed on humans. INTUBATION PERIOD: Uncertain. Probably 6 days to 10 days PERIOD OF COMMUNICABILITY: Unknown. Presumed to be on the 1 st week of illness when virus is still present in the blood CLINICAL MANIFESTATIONS: First 4 days: >febrile or invasive stage --- starts abruptly as high fever, abdominal pain and headache; later flushing which may be accompanied by vomiting, conjunctival infection and epistaxis 4th to 7th day: >toxic or hemorrhagic stage --- lowering of temperature, severe abdominal pain, vomiting and frequent bleeding from GIT in the form of melena; unstable BP, narrow pulse pressure and shock; death may occur; vasomotor collapse 7th to 10th day: >convalescent or recovery stage --- generalized flushing with intervening areas of blanching appetite regained and blood pressure already stable MODE OF TRANSMISSION: Dengue viruses are transmitted to humans through the infective bites of female Aedes mosquito. Mosquitoes generally acquire virus while feeding on the blood of an infected person. After virus incubation of 8-10 days, an infected mosquito is capable, during probing and blood feeding of transmitting the virus to susceptible individuals for the rest of its life. Infected female mosquitoes may also transmit the virus to their offspring by transovarial (via the eggs) transmission. Humans are the main amplifying host of the virus. The virus circulates in the blood of infected humans for two to seven days, at approximately the same time as they have fever. Aedes mosquito may have acquired the virus when they fed on an individual during this period. Dengue cannot be transmitted through person to person mode.

CLASSIFICATION: 1. Severe, frank type >flushing, sudden high fever, severe hemorrhage, followed by sudden drop of temperature, shock and terminating in recovery or death 2. Moderate >with high fever but less hemorrhage, no shock present 3. Mild >with slight fever, with or without petichial hemorrhage but epidemiologically related to typical cases usually discovered in the course of invest or typical cases GRADING THE SEVERITY OF DENGUE FEVER: Grade 1: >fever >non-specific constitutional symptoms such as anorexia, vomiting and abdominal pain >absence of spontaneous bleeding >positive tourniquet test Grade 2: >signs and symptoms of Grade 1: plus >presence of spontaneous bleeding: mucocutaneous, gastrointestinal Grade 3: >signs and symptoms of Grade 2 with more severe bleeding: plus >evidence of circulatory failure: cold, clammy skin, irritability, weak to compressible pulses, narrowing of pulse pressure to 20 mmhg or less, cold extremities, mental confusion Grade 4: >signs and symptoms of Grade 3, declared shock, massive bleeding, pulse less and arterial blood Pressure = 1 mmhg (Dengue Syndrome/DS) SUSCEPTABILITY, RESISTANCE, AND OCCURRENCE: >all persons are susceptible >both sexes are equally affected >age groups predominantly affected are the pre-school age and school age >adults and infants are not exempted >peak age affected: 5-9 years old DF is sporadic throughout the year. Epidemic usually occurs during rainy seasons (June November). Peak months are September October. It occurs wherever vector mosquito exists. DIAGNOSTIC TEST:

Tourniquet test >Inflate the blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressure for 5 minutes. >Release cuff and make an imaginary 2.5 cm square or 1 inch square just below the cuff, at the antecubital fossa. >Count the number of petechiae inside the box. A test is positive when 20 or more petechiae per suare are observed. Dengue haemorrhagic fever (DHF), a potentially lethal complication, was first recognized in the 1950s during the dengue epidemics in the Philippines and Thailand, but today DHF affects most Asian countries and has become a leading cause of hospitalization and death among children in several of them. Last June 16, 2008, I encountered a patient with such kind of infection. This patient has caught my attention and has given the opportunity to study his case. The objective of this study is to help me understand the disease process of Dengue Fever and to orient myself for appropriate nursing interventions that I could offer to the patient. This approach enables me to exercise my duties as student nurse which is to render care. I was given the chance to improve the quality of care I can offer and to pursue my chosen profession as future nurse. I humble myself to present my studied case and submit myself for further corrections to widen the scope of my knowledge and understanding. DENGUE PREVENTION: There is no vaccine to prevent dengue. Prevention centers on avoiding mosquito bites when traveling to areas where dengue occurs and when in U.S. areas, especially along the TexasMexico border, where dengue might occur. Eliminating mosquito breeding sites in these areas is another key prevention measure. Avoid mosquito bites when traveling in tropical areas: Use mosquito repellents on skin and clothing. When outdoors during times that mosquitoes are biting, wear long-sleeved shirts and long pants tucked into socks. Avoid heavily populated residential areas. When indoors, stay in air-conditioned or screened areas. Use bednets if sleeping areas are not screened or air-conditioned. If you have symptoms of dengue, report your travel history to your doctor. Eliminate mosquito breeding sites in areas where dengue might occur: Eliminate mosquito breeding sites around homes. Discard items that can collect rain or run-off water, especially old tires. Regularly change the water in outdoor bird baths and pet and animal water containers. NURSING HISTORY Present Health History: Three days prior to admission the patient has fever and loss his appetite. According to the SO of the patient, they went to consult a physician during the first day of his fever. The physician prescribed Paracetamol for the patient. On the third day, the patient still had the said symptoms. He went back for a check-up. He had CBC and

was determined that he has dengue. The patient then was admitted immediately to Saint Paul Hospital on June 14, 2008. Past Health History: According to the SO of the patient the patient did not yet experienced having serious health problems other than fever, colds and cough. He had no previous hospitalization. Family Health History: According to the SO of the patient, their family has the history of Hypertension.

GORDONS 11 FUNCTIONAL HEALTTH PATTERN HEALTH PERCEPTION-HEALTH MANAGEMENT PATTERN Before hospitalization: The patient perceived his health in the state of good condition. He perceives health as wealth and he values his health a lot. He manages his health by practicing proper hygiene and eating nutritious food. During hospitalization: He sees himself as a total ill person because he cannot do anymore the things he usually does like playing with his siblings. He rely his present condition with the help of the therapeutic personnel and by following the prescribed medications. The patient perceived that he is not healthy because of his condition. NUTRITIONAL-METABOLIC PATTERN Before hospitalization: The patient eats 3 times a day and with afternoon snacks after coming from school. According to the SO of the patient, he eats meat, fish and also vegetables. He doesnt have any allergies on foods and drugs. His appetite is moderate and usually depends on the food being served. He didnt complain any difficulty in swallowing. During hospitalization: The patient has loss his appetite and hasnt eaten a lot. He is on a DAT (Diet as Tolerated) EDCF (Except Dark Colored Foods). ELIMINATION PATTERN Before hospitalization: The patient does not have any problem on his elimination pattern. He usually urinates 4-5 times a day without any difficulty. He added that the color of his urine is light yellow. He didnt feel any pain in urination. The patient defecates once a day usually early in the morning before going to school with yellow to brown color. He

verbalized that sometimes however, it is hard in consistency with dark color, which generally depends on what he eats. During hospitalization: The patient urinates 2-3 times a day. The color of her urine is yellow. The patient defecates once every two days. ACTIVITY-EXERCISE PATTERN Before hospitalization: He could perform activities of his daily living. According to him, he often plays with his siblings and this serves as a form of exercise for him. During hospitalization: His activity was limited lying on bed but the patient is given his bathroom privileges. SLEEP-REST PATTERN Before hospitalization:

He has the normal 6-8 hours sleep. He also has his nap time for 1-2 hours a day. Sleeping and watching the television are his form of rest. During hospitalization: He doesnt have the adequate time of sleep since he is disturbed with the nurses that enter the room every now and then, and because of the environmental changes of his surroundings. He also has inadequate time to rest since he doesnt have enough time to sleep. COGNITIVE-PERCEPTUAL PATTERN Before hospitalization: He is normal in terms of his cognitive abilities. He has good memory and reasoning skills. He can easily comprehend on things. In terms of his perceptual pattern, he has no problems with his senses. During hospitalization: He was normal as before in his cognitive and perceptual pattern. He responds clearly and well understood. He has no sensory deficit; He responds appropriately to verbal and physical stimuli and obeys simple commands. SELF-PERCEPTION SELF-CONCEPT PATTERN He sees himself as a person with a good personality. He has been a good friend, brother and a son. He said he has to be a good person in order not to hurt others. He also describes himself as a typical type of student and person. ROLE-RELATIONSHIP PATTERN Before hospitalization:

He has a close relationship with his family. They were five siblings in their family. He was at the middle. I was also able to ask his mother about his being a son and she confessed that he is a good son but at times he doesnt obey her. He is also a responsible student and knows all his duties as a friend. During hospitalization: He had more time to bond with his family. He said that it was a nice feeling to know that your family is so supportive to him. He learned to appreciate the beauty of having a family that gives you strength and support no matter what. SEXUALITY-REPRODUCTIVE PATTERN According to him, he doesnt think of the things like having a girlfriend and getting married yet. He is still young for such matters. COPING-STRESS TOLERANCE PATTERN Before hospitalization: He does not fully identify his situations having stress but he always tell her parents when something is wrong. During hospitalization: He shares his problems to his family. He verbalizes his feelings. VALUE-BELIEF PATTERN He is a Roman Catholic devotee. He always goes with his family every Sunday to go to mass. He was taught by his family to believe and have fear to GOD. They usually believe in quack doctors.

PHYSICAL ASSESSMENT Date assessed: June 18, 2008 General assessment: conscious and coherent Initial vital signs: T=36.2 C, RR=23, BP=90/60, PR=70 Area Assessed Technique Normal Findings Actual Findings Evaluation Skin Color Inspection Light brown, tanned skin (vary according to race) Light brown skin Normal Soles and palms Inspection Lighter colored palms, soles

Lighter colored palms, soles Normal Moisture Inspection/ Palpation Skin normally dry Skin normally dry Normal Temperature Palpation Normally warm Normally warm Normal Texture Palpation Smooth and soft Smooth and soft Normal Turgor Palpation Skin snaps back immediately Skin snaps back immediately Normal Skin appendages a. Nails Inspection Transparent, smooth and convex Transparent, smooth and convex Normal Nail beds Inspection Pinkish Pale Due to decreased blood flow Nail base Inspection Firm Firm Normal Capillary refill Inspection/ Palpation

White color of nail bed under pressure should return to pink within 2-3 seconds Returns within 2-3 seconds Normal b. Hair Distribution Inspection Evenly distributed Evenly distributed Normal Color Inspection Black Black Normal Texture Inspection/ Palpation Smooth Smooth Normal Eyes Eyes Inspection Parallel to each other Parallel to each other Normal Visual Acuity Inspection (penlight) PERRLA- Pupils equally round react to light and accommodation PERRLA- Pupils equally round react to light and accommodation Normal Eyebrows Inspection

Symmetrical in size, extension, hair texture and movement Symmetrical in size, extension, hair texture and movement Normal Eyelashes Inspection Distributed evenly and curved outward Distributed evenly and curved outward Normal Eyelids Inspection Same color as the skin Blinks involuntarily and bilaterally up to 20 times per minute Same color as the skin Blinks involuntarily and bilaterally up to 18 times per minute Normal Normal

Do not cover the pupil and the sclera, lids normally close symmetrically Do not cover the pupil and the sclera, lids normally close symmetrically Normal Conjunctiva Inspection

Transparent with light pink color Transparent with light pink color Normal Sclera Inspection Color is white Color is white Normal Cornea Inspection Transparent, shiny Transparent, shiny Normal Pupils Inspection Black, constrict briskly Black, constrict briskly Normal Iris Inspection Clearly visible Clearly visible Normal Ears Ear canal opening Inspection Free of lesions, discharge of inflammation Canal walls pink Free of lesions, discharge of inflammation Canal walls pink Normal Normal Hearing Acuity Inspection Client normally hears words when whispered

Client normally hears words when whispered Normal Nose Shape, size and skin color Inspection Smooth, symmetric with same color as the face Smooth, symmetric with same color as the face Normal Nares Inspection Oval, symmetric and without discharge Oval, symmetric and without discharge Normal Mouth and Pharynx Lips Inspection Pink, moist symmetric Light pink, dry, symmetric Lack of fluid intake Buccal mucosa Inspection Glistening pink soft moist Glistening pink soft moist Normal Gums Inspection

Slightly pink color, moist and tightly fit against each tooth Slightly pink color, moist and tightly fit against each tooth Normal Tongue Inspection Moist, slightly rough on dorsal surface medium or dull red Moist, slightly rough on dorsal surface medium or dull red Normal Teeth Inspection Firmly set, shiny Firmly set, shiny With tooth decay Normal Hard and soft palate Inspection Hard palate- domeshaped Soft Palate- light pink Hard palate- domeshaped Soft Palate- light pink Normal Neck

Symmetry of neck muscles, alignment of trachea Inspection Neck is slightly hyper extended, without masses or asymmetry Neck is slightly hyper extended, without masses or asymmetry Normal