THEA MARIE MENDIOLA BSN 2B

I. INTRODUCTION

Dengue is a mosquito-borne viral disease that has rapidly spread to all regions of World Health
Organization in recent years. Dengue virus is transmitted by female mosquitoes mainly of Aedes species
mosquitoes. Aedes aegypti is identified by a striking striped pattern on its abdomen and Aedes albopictus are
easily recognized by the bold black shiny scales and distinct silver white scales on the palpus and tarsi. These
mosquitoes thrive in the presence of stagnant water, making dengue more prevalent during monsoons.

These mosquitoes usually bite early in the morning and in the evening, right before sunset. The disease
spreads when the mosquito bites an individual. Transferring the dengue virus into the blood stream and
infecting the organs. However, around 5% of all cases, a more dangerous version of dengue fever can arise,
known as Dengue Hemorrhagic Fever, this case has more complications and requires immediate treatment.
Nearly 20% of all dengue patients are toddlers and babies, mothers with dengue are liable to pass the
infection during labor.

Dengue usually begins with viral influenza-like symptoms, such as fever, runny nose, cough, and
fatigue. Children infected with the virus become unusually irritable and agitated, and cry more often. Drop of
appetite and sleep. Children might experience muscle and joint aches, dull throbbing pain behind their eyes,
back pain, etc. some children experience abdominal pain, nausea, vomiting or diarrhea, which can be mistaken
for symptoms of gastroenteritis. You may also notice a white patchy rash or bruises on the skin. Children
experience bleeding from their gums or nose due to a drop of platelet count, caused by the virus. Bleeding can
also occur in the gastrointestinal tract.

Dengue causes a wide spectrum of disease. This can range from subclinical disease (people may not
know they are even infected) to severe flu-like symptoms in those infected. Although less common, some
people develop severe dengue, which can be any number of complications associated with severe bleeding,
organ impairment and/or plasma leakage. Severe dengue has a higher risk of death when not managed
appropriately. Severe dengue was first recognized in the 1950s during dengue epidemics in the Philippines and
Thailand. Today, severe dengue affects most Asian and Latin American countries and has become a leading
cause of hospitalization and death among children and adults in these regions.
 II. OBJECTIVES

General Objectives

At the end of this case presentation, the participants and the audience will be:
 Educated about the Dengue Fever and its nursing management and acquired the proper knowledge, skills and
attitude in providing care to the child.

Specific Objectives

Knowledge

 Recognize the dengue fever discomforts felt by the patient

 Identify the different symptoms of dengue
 Discuss the common discomforts of the patient

Skills

 Evaluate outcome criteria for the achievement and effectiveness of care

 Implement a nursing care plan in managing patient’s signs and symptoms
 Document correctly the patient’s condition, nursing interventions and evaluation.

Attitude

 Recognize the patient’s needs using a holistic approach

 Facilitate health teaching
 Provide comprehensive care that considers the patient’s emotional and physical needs
 III. NURSING HEALTH HISTORY

A. Biographic Data

Patient’s Name: Andrea

Address:
Age: 6 years old
Sex: Female
Marital Status: Child
Source of Information: Patient’s Mother

B. Chief Complaint:

On and off fever, headache, abdominal pain and muscle joint pain for 3 days prior to admission.

C. History of Present Illness:

The patient has on and off fever, headache, abdominal pain and muscle joint pain for 3 days prior to admission.
She was seen and examined, and 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.

D. Past Medical History:

Andrea has no Past Medical History.

 IV. PHYSICAL EXAMINATION

Physical examination of children with Dengue should focus on assessing for the presence and degree of fever,
headache, abdominal pain and muscle joint and determining the underlying etiology. Auscultation findings include no
crackles, no rales. The patient had cold and clammy skin and looks weak and pale. The tourniquet test positive, it is a
clinical diagnostic method to determine a patients hemorrhagic tendency. Parental report of the child’s history is also
helpful in the assessment. The physical examination can be helpful in determining the etiology of Dengue.

The physical exam findings for Dengue are as follows:

 Physical examination findings for Dengue includes: nausea, vomiting, rash, aches and pains, a positive tourniquet
test, leukopenia, abdominal pain or tenderness, persistent vomiting.

Appearance of the patient:

 Patients with Dengue usually appear normal or in distress.

Vital Signs Result Normal Value (Child)

Temperature 38.9 C 36.6 C

Heart Rate 110 bpm 70 – 120 bpm

Respiratory Rate 25 bpm 20 – 30 breaths per minute

Blood Pressure 90/60 mm Hg 80/120 mm Hg

Oxygen Saturation 96% 95 - 100 %

Weight 25 kg 20-42 kg

General Condition :

Andrea came in the Emergency Room per wheelchair accompanied by her mother 3 days PTA associated with of and on
fever, headache, abdominal pain and muscle joint.

- She has a cold and clammy skin

- She looks weak and pale

Examination fo Dengue Fever :

- Petechial rash appears on the left upper arm, on the tourniquet site.
- Tourniquet test positive
 V. PATHOPHYSIOLOGY

Dengue fever is a mosquito-borne viral disease caused by 1 of 4 closely related but antigenically distinct
serotypes of dengue virus, serotypes DENV-1 through DEN-4. Infection with one dengue serotype confers lifelong
homotypic immunity and a brief period of partial heterotypic immunity (2 years), but each individual can eventually be
infected by all 4 serotypes. Several serotypes can be in circulation during an epidemic.
 Dengue presents in a nonspecific manner similar to that of many other viral and
bacterial illnesses. Fever typically begins on the third day of illness and persists 5-7 days, abating with the
cessation of viremia. Fever may reach 41C°. Occasionally, and more frequently in children, the fever abates for a day and
recurs, a pattern that is termed a saddleback fever; however, this pattern is more commonly seen in dengue
hemorrhagic fever.

Incubation period is the interval between initial contact with an infectious agent and appearance of the first sign
or symptom of disease in question. Mode of Transmission is the route by which an organism is transferred from one
host to another. It can also refer to how an infectious agent, also called a pathogen, can be transferred from one person,
object, or animal to another. Communicability period is the time during which an infectious agent may be transferred
directly or indirectly from an infected person to another person, from an infected animal to humans, or from an infected
person to animals. Prognosis is the educated prediction of the course of the disease and how a person may recover

Leukopenia, lymphopenia near the end of the febrile phase, and thrombocytopenia are common findings in
dengue fever and are believed to be caused by direct destructive actions of the virus on bone marrow precursor cells.
The resulting active viral replication and cellular destruction in the bone marrow are believed to cause the bone pain.
Approximately one third of patients with dengue fever may have mild hemorrhagic symptoms, including petechiae,
gingival bleeding, and a positive tourniquet test (>20 petechiae in an area of 2.5 X 2.5 cm). Dengue fever is rarely fatal.

Etiology
The dengue virus has 4 related but antigenically distinct serotypes: DENV-1, DENV-2, DENV-3, and DENV-4.
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.

Epidemiology
The overall incidence of dengue, as well as the explosive outbreaks of dengue, has been increasing dramatically
over the last several years. Older data suggested an estimated 50-100 million cases of dengue fever and 500,000 cases
of dengue hemorrhagic fever occur worldwide, with 22,000 deaths (mainly in children). In 2015, official data from WHO
member states reported more than 3.2 million cases, with 2.35 million cases in the Americas alone, including 10,200
cases of severe dengue and 1181 deaths. One study estimates that approximately 390 million dengue infections occur
per year (95% CI; 284-528 million), with 96 million of these presenting clinically. An estimated 2.5-3 billion people
(approximately 40%-50% of the world’s population) are estimated to be at risk for dengue infection. Recent estimates
find that 128 countries worldwide are at risk for dengue infection, which includes 36 that had once been classified as
dengue-free. The only continent that has not experienced dengue transmission is Antarctica.
 VI. DIAGNOSTIC AND LABORATORY

CBC Laboratory Results Revealed: on admission result

Results Normal Values Significance

Platelet Count – 100 x 10 (9)/L Male: 135-317 billion/L (135,000 to Platelets, also known as
317,000/mcL) thrombocytes, are a component of
Female: 157-371 billion/L (157,000- blood. Their primary function is to
371,000/mcL) stop bleeding by clotting. They also
have a role in defense mechanism by
a process known as clumping or
agglutination. Dengue virus enters the
bloodstream, it binds to platelets and
replicates leading to multiplication of
infectious virus. The infected platelet
cells tend to destroy normal platelets
which is one of the major causes for
the drop in the platelet count during
dengue fever.

Hg – 12 g/L Male: 13.2-16.6 grams/dL (132-166 Hemoglobin is associated with the

grams/L) severity of dengue. Hemoglobin in
Female: 11.6-15 grams/dL (116- dengue patients with plasma leakage
150grams/dL) was higher than in those without
leakage. High hemoglobin levels may
also point to a severe dengue
infection.

Hct – 40% Male: 38.3 - 48.6 percent A hematocrit level increase greater
Female: 35.5 – 44.9 percent than 20% is a sign of
hemoconcentration and precedes
shock. The hematocrit level should be
monitored at least every 24 hours to
facilitate early recognition of dengue
hemorrhagic fever and every 3-4
hours in severe cases of dengue
hemorrhagic fever or dengue shock
syndrome.

WBC – 8 x 10(9)/L 3.4 – 9.6 billion cells/L Patients with dengue had significantly
(3,400 to 9.600 cells/mcL) lower total WBC, neutrophil, and
platelet counts than patients with
other febrile illnesses in dengue-
endemic populations. Leukopenia in
dengue fever may be caused by virus-
induced destruction or inhibition of
myeloid progenitor cells.
Thrombocytopenia may result from by
 destruction of peripheral platelet or
bone marrow megakaryocytes by
viruses which consequently reduce
the platelet production.

Laboratory Tests Results Significance

Chest X-ray Normal Lungs Chest radiography is done to look for

pleural effusions and
bronchopneumonia. Right-sided
pleural effusion is typical. Bilateral
pleural effusions are common in
patients with dengue shock syndrome.
Head computed tomography without
contrast may be indicated in patients
with altered level of consciousness, to
detect intracranial bleeding or
cerebral edema from dengue
hemorrhagic fever.

Dengue NS1 Antigen Positive NS1 tests detect the non-structural

protein NS1 of dengue virus. This
protein is secreted into the blood
during dengue infection. A positive
NS1 test result is indicative of a
dengue infection but does not provide
serotype information. Knowing the
serotype of the infecting virus is not
necessary for patient care; however, if
serotype information is needed for
surveillance purposes  There are four
dengue serotypes (DENV-1, DENV-2,
DENV-3, DENV-4), the sample should
be tested by NAT (NAAT is a generic
term referring to molecular tests used
to detect viral genomic material.
NAAT assays are the preferred
method of diagnosis, because they
can provide confirmed evidence of
infection)

Elisa (igm) IgG Test – Igm Positive The dengue MAC-ELISA is used for the
qualitative detection of dengue virus
IgM antibodies. The MAC-ELISA is
based on capturing human IgM
antibodies on a microtiter plate using
anti-human-IgM antibody followed by
the addition of dengue virus antigens.
The antigens used for this assay are
 derived from the envelope proteins of
the four dengue virus serotypes
(DENV-1-4).

IgG Negative The results IgG appear by the

fourteenth day and persist for life.
Secondary infection shows that IgG
rises within 1 to 2 days after onset of
symptoms, simultaneously with IgM
antibodies. Therefore, patients with
secondary infections will have a
positive IgG result, usually, but not
always with a positive IgM result.

(Though IgG isa a less reliable marker

in the diagnosis of dengueamong the
2 antibodies which is (IgM and IgG)
because a reactive status may appear
in patients with past dengue
infections or currently has other kinds
of fever like enteric fever , UTI or
flavivivral infection the presence of
IgG alone is not indicative that the
patient has a dengue infection).
 VII. DRUG STUDY

Name of patient: Andrea Impression/Diagnosis: Dengue Fever

Age and Sex: 6 years old/F Ward/Bed:

NAME OFDRUG CLASSIFICATION INDICATION AND SIDE EFFECTS OR SPECIAL NURSING

AND CONTRAINDICATION ADVERSE PRECAUTION RESPONSIBILITY
MECHANISM OF EFFECTS
ACTION
PNSS Classification: Indication: Side effects: Do not connect Before:
flexible plastic -Obtain history of
Isotonic solution This intravenous Hypotension containers of the patient’s fluid
solution is indicated intravenous and electrolyte
for use in adults and solutions in status before
Dosage: 500mL pediatric patients as series therapy and
a source of connections. reassess
Mechanism of electrolytes and Adverse effect:
action: Such use could regularly.
water for hydration. -febrile response, result in air -Before giving the
Sodium and Also, designed for embolism due to bottle, check for
Frequency: use as a diluent and
chloride- major residual air being the correct
electrolytes of delivery system for
@ 125cc via -infection at the drawn from one patient to be
the fluid intermittent container before administered.
soluset started site of injection,
compartment intravenous
at the left administration of -Check for the
outside of cells administration of the fluid from a correct fluid to
metacarpal vein
(i.e, extracellular) compatible drug
-venous secondary be given.
- work together additives. container is
thrombosis or
to control phlebitis completed. During:
extracellular extending from Pressurizing -Upon inserting
volume and the site of intravenous the chamber to
blood pressure. Contraindication: injection solutions another, make
Disturbances in contained in sure that it is
sodium Contraindicated in flexible plastic inserted well.
concentrations in any situation where containers to -Be alert of fluid
-extravasation
the extracellular salt retention is increase flow overload
fluid associated undesirable such as rates can result -Check for the
with disorders of edem, heart in air embolism if patient’s
water balance. disease, cardiac -and the residual air in comfort.
decompensation hypervolemia the container is
and primary or not fully After:
secondary evacuated prior -Infuse the IV
aldosteronism. to well to its
administration. prescribed rate
-Check for the
presence of
bubbles in the IV
tube.
-Evaluate
patient’s
knowledge of
therapy
NAME OFDRUG CLASSIFICATION INDICATION AND SIDE EFFECTS OR SPECIAL NURSING
AND CONTRAINDICATIO ADVERSE EFFECTS PRECAUTION RESPONSIBILITY
MECHANISM OF N
ACTION
Paracetamol Classification: Indication: CNS: headache It is very Do not exceed
important that the
Analgesic Temporary your doctor recommended
(nonopioid) reduction of fever, check the dosage.
Dosage: temporary relief of CV: chest pain,
Antipyretic dyspnea, myocardial progress of the
250 mg/5 mL minor aches and patient while
pains and caused by damage when doses
syrup of 5-8g/day are using the Reduce dosage
common cold and medicine. This
influenza, ingested daily for with hepatic
several weeks allows the impairment.
Mechanism of headache, sore- doctor to see if
Action: throat, toothache, the medicine is
Frequency: backache, etc. working Avoid using
Thought to
5 mL q 4 hrs properly and to multiple
produce
PRN for fever GI: hepatic toxicity decide if it preparations
analgesia by and failure, renal should containing
blocking pain
Contraindications: tubular necrosis continue to acetaminophen.
impulses by
take it. Carefully check
inhibiting Contraindicated in all OTC products.
synthesis of patient
prostaglandin in Hematologic:
hypersensitivity to
the CNS or of drugs. Methemoglobinemia-
other substances cyanosis; Hemolytic Giving drugs
that sensitize anemia-hematuria, with food of GI
pain receptors to anuria; neutropenia, upset occurs.
Use cautiously with
stimulation. The leukopenia,
drug may relieve impaired hepatic
function. pancytopenia,
fever through hypoglycemia Discontinue
central action in drugs if
the hypersensitivity
hypothalamic reactions occur.
heat-regulating
center. Hypersensitivity:
rash, fever Treatment of
overdose:
Monitor serum
levels regularly,
N-acetylcysteine
should be
available as a
specific antidote.
NAME CLASSIFICATION INDICATION AND SIDE EFFECTS OR SPECIAL PRECAUTION NURSING
OFDRUG AND CONTRAINDICATION ADVERSE RESPONSIBILITY
MECHANISM OF EFFECTS
ACTION
Ranitidine Classification: Indication: CNS: Confusion, Patients with chronic Administer oral
Therapeutic: dizziness, lung disease, drugs with
Anti-ulcer -Treatment and drowsiness, diabetes, factors meals and at
prevention of
agents hallucinations, predisposing to bedtime.
heartburn, acid headache cardiac rhythm
Brand name: indigestion, and disturbances.
Zantac sour stomach. Immunocompromised Decrease doses
-Prophylaxis of GI or severely ill patient. in renal and
hemorrhage from Rule out gastric liver failure.
Mechanism of stress ulceration CV: Arrhythmias malignancy or
action: possibility of
Dosage:
Inhibits the malignancy prior to Provide
50 action of initiation of therapy. concurrent
mg/2mL/amp histamine at the Renal and hepatic antacid therapy
GI: Altered taste,
H2 receptor site impairment. Children. to relieve pain.
black tongue,
located Pregnancy and
constipation,
primarily in lactation.
dark stools,
gastric parietal Contraindication:
Frequency: diarrhea, drug- Administer IM
cells, resulting
Contraindicated in: induced dose undiluted,
in inhibition of
Q8H; 1mg/kilo hepatitis, nausea deep into large
gastric acid -Hypersensitivity,
as muscle groups.
secretion. Cross-sensitivity
recommended
dose may occur; some
oral liquids contain Arrange for
alcohol and should regular follow-
be avoided in up, including
patients with known blood tests, to
intolerance. evaluate effects.

Use Cautiously in:

-Renal impairment
-Geriatric patients
(more susceptible to
adverse CNS
reactions)
 VIII. NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Long Term: Independent:
Increased body Goal is met, as
Patient complains temperature After a week, the -Assess general -For baseline data the patient was
of on and off related to dengue patient will be condition and free from
fever and virus infection as free from vital signs complications
headache evidenced by complications with no fever.
body such as - Provide a tepid - to allow
temperature irreversible brain bath or sponge evaporative
above normal or neurologic bath cooling. Do not
Objective: range. damage with no use alcohol as it
fever. can cool the skin
T: 38.9C rapidly and may
cause shivering.
PR: 110 bpm Short term:
- Adjust and - it may be
Weight: 25kg After 4 hours, the monitor accustomed to Goal is partially
patient’s body environmental near normal body met, as the
BP: 90/60mmHg temperature will factors like room temperature, and patient had
decrease. temperature and blankets and decreased body
O2 Sat: 96% bed linens as linens may be temperature as
indicated adjusted as evidenced by
RR: 25 cpm indicated to persistent body
regulate the temp ranges from
-cold and clammy patient’s 38 – 38.5C
skin temperature.

-tourniquet tests - Encourage - if the patient is

positive adequate fluid dehydrated or
intake diaphoretic, fluid
-petechial rash loss contributes
appears on the to fever
left upper arm,
on the tourniquet Dependent:
side
Administer -To alleviate the
paracetamol as fever of the
prescribed by the patient
physician

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Long Term: Independent:
Acute Pain Goal is met, as
Patient related to After a week, the -Perform a -assessment of the patient had
complains of dengue fever as patient will comprehensive pain by improved well-
headache, evidenced by improve well – assessment of pain conducting an being as
abdominal pain headache, being such as interview helps evidenced by
and muscle joint abdominal and baseline levels of the nurse in normal vital signs
pain muscle joint pain pulse, BP, planning optimal
felt by the respirations and pain
patient relaxed muscle management
Objective: tone or body strategies
posture
T: 38.9C - Assess for the -Using charts or
Short term: location of the drawings of the
PR: 110 bpm pain by asking to body can help the
After several point to the site patient, and the Goal is met, as
Weight: 25kg hours, the that is nurse determines the patient
patient will discomforting specific pain described
BP: 90/60mmHg describe locations satisfactory pain
satisfactory pain control at the
O2 Sat: 96% control at a level -Investigate signs -Bringing level of 1 on a
of 1-2 on a rating and symptoms attention to rating scale of
RR: 25 cpm scale of 0-10 related to pain associated signs 0-10
and symptoms
-patient looks may help the
weak and pale nurse in
evaluating the
-cold and clammy pain
skin
-elevate the head -to relieve
of the bed and shortness of
encourage to sit in breath and help
a semi-fowler’s in lung expansion
position

Dependent:

Give non-opioid
-to treat mild to
analgesics
moderate pain

IX. DISCHARGE PLAN/HEALTH TEACHING

Evaluation

Patient Andrea was admitted last February February 8, 2022 per wheel chair accompanied by her mother with a chief
complaint of on and of fever, headache, abdominal pain, and muscle joint pain for 3 days prior to admission and was
diagnosed with an impression of Dengue Fever.

February 8, 2022 the first day of the nurse patient interaction, the group establish rapport and prior to gathering data,
they obtained the staffs patients and folks consent for this case study. Upon assessment, it showed that the patient has
cold and clammy skin and has been experiencing headache, abdominal pain and an on and off fever.

The goal in the nursing care plan were met because after 7 days, Andrea was observed to be more active and with
improved appetite and no fever noted. Also, within that 7 days, the care provider saw a great improvement towards the
patients condition and all the intervention that were given was accomplished.

Discharge Plan

Patient Andrea is now feeling way better. The proper treatment the patient needed was met. Her temperature went
back to normal as evidence by the absence of fever, headache, muscle joints and abdominal pain. However, we still
recommend her mother to put a screen on their windows and doors to prevent the mosquitoes from entering knowing
that they live near the slum.

As a team, we also encourage the mother to reduce the mosquito habitat such stagnant water containing object by
disposing the stored water from containers, flower pots and old tires which is most likely to be the mosquito’s breeding
place. Also, we recommend that the mother should always maintain a clean environment. Wearing pajama and applying
anti mosquito lotion for her child would also be a great help.
 X. GUIDE QUESTIONS

1. What is Dengue Fever?

Dengue fever is an infection that occurs after the bite of an infected mosquito. Dengue fever occurs
mostly in tropical regions worldwide. It is a disease caused by a family of viruses transmitted by Aedes
mosquitoes.

2. What are the signs and symptoms of Dengue?

The signs and symptoms of Dengue can be mild and this include fever, rash, muscle and joint pain. 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)

3. What is the meaning of Incubation period, mode of transmission, communicability period & prognosis.
 Incubation period the interval between initial contact with an infectious agent and appearance of the
first sign or symptom of disease in question.
 Mode of Transmission is the route by which an organism is transferred from one host to another. It can
also refer to how an infectious agent, also called a pathogen, can be transferred from one person,
object, or animal to another.
 Communicability period is the time during which an infectious agent may be transferred directly or
indirectly from an infected person to another person, from an infected animal to humans, or from an
infected person to animals.
 Prognosis is the educated prediction of the course of the disease and how a person may recover

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

Mode of transmission of Dengue are spread to people through the bites of infected Aedes species
mosquitoes. The mosquito contracts the virus when it bites an infected person. The mosquito is then infective
for the rest of its life and can spread the virus every time it bites someone.
The prognosis of Dengue fever is typically a self-limiting disease with a mortality rate of less than 1%.
When treated, dengue hemorrhagic fever has a mortality rate of 2-5%. When left untreated, dengue
hemorrhagic fever has a mortality rate as high as 50%. Survivors usually recover without sequelae and develop
immunity to the infecting serotype. The fatality rate associated with severe dengue varies by country, from 12-
44%. In a 1997 Cuban epidemic, the fatality rate in patients who met criteria for severe dengue was
approximately 6%.

5. Lists down its Predisposing and Precipitating factors.

The Predisposing factors include living in tropical areas, travelling in tropical areas, and  have had
dengue fever in the past.
The Precipitating factors include include being a neonate or young child, female sex, high body mass
index, viral load, genetic polymorphisms and previous infection with DENV-1 if the patient contracts
DENV-2 or DENV-3.

6. What are the Stages of Dengue Fever?

Stage I: Acute fever stage.(~Day 1-5) - At this phase the patients have high fever (39-40 degree Celsius)
with aching, abdominal pain, nausea, vomiting. Anti-pyritic such as paracetamol is important to lower body
temperature in order to provide the body minimizes fluid loss. REHYDRATION by food and electrolyte fluid, will
replace the fluid in the circulation for the patients. If the patient, especially children do not eat/drink enough
and look weak, seek medical attention urgently.
Stage II: Critical stage.(~Day 5-7) - at this stage when the body temperature drops, normally within 24
hours, the plasma (Fluid part of blood component) leaks and the blood pressure will drop. Patients will be
 restless, weak, have cold clammy skin, fast pulse, in severe case with very low platelets they could vomit up
blood, have internal hemorrhage and die with circulatory failure or respiratory failure due to internal bleeding/
fluid retention. It is very important to provide appropriate intravenous fluid to the patients in this stage to
prevent poor blood perfusion to the vital organ and not to overload the fluid in term of third space leakage
prevention.
Stage III: Recovery phase. - It takes a couple days for the patients to get back to normal. At this phase
the patients will gain back appetite (A), have slower pulse rate  (Bradycardia=B), have convalescent rash at legs
and arms (C) and pass more water (Diuresis=D). You may recognize these steps by A-B-C-D.

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

 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.
 Managing nose bleeds. Elevate position of the patient and apply ice bag to the bridge of the nose and to
the forehead.
 Blood pressure monitoring. Measure blood pressure as indicated.
 Trendelenburg position. Place the patient in Trendelenburg position to restore blood volume to the
head.

8. Using the Elisa test , when can you say that the above laboratory test is Positive.
The dengue MAC-ELISA is used for the qualitative detection of dengue virus IgM (immunoglobulin M)
antibodies. The MAC-ELISA is based on capturing human IgM antibodies on a microtiter plate using anti-
human-IgM antibody followed by the addition of dengue virus antigens.

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

Acetaminophen (paracetamol) is recommended for treatment of pain and fever. Aspirin, other
salicylates, and nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided. Patients with dengue
hemorrhagic fever or dengue shock syndrome may require intravenous volume replacement.

 No treatment: No specific antiviral agents exist for dengue.

 Supportive care is advised: Patients should be advised to stay well hydrated and to avoid aspirin
(acetylsalicylic acid), aspirin-containing drugs, and other nonsteroidal anti-inflammatory drugs
(such as ibuprofen) because of their anticoagulant properties.
 Fever should be controlled with acetaminophen and tepid sponge baths.
 Febrile patients should avoid mosquito bites to reduce risk of further transmission.
 10. Make at least 2 NCP and its corresponding Nursing Interventions.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Long Term: Independent:
Increased body Goal is met, as
Patient complains temperature After a week, the -Assess general -For baseline data the patient was
of on and off related to dengue patient will be condition and free from
fever and virus infection as free from vital signs complications
headache evidenced by complications with no fever.
body such as - Provide a tepid - to allow
temperature irreversible brain bath or sponge evaporative
above normal or neurologic bath cooling. Do not
Objective: range. damage with no use alcohol as it
fever. can cool the skin
T: 38.9C rapidly and may
cause shivering.
PR: 110 bpm Short term:
- Adjust and - it may be
Weight: 25kg After 4 hours, the monitor accustomed to Goal is partially
patient’s body environmental near normal body met, as the
BP: 90/60mmHg temperature will factors like room temperature, and patient had
decrease. temperature and blankets and decreased body
O2 Sat: 96% bed linens as linens may be temperature as
indicated adjusted as evidenced by
RR: 25 cpm indicated to persistent body
regulate the temp ranges from
-cold and clammy patient’s 38 – 38.5C
skin temperature.

-tourniquet tests - Encourage - if the patient is

positive adequate fluid dehydrated or
intake diaphoretic, fluid
-petechial rash loss contributes
appears on the to fever
left upper arm,
on the tourniquet Dependent:
side
Administer -To alleviate the
paracetamol as fever of the
prescribed by the patient
physician
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Long Term: Independent:
Acute Pain Goal is met, as
Patient related to After a week, the -Perform a -assessment of the patient had
complains of dengue fever as patient will comprehensive pain by improved well-
headache, evidenced by improve well – assessment of pain conducting an being as
abdominal pain headache, being such as interview helps evidenced by
and muscle joint abdominal and baseline levels of the nurse in normal vital signs
pain muscle joint pain pulse, BP, planning optimal
felt by the respirations and pain
patient relaxed muscle management
Objective: tone or body strategies
posture
T: 38.9C - Assess for the -Using charts or
Short term: location of the drawings of the
PR: 110 bpm pain by asking to body can help the
After several point to the site patient, and the Goal is met, as
Weight: 25kg hours, the that is nurse determines the patient
patient will discomforting specific pain described
BP: 90/60mmHg describe locations satisfactory pain
satisfactory pain control at the
O2 Sat: 96% control at a level -Investigate signs -Bringing level of 1 on a
of 1-2 on a rating and symptoms attention to rating of 0-10
RR: 25 cpm scale of 0-10 related to pain associated signs
and symptoms
-patient looks may help the
weak and pale nurse in
evaluating the
-cold and clammy pain
skin
-elevate the head -to relieve
of the bed and shortness of
encourage to sit in breath and help
a semi-fowler’s in lung expansion
position

Dependent:

Give non-opioid
-to treat mild to
analgesics
moderate pain
11. What are the prevention and health teachings to patient with Dengue Fever.
There are many ways to prevent dengue fever but there are no vaccines available yet.
a. Avoid crowded places. Stay away from heavily populated residential areas.
b. Mosquito repellents. Use mosquito repellents that are mild for the skin, even indoors.
c. Proper clothing. When outdoors, wear long-sleeved shirts and long pants tucked into socks.
d. Mosquito-free environment. Make sure window and door screens are secure and free of holes or
use mosquito nets.
e. Stagnant water. Empty or cover bottles, cans, and any containers with stagnant water as these can
become breeding places of mosquitoes.

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