dengue hemorrhagic fever dfs

8/13/2019 Dengue Hemorrhagic Fever DFS

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Dengue fever syndrome (DFS) and dengue hemorrhagic fever(DHF) are acute febrile diseases which occur in the tropics, can be life-threatening, and are caused by four closely related virus serotypesof thegenus Flavivirus, family Flaviviridae.It is also known as breakbone fever,since it can be extremely painful. Unlike malaria, dengue is just asprevalent in the urban districts of its range as in rural areas. Eachserotype is sufficiently different that there is no cross-protection andepidemics caused by multiple serotypes (hyperendemicity) can occur.Dengue is transmitted to humans by the Aedes aegypti mosquito ormore rarely the Aedes albopictus mosquito. The mosquitoes that spreaddengue usually bite at dusk and dawn but may bite at any time duringthe day, especially indoors, in shady areas, or when the weather iscloudy.

The WHO says some 2.5 billion people, two fifths of the world'spopulation, are now at risk from dengue and estimates that there maybe 50 million cases of dengue infection worldwide every year. Thedisease is now endemic in more than 100 countries.

As of August 2010, there where 70,000 cases reported in thePhilippines by the Department of Health and 501 reported deaths.


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This case presentation aims to identifyand determine the problems and needs

of the patient with admitting diagnosis ofdengue. We also intends to help patientto promote health and understand suchconditions through the application of

nursing skills.


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We relate this case to FlorenceNightingales Environmental Theory

because proper management of storedwater and clean environment avoidinsects and mosquitoes to lived at. It alsoprevents acquiring diseases especially

dengue cases.


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Biographical DataName: Lyssa Melandru Barrinuevo RosarioAge: 2 years old

Address: B 841-A Chrysanthemum St. Camella HomesClassic Don Bosco, Paraaque CityDate of Birth: February 02, 2008Gender: FemaleStatus: Single

Occupation: NONEDate of Admission: September 09, 2010 at 8:53pm.Attending Physician: Dr. Rodel FontanillaEmergency Contact Person: Her Father, Daniel IanDel Rosario


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Chief ComplaintUpon Admission, the client complained of fever

and cough. History of Present Illness

Four days prior to admission, the client is having afever and also an unproductive cough.

Past Health History

The client has no any history of surgicalprocedures. Her past illnesses are just fever, coughand colds.

Family Health HistoryThe clients mother has an asthma.

Social Health HistoryThe client is the only child of Mr. Daniel Ian DelRosario and Mrs. Mary Carla Del Rosario. The patientis a Roman Catholic.


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The client completed all the vaccineslike BCG given at birth, DPT 1, 2 and 3,

OPV 1, 2 and 3, Hep B 1, 2 and 3 andMMR given at 11th month.


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When the client has a fever, her fathergave her Tempra. When she has cough,

she was given Lagundi.


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Blood

Whole blood has two components: (1)blood plasma, a watery liquid matrix thatcontains dissolved substances, and (2)formed elements, which are cells and cellfragments. Blood is about 45% formedelements and 55% plasma. Normally more

than 99% of the formed elements are red-colored red blood cells. Pale colorless whiteblood cells and platelets occupy less than1% of total blood volume.


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Substances in Blood Plasma

Constituent Distribution

Water (91.5%) Liquid portion of blood. Acts as solvent andsuspending medium for components ofblood;absorbs, transports and releases heat.

Proteins (7.0%) Exert colloid osmotic pressure, which helpsmaintain water balance between blood andtissues and regulates blood volume.

Albumins Smallest and most numerous plasma proteins;produced by liver. Function as transportproteins for several steroid hormones and forfatty acids.

Globulins Produced by liver and by plasma cells, which

develop from B lymphocytes. Antibodies helpattack viruses and bacteria. Alpha and betaglobulins transport iron, lipids and fat-solublevitamins.

Fibrinogen Produced by liver. Plays essential role inblood

clotting.


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Formed Elements in Blood

Name Number Characteristics Functions

Red Blood Cells 4.8million/2L (F)5.4million/2L (M)

7-82m diameter;biconcave discs, without

a nucleus; live for about120 days

Hemoglobin within RBCstransports most of the

oxygen and part of thecarbon dioxide in theblood

White Blood Cellds 500010,000/2L Most live for a few hoursto a few days

Combat pathogens andother foreign substancesthat enter the body

Neutrophils 60-70% of all WBCs 10 122m diameter;nucleus has 2-5 Lobes

connected by thinstrands of chromatin;cytoplasm has very fine,pale lilac.

Phagocytosis.Destruction of bacteria

with lysozyme, defenses,and strong oxidants,such as super oxideanion, hydrogenperoxide, andhypochlorite anion

Eosinophils 2-4% of all WBCs 10-122m diameter;nucleus has 2-3lobes;

large red- orangegranules fill thecytoplasm

Combat the effects ofhistamine in allergic

reactions, phagocytesantigen antibodycomplexes, and destroycertain parasitic worms

Basophils 0.5-1% of all WBCs 8-102m diameter;nucleus has 2 lobes;large cytoplasm granulesappeardeep blue-purple

Liberate heparin,histamine and serotoninin allergicreactions that intensifythe overall inflammatory

response


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Lymphocytes 20-25% of allWBCs

Small lymphocytesare 6-92m indiameter; largelymphocytes are

10-14 2m indiameter; nucleusis round or slightlyindented;cytoplasm forms arim around thenucleus that lookssky blue; the largerthe cell, the more

cytoplasm is visible

Mediate immuneresponses, includingantigen-antibodyreactions. B cells

develop into plasmacells, which secreteantibodies. T cellsattach invadingviruses, cancer cellsand transplantedtissue cells. Naturalkiller cells attack awide variety of

infectious microbesand certainspontaneously arisingtumor cells.

Monocytes 3-8% of all WBCs 12-202m diameter;nucleus iskidney shaped orhorseshoe shaped;cytoplasm is blue-grayand has foamyAppearance

Phagocytosis (aftertransforming intofixed or wanderingmacrophages)

Platelets 150,000-400,000/2L

2-42m diameter cellfragments that livefor 5-9 days;contain manyvesicles but noNucleus

Form platelet plug inhomeostasis; releasechemicals thatpromote vascularspasm and bloodclotting


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Bite of a aedes mosquitocarrying a flavivirus

Mosquito inject the virus

to the victims skin

Virus enters the bloodstream

Infects cells andgenerate cellular

response

Initiate immuneresponse (stimulates

release of cytokines)

Cytokines destroycell membrane and

cell wall

When treated early with doctorprescribed medication and

manage to prevent theappearance of the other symptoms

IVFs and electrolyte replacementsand precaution

Patient recovers

When illness becamesevere

Damage cells due toboth cytokines and virus

Fluid shift from ICF - ECF

Bloody vomitus, urineand stool

Circulatorycollapsed and Shock

DEATH

Manifest evanescent rashes Rashes in several

areas of the body


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Pattern Before During Analysis

Health Perception andHealth Management

Perceives that she ishealthy

Perceives that she is notthat healthy for having adengue

Clients problem at herhealth status

Nutirtion and Metabolism Preferred rice and fish She preffered more riceand fish

Client may have anutritional imbalancedue to inconsistent foodintake

Elimination Client have a regularand routinely bowelmovement

Experienced diarrhea atfirst day of herhospitalization and now,she is constipated

Client have a probelmon her elimination

Cognitive and Sensory Client has no claims ofdifficulty in learning andpercepting differentsensations and have noany vision of hearing

problem

Client has no claims ofdifficulty in learning andpercepting differentsensations and have noany vision of hearing

problem

Clients level of cognitionand perception arenormal

Sleep and Rest Sleeps normally andcontinuously for about 8to 10 hours

Sleeps normally andcontinuously for about 8to 10 hours

There is no anydeprivation on hersleeping pattern

Self Perception and SelfConcept

Client perceived heremotions according toher feelings andattitudes about herself

Client perceived heremotions according toher feelings andattitudes about herself

Client has no anydeprivation in thispattern


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Role and Relationship Has a strong bondingwith his family andhas no disturbances

in her roles andrelationship

Has a strong bondingwith his family andhas no disturbances

in her roles andrelationship

Good family ties willpromote support forrecovery and gives

comfort and feelingof belongingness

Sexuality andReproductive

The patient identifyherself according toher orientation andher knowledge abouther sexuality

The patient identifyherself according toher orientation andher knowledge abouther sexuality

The client knows howcould she identifywhich group hersexual belong

Coping and Stress Client has no anyfactor to be stressed

The client is stressedbecause of herhospitalization

The client is notcomfortable on herhealth status thattrigger stress to her

Vakues and Belief Client is a RomanCatholic and go tochurch every

sundays. Her fatheroriented heraccording to theirbeliefs

Client is a RomanCatholic and go tochurch every

sundays. Her fatheroriented heraccording to theirbeliefs

Good Spiritual tiesthat help her to havea faster recovery and

spiritually growingthat improve tiesbetween her ansGod


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Parts Normal Findings Analysis

Head and Skull proportional tothe size of the body,round, withprominences in thefrontal areaanteriorly & theoccipital areaposteriorly,

symmetrical in allplanes, gentlyCurved

proportional tothe size of the body,round, withprominences in thefrontal areaanteriorly & theoccipital areaposteriorly,

symmetrical in allplanes, gentlycurved

NORMAL

Scalp and Hair scalp is white,clean, free frommasses, lumps, nits,dandruff & lesions,with no areas oftenderness uponpalpation; hair isblack, evenlydistributed & coversthe whole scalp,thick & shiny

scalp is white,presence of wound,nomasses, lumps, nits &dandruff,with no areas oftenderness uponpalpation; hair isblack, evenlydistributed & coversthe whole scalp,thick & shiny

Due to itching of scalp

Face oblong shaped,symmetrical, smooth& no involuntary

muscle movements

oblong shaped,symmetrical, smooth& no involuntary

muscle movements

NORMAL


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Eyes and Vision eyes are parallel & evenly

placed, symmetrical, non

protruding, with scant amount

of secretions, both eyes black

& clear; sclera is white &

clear; eyebrows are black,

symmetrical, thick, can raiseboth symmetrically & without

difficulty, evenly distributed &

parallel with each other;

eyelashes are evenly

distributed & turned outward;

upper eyelids cover a small

portion of the iris, cornea &

the sclera when the eyes are

open, when the eyes are

closed the lids meet

completely, symmetrical &

the color is the same as the

surrounding skin; lid margins

are clear, without scaling or

secretions; lower palpebral

conjunctiva are shiny, moist,

transparent & salmon pink in

color; iris are proportional to

the size of the eye, round &

symmetrical; pupils are from

pinpoint to almost the size ofthe iris, round, symmetrical,

constricts with increasing light

& accommodation; able to

move eyes in full range of

direction

eyes are parallel & evenly

placed, symmetrical, non

protruding, with scant amount

of secretions, both eyes black

& clear; sclera is white &

clear; eyebrows are black,

symmetrical, thick, can raiseboth symmetrically & without

difficulty, evenly distributed &

parallel with each other;

eyelashes are evenly

distributed & turned outward;

upper eyelids cover a small

portion of the iris, cornea &

the sclera when the eyes are

open, when the eyes are

closed the lids meet

completely, symmetrical &

the color is the same as the

surrounding skin; lid margins

are clear, without scaling or

secretions; lower palpebral

conjunctiva are shiny, moist,

transparent & salmon pink in

color; iris are proportional to

the size of the eye, round &

symmetrical; pupils are from

pinpoint to almost the size ofthe iris, round, symmetrical,

constricts with increasing light

& accommodation; able to

move eyes in full range of

direction

NORMAL

Nose nose is in midline,

symmetrical, patent;

internal nares are

clean, dark pink with

few cilia

nose is in midline,

symmetrical, patent;

internal nares are

clean, dark pink with

few cilia

NIRMAL


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Ears and Hearing parallel, symmetrical,proportional to the size ofthe head, bean-shaped,helix is in line with the outercanthus of the eye, skin is

the same color as thesurrounding area & clean;ear canal is pinkish, clean,with scant amount ofcerumen & a few cilia;able to hear whisperspoken 2 feet away

parallel, symmetrical,proportional to the size ofthe head, bean-shaped,helix is in line with the outercanthus of the eye, skin is

the same color as thesurrounding area & clean;ear canal is pinkish, clean,with scant amount ofcerumen & a few cilia;able to hear whisperspoken 2 feet away rightear

NORMAL

Mouth and Lips lips are pinkish,

symmetrical, lip margin iswell defined, smooth &moist; gums are pinkish,smooth, moist, no swelling,no retraction, nodischarge; 32 teeth arepresent, aligned, with nodental caries; tongue ispinkish, slightly rough ontop, smooth along thelateral margins, moist, shiny& freely movable; cheeksare pinkish, moist & smooth;frenulum is in midline,straight & thin; soft palate ispinkish, smooth & moist;hard palate is slightlypinkish; uvula is at thecenter, symmetrical

& freely movable

lips are pinkish,

symmetrical, lip margin iscracked & dry lips;gumsare pinkish, smooth, moist,no swelling, no retraction,no discharge; 32 teethare present, aligned,with no dental caries;tongue is pinkish, slightlyrough on top, smoothalong the lateral margins,moist, shiny & freelymovable; cheeks arepinkish, moist & smooth;frenulum is in midline,straight & thin; soft palate ispinkish, smooth & moist;hard palate is slightlypinkish; uvula is at thecenter, symmetrical

& freely movable

Sign of Dehydration


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Neck proportional to thesize of the body &head, symmetrical &

straight, no palpablelumps, masses orareas of tenderness

proportional to thesize of the body &head, symmetrical &

straight, no palpablelumps, masses orareas of tenderness

NORMAL

Thorax and Lungs chest contour issymmetrical, spine isstraight, no lumps, nomasses, no tenderareas, with clearbreath sounds

chest contour issymmetrical, spine isstraight, no lumps, nomasses, no tenderareas, with clearbreath sounds

NORMAL

Abdomen abdominal skin isunblemished, noscars, color is uniformwith thebody color,abdomen is roundedwith symmetricmovements causedby respiration;umbilicus is concave

abdominal skin isunblemished, noscars, color is uniformwith thebody color,abdomen is roundedwith symmetricmovements causedby respiration;umbilicus is concave

NORMAL


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Upper Extremities symmetrical, with visibleveins, fine hair evenlydistributed, warm, dry &elastic upon palpation,with area of tenderness onthe left arm; palms arepinkish, warm, soft &elastic; nails aretransparent, smooth &convex with light pink nailbeds & white translucenttips; 5 fingers in each hand;both shoulders, arms,elbows, hands & wrists can

be moved in differentrange of motion withrelative ease

symmetrical, with visibleveins, fine hair evenlydistributed, warm, dry &elastic upon palpation,with area of tenderness onthe left arm; palms arepinkish, warm, soft &elastic; nails aretransparent, smooth &convex with light pink nailbeds & white translucenttips; 5 fingers in each hand;both shoulders, arms,elbows, hands & wrists can

be moved in differentrange of motion withrelative ease

NORMAL

Lower Extremities skin is smooth, fine hair isevenly distributed, absenceof varicose veins, musclessymmetrical, lengthsymmetrical, 5 toes in eachfoot, sole & dorsal surface is

smooth with pink nail beds& white translucent tips;both legs, knees, ankles, &toes can be moved indifferent range of motionwith relative ease; scar onboth patellar

skin is smooth, fine hair isevenly distributed, absenceof varicose veins, musclessymmetrical, lengthsymmetrical, 5 toes in eachfoot, sole & dorsal surface is

smooth with pink nail beds& white translucent tips;both legs, knees, ankles, &toes can be moved indifferent range of motionwith relative ease; scar onboth patellar

NORMAL


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TEST NORMAL FINDINGS ANALYSIS

Red Blood Cells 3.95.3 4.21 NORMAL

Hemoglobin 110160 110 NORMAL

Hematocrit 0.310.43 0.37 NORMAL

White Blood Cells 515.5 4.4 Infection of the bodyby the DFS strain

causes in stimulationof the immunesystem to combatthe disease causingdecreased levels ofWBC count in theblood

Platelet Count 200400 152 DFS can causethrombocytopeniaby direct infection ofbone marrowmegakaryocytes aswell asimmunologicalshortened platelet

survival..


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Name of theDrug

Dosage Mechanismof actions

Indications Contraindications

AdverseEffect

Nursing Alert

Paracetamol

Syrup

120mg/5ml

5ml every 4hours PRN fortemp >37.8C

Inhibition of

cyclooxygenase (COX),While it hasanalgesicandantipyreticpropertiescomparableto those ofaspirin orother NSAIDs

relief of

fevers, achesand painsand relievepain in mildarthritis buthas no effecton theunderlyinginflammation, redness,and swellingof the joint

Should not

be used inhypersensitivity to thepreparationand insevere liverdiseases

gastrointestin

al problems,allergic skinreactions,Blooddyscrasia,nephropathy, like drugcombinations containingphenacetin,acute liverfailure,hepatotoxicity

Use liquid

form forchildren andpatients withdifficulty inswallowing

In children,dontexceed fivedoses in 24hours

Mupirocin(Bactroban

Ointment)

Apply 3x aday

Prevent skinlesions

Indicated forthe topical

treatment ofimpetigodue to:Staphylococcus aureusandStreptococcus pyogenes.

Contraindicated in

individualswith a historyof sensitivityreactions toany of itscomponents.

Burning,stinging or

painRash,nausea,erythema,dry skin,tendernessand swelling.

Check forany

reactions ofthe skintoward theappliedointment


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Augmentin 312mg/5ml

4ml every 8hours

To reducethedevelopment of drug-resistantbacteria andmaintain theeffectivenessofantibacterialdrugs, shouldbe used onlyto treat or

preventinfectionsthat areproven orstronglysuspected tobe causedby bacteria

Indicated inthetreatment ofinfectionscaused bysusceptiblestrains of thedesignatedorganisms intheconditions(UTI, LRTI,Otitis Media,

Sinusitis, andskininfections)

Contraindicated inpatients witha history ofallergicreactions toanypenicillin.

Contraindicated inpatients witha previous

history ofcholestaticjaundice/hepaticdysfunction.

Diarrhea orloose stools,nausea andvomiting, skinrashes,urticaria,and vaginitis.

Assess theclient if she isallergic inPenicillin andpreparemedicationsfor resultingany adversereaction dueto allergyoccur.

DulcolaxPediatricSuppository

Once a day To Stimulatethe bowelMovement

For thetreatment ofoccasionalconstipation.

In patientswith ileus,intestinalobstruction,acutesurgicalabdominalconditions

Rarely,abdominaldiscomfortand diarrheahave beenreported.

Check foranyabdominaldiscomfort orreport ofdiarrheal


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Cues Diagnosis ExpectedOutcome

NursingIntervention

Rationale Evaluation

Subjective:Ang anak ko

ilang araw nahindidumudumi. Asverbalized by theclients father.

Objective:Abdominal pain,urgency, andcramping.

Altered bowelsounds

Constipationrelated to

decreaseddietary intake

STG:After 8 hours of

nursinginterventions, thepatient willestablish or returnto normalpatterns ofbowelfunctioning.

LTG:After 1-2 days ofnursingintervention, theclients motherwill verbalizeways to avoidconstipation ofher child.

Independent:- Determine stool

color,consistency,frequency, andamount.

- Auscultatebowel sounds.

- Encourage fluidintake of 2500-3000 ml/daywithincardiactolerance.

- Recommendavoiding gasforming foods.

- Assist in perinialskin conditionfrequently,noting changesor beginning

breakdown.

-Assists in

identifyingcausative orcontributingfactors andappropriateinterventions.

- Bowel soundsare generallydecreased inconstipation.

- Assists inimproving stoolconsistency.

- Decreasegastric distressand abdominaldistension.

- Prevents skinexcoriation andbreakdown.

Fully Met-the patients

bowelmovement returnto its normalpattern.


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- Discuss use ofstool softeners,mild stimulants,bulk-forminglaxatives, orenemas asindicated.Monitoreffectiveness.

- Encourage toeat high-fiber richfoods.

Collaborative:

- Consult withdietitian toprovide well-balanceddiet high in fiberand bulk.

Dependent:- Administrationof laxatives.

- Facilitatesdefecation whenconstipation ispresent.

- To enhanceeasydefecation.

- Fiber resistsenzymaticdigestion andabsorbs liquids inits passage alongthe intestinaltractand therebyproduces bulk,which acts as a

stimulant todefecation.

-It helps instimulation orincrease thefrequency ofbowel

evacuation


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NursingIntervention


Objective:Dry and crackedlips.

RR: 38

Temp: 38.6CPR: 130

Fluid VolumeDeficit related tofailure ofregulatorymechanisms

STG:Within 8 hours,patient willmaintainadequate fluid

volume.

LTG:After 1-2 days ofnursingintervention theclient will notshow any signs ofdehydration

Independent:-Monitored vitalsigns; notedchanges in bodytemperature.

-Monitored I/Oqh; obtaineddaily weightsand compared

with 24-hr I/O.

-Encouraged

increase in fluidintake andconsumption offoods high in fluidcontent.

-Turned patientq2h andprovided support

for bodyprominences.

-Increased HRalong withdecreased BPand elevatedtemperature,

is present inconditions withfluid volumedeficit.

-Fluidreplacementneeds are basedon correction of

current deficitsand ongoinglosses.Decreasedurinary outputmay requireaggressive fluidreplacement.

-Relieves thirst

and aids in bodyfluidreplacement.

-Patients withfluid volumedeficit are more

at risk for skinbreakdown.

Fully met:The Clientmaintains theadequate fluidvolume


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-Provided skinand mouth care,massaged skin,and appliedemollients as

necessary.

-Monitored IVflow ratesregularly;observed formarkedelevations in BP,restlessness, moistcough, dyspnea,basilar crackles,

and frothysputum.

Dependent:-Administered IVfluids as ordered.

-Regular skin andmouth carerelieves drynessand discomfort.Light massage

promotescirculation. Useof emollients andmild soapspromotes goodhygiene andcomfort withoutexcessive dryingof the skin.

-Patients on IVfluid therapymay be at risk forcardiopulmonarycompromise.

-Aggressive fluidreplacementmay be requiredto correct fluidvolume deficit.


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NursingIntevention


Subjective:Apat na arawna maiinit anganak ko. As

verbalized by theclients father

Objective:Temp.- 38.6CFlushed skinwarm to touch

Hyperthermiarelated todisease processas evidence by

increase bodytemperaturegreater than thenormal range

After 4 hoursof effectivenursingintervention, the

patientstemperature willdecrease from38.6C to itsnormal range.

After 1-2 days ofnursingintervention theclients mother

will know how toprevent theoccurrence ofhyperthermia

INDEPENDENT*monitor coretemperatureeveryhour

*note presence ofsweating as bodyattempts toincrease heat lossby evaporation.

*increase oralfluid intake

*promote bedrest, encouragerelaxation skillsand diversionalactivities.

*temperature of38.9-41.1 Csuggest acuteinfectious diseaseprocess.

*Evaporation isdecreasedby environmentalfactors ofhigh humidity andhighambient

temperature aswell as bodyfactorsproducing loss ofability tosweat.

*to supportcirculatingvolume and tissue

perfusion.

*to reducemetabolicdemands/oxygenconsumption.

Fully Met:The clienttemperaturedecrease to 36.5


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*provide TSB asneeded

*promote surfacecooling, loosenclothing andcoolenvironment

*Review specificriskfactors/causes,signs and

symptoms withthe interventionsrequired

DEPENDENT*Administermedications asindicated totreatunderlying

cause,such as:-Paracetamol

COLLABORATIVE*administerreplacementfluidsand electrolytes

*heat is loss byevaporationand conduction.

*heat is loss byconvection,radiation andconduction.

*to promotewellness.

*to decrease thebodytemperature

*to treatunderlyingCondition


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Medications: Instruct the patient to take her

medicines as prescribed. Exercise: teach the patient to make or to conduct

exercises everyday like walking.

Treatment: Follow the ordered treatment of the

doctor Health Teaching: Teach the client to maintain a

clean environment to avoid viral infections

OPD Follow-up: Instruct the client to come back for

her follow-up check up. Diet: DAT and increase fluid intake

dengue hemorrhagic fever dfs

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