A group case presentation about

Dengue

In partial fulfillment of the requirement of NCM 166 RLE

Presented to the faculty of nursing department of PLT COLLEGE INC.

Presented by:
DULAWAN, BRYANT JAKE A.
DUMLAO, KEITH C.
EDRALIN, FEIRRA EVE M.
GUITOBNA, LIEZEL O.
KISMOD, SHANEAJ S.
LAMPITOC, HEIZELLE KHAYE C.
MAMGUE, SHAHANA KATE T.
MANANGPA, ANGELICA G.

Presented to:
ma’am Julita Rodriguez and ma’am Aki Bulabon
I.3P’s
A. PERSONAL PROFILE
Name: Friah Venus Albino
Age: 8 years old
Address: Namnama, Belance, DON
Civil Status: Single
Name of Spouse:
Occupation:
Educational Attainment: Elementary
Chief Complaint:
Admission Diagnosis: T/C Dengue Fever
Date of Admission: October 28,2024 6:50pm
Admitting Physician: Carlo Ferdinand S. De Leon,MD
Principal Diagnosis:
Date of Discharge:
B. HISTORY OF PRESENT ILLNESS
A patient who is an eight-year-old girl was brought by her mother at Dupax district hospital at
around 6:50 pm on October 28 2024. Three days prior to confinement, the patient, experienced
fever with other symptoms like episode vomiting, nausea and abdominal pain as said by the
mother. She stated that the patient has been experiencing these symptoms until she had a
convulsion on october28 morning with a temperature of 38.5, she quickly gave her
medicine(paracetamol) before immediately brought her to the nearest clinic in their barangay.
By then, they got referred to Dupax District Hospital on that same date. Upon admission her
vital signs are; BP-90 60, HR-106, RR--22 TEMPERATURE 37.4. She got examined by Dr.
Leon, order made and carried out, inserted an IVF of D5LRS 1L. medications given and
laboratories facilitated.
C.HISTORY OF PAST ILLNESS
Patient has no history of past major illnesses. According to her mother she received complete
vaccines and no known allergies. Sometimes only mild cough and colds but were managed by
over-the-counter drugs and home remedies.
II.BRIEF DESCRIPTION OR BACKGROUND OF PATIENT’S ILLNESS

Brief Description of Dengue Fever

Definition
Dengue fever is a viral illness caused by the dengue virus, primarily spread through the bites of
infected Aedes mosquitoes. It often comes on suddenly, bringing high fever and symptoms that
can feel like a bad flu, including severe headaches, joint and muscle pain, and sometimes a
rash. While many recover with supportive care, some cases can develop into more severe
forms, leading to serious complications.

Etiology

The dengue virus has four distinct types: DEN-1, DEN-2, DEN-3, and DEN-4. These viruses are
transmitted when an infected mosquito bites a person. Interestingly, if you've had dengue
before, you might be at greater risk for more severe symptoms if infected by a different type.

Predisposing Factors

Several factors can increase the risk of contracting dengue:

 Location: People living in or traveling to tropical and subtropical regions are more at risk.
 Age: Children and older adults tend to be more vulnerable.
 Previous Infections: If you've had dengue before, your risk of severe disease increases
with subsequent infections.
 Health Status: Those with weakened immune systems may be more affected.

Signs and Symptoms

Dengue fever can feel quite intense. Common symptoms include:

 High fever (often reaching up to 104°F or 40°C)

 Severe headaches and pain behind the eyes
 Intense muscle and joint pain (often described as "breaking bones")
 Rash that can appear a few days into the illness
 Mild bleeding (such as nosebleeds or bleeding gums)
 Nausea and vomiting

In severe cases, you might experience:

 Severe abdominal pain

 Persistent vomiting
 Rapid breathing
 Extreme fatigue or restlessness

Epidemiology

Dengue is widespread, particularly in over 120 countries, mainly in Southeast Asia, the Western
Pacific, the Americas, and parts of Africa. Outbreaks often follow rainy seasons when
mosquitoes thrive.

Diagnostic Procedures

1. Purpose: To confirm dengue infection and assess its severity.

 2. How It’s Done:
o NS1 Antigen Test: Detects the viral protein during the early phase of infection.
o Dengue IgM and IgG Antibody Tests: Identify antibodies in the blood.
o PCR Testing: Detects viral RNA.
3. Nursing Considerations:
o Before: Educate the patient about the procedure; ensure informed consent is
obtained.
o During: Monitor for any adverse reactions, maintain a calm environment.
o After: Provide post-procedure care, including hydration and observation for
complications.

Surgical Procedures

Dengue fever typically does not require surgical intervention. However, in severe cases, such as
dengue hemorrhagic fever or dengue shock syndrome, surgical procedures may include:

 Fluid Resuscitation: Administering IV fluids is crucial for those in shock.

 Surgical Intervention: This may be needed for severe bleeding.

Nursing Considerations:

 Before: Prepare the patient, explaining what will happen, and assess their condition.
 During: Monitor vital signs and maintain a sterile environment.
 After: Watch for improvements or complications and ensure the patient stays hydrated.

Medical Management

 Supportive Care: Focuses on hydration—both orally and through IV fluids if needed.

 Pain Management: Acetaminophen is recommended for fever and pain relief, while
NSAIDs should be avoided due to the risk of bleeding.
 Monitoring: Regular checks on vital signs and blood counts help catch any serious
changes early.

Nursing Considerations for the Whole Process

 Educate the patient and family about dengue, its transmission, and prevention
strategies.
 Monitor vital signs regularly for any signs of deterioration.
 Assess for warning signs of severe dengue (e.g., persistent vomiting, abdominal pain,
rapid breathing).
 Encourage fluid intake and monitor hydration status.
 Document any changes in condition and report to the healthcare team promptly.

III.ANATOMY AND PHYSIOLOGY

The heart is a muscular organ that circulates blood throughout the body, delivering nutrients and
oxygen to the cells while also removing waste materials. It also returns waste items, such as
carbon dioxide, to the lungs for elimination. The four chambers that make up the heart are
divided by valves that control blood flow.

•Myocarditis is uncommon, but when it does happen, an infection in the body is usually the
culprit. Myocardial inflammation can result from infections caused by bacteria, fungi, parasites,
or viruses, such as those that cause the common cold, influenza, or COVID-19.

•Pericarditis feels piercing or jagged. On the other hand, some persons have dull, pressure-like
chest pain behind their breastbones or on the left side of their chest. may extend to your arms
and shoulders. worsen while taking a deep breath, coughing, swallowing, or lying down,
particularly on your left side.

The organ in the head that regulates every bodily function is the brain. It is shielded by the
cranium, or head bones, and is composed of billions of nerve cells. The three primary
components of the brain are the cerebrum, cerebellum, and brain stem. The brain is a
sophisticated organ that governs all bodily functions, including thought, memory, emotion,
touch, motor skills, vision, respiration, temperature, hunger, and every bodily function. The
central nervous system, or CNS, is made up of the brain and the spinal cord that branches off of
it.
•The cerebellum - Although it only makes up around 10% of the brain's weight, the cerebellum,
which is located in the lower rear of the brain, is home to up to 80% of its neurons.

•The brainstem - regulates fundamental processes like breathing and joins the brain to the
spinal cord. It is believed to be the brain's earliest region.

•The cerebrum - the biggest region of the brain, is linked to higher order cognitive processes like
action and thought. The cerebral cortex, which is extremely wrinkled and contributes to the
brain's efficiency, is located there.
•The spleen is a small red-dish-purple organ in the left upper quadrant of the abdomen located
behind the 9th and 11th ribs.
Shape: the spleen is shaped like an irregular wedge, with a convex lateral surface and a
concave medial surface.
Size; the spleen is typically 1 inch thick ,3 inches wide and 5 inches long and weighs around 7
ounces
Location; the spleen is located between the stomach and the diaphragm, and is partly in the
epigastrium and is partly in the hypochondrium.
Relations; the spleen’s medial surface is related to the stomach pancreases and left kidney
Blood supply; the spleen is very vascular and contains a lot of blood.
Palpability; healthy spleen is not palpable
The spleen is connected to the stomach and kidney by parts of the greater omentum a double
fold of peritoneum that originates from the stomach
 Gastrosplenic ligament- anterior to the splenic hilum, connects the spleen to the greater
curvature of the stomach
 Splenorenal ligament- posterior to the splenic hilum connects the hilum of the spleen to
the left kidney the splenic vessels and tail of the pancreas lie within this ligament.

Structure of the spleen has a slightly oval shape. It is covered by a weak capsule that protects
the organ whilst allowing it to expand in size.
The outer surface if the spleen can be anatomically divided into two;
 Diaphragmatic surface- In contact the diaphragm and the rib cage
 Visceral surface- In contact with the other abdominal viscera.
It has an anterior, superior, posteromedial and inferior borders. The posteromedial and inferior
borders are smooth while the anterior and superior borders contain notches.
The spleen is a highly vascular organ. It receives most of its supply from the splenic artery. This
vessel arises from the coeliac trunk, pancreas, within the splenorenal ligaments as the artery
reaches the spleen, it branches into five vessels- each suppling the different parts of the organ.
Anatomical relations;

anterior posterior inferior

 stomach  diaphragm  Left colic-flexure

(splenic flexure)
 left lung
 ribs9-11

Lymphatic drainage
Lymphatic travel with blood vessels collecting into plexus that drains into lymph nodes of the
splenic hilum and the pancreatic tail. From here the lymph drains to superior pancreatic and left
gastroomental lymph nodes eventually draining into celiac nodes and the cisterna chyli.
Lungs
The lungs are the organs of respiration, they are located in the thorax either side of the
mediastinum
The function of the lungs is to oxygenate blood. They achieve this by bringing inspired air into
close contact with the oxygen-poor-blood in the pulmonary capillaries
Anatomical positions and relations; the lungs lie either side of the mediastinum, within the
thoracic cavity. Each lung is surrounded by the pleural cavity, which is formed by the visceral
and parietal pleura.
They are suspended from the mediastinum by the lung root-a collection of structure entering
and leaving the lungs. The medial surface of both lungs lies in close proximity to several
mediastinal structures

Left lung Right lung

 Heart  esophagus
 Arch of the aorta  heart
 Thoracic aorta  inferior vena cava
 esophagus  superior vena cava
 azygous vein

Lung structure
The lungs are roughly cone-shaped with an apex base three surfaces and three borders. The
left lung is slightly smaller than the right lung, this is due to the presence of the heart.
Each lung consists of;
 Apex- the blunt superior end of the lung it projects upwards above the level of the first rib
and into the floor of the next
 Base-the inferior surface of the lung which sits on the diaphragm.
 Lobes- (two or three) these are separated by fissure within the lung.
 Surface-(three) these corresponds to the area of the thorax that they face. they are
named costal, mediastinal, and diaphragmatic.
 Borders – (three) the edges of the lungs named anterior inferior and posterior borders

Lobes
The right and left lungs do not have an identical lobular structure.
The right lung has three lobes; superior, middle and inferior. The lobes are divided from each
other by two fissures;
 Oblique fissure- runs from the inferior border of the lung in a super posterior direction,
until it meets the posterior lung order
 Horizontal fissure- runs horizontally from the sternum at the level of the 4th rib to meet
the oblique fissure

Nerve Supply
The nerves of the lungs are derived from the pulmonary plexuses. They feature sympathetic,
parasympathetic and visceral afferent fibers:
 Parasympathetic- derived from the vagus nerve. They stimulate secretion from the
bronchial glands, contractions and vasodilation’s of the pulmonary vessels.
 Sympathetic-derived from the sympathetic trunks. They stimulate relaxation of the
bronchial smooth muscle and vasoconstriction of the pulmonary vessels.
 Visceral afferent- Conduct pain impulses to the sensory ganglion of the vagus nerve.
PHYSIOLOGY

MODIFIABLE RISK FACTORS

NON-MODIFIABLE RISK FACTORS - Presence of dengue cases in the
patient’s school/classroom
- Age: 8-year-old
Bite of an aedes mosquito to the skin - Open canal with poor water flow
- Tropical Area
- Presence of breeding places in the
classroom’s CR
Entry of dengue virus (DENV) through
injection of saliva in the site of bite

DENV targets and infects local cells and

immune cells (Langerhans cell, mast cells,
keratinocytes, fibroblast)

DENV replicates in the targeted cells

Suppress megakaryocytes
Increases gut motility and
precursor cell (for platelets) Infected Langerhans cell travel to the lymph
secretions
and myeloid progenitors (for nodes to alert immune cells
WBC)
Alerted macrophages and monocytes will be Elevates the hypothalamic set
DENV invades the enteric targeted and infected
DENV invades the bone point
nervous system (ENS) Infects
the ENS neurons and GI marrow infects stomal cells
epithelial cells and hematopoietic progenitor DENV travel to the lymphatic system and
cells spreads in the bloodstream
Increase prostaglandin E2
(PGE2) Plasma leakage

Activation of the vagus nerve stimulates the Activation of immune cells (T cells, B cells, Dilatation of the blood vessel
release of serotonin (from the natural killer cells) to fight the infection Stimulate the cox 2 and increased vascular
enterochromaffin cells in the GI tract) permeability

Release cytokines, chemokines, histamine

Cytokines reach muscle

Acts on the 5-HT3 receptors in the tissues lead to inflammation
brainstem’s chemoreceptor trigger zone
V.LABORATORY RESULTS AND DIAGNOSTIC STUDIES
COMPLETE BLOOD COUNT RESULT

Result Normal Values Result Normal Values

WBC 2.97 4.0-10.0×109/L MCV 84 80-100 Fl
RBC 4.56 3.8-5.4×1012/L MCH 28.2 27.0-34.0 pg
HGB 129 110-160 g/L MCHC 335 320-360 g/L
HCT 38.4 37.0-54.0% RDW 11.3 11.0-16.0%
PLT 167 150-400×109/L MPV 9.1 6.5-12.0 Fl
DIFF.CT.
%NEU 77.1 50.0-70.0% #NEU 2.28 2.0-7.0×109/L
%LYM 18.1 20.0-40.0% #LYM 0.54 0.80-4.00×109/L
%MON 4.6 3.0-12.0% #MON 0.14 0.12-1.20×109/L
%EOS 0.2 0.5-5.0% #EOS 0.01 320-360 g/L
%BAS 0.0 0.0-1.0 #BAS 0.00 0.00-0.10×109/L

URINALYSIS RESULT

Color: Light Yellow Pus Cell: 0-2/HPF Cast:

Transparency: Clear Red Blood 0-1/HPF Crystal:
Cell:
Reaction: Acidic Epithelial Rare Yeast Cells:
Cell:
Glucose: Negative Amorphous Pregnancy
Phosphates: Test:
Protein: Negative Mucus Others:
Thread:
Ph: 5.0 Bacteria: Rare REMARKS:
Specific 1.005 Rare
Gravity:
VI.PHYSICAL ASSESSMENT AND ITS PATHOPHYSIOLOGICAL BASIS

PSYCHOSOCIAL

SIGNIFICANT OTHERS Mrs. Joemin Ann Marzan Albino (Mother)

COPING MECHNISM She spares talking to her mother and praying to

God for her fast recovery.
RELIGION Roman Catholic

PRIMARY LANGUAGE Ilokano

PRIMARY SOURCE HEALTHCARE Phil Health

FINANCIAL RESOURCES Farming

OCCUPATION/EDUCATIONAL ATTAINMENT Student

ELIMINATION

STOOL a. Frequency: Once

b. Consistency Shape: Firm and soft
c. Color: Brown
URINE a. Frequency: Once
b. Color: Light yellow
c. Odor: No odor
d. Clarity: Clear
ABDOMEN a. Bowel sounds: 15
b. Contour: Soft
c. Palpation: Tenderness
TOILETING ABILITY - Patient needs assistance from her SO to go to
toilet.
REST AND ACTIVITY

CURRENT ACTIVITY LEVEL Patient can walk and turn side to side without the
help of her mother
ADL The patient cannot take a bath on her own
SLEEP 8 hours
BODY FRAME Mesomorph
POSTURE Able to stand still with her feet
GAIT Patient has a normal walking pattern but requires
assistance
COORDINATION Patient’s upper and lower extremities are well
coordinated
BALANCE Patient has a good balance of her upper and
lower extremities
MOTOR FUNCTION Patient can walk, sit upright and stand. She can
also flex, extent and rotate her arms and lower
extremities
PAIN RELIEF MEASURE MOBILITY AND USE OF Taking over the counter drugs like Paracetamol
ASSISSTIVE MEASURE

SAFETY

ALLERGIES AND REACTIONS Patient do not have any allergies to medication,

food and environment
EYES AND VISION Patient do not use glasses, pupils are equal,
round, and reactive to light from afar
HEARING/HEARING AID Patient does not use any hearing aid and can hear
clearly
SKIN INTEGRITY 2 sec.

MUCUS MEMBRANE Dry oral mucus membrane

TEMPERATURE 37.4 C
OXYGENATION

AIRWAY CLEARANCE Patient can breathe normally in her nose without

any problem
RESPIRATION Slow and regular, breathing in and out through
the nose and mouth
LUNG SOUNDS Patient’s lung sound is normal, upon auscultation

CAPILLARY REFILL Less than 1 sec.

PERIPHERAL PULSE 106 bpm

APICAL PULSE 106 bpm

EDEMA No edema is noted

NUTRITION

DIET Soft diet and healthy nutritious food

FLUID INTAKE 4-6 glasses of water

IVF D5LRS 1L X 63 ml/hr

HEIGHT AND WEIGHT 116 cm, 20.3 kg

SKIN TURGOR Skin goes back less than 1 second

ABILITY TO The patient has no difficulty chewing or

*CHEW swallowing
*SWALLOW
CBG MONITORING The patient required CBG monitoring
 VII.DRUG ANALYSIS

Name of classification Brand Name Complete Mechanism of contraindication Side effects Nursing
medication doctor’s action intervention
order
1.Ranitidine Histamine Zantac 360, Ranitidine Used to treat Patients known Nausea, Should be given
DATE GIVEN: H2 20mg W q8 certain to have vomiting, fever, before meals to
Antagonists Gen- Ranitidine hours stomach and hypersensitivity chills and decrease food-
(CAN) throat to the drug or stomach pain. induced acid
problems such any of the secretion or at
as erosive ingredients. bedtime
esophagitis.
It relieves
symptoms
such as
stomach pain
and difficulty
swallowing.
2.Paracetamo Non-opioid Acetaminophen Paracetamol Patients with Nausea Assess the
l DATE analgesic, (IV) 200mg W known active Stomach pain patients pain
GIVEN: antipyretic Q4 hours May reduce the liver disease or Rashes level before
production of severe hepatic hypersensitivity administering
prostaglandins impairment. reaction, the medication,
in the brain, nephrotoxicity routinely
which are characterized monitor serum
chemicals that by acetaminophen.
causes elevation in level to avoid
inflammation blood urea toxicity
and swelling. nitrogen.
(BUN)
 VIII. COURSE IN THE WARD

DATE FOCUS DATA/ACTION/RESPONSE

OCTOBER 28, 2024 Admission D) Admitted an 8 years old female patient with complaints of fever,
nausea, vomiting and abdominal pain. Vital signs taken as follows:
T:37.4 ⁰C, HR:106 bpm, RR: 22cpm, BP: 90/60mmHg, SpO2: 96%,
HT:116 cm, WT: 20.3kg
A) Seen and examined by Dr. De Leon with order made and carried
out.
A) Consent for admission secured.
A) Aseptically inserted an IVF of D5LRS 1 Liter at left metacarpal
vein using g.22 W. cath.
A) Medications given
A) Laboratories facilitated
A) Endorsed to general ward via wheelchair, for further care and
management.
OCTOBER 28, 2024 Altered Comfort D) On bed with an IVF of D5LRS at 900 cc level. Quiet, calm and
weak as seen. With abdominal pain as claimed.
A) Ensured safety measures.
A) Kept environment well ventilated.
A) Due meds given.
A) Provided ample time to rest and sleep.
OCTOBER 29, 2024 Health Teaching D) Received with ongoing IVF of D5LRS 1 Liter at 150cc level,
Afebrile, Negative abdominal pain, with platelet of 167
A) Encouraged to drink plenty of fluids and eat healthy nutritious
foods except dark colored foods.
A) Advised to report any signs of bleeding noted.
A) Above IVF consumed, replaced to D5LRS 1Lx 63cc/hr. needs
altered
R) With latest platelet of 155
OCTOBER 29, 2024 Hydration D) With an IVF of D5LRS at 800cc level with platelet count of 155.
A) Advised to continue drinking plenty of water.
A) Above IVF regulated accordingly.
 IX.NURSING CARE PLAN

ASSESSMENT NURSING Scientific explanation PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS

SUBJECTIVE: Pain related The virus and the Short term: 1. Recommend 1. To limit serious Short Term:
to immune system respond, Oral rehydration consequences Goal was met
“3 days na Within 4
abdominal headache, can be therapy. caused by After 4 hours of
nilalagnat si Friah hours of
pain, severe aggravated by lights, dehydration. nursing
tapos on and off nursing 2.Administer iv
headaches, odors, physical activity intervention,
ang lagnat niya, intervention fluids such as 2. to replace the
and and Valsalva goal was met,
tapos nagsusuka the patient’s normal saline or plasma lost
vomiting the patient's
pa siya hapon ng Pain: dengue fever can vital signs will ringer's lactate because of
temperature
October 28 cause pain in the bones, be in normal as doctor's increased vascular
remained
nagkakumbulsyon muscles and abdomen ranges. order. permeability.
normal.
na, 38.8 yung for a number of reasons
3. Avoid 3. To avoid the
temperature niya” including, Bone pai-virus
aspirins. increase of
as verbalized by I can activate osteoclasts
(ibuprofen) bleeding LONG TERM:
the mother. which can disrupt bone
Long term: complications. Goal was met,
homeostasis and cause 4. Monitor vital
after 3 days of
pain sometimes called After 3 days signs, note 4.To help tract the
nursing
OBJECTIVE: "bone braker" Abdominal of nursing changes in progression of the
intervention,
pain- which can be intervention temperature. disease and
VS the patient was
nonspecific or acute it the patient identify the critical
5. Remove free from signs
BP: 90/60 could be due to the will b free of phase.
excess clothes. of infection,
enlarged lymph nodes any sign of
HR: 100 Bpm 5.To avoid the (vomiting and
spasmsof the cystic duct infection, be 6. Administer
rapid increase of nausea),
or gallbladder distention. afebrile, antipyretics like
RR: 22 Bpm temperature. afebrile and
Vomiting-it is a warning report pain is paracetamol show active
TEMPERATURE: relieved and 200 mg q4 6. To relieve
sign of dengue that stability.
37.4 display hours. lethargy, body
appears in the late phase
 of dengue when the gut hemodynamic malaise, pain and
and thoracoabdominal stability. fever.
Weak appearance.
wall muscles contract.