Dengue Fever is caused by one of the four closely related, but antigenically distinct, virus s e r o t y p e s D e n g u e t y p e 1 , D e n g u e t y p e 2 , D e n g u e t y p e 3 , a n d D e n g u e t y p e 4 o f t h e g e n u s Flavivirus and Chikungunya

virus. Infection with one of these serotype provides immunity to only that serotype of life, to a person living in a Dengue -endemic area can have more than one Dengue infection during their lifetime. Dengue fever through the four different Dengue serotypes a r e m a i n t a i n e d i n t h e c y c l e w h i c h i n v o l v e s h u m a n s a n d A e d e s a e g y p t i o r A e d e s a l b o p i c t u s 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 pe rson who has Dengue a n d a f t e r a w e e k i t c a n t r a n s m i t t h e v i r u s w h i l e b i t i n g a h e a l t h y p e r s o n . D e n g u e c a n n o t b e transmitted or directly spread from person to person. Aedes aegypti is the most common aedesspecie which is a domestic, day-biting mosquito that prefers to feed on humans

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.

Dengue fever cases 2001 - 2008 Notifiable 2001 2002 2003 disease Dengue 23,235 13,187 18,039 fever Source: Department of Health 2004 15,838 2005 4,092 2006 2007 11,915 2008 13,014

From January to July on 2010, Cebu Citys CESSU recorded 820 dengue fever cases on 2010

Lapu-Lapu=58,Guadalupe=59, Mambaling=39, Punta Princessa=34, Labangon=30, Basak San Nicolas=29, Lahug=28, Talamban=27, Tisa=27, Apas=24, Mabolo=23

Patients Profile
Name: Grazylou Monteclor Age: 9 yr. old Gender: Female

Address: Sitio Atis, Banilad Cebu City Civil Status: Single

Religion: Roman Catholic Occupation: N/A (still a student) Informant: Arcenia Monteclor

Nationality: Filipino

Date Admitted: Feb. 20,2012

Time: 9:00 am

Parents name: Father: Prime Monteclor Age:42 yr. old

Occupation: Septic employee Mother: Arcenia Monteclor Age: 40 yr. old Occupation: House-wife Respiratory Rate: 19 cpm Blood Pressure: 100/80 mmHg Pulse: 92 bpm Temperature: 38.8 Celsius Weight: 24kg Physician: Dr. Bongo Jr. Final Diagnosis: Dengue Fever

Nursing History

I.

Chief Complaint and History of Present Illness: Monteclar, Grazylou a 9 yrs. old,female child came in the hospital due to fever and vomiting. 2 days PTA, patient had onset fever 38.8 Celsius given paracetamol 250 mg tab. p.o every 4 hours with temporary relief. Onset of vomiting 3x episodes after eating her breakfast. Mother also noted poor appetite and body malaise.

II.

Personal and Social History Family History

Grazylou Monteclor, a 9 yr. old female child was admitted at Vicente Gullas Memorial Hospital due to fever and vomiting. She was accompanied by her 40 yr. old mother who was Arcenia Monteclor. Her parents are still alive. Grazylou is the first daughter/eldest among the 2. She is still in Grade 4. LIVING CONDITIONS They only rented in a semi-concrete apartment, with 2 rooms in the house and with 8 persons living in same roof. NUTRITION They usually take their breakfast at 7:00-8:00 am, lunch at 12:00pm, and dinner at 7:30 pm. Grazylou takes her snacks in between every meal. She likes to eat meats, pasta, and vegetables. Furthermore, she doesnt have any dislikes. She drinks 3 glasses a day. SLEEPING PATTERNS Grazylou usually sleeps at 9 pm in a side-lying position but she doesnt take naps and doesnt awaken at night or making sounds. ELIMINATION PATTERNS Grazylou defecates every other day. Usual time of defecation is at night time. Consistency is hard with brown color. Frequent urination is 3-4x / day, yellowish color and aromatic odor. PHYSICAL HYGIENE Grazylou takes a bath only once a day and shampoos her hair every day. She washes her hands before and after meals and also brushes her teeth twice a day every.

ENVIRONMENTAL SANITATION Their family provides mineral water and they stored it in the pitcher. The source of their water is MCWD. The way they disposed their garbage is using trash can and the way they disposed their human waste is through water sealed.

SOCIAL ACTIVITY Grazylou is engaged in badminton and her hobbies are playing computer games and Chinese garter every afternoon. III. Medical History Heredofamilial Diseases: Grazylous heredofamilial disease background is asthma in her mothers side while her fathers side doesnt have any heredofamilial diseases. Communicable diseases occurring in the family They have no communicable diseases occurring in their family. Obstetrical and Gynecological Grazylou is not yet started menstruating. Previous Illness/Surgery Since 6 yr. old, Grazylou was admitted in Daan Bantayan District Hospital due to bronchial asthma. Patient took anti-asthma medication and used nebulizer in nearby health center. Present Illness >dengue fever- is a febrile illness that affects infants, young children and adults. It occurs in tropical and sub-tropical areas of the world. Symptoms appear 314 days after the infective bite. >fever- is a common medical sign characterized by an elevation of temperature above the normal range of 36.537.5 C (98100 F) due to an increase in the body temperature regulatory Subjective: Communication: ok ra ako pagdungog as stated by the patient. Objective: Patient was able to answer the questions well when interviewed.

Subjective: Oxygenation: okay ra akong pag-ginhawa as verbalized by the patient

Objective: Describe: The patient has regular respiration. RR= 20 cpm, PR=90 bpm. Having a normal breathing sound of bronchiovisicular. Subjective: Objective: Circulation: Heart Rhythm: The patients heart Wala man koy lain gipamati na as rhythm is regular without the verbalized by the patient. presence of discomfort and pain. BP= 90/60 mmHg, HR= 90 Subjective: Objective: Nutrition: The patient took only half of her mokaon rako katonga sa gi served meal because she lost her as verbalized by the patient. appetite. Subjective: Objective: Elimination: Patient has less fluid intake, urinates dili kaau ko mangihi ug kalibang as 3x a day and defecates every other stated by the patient. day. Color of urine is yellow. Consistency of stool is watery, and color yellow. Subjective: Objective: Skin Integrity: Patient has dry skin with brown wala koy kagid, walay koy samad as pigmented on both legs and arms. verbalized by the patient. Subjective: Objective: Activity/Safety: Patients activity was limited malipong ko usahay as verbalized lying on bed. Patient claims by the patient. for dizziness.

Sujective: Comfort/Sleep/Awake: okay ra akong pagkatog As verbalized by the patient. Subjective: Coping: wala ko kasabot sa ako gibati karon as stated by the patient

Objective:
She usually sleeps at 9 pm. Her room is well ventilated and peaceful.

Objective: She shares her problems to her daughter-in-law. She verbalizes her feelings. Patient is taking her medications religiously. Seen patient always smiling during nursing rounds.

LABORATORY EXAMINATIONS HEMATOLOGY REPORT

EXAMINATION HEMOGLOBIN

RESULT

REFERENCE VALUE (M) 13.018.0gm/L (F) 12.016.0gm/L

SIGNIFICANT

DATE: Feb. 21, 2012

10.9 11.3 11.5 12.4 12.8 12.5

less than the normal range

Feb. 22, 2012

Within the normal range.

Feb. 23, 2012

11.8

less than the normal range. (M)0.40-0.54 (F) 0.37- 0.47

HEMATOCRIT

Feb. 21, 2012

Feb.22, 2012

0.34 0.32 0.33 0.35 0.35 0.35 0.32 5-10x10g/L 3.13 2.66 4.41 2.69 2.38 1.86

less than the normal range

less than the normal range less than the normal range

Feb. 23,2012 WBC Date: Feb.21, 2012 Feb.22, 2012

less than the normal range less than the normal range

Feb.23,2012

3.61

less than the normal range (M) 4.5-6.0 (F) 4.0-5.5x 10^/L

RBC

Feb.21,2012

3.13 2.66 4.41

Feb.22,2012

Feb.23,2012

4.43 4.45 4.43 4.13

less than the normal range less than the normal range Within the normal range Within the normal range Within the normal range 140-440x10/L

Thrombocytes (platelets) Date: Feb.21,2012 102 159 157 Feb.22,2012 99 87 123 108

less than the normal range Within the normal range Within the normal range less than the normal range less than the normal range

Feb.23,2012

Physical Assessment Date assessed: Feb. 24,2012 Vital signs: BP=90/60 mmHg ,TEMP= 36.5 Celsius, PR=75 bpm, RR=19 cpm General Assessment: Received lying on bed, conscious and coherent

Area Assessed Head Size Shape

Hair distribution Color Texture Face Eyes Visual acuity

Actual Findings Proportion to the body And the skull is rounded and smooth symmetrical,no lice present Evenly distributed White Smooth

Eyebrows

Eyelashes Eyelids

Left eye uses lens Left eye has a higher grade of visual acuity compare to the right eye. Symmetrical in size,extension,hair texture and movement Distributed evenly and curved outward Same color as the skin Blinks involuntarily and bilaterally up to 20 times per minute Free of lesions, discharge of inflammation

Ears Ear canal opening

Canal walls pink Hearing acuity Patient normally hears word when whispered Nose Smooth,symmetric Size,shape and skin with same color as color face Nares Oval,symmetric and without discharge Mouth and Pharynx pale,dry,symmetric

lips Teeth Upper and lower dentures Neck Head centered Position,Symmetrical symmetrical Upper and lower Equal size extremities size Symmetry symmetrical Distribution of hair Evenly distributed Skin color Tanned skin Lesion No lesion

DISCHARGE PLANNING Provide written instruction about the take home meds, including its side effects, dose, frequency, and route to the significant other. Continue medications as prescribed by the physician. Advise the patient to ambulate to stimulate circulation of the body. Deep breathing exercise Avoid strenuous activity Follow up diagnostic count of CBC Dont give aspirin Advise the patient to follow medication, exercise, proper nutritional diet for faster recovery.

MEDICATION

EXERCISE

TREATMENT

HEALTH TEACHING

Advise the patient to have proper nutritional diet, adequate rest and increase fluid intake. Advise patient the pathophysiologic and awareness of dengue fever and for the control of infection Promote 4o clock habits

OUTPATIENT

DIET

SPIRITUAL

Advise the patient for follow up check-up with doctor as ordered Dress in protective clothing-long-sleeved shirts,long pants,socks and shoes Use insect repellents on your skin Encourage the patient to eat proper food nutrition and to increase her fluid intake to prevent from dehydration. Porridge and baked toasts (not fried) can be had for allaying hungers in the course of the day. Biscuits with tea can be had. The tea must be herbal, with ginger, cardamom and other such fever-reducing herbs in it. Fruits must be taken in moderation. For people with dengue fever, apples and plantains are the only advisable fruits. respect patient and her familys belief and practices by not being judgemental. Respect patients culture and belief

Nursing Care Plan ASSESSMENT Subjective: kapoy akong lawas as verbalized by the pt. Objective: - Dry and pallor skin, warm to touch - Inability to coherence - Decreased hemoglobin count - Decreased WBC - Decreased platelet - Above normal range body temperature NURSING DIAGNOSIS Body malaise related to ineffective tissue perfusion with decreased hemoglobin concentration in the blood secondary to dengue hemorrhagic fever NURSING GOAL Short term: After 4hours of nursing intervention the pt. will demonstrate behaviors to improve circulation Long term: After 4 days of nursing intervention the pt will demonstrate increased perfusion appropriately NURSING INTERVENTIONS 1. Establish rapport, Monitor vital signs 2. Note baseline data and variability 3. Monitor laboratory examinations 4. Encourage quite and restful environment 5. Instruct to avoid tiring activities 6. Encourage RATIONALE 1. To gains pt. trust to obtain baseline data to assess contributing factors 2. For comparison for current findings

OUTCOM

3. To identify alternation from normal 4. To promote comfort & decreases tissue O2 demand

After nur intervent will mani - N o e - N o - A a a a - N b - P n o fu - E a - P a

5. To decreased

light ambulation 7. Provide accurate information to pt. SO 8. Administer medication 9. Listen to pts concerns 10. Instruct pt. to take adequate rest periods 11. Increase fluid intake

cardiac workload 6. To enhance venous return

7. Being informed about progress of situation, provides emotional support, helping to decrease anxiety 8. To treat underlying cause

9. To promote healing 10. To prevent fatigue

11. T

NURSING SYSTEM REVIEW CHART Name of patient: Natividad Villigas Height: Vital signs: Temp: Pulse: RR: Blood pressure: date: july 16 201

EENT