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Dengue fever and dengue hemorrhagic fever are acute febrile diseases. Dengue is
classified as mild, moderate and severe depending on symptoms manifested. It also has
grading and staging from grade 1-4 based on severity and condition.

Dengue hemorrhagic fever (DHF), a potentially lethal complication, was first recognized
in the 1950͛s during the dengue epidemics in the Philippines and Thailand. Dengue Fever is
caused by one of the four distinct virus serotypes Dengue type 1,2,3 and 4 of the Genus
Flavivirus and Chikungunya Virus. Infection with one of this 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 serotypes are transmitted by Aedes
Aegypti through bite. It becomes infected with the Dengue Virus when it bites a person who
has Dengue and after incubation period of 6-10 days transmits the virus to healthy person.
Dengue may also be transmitted via infected blood products, it cannot be transmitted or
directly spread from person to person.

Clinical manifestation of Dengue Fever in severe type are frank type flushing, sudden
high fever, severe hemorrhage, followed by sudden drop of temperature, shock and
terminating in recovery or death. For moderate type high fever and spontaneous bleeding
are present. For mild slight fever, with or without petechial hemorrhage are evident.

The mainstay of treatment is timely supportive therapy to tackle circulatory shock due
to hemoconcentration and bleeding. Close monitoring of vital signs in the critical period.
Oral rehydration therapy is recommended to prevent dehydration in moderate to severe
cases. Supplementation with intravenous fluids may be necessary to prevent dehydration
and significant concentration of the blood if the patient is unable to maintain oral intake. A
platelet transfusion may be indicated if the platelet level drops significantly or if there is
significant bleeding. The presence of melena may indicate internal gastrointestinal bleeding
requiring platelet and/or red blood cell transfusion. Aspirin and non-steroidal anti-
inflammatory drugs should be avoided as these may worsen the bleeding tendency
associated with some of these infections. Patients may receive paracetamol, acetaminophen
and preparation to deal with these symptoms if dengue is suspected.

The WHO says 2.5 billion people, are now at risk from dengue and estimates that there
may be 50 million cases of dengue infection worldwide every year. All persons are
susceptible and both sexes are equally affected. Dengue Fever is sporadic throughout the
year. Epidemic usually occurs during rainy seasons (June-November) peak months are
September-October.
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This case presentation aims to identify and determine the general health problems and needs of
the patient with an admitting diagnosis of Dengue Hemorrhagic Fever Type 1. This presentation also
intends to help patient promote health and medical understanding of such condition through the
application of the nursing skills and for the students to gain knowledge, skills and attitude.



×Ê To raise the level of awareness of patient on health problems that she may encounter.
×Ê To facilitate patient in taking necessary actions to solve and prevent the identified
problems on her own.
×Ê To help patient in motivating her to continue the health care provided by the health
workers.
×Ê To render nursing care and information to patient through the application of the nursing
skills.
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×Ê 


This is a case of CB, 5years old, male, from Pasig City. The patient is admitted for the
first time at Rizal Medical Center last September 04, 2010 with a chief complaint of fever.

×Ê  
c 

Three days prior to admission the patient experience intermittent fever of 38-39°C. They
consult to a private physician and prescribed meds of co-amoxclav. Few hours prior to admission
the patient is still with fever, with abdominal pain and CBC done platelet is 158.

×Ê  c 

The patient is never hospitalized before. He has no allergies on any substance or food.

×Ê acc 

No hereditary disease can be attributed from her father side, but her mother had a
family health history of hypertension. Other than the latter, no other hereditary disease from
both of his parents are within the patient͛s mother knowledge.

×Ê 
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c 

The patient lives near the riverside. They have some stocks of container with water that
doesn͛t have cover.

×Ê
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The patient eats all kinds of food. He drinks 4-6 glasses a day.

×Ê cc
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Elimination pattern for bowel is once a day. He doesn͛t have any difficulty in urinating.

×Ê   c


The patient is on his preschooler stage. He learns how to things and that doing a thing is
desirable. He learns sexual identity through awareness of genital area.
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 !"# $   %"# $ 
  100/70 mm Hg 100/70 mm Hg Normal
 38.9 °C 37.8 °C With fever
  98 bpm 96 bpm Normal
 c 19 bpm 20 bpm Normal


 Conscious and coherent Conscious and coherent Normal

  


  
ac
c
  ac
c
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 !"# $   %"# $ 
 ×Ê Round and Round and symmetrical Round and symmetrical

 symmetrical. Smooth, without mass Smooth, without mass and 
×Ê Smooth, and not tender not tender 
without masses or 
depressions, 
non tender. 

c ×Ê Can be black, Black, smooth and no Black, smooth and no

 brown or burgundy presence of parasites presence of parasites 
 (no evidences of 
 Alopecia), no 
 parasites, and the 
 amount is 
 variable 
  
 ×Ê Moist, no scars, Moist, no scars, no lice Moist, no scars, no lice and

 free from lice and and dandruffs dandruffs 
 dandruff 
 
 
 ×Ê Symmetrical, no Symmetrical, no edema, Symmetrical, no edema, no

 edema, no no involuntary involuntary movements 
 involuntary movements 
 movements 
 
a ×Ê Symmetrical or Symmetrical and non Symmetrical and non

 evenly placed and protruding protruding 
 inline with each 
 other. 
 
  ×Ê Non Symmetrical and non Symmetrical and non

 protruding and protruding protruding 
 equal palpebral 
 fissure 
 
 ×Ê white, moist and white, moist and white, moist and without

 without without lesions 
 lesions lesions 
 



c ×Ê shiny, shiny, not swelling, pale shiny, not swelling, slightly ( )*
 smooth, and pink in color pale in color than before 
 or red, absence 
 of swelling, no 
 lesions and moist 
 
 
 

  ×Ê Symmetrically, Symmetrical, no masses, Symmetrical, no masses, no (+
 without swelling, no flaring, bleeding flaring )*
 bleeding, lesions, 
 or masses. No 
 discharge or flaring 
 and uniform 
 color, 
 
 ×Ê pink, soft moist, pale in color, no lesions Slightly pale in color than *)+(+
 smooth texture or inflammations before, no lesions or  )*
 with no evidence inflammations 
 of lesions or 
 inflammation. Not 
 crack and 
 symmetrical. 
 
  ×Ê Cerumen should be No deformities No deformities
)
 moist and not 
 obscure the 
 lympanic 
 membrane, no 
 foreign bodies, 
 redness, 
 drainage, 
 deformities, 
 nodules or 
 lesions 
 

& ×Ê muscles of the Symmetrical Symmetrical
)
 neck are 
 symmetrical with 
 the head at a 
 central position 
 

  ×Ê Îymph nodes (+) palpable posterior (+) palpable posterior cervical ()
 should not be cervical lymph nodes lymph nodes )
 visible or inflamed 
 
and not palpable
 
 
'  ×Ê ouiet, rhythmic Symmetrical chest Symmetrical chest expansion,
)

c respiration. expansion, clear breath clear breath sounds 
 Normal breathing sounds 
 rate 
 
 
 ×Ê no pain, No pain, no tenderness No pain, no tenderness
)
 tenderness, rigidity 
 and muscle 
 guarding 
 

 ×Ê Extremities are Warm to touch, with IV Warm to touch, with IV ,-.+*)
, equal in size catheter hooked at right catheter hooked at right arm. )
'cc  ×Ê No involuntary arm.
movements
×Ê No lesions and
edema
×Ê Temperature is
warm and even
×Ê Can perform ROM


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MODIFIABÎE NON-MODIFIABÎE
Environment ʹ near river Both sexes- male & female
side

Bite of Aedes Aegypti mosquito carrying virus

Viruses go into the circulation

Initiates destruction of platelets

ј potential for hemorrhage

Stimulates inflammatory response

Fever of 38.9°C Îoss of appetite Restlessness Irritability Platelet Count - 24

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)/) 135.00-180.00 128 123
) 0.400-0.540 0.363 0.348
)* 150-450 58 102

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Decrease hemoglobin and hematocrit can rule out anemia due to blood loss and destruction of
blood cells internally.

Decreased platelet count can rule out Rule out premature destruction states such as immune-mediated
thrombocytopenia, acute blood loss.
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*2.*(1 ×Ê Short term goal
ƒ Nilalagnat ang anak ko
mainit po siya͟, as the
patient͛s mother
verbalized.
2.*(1
×Ê Weakness
×Ê Flush skin
×Ê Warm to touch
×Ê Pale
×Ê Febrile ʹ 38.9°C
×Ê Îoss of appetite
×Ê Provide surface ×Ê To promote core Patient condition
After an hour of cooling such as TSB cooling by helping improved
nursing intervention, and removing of extra reduce body
the client͛s clothing. temperature.
temperature will
subside from 38.9°C- ×Ê Encouraged increase ×Ê To prevent
38.0°C. fluid intake. dehydration because
increase in body
temperature causes
fluid loss such as
sweating.
×Ê Provide bed rest. ×Ê To detect further
existing discomfort
and promote rest.

×Ê Administer ×Ê Paracetamol are

 c
c
 c  Paracetamol 5ml p.o classified as analgesics
as ordered by the and antipyretic which
Hyperthermia related to physician. acts on the
infection Hypothalamus to
regulate normal body
temperature.
   
 

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*2.*(1 After an hour of nursing ×Ê Assess for signs of GI ×Ê The GI tract is the Patient condition
ƒDumudugo ang ilong ng intervention, the client will bleeding. Observe most usual source of improved
anak ko͟, as the patient͛s be able to demonstrate color and consistency bleeding of its
mother verbalized. behaviors that reduce the of stools or vomitus. mucosal fragility
risk for bleeding.
2.*(1 ×Ê Focus for presence of ×Ê To prevent other
×Ê Weakness bleeding from one or complications
×Ê Irritability more sites.
×Ê Restlessness
×Ê Pale ×Ê Inhibit of taking ×Ê To prevent risk for
×Ê Febrile- 38.9°C aspirin containing hemorrhage
×Ê Platelet count ʹ 58 products

×Ê Monitor Hb and Hct ×Ê Indicators of anemia,

 c
c
 c  and clotting factors active bleeding or
impending
Bleeding related to altered complications
clotting factor
×Ê Increase fluid intake ×Ê To prevent
dehydration

×Ê Place patient on a bed ×Ê To detect further

rest existing discomfort
 c' Ê  

 + (() -( )(/ c+) )+) +.(
*(/()((


 ))
  Anti-pyretic Îessens the Syrup Symptomatic · Contraindicated · Hematologic: ×ÊUse liquid form for
 c core 5ml relief of pain in patients hemolytic children and
  temperature every and hypersensitive to anemia, patients who have
  of the body four fever. drug. neutropenia, difficulty
  hours · Use cautiously leucopenia, swallowing.
  in patients with pancytopenia. · In children, don͛t
 c long · Hepatic: exceed five doses
  term alcohol use Jaundice in 24 hours.
  because · Metabolic: · Advise patient that
 therapeutic Hypoglycemia drug is only for
 doses cause · Skin: rash, short term use and to
 hepatotoxicity in urticaria. consult the
 these physician if giving to
patients. children for
longer than 5 days or
adults for
longer than 10 days.
· Advise patient or
caregiver that
many over the counter
products
contain acetaminophen;
be aware
of this when calculating
total daily
dose.
· Warn patient that high
doses or
unsupervised long term
use can
cause liver damage.


 + (() -() )(/ c+) )+) +.(
*(/


 )  ()((
  Antibiotic Ampicillin 460 mg For Hypersensitivity; GI upset, ×Ê Should
  exerts via IV susceptible infectious nausea, administer the
  bactericidal infections mononucleosis. vomiting, medication using
c  action on both diarrhoea; aseptic technique
  gm+ve and gm- blood ×Ê Monitor if there
c c ve organisms. dyscrasias; is side effect.
  Its spectrum urticaria, ×Ê Discontinued if
 includes gm+ve exfoliative there are any
c organisms eg, S dermatitis, reactions.

 pneumoniae rash; fever,
and other seizures;
Streptococci, Î interstitial
monocytogenes nephritis.
and gm-ve
bacteria eg, M
catarrhalis, N
gonorrhoea, N
meningitidis, E
coli, P mirabilis,
Salmonella,
Shigella, and H
influenzae.
Ampicillin
exerts its action
by inhibiting
the synthesis of
bacterial cell
wall.

 'Ê c
 

 ×Ê Advise the relatives of the patient to continue the prescribed home

medication ordered by the physician

 ×Ê Provide a clean environment

×Ê Avoid heavily polluted areas
×Ê Use of screens when sleeping
×Ê Avoid having stocked water on a container without cover in your house.
 ×Ê Advise the patient to increase intake of fluids
×Ê Instruct to have enough rest at home

 ×Ê Advise to put some insect repellants

×Ê Maintain good hygiene by daily taking a bath.

 ×Ê Instruct to continue consulting to a doctor as ordered.

 ×Ê Eat healthy foods such as fruits, meats and vegetables

×Ê Drink plenty of water at least 8-10 glasses of water a day

 ×Ê Advise family not to go to places with dirty surroundings to prevent possible

source of infection.

 
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This case study enables the students to identify and determine the general health
problems and needs of the patient with an admitting diagnosis of dengue fever. It also help
patient to promote health and medical understanding of such condition. This also help student
to gain more knowledge, skills and attitude. This will present as a reference to student and
readers.