23 Pathophysiology (Theoretical Based)

Modifiable Factors

Non Modifiable Factors

Lifestyle: smoking and people working in unsanitized environment like garbage men and street vendors. Diet: High Cholesterol rich food and fatty oil food intake. Environment: Unsanitized environment like squatters area and Unhealthy diet nd liestyle especially those with low immune system.

Age: 52 yrs old (All age applies) Gender: Both Genders Geographical Location: Tropical areas, most especially areas with 2 seasons, Hot and cold Cimate (Philippines)

Aedes aegypti (dengue virus carrier): 812 days of viral replication on mosquitos salivary glands

Bite from mosquito (Portal of Entry in the Skin) Allowing dengue virus to be inoculated towards the circulation/blood (Incubation Period: 3-14 days)

Redness & itchiness in the area

Diagnostic: Hematology : Decreased Monocytes: 4%(8-14%) Decreased Neutrophils: 49%(50-70%)

Virus disseminated rapidly into the blood Antibodies attach to the viral and stimulates WBCs including B antigens, and then lymphocytes that produces and secretes monocytes/macrophages will immunoglobulins (antibodies), and perform phagocytosis through Fc monocytes/macrophges, neutrophils receptor (FcR) within the cells and dengue virus replicates in the cells of monocytes/macrophages

Diagnostic: Hematology : Increased WBC: 12,900/cumm (5,000- 10,000/cumm) Increased Lymphocytes: 49% (2040%)

24

Recognition of dengue viral antigen on infected monocyte by cytotoxic T cells Release of cytokines which consist of vasoactive agents such as interleukins, tumor necrosis factor, urokinase and platelet activating factors which stimulates WBCs and pyrogen release

Entry to the spleen, and liver

Entry to the bone marrow

Signs/ symptoms: Febrile: 38.6C Diaphoresis, warm skin, flushed; headache of 3/10 pain scale; whitish spots; body weakness Virus ultimately targets liver and spleen parenchymal cells where infection produces apoptosis/cell death Diagnostic: Ultrasound: minimal hepatospleno megaly Blood Chemistry: SGOT: 558.0 Signs/ U/L(Up to 46) Signs/ symptoms: symptoms: Epistaxis, High Red sclera in Grade Fever, both eyes Chills and Petechiae severe loss of

Dengue Fever

Cellular direct destruction and infection of red bone marrow precursor cells as well as immunological shortened platelet survival causing platelet lyses

size of the pores in Signs/ Signs/ symptoms: the capillaries which symptoms: >Abdominal pain leads to a leakage of Intense bleeding with 5/10 pain Signs/ symptoms:from the blood Pulmonary scale as fluid Abdominal distention interstitial fluid Edema verbalized.to the with abdominal girth (capillary leakage) of Fainting of 93cm (36.6 inches); Very the different organs low blood hypoactive bowel pressure and skin sounds of 2/min

Hepatosplenomeg Increase number and aly

Thrombocytop enia

Signs/ symptoms: +1 Bipedal edema; weak bounding pulse

Diagnostic: Hematology: Decrease Platelet Signs/ count and delay symptoms: productionnonProfuse 68.00 cu/mm cough productive with white sputum with blood spots noted; shallow & rapid respirations of 35cpm;

25
Diagnostic: Ultrasound: Conclusion: Minimal bilateral pleural effusion.

Pleural effusion

Ascite s

Diagnostic: Ultrasound: Conclusion: Moderate ascites

Dengue Hemorrhagic Fever

Legend: - Pathophsiology

- Medications

- Signs and symptoms

- Diagnostic exams

- Complications

- Interventions

- Early signs

Client Based Pathophysiology

26 Predisposing Factor Geographical area tropical islands in the Pacific (Philippines) Precipitating Factors Environmental conditions (house near a river, presence of mosquito in their house) Aedes aegypti mosquito carrying dengue virus