DENGUE VIRUS

PREPARED BY: MICHAEL CRUZ

OBJECTIVES:
General

To understand the disease process in order to provide an appropriate nursing

management and quality care for the patients.

SPECIFIC
To provide ample information about the

dengue infection such as epidemiology,

pathophysiology and risk factors.
To recognize the history and manifestation of the infection through research and
observing a positively identified patient with dengue.

To identify the prescribe medications, IV fluids and laboratory tests undergone by

the patient.

To provide necessary NCP to prioritize the immediate problem of the patient.

WHY DID I CHOOSE THIS

TOPIC?

WHAT IS DENGUE?
Dengue viruses are arboviruses
(arthropod-borne virus) that are
transmitted primarily to humans
through the bite of an infected Aedes
species mosquito. Transmission may
also occur through transfusion of
infected blood or transplantation of
infected organs or tissues.

Dengue virus is transmitted by

female mosquitoes mainly of the
speciesAedes aegyptiand, to a
lesser extent,A. albopictus. The
disease is widespread throughout
the tropics, with local variations in
risk
influenced
by
rainfall,
temperature and unplanned rapid
urbanization.

LETS TALK ABOUT HISTORY

The four dengue viruses originated in

monkeys and independently jumped to

humans in Africa or Southeast Asia between
100 and 800 years ago.
In 1771, Dr. Jose Sabater Break-bone Fever
In 1780, Dr. Benjamin Rush recorded an

epidemic of the disease Bilious Remitting

Fever
Slaves in the West Indies - "Dandy Fever"
Queen Luisa of Spain 1801 -The

worddengueis Spanish for "affectation,"

"careful," or "fastidious.
Some researchers believe that the name

came from a Swahili phraseKa dinga pepo,

or a disease caused by an evil spirit.

Franken-Skeeters "Frankenbugs
British biotech firm
called Oxitec.
Known as the
OX513-A
Brazil 04/2014Florida
"sterile insect
technique"

GLOBAL DENGUE TESTIMONIES

World Health Organization officials regard dengue as a major international public

health concern in urban and semi-urban areas in tropical and subtropical regions.
Today about 2.5 billion people, or 40% of the worlds
For instance, there population,
was a dengue
epidemic
in Hawaii
live in
areas where
there isina 2001,
risk of and dengue
outbreaks appeardengue
with increasing
frequency
along
the in
Texas-Mexican
border. The
transmission.
Dengue is
endemic
at least
dengue viruses 100
alsocountries
circulateinwithin
U.S.
tropical
and commonwealths,
Asia, the
Pacific,
the territories
Americas, Africa,
the Caribbean.
The World
Health Organization
and they continueand
to afflict
U.S. travelers
overseas.
(WHO) estimates that 50 to 100 million infections
In 2011, Bolivia, Brazil,
Columbia, Costa Rica, El Salvador, Honduras, Mexico,
occur yearly, including 500,000 DHF cases and
Peru, Puerto Rico, and 22,000
Venezuela
reported
large children.
number of dengue cases.
deaths,
mostly a
among
Thailand reported the worst dengue outbreak in 20 years, with 126 deaths and
135,344 people infected with the virus, as of October 2013.

GEOGRAPHICAL DISTRIBUTION

WHO: DENGUE IN THE PHILIPPINES 2014

The National Epidemiology Center of the Philippines' Department of Health

reports a total of 59,943 dengue cases from January 1 to September 6,

2014. This is 59.57% lower compared to the same time period last year
(148,279).
Of the total cases, 10.47% came from Northern Mindanao (Region X), 9.6%
from CARAGA (Region XIII), 9.19% from Davao Region (Region 11). Next is
from Region IV-A and , Region III, which are 8.93% and 8.01% respectively,
to the overall figure.
Majority of the infected patients were 5 to 14 year old children (38.91% of
the total cases), and more than half were males (52.77%). A total of 242
deaths (CFR 0.40%) was recorded since January 2014, and most of them
were children.

WHO: DENGUE IN THE PHILIPPINES 2015

Denguefevercases have increased slightly in thePhilippinesduring the first three

months of 2015 as compared to the same period in 2014, according to

thePhilippinesDepartment ofHealth.
From Jan to Mar. 2015, there were19,946 suspected dengue cases reported on
vaccine
in PH by
July
the archipelago, aDengue
little more
than aout
six percent
increasefrom
2014s18,730
2015
cases during the first quarter.
Health Secretary Enrique Ona says the
ThehardesthotregionwasCALABARZON, orRegionIV-A with 3,778 cases.
vaccine should significantly contribute
Theregion consists
provincesCavite,
Laguna,
Batangas, Rizal, andQuezon.
to of5
the Philippines
achieving
its Global
Although the totalStrategy
cases are
this year,
dengue and
related fatalities are down, 53
forup
Dengue
Prevention
versus 85, respectively.
Control Goals by 2020

DOH: DISEASE SURVEILLANCE YEARLY REPORT

Chart Title

AEDES AEGYPTI MOSQUITO

D -ay biting mosquito.

L -ow flaying (400
meters)
S -tagnant clear
water
U -rban

DENGUE VIRUS

A -rbovirus (arthropod borne

virus)
R -NA virus
F -laviviridae (Family)
F lavivirus (Genus)

CASE STUDY
DENG UE W ITH WA RNING SIGN S

DOH: REVISED DENGUE CASE CLASSIFICATION

CLINICAL SUMMARY
General Data
An 18 year old male, single and Filipino
patient rushed in the E.R complaining of
blood in the urine and fever. Patient EEI
admitted at SLH last June 19, 2015 exactly
4:30pm in PAV 4 diagnosed as dengue
with warning sings under Dr. Jelvie Lajom
as the attending physician.
Patient EEI is currently living with his
parents at Brg. Tonghin, Infanta, Quezon.
He is second among his 3 siblings and
born on November 11, 1996 in Tiaong
Quezon province too.

CLINICAL SUMMARY
History of Present Illness
Two days PTA patient was
confined to Claro M. Recto District
Hospital due to high grade fever
for
3
consecutive
days
accompanied by headache and
body malaise. The next day
patient
noticed
blood
upon
urination.
Persistence
of
hematuria resulted in referral to
this
institution
for
further

CLINICAL SUMMARY
Past Medical History

Occasional smoker
Occasional alcohol drinker

FAMILIAL HISTORY

(-) Diabetes Mellitus

(-) Hypertension

CLINICAL SUMMARY
Environmental History

The patient and his family are living in the Quezon province. Her mother told me
that they have a sapa at the back of their house and different kinds of plants and
trees. The patients mother said that they blocked a small portion of the sapa
because they are planning to put a fish pen, but until now, it remains empty, and
had accumulated stagnant water.

PHYSICAL ASSESSMENT
Findings

Values

Analysis/Interpretatio
n

June 19, 2015

Measurement of HT + WT = BMI

BMI-17.4
Underweight

HT 56 ft
WT 108 lbs

Normal value is 18.524.9

(health-calc)

Vital signs
Temperature
Cardiac rate
Respiratory rate
Blood pressure
O2 sat %

38.8
63
24
90/60
96%

36.5 37.4
60 100
12 20
120/80
95 100%

Febrile
Normal
Tachypnea
Normal
Normal

June 22, 2015

Measurement of HT + WT = BMI

BMI-17.1
Underweight

HT 56 ft
WT 106 lbs

Normal value is 18.524.9

(health-calc)

Vital signs
Temperature
Cardiac rate
Respiratory rate
Blood pressure

37.8
70
22
90/60

36.5 37.4
60 100
12 20
120/80

Febrile
Normal
Tachypnea
Normal

PHYSICAL ASSESSMENT
Body Parts

Normal Findings

Actual Findings

Analysis/Interpretati
on

Skin

Light to deep brown,

except in the areas
exposed to sun, no
edema present and no
other lesions

Flushes and redness are

allover the body

Fever; rashes may be

due to increase of
blood pressure in the
vessels.

Mouth / Lips

Lips pink in color,

moist, smooth texture,
ability to purse lips

Some dryness and light pink

Dehydration due to
fever and present
condition

Abdomen

Uniform color, no
evidence of enlarged
liver or spleen

Warm to touch

Febrile; rash may be

due to increase of
blood pressure in the
vessel.

Upper Extremities

Symmetrical in size
and length, smooth
texture

No fractures, symmetrical in
movement, has rashes,
capillary refills at 2-3
seconds

Fever; rash may be due

to increase of blood
pressure in the vessel.

ACTIVITIES OF DAILY LIVING

Before
hospitalization

During
hospitalization

Analysis/Interpreta
tion

Nutrition

He eats 3x a day
(any food)
Seldom to drink
water

Hindi ako
makakain wala
akong pang lasa,
pinipilit ko lang.
Hospital food and
biscuits except
dark colored food

Weight loss due to

appetite problem
As per doctor: DAT
and EDCF - mimic
bleeding episode

Elimination

He is able to urinate
for more than 3x and
defecate (1-2x a day)
normally every day
tapos un medyo iba
kulay ng ihi ko

He can still urinate &

defecate pero hindi
ako makadumi ng
maayos parang
namamahay.

Hematuria due to
present condition

ACTIVITIES OF DAILY LIVING

Before
hospitalization

During
hospitalization

Analysis/Interpreta
tion

Exercise/Activity

His daily routine is

going to school, then
playing basketball

Most of the time

sleeping and texting
then talking to his
mother.

The client have

minimal movement
compare to his usual
routine due to present
condition

Rest/Sleep

Natutulog ako ng
11pm madalas, tapos
gumugisng ako ng
6am tapos papasok
na ko agad
The patient brushes
his teeth twice daily
then taking his bath
morning and before

Nagigising po ako
minsan lalo kapag
dumadating mga
duktor at nurse.

This may be due to

giving of medication
and rounds.

Masama ang
pakiramdam ko at
masakit katawan
ko

This may be
concerning his
privacy and
present condition

Hygiene

LABORATORY FINDINGS: HEMATOLOGY(CLARO M.

RECTO)
JUNE 17, 2015/
4;45pm

Result

Reference Range

Analysis/Interpretat
ion

Hematocrit

0.55

M 4.50-0.54

Increased

Platelet count

189

A 150-450 x /L

Normal

Result

Reference Range

Analysis/Interpretat
ion

Hematocrit

0.60

M 4.50-0.54

Increased

Platelet count

165

A 150-450 x /L

Normal

Result

Reference Range

Analysis/Interpretat
ion

Hematocrit

0.57

M 4.50-0.54

Increased

Platelet count

152

A 150-450 x /L

Normal

JUNE 17, 2015

JUNE 18, 2015

LABORATORY FINDINGS: HEMATOLOGY REPORT (SLH)

Findings

Normal
Values

Analysis/Interpreta
tion

Hematocrit

0.55 (H)

0.42-0.52

Increased

Platelet count

98 (L)

150-400 x /L

Thrombocytopenia

Hematocrit

0.53 (H)

0.42-0.52

Increased

Platelet count

73 (L)

150-400 x /L

Thrombocytopenia

Hematocrit

0.48 (H)

0.42-0.52

Normal

Platelet count

81 (L)

150-400 x /L

Thrombocytopenia

Date/Time
June 19, 2015

June 20, 2015/

9:15

June 20, 2015/

15:23

LABORATORY FINDINGS: HEMATOLOGY REPORT (SLH)

Findings

Normal
Values

Analysis/Interpret
ation

Hematocrit

0.50 (H)

0.42-0.52

Normal

Platelet count

174 (L)

150-400 x /L

Normal

Hematocrit

0.50 (H)

0.42-0.52

Normal

Platelet count

358 (L)

150-400 x /L

Normal

Date/Time
June 21,
2015/19:13

June 22,
2015/21:38

LABORATORY FINDINGS: URINALYSIS (CLARO M.

RECTO)
June 17, 2015

Result

Reference Range

Analysis/Interpreta
tion

Color

Amber

Specific gravity

1.015

1.015 1.030

Normal

pH reaction

Acidic

Protein

+4

<10 mg/dL

Sugar

Negative

Normal

Blood

+4

<0.03 mg/dL

Hematuria

WBC

0-2 / HPF

0 5 / HPF

Normal

RBC

1-2 / HPF

0 2 / HPF

Normal

LABORATORY FINDINGS: URINALYSIS (SLH)

June 19, 2015/
3:52pm

Result

Reference Range

Analysis/Interpreta
tion

Color

Dark Amber

Blood

>= 1.0 mg/dL

<0.03 mg/dL

Hematuria

Leukocytes

75 WBCs/L

<25 WBCs/L

Presence of Infection

WBC

11-20 / HPF

0 5 / HPF

Presence of Infection

June 23, 2015/

11:07am

Result

Reference Range

Analysis/Interpreta
tion

Color

Dark Amber

Blood

Negative

<0.03 mg/dL

Normal

Leukpcytes

Negative

<25 WBCs/L

Normal

WBC

Negative

0 5 / HPF

Normal

LABORATORY FINDINGS: SD DENGUE DUO (RAPID ICT)

Method

Result
NS1

ICT/LOT #
11DD14012

Interpretation
Positive

IgM

Positive

IgG

Positive

Infected with
denguevirus

COURSE IN THE WARD

Assessment

Progress note

Nursing action

Medication

Laboratory

Day 1
Jun 19,
2015/10am
Elevated body
temp

Febrile T= 38.0
(+) Occasional
abd pain

TSB instructed Paracetemol

&
500mg Tab q4
demonstrated
T- > 37.9
Antipyretic
PLR 1l x
given as
150cc/hr
ordered
@500cc
IVF checked & Omeprazole
regulated
ORS instructed
and reinforced
Encourage to
get adequate
rest

Hematology
WBC 6.87
WBC 7.07
(N= 4.8
10.8)
PC 73
PC 81
(N 150-400
x /L )

COURSE IN THE WARD

Assessment

Progress note

Nursing action

Medication

Laboratory

Day 4
Jun 22,
2015/10am
Awake and
Coherent

No fever
No bleeding
No abd pain
Dry lips

Health
teaching
Encouraged
to sleep
more than 8
hrs
Instructed to
inc OFI
Advised to
report any
signs of
bleeding

PLR X 98 cc/hr Hematology

@400cc
WBC 9.88
Start ampicillin
PC 174
+ sulbactam
Urinalysis
750mg q6 TIV
WBC 11-20
anst (-)
(N= 0 5 /
HPF)

COURSE IN THE WARD

Assessment

Progress note

Nursing action

Medication

Laboratory

Day 4
Jun 22,
2015/10am
Awake and
Coherent

No abd pain
CR > 3 sec

IVF checked
and regulated
IV care done
reminded
about the diet
(DAT -EDCF)

Under
continue
medication
PLR X 98 cc/hr
@600cc

Day 5
Jun 23
Day 5
2015/10am
Jun 23 and
Awake
2015/10am
Coherent
Awake and
Coherent

No
No
No
No
No

Health
teaching on
hand
Healthwashing
teaching
and
oral care
on
Advised
hand washing
MGH
and oral
after
lasts
care
U.A
result
Advised MGH

Under
continue
medication
Under
PLR
continue
X 98 cc/hr
medication
@500
PLR X 98 cc/hr
@500

fever
bleeding
feverpain
abd
bleeding
abd pain

Hematology
WBC 10.28
(N= 4.8
10.8)
PC 358
(N 150-400
x /L )
Hematology
PC 358
Hematology
(N= 4.8
PC 358
10.8)
(N= 4.8
10.8)

DISEASE DISCUSSION: LYMPHATIC SYSTEM

DISEASE DISCUSSION: LYMPHATIC SYSTEM

The lymph system is a network of

organs, lymph nodes, lymph
ducts, and lymph vessels that
make and move lymph from
tissues to the bloodstream. The
lymph system is a major part of
the body's immune system.

DISEASE DISCUSSION: LYMPHATIC SYSTEM

Disease discussion:
Pathophysiology

Modifiable
Nonmodifiable

Infected
Mosquito

Infection can
trigger strong
inflammatory
reaction

Resetofhypoth
alamicthermos
tat
Fever

Transfer the
virus through
saliva

Will travel
through the
blood of the
infected person
(viremia)

Activation of
immune
response
WBC

Virus will
infect the
immune cells
& skin tissue

During
Incubation the
virus will
replicates
locally

Increase
blood
pressure in
vessel

Enter the
lymphatic
system

Body rash
Vomiting
Headache
Peri-orbital
pain

NURSING CARE PLAN 1

Focus

Data

Action

Jun 19,2015/10:15am
Elevated body
temperature

Temperature of
38.0OC via axilla
Skin is flushed and
warm to touch

TSB instructed and

demonstrated
Encouraged
adequate oral fluid
intake
Encouraged
adequate rest
Advised NOD 500mg tab
Paracetamol as per
doctors order

Response
Temperature
decreased from
38.0 to 37.4OC
-1pm

NURSING CARE PLAN 2

Focus

Data

Jun 22, 2015/10:15am Dry lips

Risk for deficient fluid Hct 0.55 (N=0.42volume
0.52)

Action
Encouraged
adequate oral fluid
intake at least
more than 8
glasses a day/1.5L
ORS instructed and
reinforced

Response
Moist mucous
membranes and
lips 2pm

NURSING CARE PLAN 3

Focus
Jun 23, 2015/10:20
Knowledge deficit
related to disease
process dengue

Data
Nakuha ko po ito
nung makitulog ako
sa kaibigan ko.
Kinabukasan ng
hapon nilalagnat na
po ako at nakagalitan
ako ng nanay ko. as
verbalized by the
patient.

Action
Educate about the
transmission of
dengue before the
signs may appear.

Response
Salamat po sir

MEDICATION
Generic/Brand
Name

Paracetamol

Dosage
Frequency
Route

500mg Tab q4

Mechanism of
Action

Paracetamol is a
pain reliever and
a fever reducer.

Side Effects

Side-effects are
rare and include
skin rashes and
blood disorders.

Nursing
Considerations
Assess
patients fever
or pain: type
of pain,
location,
intensity,
duration
Assess for
possible
allergic
reaction
Check for
decreased
liver and

MEDICATION
Generic/Brand
Name

Omeprazole

Dosage
Frequency
Route

40mg TIV OD

Mechanism of
Action
Suppresses
gastric acid
secretion
relieving
gastrointestinal
distress and
promoting ulcer
healing.

Side Effects

constipation
gas
nausea
vomiting
headache

Nursing
Considerations
Monitor
therapeutic
effectiveness
andadverse
reactions
Allergic
reaction
Before meals

MEDICATION
Generic/Brand
Name

Oral Rehydrating
Salt

Dosage
Frequency
Route

1 sachet in
200mL of water

Mechanism of
Action

Side Effects

Mild vomiting
may occur
when oral
therapy has
begun.
Rarely,
symptoms of
Oral replacement
hypernatreami
of electrolytes
a dizziness,
and fluids in
fast heartbeat,
patient with
high blood
dehydration
pressure,
irritability,
swelling of

Nursing
Considerations

Assess vital
signs, noting
peripheral
pulses.
Monitor blood
pressure
Strictly
monitor intake
and output
Observe the
physical

NURSING CARE PLAN 3

Generic/Brand
Name

Ampicillin +
sulbactam

Dosage
Frequency
Route

750mg q6 TIV

Mechanism of
Action

Antibiotic
agent with
activity
resulting from
betalactamase
inhibition.
Sulbactam
inhibits betalactamases
most
frequently
responsible for

Side Effects

Less common
Changes in
skin color
Diarrhea
Pain,
tenderness, or
swelling of the
foot or leg
Rare
Bloody nose
Burning while
urinating

Nursing
Considerations
Assess for
possible
allergic
reaction
hypersensitivi
ty to
penicillins
Report
promptly
unexplained
bleeding
Monitor I&O
ratio and
pattern.

DISCHARGE PLANNING

DISCHARGE PLANNING

D- discuss the possible source of infection of thedisease.

E- educate the family/patient on howto eliminate those
vectors.
N- Never stocked water in a container without cover.
G- Gallon, container and tires must haveproper way of
disposal.
U- Use insecticides at home to kill orreduce mosquito.
E- Encourage the family of thepatient to clean the
surroundings to destroy thebreeding places of mosquito

REFERENCES / RESOURCES
http://outbreaknewstoday.com/philippines-and-malaysia-dengue-updates-79406/
http://www.medicinenet.com/dengue_fever/page2.htm
http://www.rappler.com/nation/63497-dengue-vaccine-ph-july-2015
http://www.nature.com/scitable/topicpage/what-is-dengue-fever-22399100
http://newsinfo.inquirer.net/620019/anti-dengue-vaccine-developed-available-july-2015
http://www.health-calc.com/body-composition/bmi-adults
http://www.who.int/csr/disease/dengue/en/
http://www.wpro.who.int/philippines/areas/communicable_diseases/dengue/continuation_dengue_area_page/en/
https://www.microbemagazine.org/index.php?option=com_content&view=article&id=2966:dengue-fever-is-expandi

ng-globally&catid=686&Itemid=910
http://www.cdc.gov/dengue/epidemiology/index.html
http://www.onlymyhealth.com/cause-low-platelet-count-in-dengue-fever-1301653922
http://www.nlm.nih.gov/medlineplus/ency/article/002247.htm
http://www.drugs.com/ppa/ampicillin-sodium-sulbactam-sodium.html