CASE

PRESENTATION

Presented by:

BIOGRAPHICAL DATA

NAME: JPP

AGE: 16 years old

ADDRESS: SEX: Female

BIRTHDAY: August 16, 2003

RELIGION: Roman Catholic

NATIONALITY: Filipino

CHIEF COMPLAIN: Fever

ADMITTING DIAGNOSIS: Dengue Fever

HEALTH HISTORY

REASON FOR SEEKING HEALTH CARE

One day prior to admission. The patient experienced fever associated with headache and abdominal
pain. On the day of admission, 2nd day of illness, still with headache and abdominal pain, baseline of CBC
& dengue test with and admitting.

COLDSPA

CHARACTER: Intermittent fever as the patient’s mother verbalized “”

ONSET: The fever started on September 12, 2019 around midnight.

LOCATION: N/A

DURATION: Started on Thursday, September 12, 2019 until Monday, September 23, 2019.

SEVERITY: The temperature of the patient increased up to 40.3 oC

PATTERN: The temperature of the patient will suddenly increased in just 2 hours and will decreased
through rendering TSB and administering Paracetamol

ASSOCIATED FACTORS: Aside from fever, the patient also experienced abdominal pain and headache
5/10 in scale.

GENOGRAM

FATHER SIDE MOTHER SIDE

78y/o A&W
DECEASED A&W
m A&W
89y/o 79y/o
LEGEND:

- MALE

- FEMALE

A&W – Alive and well

- CVA

- Allergy to pollen

EXPLANATION:

The grandfather and the father of the patient has CVA which is hereditary and may also be inherit by
the patient. The patient acquired dengue fever by the bite of female aedes aegypti mosquito.
Review of Systems Physical Examination
Eyes: Eyes:
-no eye pain -eyebrows symmetrically aligned
-with clear vision -white sclera and pinkish conjunctiva
Pupils constrict
Mouth: Mouth:
-with complete set of teeth -no inflammation of tonsils
-does not experience difficulty in swallowing -tongue centrally located
-with complete set of teeth
-pinkish tongue
Integumentary: Integumentary:
-no complaint of itchiness -with good skin turgor
-hair equally distributed
-with presence of flakes
-with long, curly, black hair
-with good capillary refill at 1-2 seconds
-with moist skin
-skin is light brown
Respiratory: Respiratory:
-with history of asthma and dry cough -no wheezing
-no respiratory distress

Breast / Chest: Breast / Chest:

-no problem experienced as the patient stated -no lumps
-no masses
-fair skin color
Cardiovascular: Cardiovascular:
-no history of deep vein thrombosis -no murmur heard
-no tires on exertion nor fainting

Gastrointestinal: Gastrointestinal:
-with complaint of stomach-ache -flabby
-normal active bowel sound
-no tenderness
Genitourinary: Genitourinary:
-no history of hematuria and dysuria -didn’t perform this physical examining because it
is not necessary

Muscoskeletal: Muscoskeletal:
-no history of joint swelling and trauma -no deformities
-can move around and walk around with support
-with body malaise
Neurological: Neurological:
-no history of seizure and stoke -alert and cooperative
-irritable
-with complaint of headache
Allergies:
-no history of allergy noted

Psychological:
-no history of hallucination

General Survey:
 VS:
BP: 100/80
PR: 83
RR: 30
Temp: 38

S- The face and the body is symmetrical

O- Looks are appropriate for the age

M- The patient is alert

E- Patient has neutral expression

T- With symmetrical chest expansion

E- Doesn’t have any deformities

A- The patient is clean and well dressed

M- She can move around

S- The speech is clear and understandable

Pathophysiology of Dengue Fever

Risk Factors

Dengue Infection

Antibody formation

Reinfection

Augmentation of virus multiplication

Increased vascular permeability Reduce platelets

 Plasma leakage Disseminated intravascular coagulation Coagulopahty

Hypovolemia

Shock Severe Bleeding

Death

Dengue virus (DENV) is a single-stranded RNA virus that belongs to the genus Flavivirus,. Dengue virus
infection is transmitted to humans by mosquitoes, primarily the Aedes aegypti species. It is a febrile illness
that affects infants, young children and adults with symptoms appearing 3-14 days after an infective bite.

Dengue virus infection is caused by any one of four related viruses, DENV-1, DENV-2, DENV-3 and
DENV-4, also referred to as Dengue serotypes, which co-circulate in endemic areas. Infection with one
dengue serotype confers lifelong immunity but subsequent infection with other dengue serotypes is
associated with an increased risk of developing severe dengue disease. Early clinical diagnosis and careful
clinical management are essential for increasing patient survival.

Transmitted by mosquitoes, dengue fever is a threat to almost half of the world’s population. When biting a
person for its blood meal, an infected mosquito releases saliva containing dengue virus, once in the body the
virus infects the immune cells in the skin tissue and enters in the lymphatic system. The viral infection can
then trigger a strong inflammatory reaction. During the incubation period the virus first replicates locally
and then spreads in into the blood stream of the infected person. This is called viremia. For some patients the
virus can cause severe forms of the disease including dengue hemorrhagic fever. The blood vessels become
permeable resulting in plasma leakage. When a mosquito bites a person who already infected it draws in the
dengue virus contaminated in the blood.

White blood cell count decreases in Dengue

This is because of the following:

 Dengue suppresses bone marrow, which is the platelet-producing area, leading to decreased
platelet count.
 Blood cells affected by dengue virus damage platelets, leading to their drastic fall in numbers
 Antibodies produced in dengue also lead to massive destruction of platelets.

Erik Erikson’s Psychosocial Development

Identity vs. Role Confusion

Virtue: Fidelity

In this stage adolescent need to develop a sense of self and personal identity. Positive resolution leads to an
ability to stay true to self or may develop personal identity. While, Negative resolution leads to role
confusion and weak sense of self
 The patient is in this stage of psychosocial development wherein different physical body changes happens,
experiencing struggle for identity, breaking away from parents and very active socially. The patient’s
physical appearance may not be seen as appropriate to her age, she is not properly groomed and she doesn’t
practice proper hygiene. And the way the patient act may not be seen as appropriate to her age. The patient
tends to depend herself to her mother even on simple things and even on simple decision making. When it
comes on socializing, she can interact with other people but her attitude depends on the people she is
interacting to.

Interpretation: Negative Resolution

FREUD’S STAGES OF DEVELOPMENT

Believing that most human suffering is determined during childhood development, Freud placed
emphasis on the five stages of psychosexual development. As a child passes through these stages unresolved
conflicts between physical drives and social expectation may arise.

Stages of Development

 Oral (0 – 1.5 years of age): Fixation on all things oral. If not satisfactorily met there is the likelihood of
developing negative oral habits or behaviors.
 Anal (1.5 to 3 years of age): As indicated this stage is primarily related to developing healthy toilet training
habits.
 Phallic (3 – 5 year of age): The development of healthy substitutes for the sexual attraction boys and girls
have toward a parent of the opposite gender.
 Latency (5 – 12 years of age): The development of healthy dormant sexual feelings for the opposite sex.
 Genital (12 – adulthood): All tasks from the previous four stages are integrated into the mind allowing for
the onset of healthy sexual feelings and behaviors.
Interpretation to patient:

Being at the age of 16 years old the patient is at the Genital Stage, wherein this stage she already
have a malice feelings for the opposite sex and also she is capable to decide on her own behavior.

KOHLBERG’s MORAL DEVELOPMENT

Kohlberg became interested in Jean Piaget's theories of moral development in children and adolescents
while studying for his doctorate degree. His research involved studying American boys. Piaget's two stages
of moral development were the basis for Kohlberg's six stages. Kohlberg’s model for moral development
and moral reasoning, while similar to Piaget’s, is more complex. Kohlberg’s theory includes three levels of
moral reasoning. The three levels that Kohlberg described are Level 1: Pre-Conventional morality, Level 2:
Conventional Morality, and Level 3: Post-Conventional morality. Each of these levels are divided into two
stages, for a total of six stages.

Interpretation:

Patient’s cognitive reasoning is at the stage 3 whereas her decisions are more on based on approval of
others, like a typical kind of a teenager, she’s afraid of judgment. Mostly she will do good things for
her own image because of other people. The way she treats her mother and the way she communicate
with other people there’s a big difference, even if they’re that close as a parent daughter relationship

Piaget’s Stages of cognitive Development

Interpretaion:

The Patient is at the Formal Operational Stage whereas

She is more realistic about what she wants and doing something or some steps to
achieve it like her goals ad dreams in life. She has the ability to hypothesize, test and
reevaluate. She’s not that systematic but she has very abstract concepts like freedom,
love and confident
Laboratory results:

HEMATOLOGY

 CBC

Normal 9/13 9/14 9/15 9/16 9/17 9/18 9/19 9/20 9/21
Range
Hemoglobin 11.5-14.8 12.7 g/dL 11.6 12.1 11.4 11.3 10.4 10.3 10.8 10.7
Hematocrit 38.0-44.0 38.6 35.9 37.3 36.2 33.2 29.7 30.3 31.5 31.6
Total RBC 3.80-5.80 4.63 4.34 4.30 4.36 3.97 3.56 3.62 3.76 3.76
MCV 80.0-100.0 83.3 82.7 82.8 83 83.6 83.3 83.8 83.8 84
MCH 27.00-32.00 27.40 26.60 26.80 26.10 28.50 29.10 28.50 28.80 28.40
MCHC 32.0-36.0 32.9 32.2 32.4 31.5 34.1 34.9 34 34.3 33.8
RDW-CV 11.5-14.0 12.2 12.3 12.2 12.2 12.4 12.5 12.6 12.9 12.9
Total WBC 5.00-10.00 7.30 6.32 4.83 5.10 4.64 4.77 5.36 5.79 6.75
Neutrophils 35-65 61 68 63 69 75 67 74 67 69
Lymphocytes 19-48 31 23 33 21 21 25 18 24 23
Monocytes 3-10 5 8 4 3 4 8 7 7 7
Eosinophils 0-5 2 1 - 1 - - 1 2 1
Basophils 1 - - - - - - -
MPV 7.50 8.30 8.20 8.80 10.50 9.80 9.80 9.20 9.40
Platelet Count 150-450 268 244 213 202 233 216 240 239 245
PCT 0.12-0.36 0.20 0.20 0.17 0.17 0.24 0.21 0.24 0.22 0.23
PDW 8.10-25.00 54.00 54.90 54.80 55.80 16.10 16 16 15.60 15.70
High

Low

Clinical Microscopy

Urinalysis

MACROSCOPIC

Color - Yellow

Transparency - Clear

Protein - Negative

Sugar - Negative

pH - 6.0

Specific Gravity - 1.025

Blood - Negative

Nitrite - Negative

Urobilinogen - Negative
Ketones - Negative

Leukocytes - Negative

MICROSCOPIC

Pus Cells - 0-1 / HPF

RBC - 0-1 / HPF

Epithelial Cells - ++

Sodium Potassium

SODIUM - 131.00 mmol/L Normal: 136.00-145.00

POTASSIUM - 3.48 mmol/L Normal: 3.50-5.10

DENGUE DUO

Results

Dengue Ns1 Negative

Dengue IgG Reactive

Dengue IgM Reactive

DENGUE
- Is a fast emerging pandemic-prone viral disease.
- flourishes in urban poor areas suburbs and the countryside but also affects more affluent neighborhoods in tropical and subtropical
countries.
- mosquito-borne viral infection causing a severe flu-like illness.
- Severe dengue (previously known as dengue hemorrhagic fever) was first recognized in the 1950s
- during dengue epidemics in the Philippines and Thailand.
- Aedes aegypti mosquito is the main vector that transmits the viruses that cause dengue
- The viruses are passed on to humans through the bites of an infective female Aedes mosquito, which mainly acquires the virus while
feeding on the blood of an infected person.
Dengue IgG - presence of IgG-class antibodies to dengue virus is consistent with exposure to this virus sometime in the past.

Dengue IgM: Presence of igM-class antibodies to DV is consistent with acute-phase infection.

Interpretation:

It means that the patient had a dengue virus in the past and is currently onset for the virus in the present .

SGOT

Serum Glutamic-oxaloacetic Transaminase

Result Normal Values

09/14/19 SGOT(AST) - 32.00 U/L 15.00-37.00

09/17/19 SGOT(AST) - 51.00 U/L

SGOT test - Measures one of two liver enzymes.

Evaluates how much of the liver enzyme is in the blood.

Interpretation:

Since the patient has an onset dengue virus, it attacks the liver because of its enzymes that is why the result of her SGOT test
is high compared to normal values. She is at risk of having liver damage if treatment will not be continued.

TYPHIDOT

Results

T- IgG Non-Reactive

T - IgM Non-Reactive

Typhoid - is a bacterial infection that can lead to a high fever, diarrhea, and vomiting. It can be fatal. It is caused by the bacteria Salmonella
typhi. The infection is often passed on through contaminated food and drinking water, and it is more prevalent in places where handwashing
is less frequent. It can also be passed on by carriers who do not know they carry the bacteria.
Interpretation:

There’s no presense of salmonella typhi in the body and no history of having typhoid fever.
 NURSING CARE PLAN

Nursing Inference Plan of Intervention Rationale Evaluation

Diagnosis care
Self-care deficit Self-care deficit is After 1 -Determine the -Various etiological After 1 hour of
related to body an impaired hour of cause of self- factors may need nursing
weakness and ability to perform nursing care deficit. more explicit intervention the
discomforts as proper care and interventio interventions to patient was able
manifested by: hygiene for self. n the -Explain the enable self-care. to:
Discomforts and patient will importance of
Subjective: body weakness be able to: having proper -Having knowledge  Verbalize
“ayaw ko po may lead to Verbalized, hygiene about the importance d,
ipagalaw yung reduce in appreciate of proper hygiene is appreciat
buhok ko kasi psychomotor and have -Establish short important to convince e and
kumakati saka activity and poor initiative to term goal with the patient perform initiate to
sumasakit pag hygiene which perform the client the hygiene perform
ginagalaw” as can cause dirts proper proper
stated by the especially in hair hygiene. -Instruct the -Helping the patient hygiene.
client. and will lead to patient about with setting realistic
snarls and flakes simple0easy goals will reduce
Objective: on hair. way of doing frustration.
 Snarls proper hygiene.
and -Giving information
flakes on on simple/easy way
hair to perform hygiene
 No may encourage her to
initiative perform it.
to
perform
proper
 hygiene
 Weaken
and
discomfo
rts
 Nursing Inference Plan of Care Nursing Rationale Evaluation
Diagnosis Intervention

Hyperthermia Hyperthermia is At the 6 •Monitor the •Fever After the 6

related to a condition hours of the patient pattern may hours of the
presence of where an nursing temperature aids in nursing
illness individual's body intervention diagnosinig intervention
secondary to temperature is the patient underlying the patient
dengue elevated beyond will be able disease will be able
infection as normal due to to decrease to decrease
failed
manifested by the the
thermoregulation.
temperature •Chills often temperature
The person's
of the patient precede and go back
body produces or
Subjective: absorbs more •Observe for during high the
"nilagnat yan heat than it shaking and temperature temperature
kahapon dissipates chills to the normal
tapos ang taas range of 36.5
ng lagnat nya" – 37.4
•May help to
reduce fever.
Use of ice
•Provide
Objective: water and
tepid sponge
alcohol may
Increase in baths and
cause chills
body avoid the use
and can
temperature of ice water
elevate
above normal and alcohol
temperature
range T 39.1

Increase
respiratory •Used to
rate RR 30 reduce fever
by its central
Skin is flushed
action on the
and warm to hypothalamus
touch

Body •Administer
weakness anti-pyretics •to prevent
as prescribed dehydration
Presence of
and to
chills facilitate
decrease
temperature

•Encourage
increase fluid To treat the
intake presence of
infection

Administer
antibiotics as •to enhance
prescribed immune
system and
for faster
•Advise to recovery
eat healthy
food
especially
rich in
vitamin C
 Drug study
Generic Dosage Form/ Dosage & Specific Specific Mechanism of Contraindication Side effect Adverse effect Nursing
and Route and Stock dose classification Indication action Responsibilit
Brand Administration ies
name

PREVACI Tablet 15mg/30mg Antiulcerdrug For Inhibits proton •hypersensitivity •abdominal •constipation •for best
D abdominal pump activity pain effect,
oral pain by binding to instruct the
Lansopra hydrogen- •nausea patient to
zole potassium take drug 30
adenosine to 60 mins.
triphospates, Before
located at eating
secretory
surface of •teach
gastric parietal patient how
cells, to to take drug
suppress and
gastric acid alternative
secretion methods if
needed

•Assess if
there is a
sign of
abdominal
pain before
giving the
drug

•take
medicine as
prescribed
FLUIMUC Tablets 500mg/2.5g Mucolytics For dry Reduce the •hypersensitivity •fever •dyspnea •monitor
IL (effervescent cough viscosity of cough type
for oral pulmonary • •drowsiness •throat and
Acetylcys solution) secretions by tightness frequency
teine •chest
splitting
tightness •pruritus •Warn the
molecular
complexes. patient that
•tachycardia •urticaria
Also, restores drug may
liver stores of •nause have a foul
glutathione to taste or
treat •vomiting smell that
acetaminophen may be
toxicity distressing

•for
maximum
effect,
instruct the
patient to
cough to
clearly
airway
before
aerosol
administrati
on

advised
patient to
increase
fluid intake
to help
loosen
 secretion

BIOGESIC Tablet 325mg/500mg Antipyretic Fever Drug may •hypersensitivity •anxiety •hypertension •consult
relieve fever prescriber
Paraceta oral through central •For liver •fatigue •hypotension before giving
mol action in the disorder drugg
•headache •urticaria
hypothalamic
heat regulating •warn
•nausea •pruritus
center patient that
•vomiting high doses
long term
use we can
cause liver
damage

•tell the
patient not
to use when
fever higher
than 39.5

•advise to
increase
fluid intake

•take the
med as
prescribed

PNSS 1L IV fluid 1000ml Isotonic Make the Normal saline •heart failure •hypotension •febril Monitor
Intravenous person feel is a sterile, response patient
Sodium solution hydrated, nonpyrogenic •pulmonary
Chloride preventing solution for edema •infection at •Signs of
solution hypotension fluid and the site of infiltration
•renal injection
electrolyte
impairment •signs of
 replenishment •sodium •hypervolemia infection
retention
to treat •check the
mild correct
hyponatrem solution and
ia medication
volume

•Check and
regulate the
drop rate

PLR 1L IV fluid 1000ml Isotonic Lactated • allergic hypersensitivit Monitor

Intravenous extracellular Ringer's is a reactions, y, patient
Sodium solution fluid/electro sterile solution PLR
Lactate lyte for fluid and contraindicated Fever, Electrolytes •Signs of
replacemen electrolyte to patients infection at imbalance infiltration
t replenishment. known injection site (specially
hypersensitivity or redness hyperkalemia, •signs of
It restores fluid
(sodium lactate) and swelling hypercalcemia infection
and electrolyte
balances, from the site ),
•check the
produces of injection hypervolemia
correct
diuresis, and solution and
acts as medication
alkalizing agent volume
(reduces
acidity). •Check and
regulate the
drop rate

: to monitor
electrolytes
 levels

Generic Brand Name Route of Stock Classificatio Mechanism of Indication Contraind Side Adverse Drug to Drug to Nursing
Name Administr Dose n action ication Effects Effects drug food Responsibility
ation Interactio Interactio
n n
Azithromyci ZITHROMAX Oral 500mg/t Macrolides Azithromycin is Interstitia Contraind Diarrhea CNS: Antiarryht Any Food -Monitor
n ab used to treat l icated in Nausea fatigue,he hmics(am patient for
certain Pneumoni patients Vomiting adache iodarone) allerguc and
bacterial tis hypersens Stomach CV: chest ; may skin reactions
infection such itive to pain pain, increase -Tell patient t
as respiratory azithromy palpitatio risk of life take drug as
infection,it cin and in ns threateni prescribed
binds to the those ng even after
subunit of the with arrhythmi feeling better
bacterial history of as. -Take the dru
ribosome,thus cholestati before meal o
inhibits c 2 hrs after
translation of jaundice, meal to
MRNA. or hepatic prevent GI
dysfuncti iiritation.
on from
prior use.

Ciprofloxaci CIPROXIN Oral 250mg/t Flouroquin Ciprofloxacin is Nosocomi Contraind Stomach CNS: Calcium Dairy Monitor
n ab olones used to treat al icated in upset seizures carbonate products; patients intak
certain Pneumoni patients Diarrhea GU: . May may delay and output an
infection a hyoersens Headcahe crystalluri decrease peak drug observe
 caused by itive to a ciprofloca levels. patient for
bacteria such this drug. xin signs of
as absorptio crystalluria.
pneumonia,acti n and - Advise
ve against gram effects. patient to dri
(+) and gram (-) penty of fluid
bacteria,inhibit to reduce risk
s DNA gyrase of urine
and a type II, crystals.
topoisomerase
IV, necessary to
separate
bacterial DNA,
inhibits cell
division

Garlic;
reduce
Ibuprofen ADVIL Oral 200mg/t NSAID’S Ibuprofen is Fever,Hea Contraind Decrease CNS: Warfarin; blood Tell patient to
ab used to treat dache icated in d Headache may clotting take drug w/
mild to patients Appetite GI: increase ability, meals to
moderate pain, hypersens Diarrhea Abdomin risk of garlic reduce GI
fevre,inhbits itive to Mild al pain serious GI products irritation.
prostaglandin this drug. Itching GU: acute bleeding. can cause
syntheis to renal bleeding
providean ati- failure in rare
infammaory,an cases.
AMOCLAV Oral 625mg/t Aminopenic algesic,and Nosocomi Contraind Diarrhea
Coamoxiclav ab illins-beta anti-pyretic al icated in Skin rash CNS: Probeneci Tell patient to
lactamase effect. Pneumon patients Headache dizziness d; ma None take entire
inhibitors hypersens GI: increase quantity of
 itive to indigestio level of drug to exact
drug or n amoxicilli as prescribed
other n and even after
Co amoxivlav penicillins other feeling better
inhibits and in penicillins
bacterial cell those .
wall synrhesis, with a
it is used to history of
treat commnon amoxicilli
infectins such n-related
as respiratory or hepatic
infection. dysfuncti
on

Cefixime AMICEF Oral 200mg/t Cephalospo Cefixime is Nosocomi Contrainic Stomach Hypersen monoglyc None If large doses
ab rins used to treat al ated to upset sitivity oside;ma are
antibiotics certain Pneumoni patients Diarrhea reactions y increase given,theraph
bacterial s hypersens Nausea nephotoxi is prolonged ,
infection,such itive to city, patient is at
as respiratory drug or high
infection,inhibit other Warfairn; risk,monitor
s cell wall cephaloso may signs and
syntheis,promo rins.. increase symotoms og
ting ossmotic anticoagu bea.
instability, lation
usually effect.
bactericidal.

Vein
Sterofundin Intraveno 1L Isotonic Sterofundin is Replacem Contraind irritation Febrile Digitalis Monitor
us electrolyte used to correct ent of icated to Local pain response glycosides patient’s IV
solution extracellular extracellu patients or ; may insertion site
fluid losses of lar fluid hypersens reaction undergo to prevent
water and losses in itive to enhance extravasation
electrolyts. the case sterofund ment of
of in with their
isotonic high effects
dehydtari blood during
on, where calcium hyperkale
acidosis is level. mia and
present lead to
or serious or
imminent fatal
cardiac
arrythmia
.