Thursday, May 15, 2014
OBJECTIVES
General
This case presentation aims to identify and determine the general heath 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.
Specific
- To raise the level of awareness of patient on health problems that she may encounter.
- To facilitate patient in taking necessary actions to solve and prevent the identified problems on her own.
- To help patient in motivating her to continue the health care provided by the health workers.
- To render nursing care and information to patient through the application of the nursing skills.
Dengue fever is an infectious disease carried by mosquitoes and caused by any of four related dengue viruses. This disease used to be called “break-bone” fever because it sometimes causes severe joint and muscle pain that feels like bones are breaking, hence the name. Health experts have known about dengue fever for more than 200 years.
INTRODUCTION
Dengue fever is found mostly during and shortly after the rainy season in tropical and subtropical areas of
- Africa
- Southeast Asia and China
- India
- Middle East
- Caribbean and Central and South America
- Australia and the South and Central Pacific
An epidemic in Hawaii in 2001 is a reminder that many states in the United States are susceptible to dengue epidemics because they harbor the particular types of mosquitoes that transmit it. Worldwide, more than 100 million cases of dengue infection occur each year. This includes 100 to 200 cases reported annually to the Centers for Disease Control and Prevention (CDC), mostly in people who have recently traveled abroad. Many more cases likely go unreported because some health care providers do not recognize the disease. During the last part of the 20th century, many tropical regions of the world saw an increase in dengue cases. Epidemics also occurred more frequently and with more severity. In addition to typical dengue, dengue hemorrhagic fever and dengue shock syndrome also have increased in many parts of the world.
Dengue fever can be caused by any one of four types of dengue virus: DEN-1, DEN-2, DEN-3, and DEN-4. You can be infected by at least two, if not all four types at different times during your lifetime, but only once by the same type.
You can get dengue virus infections from the bite of an infected Aedes mosquito. Mosquitoes become infected when they bite infected humans, and later transmit infection to other people they bite. Two main species of mosquito, Aedes aegypti and Aedes albopictus, have been responsible for all cases of dengue transmitted in this country. Dengue is not contagious from person to person.
Symptoms of typical uncomplicated (classic) dengue usually start with fever within 5 to 6 days after you have been bitten by an infected mosquito and include
- High fever, up to 105 degrees Fahrenheit
- Severe headache
- Retro-orbital (behind the eye) pain
- Severe joint and muscle pain
- Nausea and vomiting
- Rash
The rash may appear over most of your body 3 to 4 days after the fever begins. You may get a second rash later in the disease. Symptoms of dengue hemorrhagic fever include all of the symptoms of classic dengue plus
- Marked damage to blood and lymph vessels
- Bleeding from the nose, gums, or under the skin, causing purplish bruises
This form of dengue disease can cause death.
Symptoms of dengue shock syndrome-the most severe form of dengue disease-include all of the symptoms of classic dengue and dengue hemorrhagic fever, plus
- Fluids leaking outside of blood vessels
- Massive bleeding
- Shock (very low blood preasure)
This form of the disease usually occurs in children (sometimes adults) experiencing their second dengue infection. It is sometimes fatal, especially in children and young adults.
NURSING ASSESSMENT
Present Health History
The present health history started 8 days ago prior to admission. The patient had a sudden onset of headache; no medication and consultation to the doctor was done. Few days prior to admission,the patient had high grade fever at 42°C accompanied with throbbing headache. She self-medicated with equaline 1000mg TID and afforded temporary relief. Due to persistence of the said signs and symptoms, the patient seek consultation and hence admitted at East Avenue Medical Center with Dr. Rivera as attending physician. She was admitted last September 20 at around 12:30 am. On September 23 at 11:25pm, she was transferred from Ward I to Female Surgical Ward.
Past Health History
Prior to her hospitalization at East Avenue Medical Center, she denies in having any record or medical history of being admitted due to trauma, accident and disease. She also denies having allergies to food and drugs. She says that she is allergic to dust and particles.
Family Health History
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 patient’s knowledge.
Review of Systems
Psychosocial
Psychosocial
Being the eldest among six children, she considers herself as an active individual who is fond of interacting with other people. She considers herself as friendly even at home and at work.
Elimination
Her elimination pattern has somehow deviated from her usual urine and stool elimination. Before her confinement, she usually urinates for 7 times a day and defecates at least 2 times per day. During her confinement, she now urinates 5 times a day and defecates 3 times a day. According to her the variation from her elimination pattern is due to change in appetite and setting.
Rest & Activity
A typical day to her would be waking up at around 3:00 am to do her responsibilities such as cleaning the house and attending to her boss’ business. She had no time take naps in the afternoon but rather sleeps at around 11 o’clock in the evening. During her confinement, she was able to rest and have enough sleep as well. During her leisure time before confinement, she usually reads magazines and newspaper to get updated with the current events. She is not allowed to go out and have her day off on Sundays because her bosses are always busy and usually does not stay home.
Safety
She usually stays home during her stay with her boss’ house. There is no physical threat for her safety. Unfortunately, the vector-borne disease affected her and almost cost her life.
Oxygenation
According to her, before and during her confinement she had no difficulty in breathing and ventilation.
Nutrition
According to her, she eats moderately. She often eats fish and vegetables, she only eats meat every once a week. She admits that she drinks plenty of water and gets herself well-hydrated.
MEDICAL & SURGICAL MANAGEMENT
Dengue fever can be diagnosed by doing two blood tests, 2 to 3 weeks apart. The tests can show whether a sample of your blood contains antibodies to the virus. In epidemics, a health care provider often can diagnose dengue by typical signs and symptoms.
There is no specific treatment for classic dengue fever, and like most people you will recover completely within 2 weeks. To help with recovery, health care experts recommend
- Getting plenty of bed rest
- Drinking lots of fluids
- Taking medicine to reduce fever
Often health care provider advises people with dengue fever not to take aspirin. Acetaminophen or other over-the-counter pain-reducing medicines are safe for most people. For severe dengue symptoms, including shock and coma, early and aggressive emergency treatment with fluid and electrolyte replacement can be lifesaving.
The best way to prevent dengue fever is to take special precautions to avoid contact with mosquitoes. Several dengue vaccines are being developed, but none is likely to be licensed by the Food and Drug Administration in the next few years.
When outdoors in an area where dengue fever has been found
- Use a mosquito repellant containing DEET, picaridin, or oil of lemon eucalyptus
- Dress in protective clothing-long-sleeved shirts, long pants, socks, and shoes
Because Aedes mosquitoes usually bite during the day, be sure to use precautions especially during early morning hours before daybreak and in the late afternoon before dark.
Other precautions include
- Keeping unscreened windows and doors closed
- Keeping window and door screens repaired
- Getting rid of areas where mosquitoes breed, such as standing water in flower pots, containers, birdbaths, discarded tires, etc.
Most people who develop dengue fever recover completely within 2 weeks. Some, however, may go through several weeks to months of feeling tired and/or depressed. Scientists supported by the National Institute of Allergy and Infectious Diseases (NIAID) are trying various approaches to develop vaccines against dengue. Researchers in NIAID laboratories in Bethesda, Maryland, are using weakened and harmless versions of dengue viruses as potential vaccine candidates against dengue and related viruses. Other NIAID-funded investigators are trying to develop dengue virus vaccines using recombinant proteins (with or without adjuvants), viral vectors, and DNA. Several projects are currently ongoing to identify the host and viral factors that determine the virulence and transmissibility of different dengue virus strains. Other researchers supported by NIAID are investigating ways to treat infected individuals and to prevent dengue viruses from reproducing inside mosquitoes.
Although dengue virus has emerged as a growing global threat, scientists know little about how the virus infects cells and causes disease. New research is beginning to shed light on how the virus interacts with humans-how it damages cells and how the human immune system responds to dengue virus invasion.
DISCHARGE PLAN
M – edication
Intake of appropriate vitamin supplement and diuretics to increase protection mechanism of the immune system and decreases renal vascular resistance and may increase renal blood flow, respectively.
E – conomic
The use of nonpharmacotherapy such as drinking plenty of water will promote increase plasma in blood to increase immunity and proper hygiene and promotion of cleanliness at home and work area.
T – reatment
Management of such condition would be through hydration and doing control measures to eliminate vector by promoting cleanliness in the environment through proper disposal of rubber tires, changing of water of lower vases once a week, destruction of breeding places of mosquito and residual spraying with insecticides.
H – ygiene
Advise to follow proper body hygiene and to maintain cleanliness on surroundings. This would prevent additional cases of DHF.
O – ut Patient/ Follow-up
Any odd signs such as fever, petechiae, recurrence of fever,etc. must be immediately reported to the physician.
D – iet
Instruct to eat foods that are low fat, low fiber, non-irritating and non-carbonated.
EVALUATION
CONCLUSION
The patient in this study had undergone supportive and symptomatic management. She was admitted last September 20, and was transferred from Ward 1 to the Female Medical Ward last September 23.
Proper nursing care such as water therapy and administration of prescribed drugs were done to promote comfort and repression of symptoms. Hygiene was also strictly implemented to avoid risk for further infection. Nursing assistance was also given to help him in his activities of daily living.
Health teaching is a very important role on the part of the nurses. This is of great significance to the knowledge deficit of patients regarding health and illness.
Recommendation
Strict compliance to the medical treatment, health teachings and medical check-up is advised. With proper nutrition and conformity to the medications & therapy, recovery would be easier and faster.
