Case Presentation:
Dengue
PRESENTED BY:
Bacaoco, Llanica Mariae
Chung, Anne Margarette Claire
De Asis, Maireen
Patient information
Patient Initial: J.P
LATEST VS:
Age: 29 years old
BP: 120/80
Chief complaint:
RR: 20
Body Malaise, Fever
PR: 90
Diagnosis: Dengue
Temp: 36.9
Fever with warning
O2: 97%
signs
Health & Medical
History
Patient J.P is a 20 y..o mal experienced fever for 5 days
that was not relieved by paracetamol, additionally he
also complained of body malaise that led him to be
admitted into the ER and transferred in the ward. The
patient has no history of allergies, cigarette use but
occasionally consumes alcohol.
Signs and
Symptoms
1. Febrile Phase (Days 1-3)
Sudden high fever (≥40°C/104°F)
Severe headache and pain behind the eyes
Muscle, joint, and bone pain ("breakbone fever")
Nausea, vomiting, and appetite loss
Skin flushing or mild rash
Mild bleeding (nose or gums)
2. Critical Phase (Days 4-6)
Fever subsides, but condition worsens
Severe abdominal pain
Persistent vomiting
Rapid breathing or difficulty breathing
Bleeding tendencies (gums, nose, or internal bleeding)
Fluid accumulation (chest or abdomen)
Signs of shock (cold, clammy skin, low blood pressure)
:
Signs and
Symptoms
3. Recovery Phase (Days 7-10)
Gradual return of appetite
Rash (may appear or worsen)
Fatigue and body aches slowly improve
Fluid reabsorption, leading to swelling
In severe cases (Dengue Hemorrhagic Fever):
Severe abdominal pain.
Persistent vomiting.
Bleeding (internal or external).
Difficulty breathing.
Risk Factors
1. Living in or traveling to endemic
areas
2. Previous dengue infection
3. Mosquito exposure
4. Lack of vector control
5. Urbanization and overcrowding
6. Age (children and older adults)
7. Weakened immune system
Definition
Dengue is a viral infection that spreads
from mosquitoes to people. It is more
common in tropical and subtropical
climates. While many dengue infections
are asymptomatic or produce only mild
illness, the virus can occasionally cause
more severe cases, and even death.
Prevention and control of dengue depend
on vector control. There is no specific
treatment for dengue/severe dengue, and
early detection and access to proper
medical care greatly lower fatality rates of
severe dengue.
Pathophysiology
Pathophysiology
Diagnostic Tests &
Laboratory Findings
Diagnostic Tests:
NS1 Antigen Test
>Used to detect dengue virus early
(1–7 days after fever onset)
>Positive result confirms the
presence of the virus.
• IgM/IgG Antibody Test: o IgM
>Detectable from days 5–7, peaks in
2 weeks, indicates recent infection.
>IgG: Appears later, indicating past
infection or secondary dengue.
Diagnostic Tests &
Laboratory Findings
• RT-PCR
> Confirms viral RNA and identifies the
specific serotype (DENV-1 to DENV-4).
> Critical for epidemiological tracking.
Laboratory Findings:
• Complete Blood Count (CBC):
1. Leukopenia: WBC < 5,000/mm³
2. Thrombocytopenia: Platelet count <
100,000/mm³ (critical phase
hallmark).
Diagnostic Tests &
Laboratory Findings
3. Hemoconcentration: Hematocrit > 20% above
baseline due to plasma leakage.
• Liver Function Tests (LFTs):
1. Elevated ALT (>45 U/L) and AST (>45 U/L)
indicate liver damage.
2. Coagulation Profile: o Prolonged PT (>14
seconds) and aPTT (>40 seconds) in severe
cases.
3. Electrolytes: o Hyponatremia (<135 mEq/L)
due to plasma leakage or hemodilution. •
Urinalysis: o May show proteinuria in severe
plasma leakage.
Diagnostic Tests &
Laboratory Findings
Laboratory Findings
1. Complete Blood Count (CBC):
Leukopenia: Decreased WBC count.
Thrombocytopenia: Platelet count <
150,000/mm³, significant in the critical phase.
Hemoconcentration: Elevated hematocrit
(>20% rise) suggests plasma leakage.
2. Liver Function Tests (LFTs): Elevated ALT and AST
levels due to liver involvement.
3. Serum Electrolytes: Potential imbalances like
hyponatremia.
4. Coagulation Studies: Prolonged PT and aPTT in
severe case
Medical Management
1. Supportive and Symptomatic Treatment
Hydration Therapy:
▪ Oral Rehydration Solutions (ORS) for mild dehydration.
▪ IV fluids (e.g., Ringer’s lactate or isotonic saline) for
moderate/severe dehydration or when oral intake is
insufficient.
2. Medications:
Paracetamol: For fever and pain management (maximum
4g/day; avoid NSAIDs).
Ursodeoxycholic Acid (UDCA): Protects liver function by
promoting bile flow and reducing liver inflammation. Often
indicated if transaminitis is present.
Omeprazole: Proton pump inhibitor (PPI) to prevent or
manage gastric irritation, particularly in patients with a
history of gastritis or high risk of gastrointestinal bleeding.
Medical Management
Bifilac (Probiotic): Maintains gut integrity, restores
normal intestinal flora, and reduces diarrhea severity if
present.
Norgesic Forte (Paracetamol + Orphenadrine): Used to
manage muscle pain or spasms. Ensure proper platelet
count before prescribing to minimize bleeding risks.
3. Other Interventions:
Blood Component Therapy: Platelet transfusion or fresh
frozen plasma for patients with active bleeding or
profound thrombocytopenia.
Oxygen Therapy: For patients in respiratory distress or
hypoxia.
Nursing management
1. Comprehensive Assessment and Monitoring
• Monitor Vital Signs: Every 1–2 hours, focusing on blood pressure, heart
rate, and temperature.
• Shock Indicators: Assess for cold extremities, prolonged capillary refill
time, or narrowed pulse pressure.
• Bleeding Signs: Check for petechiae, gum bleeding, epistaxis, or
gastrointestinal bleeding (black tarry stools, hematemesis).
• Neurological Status: Watch for signs of irritability, confusion, or
lethargy, which may indicate worsening disease or dehydration.
2. Hydration Management
• Administer IV fluids as prescribed, ensuring accurate flow rates to
avoid fluid overload
.• Encourage oral fluid intake (coconut water, soup, ORS) when
possible.
3. Skin and Mucosal Care
• Apply cold compresses for fever relief instead of sponge baths
Nursing management
. • Use a soft-bristled toothbrush to minimize gum trauma. • Protect the
skin by keeping it clean and dry, and apply emollients to prevent
dryness or cracks.
4. Gastrointestinal and Liver Care
• Administer UDCA and omeprazole as prescribed, ensuring proper
timing (e.g., omeprazole before meals)
.• Monitor for abdominal pain, nausea, or vomiting, which could
indicate worsening liver or gastrointestinal involvement
.• Provide a bland diet, avoiding spicy or fatty foods to reduce gastric
irritation.
5. Pain and Comfort Management
• Administer Norgesic Forte as prescribed, ensuring it is well-tolerated.
• Position the patient in a comfortable semi-Fowler’s position to relieve
muscle pain and ease breathing.
• Provide non-pharmacological measures like warm compresses for
muscle relaxation if pain persists
Nursing management
6. Laboratory and Diagnostic Follow-Up
• Collect daily CBC to track trends in hematocrit and platelet counts.
• Monitor LFT results for any worsening liver involvement
• Observe electrolyte levels and manage any imbalances (e.g.,
replace potassium for hypokalemia).
7. Psychological Support
• Reassure the patient and family about the progression of the
disease.
• Educate them on the expected recovery phases: febrile, critical, and
recovery phases.
8. Health Education and Discharge Planning
• Hydration: Continue oral rehydration at home.
• Warning Signs: Teach the family to identify red flags like severe
abdominal pain, persistent vomiting, bleeding, or confusion and seek
immediate medical attention.
Nursing management
• Infection Prevention:
Use bed nets or insect repellent at home. o
Remove stagnant water around the household to
prevent mosquito breeding.
Medication Adherence: o Emphasize taking
prescribed medications (e.g., UDCA, omeprazole,
Bifilac) as directed.
Follow-Up: Encourage follow-up consultation for
repeat blood tests and clinical evaluation
Thank You For
Listening
