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INTRODUCTION

We live in our world today where everything seems to be in a fast face. As

it is, we cannot deny that things change over or in a certain period of time. New
technologies were being invented, clothes for fashion, jewelries, luxuries mode of
entertainment, etc. It’s just like having a new mode of socialization, cultures,
beliefs, perceptions, adaptation to life and environment. With all of these, one
aspect of human being which are greatly affected and the one which we have to
be most concern of would be in the side of our health and wellbeing.
In the Philippines there are many diseases illness arising because of
environmental changes that may be caused by human activities and geographical
conditions. It is considered as one of the tropical countries and so disease can
spread throughout the country (Wilson, M.L, 2001).
One example of these disease is what we called Dengue fever it is an acute
febrile disease caused by one of several closely related viruses transmitted to
humans by mosquitoes, and characterized by high fever (which reoccurs after a
pause), headache, chills, eye pain, rash, and extreme muscle and joint pain.
Dengue hemorrhagic fever (DHF) is a more severe illness that occurs when
someone is reinfected with the virus after having recovered from an earlier
incidence of dengue fever and the immune system overreacts (Carson-DeWitt
2004). Dengue shock syndrome (DSS) is largely a complication of DHF (Pham et
al. 2007). Dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) is a
leading cause of hospitalization and death among children (Kouri et al. 1989).
Moreover, Halstead SB, 2007 described DHF/DSS is characterized by
thrombocytopenia, with the resultant hemorrhagic manifestations; in addition,
there is increased vascular permeability, resulting in depleted intravascular volume
and shock. Severe, profound shock is known to occur in extreme cases and is
associated with high mortality.
WHO 2013 defined and described the features of dengue hemorrhagic fever
by the following:
 Fever, or history of acute fever, lasting 2–7 days, occasionally biphasic
 Hemorrhagic tendencies, evidenced by at least one of the following
 A positive tourniquet test
 Petechiae, ecchymoses, or purpura
 Bleeding from the mucosa, gastrointestinal tract, injection sites, or other
locations
 Hematemesis or melena
 Thrombocytopenia (100000/mm3 or less)
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 Evidence of plasma leakage due to increased vascular permeability,

manifested by at least one of the following;
a. A rise in hematocrit ≥20% above the average for age, sex and
population
b. A drop-in hematocrit following volume replacement equal to or
greater than 20% of the baseline
c. Signs of plasma leakage such as pleural effusion, ascites or
hypoproteinemia

The factors which place patients at higher risk of developing dengue shock
are not clearly identified yet. DHF/DSS is more likely to occur in children and the
elderly. Dengue infection also appears to be more severe in females. Severe
dengue is more likely to occur in patients with chronic illness such as diabetes
mellitus or asthma. Although malnutrition predisposes to many infectious diseases
it does not appear to increase the likelihood of severe dengue (Chang JM, 2008).
The mainstay of treatment is timely supportive therapy to tackle circulatory
shock due to hemoconcentration and bleeding. Close monitoring of vital signs in
the critical period. Oral rehydration therapy is recommended to prevent
dehydration in moderate to severe cases. Supplementation with intravenous fluids
may be necessary to prevent dehydration and significant concentration of the
blood if the patient is unable to maintain oral intake. A platelet transfusion may be
indicated if the platelet level drops significantly or if there is significant bleeding.
The presence of melena may indicate internal gastrointestinal bleeding requiring
platelet and/or red blood cell transfusion. Aspirin and non-steroidal anti-
inflammatory drugs should be avoided as these may worsen the bleeding tendency
associated with some of these infections. Patients may receive paracetamol,
acetaminophen and preparation to deal with these symptoms if dengue is
suspected (Dung NM, 2009.

The WHO says 2.5 billion people, are now at risk from dengue and
estimates that there may be 50 million cases of dengue infection worldwide every
year. All persons are susceptible and both sexes are equally affected. Dengue
Fever is sporadic throughout the year. Epidemic usually occurs during rainy
seasons (June-November) peak months are September-October.

This case study which primarily talks about Dengue Shock Syndrome is
directed towards presenting this disease, the management and intervention and
the other vital facts that remain in oblivion to the great number of populations of
this country.
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Considering that the Dengue Fever truly and evidently has a devastating
impact of our nation’s health. The respondents have regarded this study significant
to the fields of nursing education practice and research because the completion of
this study does not only meet the terms of dissemination information purposes, but
sensible learning as well.
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OBJECTIVES OF THE STUDY

General:

This case presentation aims to identify and determine the general health
problems and needs of the patient with an admitting diagnosis of Dengue Fever
that lead to Dengue Shock Syndrome. This study also intends to help promote
health and medical understanding of such condition through the application of the
nursing skills.

The proponents have formulated the following Specific Objectives to guide

the proponents towards the completion of this case study.

Knowledge:

 Enhance knowledge and acquire more information about Dengue Fever

 Give an idea of how to render proper nursing care for clients with this
condition thus it can be applied for future exposures of student
 Gather the needed data that can help to understand how and why the
disease occurs
 Identify laboratory and diagnostic studies used in Dengue Fever
 Enumerate the clinical manifestations of the disease so as to provide
prompt intervention of its occurrence

Skills:

 Select a relevant subject for the proponents’ case study

 Collect data regarding the past and present history of the patient
 Perform physical assessment to the patient systematically
 Determine and discuss the anatomy and physiology of the body systems
involved
 Share knowledge and skills to the chosen patient
 Educate the client and family regarding the importance of environmental
sanitation
 Provide significant health teachings that would promote the patient’s health
and wellness
 Implement nursing care plans appropriately

Attitude:

 Establish a good interpersonal and professional relationships with the

patient and his accompanying family member
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 Develop awareness of the needs and emotions of the patient and his family
 Exhibit culturally sensitive approach to the patient when dealing with their
own opinions and ideas
 Appreciate the manifestations of the patient’s signs and symptoms to the
underlying pathophysiologic process
 Observe confidentiality on patient’s data and
 Develop sensitive attitude and open – mindedness to listen any criticism
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REASON FOR CHOOSING THIS CASE

The proponents chose this case of Ms. Deng, a 5 years old female a client
in Intensive Care Unit at Bukidnon Provincial Hospital last September 19, 2018.
She was initially diagnosed with Dengue Shock Syndrome with a chief complaint
of fever upon admission. The proponents decided to study and present this case
due to that the case of Ms. Deng made very interesting and it was related to the
proponents’ recent concept NCM 67.1: Care of Client with Problem in Cellular
Aberration, Acute Biologic Crises Including Emergency and Disaster Nursing.
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Theoretical Framework

The first theory that needs to be taken account, Florence

Nightingale’s Environmental theory. He linked health with five environmental
factors; pure or fresh air, pure water, efficient drainage, cleanliness and light,
especially the sunlight. This theory was applied in order to assess the following
environmental factors that needs to be improved to minimize the possibility of
worsening the patient’s condition. Nightingale said that a healthy environment is
essential for healing. Since our chosen patient has a poor immunity which makes
him prone to diseases and infections and these things are usually acquired from
the environment. We focused on altering the patient’s environment in order to help
him attain optimum state of wellness. The usually breeding site occurs in the
environment.

Another theory used was the theory of Virginia Henderson where she
defines nursing to assist the individual in the performance of those activities
contributing to health and its recovery that he would perform unaided if he had the
necessary strength, will or knowledge. The following are some of the components
of Basic Nursing Care that is needed for us to understand and help our chosen
patient and its family to gain independence specially of obtaining the following;
Breathe normally, Eat and drink adequately, eliminate body wastes, Sleep and
rest, select suitable clothes, maintain body temperature, keep body clean and well
groomed, avoid dangers in environment and avoid injuring others. And this aspect
is important in attaining the optimum level of wellness.