Introduction

We agreed to choose Dengue Fever as our case study to be presented in this case presentation. We chose this as our subject because it is timely and during this time there are many people suffering this disease so we need to be equipped, equipped with the knowledge and skills that could truly help us, patients in the ward and the people in our community.

Through this study we will be able to identify the etiology of the disease, the factors that can contribute to the spread of the disease, the precautions and health teachings that we can give to our patients before, during and after the occurrence of the disease. With this knowledge, as a student we can now face the horror of this disease, we are well established and confident on the interventions that we can offer to the clients so we can give the best of care that they deserve and we as students can simply save lives, life that is a gift from God , life that we should treasure.

As future nurses we will be touching life with our own hands as of now we re only at the glimpse of a miles away journey. We still have a lot of learning s to learn to be prepared on the real battle field on the real world. Learning should always start with us and it doesn t only stay in our mind but also with our heart.

Patient s Profile
Name: J.M Age: 24 Gender: Male Address: San Jose, Bian Laguna Birthday: Birthplace: Marawi, Mindanao Religious orientation: Fil-Muslim Civil status: Married Occupation: Businessman AP: Chief complaint: High grade fever Admission diagnosis: Dengue fever Date of admission: September 20, 2010 History of present illness: Patient came to E.R with complaints of high grade fever and abdominal pain in the RUQ. Relatives gave paracetamol at home and reported no changes in temperature. Rashes are noted on upper extremities. Doctor ordered CBC and platelet count. Results showed low Hct and Platelet count hence advised admission.

ANATOMY AND PHYSIOLOGY

BLOOD Blood is considered the essence of life because the uncontrolled loss of it can result to death. Blood is a type of connective tissue, consisting of cells and cell fragments surrounded by a liquid matrix which circulates through the heart and blood vessels. The cells and cell fragments are formed elements and the liquid is plasma. Blood makes about 8% of total weight of the body. Functions of Blood: >transports gases, nutrients, waste products, and hormones >involve in regulation of homeostasis and the maintenance of PH, body temperature, fluid balance, and electrolyte levels >protects against diseases and blood loss

PLASMA Plasma is a pale yellow fluid that accounts for over half of the total blood volume. It consists of 92% water and 8% suspended or dissolved substances such as proteins, ions, nutrients, gases, waste products, and regulatory substances. Plasma volume remains relatively constant. Normally, water intake through the GIT closely matches water loss through the kidneys, lungs, GIT and skin. The suspended and dissolved substances come from the liver, kidneys, intestines, endocrine glands, and immune tissues as spleen.

Formed elements
Cell type
Erythrocytes (RBC)

Description
Biconcave disk, no nucleus, 7- 8 micrometers in diameter

Function
Transport oxygen and carbon dioxide

Leukocytes (WBC) Neutrophil Spherical cell, nucleus with two or more lobes connected by thin filaments, cytoplasmic granules stain a light pink or reddish purple, 12-15 micrometers in diameter Spherical cell, nucleus, with two indistinct lobes, cytoplasmic granules stain blue-purple, 10-12 micrometers in diameter Spherical cell, nucleus often bilobed, cytoplasmic granules satin orange-red or bright red, 10-12 micrometers in diameter Spherical cell with round nucleus, cytoplasm forms a thin ring around the nucleus, 6-8 micrometers in diameter Phagocytizes microorganism

Basophil

Releases histamine, which promotes inflammation, and heparin which prevents clot formation

Eosinophil

Releases chemical that reduce inflammation, attacks certain worm parasites

Lymphocyte

Produces antibodies and other chemicals responsible for destroying microorganisms, responsible for allergic reactions, graft rejection, tumor control, and regulationof the immune system Phagocytic cell in the blood leaves the circulatory system and becomes a macrophage which phagocytises bacteria, dead cells, cell fragments, and debris within tissues

Monocyte

Spherical or irregular cell, nucleus round or kidney or horse-shoe shaped, contain more cytoplasm than lymphocyte, 10-15 micrometers in diameter

Platelet

Cell fragments surrounded by a cell membrane and containing granules, 2-5 micrometers in diameter

Forms platelet plugs, release chemicals necessary for blood clotting

PREVENTING BLOOD LOSS When a blood vessel is damaged, blood can leak into other tissues and interfere with the normal tissue function or blood can be lost from the body. Small amounts of blood from the body can be tolerated but new blood must be produced to replace the loss blood. If large amounts of blood are lost, death can occur.

BLOOD CLOTTING Platelet plugs alone are not sufficient to close large tears or cults in blood vessels. When a blood vessel is severely damaged, blood clotting or coagulation results in the formation of a clot. A clot is a network of threadlike protein fibers called fibrin, which traps blood cells, platelets and fluids. The formation of a blood clot depends on a number of proteins found within plasma called clotting factors. Normally the clotting factors are inactive and do not cause clotting. Following injury however, the clotting factors are activated to produce a clot. This is a complex process involving chemical reactions, but it can be summarized in 3 main stages; the chemical reactions can be stated in two ways: just as with platelets, the contact of inactive clotting factors with exposed connective tissue can result in their activation. Chemicals released from injured tissues can also cause activation of clotting factors. After the initial clotting factors are activated, they in turn activate other clotting factors. A series of reactions results in which each clotting factor activates the next clotting factor in the series until the clotting factor prothrombin activator is formed. Prothrombin activator acts on an inactive clotting factor called prothrombin. Prothrombin is converted to its active form called thrombin. Thrombin converts the inactive clotting factor fibrinogen into its active form, fibrin. The fibrin threads form a network which traps blood cells and platelets and forms the clots. CONTROL OF CLOT FORMATION Without control, clotting would spread from the point of its initiation throughout the entire circulatory system. To prevent unwanted clotting, the blood contains several anticoagulants which prevent clotting factors from forming clots. Normally there are enough anticoagulants in the blood to prevent clot formation. At the injury site, however, the stimulation for activating clotting factors is very strong. So many clotting factors are activated that the anticoagulants no longer can prevent a clot from forming. CLOT RETRACTION AND DISSOLUTION After a clot has formed, it begins to condense into a denser compact structure by a process known as clot retraction. Serum, which is plasma without its clotting factors, is squeezed out of the clot during clot retraction. Consolidation of the clot pulls the edges of probability of infection and enhancing healing. The damaged vessel is repaired by the movement of fibroblasts into damage area and the formation of the new connective tissue. In addition, epithelial cells around the wound divide and fill in the torn area.

The clot is dissolved by a process called fibrinolysis. An inactive plasma protein called plasminogen is converted to its active form, which is called plasmin. Thrombin and other clotting factors activated during clot formation, or tissue plasminogen activator released from surrounding tissues, stimulate the conversion of plasminogen to plasmin. Over a period of a few days the plasmin slowly breaks down the fibrin.

Saint Michael s College of Laguna Old National Road, Binan , Laguna

Case Study
Dengue Fever
FERNANDEZ, Jeffrey GRAJO, Emir- Chiesa BSN III Group 3