INTERVENTIONS:
INDEPENDENT:
- Monitor vital signs
- Assess patient's skin turgor
- Routinely assess IV site condition.
- Monitor patient's I & O
Car e o f Pat i e nt s w / De ng u e
Sho c k Sy ndr o me & Se v e r e
De hy dr at i o n
Risk Factors:
- Presence of mosquito
vector breeding sites.
- Urbanization
- Living or traveling in
tropical areas
Case Scenario:
A 30-year old female presented to the local distric hospital
with a 6-day history of continuous fever and petechial rash
PTA. She became more ill during her 3rd day of
hospitalization with persistent bouts of severe vomiting;
verbalized abdominal pain; lightheadedness; blurred
vision; and reduced, dark-colored urine output. Upon
interview, the patient mentioned that she had a prior
experience of having a dengue fever, the previous year.
COLLABORATIVE:
- Encourage patient to increase fluid
intake
DEPENDENT:
- Administer
acetaminophen/paracetamol as
prescribed by the physician.
Severe dehydration as evidenced by
reduced, dark-colored urine; poor
capillary refill time and poor skin
turgor
Virus penetrates the
skin
Acute pain as evidenced by
patient verbalization
INTERVENTIONS:
Antigen Presenting
Cell (APC) takes up
the Virus
Vital signs:
- BP - 80/50 mmHg (Average Normal BP: 120/80 mmHg)
- T - 37°C
- PR - 120 bpm (Normal: 60-100 bpm)
- RR - 36 cpm (Normal: 16-20 cpm)
Virus replicates inside
the APC causing it to
mature
Virus travels to the
blood stream
PA Findings:
- Capillary refill time - 4-5 secs (Normal: <3 secs)
- Poor skin turgor
- Notable petechial rash over her antecubital fossa
Laboratory Values:
CBC:
- Hematocrit - 57% (Normal - 36-48%)
- Hemoglobin - 11.8 g/dL (Normal - 12.1-15.1 g/dL)
- RBC - 4 M cells/mcL (Normal - 4.2-5.4 M cells/mcL)
- WBC - 4,000 cells/mcL (Normal - 4,500-11,000 cells/mcL)
- Platelets - 90 T/mcL (Normal - 150-450 T/mcL)
INDEPENDENT:
- Provide non-pharmacologic pain
management
- Accept and acknowledge the
patient's pain
DEPENDENT:
- Start IV therapy for fluid and
electrolyte resuscitation as
prescribed by the physician.
Bite of an infected
female Aedes
Aegypti mosquito
INTERVENTIONS:
Attacks the bone
marrow
??
RBCs
??
WBCs
Enters a receptive
lymphatic vessel and
travels through the
lymp node.
INDEPENDENT:
- Monitor vital signs
- Assess patient's skin turgor
- Routinely assess IV site condition.
- Monitor patient's I & O
Persistent
severe
vomiting
DEPENDENT:
- Start IV therapy for fluid
resuscitation as prescribed by the
physician.
Severe
dehydration
Ascites
Poor
capillary
refill (4-5
secs)
Poor skin
turgor
Reduced,
dark-colored
urine
output
Decrease blood volume r/t inadequate
plasma in the blood
??
PR (120 bpm);
??
Bp (80/50)
??
RR (36 cpm)
Mature APC attracts
and activates T cells
T cells react and
secret
pro-inflammatory
molecules
acetaminophen/paracetamol
Ultrasound
??
Platelets
- Dengue NS1 test - Positive
- Dengue Duo test - Positive
- X-ray Impression - Right-sided pleural effusion
Abdominal
pain
Pro-inflammatory
molecules enters the
bloodstream to help
eliminate the virus
Pro-inflammatory
molecules breakdown
the glycocalyx layer of
the blood vessels
Plasma
leakage
occurs
Decrease
blood
pressure
Hypovolemic
shock
Risk Factor:
- Having dengue for
the 2nd, 3rd, or 4th
time
Legends:
Pathogenesis
Nrsing Dx
CBC
Signs &
Symptoms
Management
Risk for bleeding. Risk factor:
decreased platelet count
Lightheadedness;
blurred vision
??
Hematocit
(57%)
Poor skin
turgor
Complication Medication
INTERVENTIONS:
Lab.
Findings
Risk factors
Diagnostic Test
INDEPENDENT:
- Assess the patient's skin and mucous membranes
for signs of bleeding.
- Monitor patients stool and urine output for
bleeding.
- Educate patient and family not to take NSAIDS
(non-steroidal anti-inflammatory drugs) like
ibuprofen and aspirin.
- Instruct patient and family to report any signs of
bleeding.
DEPENDENT:
- Start blood transfusion like fresh whole blood or
platelet concentrate as prescribed by the physician.
??
RR (36
cpm)
Pleural
effusion
Ineffective gas exchange r/t
accumulation of fluid in the lungs
INTERVENTIONS:
INDEPENDENT:
- Place patient in a semi-Fowler's position
- Administer oxygen therapy
- Monitor patient's breathing pattern
- Monitor patient's intake and output
DEPENDENT:
- Administer diuretic like Furosemide
Poor
capillary
refill (4-5
secs)
X-ray
Inadequate tissue
perfusion
INTERVENTIONS:
INDEPENDENT:
- Monitor vital signs
- Administer oxygen therapy
DEPENDENT:
- Start IV therapy for fluid
resuscitation as prescribed by the
physician.