GOVT COLLEGE OF NURSING,

MBGH UDAIPUR

CASE PRESENTATION
On
DENGUE FEVER

Subject: - Advance Nursing Practice

Submitted to: - Submitted by:-

Mr. Rohit yadav Mr. Bhupesh jain
(Assist prof.) Msc (n) part- i

Submitted on
10. Jan.2017
  PATIENT PROFILE:-

Patient Name :- Mr Rakesh Joshi

Age :- 62yrs

Sex :- Male

Ward :- Geriatric Medicine Ward

IPD No. :- 49688

Religion :- Hindu

Address :- 93, Ganpati Vihar, street no.-22, Udaipur

Occupation :- Teacher

Date of Admission :- 22 nov. 2016

Provisional Medical Diagnosis :- Dengue Fever

Consultant Doctor :- Dr R.L. Meena

Provisional Date of Discharge :- 27 nov 2016

 HISTORY TAKING :-
 Chief Complaints:- Mr. Rakesh Joshi have some are the symptoms onset like
weakness, vomiting, anxiety, headache, vertigo etc. These symptoms are arise due to
dengue and he also have persistent fever 100 degree F.
o Present Medical History:- Mr. Rakesh Joshi going as the treatment of
antiviral drug, antibiotics therapy and platelet transfusion therapy.
o Present Surgical History:- Mr. Rakesh Joshi have not undergo any surgery.
o Past Medical History:- Previously Mr. Rakesh Joshi already have
experiences of injury of spinal cord due to road traffic accident [RTA].
In that time he rest 6 months and on bed & on bed months. He relief feel by use of
orthotics of waist.
o Past Surgical History: - Mr. Rakesh Joshi undergo spinal surgery done
already. But know he is well condition he perform all activities and their job also.
o Personal History:-
1. Diet:- he takes vegetarian diet in two time a day. His family have used
balanced diet.
2. Like:- He like watch TV and read newspaper.
 3. Dislike:-Noise quarrels and smoking.
4. Habits: - He not has a any bad habits but he take 5-6 tea everyday and also
used spicy food.
5. Life styles: - His life style according to situational but he live as royal
family.
6. Belief: - He also believes in God.
o Family History: - In the family of Mr. Rakesh Joshi 5 family member and he
is head of family. His family living well.
Family Tree:-

62 years 58 years

40 years 37 years 35 years

S.N. NAME RELATION AGE SEX EDUCATION OCCUPATION REMARK

1 Mr. Rakesh Joshi Self 62yr M M.A. Clerk Cholecystitis

2 Mrs. Sumitra Joshi Wife 58yr F 10th House wife Healthy

3 Ms. Anupriya Joshi Daughter 40yr M M.Com. Bank Healthy

Manager
4 Mr. Ankur Joshi Son 37yr F B.Com. Teacher Healthy

5 Ms. Ruchika Joshi Daughter 35yr F B.Sc. (Hon.) Teacher Healthy

 General body examination:-

Body temperature : - 100.8F
Pulse rate : - 95 Beat per minute
Respiration Rate : - 20 Breath per minutes
Blood Pressure : - 130/110 mm of Hg
SPO2 :- 97%
 Pain Status : - No pain
Level of consciousness : - Conscious
Level of orientation : - Orientationed
Height :-170 cm
Weight :-68 kg

 Head To examination:

Head and Neck:-

o Shape & symmetry of skull:- Normal
o Tenderness:- Absent
o Hair and Pedicilosis:- Hair well distributed and black
o Scalp:- Normal

Eyes:
o Visual Acuity:- Normal
o Eyebrows:- Present
o Cornea:-Normal
o Conjunctive:-Normal
o Papillary response:-Normal
o Position & movement of eyelid:- Normal

Ears:-
o Ear shape, size:- Normal
o Discharge:-Wax is present
o Tympanic membrane:-Normal
o Hearing:-Normal

Nose:-
o Shape & size:-Normal
o Blockage:-Absent
o Bleeding:-Some time present

Mouth:-
o Lips:-Normal
o Buccle mucosa:-Moist
o Teeth:-All present, white well shaped
o Gums:-Normal
o Tongue:-Normal

Neck:-
o Skin:-Normal
 o Neck Vein:-Distended
o Postural alignment:-Normal
o ROM:-Normal
o Carotid Pulse:-Normal
o Thorax:-Normal
o Expansion:-Normal
o Breath :-Normal

Abdomen:-
o Inspection:-Rash maculo popular
o Auscultation:-Normal
o Palpation:-Normal
o Percussion:-Normal

Extremities:-
o Strength:-All present 2 lower and 2upper limb
o ROM:-Normal
o Joint pain:-Pain in knee
o Edema:-Absent
o Coordination:-Well

Back:-
o Spinal curves:-Normal

SYSTEMIC EXAMINATION:-

INTEGUMENTRY SYSTEM:-
o Temperature:-101o F
o Vascularity:-Good
o Skin:-Dry
o Nail:-Well shaped, flexible
o Rash formation:-Present

RESPIORATORY SYSTEM:
o Breath:-Shortness of breath:-
o Bleeding through nose:-Present
o Respiration rate:-More than 100 breath per min.
o Chest movement:-Asymmetrical
o Percussion:-Resonant

CARDIOVASCULAR SYSTEM:-
 o Test tornikuet:-Present
o Spontaneous bleeding
o Pulse pressure:-Narrow
o Pulse:-Weak
o Cyanosis:-Around the mouth, nose, fingers
o BP:-Hypotension

URINARY SYSTEM:-
o Urine production:-Decreased
o Urine output:-Some time less than 30ml/hr
o Urine colour:-Red

DIGESTIVE SYSTEM:-
o Bleeding from gums, dry mucous membranes
o Difficulty in swallowing
o Tenderness at epigastric region
o Spleen:-Enlarged
o Liver:-Enlarged
o Appetite:-Decreased
o Nausea and vomiting:-Present

INVESTIGATION:-

S. NAME OF TEST NORMAL VALUES PATIENT VALUES REMARKS

NO.

1. TLC 4000-11000/cumm 10640/cumm Increased

2. RBC 3.9-5.6 3.99 million/cumm Normal

million/cumm

3. HB 13.5-18 gm/dl 14 gm/dl Normal

4. HCT 40-54% 37% Normal

5. MCV 76-94 fl 78 fl Normal

6. HCH 27-32 pg/dl 30 pg/dl Normal

7. MCHC 32-36 gm/dl 35 gm/dl Normal

8. Platelet Count 1.6-3.0 lac/cumm 90000 Decreased

thousands/cumm

9. Polymorphs 40-75% 38% Decreased

10. Lymphocytes 20-60% 35% Normal

11. Monocytes 2-10% 5% Normal

12. Eosionophils 1-6% 00% Decreased

DENGUE IgG And DENGUE IgM:- Dengue IgM Positive.

TREATMENT CHART:-

S.N NAME DOSE ROU ACTION INDICAT CONTRAINDI NRURSE

o. OF TE ION CATION RESPONSI
DRUG BILITIES

1. ORS 10 gm Orally Rehydrati Dehydrati Fluid overload Nurse give

with on on solution
water properly
a day. and
maintain-n
electrolyte.

2. Paraceta- 500m Orally Antipyreti Fever Acute Maintain

mol g /IV cs & leukaemia. patient’s
Analgesics and check
. temperature
after
medication.

3. Ringal 250ml IV Rehydrati Dehydrati Fluid Excess. Maintain

Lactate /Hr on on and fluid &
Solution Haemorrh electrolyte
age. balance.

DISEASE DISCRIPTION:-

BOOCK PICTURE CLINICAL PICTURE

DEFINITION:-

Dengue fever is an infectious disease After the pt. get infection he feel weakness
caused by Dengue virus and characterized and bleeding also from nasal cavity and
by asymptomatic and symptomatic having fever 1000 F and clinically
thrombocytopenia which is manifested by manifested thrombocytopenia[Platelet
haemorrhage, weakness fever etc. count less than 1 lacks/cumm].
ETIOLOGY:-

Dengue virus infection treatment into Over population of mosquito and they bite
through mosquito Aedes Agypti and Aedes in day time.
Albopicrtus

SIGN AND SYMPTOS:-

 Fever 100 - 102 F

*

 Haemorrhage  Fever 101o

 Asymptomatic/ Symptomatic  Symptomatic
 Headache, Vertigo, Diarrhoea  Dehydration
 Thrombocytopenia, Shock  Headache, Vertigo, Diarrhoea
 Platelet count less than 1
lack/cumm
 Shock Absent

DIAGNOSTIC EVALUATION:-

 CBC  Platelet is 1 lack/cumm that is

 Platelet count less than 1 below Normal.
lack/cumm  Mild DHF[Dengue haemorrhage
 Dengue Antibody IgG & IgM fever]
 Dengue Antigen  Dengue IgM positive
 According to haemorrhage: - Mild,  Anaemia Present
Moderate, Severe.

MEDICAL MANAGEMENT:-

 ORS
 Paracetamol  ORS
 Saline Solution/RL Solution  Paracetamol
 Antibiotics.  Ringal lactate Solution
 Antibiotics:- Levoflxacin and
Oxfloxacin.

NURSING DIAGNOSIS:-

 Ineffective tissue perfusion may be related to Hypovolemia.

 Fluid volume deficient may be related to etiology as defined dehydration,
diarrhoea, vomiting, etc. Manifested by thirst desire.
 Nutrition less than body requirement related to anorexia.
 Powerlessness may be related to chronic nature of illness.
  Knowledge deficit regarding disease pathophysiology and treatment plan of
disease.

HEALTH EDUCATION:-
I had given health education to patient at discharge time regarding:-
o Bed rest is advisable during the acute febrile phase.
o Aspirin should be avoided.
o Sponging is required to keep the body temperature below 40o C.
o Take a medicine in regular time by your treatment plant.
o Using soft brush for brushing because risk for bleeding from gums.
o Take a high protein and calorie diet.
o Techniques about how to control bleeding from nose and any part of the body.
o Personal sanitation are necessary initial steps in modern control of mosquito borne as
it involves removal of possible breeding sites of larvae.
o Awareness of dengue vector life cycle and it’s preferable domestic and peri-domestic
habitats is almost absent.
o Public awareness and health education regarding the habitat and life cycle of the
mosquito vector, as well as physical and cultural control, are important in population
management.
o Educate the patient to break the mosquito life cycle by destroying the possible
mosquito breeding sites such as concrete pools, water, tanks, aquaria, irrigation
ditches, and drainages as well as air-conditioners and disposable tires.
o Enhancing self –awareness among the people through health education programmes.
o Educate patient about the adverse effects of the arbitrary application of insecticides
without prior knowledge on dose, resistance on dose, resistance and side effects of
these chemicals.
o Follow up care.

CONCLUSION:- Mr. Rakesh Joshi admitted in hospital with complain of weakness,

joint pain, fever with chills, vomiting , nasal bleeding and anxiety. He was admitted in
Geriatric medicine Ward for 3 days under his consultant Doctor R.L. meena. Sign and
symptoms, Health history and laboratory investigation basis DR. R.L Meena finally
diagnosed Mr. Rakeshi Joshi had suffering from Dengue fever. After medical treatment the
patient feel have better than past.

BIBLIOGRAPHY:-
 (1) Lippincott , Manual of Nursing Practice, 8th Edition, Lippincot York, Page no. – 452 -
456

(2) Brunner and Sugharths, Text book of Medical Surgical Nursing,

10th Edition, Lippincott Williams and Wilkins, Page no. – 777 - 782

(3) Levis, Medical Surgical Nursing, 6th Edition, Mosby Publication,

Page no. – 445 -448

(4) Sembulligum k. Essentials of Medical Physiology, 3rd Edition,

Jaypee Publication, Page no. – 556 - 558

(5)Gulanick / Myers, Nusing Care Plan, 6th Edition, Mosby Elsevier

Publication, Page no. – 445 - 456

(6)Davis, Drug Guide for Nuses, 20th Edition, F.A. Davis Company,

Philadelphia, Page no. – 145-146, 234-235,566-567

(7) Hollowry Nancy, Medical Surgical Care Planning, 8th Edition, Spring

house Publication, Page no. – 555 -5

(8) Internet Resourses –
www.Google.com

www.wikipedia.org.

www.emedicine.medcape.com