A CLINICAL STUDY ABOUT A PATIENT

DIAGNOSED WITH DENGUE FEVER

SYNDROME

A Case Study
Presented to the College of Nursing, Public Health and Midwifery
Of University of La Salette, Inc.
Santiago City, Isabela

Submitted by:

Dugyonon, Joshrey D.

BSN-3B
(Group D)
I. CASE DESCRIPTION

Definition

Dengue Fever is an acute febrile illness caused by infection with the Dengue virus (DENV),
which has four serotypes (DENV-1, DENV-2, DENV-3, and DENV-4). The disease is
transmitted through the bites of infected Aedes aegypti or Aedes albopictus mosquitoes. It ranges
in severity from mild febrile illness to severe life-threatening conditions like Dengue
Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS).

Etiology

 Pathogen: Dengue Virus (DENV), a single-stranded RNA virus of the Flavivirus genus.
 Vector: Female Aedes mosquitoes, which are active during the day, particularly in the
early morning and late afternoon.

Clinical Manifestations

1. Febrile Phase (2–7 days):

o Sudden onset of high-grade fever (up to 40°C).
o Severe headache, retro-orbital pain, and body ache ("break-bone fever").
o Rash: Initially macular or maculopapular, progressing to petechial.
o Mild bleeding (epistaxis, gum bleeding).
o Nausea, vomiting, and fatigue.
2. Critical Phase (after defervescence):
o Vascular leakage leading to hypotension, pleural effusion, and ascites.
o Thrombocytopenia, leading to spontaneous bleeding.
o Organ dysfunction in severe cases (liver, kidneys).
3. Recovery Phase: Gradual reabsorption of leaked plasma and resolution of symptoms.

Diagnosis

1. History and Clinical Examination:

o Fever lasting 2–7 days, with associated symptoms like rash, bleeding, and fatigue.
o Travel to or residence in an endemic area.
2. Laboratory Tests:
o Hematology:
 Thrombocytopenia (<100,000/μL).
 Hemoconcentration (elevated hematocrit).
o Serology:
 NS1 antigen test (early detection).
 Dengue IgM and IgG antibodies (to confirm recent or past infection).
o Molecular Tests:
 RT-PCR to detect viral RNA.
Treatment and Management

There is no specific antiviral treatment for Dengue. The goal is supportive care to manage
symptoms and prevent complications.

1. Supportive Management:
o Fluid Therapy:
 Oral rehydration therapy for mild cases to prevent dehydration.
 Intravenous (IV) fluid therapy for cases with significant plasma leakage.
 Monitor urine output and vital signs to assess fluid balance.
o Fever and Pain Management:
 Acetaminophen for fever and body aches. Avoid NSAIDs (e.g., aspirin,
ibuprofen) due to bleeding risk.
o Hemodynamic Monitoring:
 Regularly assess blood pressure, pulse, and capillary refill time, especially
during the critical phase.
2. Management of Severe Dengue:
o Management of Shock:
 Rapid IV boluses of isotonic crystalloids for compensated shock.
 Transition to colloids or blood products if shock persists.
o Management of Bleeding:
 Transfusion of platelets or fresh frozen plasma for severe
thrombocytopenia or active bleeding.
o Organ Support:
 Dialysis for acute kidney injury.
 Ventilatory support for respiratory failure.
3. Prevention and Education:
o Vector Control: Use of insecticides, mosquito nets, and removing stagnant water.
o Vaccination: Dengvaxia is approved for use in some populations.
o Patient Education: Encourage early consultation for warning signs such as
persistent vomiting, severe abdominal pain, or sudden dizziness.
II. ANATOMY AND PHYSIOLOGY

Overview

Dengue fever primarily affects the circulatory, integumentary, and immune systems. Below is an
overview of their anatomy and physiological functions:

1. Circulatory System
The circulatory system, comprising the heart, blood, and blood vessels, is vital for the transport
of oxygen, nutrients, hormones, and waste products. It maintains homeostasis and facilitates
immune responses during infections.

 Heart:
o A muscular organ located in the thoracic cavity, enclosed in the pericardium.
o Composed of four chambers (right atrium, right ventricle, left atrium, left
ventricle) and valves (tricuspid, pulmonary, mitral, and aortic valves) to ensure
unidirectional blood flow.
o Pumps oxygenated blood from the left ventricle to the body via the aorta and
deoxygenated blood from the right ventricle to the lungs via the pulmonary
arteries.
o Cardiac output and vascular tone are tightly regulated to adapt to physiological
demands.

 Blood:
o Contains plasma and cellular components: erythrocytes (red blood cells),
leukocytes (white blood cells), and platelets.
o Platelets play a critical role in hemostasis and wound repair by forming clots at
sites of vascular injury.
o The plasma portion carries proteins like fibrinogen, crucial for the clotting
cascade.

 Blood Vessels:
o Arteries: Carry oxygenated blood under high pressure from the heart to the
tissues.
o Veins: Return deoxygenated blood to the heart and are equipped with valves to
prevent backflow.
o Capillaries: Thin-walled vessels facilitating exchange of gases, nutrients, and
waste products between blood and tissues.
2. Immune System
The immune system protects the body against pathogens, including viruses through innate and
adaptive immune mechanisms.

 Innate Immunity:
o First line of defense, involving physical barriers (skin and mucosa), phagocytic
cells (macrophages, neutrophils), and natural killer (NK) cells.
o Cytokines like interleukins and interferons play a key role in inflammation and
antiviral defense.

 Adaptive Immunity:
o Involves lymphocytes (T-cells and B-cells) that generate specific responses to
pathogens.
o T-cells destroy infected cells, while B-cells produce antibodies to neutralize the
virus.
o Memory cells ensure a faster response during subsequent exposures to the same
pathogen.

 Lymphatic System:
o Includes lymph nodes, spleen, thymus, and lymphatic vessels.
o Filters pathogens from lymph fluid and facilitates the activation of immune cells.

3. Integumentary System
The integumentary system serves as the body's first line of defense and is involved in
thermoregulation and sensory reception.

 Skin:
o Composed of three layers: epidermis, dermis, and hypodermis.
 Epidermis: Outermost layer, provides a barrier against pathogens and
contains melanocytes for UV protection.
 Dermis: Contains blood vessels, nerves, sweat glands, and hair follicles. It
plays a key role in temperature regulation and sensation.
 Hypodermis: Subcutaneous layer of fat and connective tissue that
provides insulation and stores energy.
o In dengue, the skin is involved due to rash formation and petechiae, which result
from capillary damage.

 Hair and Nails:

o Keratinized structures that provide minor protection and sensory functions.

 Sweat and Sebaceous Glands:

o Sweat glands regulate body temperature through perspiration.
o Sebaceous glands secrete sebum, which has antimicrobial properties
IV. NURSING HISTORY
A. Demographic Data

Name: Patient Y
Age: 19 years old
Address: Purok 6, Cabulay Santiago City
Sex: Male
Religion: Roman Catholic
Civil Status: Single
Height: 170 cm
Weight: 59 kg
Date of Admission: December 08, 2024
Time of Admission: 8:11 AM
Chief Complaint: Fever of 2 days
Admitting Diagnosis: Dengue Fever Syndrome
Admitting Physician: Dra. Untalan
Initial Vital Signs:
T: 38.3 ℃
RR: 21 cpm
PR: 107 bpm
BP: 100/70 mmHg

B. History of Present Illness

Two days prior to admission, the patient experienced fever and took paracetamol as a
treatment. One day prior to admission, the medication was not effective and the fever
progressed associated with head ache. The persistent symptoms prompted a consultation at
Callang General Hospital, where the patient manifested body weakness, myalgia, sunken
eyeball, anorexia, leading to his admission.

C. History of Past Illness

The patient verbalized that he has no history of hospitalization

D. Familial History

The patient verbalized that there are genetically transmittable diseases in his family,
specifically his father which has hypertension.
E. Social History

The patient usually interacts with his classmates at school during the day. At night, he plays
mobile games with his friends.
F. Gordon’s Functional Health Patterns
Date: December 12, 2024
HEALTH PERCEPTION/ MANAGEMENT
BEFORE DURING
The patient verbalized that he was vaccinated During hospitalization, the patient is
with Hepatitis B vaccine last September, compliant in taking his medications, as he
2023. He also verbalized that he is taking took them at the right time.
Vitamin C
• NUTRITIONAL-METABOLIC
BEFORE DURING
The patient verbalized that he eats two times During hospitalization, the patient eats three
a day. He usually eats whatever is served like times a day. He also sometimes sinigang na
Dinengdeng. He usually drinks 2 liters of baboy or anything his mother brings. The
water per day. patient has no food restrictions, except
colored foods. He usually drinks 2 liters of
water per day.

ELIMINATION
BEFORE DURING
The patient verbalized that he urinates once The patient verbalized that he urinates
every other day, and his urine is yellow to usually 8-9 times during the day, and his
orange in color. He defecates once a day, urine is yellow to orange in color. He
usually brown in color and sometimes solid defecates twice a day, usually brown in color
or soft in consistency. and soft.

ACTIVITY AND EXERCISE

BEFORE DURING
The patient verbalized that he performs During hospitalization, the patient walks
biking once a month. The patient does around the room as a way of exercising. He
perform any household chores. During his also watches on the TV when he is bored.
free time, he watches video on his cellphone.

COGNITIVE-PERCEPTUAL
BEFORE DURING
The patient reports no issues with memory The patient does not experience any
and is able to accurately determine the time, problems with his memory and demonstrates
people, and place. the ability to accurately discern and track
time.
SLEEP-REST
BEFORE DURING
 The patient usually sleeps 8 hours. He The patient verbalized that he is only able to
usually sleeps from 10 pm to 6 am. sleep for 6-7 hours and is only interrupted
Sometimes, he also takes 1 hour of sleep in whenever the nurse takes his vital signs
the afternoon.
SELF-PERCEPTION/ SELF-CONCEPT
BEFORE DURING
The patient verbalized that he is confident The patient states that he feels good about
about himself and is not insecure with his himself and does not feel insecure with his
body and condition. looks.
ROLE RELATIONSHIP
BEFORE DURING
The patient is a father of six children. He During hospitalization, the patient is with his
verbalized that he is close to his family, and 6th child. He verbalized getting even closer
he lives in his own house together with his to his other children as they frequently visit
wife and the family of his first child. him in the hospital.
SEXUALITY AND REPRODUCTIVE
The patient’s gender is male and he is not The patient’s gender is male and he is not
sexually active given his status. sexually active given his status.
COPING-STRESS TOLERANCE
BEFORE DURING
The patient copes with stress by using During hospitalization, the patient copes with
earphones while playing music then proceeds stress by watching on his phone or TV.
to sleeping.
VALUE-BELIEF
BEFORE DURING
The patient was baptized in a Roman During hospitalization, the patient is silently
Catholic church. He sometimes attends mass praying for the betterment of his condition.
on school

V. PHYSICAL ASSESSMENT
A. GENERAL SURVEY

The patient is wearing a shirt and pajama, sitting in bed, and is conscious and alert but weak
looking. He has an IV line in his left hand infused with PLRS, there are rashes on both arms and
on his neck.

Vital Signs (Dec. 12, 2024 – 10 AM):

- TEMPERATURE: 36.1℃

- PR: 72 bpm

- RR: 17 cpm
 - BP: 110/80 mmHg

B. CEPHALOCAUDAL ASSESSMENT (Dec. 12, 2024)

AREA METHOD FINDINGS INTERPRETATION
Head Inspection -Hair Color and - Normal
distribution: The
hair color is black
and is evenly
distributed. There is
no presence of
dandruff and lice.

Palpation (-) tenderness upon - Normal

palpation.
Eyes Inspection - symmetrical - Normal

- Color of iris is - Normal

brown.

- Color of sclera is - Normal

white

(-) presence of - Normal

eyebags

Ears Inspection - Shape and - Normal

condition:
symmetrical in
shape and has no
hearing difficulties.

-Lesions: No lesions - Normal

noted.

-Hearing ability: - Normal

During conversation
the patient responds
to question without
repeating it.

Palpation -No tenderness - Normal

 upon palpation
Nose Inspection - Color is the same - Normal
as the rest of the
face; the nasal
structure is smooth
and symmetric; And
there is no presence
of discharge.

Palpation -Noted no - Normal

tenderness upon
palpation.
Mouth Inspection -Lips: The lips are - Normal
moist with no
cracking

-Oral cavity: - Normal

pinkish in color and
is moistened.
Skin Inspection -General skin - Normal
colorization: The
skin color is brown.

-Appearance: (+) - due to viral infection

rashes on both arms

- Odors emanating - Normal

from the skin: There
is no odor of
perspiration

Palpation - Lesions: Skin has - Normal

no any lesions and
appears smooth.

Neck Inspection Flexion and - Normal

extension: Can flex
and extend his neck

Palpation (+) rashes - due to viral infection

- No tenderness - Normal
upon palpation
Chest Inspection Rise and fall: the -Normal
chest rise and falls
as the patient
 breathes.

Shape: The shape is -Normal

bilaterally
symmetrical
without undue
elevation or
depression.

(+) rashes - due to viral infection

Palpation -No presence of - Normal

tenderness

Auscultation -No abnormal lung -Normal

sound heard
Abdomen Inspection -Contour: The - Normal due to fats
abdomen is
rounded.

- Present bowel - Normal

sounds in all four
quadrants
Auscultation
- No tenderness - Normal
upon palpation

Palpation
Nails Inspection -Cleanliness: Nails - Normal
are long and have
deposits/pits.

- Color of nailbeds: - Normal

pinkish white

Capillary refill: less - Normal

than 2 seconds
Palpation
Lower Extremities Inspection - There is no - Normal
presence of swelling
and redness.

(+) rashes on both - due to viral infection

 legs

Palpation (-) tenderness - Normal

VI. LABORATORY DIAGNOSIS

CERTIFICATION

Name: Patient Y Date: December 8, 2024

Age: 19 yrs old Room: 210

Sex: Male Time processed:

Birthday: Jan. 03, 2024 Physician:

METHOD RESULT

SARS-COV-2 NEGATIVE

RAPID ANTIGEN TEST NEGATIVE

IMMUNOLOGY & SEROLOGY

Name: Patient Y Date: December 10, 2024

Age: 19 yrs old Room: PRVT-2

Sex: Male Time processed:

Birthday: Jan. 03, 2024 Physician:

TEST RESULT NORMAL VALUES INTERPRETATION

PRO- 1.231 <0.046 ng/mL Indicates systemic inflammation

CALCITONIN or possible bacterial co-infection,
a concern in severe cases of
dengue fever
 URINALYSIS
Name: Patient Y Date requested and released: December 8, 2024

Age: 19 yrs old Room: Room 210

Sex: Male Time released: 7:36 AM

Birthday: Jan. 03,2005 Requesting physician:

MICROSCOPIC EXAM RESULT INTERPRETATION

Color YELLOW NORMAL

Transparency TURBID NORMAL

Ph/reaction 6.5 NORMAL

Specific Gravity 1.015 NORMAL

CHEMICAL EXAM RESULT INTERPRETATION

Protein TRACE Indicates mild proteinuria

Glucose NEGATIVE NORMAL

Bilirubin

Ketone

Nitrate

RBC 0-1/HPF

Pus Cells 0-1/HPF

Epithelial Cell RARE

Amorphous Materials
 Mucus Threads MANY Indicates inflammation or irritation
of the urinary tract but not
necessarily an infection.

Bacteria MODERATE Suggests a possible urinary tract

infection or contamination during
sample collection.

Others

WBC CLUMPS

HEMATOLOGY

Name: Patient Y Date: December 08, 2024

Age: 19Y11M5D Room: 0

Sex: Male Time processed: 7:35 AM

Birthday: Jan. 03, 2024 Physician:

EXAM RESULT REFERENCE INTERPRETATION

VALUE

Hematocrit 38.3(L) 40.0-54.0% Indicates decreased red blood cell concentration,

Male commonly due to hemodilution or plasma leakage in
dengue fever.

Hemoglobin 13.8 13.0-18.0 g/dl

Male

Hematocrit 27.0-47.0 %
Female

Hemoglobin 11.0-16.0 g/dl

Female

WBC Count 3.80(L) 5.0-10.0 x Indicates leukopenia, a common feature of dengue

10^9/L fever due to bone marrow suppression.

Differential Count

Neutrophil 76.0(H) 50.0-65.0 % Suggests a stress response

or bacterial co-infection
Lymphocyte 9.5(L) 25.0-35.0 % Indicates lymphopenia,
often seen during the early
phase of viral infections.

Eosinophils 0.0(L) 3.0-5.0 % Suggests increased immune

activity to fight viral
infection.

Basophils 0.8 0.1-1.0 %

Monocyte 13.7(H) 3.0-5.0 %

Stabs 3.0-5.0 %

Platelet Count 142(L) 150-400 x 10^9/L Indicates severe

thrombocytopenia.

RBC Count 5.28(H) 4.5-5.0 x 10^12/L Indicates

hemoconcentration due to
plasma leakage in dengue.

MCV 72.5(L) 80.0-110.0 fl

MCH 24.6(L) 26.0-38.0 pg

MCHC 33.9 31.0-37.0 g/dl

Reticulocyte Count 0.5-1.5 %

Erythrocyte 0.0-10.0 mm/hr

Sedimentation rate (ESR)
Male

Erythrocyte 0.0-20.0 mm/hr

Sedimentation rate (ESR)
Female

Prothrombin Time 10.0-14.0 sec

% Activity 70.0-120.0 %

INR 0.0-1.2

A.P.T.T 25.0-37.0 sec

Ratio 0.0-.1.2

Blood Type
 Methods

Clotting Time 3.0-6.0 mins

Bleeding Time 2.0-.4.0 mins

HEMATOLOGY

Name: Patient Y Date: December 09, 2024

Age: 19Y11M6D Room: PRIVATE 2

Sex: Male Time processed: 6:27 AM

Birthday: Jan. 03, 2024 Physician: Dra. Ramos

EXAM RESULT REFERENCE INTERPRETATION

VALUE

Hematocrit 34.2(L) 40.0-54.0% Indicates a further decrease in red blood cell

Male concentration, likely due to continued plasma
leakage.

Hemoglobin 11.5(L) 13.0-18.0 g/dl Indicates mild anemia, likely from hemodilution or
Male early blood loss.

Hematocrit 27.0-47.0 %
Female

Hemoglobin 11.0-16.0 g/dl

Female

WBC Count 2.12(L) 5.0-10.0 x 10^9/L Indicates worsening leukopenia, commonly due to
bone marrow suppression in dengue.

Differential Count

Neutrophil 70.2(H) 50.0-65.0 % Indicates a continued stress

response or possible co-
infection.

Lymphocyte 15.6(L) 25.0-35.0 % Indicates persistent

lymphopenia due to viral
infection.

Eosinophils 0.0(L) 3.0-5.0 %

Basophils 0.5 0.1-1.0 %

Monocyte 13.7(H) 3.0-5.0 %

Stabs 3.0-5.0 %

Platelet Count 104(L) 150-400 x 10^9/L Indicates worsening

thrombocytopenia,
increasing the risk of
bleeding complications.

RBC Count 4.63 4.5-5.0 x 10^12/L

MCV 73.9(L) 80.0-110.0 fl

MCH 24.8(L) 26.0-38.0 pg

MCHC 33.6 31.0-37.0 g/dl

Reticulocyte Count 0.5-1.5 %

Erythrocyte 0.0-10.0 mm/hr

Sedimentation rate (ESR)
Male

Erythrocyte 0.0-20.0 mm/hr

Sedimentation rate (ESR)
Female

Prothrombin Time 10.0-14.0 sec

% Activity 70.0-120.0 %

INR 0.0-1.2

A.P.T.T 25.0-37.0 sec

Ratio 0.0-.1.2

Blood Type

Methods

Clotting Time 3.0-6.0 mins

Bleeding Time 2.0-.4.0 mins

 HEMATOLOGY

Name: Patient Y Date: December 10, 2024

Age: 19Y11M7D Room: PRIVATE 2

Sex: Male Time processed: 5:52 AM

Birthday: Jan. 03, 2024 Physician: Dra. Untalan

EXAM RESULT REFERENCE INTERPRETATION

VALUE

Hematocrit 34.6(L) 40.0-54.0% Indicates continued hemodilution.

Male

Hemoglobin 12.6(L) 13.0-18.0 g/dl Mild anemia persists, likely due to plasma leakage.
Male

Hematocrit 27.0-47.0 %
Female

Hemoglobin 11.0-16.0 g/dl

Female

WBC Count 1.80(L) 5.0-10.0 x 10^9/L Severe leukopenia indicates significant suppression
of white blood cell production.

Differential Count
Neutrophil 83.6(H) 50.0-65.0 % Suggests a strong stress
response, often seen in
severe infections.

Lymphocyte 13.7(L) 25.0-35.0 % Indicates persistent

lymphopenia due to viral
effects.

Eosinophils 0.1(L) 3.0-5.0 %

Basophils 1.6(H) 0.1-1.0 %

Monocyte 1.0(L) 3.0-5.0 %

Stabs 3.0-5.0 %

Platelet Count 52(L) 150-400 x 10^9/L Indicates severe

thrombocytopenia.
significantly increasing
bleeding risk.

RBC Count 4.59 4.5-5.0 x 10^12/L

MCV 75.3(L) 80.0-110.0 fl

MCH 27.5 26.0-38.0 pg

MCHC 36.5 31.0-37.0 g/dl

Reticulocyte Count 0.5-1.5 %

Erythrocyte 0.0-10.0 mm/hr

Sedimentation rate (ESR)
Male

Erythrocyte 0.0-20.0 mm/hr

Sedimentation rate (ESR)
Female

Prothrombin Time 10.0-14.0 sec

% Activity 70.0-120.0 %

INR 0.0-1.2

A.P.T.T 25.0-37.0 sec

Ratio 0.0-.1.2

Blood Type

Methods

Clotting Time 3.0-6.0 mins

Bleeding Time 2.0-.4.0 mins

 HEMATOLOGY

Name: Patient Y Date: December 10, 2024

Age: 19Y11M7D Room: PRIVATE 2

Sex: Male Time processed: 7:59 PM

Birthday: Jan. 03, 2024 Physician: Dra. Untalan

EXAM RESULT REFERENCE INTERPRETATION

VALUE

Hematocrit Male 36.5(L) 40.0-54.0% Slight improvement but still indicates

hemodilution.

Hemoglobin 13.3 13.0-18.0 g/dl

Male

Hematocrit 27.0-47.0 %
Female

Hemoglobin 11.0-16.0 g/dl

Female

WBC Count 2.07(L) 5.0-10.0 x 10^9/L Persistent leukopenia due to dengue-induced bone
marrow suppression.

Differential Count
Neutrophil 76.1(H) 50.0-65.0 % Suggests a strong stress
response, often seen in
severe infections.

Lymphocyte 20.6(L) 25.0-35.0 % Indicates persistent

lymphopenia due to viral
effects.

Eosinophils 0.5(L) 3.0-5.0 %

Basophils 1.0 0.1-1.0 %

Monocyte 1.8(L) 3.0-5.0 %

Stabs 3.0-5.0 %

Platelet Count 41(L) 150-400 x 10^9/L Indicates worsening

thrombocytopenia,
requiring close monitoring.

RBC Count 4.86 4.5-5.0 x 10^12/L

MCV 75.2(L) 80.0-110.0 fl

MCH 27.3 26.0-38.0 pg

MCHC 36.3 31.0-37.0 g/dl

Reticulocyte Count 0.5-1.5 %

Erythrocyte 0.0-10.0 mm/hr

Sedimentation rate (ESR)
Male

Erythrocyte 0.0-20.0 mm/hr

Sedimentation rate (ESR)
Female

Prothrombin Time 10.0-14.0 sec

% Activity 70.0-120.0 %

INR 0.0-1.2

A.P.T.T 25.0-37.0 sec

Ratio 0.0-.1.2

Blood Type

Methods

Clotting Time 3.0-6.0 mins

Bleeding Time 2.0-.4.0 mins

 HEMATOLOGY

Name: Patient Y Date: December 11, 2024

Age: 19Y11M8D Room: PRIVATE 2

Sex: Male Time processed: 6:46 AM

Birthday: Jan. 03, 2024 Physician: Dra. Untalan

EXAM RESULT REFERENCE INTERPRETATION

VALUE

Hematocrit Male 37.3(L) 40.0-54.0% Indicates continued hemodilution or reduced red

blood cell volume.

Hemoglobin 12.5(L) 13.0-18.0 g/dl Persistent mild anemia.

Male

Hematocrit 27.0-47.0 %
Female

Hemoglobin 11.0-16.0 g/dl

Female

WBC Count 2.07(L) 5.0-10.0 x 10^9/L Indicates Persistent leukopenia.

Differential Count
Neutrophil 34.3(L) 50.0-65.0 % Suggests a strong stress
response, often seen in
severe infections.

Lymphocyte 44.9(H) 25.0-35.0 %

Eosinophils 1.9(L) 3.0-5.0 %

Basophils 1.0 0.1-1.0 %

Monocyte 17.9(H) 3.0-5.0 %

Stabs 3.0-5.0 %

Platelet Count 14(L) 150-400 x 10^9/L Indicates life-threatening

thrombocytopenia,
requiring urgent
management.

RBC Count 5.06(H) 4.5-5.0 x 10^12/L

MCV 73.7(L) 80.0-110.0 fl

MCH 24.7(L) 26.0-38.0 pg

MCHC 33.5 31.0-37.0 g/dl

Reticulocyte Count 0.5-1.5 %

Erythrocyte 0.0-10.0 mm/hr

Sedimentation rate (ESR)
Male

Erythrocyte 0.0-20.0 mm/hr

Sedimentation rate (ESR)
Female

Prothrombin Time 10.0-14.0 sec

% Activity 70.0-120.0 %

INR 0.0-1.2

A.P.T.T 25.0-37.0 sec

Ratio 0.0-.1.2

Blood Type

Methods

Clotting Time 3.0-6.0 mins

Bleeding Time 2.0-.4.0 mins

 BLOOD BANK

Name: Patient Y Date: December 11, 2024

Age/ Sex: 19/M Date & Time Released: 12/11/2024 12:43 PM

Receiving BSF: Callang Physician: Dra. Untalan

Component SERIAL BLOOD TYPE EXTRACTION EXPIRATION

NUMBER DATE DATE

Platelet QPMBD24-2014 “B” Rh Positive 12/08/24 12/13/24

Concentrate

Platelet QPMBD24-2014 “B” Rh Positive 12/08/24 12/13/24

Concentrate

Screening Results: NONREACTIVE: HBsAG, HCV, HIV 1&2, AND SYPHILIS

NEGATIVE: MALARIA

Remarks: Screening done at SIMC

BLOOD BANK

Name: Patient Y Date: December 11, 2024

Age/ Sex: 19/M Date & Time Released: 12/11/2024 12:43 PM

Receiving BSF: Callang Physician: Dra. Untalan

 Component SERIAL BLOOD TYPE EXTRACTION EXPIRATION
NUMBER DATE DATE

Platelet QPMBD24-2014 “B” Rh Positive 12/08/24 12/13/24

Concentrate

Platelet QPMBD24-2014 “B” Rh Positive 12/08/24 12/13/24

Concentrate

Screening Results: NONREACTIVE: HBsAG, HCV, HIV 1&2, AND SYPHILIS

NEGATIVE: MALARIA

Remarks: Screening done at SIMC

HEMATOLOGY

Name: Patient Y Date: December 11, 2024

Age: 19Y11M8D Room: 210

Sex: Male Time processed: 8:14 PM

Birthday: Jan. 03, 2024 Physician: Dra. Untalan

EXAM RESULT REFERENCE INTERPRETATION

VALUE

Hematocrit Male 37.1(L) 40.0-54.0% Slight improvement but still indicates

hemodilution.

Hemoglobin 13.53 13.0-18.0 g/dl

Male

Hematocrit 27.0-47.0 %
Female

Hemoglobin 11.0-16.0 g/dl

Female

WBC Count 3.08(L) 5.0-10.0 x 10^9/L Persistent leukopenia due to dengue-induced bone
marrow suppression.

Differential Count
Neutrophil 55.0 50.0-65.0 %
Lymphocyte 36.3(H) 25.0-35.0 %

Eosinophils 1.9(L) 3.0-5.0 %

Basophils 1.3(H) 0.1-1.0 %

Monocyte 5.5(H) 3.0-5.0 %

Stabs 3.0-5.0 %

Platelet Count 40(L) 150-400 x 10^9/L Indicates severe

thrombocytopenia.

RBC Count 4.96 4.5-5.0 x 10^12/L

MCV 74.9(L) 80.0-110.0 fl

MCH 27.2 26.0-38.0 pg

MCHC 36.4 31.0-37.0 g/dl

Reticulocyte Count 0.5-1.5 %

Erythrocyte 0.0-10.0 mm/hr

Sedimentation rate (ESR)
Male

Erythrocyte 0.0-20.0 mm/hr

Sedimentation rate (ESR)
Female

Prothrombin Time 10.0-14.0 sec

% Activity 70.0-120.0 %

INR 0.0-1.2

A.P.T.T 25.0-37.0 sec

Ratio 0.0-.1.2

Blood Type

Methods

Clotting Time 3.0-6.0 mins

Bleeding Time 2.0-.4.0 mins

 Date & Time: Dec. 12, 2024/ 2:30AM

SEROLOGY-IMMUNOLOGY REPORT FOR BLOOD UNITS

Serial ABO & Rh Components Date Extracted Expiry Date

Number Typing

0000857 “B” Rh PLATELET 08 DEC. 2024 12-13-2024/

POSITIVE CONCENTRATION 11:59 PM

0000861 “B” Rh PLATELET 08 DEC. 2024 12-13-2024/

POSITIVE CONCENTRATION 11:59 PM

0000863 “B” Rh PLATELET 08 DEC. 2024 12-13-2024/

POSITIVE CONCENTRATION 11:59 PM

0000865 “B” Rh PLATELET 08 DEC. 2024 12-13-2024/

POSITIVE CONCENTRATION 11:59 PM

SEROLOGIC EXAMINATION
 Test Method

Hepatitis B Surface Antigen (HBsAG) CMIA*

HIV Antigen/ Antibody (HIV Ag/Ab) CMIA*

Hepatits C Virus Antibody (HCV) CMIA*

Malarial Parasite (MP) Immunochromatography

Syphilis CMIA*

Date & Time: Dec. 12, 2024/ 2:30AM

SEROLOGY-IMMUNOLOGY REPORT FOR BLOOD UNITS

Serial ABO & Rh Components Date Extracted Expiry Date

Number Typing

0000857 “B” Rh PLATELET 08 DEC. 2024 12-13-2024/

POSITIVE CONCENTRATION 11:59 PM

0000861 “B” Rh PLATELET 08 DEC. 2024 12-13-2024/

POSITIVE CONCENTRATION 11:59 PM

0000863 “B” Rh PLATELET 08 DEC. 2024 12-13-2024/

POSITIVE CONCENTRATION 11:59 PM

0000865 “B” Rh PLATELET 08 DEC. 2024 12-13-2024/

POSITIVE CONCENTRATION 11:59 PM

SEROLOGIC EXAMINATION
 Test Method

Hepatitis B Surface Antigen (HBsAG) CMIA*

HIV Antigen/ Antibody (HIV Ag/Ab) CMIA*

Hepatits C Virus Antibody (HCV) CMIA*

Malarial Parasite (MP) Immunochromatography

Syphilis CMIA*

Date & Time: Dec. 12, 2024/ 2:30AM

SEROLOGY-IMMUNOLOGY REPORT FOR BLOOD UNITS

Serial ABO & Rh Components Date Extracted Expiry Date

Number Typing

0000857 “B” Rh PLATELET 08 DEC. 2024 12-13-2024/

POSITIVE CONCENTRATION 11:59 PM

0000861 “B” Rh PLATELET 08 DEC. 2024 12-13-2024/

POSITIVE CONCENTRATION 11:59 PM

0000863 “B” Rh PLATELET 08 DEC. 2024 12-13-2024/

POSITIVE CONCENTRATION 11:59 PM

0000865 “B” Rh PLATELET 08 DEC. 2024 12-13-2024/

POSITIVE CONCENTRATION 11:59 PM

SEROLOGIC EXAMINATION
 Test Method

Hepatitis B Surface Antigen (HBsAG) CMIA*

HIV Antigen/ Antibody (HIV Ag/Ab) CMIA*

Hepatits C Virus Antibody (HCV) CMIA*

Malarial Parasite (MP) Immunochromatography

Syphilis CMIA*

Date & Time: Dec. 12, 2024/ 2:30AM

SEROLOGY-IMMUNOLOGY REPORT FOR BLOOD UNITS

Serial ABO & Rh Components Date Extracted Expiry Date

Number Typing

0000857 “B” Rh PLATELET 08 DEC. 2024 12-13-2024/

POSITIVE CONCENTRATION 11:59 PM

0000861 “B” Rh PLATELET 08 DEC. 2024 12-13-2024/

POSITIVE CONCENTRATION 11:59 PM

0000863 “B” Rh PLATELET 08 DEC. 2024 12-13-2024/

POSITIVE CONCENTRATION 11:59 PM

0000865 “B” Rh PLATELET 08 DEC. 2024 12-13-2024/

POSITIVE CONCENTRATION 11:59 PM

SEROLOGIC EXAMINATION
 Test Method

Hepatitis B Surface Antigen (HBsAG) CMIA*

HIV Antigen/ Antibody (HIV Ag/Ab) CMIA*

Hepatits C Virus Antibody (HCV) CMIA*

Malarial Parasite (MP) Immunochromatography

Syphilis CMIA*

HEMATOLOGY

Name: Patient Y Date: December 12, 2024

Age: 19Y11M8D Room: 210

Sex: Male Time processed: 8:02 AM

Birthday: Jan. 03, 2024 Physician: Dra. Untalan

EXAM RESULT REFERENCE INTERPRETATION

VALUE

Hematocrit Male 36.7(L) 40.0-54.0% Slight improvement but still indicates

hemodilution.

Hemoglobin 12.2 13.0-18.0 g/dl

Male

Hematocrit 27.0-47.0 %
Female

Hemoglobin 11.0-16.0 g/dl

Female

WBC Count 4.34(L) 5.0-10.0 x 10^9/L Persistent leukopenia due to dengue-induced bone
 marrow suppression.

Differential Count
Neutrophil 21.9 50.0-65.0 %

Lymphocyte 35.7(H) 25.0-35.0 %

Eosinophils 0.9(L) 3.0-5.0 %

Basophils 0.5 0.1-1.0 %

Monocyte 41.0(H) 3.0-5.0 %

Stabs 3.0-5.0 %

Platelet Count 19(L) 150-400 x 10^9/L Indicates severe

thrombocytopenia.

RBC Count 5.00 4.5-5.0 x 10^12/L

MCV 73.4(L) 80.0-110.0 fl

MCH 24.4(L) 26.0-38.0 pg

MCHC 33.2 31.0-37.0 g/dl

Reticulocyte Count 0.5-1.5 %

Erythrocyte 0.0-10.0 mm/hr

Sedimentation rate (ESR)
Male

Erythrocyte 0.0-20.0 mm/hr

Sedimentation rate (ESR)
Female

Prothrombin Time 10.0-14.0 sec

% Activity 70.0-120.0 %

INR 0.0-1.2

A.P.T.T 25.0-37.0 sec

Ratio 0.0-.1.2

Blood Type
 Methods

Clotting Time 3.0-6.0 mins

Bleeding Time 2.0-.4.0 mins

Patient's Name: Patient X Requesting MD:

Age/Gender: 19/M Date: Dec. 8, 2024

X-RAY REPORT
Examination: CHEST X-RAY PA/L
Radiological Findings:
• Both lung fields are clear.
• Heart is not enlarged.
• The diaphragm and sulci are intact.
IMPRESSION
-Normal chest findings

Patient's Name: Patient X Requesting MD:

Age/Gender: 19/M Date: Dec. 10, 2024
 X-RAY REPORT
Examination: CHEST X-RAY PA/L
Radiological Findings:
• No frank parenchymal infiltrates are noted.
• Cardiac shadow is not enlarged.
• The pulmonary vascular pattern is within normal
• The diaphragm, lateral costophrenic sulci and bony thoraces are unremarkable
IMPRESSION
-No significant chest findings

VII. COURSE IN THE WARD

TIME PROGRESS DOCTOR’S RATIONALE NURSING
NOTES ORDER CONSDERTION
DECEMBER 08, 2024
12/08/24 -Please admit to -Allow patient to stay -Provide immediate care,
room of choice in the hospital for standing orders and
8:50am
observation, treatment resource available.
and care.
-Secure consent -Securing consent -Be a witness.
from both health
provider and the
patient.
-DAT except -To allow the patient - Assess the patient’s
colored food to progress their diet ability to tolerate oral
based on individual intake, including any signs
tolerance, which of nausea, vomiting, or
supports recovery and discomfort.
provides nutritional
support as needed
 -Educate the patient on
dietary options available
- Avoiding colored
as they progress from
foods (e.g., red,
clear liquids to a regular
orange) prevents
diet.
misinterpretation of
gastrointestinal
symptoms, such as -Monitor intake and
blood in vomitus or output, and document any
stool, particularly in adverse reactions to the
patients at risk of diet to adjust meal plans
bleeding. accordingly.
-PLRS 1L to run -To maintain -Verify the accuracy of
for 8 hours hydration, electrolyte the prescribed
balance, and provide intravenous fluids and
fluid resuscitation as infusion rates.
necessary.

- Monitor the patient

closely for signs of fluid
overload,
hyperglycemia, or
electrolyte imbalances
throughout the
administration.

- Document the
administration
accurately, including the
type and number of
fluids given, infusion
rates, and the patient's
response.
-Please request - These tests assess for -Ensure specimens are
CBC, U/A, infection, kidney labeled correctly and sent
Dengue NS1 AG, function, and dengue promptly to the lab.
RAT infection, which are
critical for diagnosis -Educate the patient about
the purpose of these tests.
and management.
 -Paracetamol 1 -Reduces fever and -Administer on schedule
amp IV every 4 provides symptomatic and monitor the patient for
hours for fever relief. fever reduction.
-Watch for any adverse
reactions, such as rash or
hypotension.

-Isoprinosine 1 -Enhances the immune -Administer with food to

TAB TID response, potentially prevent GI upset.
aiding recovery from -Educate the patient on the
viral infections. purpose and possible side
effects, such as nausea.
-Vit. C + zinc 1 -Boosts the immune -Administer as prescribed.
CAP OD system and supports -Educate the patient on its
recovery during benefits in immunity and
illness. healing.
-RPR every shift -Regularly monitoring Record vital signs every
and record vital signs detects shift and report significant
changes in the deviations promptly.
patient's condition
early.
-Refer -Ensures an open -To provide immediate
communication in all care, standing orders and
levels of health care resource available
providers in giving
care to the patient.
12/08/24 - Increase IVF to -Adjusts fluid therapy Monitor for signs of fluid
1L X 6 hours to manage dehydration overload, such as edema
9:40 am
or maintain hydration or respiratory distress.
levels as per patient’s
needs.
-Next IVF PLRS -Provides consistent -Ensure seamless
1L X 6 hours X 2 hydration and transition between cycles.
cycle then 1L X 8 electrolyte -Document the patient’s
hours thereafter management over response and any
 time. complications.
-Paracetamol -Maintains continuous -Administer on time and
300mg IV every 4 fever control for observe for therapeutic
hours RTC X 24 symptomatic relief. effects or adverse
hours then every reactions.
4 hours for fever -Reassess the need for
thereafter PRN administration after
24 hours.
-For Chest X-Ray -Evaluates lung status - Ensure patient
PAL for any infection or cooperation during the
pathology, especially procedure. Explain the
in fever cases. purpose of the X-ray to
alleviate anxiety.

-Repeat CBC - Monitors blood - Draw blood as ordered,

with Platelet count and platelet label accurately, and
concentration, levels to evaluate transport promptly to the
include blood disease progression or lab.
typing on next treatment efficacy.
blood draw -Blood typing ensures
compatibility in case
of transfusion.
-WOF -Ensures early -Regularly assess BP,
Hypotension, detection of potential monitor for signs of non-
NPP or bleeding complications like palpable pulses (NPP),
shock or active and check for active
bleeding. bleeding.
-Report immediately if
observed.
-Norpriexia forte -Provides pain relief -Administer only when
1tab TID PRN for as needed, promoting pain is reported.
pain patient comfort. -Monitor for side effects,
such as dizziness or GI
upset.
DECEMBER 09, 2024
12/09/24 -For repeat CBC -Monitors platelet - Perform the procedure as
with platelet levels and overall ordered and ensure timely
10:25 am
concentration blood count to guide submission of specimens
further management. to the lab.
(-) Bleeding
(-) Abdominal pain -Next IVF PLRS -Maintains hydration -Verify the infusion rate
1L X 8 hours X 3 and supports recovery. and monitor the patient for
cycle any fluid-related
complications.
-Increase -Provides continuous -Administer on schedule
Norpriexia forte pain management to and assess pain levels
to 1tab TID RTC improve the patient’s regularly.
comfort. -Watch for potential side
effects.
-Paracetamol -Controls fever as -Reassess the patient’s
300mg IV every 4 needed to improve temperature before
hours PRN for patient comfort. administering.
fever -Ensure the fever
threshold for PRN
administration is clearly
defined.
-Refer
DECEMBER 10, 2024
12/10/24 -For CBC with -Provides frequent - Follow timing strictly.
platelet every 12 monitoring of platelet
10:05 am
hours trends to guide -Label and deliver
treatment decisions, specimens promptly to the
especially for lab.
(+) Weak looking
transfusion.
(-) Abdominal pain
-For Chest X-Ray -Reassesses lung -Coordinate with the
(+) Fever
(PAL) health and checks for radiology department and
signs of infection or ensure patient comfort
fluid accumulation. during the procedure.
-Next IVF PLRS -Continues to address -Monitor for signs of
1L X 6 hours X 2 hydration and overhydration or
cycle electrolyte balance as dehydration.
part of ongoing
therapy.
-Reserve 6unit -Ensures availability -Coordinate with the
platelet of platelets in case blood bank and document
concentration transfusion becomes the reservation for future
 necessary. use.
-Paracetamol -Maintains continuous -Administer on schedule
300mg IV every 4 fever control. and assess the patient’s
hours RTC X 24 response to the
hours medication.
-Include -Helps detect and -Ensure proper blood
Procalcitonin to monitor systemic collection and timely
next blood draw infection or sepsis. delivery to the lab.
-No IVF to follow -Same IVF to -Continuation of -Verify the accurate
follow: PLRS 1L PLRS (Lactated infusion rate to ensure
every 6 hours X 2 Ringer’s Solution) at timely completion of each
cycle 1L every 6 hours 6-hour cycle.
ensures sustained
hydration, electrolyte
balance, and adequate
circulatory support.
DECEMBER 11, 2024
12/11/24 -Transfuse 6units -Addresses -Monitor for transfusion
platelet thrombocytopenia to reactions.
concentration as reduce the risk of -Record pre- and post-
(-) Fever fast drip once bleeding. transfusion vital signs.
(+) Petechiae available
-Next IVF PLRS -Supports ongoing -Verify proper infusion
1L X 6 hours X 4 hydration and rates and monitor for
cycle recovery. adverse effects.
Addendum:
-Start Ceftriaxone -Broad-spectrum -Administer slowly as
(xtenda) 2g IV antibiotic to treat prescribed.
OD bacterial infection. -Monitor for allergic
reactions and document
the patient’s response.
8:15am -Repeat CBC -Monitors response to -Perform the procedure at
with platelet transfusion and overall the scheduled time and
blood status. submit samples promptly.
X. DISCHARGE PLANNING

1. Medication Management

 Purpose: Ensure proper compliance with prescribed medications to aid recovery and
prevent complications.
 Instructions:
o Take medications as prescribed by the doctor (e.g., paracetamol for fever, oral
rehydration solutions).
o Avoid NSAIDs such as aspirin or ibuprofen as they may increase bleeding risk.
o Use antipyretics only if fever persists above 38°C, following the prescribed
dosage.
 Education:
o Explain potential side effects of prescribed medications (e.g., nausea, dizziness).
o Use a medication reminder app or a schedule to prevent missed doses.

2. Diet and Nutrition

 Purpose: Promote recovery through adequate hydration and balanced nutrition.

 Instructions:
o Increase fluid intake (water, oral rehydration solutions, fresh fruit juices, soups) to
combat dehydration.
o Eat small, frequent meals rich in essential nutrients, including:
 High-protein foods (e.g., lean meat, fish, legumes).
 Fruits like papaya and citrus fruits to boost immunity.
 Vegetables for vitamins and minerals.
 o Avoid greasy, spicy, or overly processed foods that may upset digestion.

3. Activity Recommendations

 Purpose: Prevent overexertion while gradually regaining strength.

 Instructions:
o Rest as needed, especially during periods of fatigue.
o Limit physical activities and avoid strenuous exercises until full recovery.
o Gradually resume normal activities as energy levels improve.

4. Prevention of Dengue Reinfection

 Purpose: Reduce the risk of future dengue infections.

 Instructions:
o Ensure the use of mosquito repellents and wear long-sleeved clothing, especially
during early morning and late afternoon when mosquitoes are most active.
o Use mosquito nets while sleeping, even during daytime naps.
o Eliminate potential mosquito breeding sites:
 Empty and clean water containers regularly.
 Avoid stagnant water accumulation in plant pots, tires, or other outdoor
areas.

5. Warning Signs to Monitor

 Purpose: Prompt recognition of complications requiring immediate medical attention.

 Instructions:
o Return to the hospital if any of the following occur:
 Severe abdominal pain.
 Persistent vomiting.
 Bleeding from the nose, gums, or under the skin.
 Black or tarry stools.
 Sudden onset of cold, clammy skin or difficulty breathing.

6. Follow-Up Care
  Purpose: Ensure continuous monitoring of health and progress.
 Instructions:
o Schedule a follow-up appointment within 1 week after discharge for repeat blood
tests (e.g., platelet count, hematocrit) and overall assessment.
o Regularly monitor platelet count and hemoglobin levels if advised by the
physician.

7. Patient and Family Education

 Purpose: Empower the patient and family to manage recovery effectively.

 Instructions:
o Educate on the nature of dengue fever, its progression, and recovery phases.
o Emphasize the importance of hydration and balanced meals in recovery.
o Clarify any doubts regarding prescribed medications and activity restrictions.