Which of the following nursing interventions is most important for a patient recovering from dengue fever with thrombocytopenia?

C) Monitor for signs of bleeding

A) Encourage a high-protein diet

B) Administer NSAIDs for pain management

C) Monitor for signs of bleeding

D) Provide a warm compress for muscle aches

What is the primary nursing intervention to monitor for potential complications in a patient with thrombocytopenia due to dengue fever?

B) Monitor for signs of bleeding

A) Encourage increased physical activity

B) Monitor for signs of bleeding

C) Administer NSAIDs for pain management

What is the primary reason for avoiding NSAIDs in a patient recovering from thrombocytopenia due to dengue fever?

B) They may exacerbate bleeding risks

A) They can cause gastrointestinal upset

B) They may exacerbate bleeding risks

C) They are contraindicated in all viral infections

D) They interfere with platelet production

Which nursing intervention is most appropriate for M.L.D. considering her current condition and history of thrombocytopenia?

B) Monitor for signs of bleeding and avoid invasive procedures

A) Encourage the use of NSAIDs for pain management

B) Monitor for signs of bleeding and avoid invasive procedures

C) Discontinue IV fluids as her vitals are stable

D) Increase physical activity to promote circulation

What is the primary reason for advising M.L.D. to avoid NSAIDs following her discharge?

B) NSAIDs may lead to increased bleeding risk.

A) NSAIDs can cause dehydration.

B) NSAIDs may lead to increased bleeding risk.

C) NSAIDs can result in increased blood pressure.

D) NSAIDs are contraindicated due to their sedative effects.

A nurse is preparing to discharge a patient who has shown improvement in platelet count following treatment. Which instruction should the nurse include in the discharge teaching to help prevent complications related to low platelet levels?

A) Encourage the use of acetaminophen for pain relief instead of NSAIDs

B) Advise to increase vitamin K intake to improve platelet function

C) Suggest taking aspirin daily to maintain platelet health

D) Instruct to engage in contact sports to enhance circulation

What is the most appropriate nursing action to recommend for M.L.D.'s mild joint pain following viral illness?

A) Administer acetaminophen as needed

B) Apply a hot compress to affected joints

C) Encourage bed rest until symptoms resolve

D) Advise discontinuing all current medications

What is the most appropriate nursing action when a patient with a post-viral rash and joint pain, like M.L.D., is recovering at home?

B) Encourage the patient to maintain adequate hydration

A) Advise the patient to stop all medications until symptoms resolve

B) Encourage the patient to maintain adequate hydration

C) Recommend the patient to increase physical activity to improve circulation

D) Suggest the patient to apply topical antibiotics on the rash

What is the most important nursing intervention for ensuring M.L.D.'s continued recovery from her illness?

A) Encouraging the family to monitor for any signs of deterioration

B) Advising M.L.D. to increase her physical activity to regain strength

C) Suggesting that M.L.D. reduce her fluid intake to prevent edema

D) Recommending that M.L.D. avoid all social interactions to prevent re-infection

Which vital sign measurement indicates that M.L.D. is maintaining good respiratory function?

D) Oxygen saturation of 99% on room air

B) Blood pressure of 114/76 mmHg

C) Respiratory rate of 18 breaths/min

D) Oxygen saturation of 99% on room air

Dengue fever Pt initials : M. L. D DOB : 8-7-09 17 yo Female Religion : Roman Catholic Civil status : Child/Single Date admitted : 10/16/26 (6:40PM) Date discharge : 10/20/26 (11:00AM) Ward : Private #6 Physician : Dr. K.C So our CI only wants us to create a case study from the date we started handling our patient (but we didn't handle them we just took VS) and it was at 10/19/26 so that's our scope of study only so here's what I got from the patient's chart regarding that : - patient is administered IVF DSLR 1L run at 33 gtts/min - patient is afebrile the whole day since meds are given, daily CBC, PC requested afebrile Oct 10 - patient is afebrile and was discharged that day history of present illness : - 4 day PTA, px had on and off undocumented fever associated w/ myalgia self-medicated w/ paracetamol 500 mg tablet which provided no relief of symptoms hence consulted to anothee clinic few hours PTA vital signs : T= 38.6° HR= 101 RR= 21 BP= 110/80 SpO2= 100% W= 58.5kg H=158 cm GCS 15 cardiac : AP, tachycardia, RR = adynamic precordium, tachycardia, regular rhythm skin : fair, CRT = <2 respiratort : SCE, CBS Past medical history : - revealrd decreased platelets (79k) and was advised admission but opted to transfer in our institution she also was administered these drugs/medicine : Omeprazole 40mg TIV OD Paracetamol 300 mg TIV Q4 PRN fever Flotera chewable 1 tab BID Isoprinosine 500 my 1 tab BID Cetirizine 10 mg 1 tab Q12 - Nursing Case Study

Pathophysiology

• Primary mechanism: Dengue fever is caused by the dengue virus, which is transmitted through the bite of an infected Aedes mosquito. The virus targets and replicates within white blood cells, leading to the release of signaling proteins that cause increased vascular permeability and a systemic inflammatory response.

• Secondary mechanism: The infection triggers an immune response that includes the production of cytokines and antibodies. In some cases, this immune response can lead to a phenomenon called antibody-dependent enhancement (ADE), where non-neutralizing antibodies facilitate increased viral entry into host cells, exacerbating the disease.

• Key complication: A critical complication of dengue is thrombocytopenia, or a significant drop in platelet count, which can lead to bleeding tendencies. This patient's platelet count of 79,000/µL highlights this risk, necessitating careful monitoring and supportive care to prevent hemorrhagic complications.

Patient Profile

Demographics:

17-year-old female, student

History:

• Key past medical history: History of decreased platelets (79k) due to Dengue fever

• Current medications: Omeprazole 40mg TIV OD, Paracetamol 300 mg TIV Q4 PRN fever, Flotera chewable 1 tab BID, Isoprinosine 500 mg 1 tab BID, Cetirizine 10 mg 1 tab Q12

• Allergies: None reported

Current Presentation:

• Chief complaint: Fever and myalgia

• Key symptoms: On and off fever, myalgia

• Vital signs: T= 38.6° C, HR= 101 bpm, RR= 21 breaths/min, BP= 110/80 mmHg, SpO2= 100%

Section 1

On October 19, 2026, M.L.D. was monitored closely due to her recent history of dengue fever and the associated risk of thrombocytopenia. The nursing team performed an initial assessment, noting her vital signs were stable: temperature remained afebrile at 37°C, heart rate at 85 bpm, respiratory rate at 20 breaths/min, blood pressure at 110/75 mmHg, and oxygen saturation at 98% on room air. The patient appeared alert and oriented, with a Glasgow Coma Scale score of 15, indicating no neurological impairment at this stage.

A repeat Complete Blood Count (CBC) was conducted to evaluate her platelet levels and other hematological parameters. The results indicated a slight improvement in platelet count to 85,000/µL, suggesting a positive trend in her recovery from thrombocytopenia. However, the count remained below normal, warranting continued observation for any signs of bleeding, such as petechiae, gum bleeding, or epistaxis. The nursing staff remained vigilant in monitoring for these symptoms while ensuring adequate hydration through the ongoing administration of intravenous fluids (IVF) and supportive medications.

Despite the initial concern for potential complications, M.L.D. demonstrated a favorable response to the interventions in place. Her symptoms of myalgia had subsided, and she reported feeling more comfortable. The nursing team provided education on recognizing warning signs of dengue complications and emphasized the importance of follow-up care post-discharge. As the patient prepared for possible discharge the following day, the focus shifted to ensuring a smooth transition to home care with instructions for maintaining hydration, avoiding NSAIDs, and adhering to prescribed medications.

Section 2

On October 19, 2026, during the evening shift, M.L.D.'s condition remained stable, reflecting a positive response to the current treatment plan. The nursing team continued to monitor her closely, noting that her vital signs were consistently within normal limits: her temperature was 37°C, heart rate 82 bpm, respiratory rate 18 breaths/min, blood pressure 112/78 mmHg, and oxygen saturation steady at 98% on room air. Her alertness and orientation remained intact, with a Glasgow Coma Scale score of 15, confirming no neurological decline.

A follow-up Complete Blood Count (CBC) was performed to further assess her recovery from thrombocytopenia. Encouragingly, her platelet count had increased to 90,000/µL, reflecting a continuing upward trend. Although still below the normal range, this improvement reduced the immediate concern for significant bleeding risks. The nursing staff remained diligent in observing for any signs of bleeding or other potential complications, while also ensuring M.L.D. continued to receive adequate hydration through her intravenous fluids and supportive care.

With M.L.D. responding well to interventions and her platelet count showing gradual improvement, the healthcare team initiated discussions around her discharge planning. They emphasized the importance of continued monitoring for any signs of dengue complications at home, such as severe abdominal pain or persistent vomiting, and reinforced the need to avoid NSAIDs which could exacerbate bleeding risks. The patient and her family were provided with detailed instructions for follow-up appointments and were encouraged to maintain regular communication with her healthcare provider to ensure a smooth and safe recovery process.

Section 3

On October 20, 2026, during the morning shift, the nursing team conducted a final assessment before M.L.D.’s planned discharge. Her condition remained stable, with vital signs recorded as follows: temperature 36.8°C, heart rate 78 bpm, respiratory rate 17 breaths/min, blood pressure 110/76 mmHg, and oxygen saturation at 99% on room air. These findings were reassuring and indicated that M.L.D. was maintaining homeostasis effectively. Her alertness and orientation were unchanged, with a Glasgow Coma Scale score of 15, further confirming her stable neurological status.

A repeat Complete Blood Count (CBC) was performed that morning to evaluate her progress. The results showed a platelet count of 100,000/µL, continuing the upward trend and nearing the lower limit of the normal range. This further alleviated concerns about potential bleeding complications and reinforced confidence in the effectiveness of the treatment and supportive care she had received. The nursing staff conducted a thorough skin assessment, finding no signs of petechiae or any other indications of bleeding, which was a positive outcome reflecting her recovery trajectory.

With these encouraging results, the healthcare team proceeded with the discharge process, ensuring that M.L.D. and her family received comprehensive education on home care management. They were advised to maintain hydration, monitor for any unusual symptoms, and follow up with her primary care provider as scheduled. The team also reiterated the importance of avoiding NSAIDs and encouraged them to seek medical attention if any concerns arose. This careful planning and education aimed to empower M.L.D. and her family to manage her recovery confidently and safely at home, marking a successful transition from hospital care to home management.

Section 4

Following the discharge of M.L.D., the nursing team received a phone call from her mother two days later, expressing concern about her daughter's new symptoms. M.L.D. had developed mild joint pain and a slight rash on her arms and legs. Her mother reported that M.L.D. had remained afebrile, and her appetite was gradually improving. However, the appearance of these additional symptoms prompted a follow-up visit with her primary care provider to ensure there were no new complications developing.

During the follow-up examination, the physician performed a comprehensive assessment. M.L.D.'s vital signs were stable: temperature 36.9°C, heart rate 80 bpm, respiratory rate 18 breaths/min, and blood pressure 112/78 mmHg. Her oxygen saturation remained at 98% on room air. A repeat Complete Blood Count (CBC) was ordered to further evaluate her hematological status. The results showed continued improvement with a platelet count of 120,000/µL, indicating a positive recovery trend. Despite the new symptoms, the physician assessed that the rash and joint pain were consistent with an expected post-viral response and not indicative of severe dengue complications.

The care team took the opportunity to reinforce education regarding symptom management and hydration. M.L.D. was advised to continue with her current medications and maintain adequate fluid intake. Her family was reassured about the benign nature of her new symptoms and encouraged to monitor for any changes or escalations. With this guidance, M.L.D. and her family felt more confident in managing her recovery at home, understanding that these symptoms often resolved spontaneously as part of the natural healing process.

Section 5

In the days following M.L.D.'s follow-up visit with her primary care provider, her symptoms began to gradually resolve, and her overall condition improved significantly. Her mother reported that the joint pain had diminished, and the rash on her arms and legs was fading. M.L.D.'s energy levels increased, and she was able to resume some of her daily activities, although she was cautious not to overexert herself.

A follow-up phone call from the nursing team revealed that M.L.D. was adhering to her medication regimen and maintaining good hydration as advised. Her appetite had returned to normal, and she was eating regular meals without any gastrointestinal discomfort. The family was consistent in monitoring her for any signs of deterioration, but they observed only positive changes. M.L.D.'s vital signs remained within normal limits: temperature 36.7°C, heart rate 76 bpm, respiratory rate 18 breaths/min, and blood pressure 114/76 mmHg. Oxygen saturation was stable at 99% on room air, reflecting her improved health status.

As M.L.D. continued her recovery, the care team reiterated the importance of follow-up appointments to monitor her progress and ensure there were no lingering complications. The positive trend in her platelet count and the resolution of symptoms were encouraging signs that M.L.D. was on the right path to recovery. Her family expressed relief and gratitude for the support and education provided by the healthcare team, which equipped them to manage her recovery confidently at home. This phase of M.L.D.'s journey highlighted the significance of comprehensive care and patient education in managing post-viral symptoms effectively.