Nursing Care for Patients Suffering from Dengue Shock Syndrome (DSS) : Case Study

Abstract

The purpose of this study aimed to study individual case study. The objective of this study is to nursing care to the children patient with dengue shock syndrome (DSS) : case study at Pediatric Intensive Care Unit (PICU) in Chaiyaphum hospital.  Author study from 17^th June 2019 to 29^st February 2020. The case study is a Thai child male, age 14 years old, weight 32 kilograms and 145 centimeters tall. Chief complaint, Four days before admitting to Phukhiew Chalermprakiet hospital, he had been having fever, drowsiness and fatigue. After 7 hours, under the care of Phukhiew Chalermprakiet hospital, he had conditions of dyspnea, tachycardia and shock. Therefore, he was intubated and transferred through Refer fast track to PICU Chaiyaphum hospital. Later, he was diagnosed with dengue shock syndrome (DSS). His symptoms at the time off arrival was disorientation, fatigue, sweating and clammy skin. He had petechiae at chest wall and extremities, hepatomegaly 1 FB below RCM., Capillary refill less than 3 second. He had oroendotracheal tube No. 6.5 mm. depth 18 cms. with ventilator support, on 5% D/NSSⓥdrip 40 cc./hr., Dobutamine 500 mg. in 5%D/W 250 ml.ⓥdrip 10 ml./hr., Dopamine 500 mg. in 5%D/W 250 ml.ⓥdrip 10 ml./hr. He had blood loss : gastric content coffee ground about 50 cc. Vital signs T = 38^oC, pulse  120/min weak, Heart rate 120/min, respiration rate 20/min, blood pressure 90/40 mm.Hg. weak and O₂ saturation 97%. Result of laboratorys: Hematocrit = 27%, White Blood Cell Count = 2,700 cell/mm.³, Platelet Count = 48,000 cell/mm.³, DTX = 118 mg%, BUN = 21.1 mg/dL, Creatinine = 1.55 mg/dL, Sodium = 125 mEq/L, Potassium = 3.3 mEq/L, Chloride = 104 mEq/L, Bicarbonate = 19.9 mEq/L, Calcium = 8.0 mg/dL, Magnesium = 1.6 mg/dL, AST = 276 Unit/L, ALT = 186 Unit/L, Prothombin time = 22.1 second, Activate Partial Tromboplast = 47.1 second, INR = 1.88 These following nursing problems were found: Shock period 1) hypovolemic shock due to plasma leakage 2) blood loss due to decrease platelet 3) electrolyte imbalance due to DSS 4) hypocalcemia and hypomagnesemia due to DSS 5) risk for tissue hypoxia due to shock period  6) risk for kidney functioned ineffectively due to shock period, renal blood flow insufficiency 7) risk for brain symptoms due to hepatic failure 8) Family members being anxious about patient health issue 9) He cannot do personal hygiene due to shock period 10) He is unable to communicate verbally due to intubation. Recovery period : 1) Patient experienced fluid overload due to intake over output and plasma reabsorption to vessel 2) Patient felt uncomfortable causing by abdominal discomfort and itching 3) He had risk of malnutrition and electrolyte imbalance due to DSS. The nursing care was performed according to the schedule. He is alert and normally vital signs. He was discharged after 15 days.