The Department of Health initiated the National Dengue Prevention and Control Program since 1993.They are aiming for reducing morbidity and mortality from dengue infection by preventing the transmission of the virus from the mosquito vector human. In line with this their mission is to improve the quality of health of Filipinos by adopting an integrated dengue control approach in the prevention and control of dengue infection.
According to them there are 62,503 cases of the mosquito-borne illness have been reported in the Philippines from January 1 to August 21, up nearly 90 percent from the same period last 2010. The death toll was also up from 350 in the same period 2010. The department said the number of dengue cases in the country started to rise in May and peaked last month at the onset of the rainy season. Disease experts are now closely monitoring several barangays across the country for cases of dengue outbreak. In line with this, the group decided to conduct a class and project regarding the prevention and control of dengue fever to raise the awareness of the residents of Barangay Macapagal Village Zone 3.
II.CONTENT OF THE TOPIC TO BE DISCUSSED
What is Dengue?
Dengue fever is an acute febrile disease caused by infection one of the serotypes of dengue virus which is transmitted by genus Aedes. It refers to a benign form of disease with systematic symptoms, fever and often rash associated with pain behind the eyes, the joints, and the bones. Dengue hemorrhagic fever is a severe, sometimes fatal manifestation of dengue virus infection characterized by a bleeding diathesis and hypovolemic shock. Etiologic agent and vector
Dengue viruses (DEN) types 1, 2, 3, 4, which are classified as flaviviridae, are principally transmitted from human to human through the bites of the Aedes aegypti mosquitoes. The female mosquito bites the infected human during the day and can transmit the virus to another host immediately or after 8 to 10 days of incubation within the salivary gland of the mosquito. The mosquito host remains infected for life.
Mode of Transmission
By bite of an infected mosquito, principally the Aedes Egypti – is a day biting mosquito (they appear two hours after sunrise and two hours before sunset ). It breeds on stagnant water. It has a limited and low flying movement. It has fine white dots at the base of the wings; with white bands on the legs.
Aedes albopictus may contribute to transmission of dengue virus in rural areas. And other contributory mosquitoes are the Aedes polynensis and Aedes scutellaris simplex.
After an individual is bitten by an infective mosquito, the virus undergoes an incubation period of 3 to 14 days.
Signs and symptoms of dengue fever vary, depending on the form and severity of the disease. Dengue fever
With the mild form of the disease, you may experience some or all of these signs and symptoms:
← High fever, up to 105 F (40.6 C)
← A rash over most of your body, which may subside after a couple of days and then reappear
← Severe headache, backache or both
← Pain behind your eyes
← Severe joint and muscle pain
← Nausea and vomiting
Sign and symptoms usually begin about four to seven days after being bitten by a mosquito carrying a dengue virus. Mild dengue fever rarely causes death, and your symptoms will usually subside within a week after starting.
Dengue hemorrhagic fever
More-severe forms of the disease usually begin the same way as the mild form (dengue fever) then become worse after several days. Dengue hemorrhagic fever a more severe form of the disease than initial dengue fever can cause signs and symptoms of dengue fever plus:
← Significant damage to your blood and lymph vessels
← A decrease in the number of blood cells that help your blood clot (platelets)
← Bleeding from the nose and mouth
← Bleeding under the skin, which gives the appearance of bruising
Dengue shock syndrome
Dengue shock syndrome the most severe form of the disease may cause signs and symptoms of mild dengue fever plus:
← Severe abdominal pain
← Frequent vomiting
← Fluid (plasma) leakage from blood vessels
← Heavy bleeding
← A sudden drop in blood pressure (shock)
Severe signs and symptoms may appear after your fever has improved. In a small number of cases, people with a severe form of the disease die of it. Modern supportive hospital care decreases this risk.
Torniquet Test (Rumpel Leads Test) – First, Inflate the blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressure for 5 minutes. Second, release cuff and make an imaginary 2.5 cm, square or 1 inch square just below the cuff, at the antecubital fossa. Lastly, count the number of petechiae inside the box. A test is (+) when 20 or more petechiae per 2.5 cm square or 1 inch square are observed.
How is it treated?
For a mild form of the disease:
← Drinking plenty of fluids to avoid dehydration from vomiting and high fever. ← Taking acetaminophen (Tylenol, others) to alleviate pain and reduce fever ← Don’t take aspirin or other non-steroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve, others). These can increase the risk of bleeding complications. For a more severe form of the disease, treatment consists of: ← Supportive care in a hospital
← Intravenous (IV) fluid and electrolyte replacement
← Blood pressure monitoring
← Transfusion to replace blood loss
Methods of Prevention and Control
The prevention of dengue is directed at community and personal mosquito control in endemic areas.
← Cover water drums and water pails at all times to prevent mosquitoes from breeding.
← Replace water in flower vases once a week.
← Clean all water containers once a week.
← Scrub the sides well to remove eggs of mosquitoes sticking to the sides.
← Clean gutters of leaves and debris so that rain water will not collect as breeding places of mosquitoes.
← Old tires used as roof support should be punctured or cut to avoid accumulation of water.
← Collect and dispose all unusable tin cans, jars, bottles and other items that can collect and hold water.
← To prevent mosquito bites, wear long pants and long sleeves.
← For personal protection, use mosquito repellant sprays that contain DEET when visiting places where dengue is endemic.
← Limiting exposure to mosquitoes by avoiding standing water and staying indoors two hours after sunrise and before sunset will help.
Public Health Nursing Responsibilities
Since there is no known immunization agent against Dengue, nursing efforts should be directed toward the immediate control of its cause by knowing the nature of the disease and its causation. The following are important: Report immediately to the Municipal Health Office if there is any known case outbreak
← Refer immediately to the nearest hospital, if there are cases that exhibit symptoms of hemorrhage from any part of the body ← Conduct a strong health education program directed towards environmental sanitationparticularly destruction of all known breeding places of mosquitoes ← Assist in the diagnosis based on the signs and symptoms. For those with no signs of hemorrhage, the nurse may perform the tourniquet test. ← Conduct epidemiologic investigations as means of contacting families, case finding and as well as community health education.
Any disease or condition associated with hemorrhage is enough to cause alarm. Immediate control of hemorrhage and close observation of the patient for vital signs leading to shock are the nurses primary concern. Nursing measures are directed towards the symptoms as they occur but immediate medical attention must be sought.
1. For hemorrhage keep the patient ate rest during bleeding episodes. For nose bleeding, maintain an elevated position of trunk and promote vasoconstriction in nasal mucosal membrane through an ice bag over the forehead. For melena, place ice bag over the abdomen. Avoid unnecessary movement, If transfusion is given, support patient during therapy. Observe signs of deterioration (shock) such as low pulse, cold clammy perspiration, prostration.
2. For shock – Prevention is the best treatment. Dorsal recumbent position facilitates circulation.
3. Adequate preparation of the patient, mentally, and physically prevents occurrence of shock. 4. Provision of warmth through lightweight covers (overheating causes vasodilation which aggravates bleeding) 5. Diet -low fat, low fiber, non-irritating, non-carbonated. Noodle soup may be given.
III. LESSON PLAN
Our expected learners are the selected residents of Barangay Macapagal Village Zone 3.
The topic to be discussed is about dengue, which is a disease caused by a family of viruses that are transmitted by mosquitoes.
After 40 minutes of discussion, the student nurses will be able to:
✓ Establish rapport to the participants of Chat Session ✓ Teach learners about prevention and control of dengue. ✓ Provide basic knowledge on how dengue is prevented and its signs & symptoms ✓ Increase the learner’s awareness on how dengue is transmitted ✓ Realize the importance of giving health teachings especially in the community
➢ Client- centered
After 40 minutes of discussion, the participants will be able to:
✓ Acknowledge the purpose of the class
✓ Participate well in the said session
✓ Understand the given health teachings by the student nurses as shown by the participants ability to answer questions given by student nurses at the end of the class.
D. Method of Teaching
The method of teaching would be in a form of classroom type discussion wherein the group will act as instructors and the learners as the students. There will be use of visual aids like Manila paper to guide the learners.
✓ Manila paper
✓ Pictures (visual aid about dengue prevention and control)
It was a bright, sunny day as the group 3 headed their way to Barangay Macapagal Village Zone 3, to conduct their Chat Session. The group was hoping for the Chat Session to go smoothly as planned, and with God’s grace the class went on well. The group was able to achieve their objectives at the end of the class.
After 40 minutes of discussion, the student nurses were able to discuss about the prevention and control of dengue by giving basic knowledge on how to be prevented including the signs and symptoms. Also increasing the awareness of listeners on how it is transmitted lastly, to realize the importance of giving health teachings. The participants acknowledge the purpose of the discussion by participating and they had an ability to answer are questions. In line with this, the participants understand on how can be prevented and controlled dengue.
Handbook of Common Communicable and Infectious Disease, Revised edition by Dionesia Mondejar-Navales RN,MAEd
NLPGNI (2007).Public Health Nursing in the Philippines.National League of Philippine Government Nurses, PhilippinesMayo Clinic (September 30, 2009). Dengue Fever. RetrievedSeptember13,2010from
http://www.mayoclinic.com/health/denguefever/D/DSECTION=symptomsDOH (2006).DengueRetrievedSeptember13,2010, fromhttp://www.doh.gov.ph/healthadvisories/dengue/