Discharge Planning Diet: > Encourage nutritious foods like vegetables, meat and fruits.

> Instruct the family members to give the client protein rich foods such as meat, fish, eggs and nuts, vitamin K rich foods such as green leafy vegetables, vit C rich foods(guava and tomatoes and other citrus fruits), carbohydrates rich food (breads and rice) Medications: > Give acetaminophen in case the temperatures increases. > Give oresol to replace fluid in the body. >Remind to take the prescribed medicine, having a written reminder of the correct medication, time to take, and the right frequency of the medicine on the way home to establish assurance of medication compliance. >Dont give aspirin and NSAIDs, they increase the risk of bleeding. Any medicines that decrease platelet count should be avoided. Exercise : >Instruct to avoid excessive activities that may result to stress. >Just advised to perform range of motions and repetitive body movements for promotion of optimum Treatment:
Currently, no medications are available to treat dengue hemorrhagic fever.

> Increased oral fluid intake.

>Admission to an intensive care unit >Intravenous fluids and electrolytes

>Oxygen therapy > Transfusions of blood and platelets as needed > Bed rest Out-Patient Follow-Up Care : >Instruct the family members to have a check-up or to consult physician once a while to monitor patients condition and for detection of recurrences and other complications that may arise on to it. Health Teaching: ( for prenvention) > D- discuss the possible source of infection of the disease. > E- educate the family/patient on how to eliminate those vectors. > N- Never stocked water in a container without cover. > G- Gallon, container and tires must have proper way of disposal. > U- Use insecticides at home to kill or reduce mosquito.

> E- Encourage the family of the patient to clean the surroundings to destroy the breeding places of mosquito.

When outdoors in an area where dengue fever has been found

Use a mosquito repellant containing DEET, picaridin, or oil of lemon eucalyptus Dress in protective clothing-long-sleeved shirts, long pants, socks, and shoes
Keeping unscreened windows and doors closed Getting rid of areas where mosquitoes breed, such as standing water in flower pots, containers, birdbaths, discarded tires, etc.

Recommendation Strict compliance to the medical treatment, health teachings and medical check-up is advised. With proper nutrition and conformity to the medications & therapy, recovery would be easier and faster. . To help with recovery, health care experts recommend

Getting plenty of bed rest Drinking lots of fluids Taking medicine to reduce fever

Currently, no medications are available to treat dengue hemorrhagic fever. The goal of care is to provide comfort and support during the crisis phase of dengue hemorrhagic fever.

One thing to remember also is that we should avoid giving the patients foods or drinks like chocolate drinks, coffee, black chocolate and etc. because it can confuse to us if the patient will vomit
(Platelets are cells in blood that help to stop bleeding. Haematocrit indicates the thickness of blood).

fresh fruits and vegetables to increase body`s vitality

Encourage patient to eat high protein and high calorie foods to enhance faster recovery. RbC carries oxygen..( decrease), there is a need for oxygen therapy Vit. K- help platelets in forming clot

Platelet Count 101 x 10^g/dL 150-450 x 10^g/L blood Increased due to viral infection Due to presence of bleeding DISCHARGE TEACHING Medication Remind to take the prescribed medicine, having a written reminder of the correct medication, time to take, and the right frequency of the medicine on the way home to establish assurance of medication compliance. Dont give aspirin and NSAIDs, they increase the risk of bleeding. Any medicines that decrease platelet count should be avoided. Exercise Instruct to avoid excessive activities that may result to stress. Just advised to perform range of motions and repetitive body movements for promotion of optimum health. Remind about the need for health promotion activities such as reading, watching T.V, etc. Treatment Bed rest is advisable during the re-occurrence of fever phase. Instruct to drink plenty of water or fluids that are available at home and eat nutritious diet. Advised to look for re-occurrence of danger signs and symptoms and report immediately. HygieneEncourage to continue the routinely hygienic care of the patient Out-Patient Follow-Up Care

Instruct the family members to have a check-up or to consult physician once a while to monitor patients condition and for detection of recurrences and other complications that may arise on to it. Diet Instruct the family members to give the client protein rich foods such as meat, fish, eggs and nuts, vitamin K rich foods such as green leafy vegetables, vit C rich foods(guava and tomatoes and other citrus fruits), carbohydrates rich food (breads and rice)

Intake of appropriate vitamin supplement and diuretics to increase protection mechanism of the immune system and decreases renal vascular resistance and may increase renal blood flow, respectively.

Recommendation Strict compliance to the medical treatment, health teachings and medical check-up is advised. With proper nutrition and conformity to the medications & therapy, recovery would be easier and faster. . To help with recovery, health care experts recommend

Getting plenty of bed rest Drinking lots of fluids Taking medicine to reduce fever

When outdoors in an area where dengue fever has been found

Use a mosquito repellant containing DEET, picaridin, or oil of lemon eucalyptus Dress in protective clothing-long-sleeved shirts, long pants, socks, and shoes
Keeping unscreened windows and doors closed Getting rid of areas where mosquitoes breed, such as standing water in flower pots, containers, birdbaths, discarded tires, etc.

Signs and symptoms depend on the Grade: Grade I (+) fever lasting 3 5 days

Abdominal pain Anorexia, nausea and vomiting Pain behind the eyes Joint pains (+) eveidence of vascular changes petechiae Hermans sign general flushing of the skin

Grade II signs and symptoms of Grade I + Bleeding

Gum bleeding, epistaxis, hematemesis, melena, hematochezia

Grade III signs and symptoms of Grade II + Circulatory failure

Hypotension, rapid but weak pulse

Grade IV signs and symptoms of Grade III + Shock Nursing Intervention

1. Control Measure

Eradication of mosquitoes by eliminating breeding places

1. Any disease or condition with hemorrhage is enough to cause alarm. Immediate control of hemorrhage enclose observation of the patient for the vital sign leading to shock 2. For hemorrhage 1. 1. keep patient at rest during bleeding episodes 2. observe for signs of deterioration 3. control bleeding 4. For Shock a. prevention is the best treatment b. restore blood volume Symptoms of typical uncomplicated (classic) dengue usually start with fever within 5 to 6 days after you have been bitten by an infected mosquito and include

High fever, up to 105 degrees Fahrenheit Severe headache Retro-orbital (behind the eye) pain Severe joint and muscle pain Nausea and vomiting Rash

The rash may appear over most of your body 3 to 4 days after the fever begins. You may get a second rash later in the disease. Symptoms of dengue hemorrhagic fever include all of the symptoms of classic dengue plus

Marked damage to blood and lymph vessels Bleeding from the nose, gums, or under the skin, causing purplish bruises

This form of dengue disease can cause death. Symptoms of dengue shock syndrome-the most severe form of dengue disease-include all of the symptoms of classic dengue and dengue hemorrhagic fever, plus

Fluids leaking outside of blood vessels Massive bleeding Shock (very low blood pressure)