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high (Noer, et al, 1999). A. Nursing Assessment of Dengue Hemorrhagic Fever (DHF) 1.

Identity Dengue Hemorrhagic Fever (DHF) is a tropical disease that often causes the death of children, adolescents and adults (Effendy, 1995). 2. Main complaint Patients complain of fever, headache, weakness, heartburn, nausea and decreased appetite. NURSING ASSESSMENT Present Health History The present health history started 8 days ago prior to admission. The patient had a sudden onset of headache; no medication and consultation to the doctor was done. Few days prior to admission, the patient had high grade fever at 42C accompanied with throbbing headache. She self-medicated with equaline 1000mg TID and afforded temporary relief. Due to persistence of the said signs and symptoms, the patient seek consultation and hence admitted at East Avenue Medical Center with Dr. Rivera as attending physician. She was admitted last September 20 at around 12:30 am. On September 23 at 11:25pm, she was transferred from Ward I to Female Surgical Ward. Past Health History Prior to her hospitalization at East Avenue Medical Center, she denies in having any record or medical history of being admitted due to trauma, accident and disease. She also denies having allergies to food and drugs. She says that she is allergic to dust and particles. Family Health History No hereditary disease can be attributed from her father side, but her mother had a family health history of hypertension. Other than the latter, no other hereditary disease from both of his parents are within the patients knowledge. \Definition Dengue is a tropical virus disease transmitted by mosquitoes and characterized by fever, headache, pain in the limbs, and rash (Brooker, 2001). Dengue fever is a disease primarily in children, adolescents, or adults, with clinical signs of fever, sore muscles, or joints accompanied by leukopenia, with / without rash (rash) and lymphadenopathy, biphasic fever, severe headache, pain on the movement of the eyeball, taste menyecap impaired, mild thrombocytopenia, and bleeding spots (ptekie) spontaneous (Noer, et al, 1999). Dengue hemorrhagic fever is a disease caused by dengue viruses (arboviruses) that enters the body through the bite of the mosquito Aedes aegypti (Suriadi & Yuliani, 2001). Pathophysiology Dengue virus enters the body through the bite of aedes aegypti mosquito and then reacted with the antibody and virus-antibody complexes formed in circulation will activate the complement system (Suriadi & Yuliani, 2001). Dengue virus enters the body through mosquito bites and infection first causes dengue fever. Body reaction is a reaction commonly seen in infections by viruses. A very different reaction would seem, when someone gets repeated infections with different dengue virus types. And DHF can occur when a person is infected after the first time, got the other dengue virus infection recurs. Re-infection will cause an anamnestic antibody reaction, giving rise to the concentration of antigen-antibody complex (virus-antibody complexes) is 1. Hyperthermia related to dengue virus infection process. 2. Risk for fluid deficit related to movement of the intravascular to the extravascular fluid. 3. Risk for fluid volume deficit related to excessive bleeding, intravascular to the extravascular fluid displacement. 4. Risk for impaired nutritional needs less than body requirements related to inadequate nutritional intake due to nausea and decreased appetite. 5. Risk for hemorrhage related to a decrease of blood clotting factors (thrombocytopenia). 6. Anxiety: parents related to the child's condition. 7. Knowledge deficit: about disease, prognosis, the effect of the procedure, and the care of sick family members associated with less exposure / recall information. Physical examination for Dengue Hemorrhagic Fever (DHF) 3. History of present illness Medical history showed headache, muscle pain, soreness throughout the body, pain on swallowing, weakness, fever, nausea, and decreased appetite. 4. History of previous illness No illness in specific. 5. Family history of disease A history of DHF disease on other family members is crucial, since DHF disease is a disease that can be transmitted through mosquito bites aigepty aides. 6. Environmental Health History Normally less clean environment, lots of clean water puddles like tin cans, old tires, where the drinking water of birds that are rarely changed the water, the tub is rarely cleaned. 7. Historical Growth Physical Examination for Dengue Hemorrhagic Fever (DHF) 2. Nursing Diagnosis of Dengue Hemorrhagic Fever (DHF)

1. General condition:

Grade 1: complaints of high fever, consciousness either. Grade 2: The fever is still there, or has been dropped. Children looked tired, and lethargic.

Grade 3: Children's restless, anxious, very tired, moist clammy skin. Grade 4: Children experiencing loss of consciousness, cold clammy skin.

hepatomegaly accompanied with tender not accompanied by jaundice, abdominal stretch, decreased appetite, nausea, vomiting, pain on swallowing, may vomit blood / hematemesis, dysentery / melena.

2. Respiratory System:

7. Integumentary System

Shortness of breath, bleeding through the nose / epistaxis, shallow breathing, tachypnea, asymmetrical chest movement, resonant percussion, auscultation sounds Ronchi and pleural effusion (crackles)

There was an increase in body temperature / fever, dry skin and rash makulo popular.

8. The degree of dehydration

3. Cardiovascular System:

Performed by examination of the degree of edema.

Grade I Test tornikuet (+), thrombocytopenia, spontaneous bleeding and hemoconcentration

How to check:

examiner pressed the leg area (lateral tibia musculus) with 2 fingers, release the pressure and note the time required to return to normal skin (in seconds)

Grade II Accompanied by spontaneous bleeding in the skin or other bleeding

inform the results of examination of the patient and

note on the status. Email ThisBlogThis!Share to TwitterShare to Facebook

Grade III Circulatory failure may occur that is fast and weak pulse (tachycardia), narrow pulse pressure, hypotension, cyanosis around the mouth, nose, and fingers, as well as cool and moist skin Summer season has now lapsed and rainy days are setting in. Philippines as a tropical country, is included to the Center for Disease Control and Prevention list for one which has dengue outbreaks for the past years. According to the statistics, there were 126,000 dengue cases in the country last 2011. Thus, Grade IV No palpable pulse, and blood pressure can not be measured recently theDepartment of Health (DOH) strictly encourages the public citizens to continue and strengthen their fight against dengue. Today, the goal of the DOH 4.Sistem Neurology according to Dr. Eric Tayag is to decrease the number of dengue cases to atleast 100,000 cases comparative to last In grade I and II, the awareness of compost mentis. In grade III and IV, restless, fussy, whiny, apathy, sopor coma. Grade I-IV can occur cramps, headache, and pain in various parts of the body, vision fotophobia, and pain behind the eyeball. years figures. There was a slight gist of hope for all since DOH has reported an 8.52% decline in dengue cases last January 1 to May 5 of this year; compared to the growth of cases last year on the same said period. Nevertheless, we should not be at ease of 5. Urinary system this since the peak season of dengue fever is still somewhere between the months of July and August. So, here are the Decreased urine production, sometimes less than 30 cc per hour, especially in grade III, will reveal the pain while urinating. Red colored urine. things we should know about dengue hemorrhagic fever and its corresponding nursing care management. Dengue hemorrhagic fever is caused by a bite of a vector mosquito called, Aedes Aegypti. This mosquito is considered 6. Digestive system (gastrointestinal) to be a day- biting and low flying mosquito and commonly be found inside the household. On the other hand, some reports Bleeding gums, dry mucous membranes, difficulty swallowing, epigastric tenderness, an enlarged spleen, enlarged liver / initiated by a study in the UP Los Banos had produced another suspicious mosquito to be a dengue carrier- known as Aedes

Albopictus. This time, this said mosquito is a night biting mosquito and can be found spreading the virus in the outdoors. DOH is however unsure if this specie ofAedes mosquito is the one responsible for the cases of dengue nowadays. The etiologic agents carried by the vector mosquito include Dengue Virus Types 1, 2, 3, 4, and Chikungunya virus. The condition causes an acute febrile infection with sudden onset that could be manifested in three stages:

1. DHF Grade I:

Fever accompanied by non- specific

symptoms like anorexia, vomiting, and abdominal pain; the only hemorrhagic manifestation is (+) tourniquet test and/ or easy bruising

2. DHF Grade II: Spontaneous bleeding plus the

manifestations with Grade I (usually observed in GIT or mucocutaneous

3. DHF Grade III (DSS): Presence of circulatory failure

as evidenced by rapid, weak pulse, narrowing of pulse pressure or hypotension, and cold clammy skin.

4. DHF Grade IV (DSS): Profound shock with

undetectable blood pressure or pulse. Nursing Considerations and Nursing Care Management:

Preventive and control measures that would involve

health education and strongly advocating the implementation of 4S, recognition of disease, case finding and reporting for cases in the community. The Four S drive implemented by the Department of Health corresponds to:

Incubation Period: Approximately one week Period of Communicability: Upon infection of

Search and destroy the mosquito dengue

carriers breeding sites (recently pinpointing buko shell or coconut shells, tires, and bromeliads) It may also involve frequent changing of water and scrubbing sides of vases and keeping water containers covered at all times, destroying of breeding places stated above by cleaning the surroundings (3Oclock habit) and proper disposal of tires and containers.

virus in the blood, within the first week of illness. Susceptibility, Resistance, and Occurrence: It is

universal with both sexes equally affected. It primarily involves children aging 5- 9 years, especially those in preschool and school ages. However, it does not exempt adults and infants. It is an acquired illness through the said vector with temporary immunity, though to some cases it is permanent. It is sporadic throughout the year according to statistics and becomes epidemic during the months of June to November.

Self protection against mosquito (use of loose

clothing with long sleeves and long socks, use of mosquito nets, tested mosquito repellants and the like)

Seek early consultation (Early detection of

condition means treatment could be administered readily to prevent fatal complications of dengue)

Classification of Dengue Hemorrhagic Fever: (Depending on Severity)

Say NO to indiscriminate fogging (Fogging is not

1. Mild Client may manifest fever, with or without

petechial hemorrhage.

advised nowadays because it does not really eliminate mosquitoes but it only scares them away. It is also not recommended because of its respiratory consequences.) Supportive management which could be symptomatic in nature may involve:

2. Moderate Client may experience high fever, but

with less hemorrhage and no progression to shock.

3. Severe, frank type- Sudden onset of fever may

occur with severe hemorrhage; which is accompanied by an abrupt decrease in temperature, shock and termination of recovery. Grading of Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) According to 2010 Guideline:

Rapid replacement of fluids: clients are encouraged

to increase their fluid intakes as much as possible if tolerated; In the community, ORS is given to halt moderate dehydration at 75ml/ kg in 4 -6 hours or up to 2- 3 liters in adults.

Administration of antipyretic/ analgesics as indicated

by the physician

Close observation and intensive monitoring of vital

idn=&nid=7&rid=426651Philippine Nurses Association. (May 16, 2012). DOH Urges Public to Continue Search and Destroy of Dengue MosquitoBreeding Sites. Retrieved last May 20, 2012 from http://www.pna.gov.ph/index.php? idn=&nid=7&rid=426358 Reyala, J.P., et.al. (2000).Community Health Nursing Services in the PhilippineDepartment of Health. 9th Edition.

signs Early detection for signs of bleeding and immediate

referral Use of Tourniquet test (Rumpel Leade test) to detect

petechial hemorrhage

Health education on the prevention of hemorrhage may include:

Avoidance of dark colored foods and liquids Client is encouraged to prevent from using sharp-

bristled toothbrushes, instead advised to gargle with saline solution

Clients are educated not to use hot liquids for

alleviation of chills etc. Avoidance of sharp objects like razors are

emphasized on adults The use of ASPIRIN is strictly prohibited.

In cases that hemorrhage sets in, nursing care may involve the following:

Keep the client at bed rest and ensure safety to

prevent from injury Client is usually placed in dorsal recumbent position. Hourly monitoring noting for narrowing pulse

pressure, sudden drop in temperature, decreased blood pressure and pulse rate and other signs of deterioration.

Administration of blood products and monitoring

client for signs of adverse reactions. Strict monitoring of fluid intake and output Immediate referral for any change in clients status

and proper documentation of procedures given.


Center for Disease Control and Prevention. (May 16, 2012). Update: Dengue in Tropical and Subtropical Regions. Retrieved last May 23, 2012 from http://wwwnc.cdc.gov/travel/notices/in-the-news/denguetropical-sub-tropical.htmGonzales, M.L.A., et.al. (October 2010). 2010 Interim Guidelines on Fluid Management of DF/DHF. Retrieved last May 24, 2012 from http://ppsstc.com/files/2010%20PPS%20Guidelines%20on %20Dengue.pdfPhilippine Nurses Association. (May 17, 2012). DOH Targets No More Than 100, 000 Dengue Cases for 2012. Retrieved last May 20, 2012 from http://www.pna.gov.ph/index.php?