DHF

Definisi

a. Dengue fever is a severe clinical manifestations of arbovirus diseases. (Soedarmo Sumarno, 2005).

b. Dengue infection is an arbovirus (arthropod-borne virus) infection is transmitted by the mosquito

Aedes species. (Hasan Rusepno, 2007).

c. Dengue is a disease caused by the dengue virus belonged to the arbovirus through the bite of
female Aedes aegypti mosquito. (Hidayat A. Aziz Alimul, 2008).

Etiologi

The cause of the disease is Dengue Dengue virus. In Indonesia, the virus has to date been isolated
into four serotypes of dengue virus were included in group B arthropediborne viruses (Arboviruses),
the DEN-1, DEN-2, DEN-3 and DEN-4. (Nursalam Susilaningrum, 2005) ,

The disease is caused by Dengue virus and transmitted by Aedes mosquitoes. In Indonesia there are
two types of mosquito Aedes namely:

a. Aedes aegypti

1) Most commonly found

2) Are the mosquitoes that live in the tropics, especially live and breed in the house, which is in clear
water reservoirs or water reservoirs around the house.

3) This mosquito cursory looks mottled, speckled white spots.

4) Usually bite during the day, especially during the morning and afternoon.

5) The distance to fly 100 meters

b. Aedes Albopictus

1) Place in a water habitat. Usually around the house or trees, such as banana trees, pandanus tin
cans.

2) Biting at noon

3) Distance flew 50 meters.

(Rampengan T H 2007)
Klasifikasi

a. Grade I: Fever accompanied by other clinical symptoms or spontaneous bleeding, positive

tourniquet test, thrombocytopenia, and hemokosentrasi.

b. Degree II: Grade I with spontaneous bleeding or other bleeding skin

c. Grade III: Failure circulation: fast and weak pulse, hypotension, cool moist skin, nervous.

d. Degree IV: severe shock, pulse, and blood pressure can not be measured. Accompanied by
Dengue Shock Syndrome. (Suriadi and Rita Yuliani, 2006).

Manifestasi Klinis

a. High fever for 5-7 days

b. Bleeding, especially bleeding under the skin: petechie, ecchymosis, hematoma.

c. Epistaxis, hematemesis, melena, hematuria.

d. Nausea, vomiting, no appetite, diarrhea, constipation

e. Muscle aches, joints, abdomen, and heart uluh

f. Headache

g. Swelling around the eyes

h. Enlargement of the liver, spleen, and lymph nodes

i. Signs and shock (cyanosis, clammy skin, decreased blood pressure, anxiety, rapid and weak pulse).
(Suriadi and Rita Yuliani, 2006).

Patofisiologi

a. Dengue virus will enter the body through the bite of the Aedes aegypti mosquito and then react
with the antibody and virus antibody complexes formed, the circulation will activate the
complement system. DanC5 C3 activation due to be released C3a and C5a, 2 peptides powerless to
release histamine and a strong mediator as a factor heightened permeability of the blood vessel wall
and eliminate the plasma through the endothelial wall.

b. Thrombocytopenia, decreased platelet function and decreased coagulation factors (protrobin,

factor V, VII, IX, X and fibrinogen) are factors causing severe bleeding, particularly gastrointestinal
tract bleeding in DHF.

c. Which determines the severity of the disease is the permeability of blood vessel walls, decrease in
plasma volume, hypotension, thrombocytopenia and hemorrhagic diathesis, shock occurs acutely.
d. Hematocrit values increased along with the loss of plasma through the endothelial walls of the
blood vessels. and with the loss of clients suffered hypovolemic plasma. If not addressed could
happen tissue anoxia, metabolic acidosis and death. (Suriadi and Rita Yuliani, 2006).
Diagnostic test

a. Complete blood: hemoconcentration (hematocrit increased by 20% or more), thrombocytopenia

(100,000 / mm3 or less)

b. Serologic tests HI (hemoglutination inhibition test)

c. Chest X-ray: pleural effusion. (Suriadi and Rita Yuliani, 2006).

Komplikasi

a. dengue encephalopathy

b. kidney disorders

c. Pulmonary edema. (Hadinegoro H Sri Rezeki, 2005).

a. Treatment

Management of Dengue Fever client is handling on stage I to stage IV.

Grade I and II

1) Provision of adequate fluid with RL infusion at a dose of 75 ml / kg / day for children weighing less
than 10 kg or with a given ORS, juice or milk to taste, or fluids within 24 hours as follows:

a) 100 ml / kg / 24 hours for children with BW <25 kg

b) 75 ml / kg / 24 hours for children with BB 26-30 kg

c) 60 ml / kg / 24 hours for children with BB 31-40 kg

d) 50 ml / kg / 24 hours for children with BB 41-50 kg

2) Giving antibiotics if secondary infection

3) Giving antipieritika to reduce the heat.

4) If there is severe bleeding, give blood 15 cc / kg / day.

Third degree

1) Provision of adequate fluid with the infusion of RL at a dose of 20 ml / kg / hour, if there is

improvement continue peberian RL 10 m / kg / h, if the pulse and blood pressure is unstable fill in
the amount of liquid based on the needs within 24 hours of reduced fluid already entered.
2) Provision of plasma or plasma expanders (dextran L) of 10 ml / kg / h and can be repeated a
maximum of 30 ml / kg in 24 hours, if after 1 hour use of RL 20 ml / kg / hour state of the blood
pressure of less than 80 mmHg and weak pulse, then give adequate fluid form RL infusion at a dose
of 20 ml / kg / hour if either continue RL as further calculations.

3) When 1 hour giving 10 ml / kg / hour state of tension is still declining and below 80 mmHg the
patient should get a plasma expander 10 ml / kg / hour is repeated a maximum of 30 mg / kg / 24
hours when both continue RL as calculation above

Degree IV

1) Provision of adequate fluid with RL infusion at a dose of 30 ml / kg / hour, when the state of good
blood pressure, lanjutkann RL 10 ml / kg / hour.

2) If the state of tension worsens then it should be installed. 2 channel infusion with the purpose to
RL 10 ml / kg / 1hour and only giving palasma expanders or dextran L of 20 ml / kg / hour dive 1
hour,

3) If the situation is still too bad, then give plasma expanders 20 ml / kg / hour,

4) If it still deteriorating, give plasma expanders 10 ml / kg / hour is repeated a maximum of 30 ml /

kg / 24h.

5) If after 2 hours of administration of plasma and RL did not show improvement then consult gets
anesthesia to whether or not mounted central vascular pressure, or CVP. (Hidayat A Aziz Alimul,
2008).

b. Prevention

1) There are 3 ways to eradicate vector

a) Fogging focus

In the state of the current economic crisis, the limited funds the activities of fogging is only done
when the results of epidemiologic investigations butul-butul meet the criteria

b) Abatisasi

Implemented in villages / wards endemic especially in schools and public places.

c) Without inteksida

Eradicate the mosquito-borne dengue larvae by means 3M:

- Drain on a regular basis once a week or sprinkled abate / altosit relocation clean water.

- Shut it down tightly water reservoirs.

- Burying or get rid of cans, plastic and used goods, others that can collect rain water, so it does not
become Aedes aegypti mosquito breeding.

2) Education (Health Education)

Nurses can do counseling or Health Education about how to prevent effective vector. Counseling can
be done to parents in schools, at the Posyandu, which is in the house should always be honest, do
not hang clothes on the former is used mainly in the bedroom because the mosquitoes will be happy
to perch on the second-hand clothing used which has the smell of sweat. BAK bathroom or a vase of
flowers in the flower so often cleaned and replaced the water every 2 days to fix or set the page so
that no place is filled with water, such as broken bottles, coconut shells, cans or objects that can
hold water , Dry leaves that had accumulated should be wiped out. In addition, the water can not be
accommodated, manage waste according to local circumstances, whether burned or removed by
junk cars to be disposed of to landfill so that mosquitoes do not breed. (Hadinegoro H Sri Rezeki,
2005).