Dengue hemorrhagic fever

Dengue hemorrhagic fever is a severe, potentially deadly infection spread by certain species of mosquitoes (Aedes aegypti). See also: Dengue fever Causes Four different dengue viruses are known to cause dengue hemorrhagic fever. Dengue hemorrhagic fever occurs when a person catches a different type dengue virus after being infected by another one sometime before. Priorimmunity to a different dengue virus type plays an important role in this severe disease. Worldwide, more than 100 million cases of dengue fever occur every year. A small number of these develop into dengue hemorrhagic fever. Most infections in the United States are brought in from other countries. It is possible, but uncommon, for a traveler who has returned to the United States to pass the infection to someone who has not traveled. Risk factors for dengue hemorrhagic fever include having antibodies to dengue virus from prior infection and being younger than 12, female, or Caucasian. Symptoms Early symptoms of dengue hemorrhagic fever are similar to those of dengue fever, but after several days the patient becomes irritable, restless, and sweaty. These symptoms are followed by a shock -like state. Bleeding may appear as tiny spots of blood on the skin (petechiae) and larger patches of blood under the skin (ecchymoses). Minor injuries may cause bleeding.

Shock may cause death. If the patient survives, recovery begins after a one-day crisis period. Early symptoms include:

Decreased appetite Fever Headache Joint aches Malaise Muscle aches Vomiting

Acute phase symptoms include:

Restlessness followed by: o Ecchymosis o Generalized rash o Petechiae o Worsening of earlier symptoms Shock-like state o Cold, clammy extremities o Sweatiness (diaphoretic)

Exams and Tests A physical examination may reveal:

Enlarged liver (hepatomegaly) Low blood pressure Rash Red eyes Red throat Swollen glands

Weak, rapid pulse

Tests may include:

Arterial blood gases Coagulation studies Electrolytes Hematocrit Liver enzymes Platelet count Serologic studies (demonstrate antibodies to Dengue viruses) Serum studies from samples taken during acute illness and convalescence (increase in titer to Dengueantigen) Tourniquet test (causes petechiae to form below the tourniquet) X-ray of the chest (may demonstrate pleural effusion)

Treatment Because Dengue hemorrhagic fever is caused by a virus for which there is no known cure or vaccine, the only treatment is to treat the symptoms.

A transfusion of fresh blood or platelets can correct bleeding problems Intravenous (IV) fluids and electrolytes are also used to correct electrolyte imbalances Oxygen therapy may be needed to treat abnormally low blood oxygen Rehydration with intravenous (IV) fluids is often necessary to treat dehydration Supportive care in an intensive care unit/environment

Outlook (Prognosis) With early and aggressive care, most patients recover from dengue hemorrhagic fever. However, half of untreated patients who go into shock do not survive.

Possible Complications

Encephalopathy Liver damage Residual brain damage Seizures Shock

When to Contact a Medical Professional Call your health care provider if you have symptoms of dengue fever and have been in an area where dengue fever is known to occur, especially if you have had dengue fever before. Prevention There is no vaccine available to prevent dengue fever. Use personal protection such as full-coverage clothing, netting, mosquito repellent containing DEET, and if possible, travel during periods of minimal mosquito activity. Mosquito abatement programs can also reduce the risk of infection. Alternative Names Hemorrhagic dengue; Dengue shock syndrome; Philippine hemorrhagic fever; Thai hemorrhagic fever; Singapore hemorrhagic fever

A nursing diagnosis is always based upon the abnormal things you find out about a patient during your assessment (data collection). This data collection is an ongoing activity that you perform as a nurse. When a patient is being discharged you are going to assess things like the environment that patient is going to be going home to, will they have any help with any care they need, do they still have any symptoms of

the dengue that are being treated, do they understand the ongoing treatment, do they know the side effects to watch for with the medication they are taking, did they have a rash or joint pain and has that resolved or do they still have these problems and need help with them, do they know what to look for if they are reinfected with dengue, do they know when to follow up with their physician. Much of this can be included under a nursing diagnosis ofKnowledge Deficit. However, if the patient had other symptoms that still need monitoring, an appropriate nursing diagnosis for them can also be used. If they still have a rash that is being treated a nursing diagnosis of Impaired Comfort, Impaired Skin Integrity or Risk for Infection (this would be due to broken skin from scratching) would be appropriate. If the patient still has, or is taking medication for, the headache or joint pain caused by the dengue then nursing diagnoses of Acute Pain, Activity Intolerance, Impaired Physical Mobility, orone of the Self-care Deficits would be appropriate to use. When a patient is being discharged you can always assess the patient's ability to perform their activities of daily living at home (ADL assessment is a primary nursing function) as well as their ability to continue following the medical plan of care. Any problems you foresee can be turned into nursing diagnoses and nursing interventions applied. Nursing diagnoses are based upon the symptoms and needs the patient has, not upon their medical diagnosis, although the medical diagnosis does affect the medical treatment plan which in turn affects some of the nursing care.

Causes
Four different dengue viruses are known to cause dengue hemorrhagic fever. Dengue hemorrhagic fever occurs when a person catches a different type dengue virus after being infected by another one sometime before. Prior immunity to a different dengue virus type plays an important role in this severe disease. Worldwide, more than 100 million cases of dengue fever occur every year. A small number of these develop into dengue hemorrhagic fever. Most infections in the United States are brought in from other countries. It is possible, but uncommon, for a traveler who has returned to the United States to pass the infection to someone who has not traveled. Risk factors for dengue hemorrhagic fever include having antibodies to dengue virus from prior infection and being younger than 12, female, or Caucasian.
Back to TopSymptoms

Early symptoms of dengue hemorrhagic fever are similar to those of dengue fever, but after several days the patient becomes irritable,restless, and sweaty. These symptoms are followed by a shock -like state. Bleeding may appear as tiny spots of blood on the skin (petechiae) and larger patches of blood under the skin (ecchymoses). Minor injuries may cause bleeding. Shock may cause death. If the patient survives, recovery begins after a one-day crisis period. Early symptoms include:

Decreased appetite Fever Headache Joint aches Malaise Muscle aches Vomiting Acute phase symptoms include: Restlessness followed by: o Ecchymosis o Generalized rash o Petechiae o Worsening of earlier symptoms

Shock-like state o Cold, clammy extremities o Sweatiness (diaphoretic)

Back to TopExams

and Tests

A physical examination may reveal:

Enlarged liver (hepatomegaly) Low blood pressure Rash Red eyes Red throat Swollen glands Weak, rapid pulse Tests may include: Arterial blood gases Coagulation studies Electrolytes Hematocrit Liver enzymes Platelet count Serologic studies (demonstrate antibodies to Dengue viruses) Serum studies from samples taken during acute illness and convalescence (increase in titer to Dengue antigen) Tourniquet test (causes petechiae to form below the tourniquet) X-ray of the chest (may demonstrate pleural effusion)
Back to TopTreatment

Because Dengue hemorrhagic fever is caused by a virus for which there is no known cure or vaccine, the only treatment is to treat the symptoms.

A transfusion of fresh blood or platelets can correct bleeding problems Intravenous (IV) fluids and electrolytes are also used to correctelectrolyte imbalances Oxygen therapy may be needed to treat abnormally low blood oxygen Rehydration with intravenous (IV) fluids is often necessary to treat dehydration Supportive care in an intensive care unit/environment

Back to TopOutlook

(Prognosis)

With early and aggressive care, most patients recover from dengue hemorrhagic fever. However, half of untreated patients who go into shock do not survive.
Back to TopPossible

Complications

Encephalopathy Liver damage Residual brain damage Seizures Shock

Back to TopWhen

to Contact a Medical Professional

Call your health care provider if you have symptoms of dengue fever and have been in an area where dengue fever is known to occur, especially if you have had dengue fever before.
Back to TopPrevention

There is no vaccine available to prevent dengue fever. Use personal protection such as full-coverage clothing, netting, mosquito repellent containing DEET, and if possible, travel during periods of minimal mosquito activity. Mosquito abatement programs can also reduce the risk of infection.

Dengue is transmitted by the bite of an Aedesmosquito infected with any one of the four dengue viruses. It occurs in tropical and subtropical areas of the world. Symptoms appear 314 days after the infective bite. Dengue fever is a febrile illness that affects infants, young children and adults. Symptoms range from a mild fever, to incapacitating high fever, with severe headache, pain behind the eyes, muscle and joint pain, and rash. There are no specific antiviral medicines for dengue. It is important to maintain hydration. Use of acetylsalicylic acid (e.g. aspirin) and non steroidal anti-inflammatory drugs (e.g. Ibuprofen) is not recommended. Dengue haemorrhagic fever (fever, abdominal pain, vomiting, bleeding) is a potentially lethal complication, affecting mainly children. Early clinical diagnosis and careful clinical management by experienced physicians and nurses increase survival of patients. Read the two Dengue Hemorrhagic Fever Nursing Care Plans below

Ineffective Tissue Perfusion

A mosquito which carries the dengue virus is called Aedes aegypti. The said mosquito comes in contact with a person and bites the person. The dengue virus will flow through the blood stream and destroys blood components. Patients with dengue often has decreased WBC, platelet & haemoglobin count. Hemoglobin count is used to measure oxygen carrying capacity of the blood. Hemoglobin carries oxygen.

Therefore, if there is decreased haemoglobin, there is also decreased oxygen that reaches the different tissues of the body.

Assessment

NursingDiagnosis

Objectives

Nursing Interventions

Rati

Subjective:(none)Objective:

Ineffective tissue perfusion related to decreased HgB

Short Term:After 4 Establish RapportMonitor hours of NI, the pt will demonstrate behaviours to improve circulation.Long Term: Vital SignsAssess patients condition

To g

Decreased WBC Decreased platelet Decreased HgB Decreased capillary refill time Dysrhythmias Altered LOC Fever Chills Diaphoresis

obta

asses

concentration in the blood secondary to DHF 1

Note customary baseline data Determine presence of

facto

For

curr

After 4 days of NI, dysrhythmias the pt will Perform blanch test demonstrate increased perfusion as appropriate Note presence of bleeding Elevate HOB Encourage quiet & restful atmosphere Instruct to avoid tiring activities Encourage light Check for Homans sign

To i

alter

norm

To i

dete

perf

To d

pres

thro

To d

anem

To p

ambulation Encourage use of relaxation techniques Administer medications

circu

To p

& de

O2 d

To d

work

To e

retur

To d and

To t

caus

Hyperthermia
When a person comes in contact with a mosquito, Aedes aegypti, the dengue virus flows through the blood stream. As the compensatory mechanism of the body, it will raise its temperature to allow the immune system to work better and to deteriorate the condition of the invaders thus causing hyperthermia.

Assessment

NursingDiagnosis

Objectives

Nursing Interventions

Rationale

S> (none)O>> Temp of 39.8

Hyperthermia

Short Term:After 4 hours of NI, pts temperature will

Establish RapportMonitor Vital SignsAssess neurologic response, note LOC & orientation, reaction

To gain pt

baseline da

effects & e

> Flushed skin > Skin warm to touch > Chills The pt. May manifest > Increased RR > Tachycardia

decrease from 39.8 to 37.Long Term:

to stimuli, papillary reactions & presence of seizures

hypertherm

To monito loss

After 3 days of NI, the pt will identify underlying factors & importance of treatment as well as s/sx requiring further evaluation orintervention

Note presence / absence of sweating Wrap extremities withbath towels Provide TSB q 15 minutes Apply local ice packs in axilla Instruct client to have bed rest

To minim

To reduce

temperatu

To reduce

temperatu

high blood

> Convulsions Instruct client to increase OFI > Sweating Administer replacement fluids Administer antipyretics Reassess temperature q 15 minutes

To reduce

demands /

consumpti

To preven

To suppor

blood volu perfusion

To restore

temperatu

To determ

effectiven

interventio

Source: WHO> Dengue