Nursing Care Plan for Dengue Fever

Nursing Diagnosis High Risk for Fluid Volume Deficit Possible Etiologies: (Related to) Hypermetabolic state secondary to Dengue Fever Defining characteristics: (Evidenced by) (Not Applicable) Objectives Short term goal: Client will be able to maintain adequate hydration status as evidenced by good skin turgor and oral mucous membranes, balanced fluid intake and output, and stable vital signs. Long term goal: Client will be able to participate in activities that would promote the maintenance of adequate fluid volume. Nursing Interventions 1. Obtain history of illness, age, presence of fever, and other factors. 2. Monitor the vital signs for presence of hypotension/ orthostatic hypotension, tachycardia, and fever. 2. 3. Assess skin turgor and capillary refill. 4. Strictly monitor the intake and the output. 3. 5. Emphasize increased fluid intake. 6. Weigh client daily or as indicated. 4. 7. Start fluid replacement therapy as indicated. 8. Monitor laboratory results i.e. Hemoglobin/hematocrit, coagulation studies 5. 1. Rationale It could aid in providing baseline data regarding clients status and to be to correct factors contributing to clients risk for fluid volume deficit. Presence of fever, hypotension and tachycardia are manifestations for hypovolemia or possible indication for dehydration. -These are indicators for the hydration status of the client. It helps in monitoring how the kidney functions and to determine if fluid replacement therapy is needed. It helps in maintaining adequate circulatory volume in the body. It provides the current fluid status and adequacy of fluid replacement. The type and amount of fluid depend on the degree of dehydration. Dengue fever has potential for bleeding and these parameters are essential to determine if fluid replacement is effective or not. Evaluation Clients fluid volume status will maintain adequately as evidenced by good skin turgor and capillary refill, balanced fluid intake and output, and stable vital signs. Client will know various activities that would maintain hydration status through adequate resting periods, increased fluid intake and participation in replacement therapies.

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