Pathophysiology of Dengue Hemorrhagic Fever: Stage IV

Legend: - Manifested by the patient

==== - signs & symptoms

- flow of the disease

- Treatments & diagnostic exams

PREDISPOSING FACTORS FACTORS

Age patients younger than 12 years old Sex Women and young females tend to develop severe forms of dengue fever at higher rates than males Race No racial predilection Blood Type people with blood group AB Genetic predisposition - Prior exposure to dengue virus & serotype (type 2)

PRECIPITATING
Environment tropical regions, urban or rural areas; stagnant water in containers, unused tires, fresh water Season wet or rainy Activities frequent travelling in tropical regions, specially in endemic areas Weak or Defective Immune System

Exposure to the vector (Aedes Egypti) infected by the virus

Virus (1, 2, 3, 4) enters the human blood stream s/sx: High grade fever Headache Severe muscle pains

=========================== reacts initially

Immune system is activated, interferon

Activation of killer TCells

Induce the surrounding cells to be virusresistant

Release of specific antibody which is IgM

Macrophage is released which aids in phagocytosis

Trigger release of complements

Gradual increase in capillary permeability

S/Sx:
Plasma leaking starts Increased hematocrit

=====================

Thrombocytope

s/sx: Clings in healthy soldier cells such as the monocytes, Kupffer cells and macrophages Some viruses in the blood stream resist the attack of the immune system Destruction of soldier cells

Thrombocytopenia Hemoconcentratio n

Petechiae ================= accompanied by continuous increase in vascular permeability

DENGUE HEMORRHAGIC FEVER

STAGE 3 STAGE 1
Acute fever and upper respiratory symptoms. Absence of spontaneous bleeding s/sx include:

STAGE 2
Increased vascular permeability occurs + presence of spontaneous bleeding; s/sx include:

Circulatory dysfunction, hemodynamic instability, hemorrhaging. s/sx include:

STAGE 4
Circulatory failure, severe hemorrhaging, neurologic problems, developing shock or DSS, s/sx include:

Hemoconcentration Bleeding from the ears, nose and mouth Bleeding under the skin, which gives the appearance of bruising Filiform pulse

High Grade fever Hemoconcentratio n Thrombocytopenia

Bleeding Tendencies o Epistaxis

Severe hemoconcentration Widespread vascular permeability Severe fluid plasma leaking from blood vessels Pancytopenia Heavy Bleeding

Hemoconcentration Hematemesis Melena

Aggravation of soldier cells destruction

Massive fluid shifting from the intravascular to interstitial space

Severe blood loss

With INTERVENTIONS

Without INTERVENTIONS

Diagnostic Exams: Rumpels Lead Test / Tourniquet Test Complete Blood Count Irreversible shock

Drugs/Medication: Medical Interventions: Plasma expanders Hospitalization Hypertonic and Isotonic Intravenous Fluids for replacement Platelet transfusion

Inability of the body to compensate for impending organ damage

Multi-organ dysfunction Multi-organ failure BAD PROGNOSIS

DEATH

Nursing Interventions: Assess for signs and symptoms of

bleeding frequently Maintain airway and breathing Maintain adequate perfusion Establish IV Line Administer Oxygen Raise side rails

Reinforce fluid replacement

Health Teachings: Educating the family Individual Patient teaching Bleeding precautions

Control of signs and symptoms: Increase in platelet and WBC count Decreased tendencies of bleeding Increase appetite

Gradual recovery of the patient

GOOD PROGNOSIS