Dengue Hemorrhagic Fever

I. Definition

Dengue Hemorrhagic Fever (DHF), an acute mosquito-borne viral illness

of sudden onset that usually follows a benign course with headache, fever,
prostration, severe joint and muscle pain, swollen glands (lymphadenopathy)
and rash. The presence (the "dengue triad") of fever, rash, and headache
(and other pains) is particularly characteristic of dengue. Dengue is endemic
throughout the tropics and subtropics. It goes by other names including
breakbone or dandy fever. Victims of dengue often have contortions due to
the intense joint and muscle pain.

II. Etiology

DHF is caused by one of four closely related virus serotypes (DEN-1

through DEN-4) of the genus Flavivirus, family Flaviviridae, each serotype is
sufficiently different that there is no cross-protection and epidemics caused
by multiple serotypes (hyperendemicity) can occur.

III. Signs and Symptoms

Headache, fever, exhaustion, severe joint and muscle pain, swollen

glands (lymphadenopathy), and rash. The presence (the "dengue triad")
of fever, rash, and headache (and other pains) is particularly
characteristic of dengue.

Classic dengue fever is characterized by:

1. Fever: Sudden and abrupt onset. May go up to 39.5-41.4°C. Lasts for

about 1-7 days, then fades away for 1-2 days
2. It soon recurs with secondary rashes which is usually not as severe as
before
3. Headaches
4. Fever is usually accompanied by headache in front portion of head or
behind the eyes
5. Muscular (Myalgia) or bone pain: Occurs after onset of fever. Affects
legs, joints, and lumbar spine. Usually the pain gets severe after its
onset. The pain may last for several weeks even after the fever has
subsided

Other symptoms:
 1. Nausea and vomiting
2. Loss of appetite
3. Increased sensation to touch
4. Change in taste sensation
5. Symptoms maybe milder in children than in adults
6. The acute phase of illness can last for 1 week followed by a 1 to 2
week period of recovery period that is characterized by weakness,
malaise and loss of appetite.

IV. Laboratory Results

In patient with DHF, the haematocrit is increased and the platelet count is
decreased.

Laboratory result of Jed Francis Garlando:

Test result Result (07-08-09) Result (07-14-09) Normal Values
Hemoglobin 144 134 120-00-170,00
g/L
Hematocrit 0.43 0.42 0.40-0.54
RBC Count 4.96 4.72 4.00-6.00x10^
g/L
WBC Count 1.3 8.7 5.00-
10:00x10^g/L

Defferential
Count
Neutrofil 0.46 0.42 0.50-0.70
Lemphocyte 0.43 0.38 0.20-0.40
Eosinophil 0.00 0.02 0.00-0.01
Monocytes 0.11 0.08 0.00-0.09
Atyphical
lymphocytes
Basophil 0.00 0.02 0.00-0.01

NCH 29.00 28.40 26.00-34.00 pg

MCHC 33.80 32.10 32.00-3.00 g/dL
MCV 85.90 88.30 82.00-98.00fl
BDN-CV 12.4 13.0
RDW-CV 26.8 23.8 15.00-35.00
P-LCR 11.7 10.7 9.00-14.00fl
PDW 39.1 42.4
RDW-SD 10.3 10.0 8.00-12.00 fl
Platelet Count 60 292 150.00-
400.00x10^g/L
Platelet: Decreased Adequate Normal
RBC: Decreased Normal
Time taken: 6:00 am 5:30 am

V. Management
1. Close monitoring of vital signs in critical period (between day 2 to day
7 of fever) is vital
2. Increased oral fluid intake is recommended to prevent dehydration
3. Supplementation with intravenous fluids may be necessary to prevent
dehydration and significant concentration of the blood if the patient is
unable to maintain oral intake
4. A platelet transfusion is indicated in rare cases if the platelet level
drops significantly (below 20,000) or if there is significant bleeding
5. The presence of melena may indicate internal gastrointestinal bleeding
requiring platelet and/or red blood cell transfusion.
6. Aspirin and non-steroidal anti-inflammatory drugs should be avoided
as these drugs may worsen the bleeding tendency associated with
some of these infections
7. Patients may receive antipyretic preparations to deal with these
symptoms if dengue is suspected.
NURSING DIAGNOSIS RATIONALE NURSING RATIONALE EVALUATION
INTERVENTIONS
Date: July 13, 2009 Definition: 1. Monitor vital signs -decreased pulse Goal met
pressure and blood
pressure may signifies
Risk for injury related to At risk of injury as a bleeding The client was freed
decreased platelet result of environmental from any physical injury
count conditions interacting and managed and
with the individual’s 2.Administer medication -to make sure that the minimized
adaptive and defensive and infusion using “5 infusions and complications of
resources. rights” system (right medications are decreased platelet as
patient, right administered to the evidenced by:
Objective cue: exact patient
medication, right route,
Infection of dengue right dose, right time)
virus (flavivirus) -The client don’t
– Decreased through the bite of had any physical
platelet count of Aedes aegypti mosquito injury
3. Inform and educate
60x10^g/L -to make the client
client regarding all
aware to the medication
treatment and -The client was
and treatment
medication freed from
Goals: complications of
Dengue virus attack decreased
The client will be free lymphocytes and lymph -that may contribute to
from any physical injury 4. Discuss importance platelet
tissue the occurrence of injury
and manage and of self monitoring of
minimize complications conditions
of decreased platelet.
-to avoid sever bleeding

Platelet count and 5. Monitor for any signs

immune system of bleeding and closely
response decreased monitor the amount of
bleeding which may
 occur

-to decreased any

chance of physical
Risk for Injury 6. Handle the client
injury
gently

Ref:
- to decreased any
Marilynn E. Doenges, chance of physical
Nurses Pocket Guide, 7. Encourage the client injury in the nose or
11th edition, 2008, page not to blow the nose or nasal cavity
414 insert objects in the
nose
-Use soft bristled
http://www.cdc.gov toothbrush, no flossing,
8.Teach the client to no dental extraction, no
/ncidod/dvbid/dengue/ hard food, make sure
avoid mouth trauma
slideset/set1/i/slide05.ht dentures fit
m

NURSING DIAGNOSIS RATIONALE NURSING RATIONALE EVALUATION

INTERVENTIONS
Date: July 15, 2009 Definition: 1.Assess patient -to obtain baseline data In 8 hours of nursing
condition care patient was able
to:
Diarrhea related to Diarrhea is the passage -provides colon omitting
presence of toxins of loose and watery 2. Restart oral fluid
stools often associated intake gradually -drink fluid gradually to
with gassiness, bloating replaced the loss fluid in
Goal: and abdominal pain the body
itmay also be -fruits that are stool
3 Encourage to eat food
In 8 hours of duty former -feel comfortable
accompanied by like banana and apple
patient will be: nausea, vomiting and
- -able to maintain fluid fever. Diarrhea results
intake to loss of body fluids 4. Avoid food that are
-comfortable and salts leading to oily, spicy and caffeine -promotes gastric
dehydration of varying cramping
severity
5. Monitor Input ant
output
Bacterial infection
-obtain baseline data
6. Monitor vital signs

-obtain baseline data

Salmonella,
campylobacter, e. choli 7. environmental
and shigella sanitation
-provide relaxation

8. management of the
diet -to know what are the
Diarrhea, fever, chills, things to be avoided.
sometimes blood or
 mucus in the stools.
Vomiting less common.
9. prmote bed rest -Rest decreases
intestinal motility and
reduces metabolic rate
Ref:

Marilynn E. Doenges,
Nurses Pocket Guide,
11th edition, 2008