22 - Dengue Hemorrhagic Fever

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. 2. 3. 4. 5. 6.

Nausea and vomiting Loss of appetite Increased sensation to touch Change in taste sensation Symptoms maybe milder in children than in adults 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 Hemoglobin

Result (07-08-09) 144

Result (07-14-09) 134

Hematocrit RBC Count

0.43 4.96

0.42 4.72

WBC Count

1.3

8.7

0.46 0.43 0.00 0.11

0.42 0.38 0.02 0.08

0.50-0.70 0.20-0.40 0.00-0.01 0.00-0.09

0.00

0.02

0.00-0.01

NCH MCHC MCV BDN-CV RDW-CV P-LCR PDW RDW-SD Platelet Count

29.00 33.80 85.90 12.4 26.8 11.7 39.1 10.3 60

28.40 32.10 88.30 13.0 23.8 10.7 42.4 10.0 292

26.00-34.00 pg 32.00-3.00 g/dL 82.00-98.00fl

Platelet: RBC: Time taken:

Decreased Decreased 6:00 am

Adequate Normal Normal 5:30 am

Defferential Count Neutrofil Lemphocyte Eosinophil Monocytes Atyphical lymphocytes Basophil

Normal Values 120-00-170,00 g/L 0.40-0.54 4.00-6.00x10^ g/L 5.0010:00x10^g/L

15.00-35.00 9.00-14.00fl 8.00-12.00 fl 150.00400.00x10^g/L

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

4. 5. 6.

7.

dehydration and significant concentration of the blood if the patient is unable to maintain oral intake A platelet transfusion is indicated in rare cases if the platelet level drops significantly (below 20,000) or if there is significant bleeding The presence of melena may indicate internal gastrointestinal bleeding requiring platelet and/or red blood cell transfusion. Aspirin and non-steroidal anti-inflammatory drugs should be avoided as these drugs may worsen the bleeding tendency associated with some of these infections Patients may receive antipyretic preparations to deal with these symptoms if dengue is suspected.

NURSING DIAGNOSIS

RATIONALE

Date: July 13, 2009

Definition:

Risk for injury related to decreased platelet count

At risk of injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources.

Objective cue:

–

Decreased platelet count of 60x10^g/L

Infection of dengue virus (flavivirus) through the bite of Aedes aegypti mosquito

Goals: The client will be free from any physical injury and manage and minimize complications of decreased platelet.

Dengue virus attack lymphocytes and lymph tissue

NURSING INTERVENTIONS 1. Monitor vital signs

2.Administer medication and infusion using “5 rights” system (right patient, right medication, right route, right dose, right time)

3. Inform and educate client regarding all treatment and medication

4. Discuss importance of self monitoring of conditions

RATIONALE -decreased pulse pressure and blood pressure may signifies bleeding

-to make sure that the infusions and medications are administered to the exact patient

-to make the client aware to the medication and treatment

-that may contribute to the occurrence of injury

-to avoid sever bleeding Platelet count and immune system response decreased

5. Monitor for any signs of bleeding and closely monitor the amount of bleeding which may

EVALUATION Goal met

The client was freed from any physical injury and managed and minimized complications of decreased platelet as evidenced by:

-The client don’t had any physical injury -The client was freed from complications of decreased platelet

occur

Risk for Injury

6. Handle the client gently

Ref: Marilynn E. Doenges, Nurses Pocket Guide, 11th edition, 2008, page 414

7. Encourage the client not to blow the nose or insert objects in the nose

http://www.cdc.gov /ncidod/dvbid/dengue/

8.Teach the client to avoid mouth trauma

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NURSING DIAGNOSIS

RATIONALE

NURSING INTERVENTIONS

-to decreased any chance of physical injury

- to decreased any chance of physical injury in the nose or nasal cavity

-Use soft bristled toothbrush, no flossing, no dental extraction, no hard food, make sure dentures fit

RATIONALE

EVALUATION

Date: July 15, 2009

Definition:

Diarrhea related to presence of toxins

Diarrhea is the passage of loose and watery stools often associated with gassiness, bloating and abdominal pain itmay also be accompanied by nausea, vomiting and fever. Diarrhea results to loss of body fluids and salts leading to dehydration of varying severity

Goal: In 8 hours of duty patient will be: - -able to maintain fluid intake -comfortable

Bacterial infection

1.Assess patient condition

-to obtain baseline data

-provides colon omitting 2. Restart oral fluid intake gradually

3 Encourage to eat food like banana and apple

4. Avoid food that are oily, spicy and caffeine

-fruits that are stool former

-promotes gastric cramping

5. Monitor Input ant output -obtain baseline data 6. Monitor vital signs

Salmonella, campylobacter, e. choli and shigella

Diarrhea, fever, chills, sometimes blood or

In 8 hours of nursing care patient was able to:

-obtain baseline data 7. environmental sanitation

8. management of the diet

-provide relaxation

-to know what are the things to be avoided.

-drink fluid gradually to replaced the loss fluid in the body -feel comfortable

mucus in the stools. Vomiting less common.

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

9. prmote bed rest

-Rest decreases intestinal motility and reduces metabolic rate