I.

INTRODUCTION

Dengue hemorrhagic fever is a severe, potentially deadly infection spread by mosquitos, mainly the species of Aedes aegypti. It is an acute febrile infection of sudden onset with clinical manifestations of 3 stages. The first 4 days or also called as febrile or invasive stage characterized by high fever abdominal pain and headache, later flushing which may be accompanied by vomiting, conjunctival infection and epistaxis. The 4th and 7th days (Toxic or hemmorhagic stage) are characterized by lowering of temperature, severe abdominal pain, vomiting and frequent bleeding from the gastrointestinal tract in the form of hematemesis or melena. Unstable BP, narrow pulse rate and shock can occur in severe cases. Death may occur. The 7th 10th day (convalescent or recovery stage) is characterized by flushing with interventing areas of blanching appetite regained and blood pressure already stable. Classification: Severe, frank type c/ flushing, sudden high fever, severe hemorrhage followed up by sudden drop of temperature, shock, and terminating in recovery or death. Moderate with high fever, but less hemorrhage, no shock Mild with slight fever, with or without petichial hemorrhage but epidemiologically related to typical cases usually discovered in the course of investigation of typical cases.

Mode of transmission: Mosquito bite (aedes aegypti) Incubation period: Uncertain. Probably 6 days to one week Period of communicability: Unknown, presumed to be on the 1st week of illness when virus is still present in the blood. According to statistics, about 2/3 of the worlds population live in areas infested with dengue vectors, mainly Aedes aegypti. It is estimated that up to 80 million persons become infected annually although marked underreporting results in the notification of much smaller figures. Currently dengue is endemic in all continents except Europe and epidemic dengue hemorrhagic fever (DHF) occurs in Asia, the Americas and some Pacific Islands. The DOH said that there had been 50% r in the number of the cases in davao City from January to March this year. San Lazaro Hospital reported 1608 dengue cases from January to July 1996 with 33 deaths. Actually, the total number of dengue cases nationwide reached 2845. The upsurge was said to be too early for a disease that is common during rainy season. Another twist to this years outbreak was the return of a more dangerous strain of dengue viruses called dengue-3. It was first detected in the Philippines in an outbreak in 1956. It was last monitored in 1988 which struck more than 1800 people. With dengue-3 around, more cases were expected in succeeding months. Admissions at the San Lazaro Hospital in June came from three places only Bulacan, Kalookan City and Tondo, Manila. Dengue cases have also been reported this year in 11 towns in Pangasinan and the town of Dolores in Quezon Province. In August, dengue had spread to Central and Northern Luzon.

Health authorities advised community action to prevent dengue fever. On August 2, the President, through an executive order, launched the National Tepok Lamok Dengue Sapok program and the start if the 4 oclock habit.

The DOH led the whole country in a clean-up operation to eliminate all potential mosquito breeding places every 4:00 pm. The Aedes aegypti mosquito, the cause of dengue, breeds in clear, stagnant water accumulated in cans, old tires, flower vases, pots, pails and other containers. People were advised to eliminate these things in their homes, schools and offices. Only by cleaning up the environment and prompt medical attention can the vicious cycle of transmission be broken. This supplemental reading contributes to nursing research through acquiring new knowledge and information about dengue hemorrhagic fever. Through this we can discover new possible ways on how to deal with our clients having such illness and so that we can provide the specific individualized care they need. It contributes to nursing practice because we need factual information in order to provide the care that is needed by our client. As nurses we dont just rel y on divine intervention we need base our nursing actions to facts and not just merely administering something to jour client because we just feel that it is right. I learned a lot from my own supplemental reading and as student it helps me to widen the scope of my knowledge. II. Risk Factors There are several risk factors that we must consider. First is if a person is living in a tropical area or had visited a tropical area for the past months because Aedes aegypti breeds and lives on tropical areas. Also if the child is exposed to dengue virus before it increases the risk
of having severe symptoms if you're infected a second time. This is especially true for children.

III.Signs and Symptoms Many people, especially children and teens, may experience no signs or symptoms during a mild case of dengue fever. When symptoms do occur, they usually begin four to 10 days after the person is bitten by an infected mosquito. Signs and symptoms of dengue fever most commonly include: tropical places. On factor also, is the past health history of the child. According to studies

Fever, up to 106 F (41 C) Headaches Muscle, bone and joint pain Pain behind your eyes

You might also experience:

Widespread rash Nausea and vomiting Minor bleeding from your gums or nose

Most people recover within a week or so. In some cases, however, symptoms worsen and can become life-threatening. Blood vessels often become damaged and leaky, and the number of clotforming cells in your bloodstream falls. This can cause:

Bleeding from the nose and mouth Severe abdominal pain Persistent vomiting Bleeding under the skin, which may look like bruising Problems with your lungs, liver and heart Medical Management Diagnostic tests In assessing the patients condition, the following test are the recommended tests:

IV.

Hematocrit Serum electrolytes and blood gas studies Platelet count, prothrombin time, partial thromboplastin time and thrombin time Liver Function test serum aspartate aminotransferase, serum alanine aminotransferase and serum proteins. Tourniquet test (Rumpel Leads test)

Drugs Oral Rehydration Salts to replace the loss fluids Antipyretics/Analgesics as prescribed by the physician such as Paracetamol to lower down body temperature ASPRIN is contraindicated. Intravenous Fluid and electrolytes are used to correct possible electrolyte imbalances Oxygen therapy to treat abnormally low oxygen level. V. Nursing Management Do tourniquet test. Monitor Vital signs and refer for unusualities. Administer antipyretics/analgesics to lower down body temperature. Give oral rehydration salts to halt moderate dehydration. Encourage Increase Oral Fluid intake Instruct the patient to avoid dark colored foods. Instruct the patient not to use toothbrush. Aspiring is strictly prohibited. Patient must have adequate rest. Administration of blood products and monitor signs of adverse reactions as ordered by the physician. Strictly monitoring of intake and output Immediate referral for any change in clients status. References BOOKS Reyala, J. (2000) 9th Edition. Community Health Nursing Service in the Philippines. Community Health Nursing League of Philippine Government Nurses Inc. Philippines Bare,B. (2010). 12th Edition, Brunner and Suddarths textbook of Medical Surgical Nursing. Lippincott Williams & Wilkins. Philadelphia, Pennsylvania WEBSITE www.MayoClinic.com

VI.