Dengue hemorrhagic fever

Dengue hemorrhagic fever is a severe, potentially deadly infection spread by mosquitos, mainly the
species Aedes aegypti.

1,2,3 and 4 Group B Arbovirus - Four different dengue viruses

Who Is at High Risk for Dengue Hemorrhagic Fever?

Living in or traveling to Southeast Asia, South and Central America, Sub-Saharan
Africa, and parts of the Caribbean can increase your risk of contracting the
dengue virus.
These patients are also at higher risk:
-infants and small children
-the elderly
-those with compromised immune systems

Signs and Symptoms

Early symptoms of dengue hemorrhagic fever are similar to those of dengue
fever. But after several days the patient becomes irritable, restless, and sweaty.
These symptoms are followed by a shock-like state.
Bleeding appears as tiny spots of blood on the skin (petechiae) and larger patches
of blood under the skin (ecchymoses). Minor injuries can cause bleeding.
Shock can lead t death. If the patient survives, recovery begins after a one-day
crisis period.
Early symptoms include:
Decreased appetite
Fever
Headache
Joint or muscle aches
Malaise
Vomiting

Acute phase symptoms include:

Restlessness followed by:

Ecchymosis
Generalized rash
Petechiae
Worsening of earlier symptoms
Shock-like state
Cold, clammy extremities
Sweating

Diagnostic Procedure
A physical examination may reveal:
Enlarged liver (hepatomegaly)
Low blood pressure
Rash
Red eyes
Red throat
Swollen glands
Weak, rapid pulse
Tests may include:
Arterial blood gases
Blood tests (find signs of the virus in the blood)
Coagulation studies
Electrolytes
Hematocrit
Liver enzymes
Platelet count
Serum studies from samples taken during acute illness and convalescence
(increase in titer to Dengue antigen)
Tourniquet test (causes petechiae to form below the tourniquet)
X-ray of the chest (may demonstrate pleural effusion)

Treatment
Because Dengue hemorrhagic fever is caused by a virus for which there is no
known cure or vaccine, the only treatment is to treat the symptoms.
A transfusion of fresh blood or platelets can correct bleeding problems

Intravenous (IV) fluids and electrolytes are also used to correct electrolyte
imbalances
Oxygen therapy may be needed to treat abnormally low blood oxygen
Rehydration with intravenous (IV) fluids is often necessary to treat dehydration
Supportive care in an intensive care unit/environment

Nursing Responsibilities
Assess the patients medical history
Assess the increase in body temperature, signs of bleeding, nausea, vomiting,
no appetite, heartburn, muscle pain and signs of shock (rapid and weak pulse,
hypotension, skin cold and moist, especially on the extremities, cyanosis,
restlessness, decreased awareness).

Assessment
1. Identity of Disease
2. Main Complaint
3. History of Present Disease
4. Previous Disease History
5. Family Health History
6. Environmental Health History
7. Historical Growth
8. Assessment Per System

Health Teaching
1. Encourage intake of foods with high content of Vit. C
2. Encourage increase fluid intake
3. Explain to the patient and family sign of bleeding, and immediately report if
bleeding occurs

Direct Patient Care

1. Assess level of consciousness and cognitive level.
2. Provide safe environment (pad, side rails, prevent falls)
3. Observe for each stool color, consistency and amount
4. Observe for each stool color, consistency and amount
5. Assess pts condition and monitor vital signs.
6. Provide comfort measures, such as stretching bed linens.
7. Avoid SC, IM route of injection as possible

8. provide TSB