DENGUE HEMORRAGIC FEVER

(DHF)
 Menurut World Health Organization (WHO), Dengue
Hemmorhagic Fever (DHF) atau Demam Berdarah
Dengue (DBD) merupakan penyakit yang disebabkan
oleh gigitan nyamuk Aedes yang terinfeksi salah satu
dari empat tipe virus dengue dengan manifestasi klinis
demam, nyeri otot dan nyeri sendi yang disertai
leukopenia, ruam, limfadenopati, trombositopenia dan
diathesis hemoragik (WHO, 2011). Terdapat tiga tahapan
yang dialami penderita penyakit DBD, yaitu fase
demam, fase kritis, dan fase pemulihan (WHO,2009).
pengertian
Demam Berdarah Dengue (DBD) adalah penyakit yang
disebabkan oleh virus dengue yang tergolong Arthropod-
Borne Virus, genus Flavivirus, dan family Flaviviridae.
DBD ditularkan melalui gigitan nyamuk dari genus
Aedes, terutama Aedes aegypti atau Aedes albopictus
Etiologi
Place Your Picture Here

Place Your Picture Here

Penyakit demam berdarah dengue disebabkan oleh
virus dengue dari genus Flavivirus, famili
Flaviviridae. DBD ditularkan ke manusia melalui
gigitan nyamuk Aedes yang terinfeksi virus dengue.
Virus Dengue penyebab Demam Dengue (DD), Place Your Picture Here

Demam Berdarah Dengue (DBD) dan Dengue

Shock Syndrome (DSS) termasuk dalam kelompok Place Your Picture Here
B Arthropod virus Arbovirosis yang sekarang
dikenal sebagai genus Flavivirus, famili Flaviviride,
dan mempunyai 4 jenis serotipe, yaitu : DEN-1,
DEN- 2, DEN-3, DEN-4 (Depkes RI, 2016).
 Patofisiologi
Virus dengue masuk ke dalam tubuh kemudian
akan beraksi dengan antibody dan terbentuklah
kompleks virus antibody, dalam sirkulasi akan
mengaktivasi sistem komplemen, akibat aktivasi
C3 dan C5 akan dilepas C3a dan C5a, dua
peptide yang berdaya untuk melepaskan
histamine dan merupakan mediator kuat sebegai
faktor meningginya pemeabilitas dinding
pembuluh darah. Peningkatan permeabilitas
dinding kapiler mengakibatkan berkurangnya
volume plasma, sehingga terjadi hipotensi,
hemokonsentrasi, dan hipoproteinemia serta
efusi dan renjatan (syok) .
 Manifestasi klinis

He re
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Place
Tanda dan gejala yang mungkin muncul pada klien dengan
DHF yaitu: Demam atau riwayat demam akut antar 2-7
hari. Keluhan pada saluran pencernaan, mual, muntah,
anoreksia, diare, konstipasi. Keluhan sistem tubuh yang
lain: nyeri atau sakit kepala, nyeri pada otot, tulang dan
sendi, nyeri ulu hati, dan lain-lain.
 Pemeriksaan penunjang

Pada renjatan yang Hb dan PCV Trombositopen Leukopenia Isolasi virus Serologi ( Uji
berat, periksa : Hb, meningkat ( ≥ ia ( ≤ 100.000 / ( mungkin H) : respon
PCV berulang 20 %) ml ) normal atau antibody
kali( setiap jam leukositosis ) sekunder
atau 4-6 jam
apabila sudah
menunjukkan
tanda
perbaikan),Faal
hemostatis, FDP,
EKG, Foto dada,
BUN.(Nurarif dan
Kusuma 2015).
Penatalaksanaan
Tirah baring atau istirahat baring, Diet makan
lunak

Minum banyak (2 – 2,5 liter/24 jam) dapat berupa :

susu,teh manis, sirup dan beri penderita sedikit oralit,
pemberian cairan merupakan hal yang paling penting
bagi penderita DHF

Pemberian cairan intravena (biasanya ringer laktat, NaCl

Faali) merupakan cairan yang paling sering digunakan

Monitor tanda-tanda vital tiap 3 jam (suhu, nadi, tensi,

pernafasan) jika kondisi pasien memburuk, observasi
ketat tiap jam

Periksa Hb, Ht dan trombosit setiap hari Pemberian

obat antipiretik sebaiknya dari golongan asetaminopen
 Komplikasi

Gagal jantung

Hepatomegaly

Efusi pleura

Gagal ginjal
ASKEP B. Analisa data
1. Validasi data kembali, teliti kembali data yang dikumpul

TEORI DHF 2. Identifikasi kesenjangan data

3. Susun kategori data secara sistematik dan logis
4. Identifikasi kemampuan dan keadaan yang menunjang asuhan keperawatan klien
5. Buat hubungan sebab akibat antara data dengan masalah yang yang timbul serta
Pengkajian penyebabnya

A. Pengumpulan data
1. Identitas pasien C. Diagnosa

2. Keluhan utama 1. Peningkatan suhu tubuh (hipertermia) berhubungan dengan proses infeksi virus dengue
3. Riwayat penyakit sekarang 2. Ketidakseimbangan nutrisi kurang dari kebutuhan tubuh berhubungan dengan intake nutrisi
4. Riwayat penyakit dahulu yang tidak adekuat akibat mual dan nafsu makan yang menurun
5. Pemeriksaan fisik 3. Resiko perdarahan berhubungan dengan penurunan factor-faktor pembekuan darah
a. B1 (Breathing) (trombositopeni)
b. B2 (Boold) 4. Kekurangan volume cairan berhubungan dengan dehidrasi karena peningkatan
c. B3 (Brain) suhu tubuh
d. B4 (Bladder) 5. Nyeri akut berhubungan dengan kehilangan fungsi trombosit agregasi
e. B5 (Bowel) 6. Resiko syok (hipovolemik) berhubungan dengan perdarahan yang berlebih
f. B6 (Bone) 7. Defisiensi pengetahuan berhubungan dengan kurangnya informasi
g. B7 (pengindraan)
h. B8 (system endokrin)
 Intervensi
1. Peningkatan suhu tubuh (hipertermia) berhubungan dengan proses infeksi virus dengue.
Intervensi a.
: Jelaskan pada keluarga pasien tentang demam
b. Anjurkan orang tua untuk memberikan pakaian tipis dan mudah menyerap keringat.
c. Anjurkan orang tua untuk meningkatkan asupan cairan pada pasien.
d. Ajarkan cara yang benar yaitu lipat paha dan aksila.
e. Observasi suhu tubuh pasien, diaphoresis.
f. Kaloborasi pemberian antipiretik sesuai dengan kondisi pasien

2. Ketidakseimbangan nutrisi kurang dari kebutuhan tubuh berhubungan dengan

intake nutrisi yang tidak adekuat akibat mual dan nafsu makan yang menurun.
Intervensi a.
: Jelaskan tentang pentingnya nutrisi.
b. Berikan makanan dalam porsi sedikit dengan frekuensi sering.
c. Berikan makanan dalam keadaan hangat dan menarik.
d. Anjurkan orang tua tetap memaksimalkan ritual makanan yang disukai anak selama diRs.
e. Timbang BB setiap hari atau sesuai indikasi.
f. Observasi intake dan output makanan.
g. Berikan kebersihan oral.
h. Kaloborasi dengan ahli gizi untuk menentukan jumlah kalori dan nutrisi yang dibutuhkan
pasien
 Intervensi
3. Resiko perdarahan berhubungan dengan penurunan factor-faktor pembekuan darah
(trombositopeni).
Intervensi : a. Monitor tanda-tanda penurunan trombosit yang disertai tanda klinis.
b. Anjurkan pasien untuk banyak istirahat (bedrest).
c .Kolaborasi, monitor trombosit setiap hari.
d. Antisipasi adanya pendarahan : gunakan sikat gigi yang lunak, pelihara kebersihan mulut,
berikan tekanan 5-10 menit.
e. Lindungi pasien dari trauma yang dapat menyebabkan pendarahan.
f. Kolaborasi monitor trombosit setiap hari.

4. Kekurangan volume cairan berhubungan dengan dehidrasi karena peningkatan

suhu tubuh.
Intervensi : a. Jelaskan pada orang tua mengenai dampak yang timbul apabila anak kekurangan cairan
b. Pertahankan catatan input dan output yang akurat
c. Monitor status dehidrasi (observasi turgor kulit, observasi membrane mukosa, dan nadi
adekuat jika diperlukan).
d. Observasi tanda-tanda vital.
e. Anjurkan klien untuk minum banyak minimal 2500 cc atau sesuai toleransi.
f. Kolaborasi pemberian cairan IV
 Intervensi
5. Nyeri akut berhubungan dengan kehilangan fungsi trombosit agregasi
Intervensi : a. Observasi tingkat nyeri anak dengan melihat ekspresi wajah anak/menggunakan skala.
b.Observasi faktor yang mempengaruhi anak terhadap nyeri.
c. Berikan posisi yang nyaman dan ciptakan suasana ruangan yang tenang.
d. Berikan suasana yang gembira bagi anak untuk mengalihkan perhatian anak terhadap nyeri.
e. Kolaborasi pemberian analgesic.

6. Resiko syok (hipovolemik) berhubungan dengan perdarahan yang berlebih.

Intervensi :a. Jelaskan pada klien dan keluarga tanda pendarahan, dan segera laporkan jika terjadi
pendarahan.
b. Observasi vital sigh setiap 3 jam atau lebih.
c. Monitor keadaan umum pasien.
d. Monitor status sirkulasi darah, warna, kulit, suhu kulit, denyut jantung, ritme nadi perifer,
dan kapiler refil.
e. Kolaborasi pemberian intravena.
f. Kolaborasi pemberian HB, PCV, trombosit.

7. Defisiensi pengetahuan berhubungan dengan kurangnya informasi.

Intervensi :a. Jelaskan tentang definisi penyakit DHF, proses penyalit, tanda gejala,
identifikasi penyebab dan kondisi pasien.
b. Jelaskan tentang program pengobatan dan alternative pencegahan.
c. Tanyakan kembali pengetahuan keluarga pasien dan pasien tentang penyakit,
prosedur perawatan dan pengobatan.
 Rasional
1. Peningkatan suhu tubuh (hipertermia) berhubungan dengan proses infeksi virus dengue.
Rasional :a. Suhu 38.90C – 41.10C menunjukkan proses penyakit infeksius akut. Pola demam dapat membantu dalam diagnosis
misalnya kurva demam lanjut berakhir berakhir lebih dari 24 jam menunjukkan pneumonia pneumokokal, demam scarlet atau tifoid
b. Untuk memberikan rasa nyaman pakaian yang tipis mudah menyerap keringat dan tidak merangsang peningkatan suhu tubuh
c. Untuk mencegah dehidrasi pada pasien
d. Dapat membantu mengurangi demam pada pasien
e. 5) Suhu 38.90C – 41.10C menunjukkan proses penyakit infeksius akut demam yang kembali normal.
f. Digunakan untuk mengurangi demam dengan aksi sentral nya pada hipotalamus, meskipun demam mungkin dapat berguna
dalam membatasi pertumbuhan organisme, dan meningkatkan autodestruksi dari sel- sel yang terinfeksi.

2. Ketidakseimbangan nutrisi kurang dari kebutuhan tubuh berhubungan dengan intake nutrisi yang tidak adekuat akibat mual
dan nafsu makan yang menurun.
Rasional :a. Untuk menambah pengetahuan pasien.
b. Dapat meningkatkan masukan meskipun nafsu makan mungkin lambat untuk kembali.
c. Untuk menambah nafsu makan pasien.
d. Memungkinkan makanan yang disukai pasien akan memampukan pasien untuk mempunyai pilihan terhadap
makanan yang dapat dimakan dengan lahap.
e. Memberikan informasi tentang kebutuhan diet atau keefektifan terapi.
f. Mengidentifikasi kekurangan makanan dan kebutuhan.
g. Mulut yang bersih dapat meningkatkan rasa makanan.
h. Suplemen dapat memainkan peran penting dalam mempertahankan masukan kalori dan protein.
 Rasional
3. Resiko perdarahan berhubungan dengan penurunan factor-faktor pembekuan darah (trombositopeni).
Rasional :a. Penurunan trombosit merupakan tanda adanya kebocoran pembuluh darah yang pada tahap tertentu dapat menimbulkan
tanda-tanda klinis seperti epistaksis, ptekie.
b. Aktifitas pasien yang tidak terkontrol dapat menyebabkan terjadinya perdarahan.
c. Dengan trombosit yang dipantau setiap hari, dapat diketahui tingkat
Kebocoran pembuluh darah dan kemungkinan perdarahan yang dialami pasien.
d. Mencegah terjadinya perdarahan lebih lanjut.
e. untuk mengurangih resiko perdarahan pada pasien.
f. Dengan trombosit yang dipantau setiap hari, dapat diketahui tingkat kebocoran
pembuluh darah dan kemungkinan perdarahan yang dialami pasien.

4. Kekurangan volume cairan berhubungan dengan dehidrasi karena peningkatan suhu tubuh.
Rasional :a. Agar orang tua mampu memahami dampak yang timbul apabila anak kekurangan cairan.
b. Evaluator langsung status cairan. Perubahan tiba-tiba pada berat badan dicurigai kehilangan/retensi cairan.
c. Peningkatan suhu demam meningkatkan laju metabolik dan kehilangan cairan melalui evaporasi TD ortotastik berubah
dan peningkatan takikardia menunjukkan kekurangan cairan sistemik.
d. Memantau perubahan tanda-tanda vital pada klien.
e. Untuk memenuhi kebutuhan cairan tubuh peroral.
f. Cairan dapat dibutuhkan untuk mencegah dehidrasi.
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Simple PowerPoint
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and I believe that this
Template will your Time,
Money and Reputation.
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Simple PowerPoint Simple PowerPoint Simple PowerPoint
Presentation Presentation Presentation
You can simply impress You can simply impress You can simply impress
your audience and add a your audience and add a your audience and add a
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your Presentations. I hope your Presentations. I hope your Presentations. I hope
and I believe that this and I believe that this and I believe that this
Template will your Time, Template will your Time, Template will your Time,
Money and Reputation. Money and Reputation. Money and Reputation.
Easy to change colors, Easy to change colors, Easy to change colors,
photos. Get a modern photos. Get a modern photos. Get a modern
PowerPoint Presentation PowerPoint Presentation PowerPoint Presentation
that is beautifully that is beautifully that is beautifully
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 Fully Editable Icon Sets: C

You can Resize without

losing quality
You can Change Fill
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Line Color

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www.allppt.com