Dengue is transmitted by the bite of an Aedesmosquito infected with any one of the four dengue viruses. It occurs in tropical and sub-tropical areas of the world. Symptoms appear 3—14 days after the infective bite. Dengue fever is a febrile illness that affects infants, young children and adults.
Symptoms range from a mild fever, to incapacitating high fever, with severe headache, pain behind the eyes, muscle and joint pain, and rash. There are no specific antiviral medicines for dengue. It is important to maintain hydration. Use of acetylsalicylic acid (e.g. aspirin) and non steroidal anti-inflammatory drugs (e.g. Ibuprofen) is not recommended.
Dengue haemorrhagic fever (fever, abdominal pain, vomiting, bleeding) is a potentially lethal complication, affecting mainly children. Early clinical diagnosis and careful clinical management by experienced physicians and nurses increase survival of patients.
Ineffective Tissue Perfusion
A mosquito which carries the dengue virus is called Aedes aegypti. The said mosquito comes in contact with a person and bites the person. The dengue virus will flow through the blood stream and destroys blood components. Patients with dengue often has decreased WBC, platelet & haemoglobin count. Hemoglobin count is used to measure oxygen carrying capacity of the blood. Hemoglobin carries oxygen. Therefore, if there is decreased haemoglobin, there is also decreased oxygen that reaches the different tissues of the body.
| Assessment | Nursing Diagnosis | Objectives | Nursing Interventions | Rationale | Expected Outcome |
| Subjective: (none) Objective: Decreased WBC Decreased platelet Decreased HgB Decreased capillary refill time Dysrhythmias Altered LOC Fever Chills Diaphoresis | Ineffective tissue perfusion related to decreased HgB concentration in the blood secondary to DHF 1 | Short Term: After 4 hours of NI, the pt will demonstrate behaviours to improve circulation. Long Term: After 4 days of NI, the pt will demonstrate increased perfusion as appropriate | Establish Rapport Monitor Vital Signs Assess patient’s condition Note customary baseline data Determine presence of dysrhythmias Perform blanch test Check for Homan’s sign Note presence of bleeding Elevate HOB Encourage quiet & restful atmosphere Instruct to avoid tiring activities Encourage light ambulation Encourage use of relaxation techniques Administer medications | To gain pt’s trust To obtain baseline data To assess contributing factors For comparison with current findings To identify alterations from normal To identify / determine adequate perfusion To determine presence of thrombus formation To determine risk of anemia To promote circulation To promote comfort & decrease tissue O2 demand To decrease cardiac workload To enhance venous return To decrease tension and anxiety level To treat underlying cause | The pt shall have demonstrated behaviours to improve circulation The pt shall have demonstrated increased perfusion as appropriate |
Hyperthermia
When a person comes in contact with a mosquito, Aedes aegypti, the dengue virus flows through the blood stream. As the compensatory mechanism of the body, it will raise its temperature to allow the immune system to work better and to deteriorate the condition of the invaders thus causing hyperthermia.
| Assessment | Nursing Diagnosis | Objectives | Nursing Interventions | Rationale | Expected Outcome |
| S> (none) O> > Temp of 39.8 > Flushed skin > Skin warm to touch > Chills The pt. May manifest > Increased RR > Tachycardia > Convulsions > Sweating | Hyperthermia | Short Term: After 4 hours of NI, pt’s temperature will decrease from 39.8 to 37. Long Term: After 3 days of NI, the pt will identify underlying factors & importance of treatment as well as s/sx requiring further evaluation or intervention | Establish Rapport Monitor Vital Signs Assess neurologic response, note LOC & orientation, reaction to stimuli, papillary reactions & presence of seizures Note presence / absence of sweating Wrap extremities with bath towels Provide TSB q 15 minutes Apply local ice packs in axilla Instruct client to have bed rest Instruct client to increase OFI Administer replacement fluids Administer antipyretics Reassess temperature q 15 minutes | To gain pt’s trust To obtain baseline data To evaluate effects & extent of hyperthermia To monitor heat & fluid loss To minimize shivering To reduce body temperature To reduce body temperature in areas of high blood flow To reduce metabolic demands / oxygen consumption To prevent dehydration To support circulating blood volume and tissue perfusion To restore normal body temperature To determine effectiveness of interventions done | The pt shall have a decreased body temperature from 39.8 to 37 The pt shall have identified underlying factors and importance of treatment as well as s/sx requiring further evaluation or intervention |
