dengue fever (DOC) by carlzburg







Dengue hemorrhagic fever (DHF): A syndrome due to the dengue virus that tends to affect children under 10, causing abdominal pain, hemorrhage (bleeding) and circulatory collapse (shock). DHF starts abruptly with high continuous fever and headache plus respiratory and intestinal symptoms with sore throat, cough, nausea, vomiting, and abdominal pain. Shock occurs after 2 to 6 days with sudden collapse, cool clammy extremities, weak thready pulse, and blueness around the mouth (circumoral cyanosis). There is bleeding with easy bruising, blood spots in the skin (petechiae), spitting up blood (hematemesis), blood in the stool (melena), bleeding gums and nosebleeds (epistaxis). Pneumonia and heart inflammation (myocarditis) may be present. The mortality is appreciable ranging from 6 to 30%. Most deaths occur in children. Infants under a year of age are especially at risk of death. DHF is also called Philippine, Thai, or Southeast Asian hemorrhagic fever and dengue shock syndrome.

Aedes aegypti, the transmitter of the disease, is a day-biting mosquito which lays eggs in clear and stagnant water found in flower vases, cans, rain barrels, old rubber tires, etc. The adult mosquitoes rest in dark places of the house.

Signs and Symptoms
        Sudden onset of high fever which may last 2 to 7 days. Joint & muscle pain and pain behind the eyes. Weakness Skin rashes - maculopapular rash or red tiny spots on the skin called petechiae Nosebleeding when fever starts to subside Abdominal pain Vomiting of coffee-colored matter Dark-colored stools

Exams and Tests
A physical examination may reveal:
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Enlarged liver (hepatomegaly) Low blood pressure

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Rash Red eyes Red throat Swollen glands Weak, rapid pulse

Tests may include:
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Arterial blood gases Coagulation studies Electrolytes Hematocrit Liver enzymes Platelet count Serologic studies (demonstrate antibodies to Dengue viruses) 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)

The mainstay of treatment is supportive therapy. Increased oral fluid intake is recommended to prevent dehydration. If the patient is unable to maintain oral intake, supplementation with intravenous fluids may be necessary to prevent dehydration and significant hemoconcentration. A platelet transfusion is rarely indicated if the platelet level drops significantly (below 20,000) or if there is significant bleeding. The presence of malaena may indicate internal gastrointestinal bleeding requiring platelet and/or red blood cell transfusion. It is very important to avoid Aspirin and non-steroidal anti-inflammatory medications. These drugs are often used to treat pain and fever, but in this case, they may actually aggravate the bleeding tendency associated with some of these infections. If dengue is suspected, patients should receive instead acetaminophen preparations to deal with these symptoms. In addition, monitoring for signs of hemorrhagic fever and early appropriate treatment are key to ensure survival if the patient progresses to a more severe form of dengue infection.

Nursing care management
      Monitored vital signs Continue medications Watch out for persistence of vomoting Monitored progress/improvement of CBC Advised to avoid dark color foods Advised to increase oral body fluid intake

Prevention and Control
 Cover water drums and water pails at all times to prevent mosquitoes from breeding.  Replace water in flower vases once a week.  Clean all water containers once a week. Scrub the sides well to remove eggs of mosquitoes sticking to the sides.  Clean gutters of leaves and debris so that rain water will not collect as breeding places of mosquitoes.  Old tires used as roof support should be punctured or cut to avoid accumulation of water.  Collect and dispose all unusable tin cans, jars, bottles and other items that can collect and hold water. There is no vaccine available to prevent dengue fever. Use personal protection such as full-coverage clothing, netting, mosquito repellent containing DEET, and if possible, travel during periods of minimal mosquito activity. Mosquito abatement programs can also reduce the risk of infection.

Health Teachings
 Encouraged to eat foods rich in iron like green leafy vegetables and organ meat.  Instructed patient to maintain proper hygeine like taking a bath everyday.  Instructed to come back after a week for follow up check-up after discharge.  Encouraged to resume daily activities at home.  Encouraged to maintain the regular fluid intake.

Bite of a virus carrying aedes mosquito Mosquito injects fluid to victim’s skin Virus enters blood stream Infects cell and generate cellular response Initiates immune response (stimulates release of cytokines)

Cytokines destroys cell membrane and cell wall (viral antigens found in monocytes) fluid shift

When treated early with doctor prescribed medications and managed to prevent the appearance of the other symptoms

When illness become severe

Damage cells due to both cytokines and virus Fluid shift from ICF-ECF

IVF’s and electrolyte replacements and precautions

Patient recovers

Manifest evanescent rashes Bloody vomitus, urine, and stool

Rashes in several areas of the body

Circulatory collapse shock DEATH

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