REPORT INTRODUCTION

DENGUE SHOCK SYNDROME (DSS)

BAIQ NURLITA DEWI S.Kep.

016.02.0610

SEKOLAH TINGGI ILMU KESEHATAN (STIKES) MATARAM

PROGRAM PROFESI NERS
2016
 REPORT INTRODUCTION DENGUE SHOCK SYNDROME (DSS)

A. DEFINITIONS
Dengue disease is an acute infection caused by an arbovirus (arthropod- borne viruses) and is
transmitted through the bite of Aedes mosquito (Aedes albopictus and Aedes aegypti) (Ngastiyah and
Pediatrics) Haemoragie Dengue Fever disease is a disease of Dengue Fever with bleeding
manifestations (SUMARMO et al ; 2008) diseases Dengue shock Syndrome (DSS) is a disease of
DHF were experiencing shock or shock (Mansjoer, Arief.dkk; 2010.428)
B. Etiology.
Dengue virus, including group B arthropod borne viruses (arboviruses) and is now known as a
flavivirus genus / family Flaviviridae which have 4 types of serotype named Den-1, Den-2, Den-3
and Den-4. (SUMARMO, s et al; 2008.156) with dengue virus serotype Den-1 to Den-4 which is
transmitted through mosquito vector Aedes Aegypi, Aedes albopictus and Aedes Polynesiensis and
several other species that are less instrumental vector. Infection with one serotype will cause lifelong
antibodies against serotype concerned but no antibody protection against other serotypes. (Mansjoer,
arief; 2001.419)
a)Aedes aegypti
1. Most commonly found
2. Was the mosquitoes that live in the tropics, especially live and breed in the house, which is in
clear water tanks or reservoirs around the house.
3. This mosquito cursory look mottled, speckled white spots.
4. usually bite during the day, especially in the morning and afternoon.
5. The distance to fly 100 meters
b) Aedes Albopictus
1. Place in a water habitat. Usually around the house or trees, such as banana trees, pandanus tin
cans.
2. Biting at noon Distance flew 50 meters. (Rampengan T H 2007)
c)Clinical Manifestations
Dengue virus infection is similar to a viral infection that other which is a self-limiting infections
desease which will expire between days 2-7, dengue virus infection resulting in a spectrum of
clinical manifestations varying from mild disease (mild undifferentiated febrile illness), dengue
fever, dengue fever to dengue shock syndrome dengue where al clinical criteria:
1. Sudden high fever and continuously for 2-7 days with reasons that are obvious and can
hardly be influenced by antipiretika and surface cooling.
2. Weak, lethargic
3. Decreased appetite
4. Pain in the limbs, back, head, joints.
5. Bleeding manifestations: positive tourniquet test / RL +
6. Spontaneous bleeding: ptekie, ecchymosis, epistaxis, bleeding gums
7. Enlargement of the liver
8. Shock is characterized by a weak and rapid pulse until intangible, blood pressure dropped
to 80mmHg to zero and the pulse pressure to 20 mmHg to zero, cold clammy skin, moist,
 especially extremitas patient became agitated until loss of consciousness until the cause of
death.
According to the 1975 WHO clinical symptoms of dengue are divided into 4
Grade I
Sudden onset of fever accompanied by symptoms that are not typical and the only
manifestation of bleeding is a positive tourniquet test (RL +)
Grade II
Grade I with spontaneous bleeding or bleeding skin and others.
Grade III
Grade II and the discovery of signs of circulatory failure is rapid and gentle pulse,
decreased blood pressure (<20 mmHg) or hypotension with cold skin, moist and the
patient became agitated
Degree IV
Grade III plus the shock of weight with no palpable pulse and blood pressure
immeasurable loss of consciousness, acidosis and cyanosis. The occurrence of shock /
shock timeout fever down that day 3 to 7 or even the up to day 10.

C. Pathophysiology.
Pathophysiology of the major dengue shock syndrome are antigen-antibody reaction in the circulation
that cause the activation of the complement system C3 and C5 which releases C3a and C5a where
two peptides such as histamine body is a strong mediator the increased permeability of blood vessel
walls suddenly as a result of leachate plasma and electrolytes through the endothelial walls of the
blood vessels and into the interstitial space, causing hypotension, increasing hemokonsentrasi,
hipoproteinemia and effusion of serous fluid in the cavity. In patients with shock / shock the plasma
volume can be reduced to approximately 30% and lasts for 24-48 hours. This hypovolemic shock if
not treated immediately will cause tissue anoxia, metabolic acidosis resulting in a shift of calcium
ions from intracellular to extracellular. This mechanism was followed by a decrease in heart muscle
contraction and venous pooling so much to aggravate the condition of shock / shock. Additionally
DSS patient death is severe bleeding digestive tract that usually occur after a seizure lasts longer and
is not addressed adequately. Bleeding is caused by:
severe thrombocytopenia, which began to decline in the time platelets dna fever reached its
lowest value at the time of seizure.
Impaired platelet function
Abnormal coagulation system, partial thromboplastin time, prothrombin time elongated while
most patients obtained normal thrombin time, some clotting factors include factor decreased, V,
VII, IX, X, and fibrinogen.
DIC / Desiminata Intravakuler Coagulasi In the early period DBD DIC less prominent role than
the plasma leakage, but if the disease worsens, causing shock and metabolic acidosis then the
shock will accelerate the incidence of DIC so that its role will be prominent. Shock and DIC salig
influence that the incidence of irreversible shock accompanied by severe bleeding in all vital
organs and lead to death. (Rampengan et al; 1997.143)
 Pathway

D. Medical Diagnostics
Medical diagnosis of DHF / DSS is based patokanWHO 1975 consisting of four criteria and two
laboratory criteria with the proviso when criteria laboratory fulfilled at least 2 clinical criteria one of
 which is a fever, stage I and II referred to DHF / dengue while stage III and IV DHF / dengue with
renjatan or DSS.
E. Investigations.
In determining the diagnosis of DHF / dengue minimum of two criteria, namely laboratirik
1) Hemoconcentration is heightened hematocrit / Ht> 20%
2) Thrombocytopenia is a decrease in platelets below 100,000 / mm3
3) preparations should be of peripheral blood are indicative t'jadinya t'dapat fragmentosit hemolysis.
4) The bone marrow contained system hipoplasi eritopoietik accompanied hiperplasi system RE
5) Electrolyte Abnormalities:
Hyponatremia
Hyperkalemia
mild Hipoloremia
metabolic acidosis with compensatory alkalosis
decreased plasma osmolality.
6) Pressure decreased colloid oncotic
7) decreased plasma protein
8) slightly elevated serum transaminases
F. Complications.
1) Bleeding massif
2) Respiratory failure due to pulmonary edema and lung collapse
3) Encephalopathy dengue
4) Heart failure.
ASUHAN KEPERAWATAN

A. Assessment
1. Identity: age, address (endemic areas, the home environment / school there were exposed DB)
2. Health history
The main complaints (complaints from the patient assessment): heat, vomiting, epistaxis,
bleeding gums
Current medical history (history of the disease suffered by patients upon hospital admission):
when a hot start?
past medical history (a history of the same disease or any other disease ever suffered by the
patient)
Family health history (a history of the same disease or any other disease ever suffered by
other family members either is genetic or not)
History's growth: is there any developmental delays?
B. Nursing Diagnosis and Intervention
1. Hipertermi b / d process dengue virus infection (viremia)
Objective: Normal body temperature back after getting care measures.
Expected outcomes: Body temperature is between 36-37, mucous membranes moist, the pulse in
the normal range (80-100 x / min), muscle pain disappeared.
intervention:
Give compress (water / faucet).
Give / instruct the patient to drink plenty of 1500-2000 cc / day (as tolerated)
Encourage the family to wear thin and easy to absorb sweat on the client.
Observation of intake and output, vital signs (temperature, pulse, blood pressure) every 3
hours or more frequently.
Collaboration: intravenous fluid administration and administration of antipyretic drugs
according to the program.
2. Lack of fluid volume b / d displacement of fluid from the intravascular to the extravascular
Objective: Not happening from Volume deficit liquids / Not occur hypovolemic shock.
Criteria: Input and output balance, Vital signs within normal limits (BP 100/70 mmHg, N: 80-
120x / mnt), No sign presyok, Akral warm, Capilarry refill <3 seconds, a strong pulsation.
intervention:
Observas vital signs every 3 hours / more often
Observation of capillary Refill
Observation of intake and output. Record number, color, concentration, BJ urine.
Suggest to drink 1500-2000 ml / day (as tolerated)
Collaboration: administration of intravenous fluids, plasma or blood.
3. Imbalance nutrition less than body requirements b / d intake in adequate
Goal: No disruption nutritional needs
Criteria: No signs of malnutrition, not weight loss, appetite increases, the portion of the food
served capable spent on clients, nausea and vomiting reduced.
intervention:
Assess nutritional history, including the preferred food
Observe and record the patient's food intake
Weigh BB every day (if possible)
Give / Instruct the client for the food, frequent and or eat between meals
Give and Help oral hygiene.
Avoid foods that stimulate (spicy / sour) and gassy.
Explain to the client and family about the importance of nutrition / food for the healing
process.
Serve food in a warm state.
Instruct the client to take a deep breath if nausea.
Collaboration in the provision of software and low-fiber diet.
Observation of client eating, weight and client complaints.
 DAFTAR PUSTAKA

Arif Mansjoer dkk, Kapita Selekta Kedokteran, Media Aesculapius FKUI Jakarta, 2010

Budi Santosa, Panduan Diagnosa Keperawatan NANDA 2005-2006, Prima Medika

Dina Kartika S, Pediatricia, Tosca Enterprise, Yogyakarta, 2005

Fakultas Kedokteran UGM, Demam Berdarah Dengue : Naskah Lengkap Pelatihan bagi keperawatan

klinik

Hardiono D. Pusponegoro dkk, Standar Pelayanan Medis Kesehatan Anak, IDAI, 2004

Judith M. Wilkinson, Prentice Hall Nursing Diagnosis Handbook with NIC Intervention and NOC

Outcomes, Upper Saddle River, New Jersey, 2005

Marion Johnson, Nursing Outcomes Classification (NOC), Mosby-Year Book, 2000

Swearingen, Pocket Guide to Medical-Surgical Nursing : terjemahan, EGC, 2000

Tri Atmadja DS, Standar Pelayanan Medis Kesehatan Anak, RSUD Wates, 2001