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Dengue fever is an acute febrile disease caused by infection with one of the serotypes of dengue virus. It
is a mosquito-born disease caused by genus Aedes.

Dengue is also known as Breakbone Fever, Hemorrhagic Fever, Dandy Fever, Infectious
Thrombocytopenic Purpura.

Dengue hemorrhagic fever is a fatal manifestation of dengue virus that manifest with bleeding diathesis
and hypovolemic shock.

These viruses are related to the viruses that cause the West Nile infection and yellow fever.

The pathophysiology of dengue hemorrhagic fever include:

Initial phase. The initial phase of DHF is similar to that of dengue fever and other febrile viral illnesses.
The virus is deposited in the skin by the vector, within few days viremia occurs, lasting until the 5th day
for the symptoms to show.

Hemorrhagic symptoms. Shortly after the fever breaks or sometimes within 24 hours before, signs of
plasma leakage appear along with the development of hemorrhagic symptoms.

Vascular leakage. Vascular leakage in these patients results in hemoconcentration and serous effusions
and can lead to circulatory collapse.

The etiologic agent and vector of dengue: Aedes aegypti

Flavivirus. It is caused by infection of one of the four serotypes of

dengue virus, which is a Flavivirus, a genus of single-stranded
nonsegmented RNA virus.
Aedes aegypti. Dengue virus is transmitted by day-biting mosquitoes
of the genus Aedes that breeds in stagnant water. It has white dots at
the base of its wings, with white bands on the legs.
Incubation period. It has an incubation period of three to ten days.

Clinical Manifestations

Symptoms, which usually begin 4 to 6 days after infection and may last to up to
10 days, include:

Symptoms of Dengue

High fever. Sudden high fever

occurs as a result of the
infection.
Severe headaches. Severe
headaches also torment the
patient.
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Damage to lymph and blood vessels. As the virus slowly spreads,

even the lymphand blood vessels are affected.
Bleeding. Bleeding from the nose and gums is a characteristic of DHF.
Enlargement of the liver. The dengue virus could also penetrate
the liver, causing fatal damage.
Circulatory system failure. The circulatory system ultimately fails
eventually if the disease is not treated promptly.

Prevention

There are many ways to prevent dengue fever but there are no vaccines
available yet.

Avoid crowded places. Stay away from heavily populated residential

areas.
Mosquito repellents. Use mosquito repellents that are mild for the
skin, even indoors.
Proper clothing. When outdoors, wear long-sleeved shirts and long
pants tucked into socks.
Mosquito-free environment. Make sure window and door screens
are secure and free of holes or use mosquito nets.
Stagnant water. Empty or cover bottles, cans, and any containers
with stagnant water as these can become breeding places of
mosquitoes.

Complications

Dengue cases may be not adequately recognized in the United States, and as a
result, many cases often end up with complications.

Dengue shock syndrome. Common symptoms in impending shock

include abdominal pain, vomiting, and restlessness.

Assessment and Diagnostic Findings

Laboratory criteria for the diagnosis of dengue virus may include 1 of the
following:
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Dengue virus isolation. Isolation of the dengue virus from

serum, plasma, leukocytes, or autopsy samples.
Immunoglobulin titers. Demonstration of a fourfold or greater
change in reciprocal immunoglobulin or IgM antibody titers to one or
more dengue virus antigens in paired serum samples.
Immunohistochemistry. Demonstration of the dengue virus antigen
in autopsy tissue via immunohistochemistry or immunofluorescence.
Polymerase chain reaction. Detection of viral genomic sequences in
autopsy tissue, serum, or cerebrospinal fluid samples via PCR.
Complete blood count. In DHF, there may be presence of increases
hematocrit level secondary to plasma extravasation and/or third-space
fluid loss.
Decreased platelet count. This test confirms dengue.
Guaiac test. Guaiac testing for occult blood in the stool should be
performed on all patients suspected with dengue virus infection.

Medical Management

The management of DHF is actually simple as long as it is detected early.

Oral rehydration therapy. Oral rehydration therapy is recommended

for patients with moderate dehydration caused by high fever and
vomiting.
IV fluids. IVF administration is indicated for patients with dehydration.
Blood transfusion and blood products. Patients with internal or
gastrointestinal bleeding may require transfusion, and patients with
coagulopathy may require fresh frozen plasma.
Oral fluids. Increase in oral fluids is also helpful.
Avoid aspirins. Aspirin can thin the blood. Warn patients to avoid
aspirins and other NSAIDs as they increase the risk for hemorrhage.

Nursing Management

Nursing management of patients with DHF is essential in achieving complete

recovery.
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Nursing Assessment

Assessment of a patient with DHF should include:

Evaluation of the patients heart rate, temperature, and blood

pressure.
Evaluation of capillary refill, skin color and pulse pressure.
Assessment of evidence of bleeding in the skin and other sites.
Assessment of increased capillary permeability.
Measurement and assessment of the urine output.

Nursing Diagnosis

Based on the assessment data, the major nursing diagnoses for a patient with
DHF are:

Risk for bleeding related to possible impaired liver function.

Deficient fluid volume related to vascular leakage.
Pain related to abdominal pain and severe headaches.
Risk for ineffective tissue perfusion related to failure of the
circulatory system.
Risk for shock related to dysfunction in the circulatory system.

Nursing Care Planning and Goals

The goals in a patient with DHF are:

Be free of signs of bleeding.

Display laboratory results within normal range for individuals.
Maintain fluid volume at a functional level.
Report pain is relieved or controlled.
Follow prescribed pharmacologic regimen.
Demonstrate adequate tissue perfusion.
Display hemodynamic stability.
Be afebrile and free from other signs of infection.

Nursing Interventions

Nursing interventions appropriate for a patient with DHF include:

Blood pressure monitoring. Measure blood pressure as indicated.

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Monitoring pain. Note client report of pain in specific areas, whether

pain is increasing, diffused, or localized.
Vascular access. Maintain patency of vascular access for fluid
administration or blood replacement as indicated.
Medication regimen. There must be a periodic review of the
medication regimen of the client to identify medications that might
exacerbate bleeding problems.
Fluid replacement. Establish 24-hour fluid replacement needs.
Managing nose bleeds. Elevate position of the patient and apply ice
bag to the bridge of the nose and to the forehead.
Trendelenburg position. Place the patient in Trendelenburg position
to restore blood volume to the head.

Evaluation

A successful nursing care plan has achieved the following:

Absence of signs of bleeding.

Displayed laboratory results within normal range for individuals.
Maintained fluid volume at a functional level.
Reported pain is relieved or controlled.
Followed prescribed pharmacologic regimen.
Demonstrated adequate tissue perfusion.
Displayed hemodynamic stability.
Afebrile and free from other signs of infection.

Discharge and Home Care Guidelines

A patient with DHF discharged from the health care facility should be instructed
to:

Avoid diuretics. Avoid caffeine and alcohol as indicated to reduce

effects of diuresis.
Follow-up appointments. Comply with the recommended medical
and laboratory follow-ups.
Oral care. Recommend use of soft toothbrush to reduce risk of injury
to the oral mucosa.
Diet. Foods rich in vitamin K should be recommended to promote
blood clotting.
Education. Educate patient on the use of mosquito nets and
insecticides.
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Documentation Guidelines

The focus of documentation in a patient with DHF include:

Factors that potentiate blood loss.

Baseline vital signs, mentation, urine output, and subsequent
assessments.
Results of laboratory and diagnostic studies.
Degree of deficit and current sources of fluid intake.
I&O and fluid balance.
Clients description of response to pain and acceptable level of pain.
Plan of care.
Teaching plan.
Response to interventions, teachings, and actions performed.
Attainment or progress towards desired outcomes.
Modifications to plan of care.