Introduction

Dengue (DENG-gay) fever is a disease — ranging from mild to severe — caused by four related
viruses spread by a particular species of mosquito. Mild dengue fever causes high fever, rash,
and muscle and joint pain. More-severe forms of the disease — dengue hemorrhagic fever and
dengue shock syndrome — can additionally cause severe bleeding, a sudden drop in blood
pressure (shock) and death.

No specific treatment for dengue fever exists, and most people recover. But if you have a severe
form of the disease, you need hospital care.

Millions of cases of dengue infection occur worldwide each year. Most often, dengue fever
occurs in urban areas of tropical and subtropical regions. A few cases have been reported in the
United States — particularly in Texas, along the border with Mexico, and in Hawaii.

Symptoms
Signs and symptoms of dengue fever vary, depending on the form and severity of the disease.

Dengue fever
With the mild form of the disease, you may experience some or all of these signs and symptoms:

 High fever, up to 105 F (40.6 C)

 A rash over most of your body, which may subside after a couple of days and then
reappear
 Severe headache, backache or both
 Pain behind your eyes
 Severe joint and muscle pain
 Nausea and vomiting

Sign and symptoms usually begin about four to seven days after being bitten by a mosquito
carrying a dengue virus. Mild dengue fever rarely causes death, and your symptoms will usually
subside within a week after starting.

Dengue hemorrhagic fever

More-severe forms of the disease usually begin the same way as the mild form (dengue fever)
then become worse after several days.

Dengue hemorrhagic fever — a more severe form of the disease than initial dengue fever — can
cause signs and symptoms of dengue fever plus:

 Significant damage to your blood and lymph vessels

 A decrease in the number of blood cells that help your blood clot (platelets)
 Bleeding from the nose and mouth
 Bleeding under the skin, which gives the appearance of bruising
  Death

Dengue shock syndrome — Dengue shock syndrome — the most severe form of the disease —
may cause signs and symptoms of mild dengue fever plus:

 Severe abdominal pain

 Frequent vomiting
 Disorientation
 Fluid (plasma) leakage from blood vessels
 Heavy bleeding
 A sudden drop in blood pressure (shock)
 Death

Severe signs and symptoms may appear after your fever has improved. In a small number of
cases, people with a severe form of the disease die of it. Modern supportive hospital care
decreases this risk.

When to see a doctor

If you have any signs or symptoms of dengue fever, see your doctor. If you've recently traveled
to a region in which the disease is known to occur, be sure to inform your doctor.

Causes
Dengue fever is caused by any one of four dengue viruses spread by the Aedes aegypti mosquito.
These mosquitoes thrive in and near human habitations, where they breed in even the cleanest
water.

Mosquitoes transmit the virus back and forth between humans. When a mosquito bites a person
infected with a dengue virus, the virus enters the mosquito's bloodstream. It then circulates
before settling in the salivary glands. When the infected mosquito then bites another person, the
virus enters that person's bloodstream, where it may cause the serious illness.

You can become infected with dengue fever more than once. This happens when you're exposed
to a different one of the four dengue viruses from the one to which you were previously exposed.
Infection a second time is typically what causes the more severe form of the disease — dengue
hemorrhagic fever.

Risk factors
Factors that put you at greater risk of developing dengue fever or a more severe form of the
disease include:

 Living or traveling in tropical areas. Being in tropical and subtropical areas around the
world — especially in high-risk areas, such as tropical Asia, Central and South America,
and the Caribbean — increases your risk of exposure to the virus that causes dengue
 fever. Dengue virus transmission occurs year-round, although the risk is highest during a
recognized dengue fever outbreak.
 Prior infection with a dengue fever virus. Previous infection with a dengue fever virus
increases your risk of a more severe form of the disease. This is especially true for
children. If you've had dengue fever before, you can get it again if you become infected
with another one of the four dengue-causing viruses. Having antibodies to a virus in your
blood from a previous infection usually helps protect you. But in the case of dengue
fever, it actually increases your risk of severe disease — dengue hemorrhagic fever — if
you're infected again.

Complications
Most people with dengue fever recover within five to 14 days. Some, particularly adults, may
feel listless, tired and even depressed for several weeks to months after being infected.

If severe, dengue fever can lead to dengue hemorrhagic fever and dengue shock syndrome,
which can cause heavy bleeding, shock and — in a small number of those with these conditions
— death. Those who survive may experience liver, blood vessel and brain damage, as well as
seizures.

Tests and diagnosis

Diagnosing dengue fever can be difficult. That's because its signs and symptoms can be easily
confused with those of other diseases, such as malaria, leptospirosis and typhoid fever. To
diagnose dengue fever, your doctor will:

 Evaluate your signs and symptoms

 Review your medical and travel history
 Test your blood for evidence of a dengue virus

Medical history
Your doctor will likely ask about your medical and travel history and any exposure to
mosquitoes. Be sure to describe international trips in detail, including the countries you visited
and the dates, as well as any contact you may have had with mosquitoes.

Blood tests
Laboratory tests, usually using a sample of your blood, are needed to confirm a diagnosis of
dengue fever. If you have dengue fever, your blood may reveal the virus itself. If not, blood tests
known as hemagglutination inhibition (HI) assay, enzyme-linked immunosorbent assay (ELISA)
and reverse transcriptase-polymerase chain reaction (RT-PCR) can detect antigens, antibodies or
nucleic acids specific to the viruses. These tests may take several days.
Treatments and drugs
No specific treatment for dengue fever exists.

For a mild form of the disease, your doctor may recommend:

 Drinking plenty of fluids to avoid dehydration from vomiting and high fever.
 Taking acetaminophen (Tylenol, others) to alleviate pain and reduce fever. Don't
take aspirin or other nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil,
Motrin, others) and naproxen sodium (Aleve, others). These can increase the risk of
bleeding complications.

For a more severe form of the disease, treatment consists of:

 Supportive care in a hospital

 Intravenous (IV) fluid and electrolyte replacement
 Blood pressure monitoring
 Transfusion to replace blood loss

If you have any form of dengue fever, you may also be kept away from mosquitoes, to avoid
transmitting the disease to others.

Prevention
A dengue fever vaccine is in development but isn't generally available. If you're living or
traveling in an area where dengue fever is known to be, the best way to avoid dengue fever is to
avoid being bitten by mosquitoes that carry the disease.

To reduce your risk of mosquito bites, minimize your exposure to mosquitoes:

 Schedule outdoor activities for times when mosquitoes are less prevalent. Avoid
being outdoors at dawn, dusk and early evening, when more mosquitoes are buzzing
about.
 Wear long-sleeved shirts, long pants, socks and shoes when you go into mosquito-
infested areas.
 Stay in air-conditioned or well-screened housing. Patch screens if necessary, especially
where there will be nighttime exposure.
 Apply permethrin-containing mosquito repellent to your clothing, shoes, and
camping gear and bed netting. You can also buy clothing made with permethrin already
in it.
 Use repellent with a 10 to 30 percent concentration of DEET on your skin. Choose the
concentration based on the hours of protection you need — a 10 percent concentration of
DEET is effective for about two hours; higher concentrations last longer. However,
chemical repellents can be toxic, so use only the amount needed for the time you'll be
outdoors.
 patho
 bite of a virus carrying Aedes mosquito
 mosquito injects fluids into victim’s skin
 virus enters blood stream
 infect cells and generate cellularresponse
 initiates immune response (stimulaterelease of cytokines)
 cytokines destroys cell membrane and
 cell walls (viral antigens found in monocytes)
 fluid shift
 symptoms manifest itself

Nursing Care Management

Monitored vital signs

Continued medications

Watch out for persistence of vomiting

Monitored progress/improvement CBC

Advised to avoid dark color foods

Advised to increase oral body fluid intake

Health Teaching:

> D- discuss the possible source of infection of the disease.

> E- educate the family/patient on how to eliminate those vectors.

> N- Never stocked water in a container without cover.

> G- Gallon, container and tires must have proper way of disposal.

> U- Use insecticides at home to kill or reduce mosquito.

> E- Encourage the family of the patient to clean the surroundings to destroy the

breeding places of mosquito.

INTRODUCTION

In the Philippines there are many diseases illness arising because of environmental changes that may be
caused by human activities and geographical conditions. It is considered as one of the tropical country
and so disease can spread throughout the country.

One example of these is disease is what we called Dengue Fever and dengue Hemorrhagic Fever (DHF).
It is considered as one of the acute febrile diseases caused by one of the four closely related virus
serotype of the genus flavivirus. It can be transmitted by Aedes Aegypti mosquito to humans usually
attacking during the day. One will experience onset of fever, severe headaches, muscle and joint pains
which will give name to Breakbone Fever or Bonecrusher. There are also rashes characterized by bright
red petechaie commonly seen on the lowers limbs and on the chest. There may also be gastritis
associated to abdominal pain, nausea, vomiting, or diarrhea. Proper attention of health care provider
should be given including good assessment, early detection or diagnosis and medications which are
essential for total interference of prevention.

PATIENT’S PROFILE

Name:

Age:

Gender:Mal e

Address:

Date of Birth:

Place of Birth:

Nationality: Filipino

Religion: Roman Catholic

Civil Status: Single

Occupation: N /A

Date of Admission:

Time of admission: 4:00 am

Physician:

Place of Admission:
Admitting Diagnosis: Dengue Fever Syndrome