DENGUE HEMORRHAGIC FEVER (DHF)

PRELIMINARY REPORT

Arrange By:

Risqon Nafia 201501189

Class E

DEPARTMENT OF NURSING

INSTITUTE OF HEALTH SCIENCE

OF HEALTH PPNI MOJOKERTO

2018/2019
 LITERATURE REVIEW

DENGUE HEMORRHAGIC FEVER (DHF)

A. Definition of Dengue Hemorrhagic Fever (DHF)

DHF is a disease by dengue virus that is transmitted through the bite of

Aedes aegypti mosquitoes that attack blood cells. If someone has been

infected with this virus, they will experience muscle aches, headaches, joint

pain, and a decrease in the number of white blood cells. A decrease in the

number of white blood cells causes failure, so the patient will suffer from

dengue shock syndrome.

Dengue Hemorrhagic Fever (DHF) is a disease caused by the dengue

virus that can attack children and adults with the main symptoms of fever,

muscle and joint pain that usually worsens after the first two days.

B. Classification of dengue hemorrhagic fever

According to Suriadi, (2006: 60) classification of dengue hemorrhagic

fever, namely:

1. Degree I: Fever accompanied by other clinical symptoms or spontaneous

bleeding, positive tourniquet, Thrombocytopenia and Hemoconcentration

2. Degree II: Degree I accompanied by spontaneous bleeding in the skin and

or bleeding Other

3. Degrees III: Circulatory failure: rapid and weak pulse, hypotension, cold

moist skin, restless

4. Degree IV: Severe shock, pulse and blood pressure cannot be measured
C. Etiology of Dengue Hemorrhagic Fever (DHF)

DHF is caused by dengue virus from the Arbovirus B group , namely

arthropod-borne or a virus spread by arthropods. This virus belongs to the

genus flavivirus from the flaviviridae family. Female Aedes mosquitoes are

usually infected with dengue virus when sucking blood from someone who is

in the stage of acute fever (viraemia). After going through the extrinsic

incubation period for 8 to 10 days, the Aedes salivary gland will become

infected and the virus will be transmitted when the mosquito bites and

secretes the saliva into the bite wound into other people's bodies. After an

intrinsic incubation period of 3-14 days (on average for 4-6 days) the initial

symptoms of sudden illness occur, which are characterized by fever,

dizziness, myalgia (muscle pain), loss of appetite and various non-specific

signs or symptoms such as nausea (nausea), vomiting and rash (rash on the

skin). These times are critical times where sufferers are very infective for

mosquito vectors that play a role in the transmission cycle (Widoyono, 2008;

Sitio, 2008).

The characteristics of the Aedes aegypti mosquito are:

1) Common dengue transmission through Aedes aegypti mosquito bites.

Although it can also be transmitted by Aedes Albopictus who usually

live in gardens. His body is black and white striped.

2) Biting during the day

3) Breed in clean and clear water that does not flow

D. Signs and Symptoms of Dengue Hemorrhagic Fever (DHF)

Symptoms of DHF until now are unexpected. But in general, this disease

has characteristics such as high heat, dizziness, even vomiting of blood. But

unfortunately, the same symptoms are often found in other diseases as a result

of which there is often a misdiagnosis. The following signs and symptoms of

Dengue Hemorrhagic Fever include:

1. Suddenly high heat for 2-7 days, looks weak lethargic body

temperature between 38ºC to 40ºC or more.

2. Red spots appear on the skin and if the skin is stretched the red spots

do not disappear.

3. Sometimes bleeding in the nose (nosebleeds).

4. Maybe there is blood vomiting or blood defecation.

5. A positive Torniquet test.

6. Petechia, akimosis or purpura bleeding.

7. Sometimes heartburn, due to bleeding in the granary.

8. When it is severe, the patient is restless, the tips of the hands and feet

are cold Sweating Bleeding mucous mucous membranes,

gastrointestinal digestive tract, injection site or elsewhere.

9. Hematemesis or melena.

10. Thrombocytopenia

11. Plasma enlargement that is closely related to the increase in

permeability of blood vessel walls, which is characterized by the

appearance of one or more of:

 ● Increase in value of 20% hematocrit or more depending on age

and sex.

● The decrease in hematocrit value from a baseline value of 20%

or more after treatment.

● Signs of plasma enlargement are pleural effusions, ascites,

hypo-proteininaemia.

E. Diagnostic Examination

Diagnostic examinations in patients with dengue hemorrhagic fever

according to Suriadi (2006: 59) are as follows:

1. Complete blood

● Hemoconcentration (hematocrit increases 20% or more)

● Thrombocytopenia (100,000 / mm³ or less)

2. Serology or HI Test (Hemoaglutination Inhibition test)

3. Thorax X-ray is there any pleural effusion

F. Prevention of Dengue Hemorrhagic Fever (DHF)

Eradication of DHF as well as other infectious diseases is based on

breaking the transmission chain, consisting of viruses, aedes and humans.

Because until now there is no effective vaccine for the virus, eradication is

aimed at humans, especially in the vector (Soemarmo, 1998).

1. How to prevent Dengue Hemorrhagic Fever

How to reduce the population of Aedes Aegypti mosquitoes in a

way that has been introduced by the community, namely through 4M,
according to Handrawan Nadesul (2007), in Triyani's book (2010), as

follows:

● Drain

Drain the water storage area (TPA) for daily needs and do it

once a week and continuously. This is done to cut the mosquito's

development cycle by killing the larvae in the water reservoir by

draining once a week, so that the larvae cannot develop.

● Close

Close the landfill tightly, so that mosquitoes cannot enter

and breed. This effort is done by closing all places that hold water

as a place for mosquito vector development.

● Bury

Burying used goods that become landfill. Used goods that

are not used and can hold water should be buried, because it can

be a breeding ground for mosquitoes. Recently, the prevention

and eradication of DHF cannot only be done through 3M, but the

most effective way is through the eradication of mosquito larvae

(PSJN) to reduce the number of dengue cases. In addition to the

obvious larvae, which is in the water reservoir (TPA), also

because larvae are the beginning of the life phase of mosquitoes.

● Monitor
 Monitor all water containers that have the potential to breed

aedes mosquitoes. Do not hang clothes, apply larvicides, and

sleep using mosquito nets.

G. General management (medical and nursing)

Management in patients with dengue hemorrhagic fever according to

Suriadi, (2006: 60) are as follows:

1. Medical management

● Giving Antipyretics if there is fever

● Give anticoavulsants if seizures

● Provide IVFD therapy, if the patient has difficulty drinking and

hematocrit tends to increase

2. Nursing management

● Drink lots of 1.5 to 2 L / day with tea, sugar or milk. This is because

patients with DHF are at high risk of experiencing a lack of excess

fluid volume. Prevent the occurrence of a lack of fluid volume.

● Improve adequate tissue perfusion, Assess and record vital signs

(quality and pulse frequency, blood pressure, CRT)

● Provide adequate nutrition. Give food accompanied by nutritional

supplements to improve the quality of nutrient intake.

● Support adaptive family coping. Allow parents and family to

respond at length, and identify the factors that most concern the

family.
 ● Maintain body temperature within normal limits. Measure vital

signs: temperature and teach family to measure body temperature.

Normal body temperature 360C to 370C

H. Complications

Complications from dengue hemorrhagic fever according to

Indartoas (2009: 7) are:

1. Broad bleeding: Due to the increase in high temperatures, fragments

of blood vessels occur in most of the body.

2. Shock (regimen): Shock can occur in Dengue Shock Syndrome ()

patients

3. Pleural Effusion: Pleural effusion occurs due to increased vascular

permeability which causes extravascular extraction of intravascular

fluid.

4. Decreased consciousness: It occurs due to severe hypovolemia so

that blood cells are reduced and unable to carry oxygen adequately

into the brain.

 REFERENCES

Hidayat, Aziz Alimul. (2008). Introduction to Child Nursing. Jakarta: Salemba Medika

Nelson. (2000) .ilmu child health. Edition 15 vol 2 Jakarta: EGC

Soedarto. (2012). Dengue Hemorrhagic Fever. Jakarta: Salemba Medika

Suriadi. (2006). Nursing Care in Children. Edition 2. Jakarta: Sagung Seto

Wong, DL (2004). Pediatric Nursing, (Issue 4) Jakarta, EGC