Name: Carlo M.

Yao
Bachelor of Science in Nursing
Dengue Hemorrhagic Fever
Philippine Hemorrhagic fever was first reported in 1953. In 1958,
hemorrhagic fever became a notifiable disease in the country and
was later reclassified as Dengue Hemorrhagic Fever.
Partially data from National Epidemic Sentinel Surveillance
System shows a total of 7,894 dengue fever cases from all regions
from January 1 to November 19, 1999. Most (38%) of cases are the
national capital region (NCR), Nueva Ecija, Pampanga, Cebu and
Tarlac. There was no clustering of cases in any barangay. Majority
(53%) of the cases were male. Most (49%) cases belong to the 1-9
years age group. The next most affected age group is the 10-19
years. The were 113 deaths and the Case Fatality Ration (CFR) is 1.4
CFR was highest (3.4%) among cases forty years and above.
Etiology Agent

Dengue Virus Type 1, 2, 3, & 4

and Chikungunya virus
Source of Infection
Immediate source is a vector mosquito,
the Aedes Aegypti or the common
household mosquito.

The infected person.

Description:
An acute febrile infection of sudden onset with
clinical manifestation of 3 stages:

First 4 days – Febrile or invasive stage starts abruptly

as high fever, abdominal pain and headache; later
flushing which may be accompanied by vomiting,
conjunctival function and epistaxis.
4th-7th days – Toxic or hemorrhagic stage – lowering of
temperature, severe abdominal pain, vomiting and
frequent bleeding from gastrointestinal tract in the
form of hematemesis or melena. Unstable B.P., narrow
pulse pressure and shock. Death may occur.
Tourniquet test which may be positive on 3rd day may
become negative due to low or vasomotor collapse.

7th-10th days – Convalescent recovery stage generalized

flushing with intervention areas of blanching appetite
regained and blood pressure already stable.
Classification
Sever, frank type – with flushing, sudden high fever,
sever hemorrhagic, followed by sudden drop of
temperature, shock and terminating in recovery or
death.
Moderate – with high fever, but less hemorrhage, no
shock
Mild – with slight fever, with or without petichial
hemorrhage but epidemiological related to typical cases
usually discovered in the course of investigation of
typical cases.
Mode of Transmission

Mosquito bite (Aedes Aegypti)

Incubation Period

Uncertain. Probably 6 days to one week.

Period of communicability

Unknown.

Presume to be on the 1st week of illness

when virus is still present in the blood.
Susceptibility, Resistance and
occurrence
All person are susceptible. Both sexes are equally affected.
Age group predominantly affected are the preschool age
and school age. Adults and infants are not exempted. Peak
age affected 5-9 years.

Sporadic throughout the year. Epidemic usually occur

during the rainy seasons June – November. Peak months
are September and October.

Occurs wherever vector mosquito exists. Susceptibility is

universal. Acquired immunity may be temporary but
usually permanent.
Diagnostic Test
Tourniquet Tests (Rumpel Leads Test)

 Inflate the blood pressure cuff on the upper arm to a

point midway between the systolic and diastolic
pressure for 5 minutes.
 Release cuff and make an imaginary 2.5 cm. square or
1inch square just below the cuff, at the antecubital fossa.
 Count the number of petechiae inside the box.

A test is (+) when 20 or more petechiae per 2.5cm square

or 1 inch square are observed.
Management

Supportive

Symptomatic

e.g. for fever, give paracetamol for muscle pains.

For headache, give analgesic. Don’t give ASPIRIN.
Cont…
Rapid replacement of body fluids is the
most important treatment.

Includes intensive monitoring/follow-up

 Give ORESOL to replace fluid as in moderate

dehydration at 75ml/kg in 4-6 hours or up to 2-3L in
adults.
 Continue ORS intake until patient’s condition improves.
Methods of Prevention and Control

The infected individual, contacts and

environment:

Recognition of the disease

Isolation of patient (screening or sleeping under
the mosquito net)
Epidemiological investigation
Case finding and reporting
Health education
Control measures
Eliminate vector by:
 Changing water and scrubbing sides of lower vases once
a week.
 Destroy breeding places of mosquito by cleaning
surroundings proper disposal of rubber tires, empty
bottles and cans.
 Keep water containers covered.

Avoid too many hanging clothes inside the house.

Residual spraying with insecticide.
Public Health Nursing Responsibility

Reporting immediately to the Municipal Health Office

any know case outbreak.

Refer immediately to the nearest hospital, cases that

exhibit symptoms of hemorrhage from any part of the
body no matter how slight.

Conduct a strong health education program directed

towards, environmental sanitation particularly
destruction of all known breeding places of mosquito.
Assist in the diagnosis of suspect based on the signs
and symptoms. For those without signs of
hemorrhage, the nurse may do the “tourniquet” test.
(Apply tourniquet as is preparing for an “I.V.”. Let it
stay for 5minutes. Release. Presence of petichial
hemorrhage on skin indicates circulatory disturbance).

Conduct epidemiologic investigations as a means of

contracting families, case finding and individual as
wall as community health education.
Nursing Care

Any disease or condition associated with hemorrhage is

enough cause for alarm. Immediate control of hemorrhage and
close observation of the patient for vital signs leading to shock
are the nurse’s primary concern.

For Hemorrhage – keep the patient at rest during bleeding

episodes. For nose bleeding, maintain an elevated position of
trunk and promote vasocontriction in nasal mucosa membrane
through an ice bag over the forehead. For melena, ice bag over
the abdomen. Avoid unnecessary movement. If transfusion is
given, support the patient during the therapy. Observe signs of
deterioration (shock) such as low pulse, cold clammy
perspiration, prostration.
Cont…
For Shock – Prevention is the best treatment.
Dorsal recumbent position facilitates circulation.
 Adequate preparation of the patient, mentally and
physically prevents occurrence of shock.
 Provision of warmth through lightweight covers
(overheating causes vasodilation which aggravates
bleeding).

Diet – low fat, low fiber, non-irritating, non-

carbonated. Noodle soup may be given.
Measles
Etiology Agent

Filterable virus of measles

Source of Infection

Secretion of nose and throat of

infected persons
Description
An acute highly communicable infection characterized by
fever, rashes and symptoms referable to upper respiratory
tract. The eruption is preceded by about 2days of coryza,
during which stage grayish, pecks (Koplik spots) may be
found in the inner surface of the cheeks. A morbilliform
rash appears on the 3rd or 4th day affecting face, body and
extremities ending in branny desquamation.
 Death is due to complication, e. g, secondary
pneumonia, usually in children under 2yrs. Old. Measles
is sever among malnourished children with fatality 95-
100%.
Mode of Transmission

By droplet spread or direct contact with

infected persons, or indirect through articles
freshly soiled with secretions of nose and
throat, in some instances, probably
airborne.
Incubation Period

10 days from exposure to appearance of

fever, about 14 days until rash appears.
Period of Communicability

During the period of coryza or catarrhal

symptoms – 9 days, (from 4th day before and
5 days after rash appears).
Susceptibility, Resistance and
Occurrence

All persons are susceptible. Babies born of

mothers who had the disease before the
baby is born are immune for the first
months of life.
Methods of Prevention and Control
Avoid exposing children to any person with fever or with acute
catarrhal symptoms.

Isolation of cases from diagnosis until about 5-7 days after onset of
rash.

Disinfection of all articles soiled with secretion of nose and throat.

Encouragement by health department and by private physician of

administration of measles immune globulin to susceptible infants and
children under 3yrs. of age in families or institutions where measles
occurs.

Live attenuated and inactivated measles virus vaccines have been

tested and are available to use in children with no history of measles
at 9 months of age or soon thereafter.
Public Health Nursing
Responsibilities
Emphasize the need for immediate isolation when early catarrhal
symptoms appear.

If immune serum of globulin is available (gamma Globulin), explain this

to the family and refer to physician or clinic giving this service.

Observe closely the patient for complications during after the acute stage.

Teach, demonstrate, guide and supervise adequate nursing care

indicated.

Explain proceeding in proper disposal of nose and throat discharge.

Teach concurrent and terminal disinfection.

Nursing care
Protect eyes of patients from glare of strong light as
they are apt to be inflamed.

Keep the patient in an adequately ventilated room but

free from drafts and chilling to avoid complications of
pneumonia.

Teach, guide and supervise correct technique of giving

sponge bath for comfort of patient.

Check for corrections of medication and treatment

prescribed by physician.
GERMAN MEASLES