WELCOME

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 D231: Medical & Surgical Nursing

Lecture On

DENGUE FEVER

Presented By
SALEHA KHATUN
Deputy Nursing Superintendent
Dhaka Medical College Hospital, Dhaka.
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 Learning Objective

– Introduction about Dengue Fever

– Pathophysiology of dengue fever
– Causes
– Clinical features
– Prevention
– Complications of dengue fever
– Investigations
– Medical Management
– Nursing management of dengue fever.

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 INTRODUCTION
Dengue is a mosquito-borne viral disease that has
rapidly spread in all regions of WHO in recent years.
Dengue virus is transmitted by female mosquitoes
mainly of the species Aedes aegypti and, to a lesser
extent, Ae. albopictus. These mosquitoes are also
vectors of chikungunya, yellow fever and Zika viruses.

Dengue is widespread throughout the tropics, with

local variations in risk influenced by rainfall,
temperature, relative humidity and unplanned rapid
urbanization.

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INTRODUCTION… (Dengue fever)
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.

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 INTRODUCTION… (Dengue fever).. Cont.
Dengue (pronounced DENgee) fever is a painful, debilitating
mosquito-borne disease caused by any one of four closely
related dengue viruses. These viruses are related to the
viruses that cause West Nile infection and yellow fever.
Millions of cases of dengue infection occur worldwide each
year. Dengue fever is most common in Southeast Asia and
the western Pacific islands, but the disease has been
increasing rapidly in Latin America and the Caribbean.
An estimated 400 million dengue infections occur
worldwide each year, with about 96 million resulting in
illness. Most cases occur in tropical areas of the world.
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 Pathophysiology of Dengue 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.
Progression: If left untreated, DHF most likely progresses to
dengue shock syndrome. 7
 CAUSES of DENGUE FEVER

The etiologic agent and

vector of dengue:

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:

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 Clinical Manifestations… Cont..
 High fever. Sudden high fever occurs as a result of the
infection.
 Severe headaches. Severe headaches also torment the
patient.
 Damage to lymph and blood vessels. As the virus slowly
spreads, even the lymph and 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.
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 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. 11
Complications

• Febrile convulsions
• Dehydration
A small percentage of individuals who have
dengue fever can develop a more serious form
of disease, dengue hemorrhagic fever.

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 Investigations for Dengue Fever

Laboratory Diagnosis:
1. Complete Blood Count (CBC) including Total
Leucocyte count, Total Platelet Count and
Haematocrit.
2. Chest X-ray right lateral decubitus view or
Ultrasonography.
3. Other routine tests as indicated e. g., MP for
excluding malaria in malaria endemic zone.
4. Other tests as and when necessary e. g., serum
albumin, liver function tests etc.

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 Investigations for Dengue Fever

5. Confirmatory diagnosis:
• Serelogical detection of antibodies (IgM and IgG) by
ElISA.
• Detection of dengue virus RNA by reverse transcription
(RT)-PCR or nucleic acid sequence-based amplification
(NASBA).
• Detection of viral antigens by ELISA or rapid tests.
• Isolation of dengue virus in cell culture.

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 MEDICAL MANAGEMENT
The management 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. 15
 NURSING MANAGEMENT

ASSESSMENT
Assessment of a patient with Dengue Fever or, Dengue
Hemorrhagic fever should include:

 Evaluation of the patient’s 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. 16
 NURSING MANAGEMENT Cont..
1. 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. 17
 NURSING MANAGEMENT Cont..

Nursing Care Planning and Goals

The goals in a patient with DF 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.
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 NURSING MANAGEMENT Cont..
Nursing Interventions

• Blood pressure monitoring. Measure blood pressure as indicated.

• 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. 19
 NURSING MANAGEMENT Cont..
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.

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 Patient Education

• 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.

• Educate patient on the use of mosquito nets and

insecticides.

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