Silliman University

Resource Unit on Dengue Hemorrhage Fever (Ward Class)

College of Nursing
Dumaguete City

https://medlineplus.gov/dengue.htm https://newsnetwork.mayoclinic.org/

Maye Angela G. Regala

Hector Jr. B. Palacio
Submitted to:
Asst. Prof. Veveca V. Bustamante
July 01, 2019
Time Allotment: 60 minutes
Topic Description: This topic discusses about Dengue Hemorrhagic Fever in relation to its causative agent, prevention and control, treatment and diagnosis to the health of the
individuals in the community. It also includes concepts which help in the health promotion, health maintenance and disease prevention of the individual, family and the community.
Central Objective: At the end of the 1-hour discussion, the learners shall gain adequate knowledge and positive attitudes toward the topic and will be able to:
1. Enumerate the several factors that make up DHF
2. Identify the causes and symptoms
3. Understand the topic as a whole

Specific Objectives Content TA T-L Strategy Evaluation Method

 Understand the meaning I. Brief history of Dengue

of Dengue Hemorrhagic Hemorrhagic Fever 1. Shows a video
Fever and its history presentation about the Oral Evaluation
 Definition of Dengue Hemorrhagic given topic (10 minutes)
Fever 10 minutes

 Dengue Hemorrhagic Fever 2. Present pictures or a

visual aid Interactive Game
- is an acute febrile disease caused by
infection with one of the serotypes of (5 minutes)
dengue virus. It is a mosquito-borne
disease caused by genus Aedes 3. Provide handout to each
- also known as Breakbone Fever, learners as their guide
Hemorrhagic Fever, Dandy Fever, and during the discussion
Infectious Thrombocytopenic Purpura

 Aedes Aegypti Mosquito 4. Allow learners to point

- is the main vector that out views and opinions
transmits the viruses that cause dengue

II. Pathophysiology

 Initial Phase
- occurs when the virus I deposited in the
skin 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 long
with the development of hemorrhagic
symptoms

 Vascular leakage
- In these patients results in hem
concentration and serous effusions and
can lead to circulatory collapse

 Progression
- If left untreated, DHF most likely
progresses to dengue shock syndrome

III.
1. Cause of DHF
 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-
bitting 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

2. Signs & Symptoms

 Sudden High Fever
 Severe headaches
 To provide an overview  Sever joint and muscle pains
on the topic  Nausea
 Vomiting
 Mild bleeding 10 minutes

3. Classification
 Severe, frank type
- With flushing, sudden high fever,
severe hemorrhage, followed by a
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
petechial hemorrhage but
epidemiologically related to typical
cases usually discovered in the course
of investigation of typical cases

4. Source of Infection
 Know the several factors
 Immediate source is a vector mosquito,
that influence the
the Aedes Aegypti or the common 10 minutes
existence of the disease
household mosquito
  The infected person

IV. Complications
 Dengue shock syndrome
- Common symptoms in impending
shock include abdominal pain,
vomiting and restlessness

V. Clinical Manifestations
 High fever
- Sudden high fever occurs as a result of
the infection

 Severe headache
- Severe headache also torments the
patient

 Damage to lymph and blood vessels

- As the virus slowly spreads, even the
lymph and blood vessels are affected

 Be aware of any clinical  Bleeding

manifestations that might - Bleeding from the nose and gums is a
acquire this disease characteristic of DHF 5 minutes

 Enlargement of the liver

- The dengue virus could also penetrate
the liver causing fatal damage

 Circulatory system failure

- The system ultimately fails eventually
if the disease is not treated promptly
 VI. Medical Management
 Oral rehydration therapy
- It is recommended for patients with
moderate dehydration caused by high
fever and vomiting

 IV fluids
- Is indicated for patients with
dehydration

 Blood transfusion and blood products

- Patients with internal or 5 minutes
gastrointestinal bleeding may require
transfusion, and patients with
coagulopathy may require fresh frozen
plasma

 Initial findings that need  Oral fluids 10 minutes

to be assessed - Increase in oral fluids is also helpful

 Avoid aspirins
Warn patients to avoid aspirins and other
NSAIDS as they increase the risk for
hemorrhage

VII. Assessment and Diagnostic

Findings
 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 pared serum
samples

 Immunohistochemistry
- Demonstration of the dengue virus
antigen in autopsy tissue via
immunochemistry 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
 Identify the different plasma extravasation and/or third-space 10 minutes
treatments available fluid loss

 Decreased platelet count

- This test confirms dengue

 Guaiac test
- This is for occult blood in the stools
should be performed on all patients
suspected with dengue virus infection
-
VIII. Nursing Responsibilities
 Tell patients to drink plenty of fluids
and get plenty of rest
 Tell patients to take antipyretics to
control their temperature. Children
with dengue are at risk for febrile
seizures during the febrile phase of
illness
 Warm patients to avoid aspirin and
other nonsteroidal, anti-inflammatory
medications because they increase the
risk of hemorrhage
 Monitor your patients’ hydration status
during the febrile phase of illness.
Educate patients and parents about the
signs of dehydration and have them
monitor their urine output
 If patients cannot tolerate fluids orally,
they may need IV fluids. Assess
hemodynamic status frequently by
checking the patient’s heart rate,
capillary refill, pulse pressure, blood
pressure and urine output.
 Perform hemodynamic assessments,
baseline hematocrit testing and platelet
counts
 Continue to monitor your patients
closely during defervescence. The
critical phase of dengue begins with
 defervescence and lasts 24-48 hours

IX. Prevention
 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 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
mosquitos

References:
Books
Reyala, J.P. et.al. (2000) Community Health Nursing Services in the Philippines
Online Sources
Belleza, M. (2016. December 07) Dengue Hemorrhagic Fever. Retrieved by
Laflamme, M.R. (2015. December 17) Dengue Hemorrhagic Fever. Retrieved by www.healthline.com