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DLNGUL nLMCkknAGIC ILVLk (nIever)

C8ILC1IVLS

A Genera| Cb[ect|ves
O 1o glve healLh Leachlngs abouL Lhe uengue Pemorrhaglc lever
O 1o glve Lhe dlfferenL lnformaLlon abouL Lhe dlfferenL meLhods of prevenLlon and
conLrol of uengue Pemorrhaglc lever

8 SLCIIIC C8ILC1IVLS

now|edge 1o know Lhe beneflLs of knowlng Lhe meLhods of prevenLlon and conLrol
of uengue Pemorrhaglc lever

Sk|||s

1o be able Lo plan how Lhey wlll golng Lo apply Lhe meLhods ln prevenLlon
and conLrol of uengue Pemorrhaglc lever
1o be able Lo Leach dlfferenL beneflLs of dolng Lhe prevenLlon and conLrol of
uengue Pemorrhaglc lever
1o glve healLh Leachlng

Att|tude 1o be cooperaLlve and acLlve ln Lhe healLh Leachlng abouL uengue
Pemorrhaglc lever


IN1kCDUC1ICN

hlllpplne Pemorrhaglc fever was 1
sL
reporLed ln 1933 ln 1938 hemorrhaglc fever became a
noLlflable dlsease ln Lhe counLry and was laLer reclasslfled as uengue Pemorrhaglc lever

1he morbldlLy raLe of dengue fever ln 2003 ls much lower aL 13 cases per 100000 populaLlon
compared Lo Lhe hlghesL ever recorded raLe of 609 per 100000 ln 1998 1he case faLallLy raLlo
for dengue fever and dengue hemorrhaglc fever ln 2003 ls also lower aL 08 compared Lo Lhe
hlghesL record raLlo of 26 percenL ln 1998 Whlle Lhere were 12 ouLbreaks a year durlng Lhe
perlod of 19992004 1he sudden lncreases ln Lhe lncldence of dengue ln 1993 1998 and 2001
were expecLed because of Lhe cycllcal naLure of Lhe dlsease 1he reason dengue remalns a
LhreaL Lo Lhe publlc healLh desplLe low lncldences reporLed ln recenL years uengue cases
usually peaks ln Lhe monLhs of !uly Lo november and lowesL durlng Lhe monLh of lebruary Lo
Aprll




SIGNS AND SM1CMS

An acuLe febrlle lnfecLlon of sudden onseL wlLh cllnlcal manlfesLaLlon of 3 sLages

O llrsL 4 dayslebrlle or lnvaslve sLage sLarLs abrupLly as hlgh fever abdomlnal paln and
headache laLer flushlng whlch may be accompanled by vomlLlng con[uncLlval lnfecLlon
and eplsLaxls
O 4
Lh
Lo 7
Lh
days Loxlc or hemorrhaglc sLage lowerlng of LemperaLure severe abdomlnal
paln vomlLlng and frequenL bleedlng from gasLrolnLesLlnal LracL ln Lhe form of
hemaLemesls or melena unsLable 8 narrow pulse pressure and shock ueaLh may
occur 1ournlqueL LesL whlch may be poslLlve on 3
rd
day may become negaLlve due Lo
low or vasomoLor collapse
O 7
Lh
Lo 10
Lh
day convalescenL or recovery sLage generallzed flushlng wlLh lnLervenLlng
areas of blanchlng appeLlLe and blood pressure already sLable

CLASSIIICA1ICN

O evere frank Lype wlLh flushlng sudden hlgh fever severe hemorrhage followed by
sudden drop of LemperaLure shock and LermlnaLlng ln recovery or deaLh
O ,oderaLe wlLh hlgh fever buL less hemorrhage no shock
O ,lld wlLh sllghL fever wlLh or wlLhouL peLechlal hemorrhage buL epldemlologlcally
relaLed Lo Lyplcal cases usually dlscovered ln Lhe course of lnvesLlgaLlon of Lyplcal cases

L1ICLCGIC AGLN1

uengue vlrus 1ypes 1 2 3 4 and Chlkungunya vlrus

SCUkCL CI INILC1ICN

O lmmedlaLe source ls a vecLor mosqulLo Lhe Aedes AegypLl or Lhe common household
mosqulLo
O 1he lnfecLed person


MCDL CI 1kANSMISICN ,osqulLo 8lLe (Aedes AegypLl)

INCU8A1ICN LkICD uncerLaln robably 6 days Lo one week

LkICD CI CCMMUNICA8ILI1 unknown resumed Lo be on Lhe 1
sL
week of lllness when
vlrus ls sLlll presenL ln Lhe blood



SUSCL1I8ILI1 kLSIS1ANCL and CCCUkkLNCL

All persons are suscepLlble 8oLh sexes are equally affecLed Age groups predomlnanLly
affecLed are Lhe preschool age and Lhe school age AdulLs and lnfanLs are noL exempLed eak
age affecLed 39 years

Cccurrence ls sporadlc LhroughouL Lhe year Lpldemlc usually occur durlng Lhe ralny seasons
!une november eak monLhs are epLember and CcLober

Cccurs wherever vecLor mosqulLo exlsLs uscepLlblllLy ls unlversal Acqulred lmmunlLy may be
Lemporary buL usually permanenL

DIAGNCS1IC 1LS1

1ournlqueL 1esL (8umple Leads 1esL)
O lnflaLe Lhe blood pressure cuff on Lhe upper arm Lo a polnL mldway beLween Lhe sysLollc
and dlasLollc pressure for 3 mlnuLes
O 8elease cuff and make an lmaglnary 23 cm square or 1 lnch square [usL below Lhe cuff
aL Lhe anLecublLal fossa
O CounL Lhe number of peLechlae lnslde Lhe box
O A LesL ls (+) when 20 or more peLechlae per 23 cm square or 1 lnch square are
observed

MANAGLMLN1

upporLlve and sympLomaLlc LreaLmenL should be provlded
O lor fever glve paraceLamol for muscle palns lor headache glve analgeslc uCn'1 glve
Al8ln
O 8apld replacemenL of body flulds ls Lhe mosL lmporLanL LreaLmenL
O lncludes lnLenslve monlLorlng and followup
O lve C8LCL Lo replace fluld as ln moderaLe dehydraLlon aL 73 ml/kg ln 46 hours or up
Lo 23L ln adulLs ConLlnue C8 lnLake unLll paLlenL's condlLlon lmproves

ML1nCDS CI kLVLN1ICN AND CCN1kCL

1he lnfecLed lndlvldual conLacLs and envlronmenL
O 8ecognlLlon of Lhe dlsease
O lsolaLlon of paLlenL (screenlng or sleeplng under Lhe mosqulLo neL)
O Lpldemlologlc lnvesLlgaLlon
O Case flndlng and reporLlng
O PealLh educaLlon


CCN1kCL MLASUkLS
1 LllmlnaLe vecLor by
a Changlng waLer and scrubblng of lower vases once a week
b uesLroy breedlng places of mosqulLo by cleanlng raln guLLers and surroundlngs
c roper dlsposal of rubber Llres empLy boLLles and cans
d keep waLer conLalners clean and covered
2 Avold Loo many hanglng cloLhes lnslde Lhe house
3 8esldual spraylng wlLh lnsecLlcldes

U8LIC nLAL1n NUkSING kLSCNSI8ILI1ILS

lnce Lhere ls no known lmmunlzaLlon agenL agalnsL Pfever nurslng efforLs should be dlrecLed
Lowards Lhe lmmedlaLe conLrol of lLs cause by knowlng Lhe naLure of Lhe dlsease and lLs
causaLlon 1he followlng are lmporLanL
O 8eporL lmmedlaLely Lo Lhe ,unlclpal PealLh Cfflce any known case ouLbreak
O 8efer lmmedlaLely Lo Lhe nearesL hosplLal cases LhaL exhlblL sympLoms of hemorrhage
from any parL of Lhe body no maLLer how sllghL
O ConducL a sLrong healLh educaLlon program dlrecLed Lowards envlronmenLal sanlLaLlon
parLlcularly desLrucLlon of all known breedlng places of mosqulLoes
O AsslsL ln Lhe dlagnosls of suspecL based on Lhe slgns and sympLoms lor Lhose wlLhouL
slgns of hemorrhage Lhe nurse may do Lhe LournlqueL LesL" (apply LournlqueL as ln
preparlng for an lv" leL lL sLay for 3 mlnuLes 8elease resence of peLechlal
hemorrhage on skln lnldlcaLes clrculaLory dlsLurbances)
O ConducL epldemlologlc lnvesLlgaLlons as a means of conLacLlng famllles case flndlng and
lndlvldual as well as communlLy healLh educaLlon

NUkSING CAkL

Any dlsease or condlLlon assoclaLed wlLh hemorrhage ls enough cause for alarm lmmedlaLe
conLrol of hemorrhage and close observaLlon of paLlenL for vlLal slgns leadlng Lo shock are Lhe
nurse's prlmary concern nurslng measures are dlrecLed Lowards Lhe sympLoms as Lhey occur
buL lmmedlaLe medlcal aLLenLlon musL be soughL
1 lor hemorrhage keep Lhe paLlenL aL resL durlng bleedlng eplsodes lor nose bleedlng
malnLaln an elevaLed poslLlon of Lrunk and promoLe vasoconsLrlcLlon ln nasal mucosa
membrane Lhrough an lce bag over Lhe forehead lor melena lce bag over Lhe
abdomen Avold unnecessary movemenL lf Lransfuslon ls glven supporL Lhe paLlenL
durlng Lherapy Cbserve slgns of deLerloraLlon (shock) such as low pulse cold clammy
persplraLlon proaLraLlon





2 lor shock prevenLlon ls Lhe besL LreaLmenL uorsal recumbenL poslLlon faclllLaLes
clrculaLlon
O AdequaLe preparaLlon of Lhe paLlenL menLally and physlcally prevenLs
occurrence of shock
O rovlslon of warmLh Lhrough llghLwelghL covers (overheaLlng causes vasodllaLlon
whlch aggravaLes bleedlng)
3 uleL low faL low flber nonlrrlLaLlng noncarbonaLed noodle soup may be glven