Discharge Planning

Diet:
> Encourage nutritious foods like vegetables, meat and fruits.
> Instruct the family members to give the client protein rich foods such as meat, fish, eggs and
nuts, vitamin K rich foods such as green leafy vegetables, vit C rich foods(guava and tomatoes
and other citrus fruits), carbohydrates rich food (breads and rice)
Medications:
> Give acetaminophen in case the temperatures increases.
> Give oresol to replace fluid in the body.
>Remind to take the prescribed medicine, having a written reminder of the correct medication,
time to take, and the right frequency of the medicine on the way home to establish assurance of
medication compliance.
>Dont give aspirin and NSAIDs, they increase the risk of bleeding. Any medicines that
decrease platelet count should be avoided.
Exercise :
>Instruct to avoid excessive activities that may result to stress.
>Just advised to perform range of motions and repetitive body movements for promotion of
optimum
Treatment:
Currently, no medications are available to treat dengue hemorrhagic fever.

> Increased oral fluid intake.

>Admission to an intensive care unit
>Intravenous fluids and electrolytes

>Oxygen therapy
> Transfusions of blood and platelets as needed
> Bed rest
Out-Patient Follow-Up Care :
>Instruct the family members to have a check-up or to consult physician once a while to monitor
patients condition and for detection of recurrences and other complications that may arise on to
it.
Health Teaching: ( for prenvention)
> D- discuss the possible source of infection of the disease.
> E- educate the family/patient on how to eliminate those vectors.
> N- Never stocked water in a container without cover.
> G- Gallon, container and tires must have proper way of disposal.
> U- Use insecticides at home to kill or reduce mosquito.

> E- Encourage the family of the patient to clean the surroundings to destroy the breeding places
of mosquito.

When outdoors in an area where dengue fever has been found

Use a mosquito repellant containing DEET, picaridin, or oil of lemon eucalyptus

Dress in protective clothing-long-sleeved shirts, long pants, socks, and shoes

Keeping unscreened windows and doors closed

Getting rid of areas where mosquitoes breed, such as standing water in

flower pots, containers, birdbaths, discarded tires, etc.

Recommendation
Strict compliance to the medical treatment, health teachings and medical check-up is advised.
With proper nutrition and conformity to the medications & therapy, recovery would be easier and
faster.
. To help with recovery, health care experts recommend

Getting plenty of bed rest

Drinking lots of fluids

Taking medicine to reduce fever

Currently, no medications are available to treat dengue hemorrhagic fever. The goal
of care is to provide comfort and support during the crisis phase of dengue
hemorrhagic fever.

One thing to remember also is that we should avoid giving the patients foods
or drinks like chocolate drinks, coffee, black chocolate and etc. because it
can confuse to us if the patient will vomit
(Platelets are cells in blood that help to stop bleeding. Haematocrit indicates the thickness of blood).

fresh fruits and vegetables to increase body`s vitality

Encourage patient to eat high protein and high calorie foods to enhance
faster recovery.
RbC carries oxygen..( decrease), there is a need for oxygen therapy
Vit. K- help platelets in forming clot

Platelet Count
101 x 10^g/dL
150-450 x 10^g/L
blood
Increased due to viral
infection
Due to presence of
bleeding
DISCHARGE TEACHING
Medication
Remind to take the prescribed medicine, having a written reminder of the correct medication,
time to
take, and the right frequency of the medicine on the way home to establish assurance of
medication
compliance.
Dont give aspirin and NSAIDs, they increase the risk of bleeding. Any medicines that decrease
platelet count should be avoided.
Exercise
Instruct to avoid excessive activities that may result to stress.
Just advised to perform range of motions and repetitive body movements for promotion of
optimum
health.
Remind about the need for health promotion activities such as reading, watching T.V, etc.

Treatment
Bed rest is advisable during the re-occurrence of fever phase.
Instruct to drink plenty of water or fluids that are available at home and eat nutritious diet.
Advised to look for re-occurrence of danger signs and symptoms and report immediately.
HygieneEncourage to continue the routinely hygienic care of the patient
Out-Patient Follow-Up Care
Instruct the family members to have a check-up or to consult physician once a while to monitor
patients condition and for detection of recurrences and other complications that may arise on to
it.
Diet
Instruct the family members to give the client protein rich foods such as meat, fish, eggs and
nuts, vitamin K rich foods such as green leafy vegetables, vit C rich foods(guava and tomatoes
and other citrus fruits), carbohydrates rich food (breads and rice)

Intake of appropriate vitamin supplement and diuretics to increase protection

mechanism of the immune system and decreases renal vascular resistance and may
increase renal blood flow, respectively.

Recommendation
Strict compliance to the medical treatment, health teachings and medical check-up is advised.
With proper nutrition and conformity to the medications & therapy, recovery would be easier and
faster.
. To help with recovery, health care experts recommend

Getting plenty of bed rest

Drinking lots of fluids

Taking medicine to reduce fever

When outdoors in an area where dengue fever has been found

Use a mosquito repellant containing DEET, picaridin, or oil of lemon eucalyptus

Dress in protective clothing-long-sleeved shirts, long pants, socks, and shoes

Keeping unscreened windows and doors closed

Getting rid of areas where mosquitoes breed, such as standing water in

flower pots, containers, birdbaths, discarded tires, etc.

Signs and symptoms depend on the Grade:

Grade I (+) fever lasting 3 5 days

Abdominal pain

Anorexia, nausea and vomiting

Pain behind the eyes

Joint pains

(+) eveidence of vascular changes

petechiae

Hermans sign general flushing of the skin

Grade II signs and symptoms of Grade I + Bleeding

Gum bleeding, epistaxis, hematemesis, melena, hematochezia

Grade III signs and symptoms of Grade II + Circulatory

failure

Hypotension, rapid but weak pulse

Grade IV signs and symptoms of Grade III + Shock

Nursing Intervention
1. Control Measure

Eradication of mosquitoes by eliminating breeding places

1. Any disease or condition with hemorrhage is enough to cause alarm. Immediate control
of hemorrhage enclose observation of the patient for the vital sign leading to shock
2. For hemorrhage
1.
1. keep patient at rest during bleeding episodes
2. observe for signs of deterioration
3. control bleeding
4. For Shock
a. prevention is the best treatment
b. restore blood volume
Symptoms of typical uncomplicated (classic) dengue usually start with fever within 5 to 6 days
after you have been bitten by an infected mosquito and include

High fever, up to 105 degrees Fahrenheit

Severe headache

Retro-orbital (behind the eye) pain

Severe joint and muscle pain

Nausea and vomiting

Rash

The rash may appear over most of your body 3 to 4 days after the fever begins. You may get a
second rash later in the disease. Symptoms of dengue hemorrhagic fever include all of the
symptoms of classic dengue plus

Marked damage to blood and lymph vessels

Bleeding from the nose, gums, or under the skin, causing purplish bruises

This form of dengue disease can cause death.

Symptoms of dengue shock syndrome-the most severe form of dengue disease-include all of the
symptoms of classic dengue and dengue hemorrhagic fever, plus

Fluids leaking outside of blood vessels

Massive bleeding

Shock (very low blood pressure)