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PAPERS ABOUT

NURSERY CARE DENGUE HEAMORRHAGIC FEVER (DHF)

BY GROUP 07:

DEWITA MAHARANI

RESMA MASDA SYAHRI

STIKES FORT DE KOCK BUKITTINNGGI

2018
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Foreword

Praise and thankfulness we always offer to the presence of Allah SWT Because It is for
blessings and His will that we can compile and complete this paper. In completing this paper,
we faced many Difficulties. But thanks to group collaboration, this English paper on "
Nursery Care Dengue Heamorrhagic Fever" can be completed on time.
We Realize, as a student Whose knowledge is insufficient and still needs a lot of
learning in writing papers, this paper still has many shortcomings and is far from perfect.
Therefore, we really hope for positive criticism and suggestions so that this paper will be
better and useful in the future. We hope that this paper can be useful simple and useful for
readers in the future.

Bukittinggi, 24 Februari2019

Author
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TABLE OF CONTENTS

Cover page
Preface ............................................................................................................................. 2
Table of contents ............................................................................................................. 3

CHAPTER I INTRODUCTION
A. Background ................................................................................................................ 4
B. Problem formulation .................................................................................................. 4
C. Purpose of writing ...................................................................................................... 4
D. Benefits of Writing .....................................................................................................5

CHAPTER II DISCUSSION

A. Definition of Dengue Heamorrhagic Fever (DHF)................................................... 6


B. Etiology of Dengue Heamorrhagic Fever (DHF)...................................................... 9
C. Pathophysiology of Dengue Heamorrhagic Fever (DHF)......................................... 11
D. Signs and Symptoms of Dengue Heamorrhagic Fever (DHF).................................. 14
E. Complications of Dengue Heamorrhagic Fever (DHF)............................................16
F. Medical Management and Nursing Healing Dengue Heamorrhagic Fever (DHF)...19
G. Nursing Care ( DHF )................................................................................................21

CHAPTER III CLOSING


A. Conclusion ................................................................................................................ 22
B. Recommendation ...................................................................................................... 22

REFERENCES .............................................................................................................. 21
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CHAPTER I
INTRODUCTION
A. Background
Dengue spread by the virus is spread by the Aedes mosquito (Stegomyia).
Over the past two decades, the frequency of cases and epidemics of dengue fever
(dengue fever, DF), dengue fever (dengue hemorragic fever, DHF), and dengue shock
syndrome (dengue shock syndrome, DSS) have shown dramatic improvements
throughout the world.The World Health Report 1996,states that "the reappearance of
infectious diseases is a warning that the progress made so far on world security in
terms of health and prosperity is futile". The report further states that "these infectious
diseases range from diseases that occur in the tropics (such as malaria and DHF that
often occur in developing countries) to diseases found throughout the world (such as
hepatitis and sexually transmitted diseases [STDs], including HIV / AIDS) and food-
borne diseases that affect large numbers of the world's population both in poor and
rich countries.In May 1993, the 46th World Health Meeting submitted a resolution on
dengue control and prevention which emphasized that strengthening DF and DHF
prevention and control at both local and national levels should be one of the priorities
of WHO Member States where the disease is endemic. The resolution also calls for:
(1) strategies developed to address the spread and increase of dengue incidents must
be carried out by relevant countries, (2) increase public health education, (3) promote
health promotion, (4) strengthen research, (5) expand dengue surveillance, (6) guide
delivery in terms of vector control, and (7) mobilization of external resources for
disease prevention must be a priority.
To respond to WHA's resolution in the prevention and control of dengue, a
global strategy for the operation of vector control activities was developed based on
key components such as selective, integrated mosquito control measures with
community participation and cooperation between sectors, emergency preparation,
etc. One of the main pillars in the global strategy is an increase in active surveillance
and is based on accurate laboratory examinations of DF / DHF and its vectors. In
order to run smoothly, every endemic country must enter DHF disease into one type
of disease that must be reported.
This disease is commonly found in tropical areas such as Southeast Asia, India,
Brazil, America, including in all corners of Indonesia, except in places of altitude
more than 1000 meters above sea level. Doctors and other health workers, such as
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midwives and medical staff Often wrong in the diagnosis, because of the tendency of
early symptoms that resemble other diseases such as flu and typhoid (typhoid).

B. Formulation of the problem


1. What is meant by DHF?
2. What is the classification of DHF disease?
3. What is the etiology of DHF?
4. What is the pathophysiology of DHF?
5. What are the clinical manifestations of DHF?
6. What are the complications of DHF disease?
7. What is the implementation of DHF disease?
8. How to prevent DHF disease?
C. Aim
1. Students are able to explain the meaning of DHF
2. Students are able to mention the etiology of DHF
3. Students are able to explain the clinical manifestations of DHF
4. Students are able to explain the pathophysiology of DHF disease
5. Students are able to explain how to prevent DHF
6.
D. Benefit
Can add knowledge Knowing DHF nursing care As a reference for nursing students
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CHAPTER II
DISCUSSION

A. Definition of Dengue Heamorrhagic Fever (DHF)


Dengue infection is an acute fever disease caused by dengue virus (flavivirus group
belonging to family Togaviridae), transmitted by Aedes aegypti mosquitoes and other
Stegomya species such as A. albopictus, polynesiensis, scutellaris.
DBD disease is not transmitted directly from person to person. The patient becomes
infective for mosquitoes at the time of uremia, which is sometime before the onset of
the fever until the fever ends. Aedes Aegypti's nose becomes infective 8 -12 days after
sucking the blood of the previous DBD. During this period Aedes mosquitoes who
have been infected with this dengue virus will remain infective throughout their life
and potentially transmit dengue virus to other vulnerable human beings.
In accordance with the aforementioned criteria, WHO (1975) divides the degree of
DHF disease into four degrees, as follows.
1. Degree I : Fever with non-specific symptoms and the only manifestation of
bleeding is positive tourniquet test.
2. Degree II: degree one with spontaneous bleeding in the skin or other bleeding.
3. Degree III: The finding of a circulatory failure, ie rapid and soft pulse, decreased
pulse pressure (less than equal to 20 mmHg) or hypotension accompanied by cold,
moist, and restless skin.
4. Degree VI: severe shock with unmanageable pulses and unmodified blood
pressure.
5. Definition of Dengue Heamorrhagic Fever (DHF)
B. Etiology of Dengue Heamorrhagic Fever (DHF)
There are at least four different types of dengue virus (type 1-4) that have been
isolated from dengue fever. Four types of dengue virus (serotype) in Indonesia,
namely DEN-1, DEN-2, DEN-3, and DEN- 4. It turns out that DEN-2 and DEN-3 are
the most common serotype as a cause. Nimmannitya (1975) in Thailand reported that
the dominant DEN-2 serotype. Being in Indonesia especially by DEN-3, though lately
there is a trend of domination by the DEN-2 virus.
In addition, the sequence of serotype infections is a risk factor because more than
20% of the sequence of DEN-1 virus infection followed by DEN-2 causes shock,
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while the risk factor of shock in DEN-3 virus affairs followed by DEN-2 is 6% DEN-
4 followed by DEN-2 is 2%.

C. Pathophysiology of Dengue Heamorrhagic Fever (DHF)


There are two pathophysiological changes that occur in DBD:
a. Increased blood vessel permeability resulted in plasma leakage, hypovolemia, and
shock. DHF has a unique feature due to its special plasma leakage towards the
pleural and peritoneal cavity. In addition, the leakage period is quite short (24 - 48
hours).
b. Abnormal haemostasis occurs due to vasculopathy, thrombocytopenia, resulting in
various types of bleeding manifestations.

D. Signs and Symptoms of Dengue Heamorrhagic Fever (DHF)


The WHO clinical trials (1975) to diagnose the DHF are set out below.
a. High fever with sudden and continuous for 2-7 days.
b. Manifestation of bleeding, including at least positive toureniquet test and one other
form (petekia, purpura, ecomosis, epistaxis, gum bleeding), hematemesis and or
melena.
c. Enlargement of the liver.
d. Renal stress characterized by weak pulse, rapidly accompanied by decreased pulse
pressure (to 20 mmHg or less), decreased blood pressure (systolic pressure
decreased to 80 mmHg or less) with a cold and dull skin especially at the tip of the
nose, toe and toe , the patient becomes anxious, cyanosis arises around the mouth.
1. The first phase
Relatively mild with fever began to suddenly, malaise, vomiting, headache,
anorexia, and cough accompanied by 2-5 days by rapid clinical deterioration
and kollaps.
2. The second phase
Patients usually suffer from cold extremities, dampness, hot body, red face,
sweaty, restless, irritant, and mid-epigastric pain. Often there are petekies
scattered on the forehead and limbs, spontaneous ecosystems may seem, and
it's easy to bruise and bleed on where the venous function is normal. Macular
or maculopapular retin may appear, and there may be cyanosis around the
mouth and peripheral. Breathing is often fast and heavy. fast, small, and subtle
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heart sounds. Pulse pressure is often narrow (20 mmHg or less), blood
pressure can be low and difficult to obtain. The liver may be 4-6 cm below the
edge of the cavity and usually hard and painful. Less than 10% sufferers
suffering from eczotic or bleeding of the obvious gastrointestinal tract, usually
post-shock uncoupled.After 24-36 hours of critical period, convalesen is fast
enough for a healed child. Temperature can be back to normal before or during
the shock phase. Barthikardi and extracurricular ventricles are common during
conventions. There is a brain injury injury caused by old shock or sometimes
because of intracranial bleeding. The three strains of dengue virus circulating
in the main Asian regions of 1983 are accompanied mainly by severe clinical
syndrome, characterized by encephalopathy, hypoglycemia, prominent and
sometimes jaundiced liver enzymes. In contrast to the very distinctive pattern
of very severe children, secondary dengue infection is relatively mild in most
cases, ranging from unclear infections to undeferrating upper respiratory
diseases. Laboratory Data : The most frequent hematologic disorder during
clinical shock is the increase in hematocrit 20% or greater beyond the
hematocrit hematocrit, thrombocytopenia, mild leukocytosis (rarely exceeding
10,000 / mm3) elongated haemorrhage time, and moderate decreased
protrombin levels (rarely less than 40% control). The rates of fibrinogen may
be subnormal and fibrinogen fracture products rise. Other disorders are the
moderate increase in serum transaminase levels, complementary consumption,
mild metabolic acidosis with hyponatremia, and sometimes hypochloremia, a
slight increase in serum nitrogen urea, and hypoalbuminemia. Chest
Roentgenogram shows pleural effusion in almost all patients.
E. Medical Management and Nursing Healing Dengue Heamorrhagic Fever
(DHF)
The rules of DBD should be based on the mild weight of the disease found among
others:
1. Dengue cases that are allowed to undergo treatment
Patients are allowed to treat the road if only complaining of heat, but the desire
to eat and drink is still good. To overcome the high heat it is desirable to give
paracetamol hot drug 10-15 mg / kg BW every 3-4 hours repeated if the heat
symptom is still above 38.50C. Therapeutic salicylic drugs are not
recommended because they have the risk of bleeding and acidosis. Most cases
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of DBD in this way of treatment are DBD cases that show the first day and
second day heat manifestations without indicating other complications. If the
person with DHF indicates the manifestation of hyperterms and conjunctivitis
should be recommended for inpatient treatment.
2. DBD case degrees I and II
On day 3, 4, and 5 hectares are recommended for hospitalization because this
patient has a risk of occurrence when shock. To anticipate the occurrence of
shock, the patient is advised to infiltrate the cryptoid fluid with a droplet on the
basis of 7, 5, 3. During the heat phase, the patient is recommended Many
people drink or drink water or commonly used to cope with diarrhea,
hematocrit that increases more than 20% of the normal price is indicator of
plasma leakage and should be treated in the observation room at the
rehydration center for a period of 12-24 hours.
3. Management of DBD (degrees III and IV)
"Dengue Shock Syndrome" (dengue rhythm syndrome) includes emergency
cases requiring rapid handling and need to get rapid replacement fluid. Typical
acids and electrolyte (hiponatremia) disorders are found in this case. In this
case it is important to consider the possibility of DIC. blood promotes the
occurrence of DIC which can cause severe bleeding and difficult to overcome.
Rapid replacation of the missing plasma isothermal salt solution (lactic ringer,
5% dextrose solution in lactate ringer or 5% dextrose in acetic ringer solution
and normal solution of salt fait) with a total of 10-20 ml / kg / 1 hour.In very
severe cases (degree IV) can be given bolus 10 ml / kg (1 or 2x). if the shock
continues with high hematocrit, colloidal solution (dextran with 40,000
molecular weight in normal solution of salt or plasma) can be given by 10-20
ml / kg / hour.
4. Anxiety drugs
In some cases tranquilizers are needed especially in very nervous cases. Toxic
drugs should be avoided, chloral oral or rectal hydration is recommended at
doses of 12.5-50 mm / kg (but not more than 1 hour) used as a hypnotic drug.
5. Oxygen therapy
6. Blood transfusion
7. Monitoring
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The vital signs and levels of hematocrit should be monitored and evaluated
regularly to assess the outcome of treatment.
8. Criteria for returning the patient
Patient may be returned if:
a. No fever for 24 hours without antipyretic.
b. Appetite improved.
c. Clinical improvement appears.
d. Hematocrine stable.
e. Three days after shock is solved.
f. Platelet counts 200.000-300.000 / mm3
g. No respiratory distress.
h. Emergency room for dengue Haemorragic Fever (DHF)

F. Prevention of Dengue Heamorrhagic Fever (DHF)

The precise principle in the prevention of DHF (Dit.Jen.P3M., Dep. Case R.I., 1976)
is as follows.
a. Utilize the change of mosquito state as a result of natural influences by
implementing vector eradication when there is a small DHF / DSS case.
b. Decide the transmission circle by holding the vector density at very low levels to
give the patient the opportunity to heal spontaneously.
c. Introduce vector eradication at the center of the deployment area, ie schools and
hospitals, including the surrounding buffer areas.
d. Attempt vector eradication in all potential high-risk areas.
DBD Prevention includes:
1. Eradication of adult mosquitoes
Attempt to clean the places that mosquitoes prefer (eg hang clothes), install
mosquito nets on ventilation and house windows, spraying with chemicals,
fogging fumes, penetrating the life cycle by using fishfish in the water
reservoir.
2. Eradicate mosquito larvae
By doing 3M (draining, closing, and burying) means the tubing curves once a
week, closing the water storages together, the used cannabis cisterns in the
pool or hard-water storage areas can be transmitted by Abate powder.
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Guidelines for the use of Abate powder (abatization): 1 tablespoon perch (10
g) for 100 liters of water. Walls should not be brushed after sprinkling abate à
abate powder will stick to the wall of the tub or crockery. The abate powder
remains effective for up to 3 months.
3. Counseling for the community
Because DBDs have no drugs that can kill dengue virus or DBD vaccine, the
efforts to prevent dengue are very important. Fighting of mosquito nest (PSN)
is very important for the prevention of DBD. PSN movements should be done
jointly by all levels of society at home , in schools, in hospitals, and public
places such as places of worship, tombs. Thus society can change the behavior
of healthy living, especially improving environmental hygiene.
G. Complications of Dengue Heamorrhagic Fever (DHF)
1. Encephalitis such as seizures and coma may appear so complications in the case of
a long enough shock accompanied by severe bleeding.
2. Water toxicity, a relatively common introgenic complication that can cause an
orthopathy.
3. Unusual manifestations that are rarely seen in DF / DHF infections include acute
renal failure and hemolytic urinary syndrome.
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NURSING CARE IN PATIENTS


WITH DENGUE HEAMORRHAGIC FEVER

A. Assessment
Entry date: June 10, 2001 Entrance: 09.00 WIB
Space: Transmitted Children No. Reg. Med: 1005905
Assessment: June 11 2001; 09.00 WIB
Client Name: An. Y Parent's Name: Mr. YE
Birth Date: July 9, 1995 Age: 28 years old
Gender: male Gender: Male
Tribe / nation: Java / Indonesia Tribe / Nation: Java / Indonesia
Religion: Islam Religion: Islam
Education: Kindergarten education: High school
Job: - Job: Employee
Address: Gubeng Jaya Sby

1. Patient Identity
Name, age (in DHF most often affects children less than 15 years of age), gender,
address, education, parents' names, parents' education, and parents' work.
2. Main complaints
Reasons / prominent complaints in DHF patients to come to the hospital are high
heat and weak children.
3. History of Current Disease
Obtained sudden hot complaints accompanied by shivering and when the fever is
aware of mentis compost. The decline in heat occurs between the 3rd and 7th day,
and the child becomes weaker. Sometimes accompanied by complaints of coughs,
colds, swallowing pain, nausea , anorexia vomiting, diarrhea / constipation,
headache, muscle and joint pain, heartburn and sore eyeball movements, and the
presence of bleeding manifestations on the skin, gums (grade III, IV), melena or
hematemesis.
4. History of Disease that Has Been Suffered Any
illness that has been suffered. In DHF, children can experience repeated attacks of
DHF with other types of viruses.
5. Immunization History
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If the child has good immunity, then the possibility of complications can be
avoided.
6. Nutritional History The nutritional
status of children who suffer from DHF can vary. All children with good or bad
nutritional status can be at risk, if there are predatory factors. Children who suffer
from DHF often experience complaints of nausea, vomiting, and decreased
appetite. If this condition continues and is not accompanied by fulfilling adequate
nutrition, the child can experience weight loss so that his nutritional status
becomes less.
7. Environmental Conditions
Often occur in densely populated areas and less clean environments (such as
stagnant water and clothes hangers in rooms).
8. Habit Patterns
a. Nutrition and metabolism: frequency, type, abstinence, reduced appetite, and
decreased appetite.
b. Elimination of alvi (defecation). Sometimes children experience diarrhea /
constipation. While DHF in grade III-IV can occur melena.
c. Elimination of Urine (urination): it is necessary to study whether it is
frequent, little or no, sick / not. In grade IV DHF hematuria often occurs.
d. Sleep and Rest. Children often experience lack of sleep because they
experience pain / pain in muscles and joints so that the quantity and quality
of sleep and rest are lacking.
e. Cleanliness. Family efforts to maintain personal hygiene and the environment
tend to be less focused on cleaning the aedes aegypti mosquito breeding
grounds.
f. Behavior and response if there is a sick family and efforts to maintain health.
9. Physical Examination Physical
examination includes inspection, palpation, auscultation, and percussion from tip of
hair to toe. Based on the level of DHF, the child's physical condition is as follows:
a. Grade I: awareness of compost mentis, general weakness, vital signs and
weakness.
b. Grade II: awareness of compost mentis, general condition is weak, there is
spontaneous bleeding petechiae, bleeding gums and ears, and pulse weak,
small, and irregular.
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c. Grade III: awareness of apathy, somnolence, general condition is weak, pulse


is weak, small, and irregular, and blood pressure decreases.
d. Grade IV: coma awareness, vital signs: the pulse is not palpable, tension is
not measurable, irregular breathing, cold extremities, sweating, and the skin
looks blue.
10. Integumen System
a. The presence of petechiae on the skin, skin turgor decreases, and cold sweat
appears and is moist.
b. Cyanosis nails / no.
c. Head and neck. The head feels painful, the face looks reddish because of
fever (flusy), the eyes are anemic, the nose sometimes experiences bleeding
(epistaxis) in grade II, III, IV. In the mouth it is found that the dry mouth
mucosa, gum gums occur, and painful pain. While the throat has pharyngeal
hyperemia and ear bleeding occurs (in grade II, III, IV).
d. Chest. The shape is symmetrical and sometimes feels tight. In the chest X-ray
there is fluid that is buried in the right lung (pleural effusion), rales (+),
ronchi (+) which are usually found in grades III and IV.
e. Abdomen. Having tenderness, enlarged liver (hepatomegaly), and ascites.
f. Extremity. Akral cold, and there is pain in muscles, joints and bones.
11. Laboratory Examination
On blood tests a DHF patient will be found:
a. Hb and PCV increase (more than equal to 20%).
b. Trobositopenia is less than 100,000 / ml).
c. Leukopenia (may be normal or leukocytosis).
d. Ig. Dengue positive.
e. Blood chemistry examination results showed: hypoproteinemia,
hypochloremia, and hyponatremia.
f. Urium and blood pH may increase.
g. Metabolic acidosis: pCO2 <35-40 mmHg and HCO3 are low.
h. SGOT / SGPT may increase.

B. Problems / Diagnosis
1. Medical diagnosis: suspected (suspect) DHF.
2. The nursing diagnoses that are often found in DHF patients:
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a. Increased body temperature (hyperthermia) is associated with dengue virus


infection.
b. Deficit of body fluid volume is related to imbalance of input and output fluids.
c. Nutrition is less than needed related to nausea, vomiting, anorexia.
d. The high risk of hypovolemic shock is associated with severe bleeding, decreased
osmotic pressure.
e. Activity intolerance is related to physical weakness.
f. The risk of further bleeding is related to thrombocytopenia.
g. Anxiety of parents or families is related to lack of knowledge, and lack of
information. (source: DHF patient care, Christiantie efendy).

C. Planning
To overcome the problem, the planning needed is:
a. Increased body temperature (hyperthermia) is associated with dengue virus
infection.
Nursing goals:
Increased body temperature can be overcome, with criteria:
- Normal body temperature (35 ° C - 37.5 ° C).
- The patient is free from fever.
Intervention plan:
INTERVENTION RATIONAL
1. Assess for the onset of fever. 1. To identify the patient's fever
pattern.
2. Observation of vital signs
every 3 hours. 2. Vital signs are a reference for
knowing the general condition
3. Give a warm compress to the
forehead. of the patient.
3. Warm compresses can restore
4. Give plenty to drink (± 1-1.5
liters / day) a little but often. normal temperatures to
facilitate circulation.
5. Change client's clothes with
thin material to absorb sweat. 4. Reduce heat by convection
(heat is wasted with urine and
6. Give an explanation to the
client's family about the sweat while replacing body
cause of increasing body
fluids due to evaporation).
temperature.
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5. Thin clothing absorbs sweat and


7. Collaboration in providing
helps reduce body evaporation
anti-pyretic drugs.
due to increased temperature
and conduction can occur.
6. Explanations given to the
client's family can be
understood and cooperative in
providing nursing action.
7. Can reduce fever.

b. The fluid and electrolyte volume deficit associated with (fluid volume deficit) of
the body is related to the imbalance of input and output fluids.
Purpose of intervention:
Volume of body fluids balanced, with criteria:
- Good skin turgor
- Vital signs within normal limits
Intervention plan:
INTERVENTION RATIONAL
1. Assess the client's general state 1. Know quickly the deviation
and vital signs. from the normal state.
2. Assess fluid input and output. 2. Knowing the balance of fluids
3. Observation of signs of shock. and electrolytes in the body or
4. Encourage clients to drink a lot. homeostasis.
5. Collaboration with doctors in 3. In order to take immediate
administering IV fluids action in the event of shock.
4. Fluid intake is needed to
increase body fluid volume.
5. Giving IV fluids is very
important for clients who
experience a fluid volume
deficit to meet the client's fluid
needs.
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c. Nutrition is less than needed related to nausea, vomiting, and anorexia.


The purpose of the intervention:
Client's nutritional needs are met, with criteria:
- The portion of food served is spent.
Intervention plan:
INTERVENTION RATIONAL
1. Assess client's general situation. 1. Makes it easy for further
2. Give food according to the client's intervention.
body needs. 2. Stimulating the client's appetite so
3. Encourage client parents to feed a the client wants to eat.
little but often. 3. Foods in small portions but often
4. Encourage client parents to provide facilitate the digestive organs in
TKTP food in soft form. metabolism.
5. Weigh the client's weight every 4. Foods with TKTP composition
day. function to help speed up the
6. Collaboration on giving reborantia healing process.
drugs. 5. Weight is one indicator of
successful nutrition.
6. Increase appetite.

d. The high risk of hypovolemic shock is associated with severe bleeding, decreased
osmotic pressure.
Objective:
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There is no hypovolemic shock, with criteria:


- General condition improves.
- Vital signs within normal limits.
Plan for intervention:
INTERVENTION RATIONAL
1. Monitor the client's general 1. Monitor the condition of the client
condition during the treatment period,
2. Observe vital signs. especially when there is bleeding so
3. Monitor signs of bleeding that a sign of prereok, shock can be
4. Advise the patient or family to handled.
immediately report if there are 2. Vital signs within normal limits
signs of bleeding indicate the client's general condition
5. Check hemoglobin, hematocrit, and is good.
platelets 3. Rapid bleeding is known to be
resolved so that the client does not
arrive at the stage of hypovolemic
shock due to severe bleeding.
4. Family involvement to immediately
report if there is bleeding in the
patient is very helpful for the care
team to immediately take the right
action.
5. To determine the level of leakage of
blood vessels experienced by the
client and for reference to follow up
on bleeding.

e. Activity intolerance is related to physical weakness.


Objective:
Clients are able to carry out daily activities, with criteria:
- Daily activities are fulfilled.
- The client is able to be independent after having a fever.
Intervention plan:
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INTERVENTION RATIONAL
1. Assess things that the client can 1. Knowing the level of client
do. dependence in meeting their needs.
2. Help clients meet their activity 2. Assistance is needed by the client
needs according to the level of when his condition is weak in
client limitations. fulfilling daily needs without
3. Give an explanation of things that experiencing dependence on others.
can help and improve the physical 3. With explanation, patients are
strength of the client. motivated to cooperate during
4. Involve the family in fulfilling treatment, especially for actions that
the client's ADL. can increase their physical strength.
5. Explain to family and clients 4. The family is the person closest to
about the importance of the the client.
bedrest in bed. 5. To prevent the occurrence of more
severe conditions.

f. The risk of further bleeding is related to thrombocytopenia.


Objective:
There is no intra-abdominal bleeding, with criteria:
- No signs of bleeding occur.
- The number of platelets increases.
Intervention plan:
INTERVENTION RATIONAL
1. Monitor signs of platelet reduction 1. Decrease in platelet counts is a sign of
accompanied by clinical signs. leakage of blood vessels that can cause
2. Give an explanation of the effect of clinical signs in the form of real
thrombocytopenia on the family bleeding, such as epistaxis, petechiae.
3. Monitor platelet count every day. 2. So that patients or families know
4. Encourage clients to take a break. things that might happen to patients
5. Give an explanation to the patient or and can help anticipate the occurrence
family to immediately report if there of bleeding due to thrombocytopenia.
are further signs of bleeding such as: 3. With the number of platelets
hematemesis, melena, epistaxis. monitored every day can be seen the
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level of leakage of blood vessels and


the possibility of bleeding experienced
by the client.
4. Uncontrolled client activity can cause
bleeding.
5. Family involvement immediately
reporting the occurrence of bleeding
will help patients get treatment as
early as possible.

g. Family anxiety is related to lack of knowledge and lack of information.


Objective:
Family anxiety is overcome, with criteria:
- Parents do not ask questions about their child's illness.
- Cheerful facial expressions.
Intervention plan:
INTERVENTION RATIONAL
1. Assess parents' anxiety level. 1. Knowing parents' anxiety and
2. Explain the treatment procedure for making it easier to determine the
her child care. next intervention.
3. Give an opportunity for parents to 2. To increase knowledge and
ask about their child's condition. information to clients that can reduce
4. Give an explanation of each parental anxiety.
procedure or action that will be 3. To get more information and
performed on the patient and its increase knowledge and reduce
benefits to the patient. stress.
5. Give spiritual encouragement. 4. Provide an explanation of the disease
process, explain about the possibility
of intensive care if it is really needed
by patients to get more optimal care.
5. Giving peace to the client by
surrendering to God Almighty.
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CHAPTER III
COVER

A. Conclusion
There are many ways to reduce the incidence of DHF. Because the vector of DHF is
Aedes a mosquito, then there are some things that should be done to break the chain
of diseases:
1. Without insecticide:
a) Drain bath tubs, jars, drums, etc. at least once a week.
b) Close the reservoir of water tightly.
c) Clean the yard from used cans, used bottles that allow mosquitoes to nest.
2. With insecticide:
a) Malathion to kill adult mosquitoes: usually by fogging.
b) Abate to kill mosquito larvae by way of sowing on vessels holding clean water
with a dose of 1 gram of Abate SG 1% per 10 liters of water.

B. Suggestion
The author hopes that the preparation of papers on Askep in children / infants with
DHF can provide knowledge and knowledge in the fields of education and nursing
practice. And also with this paper can be a reference for the actions of the nursing
process.
22

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