NURSING CARE PLAN FOR PATIENTS WITH DENGUE HEMORRHAGIC FEVER

ASSESSMENT AND DIAGNOSTIC FINDINGS

Laboratory criteria for the diagnosis of dengue virus may include 1 of the following:

 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 paired serum samples.
 Immunohistochemistry. Demonstration of the dengue virus antigen in autopsy tissue via
immunohistochemistry 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 the presence of increases hematocrit level secondary
to plasma extravasation and/or third-space fluid loss.
 Decreased platelet count. This test confirms dengue.
 Guaiac test. Guaiac testing for occult blood in the stool should be performed on all patients
suspected of dengue virus infection.

Medical Management

The management of DHF 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.

Nursing Management

Nursing management of patients with DHF is essential in achieving complete recovery.

Nursing Assessment

Assessment of a patient with DHF 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

Nursing Diagnosis

1. Risk For/Deficient fluid volume

 Risk for deficient fluid volume related to (indicate one or more of the following related factors: migration of
intravascular fluid into the extravascular spaces, bleeding, etc.) secondary to diagnosis of dengue fever as
evidenced by (note: risk nursing diagnosis usually does not require evidences, but the following may be
included if seen during the assessment::

 Higher recorded output than input.

 Hemorrhage
 Capillary refill time more than 3 seconds
 Alteration in vital signs (increased BP, heart rate, and respiratory rate)
2. Risk for bleeding
3. Nutritional imbalance: less than body requirements
 Imbalanced Nutrition: less than body requirements related to (indicate one or more of the following related
factors: inability to ingest an amount of nutrients the body needed; anorexia; nausea and vomiting, etc.)
secondary to diagnosis of dengue fever as evidenced by (symptoms may include but are not limited to the
following during assessment::

 Aversion to food
 Inability to take oral fluids/oral food
 Complaints of nausea and/or vomiting
 Weight loss
 Body malaise
4. Risk for hypovolemic shock
5. Risk for impaired tissue perfusion
6. Pain
7. Anxiety
8. Knowledge deficit
Nursing Care Planning and Goals

The goals in a patient with DHF 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.

Nursing Interventions

Nursing interventions appropriate for a patient with DHF include:

 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.
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.

Discharge and Home Care Guidelines

A patient with DHF discharged from the health care facility should be instructed to:

 Avoid diuretics. Avoid caffeine and alcohol as indicated to reduce effects of diuresis.

 Follow-up appointments. Comply with the recommended medical and laboratory follow-ups.
 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.
 Education. Educate patient on the use of mosquito nets and insecticides.