COMMUNICABLE DISEASES OF THE

CIRCULATORY SYSTEM

 Dengue Hemorrhagic Fever (DHF)

 Malaria
Dengue Hemorrhagic Fever

Important concept:
• Dengue fever is a mosquito-borne disease that occurs in
tropical and subtropical areas of the world. It is an infectious
viral disease.
• Dengue fever is also called as breakbone fever or dandy
fever.
• Dengue fever is different from dengue hemorrhagic fever.
• Dengue fever is an affectation of the circulatory system
WITHOUT BLEEDING. It is a mild form of hemorrhagic fever.
Dengue Hemorrhagic Fever
• Causative agent:
 Arbovirus
 Carried from one person to another person by anthropods
(mosquitoes or ticks)

Types of Dengue fever

• Type 1 - Onyong-nyong virus
• Type 2 - Chikungunya
• Type 3 - West nile
• Type 4 - Flavivirus
Dengue Hemorrhagic Fever

• Mode of transmission
• Mosquito bite
• Biological transmitter
 Aeges aegypti (yellow fever mosquito)
 Aeges albopectus/ albopictus (Asian tiger mosquito)

• Mechanical transmitter
 Culex fatigans (Southern house mosquito)
AEGES AEGYPTI (YELLOW FEVER AEGES ALBOPECTUS (ASIAN TIGER
MOSQUITO MOSQUITO)
CULEX FATIGANS (SOUTHERN HOUSE MOSQUITO)
Dengue Hemorrhagic Fever
Biological transmitter
- After this mosquito has bitten an infected person, after 8-10 days, it can
transfer virus to other people.
- Virus becomes part of the system of the mosquito as long as it is alive.
- Life span of these types of mosquitoes is four months.

Mechanical transmitter
- After this mosquito bites an infected person, the very next it bites is the
only person who gets the virus.
- One is to one
- immediate transfer of virus
Dengue Hemorrhagic Fever
• Aedes aegypti (Yellow fever mosquito)
 Most common in the Philippines
 Day - biting
 Low-flying
 Low- extremities
 Breed on clear, stagnant water, usually in urban area (e.g Old
tires, Flower vase, Plant cans)
 In the Philippines, any area is a dengue risk area.
AEGES AEGYPTI (YELLOW FEVER MOSQUITO
Four classification of Dengue Hemorrhagic Fever (DHF)

DHF Grade 1
- Increased grade fever (lasts 3 – 5 days)
• Even if antipyretics are given, fever will persist
• Fever will come down but the patient is still febrile
- Important Concept!
• Therefore, give antipyretic round the clock
Four classification of Dengue Hemorrhagic Fever (DHF)

DHF Grade 1
- Pain is present
• Headache
• Periorbital pain
• Pain behind the eyes
• Joint and bone pain
• Abdominal Pain
• Nausea and Vomiting
Four classification of Dengue Hemorrhagic Fever (DHF)

DHF Grade 1
- Presence of Pathological
Vascular Changes
• Petechiae
• Herman’s Sign
• Generalized redness
• Flushing of the skin

PETECHIAE
HERMAN'S SIGN

FLUSHING OF THE SKIN

Four classification of Dengue Hemorrhagic Fever (DHF)

DHF Grade 2
- If there is persistence of signs and symptoms of DHF
Grade 1
- If there is bleeding from:
• Nose – epistaxis
• Gums- gum bleeding
• Vomiting of blood (coffee ground appearance from the
stomach)
EPISTAXIS GUM BLEEDING
Four classification of Dengue Hemorrhagic Fever (DHF)
DHF Grade 2
- Upper Gastro-Intestinal Tract Bleeding
• Melena
• Passing of black tarry stool
• Acted upon by digestive enzymes
- Lower Gastro-Intestinal Tract Bleeding
• Hematochezia
• Passing of fresh blood in the stool
- Then, these signs and symptoms indicate the START OF
HEMORRHAGIC FEVER
Four classification of Dengue Hemorrhagic Fever (DHF)
DHF Grade 3
- Persistence of signs and symptoms of DHF Grade 2
- With signs of circulatory collapse or failure
- With cold clammy skin
Nursing Alert!!!
• Check for capillary refill
- Check vital signs
• Indicators of Circulatory Failure:
• Hypotension or decreased blood pressure
• Rapid but weak pulse
• Rapid respiration
Four classification of Dengue Hemorrhagic Fever (DHF)

DHF Grade 4
- With signs and symptoms of DHF Grade 3
- With shock
- Hypovolemic shock due to excessive blood loss due to
uncontrolled bleeding
Diagnostic Tests for Dengue Hemorrhagic Fever
1. Tourniquet or Rumpel Leede’s Test
- Test for capillary fragility
Concept!
- This is only a presumptive test for DHF (not a confirmatory test)
- Not all patients are subjected to this test
Three (3) criteria that must be present before you perform the
tourniquet test:
1. Person must be at least six (6) months old
2. Fever should be more than three (3) days
3. No other signs of DHF are present
• Patient only feels fever
 Diagnostic Tests for Dengue Hemorrhagic Fever
1. Tourniquet or Rumpel Leede’s Test
How is it done?
- Get the blood pressure of the patient. Add systolic and diastolic pressures
and divide the sum by two
- Apply that pressure on the cuff. . .
• For five (5) minutes if the patient is pediatric
• For ten (10) minutes if the patient is an adult
- Deflate the Blood Pressure Cuff
- Check for the presence of petechial formation
- If greater than or equal to petechial formations per square inch, then
patient is positive (+) to Tourniquet Test.
- Therefore, patient is probably suffering from Dengue Hemorrhagic Fever.
Diagnostic Tests for Dengue Hemorrhagic Fever
2. Blood Examination
- Platelet Count
• Normal value is 150,000 to 400,000 platelets per cubic
millimeter.
• Values lower than the normal indicate that patient is positive (+)
for Dengue Hemorrhagic Fever.
- Hematocrit Determination
• Measures degree of hemoconcentration
• Normal value is 37% to 54%
• Values higher than the normal indicate that patient is positive
(+) for Dengue Hemorrhagic Fever
Dengue Hemorrhagic Fever
• Medical Management
- Symptomatic
- No specific treatment

 Important Concepts!
- If patient is febrile
– Administer antipyretic
– But never use aspirin
• Potentiates clumping of platelets and results to bleeding
Dengue Hemorrhagic Fever
 Important concept
- ASA (Acetylsalicylic acid) is not given to children below twelve (12)
years old and when cause of disease is unknown.
• Side effect is Reye’s Syndrome
- If there is bleeding
• Give coagulants
• Vitamin K
• Aquamephyton
• Konakion
- Vitamin C to increase capillary resistance
- Provide blood transfusion
Dengue Hemmorrhagic Fever
 Nursing Management
• Prioritize bleeding prevention and control
• For gum bleeding
• Use cotton swab
• This is softer than any toothbrush
• Provide ice chips
• Advise patient to gargle
• It will not cause injury
• Use mouthwash
• Use soft-bristled toothbrush
• Keep patient on NPO if patient vomits blood
Dengue Hemmorrhagic Fever
 Nursing Management
• Apply ice pack over epigastric region of patient
• Doctor may order NGT insertion
• For gastric lavage, use ice cold NSS or coagulant
• Provide adequate nutrition
• Avoid dark colored foods
 Important Concept!
- Attack of Dengue Hemorrhagic Fever does not give permanent
immunity
- Prevention:
• Practice CLEAN PROGRAM of the DOH
MALARIA

• Also called Ague

• King of tropical diseases
• Manifested by indefinite periods of chills and fever
• According to WHO, Malaria is a life-theatening disease caused by
protozoan parasites that are transmitted to people through the
bites of infected female Anopheles mosquitoes. It is preventable
and curable.
MALARIA
 Important Concepts!
• Microorganism is a PROTOZOA
• Plasmodium has four species
1. Plasmodium malariae
2. Plasmodium ovale
3. Plasmodium vivax
• One of the most common in the Philippines
4. Plasmodium falciparum
• Another of the most common in the Philippines
• The most fatal due to its tendency to multiply rapidly
MALARIA
• Plasmodium is acquired through a mosquito bite – Anopheles mosquito
• Blood is needed by the female Anopheles mosquito for the fertilization of its
eggs
 Important concept!
• Anopheles mosquito is A NIGHT biting mosquito
• It bites from sunset to sunrise or from dusk to dawn
• It breeds in CLEAR, SLOW FLOWING WATER
• It is common in: Rural Areas, Mountainous Areas, Forested Areas
(Palawan, Dumaguete, Surigao)
• It lands on the surface on a forty-five (45) degree angle or in a slanting
position
MALARIA
ANOPHELES MOSQUITO
MALARIA
Pathophysiology
1. Infected anopheles mosquito bites a person.
2. Plasmodium parasite bloodstream
• In the blood stream, attaches and enters RBC. Then the
reproduction occurs.
• Then those that not penetrate the RBC go to the liver, they do
nothing and may remain dormant for 3-5 years. They wait for
the liver to release the RBC for them to penetrate the other
RBC.
3. Once inside the Red blood cell (RBC), the microorganism
multiplies and destroy the RBC. This leads to anemia
Pathophysiology cont'd.
4. Rupturing of membranes of Plasmodium coincides with the
presence of CHILLS in the patient. Presence of more and new
microorganism in the bloodstream causes fever.
5. A dormant versions of malaria travels through the host's blood
stream, wait to be ingested by another mosquito to carry it to the
new host.
 Important Concepts!
• If you have malaria and your last attack is more than five (5)
years ago, then you can be a blood donor.
• If your last attack is less than five (5) years ago, you CANNOT
BE A BLOOD DONOR.
Malaria can also be obtained by BLOOD TRANSFUSION
Manifestation of Malaria
Stage 1 – Cold Stage
• Lasts for ten (10) to fifteen (15) minutes
• Chilling sensation is present
• Shaking, chattering of the lips is present
 Nursing Responsibilities
• Provide warmth
• Blankets
• Warm drinks
• Not warm compress
• Hot water bag on soles of the feet
• Expose to heat lamp or droplight
Manifestation of Malaria
Stage 2 – Hot Stage
• Last for four (4) to six (6) hours
• The patient has:
- Fever - Abdominal Pain
- Headache - Vomiting
 Nursing Responsibilities
• Lower the body temperature
• Provide tepid sponge bath
• Provide cold compress
• Increase fluid intake
• Provide light, loose clothing
• Provide antipyretic as ordered
Manifestation of Malaria
Stage 3 – Wet Stage
Patient exhibits:
• Profuse sweating
• Feeling of weakness
 Nursing Responsibilities
• Make patient comfortable
• Keep patient dry and warm
• Provide fluids to prevent dehydration
• Make patient rest comfortably in bed
MALARIA
Important Concepts!!!
• In other types of sicknesses or disorders, chills occur
before fever.
• This is due to body’s response to heat loss.
• In ordinary infections, higher temperatures are seen
during CHILLS because patient is trying to retain heat.
• In malaria, increased temperature occurs on FEVER or
HOT STAGE.
• Chills occur due to the release of Plasmodium
MALARIA
 Key Concept!

• If causative agent is P. falciparum, its rapid multiplication

and RBC destruction would lead to…
• Anemia
• Liver then compensates and results to HEPATOMEGALY
• Splenomegaly
• Mild jaundice sometimes occurs
Cont'd.
• Cerebral Hypoxia
• Restlessness
• Confusion
• Delirium
• Convulsions
• Loss of consciousness
• Coma
• Black Water Fever
• Passing out black urine or dark red urine due to rapid RBC
destruction. This may lead to death
Diagnostic for Malaria

1. Blood Smear or Malarial Smear

• Best time to collect
• At the HOT STAGE
• At the peak of fever (this is when the microorganism is in the
blood stream)
Concepts!
• During the Hot Stage, the microorganism is in the bloodstream
• During the Cold Stage, the microorganism is inside the red
blood cells
Blood Smear or Malarial Smear
Diagnostic for Malaria

2. Quantitative Buffy Coat (QBC)

• This is seldom done
• This test is expensive
• Specimen used is blood
• A rapid test for malaria
• You do not have to wait for fever to set in to undergo this
test
• You can extract blood earlier
Quantitative Buffy Coat (QBC)
Quantitative Buffy Coat (QBC)
Medical Management of Malaria
• Anti-malarial Agents
• Drug of Choice
• Chloroquine
• Other Drugs used:
• Primaquine
• Atabrine
• Pancidar
• Quinine
 A reserve drug for severe type of malaria
Important concept
• Anti-malarial agents are cautiously used in pregnant women
• They are considered as ABOTIFACIENT AGENTS
• They can cause ABORTION
• However, this is NOT CONTRAINDICATED because if mother
(infected with malaria) is not treated, the child may be born with
NEONATAL MALARIA
• Child with Neonatal Malaria exhibits the following:
 Decreased levels of RBC
 Immature liver
 Severe anemia
• Child may die
Key Concepts!
• Malaria may be acquired through:
• Blood Transfusion
• Vertical Transfusion
- RBC passes through the placenta (not the
microorganism)
Important Concept!
• An attack of Malaria does not provide permanent
immunity
• A repeat bite from a malaria mosquito is not needed
because the microorganism may be dormant in the liver

 Prevention
- Practice the CLEAN PROGRAM of the DOH
Thank you for listening Future RN!
GROUP 1:
• Agub, Kylene Pearl L.
• Arboleda, Abigail
• Arraz, Queenie
• Bartolome, Gracelle B.