NURSING HAEMORAGIC dengue fever (DHF)

NURSING HAEMORAGIC dengue fever (DHF)

Dengue haemorrhagic fever

A. Definition

Dengue haemorrhagic fever (DHF) is a disease caused by dengue virus of a virus belonging to arbovirus and entered into the patient's body through the bite of aedes mosquito aegypty (Christantie Efendy, 1995).
Dengue haemorrhagic fever (DHF) is a disease found in children and adults with primary symptoms of fever, muscle aches and joint pain accompanied by rash or without a rash. DHF is classified as a type of virus arbo virus and entered into the patient's body through the bite of aedes mosquito aegypty (female) (Seoparman, 1990).
DHF is a special fever carried by the aedes mosquito aegypty and several others that cause fever. Usually quickly spread efidemik. (Sir Patrick Manson, 2001).


B. Etiology

Arbovirus dengue virus type.
Dengue viruses belong to the family and is known there are 4 Flavividae serotif, Dengue 1 and 2 is found in New Guinea when the course of World War II, while dengue 3 and 4 are found at the time of the outbreak in Philippines in 1953-1954. Dengue virus rod-shaped, are termoragil, sensitive to the ins and sodium activity by diatiter diaksikolat, stable at a temperature of 70 oC.
Fourth serotif has been found also in Indonesia with serotif to 3 is the most widely serotif.


C. Pathophysiology

The virus will enter the body through the bite of aedes mosquito aegypty and then will react with the antibody and virus-antibody complex formed. In circulation would activate the complement system. Due to activation of C3 and C5 will be released C3a and C5a, two peptides which empowered to release histamine and is a strong mediator as factor
increased permeability of blood vessel walls and eliminates the plasma through the endothelial wall.

Trobositopenia occurrence, decrease platelet function and decreased coagulation factor (protombin and fibrinogen) are the factors causing the occurrence of bleeding, mainly gastrointestinal tract bleeding in DHF.

What determines the severity of the disease is heightened permeability of blood vessel walls, decrease in plasma volume, hypotension, thrombocytopenia and hemorrhagic diathesis, shock occurs acutely.

Hematocrit value increases with the loss of plasma through the endothelial wall of blood vessels. And with the loss of clients experiencing hypovolemic plasma. If not addressed could happen tissue anoxia, metabolic acidosis and death.


D. Signs and symptoms

High fever for 5-7 days.
Nausea, vomiting, no appetite, diarrhea, constipation.
Bleeding, especially bleeding under the skin, ptechie, echymosis, hematoma.
Epistaxis, hematemisis, melena, hematuri.
Sore muscles, joints, abdoment, and heartburn.
Headache.
Swelling around the eyes.
Enlarged liver, spleen, and lymph nodes.
Signs of shock (cyanosis, clammy skin, decreased blood pressure, anxiety, capillary refill of more than two seconds, fast and weak pulse.)


E. Investigations

Blood
Platelets decreased.
HB increased by over 20%
HT increased by over 20%
Leukocytes decreased on day 2 and to 3
Low blood protein
U + PH could increase
NA and low CL

Serology: HI (hemaglutination inhibition test).
Chest X-thorax: pleural effusion.
Test test tourniket (+)


F. Management

Bed rest
Provision of soft food
Giving fluids intravenously
Provision of drugs: antibiotics, antipyretics
Anti-convulsive seizure case
Monitor vital signs (Blood Pressure, Temperature, Nadi, RR).
Monitor for signs of shock
Monitor signs of further bleeding
Check the HB, HT, and Platelets every day.


G. Growth and development in children aged 6-12 years

Growth is a process of increasing the physical size of the various organs associated with the problem of changes in number, large, size or dimensions of the cellular level. Weight gain is 2-4 kg / year and in young women have started to develop secondary sex cirri.
The development focuses on aspects of the differentiation of form and function, including social and emotional changes.

Gross motor
Skipping rope
Hit
Badminton
Gross motor under the control of cognitive and based on gradually increasing rhythm and subtlety.
Fine motor
Showing balance and hand / eye coordination
Can improve the ability to sew, create models and playing musical instruments.
Cognitive
Can focus on more and one aspect and situation
Can consider a number of alternatives in solving problems
Can buy and keep track of how the sequence of events back from the beginning
Can understand the concept first, present and future.
Language
Understand the most abstract words
Using all parts of the conversation including adjectives, adverbs, conjunctions and prepositions
Using language as a means of verbal exchanges
Can use compound sentences and compound.

Assessment
Assessment is the initial stage of the nurse to obtain the data required before performing nursing care. assessment in patients with "DHF" can be done with the interview technique, measurement, and physical examination. The phases include:
Identify potential sources and available to meet patient needs.
Review the history of nursing.
Kaji an increase in body temperature, signs of bleeding, nausea, vomiting, no appetite, heartburn, sore muscles and joints, signs of shock (rapid and weak pulse, hypotension, cold and moist skin, especially on the extremities, cyanosis , restlessness, decreased consciousness).

Emerging nursing diagnosis
Hipertermi associated with the process of dengue virus infection.
Changes in nutrition less than body requirements related to nausea, vomiting, no appetite.

Intervention
Diagnosis 1. :
Impaired body fluid volume is less than body requirements related to increased capillary permeability, bleeding, vomiting and fever.
Objective: Impaired body fluid volume can be resolved
Criteria results:
Body fluid volume returned to normal
Intervention:
Kaji KU and the patient's condition
Observation of vital signs (S, N, RR)
Observation for signs of dehydration
Observation and location of the drip infusion needle stabbing
Fluid balance (input and output of fluid)
Give the patient and family encourage patients to give to drink a lot
Instruct the patient's family to replace the patient's clothes are wet by
sweat.

Diagnosis 2. :
Hipertermi associated with the process of dengue virus infection.
Objective: to overcome Hipertermi
Criteria results:
The body temperature returned to normal
Intervention:
Observation of vital signs, especially temperature
Give a cold compress (plain water) on the forehead and armpit regions
Change clothes that have been soaked in sweat
Encourage families to put on clothing that can absorb sweat like cotton.
Encourage families to provide drinking lots of approximately 1500 - 2000 cc per day
collaboration with physicians in the provision of Therapy, febrifuge.

Diagnosis 3. :
Changes in nutrition less than body requirements related to nausea,
vomiting, no appetite.
Objective: Impaired nutritional compliance resolved
Criteria results:
Nutritional intake increased client
Intervention:
Assess client's nutritional intake and the changes that occur
Weigh client daily weight
Give clients eat in warm and with a little portion but
often
Give drink warm water when the client complained of nausea
Perform physical examination Abdomen (auscultation, percussion, and palpation).
Collaboration with physicians in the provision of anti-emetic Therapy.
Collaboration with a team of nutrition in determining the diet.

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