Dengue hemorrhagic fever, or dengue fever, is a viral disease caused by the infection due to the presence of arboviruses in the body. These arboviruses are usually carried by vector Aedes aegypti mosquitoes and transmitted when the female mosquito bites a patient.
Most patients infected with dengue fever are children; however, there are also increasing cases of adult dengue infections. The infection’s signs and symptoms include fever, muscle and/or joint pains, and other flu-like symptoms. Patients who develop moderate forms of infection may also present with rashes, petechiae formation, easy bruising. In some patients who progress into severe or hemorrhagic forms of the disease, bleeding tendencies and dropping platelet values can also be seen. Other symptoms which can be seen among patients include:
- Nausea and vomiting
- GI distress (either diarrhea or constipation)
- Bleeding: melena, hematemesis, hematuria, epistaxis
- Muscle aches and joint pains
- Circumorbital swelling
While the symptoms enumerated above are the most commonly seen among patients with Dengue, some patients progress into a more severe form of the disease and manifest signs and symptoms of shock due to dropping platelet levels that cause bleeding problems. However, the manifestations of the disease vary distinctly based on the degree of the disease progression.
Assessing Patients with Dengue
Nursing care for patients with Dengue varies depending on the stage of the disease progression they are currently on. Priority of assessment falls on determining whether the patient has been displaying signs and symptoms of bleeding and whether there is a need to rehydrate the patient or start blood transfusions. Signs and symptoms of shock should also be regularly assessed, and immediate referrals should be made. The following nursing diagnoses were more commonly seen among patients with Dengue:
- Risk For/Deficient fluid volume
- Nutritional imbalance: less than body requirements
- Risk for hypovolemic shock
- Risk for impaired tissue perfusion
- Knowledge deficit
Dengue Fever Nursing Care Plan
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.
- Capillary refill time more than 3 seconds
- Alteration in vital signs (increased BP, heart rate, and respiratory rate)
After nursing interventions, the patient is expected to:
- Manifest a balanced fluid input and output
- Reduced risk of fluid volume deficit
|Assess the patient’s vital signs at least once every 3 hours, paying particular attention to the signs of hydration such as pulse rate, blood pressure, and respiratory rate.||Assessment of the vital signs helps determine the patient’s status and catch fluctuations in circulating fluid volume. It also gives the nurse the earliest indication of the progression of fluid deficits.|
|Observe and record capillary refill time regularly.||Capillary refill time is an indicator of adequate circulation as well as peripheral perfusion.|
|Note and record intake and output regularly, noting for the characteristics and quality of urine output (i.e., color, specific gravity, turbidity, transparency, etc.).||Concentrated urine usually is indicative of dehydration. A reduction of urine output is also indicative of a lower fluid intake.|
|Increase oral fluid intake, if not contraindicated.||Increasing the oral fluid intake of the patient to more than 3 liters per day helps prevent the patient from suffering from dehydration.|
|Prepare to administer intravenous fluids as prescribed.||Intravenous fluid administration can help restore adequate fluid balance and provide other nutrients that the patient with dengue fever needs.|
Imbalanced Nutrition: 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
After nursing interventions, the patient is expected to:
- Display an increase in body weight
- Eat according to nutritional needs and demands
- Verbalize the importance of taking food and nutrients according to prescribed needs.
|Assess the patient’s perceptions about food intake and food preferences.||Knowing the type of foods the patient eats allows the nurse to be able to plan for care better.|
|Allow the patient to select food preferences from the approved food list for his condition (e.g., except dark-colored food; food that contains colorants, etc.)||Allowing the patient to select his menu based on the approved list encourages him to think about food and eat more since he chooses from options that are palatable to him.|
|Encourage the patient to have small frequent feedings, eating at least once every 3-4 hours.||Eating smaller meals spaced throughout the day encourages the patient to eat according to the recommended caloric intake without overwhelming him.|
|Present the food in a visually attractive and palatable manner.||Presenting food to be visually appealing allows the patient to think that it tastes good, thereby stimulating appetite and increasing food intake.|
|Include supplements in the patient’s dietary intake as prescribed.||Some patients may need to supplement their recommended allowance with food supplements to help meet their daily needs.|
|Administer anti-emetics as prescribed.||Patients suffering from severe nausea and vomiting may need to be given anti-emetics to help prevent regurgitation of ingested food.|
|Instruct the patient to brush teeth regularly.||Cleaning teeth helps stimulate appetite by removing plaque and the unpleasant taste and sensation the patient may have in his mouth due to intake of medications or after vomiting. Remind the patient to refrain from using strong mouthwash solutions.|
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. Philadelphia: F.A. Davis.
- Carpenito, L. (2016). Handbook of Nursing Diagnosis (15th ed.).
- Herdman, T., & Kamitsuru, S. (2018). NANDA International, Inc. nursing diagnoses (11th ed.).