Home Nursing Care Plan Dengue Fever Nursing Care Plan and 8 Most Commonly Seen Nursing Diagnoses

Dengue Fever Nursing Care Plan and 8 Most Commonly Seen Nursing Diagnoses

dengue fever nursing care plan (10)

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. Dengue fever is a viral illness spread by the bite of infected Aedes aegypti mosquitoes. It can cause a range of symptoms, from mild fever and body aches to more severe conditions like dengue hemorrhagic fever, which can lead to serious complications. While anyone can get dengue, it is widespread among children and increasingly affects adults.

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, and 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.

What is Dengue?
Dengue fever is a viral illness caused by the dengue virus, which is transmitted to humans through the bite of infected mosquitoes, particularly the Aedes aegypti species. This disease is most common in tropical and subtropical regions, including parts of South America, Southeast Asia, and the Caribbean. It does not spread directly from person to person.

Causes
The dengue virus has four different strains. When a mosquito bites a person infected with the virus, it can then spread the virus to other individuals through its bites. The risk of severe dengue increases if a person has been infected with a different strain in the past.

Signs and Symptoms
Dengue fever typically starts with a sudden high fever, often reaching up to 104°F (40°C), along with other symptoms that may include:

  • Severe headache
  • Pain behind the eyes
  • Joint and muscle pain (sometimes referred to as “breakbone fever”)
  • Nausea and vomiting
  • Rash that may appear a few days after the fever starts
  • Mild bleeding (e.g., nosebleeds or easy bruising)

Other symptoms which can be seen among patients include:

  • Nausea and vomiting
  • Anorexia
  • GI distress (either diarrhea or constipation)
  • Bleeding: melena, hematemesis, hematuria, epistaxis
  • Muscle aches and joint pains
  • Headache
  • Circumorbital swelling
  • Lymphadenopathies

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. In some cases, dengue can progress to severe dengue, which may occur within 24 to 48 hours after the initial symptoms. Severe symptoms include:

  • Severe abdominal pain
  • Persistent vomiting
  • Bleeding from the nose or gums
  • Blood in vomit or stool
  • Difficulty breathing

However, the manifestations of the disease vary distinctly based on the degree of the disease progression.

Treatment
Currently, there is no specific antiviral treatment for dengue. Most cases can be managed at home by:

  • Staying hydrated by drinking plenty of fluids
  • Taking pain relievers like acetaminophen (avoid aspirin and ibuprofen as they can increase bleeding risk)
  • Resting until recovery
  • For severe cases of dengue, hospitalization may be required for intravenous (IV) fluids and close monitoring. Early detection and treatment are crucial to prevent complications.

For nurses and student nurses, understanding how to care for patients with dengue is important. A well-structured nursing care plan helps in identifying symptoms early, providing proper hydration, and managing any complications that may arise. This plan not only improves patient outcomes but also equips nursing students with essential skills for their future careers.

Assessing Patients with Dengue

Nursing care for patients with Dengue varies depending on the stage of the disease progression they are currently on.  The 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:

  1. Hyperthermia
  2. Risk for Bleeding
  3. Risk For/Deficient fluid volume
  4. Nutritional imbalance: less than body requirements
  5. Risk for hypovolemic shock
  6. Risk for impaired tissue perfusion
  7. Anxiety
  8. Knowledge deficit

Dengue Fever Nursing Care Plan

Hyperthermia

Hyperthermia refers to an elevated body temperature, typically above 104°F (40°C), resulting from the body’s inability to regulate its temperature effectively. Dengue fever is often caused by the viral infection itself, which triggers an inflammatory response, leading to fever.

Patients with dengue frequently exhibit signs of hyperthermia, such as a flushed face, hot skin, weakness, fatigue, and headache. These symptoms are critical indicators that nurses need to monitor closely.

Nursing Diagnosis

Hyperthermia

Related Factors

  • Viral infection
  • Cytokine release
  • Inflammatory response

Evidenced by

  • Elevated temperature (37.5  degrees Celsius and above)
  • Flushed face
  • Body warm or hot to touch

Desired Outcomes

After nursing interventions, the patient is expected to:

  • Maintain a core body temperature within the normal range (approximately 97°F to 99°F or 36.1°C to 37.2°C) through effective cooling measures and interventions.
  • Report a reduction in discomfort associated with hyperthermia, including headache and muscle pain, within a specified timeframe.
Nursing Action Rationale
Assess and monitor the vital signs regularly. Frequent monitoring of vital signs, including temperature, heart rate, and blood pressure, helps detect changes in the patient’s condition early. This is important for identifying signs of fever and severe dengue or shock, allowing for timely interventions.
Provide a tepid sponge bath. Tepid sponge baths help lower body temperature through the processes of conduction, convection, and evaporation. The cool water promotes heat loss from the skin, effectively reducing fever in patients with dengue fever,
Encourage increased oral fluid intake. Dengue fever often causes high fever, vomiting, and diarrhea, which can lead to significant fluid loss. Increased oral fluid intake helps replenish lost fluids and prevents dehydration, a common complication in dengue patients.

In cases of dengue hemorrhagic fever (DHF), there is a risk of plasma leakage due to increased vascular permeability. Adequate hydration helps maintain intravascular volume and supports proper circulation, reducing the risk of shock

Administer antipyretics as ordered by the physician. Administering medications like acetaminophen helps reduce fever and alleviate discomfort. Avoiding non-steroidal anti-inflammatory drugs (NSAIDs) is important because they can increase bleeding risk in dengue patients.
Prepare to administer intravenous fluids as prescribed. Intravenous fluid administration can help restore adequate fluid balance to help reduce fever and provide other nutrients that the patient with dengue fever needs.

Risk For Bleeding

Dengue virus infection can lead to increased vascular permeability, which results in plasma leakage into the extravascular space. This condition can cause hemoconcentration and may lead to shock if not managed properly. In addition, patients with dengue often experience a significant drop in platelet count (thrombocytopenia), which further exacerbates the risk of bleeding. A low platelet count diminishes the body’s ability to form clots, making even minor injuries potentially hazardous.

Nursing Diagnosis

Risk for Bleeding related to low level of blood platelet count secondary to dengue fever (note: risk nursing diagnosis usually does not require evidence, but the following may be included if seen during the assessment:

  • Bruises
  • Bleeding gums
  • Nose bleeding (epistaxis)
  • Vomiting with fresh blood

Desired Outcomes

After nursing interventions, the patient is expected to:

  • Manifest platelet count level within acceptable limits
  • Show no new signs of hemorrhage (such as gastrointestinal bleeding or mucosal bleeding, throughout the hospital stay)
  • Demonstrate an understanding of dengue fever management and preventive measures related to bleeding risks
Nursing Action Rationale
Assess the patient’s vital signs at least once every 3 hours, paying particular attention to the signs of bleeding such as low blood pressure, increased heart rate and respiratory rate. Continuous monitoring of vital signs, including blood pressure, heart rate, and respiratory rate, is crucial as changes may indicate the onset of shock or hemorrhagic complications. A drop in blood pressure or an increase in heart rate can signal significant blood loss or fluid depletion, requiring immediate intervention.
Assess and document bleeding. Regular assessment for any signs of bleeding (e.g., epistaxis, melena, hematuria) is essential. Documenting the amount and type of bleeding helps in evaluating the severity of the condition and determining the need for interventions such as fluid resuscitation or blood transfusion.
Implement strict bed rest. Patients with dengue fever, especially those with thrombocytopenia (low platelet count), should be on strict bed rest to minimize the risk of trauma and subsequent bleeding. This precaution is vital as even minor injuries can lead to significant bleeding in these patients.
Maintain fluid balance. Careful monitoring and management of fluid intake and output are critical to prevent both dehydration and fluid overload. In dengue hemorrhagic fever, maintaining euvolemia is essential to support circulation without exacerbating plasma leakage or causing respiratory distress due to fluid overload.
Avoid invasive procedures. To reduce the risk of bleeding, avoid all invasive procedures such as intramuscular injections or venipunctures unless absolutely necessary. These procedures can lead to hematoma formation or worsen bleeding risks due to compromised coagulation status in dengue patients.
Administer blood products as ordered. If significant bleeding occurs or if laboratory results indicate severe thrombocytopenia or coagulopathy, administering blood products (such as platelets or fresh frozen plasma) may be necessary. This intervention can help restore hemostatic balance and prevent further complications associated with severe bleeding.

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 a diagnosis of dengue fever as evidenced by (note: risk nursing diagnosis usually does not require evidence, but the following may be included if seen during the assessment:

  • Higher recorded output than input.
  • Hemorrhage
  • Capillary refill time of more than 3 seconds
  • Alteration in vital signs (increased BP, heart rate, and respiratory rate)

Desired Outcomes

After nursing interventions, the patient is expected to:

  • Manifest a balanced fluid input and output
  • Reduced risk of fluid volume deficit
Nursing Action Rationale
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 several nutrients the body needed; anorexia; nausea and vomiting, etc.) secondary to a 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

Desired Outcomes

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.
Nursing Action Rationale
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.

References

  1. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. Philadelphia: F.A. Davis.
  2. Carpenito, L. (2016). Handbook of Nursing Diagnosis (15th ed.).
  3. Herdman, T., & Kamitsuru, S. (2018). NANDA International, Inc. nursing diagnoses (11th ed.)
  4. Jayawickreme, K.P., Jayaweera, D.K., Weerasinghe, S. et al. A study on knowledge, attitudes and practices regarding dengue fever, its prevention and management among dengue patients presenting to a tertiary care hospital in Sri Lanka. BMC Infect Dis 21, 981 (2021).https://doi.org/10.1186/s12879-021-06685-5
  5. Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. Mosby
  6. Hinkle, J. L., & Cheever, K. H. (2014). Brunner & Suddarth’s textbook of medical-surgical nursing (Edition 13.). Wolters Kluwer Health/Lippincott Williams & Wilkins.
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