Predisposing factors: - Age: both young and old; but the very young and the very old

are more vulnerable to complications - Sex: Both sexes - Season: rainy - Location: urban communities - Race: Asian

Mosquito (A. Aegypti) carrying flavivirus bites the host

Immune-inflammatory response - Localized pain - Swelling - Warmth - Redness

Mosquito secretes saliva containing the virus to the area

Precipitating factors: - Stagnant, clean waters - Dirty, dark, cold places - Immunecompromised person - Positive health history for dengue fever - Clotting deficiencies - Vitamin K and other vitamin deficiencies - Anemia - Presence of a dengue case in the community

Virus attaches to the Langerhans cells

Langerhans cells bound with the flavivirus goes to the lymphatic circulation and lodges on the lymph nodes

Virus replicates itself inside the lymph nodes

Virus is released to the systemic circulation

Macrophages engulfs virus

Macrophage fails to neutralize/destroy virus due to viral envelope

Virus replicates through invading macrophage genetic make-up

in number of infected monocyte in thecirculation

Virus lodges into the bone marrow Immune-inflammatory response: WBC: 1710/mm3 (450011000) - Segmenters: 54% (5570) - Lymphocytes: 37% (20-35) - Monocytes: 8% (1-6)

Virus lodges into the body tissues (in the cutaneous, subcutaneous, gastrointestinal tissues, and joints) Activation of Tcells Release of CD4+ & CD8+ cytotoxic lymphocytes

Virus affects/suppresses bone marrow function by depleting hematopoietic processes especially platelet production

platelet production Platelet count: 51 T/mm3 Hct.: 43.7% Replacement of destroyed/lost platelets or administration of platelet concentrate

Thrombocytopenia & hemoconcentration blood coagulation

Infected monocytes are destroyed

Waste products from cellular lysis acts as pyrogens

Paracetamol (Tempra) 250mg/5ml syrup; 6 ml q 4hrs. for T38C IVF TF # 6 PNSS 1L @ 40 gtts/min Apply cold compress on clients forehead as ordered

Complication: Diminished Intravascular Coagulation Circulatory problems manifested by: restlessness with cool, clammy skin, and cyanosis; RBC count, Hct, Hgb; irregular, rapid & weak pulses, pulse pressure; blood pressure

blood clotting

wound healing

Circulatory problems manifested by: prothrombin time, PTT and clotting time; bleeding time

Interleukin-1 sends message to thermoregulation center in the hypothalamus Fever (39.8C) with frontal headache, ocular pain; diaphoresis; flushed and warm skin.

Encourage rest periods; do relaxation measures; encourage oral intakes of fluids; adjust bed linens and clothes, and environment; apply cool cloth to head, bathe in lukewarm bath; Acute Pain related to frontal headache associating fever & Activity Intolerance Level I r/t weakness and cases of mild frontal headache

bleeding

Provide safety for the client and avoid incurring injuries/wounds

body temperature & metabolic rate

SHOCK

DEATH

Imbalanced Body Temperature r/t immune-inflammatory process s/t dengue

Immune-Inflammatory response

Disturbed Sleeping Pattern related to itchiness on the rashes present on the extremities & Fatigue related to sleep deprivation caused by disease process & Disturbed Body Image related to presence of rashes in both extremities

Vasodilation & vascular permeability occurs to release plasma proteins, blood cells, & lymphocytes to the site of infection

Circulatory problems manifested by: restlessness with cool, clammy skin, and cyanosis; hemoconcentration: hematocrit, rapid & weak pulses, pulse pressure; blood pressure

Constant leaking of the plasma cells outside the capillaries

Provide uninterrupted rest periods; provide quiet environment and discomfort measures; provide age appropriate bedtime rituals; schedule not tiring activities; provide adequate nutrition and hydration; provide emotional support for disturbed body image and encourage client to verbalize feelings.

plasma in the intravascular circulation Continuous perivascular hemorrhage and diapedesis Extravascular Bleeding

Paracetamol (Tempra) 250mg/5ml syrup; 6 ml q 4hrs. for T38C IVF TF # 6 PNSS 1L @ 40 gtts/min Ceterizine (Allerkid) 5 mg/ 5 ml 7 ml OD HS Administer platelet concetrate

SHOCK

For Gastrointestinal manifestations: - Anorexia - Nausea - Vomiting - Generalized abdominal pain - GI bleeding with black-tarry stools For Cutaneous/Subcutaneous manifestations: - Rashes with pruritus - Flushed palms and sole - Positive tourniquet test - Manifestations of dehydration For Joints manifestations: - Backache - Arthalgia - Myalgia For Circulation manifestations: - Hypovolemia - Fatigue with RR: 28 CPM

DEATH

Virus lodges into the liver

Virus lodges into the kidneys Virus then infects the kidney tissues including the glumeruli and the nephrons Limit salt and protein intake; monitor intake and output; alert for signs of fluid volume excess such as edema, oliguria, cold, clammy skin, weak and rapid pulses.

Extravascular edema

Swelling of liver cells (Kupfer cells, etc.) hepatomegaly Liver tissue necrosis causing liver dysfunction Liver failure Liver transplantation Replacement of blood component deficiencies Increased ALT & AST Decrease production of thrombin, thromboplastin, prothrombin and Vit. K, leading to deficiencies with the above mentioned as manifested by: prothrombin time, PTT and clotting time; bleeding time Early signs of hepatitis: Anorexia Nausea Vomiting Abdominal pain Hepatomegaly

Infection then develops in the nephrons (complication: glomerulonephritis)

glumerular filtration Oliguria/anuria Edema Cold, clammy skin Rapid and weak pulses Hematuria Alterations in BUN and creatinine values (increased)

Acute kidney failure

Acute kidney failure complicates if not treated to chronic kidney failure

Supportive measures; replacement of fluid and electrolytes imbalances; comfort and supportive measures

DEATH

Kidney transplantation Kidney dialysis

Legend:

Pathophysiology

Independent nursing care management

Nursing Diagnosis

Signs and symptoms/ clinical manifestations

Dependent/Collab orative nursing care management

DENGUE HEMORRHAGIC FEVER By: John Kevin C. Giangan & Joanna Marie B. Villanueva