Dengue

Haemorragic
Fever

GROUP NAME :
- ANNISA NURUL HIKMAH
- ASTRIE MERLINDA
- DIAH AYU PRABANDINI
- NILA NURFADILLAH
- SRI WULANDARI
- YULIA INDRIANISA
DEFINITIONS

Dengue fever / DF and DHF or DHF is an

infectious disease caused by dengue virus with
clinical manifestations of fever, muscle aches
and joint pain accompanied by lecopenia, rash,
lymphadenopathy, thrombocytopenia and
hemorrhagic diathesis (Sudoyo, 2010).
 DHF disease has a very rapid course of
disease and is often fatal because many patients
die from late treatment. Dengue hemorrhagic
fever (DHF) is also called dengue hemorrhag
fever (DHF), dengue fever (DF), dengue fever, and
dengue shock syndrome (DDS (Widoyono, 2008).
ETIOLOGY

 Dengue disease is caused by dengue virus

from arbovirus B group, that is arthropod-born
envirus or virus spread by arthropod. The main
vectors of DHF are aedes aegypti mosquito (in
urban area) and aedes albopictus (rural area).
(Widoyono, 2008). The mosquitoes love to live
in clear and stagnant water, the eggs can last
for months at a temperature of 20-42 0C.
 When humidity is too low this egg will hatch
within 4 days, then to become a mosquito
nowadays takes 9 days. Adult mosquitoes that
have sucked blood 3 days can lay 100 eggs
(Murwani, 2011). Haemoragic Fever Dengue
(DHF) is caused by arbovirus (Arthopodborn
Virus) and is transmitted through the bite of
Aedes Aegepthy.
THE CHARACTERISTICS OF MOSQUITOES SPREAD OF
DENGUE FEVER ACCORDING TO (NURSALAM, 2008)
ARE:

 Small body, black color with white spots

 Live in and around the house

 Biting and sucking blood during the daytime

 Glad to settle on clothes hanging in the room

 Nested and lay eggs with clear water in and

around the house such as bathtub, crock of
flower vase
CLINICAL MANIFESTATIONS
 The main clinical symptoms of DHF are fever
and haemorrhagic manifestations either arising
spontaneously or after torniquet testing.
 A sudden high fever lasting 2-7 days
 Manifestations of bleeding
1) Positive tourniquet test
2) Spontaneous bleeding in the form of
petechi, purpura, ekimosis, epitaxis, gum
hemorrhage, hematemesis, melena.
 Hepatomegaly
 Shock, pulse fast and weak, pulse pressure
decreased (<20mmHg) or pulse is not palpable, skin
cold, and child restless.
 Nausea, vomiting, no appetite, diarrhea, constipation
 Muscle aches, joints, abdomen, and heartburn.
CLASSIFICATION

Distribution of Degrees by (Soegijanto, 2006):

 Degree I: Fever with a positive torniquet test.

 Grade II: Fever and spontaneous bleeding, usually skin or other
bleeding.
 Degree III: Fever, spontaneous bleeding, accompanied or not
accompanied
hepatomegaly and found symptoms of circulatory failure include
rapid and weak pulse, decreased pulse pressure (<20mmHg) /
hypotension with cold extremities, and restless children.
 Degree IV: fever, spontaneous bleeding accompanied or not
accompanied
hepatomegaly and found severe shock symptoms (no pulse
palpable and unmeasurable blood pressure).
COMPLICATIONS

 Dengue Encephalopathy
 Kidney disorders

 Lung Udem
DIAGNOSTIC EXAMINATION

 Examination of hematocrit
 Torniquit test

 Serology test (blood filter)

 Isolation of the virus:

MANAGEMENT
Degree I: There is a disturbance of nutritional needs and balance electrolytes
due to vomiting, anorexsia. Discomfort due to fever, epigastric pain, and eyeball
movement.
 Nurse: bed rest, soft foods (if no appetite is recommended drink plenty of
1500-2000cc / day), given cold compress, monitor general condition,
temperature, tension, pulse and bleeding, checked Hb, Ht, and thrombosit, -
antipyretic and antibiotic drugs in the event of concern about secondary
infection

Degree II: increased cardiac work of melanic epitaxsis and hemaesis.

 Nurse: in case of blood epitaxsis cleaned and pairs of tampons emporarily,
if the conscious patient may be fed in the form of fat but if the ematemesis
occurs should be satisfied first, adjust the head position is tilted so as not to
occur aspiration, when large bloated stomach is installed maag slang,
bleeding, do not get stabbed often, the treatment is given according to the
doctor's instructions, pay attention to the infusion techniques, do not
increase the bleeding, still observed the general condition, temperature,
pulse, tension and bleeding, all events recorded in the nursing record, if
things get worse immediately report the doctor
Derajat III: terdapat gangguan kebutuhan O2 karena kerja
jantung menurun, penderita mengalami pre shock/ shock.
 Perawatan: mengatur posisi tidur penderita, tidurkan
dengan posisi terlentang dengan kepala extensi,
membuka jalan nafas dengan cara pakaian yang ketat
dilonggarkan, bila ada lender dibersihkan dari mulut
dan hidung, beri oksigen, diawasi terus-meneris dan
jangan ditinggal pergi, kalau pendarahan banyak (Hb
turun) mungkin berikan transfusi atas izin dokter, bila
penderita tidak sadar diatur selang selin perhatian
kebersihan kulit juga pakaian bersih dan kering.
There are 2 kinds of vector eradication, among others:
1. Using Insecticides
Commonly used in dengue eradication programs
dengue is malathion to kill adult mosquitoes and temephos (abate) to
kill larva (larvasida). The way in which Malathion is used is by fumigation
or extraction. How to use temephos (abate) is with sand abateke in
aedes mosquito's nest is clean water container vessel, dose used is 1
ppm or 1 gram abate SG 1% per 10 liter of water.

2. Without insecticides
The trick is: Drain the tub, water jar and water reservoir at least 1 x a
week (the development of mosquito eggs for 7-10 days); Closes the
water reservoir tightly; Clean the yard of used tin cans, broken bottles
and other objects that allow mosquitoes to nest.
CASE OF DHF

Tn. N came to the hospital with a high fever,

shivering. The client said the fever was almost 1
week and did not go down. At the time of
assessment, the TTV observation was observed:
TD: 100 / 60mmHg, N: 78x / min, R: 20x / min,
S:38,5˚C. clients say fever occurs at night. When
done tourniquet test positive results obtained.
The client's situation is weak, pale, dry lips and
bad skin turgor.
CASE DHF
ASSESSMENT
Data Collection
a. Client Identity
Name : Tn.N
Age :18 years old
Gender : Male
Education : SMK
Job :-
Religion : Islam
Tribe / Nation : Sunda / Indonesia
Marital Status : Not Married
Address : Kp.Cisaranten Rt03 / 01
Admission Date : March 25 2018
Date of Review : March 26 2017
Medical Diagnosis : DHF

b. Identity of Responsible Person

Name : Tn.W
Age : 39 Years
Job : Entrepreneur
Education : High School
Gender : Male
Religion : Islam
Address : Kp.Cisaranten Rt03 / 01
Relationship With Clients : Dad
c. Medical history

 Current Health History

Clients complain of fever, no appetite, nausea and
weakness, since 5 days ago, the client on minikan febrifuge
but no improvement
 Major Complaints During Hospital Entry
Client complained already 1 hot week the body did not go
down
 Major Complaints When Assessed
The client said that the client complained of heat, felt in the
flush of hot water and felt in the whole body S: 38˚C at night
 Past Health History
The client's family says that the client has never
experienced the disease as it was in his pain
 Family Health History
The client's family says no other family member
has the same illness as the client
d. Daily Activity Patterns

No Activities Before Pain After Pain

1 NUTRITION

EAT

Frequency 2x/day 3x/day

Eating Portions 1 portion ¾ portion

Type Nasi, lauk pauk Porridge, vegetables

Complaint No Nausea
2 DRINK

Frequency 8 cups / day 5 cups / day

Types Water, milk, tea Water, milk

Complaint No No

3 ELIMINATION

BAK

Frequency Countless 3x/day

Consistency Liquid liquid

Color Yellow urine Yellow urine

Complaint No No
 BAB

Frequency 2x/day 1x/day

Consistency Solid Solid

Color Yellow feces Brownish yellow

Complaint No No

4 BREAK AND SLEEP

Napping Never 1-2hours / day

Sleep 8 hours/day 6 hours/day

Complaint No Sleep disorders

5 PERSONAL HYGIENE

BATH

Frequency 2x/day Wiped 1x / day

Complaint No No

SHAMPOOING

Frequency 3x a week Never

Complaint No No

BRUSH YOUR TEETH

Frequency 2x/day 1x/day

Complaint No No

6 HABIT PATTERNS

Activity Going to school, Playing Lying in bed

Complaint No Client feel bored

e. Physical examination

1. General Client Condition: Weak

Appearance : Composmentis
Vital sign:
TD: 100/60 mmHg Temperature: 38,3˚C
Respiration: 20x /minute pulse: 78x / min
2. Skin: Sawo mature, poor skin turgor is proven
within <3 seconds fast
3. Head and Hair
o Head
Shape : Spherical, Symmetrical
o Hair : Distribution is evenly distributed
Color :Black
Cleanliness : Clean
Rebound : Do not fall out

4. Face and Neck

o Face : Shape, Symmetrical
Color : Redness
Lesions : None
Traumatic Former: None
o Neck : Symmetrical no bumps
5. Eyes
The shape of both eyes : Symmetrical
Kongjungtiva : Pale
Pupil : Right
Sklera : White color
Light reflection : Fine, reflex pupils of
light are proven when the pupil light contracts and when the
light in the pupil dilates dilated
Vision function : Normal (client can
read newspaper about 25cm distance)

6. Ear
Shape : Symmetrical
Cleanliness : Clean
Hearing Function : Normal, the client can hear the sound
/ sound
7. Nose
Nose shape : Symmetrical
Lesions : None
Secret : There is, liquid mucus and no impurities
Nose Mucosa : Slightly reddish
Cleanliness : There is no dirt
Smell function : Normal, the client can distinguish the smell of
eucalyptus and the smell of perfume

8. Mouth
The shape of the lips : Symmetrical
Circumcision : Dry, cracked
Teeth : Complete amount of 32 Fruits
Tongue : Clean
Taste Function : Clients can taste sweet, bitter, sour and
salty
9. Chest
Shape : Symmetrical
Pulmonary breathing : Vesicular (low pitched)
Pulmonary percussion: Resonant (normal lung percussion
sound)
Breathing pattern : Regular (regular)
Pulmonary expansion: Balanced
Heart Rhythm : Regular (regular)

10. Abdomen
Shape : Symmetrical
Tenderness : None
Bowel sounds : 14x / min
Lesions : None
11. Repreductions
Genetal state : Clean
Lesions : None
Catheter : Not installed
Hemoroid : Nothing

12.Up / down extremities

o Top
Shape : Symmetrical and complete
Nail circumstances : Short, clean
Movement : Limited in left hand due to impregnated infusion
30gtt /min intravenous fluid Ringer Lactate, muscle strength (4/5)

o Bottom:
Shape : Symmetrical and complete
Nail circumstances : Short net
Movement : Unlimited but weak, normal patellar (+ / +) muscle reflex is
proven by stimulation using a hamer's reflex directly to move the reflex
forward, muscle strength (5/5)
f. Psychological Data

1. Emotional Status: Client's emotions seem stable,

proving the client is always calm
2. Anxiety: Clients look a little anxious
3. Koping Pattern: The client says leave it completely to the
medical team about the condition of the illness. In solving
problems clients often ask for help from others
4. Communication Style: Client can communicate well
5. Self Concept
 Self-image: The client appears patient in accepting
the pain in suffering
 Self-Esteem: Clients want to get home quickly to
reassemble with family and friends
 Role: Clients act as the 1st child of 2 siblings
 Self Identity: The client is male, the client feels
helpless
 Ideal Self: Clients can interact with student nurses
g. Social Data : Clients say want to get well soon
to get school as usual

h. Spiritual Data
o Implementation of worship: Selamadi care for
clients perform worship
in bed
o Trust / Religion: Confident (Clients pray a lot)
DATA ANALYSIS
No Data Interpretation (cause) Problem

1 Ds: - Clients complain of body Aedes aegepty mosquitoes Impaired sense of comfort
heat increased body temperature
Do: - The temperature of the Response antigen antibody

client is 38˚C
Stimulates monocyte cells, neotrophil
- Clients seem limp
eosinophel and macrophages to release
endogenous pyrogenic substances

The impulse is delivered to the hypothalamus

of the thermoregulator via the ductus
thoraticus

Cell point temperature increases

Body temperature increases

Impaired sense of comfort increased body

temperature
2 Ds: - Clients complain limp Virus dengeu Risk deficit of body fluid
Do: - Turgor ugly skin volume
TD: 100 / 60mmHg Antigen-antibody reactions
N: 78x / min
R: 20x / min Stimulates the complement activity of body
S: 38˚C tissues

C3a-C5a

Increased permeability of blood vessels

Transfer of fluid from the blood vessels to the

tissue intert

Volume of blood vessels decreases

Hypovolemic shock

Risk deficit of body fluid volume

 NURSING DIAGNOSES

1 Impaired sense of comfort increased body temperature associated with dengue virus

2 Impaired volume of body fluids is associated with increased permeability of blood vessels
due to dengue virus
 INTERVENTION
No Diagnosa Keperawatan
1 Impaired sense of comfort
increased body temperature
associated with dengue virus
Tujuan
After the nursing action is
expected normal body
temperature with 36˚C-
37˚C client temperature
criteria
Intervention
Tindakan Rasional
• TTV observations • To know the general
• Encourage clients to state of the client
drink extra 200cc every • To memlatasikan blood
1 ° C rise in temperature vessels so that it can
• Encourage warm easily happen evaporation
compresses • To be able to absorb
• Encourage wearing a sweat well and facilitate
thin suit and easy to the evaporation process
absorb sweat
NEXT..
2 Impaired volume of body fluids
is associated with increased
permeability of blood vessels
due to dengue virus
After the treatment is • TTV observations • To know the general
expected to meet the state of the client
needs of body fluids with • Encourage extra • For body fluids to be
the criteria: drinking met
• Good skin turgor • Observe drip drops • To replace the lost
• normal TD diastole 100- electrolyte fluid to avoid
140mmHg, sistol 60- dehydration
100mmHg
• Normal temperature
36˚C-37˚C
• Respiration 16-24x /
min
• A pulse of 60-100x /
min
IMPLEMENTATION
1. Observing TTV
Result:
TD: 100 / 60mmHg
R: 20x / min
N: 78x / min
S: 38.3˚C
2. Advise clients for fluid intake
Result: Client wants to follow nurse suggestion
3. Provide warm compresses on the prontal and axilla
Result: Client temperature dropped slightly
4. Encourage clients to wear thin clothes and easy to absorb sweat
Result: The client is sweating
5. Mengobservasi drip drip
Result:
Knowing the needs of fluids and electrolytes, if the infusion is
jammed the nurse can handle it
EVALUATION
S: - The Client says no shivering
- Clients say they want to increase fluid intake
O: Good Skin Turgor
TTV: TD: 120/80 mmHg
N: 80x / min
R: 20x / min
S: 37,5˚C
A: Partially resolved problem
P: Continue Interversion • Encourage wearing a thin
suit and easy to absorb sweat
THANK YOU
