Dengue hemorrhagic fever is a severe and sometimes fatal infection that occurs tropical regions. It is most common in Southeast Asia and the western Pacific islands. The disease has been increasing rapidly in Latin America and the Caribbean.
Symptoms
Symptoms of the dengue virus generally include:
- mild, moderate, or high fever
- headaches
- nausea
- vomiting
- pain in the muscles, bones, or joints
- rashes on the skin
- restlessness
- acute fever
- bleeding or bruising under the skin
- cold or clammy skin
Exams and Tests
A physical examination may reveal:
- Enlarged liver
- Low blood pressure
- Rash
- Red eyes
- Red throat
- Swollen glands
- Weak, rapid pulse
- Arterial blood gases
- Blood tests (to find signs of the virus in the blood)
- Coagulation studies
- Electrolytes
- Hematocrit
- Liver enzymes
- Platelet count
- Serum studies from samples taken during acute illness and afterwards
- Tourniquet test (causes blood patches to form below the tourniquet)
- X-ray of the chest (may show buildup of fluid in the lungs and chest)
Nursing Care Plan and Interventions
1. Hyperthermia
Rationale: High fever is a hallmark of dengue infection in the febrile phase. Excessive body temperature increases metabolic rate and fluid loss, which may worsen dehydration and capillary leakage.
Interventions:
- Monitor body temperature regularly (e.g., every 2–4 hours), record trends.
- Maintain a comfortable, cool environment; ensure adequate ventilation.
- Administer antipyretics as ordered (e.g., acetaminophen), avoiding NSAIDs that increase bleeding risk.
- Encourage fluid intake (or intravenous fluids if indicated) to compensate for insensible fluid losses.
- Assess for signs of overheating or chills; adjust bedding/clothing accordingly.
2. Deficient Fluid Volume
Rationale: In DHF, increased vascular permeability causes plasma leakage into extravascular spaces, leading to hemoconcentration, intravascular volume depletion, risk of shock, and organ hypoperfusion. Vomiting, high fever, and hemorrhage further deplete fluid volume.
Interventions:
- Strict monitoring of fluid balance: intake and output (I&O), record oral and intravenous fluids, vomitus, bleeding, urine output.
- Measure vital signs frequently: BP, pulse, capillary refill, skin turgor, hematocrit changes.
- Administer IV fluids based on protocol (e.g., maintenance + deficit), and adjust per hemodynamic status.
- Observe for signs of fluid overload once leakage stops (e.g., pleural effusion, edema), and adjust fluid therapy accordingly.
- Reposition patient regularly, encourage frequent small sips of fluids (if oral intake permitted), and maintain oral hygiene.
3. Imbalanced Nutrition: Less Than Body Requirements
Rationale: Patients with DHF often suffer from nausea, vomiting, anorexia, and malaise — reducing oral intake. Combined with increased metabolic demands from fever and fluid shifts, this can lead to nutritional deficits and delayed recovery.
Interventions:
- Assess nutritional intake and tolerance — monitor appetite, frequency of vomiting, and tolerance to small meals.
- Provide small, frequent, easy-to-digest meals or oral rehydration solutions, once nausea is controlled.
- Encourage intake of nutrient- and energy-rich fluids (e.g., oral rehydration salts, broths, electrolyte drinks) — as long as no contraindication to fluid balance.
- Coordinate with dietitian if available for nutritional support and planning.
- Monitor for signs of malnutrition, weight loss, or prolonged weakness.
4. Altered Peripheral Tissue Perfusion
Rationale: Plasma leakage and bleeding reduce effective circulating volume, impairing perfusion to peripheral tissues. This may result in cold, pale skin, prolonged capillary refill, cyanosis, organ hypoperfusion, and in severe cases — shock.
Interventions:
- Monitor peripheral perfusion: skin color, temperature, capillary refill time, pulses, urine output, consciousness level.
- Frequent vital sign checks, especially blood pressure and pulse pressure (narrowing pulse pressure may signal impending shock). :contentReference[oaicite:10]{index=10}
- Ensure adequate fluid resuscitation to maintain perfusion but avoid overload once plasma leakage stops.
- Keep extremities warm, avoid constrictive clothing, and reposition to improve circulation.
- Prepare for immediate transfer or escalation of care if signs of shock or organ hypoperfusion appear.
5. Anxiety
Rationale: The uncertainty of disease progression (from mild dengue to DHF or shock), presence of bleeding signs, frequent monitoring, hospitalization, and potential complications can cause significant emotional stress and anxiety in patients and families.
Interventions:
- Establish a trusting nurse–patient relationship; communicate clearly about the disease process, planned interventions, and what to expect.
- Provide emotional support, reassurance, and allow patient/family to express fears and concerns.
- Educate patient and family about warning signs, importance of fluid management, signs of deterioration, and preventive measures.
- Encourage presence of family or support persons (if allowed) to reduce isolation and promote comfort.
- Refer to counseling or psychosocial support if anxiety persists or affects cooperation with care.
Additional Considerations and Monitoring
Because DHF can rapidly progress, continuous monitoring is essential. Key aspects include:
- Frequent assessment of vital signs, perfusion, fluid balance, and hemorrhagic signs (petechiae, mucosal bleeding, signs of internal bleeding).
- Laboratory monitoring: complete blood count (platelet count), hematocrit, hemoglobin, coagulation profile as ordered.
- Strict adherence to fluid management protocols — under- or over-infusion can both be dangerous.
- Educating patient/family about prevention of secondary infection, signs to report (bleeding, black stool, persistent vomiting, lethargy), and importance of rest.
- Ensuring safe environment: bed rest during critical phase, prevention of injury, careful mobilization once stable.
Conclusion
Dengue Hemorrhagic Fever is a potentially life-threatening condition due to plasma leakage, fluid imbalance, bleeding, and risk of shock. Effective nursing care — grounded in accurate nursing diagnoses such as Hyperthermia; Deficient Fluid Volume; Imbalanced Nutrition; Altered Peripheral Tissue Perfusion; and Anxiety — is vital to support the patient through the critical phase, stabilize physiological status, and promote recovery.
Nurses play a central role in early detection of warning signs, meticulous monitoring, fluid management, nutritional support, and psychosocial care. Through consistent, evidence-based nursing interventions and patient/family education, the morbidity and mortality associated with DHF can be minimized, and recovery can be supported more smoothly.
References
- World Health Organization. Dengue and severe dengue. 2023.
- Mutiara SCL, Koh SC-L, Bachtiar A, Hariman H. The Vascular Endothelium in Patients with Dengue Hemorrhagic Fever. 2019.
- Hallmark of DHF is plasma leakage – observational study on fluid requirements in DHF. BMC Infectious Diseases. 2021.
- “Dengue and Dengue Hemorrhagic Fever.” 2023.
- Nursing care for clients of Dengue Hemorrhagic Fever: literature review. Well-Being Journal. 2024.
