DHF (DENGUE HAEMORRAGHIC FEVER)

By :

1. ABDURRAHMAN AL RASYID
2. AHMAD PRAYOGI
3. AMRINA RIFIA CAHYA
4. ASTRI YULYANDA
5. BELLA MIA APRIANA

SEKOLAH TINGGI ILMU KESEHATAN (STIKes)

MUHAMMADIYAH PRINGSEWU LAMPUNG
2017
 PREFACE

Praise God for the presence of Allah SWT because of the mercy and grace of
his paper entitled "Dengue Haemoragic Fever" this can be completed on time.

Our success in writing this paper certainly can not be separated from the help
of various parties. To that end we extend our gratitude to all those who have
helped the completion of this paper.

We realize that in writing this paper is still far from perfection and there are
still many shortcomings that still need to be improved, therefore we expect
constructive suggestions for the perfection of this paper, so it can be useful for
anyone who reads it.

Pringsewu, November 2017

Arranged

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 TABLE OF CONTENTS

TITLE PAGE .................................................................................................. i

PREFACE ....................................................................................................... ii
CONTENTS .................................................................................................... iii

CHAPTER I INTRODUCTION ..................................................................... 1

A. Background ................................................................................................ 1

CHAPTER II DISCUSSION .......................................................................... 3

A. Definition ................................................................................................... 3
B. Etiology ...................................................................................................... 3
C. Pathophysiology ......................................................................................... 5
D. Symptom Signs .......................................................................................... 7
E. Diagnostic Examination .............................................................................. 7
F. Prevention ................................................................................................... 8
G. Treatment ................................................................................................... 8
H. Scope of Assessment .................................................................................. 9

CHAPTER III CLOSING

BIBLIOGRAPHY

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 CHAPTER I
PRELIMINARY

A. Background
DHF (Dengue Haemorraghic Fever) in ordinary people is often referred to as
dengue fever. According to experts, dengue hemorrhagic fever is referred to as
a disease (especially common in children) caused by Dengue virus with major
symptoms of fever, muscle aches, and joints followed by symptoms
spontaneous bleeding such as; red spots on the skin, nosebleeds, even in
severe conditions accompanied by vomiting or bloody chapter.
Dengue Haemorrhagic Fever (DHF) is a disease caused by the virus Dengue
Famili Flaviviridae, with the genus is flavivirus. This virus has four serotypes
known as DEN-1, DEN-2, DEN-3 and DEN-4.This clinically has different
levels of manifestation, depending on the serotype of Dengue virus.Morbidity
of DHF spreads in tropical countries and Subtropical.
In every country DHF has different clinical manifestations. In Indonesia DHF
was first discovered in 1968 in Surabaya and now spread throughout the
province in Indonesia. The incidence of dengue disease is suspected of a
correlation between strains and genetics, but lately there is a tendency to cause
DHF agents in different areas. This is probably a geographical factor, in
addition to the genetic factors of the host. In addition, based on the kinds of
clinical manifestations that arise and management of conventional DBD has
changed. Dengue virus infection has become a serious health problem in many
tropical and sub tropical countries.

B. Writing Methods
In making this paper, using the method of literature. Review the library of
library materials in accordance with the issues raised in this paper. As a
reference also obtained from the internet web site that discusses about DHF.

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 CHAPTER II
DISCUSSION

A. Definitions
Dengue haemorhagic fever (DHF) is a disease caused by a dengue virus
belonging to a virus belonging to arbovirus and entering into the patient's body
through aedes aegypty mosquito bites (Christantie Efendy, 1995).
Dengue haemorhagic fever (DHF) is a disease found in children and adults
with the main symptoms of fever, muscle pain and joint pain accompanied by
a rash or without a rash. DHF is a virus that belongs to the arbo virus and into
the patient's body through the bite of aedes aegypty mosquito (female)
(Seoparman, 1990).
DHF is a special fever carried by aedes aegypty and some other mosquitoes
that cause fever. Usually rapidly spread efidemically. (Sir, Patrick manson,
2001). Haemorhagic fever haemorrhagic fever (DHF) is an acute disease
caused by viruses transmitted by aedes aegypty mosquitoes (Seoparman,
1996). From some of the above understanding it can be concluded that dengue
haemorhagic fever (DHF) is a disease caused by a dengue virus of a virus
belonging to the arbovirus and entering into the patient's body through aedes
aegypty mosquito bites found in children and adults with the main symptoms
of fever, muscle aches and joint pain accompanied by a rash or without a rash.

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B. Etiology
a. Dengue virus similar arbovirus.
b. The dengue virus belongs to the Flavividae family and is known to be 4
serotifs, Dengue 1 and 2 were found in Irian during World War II, while
dengue 3 and 4 were found at the time of the Philippine epidemic of 1953-
1954. The dengue virus is rod-shaped, thermoragile, sensitive to inactivity
by diaters and sodium dioxicolate, stable at 70 ° C.

C. Pathophysiology
The virus will enter the body through aedes aegypty mosquito bites and will
then react with the antibody and form the virus-antibody complex. In
circulation will activate the complement system. As a result of activation of
C3 and C5 will be released C3a and C5a, two peptides are powerless to release
histamine and is a powerful mediator as a factor increased permeability of
blood vessel walls and removal of plasma through the wall's endothelium.
The occurrence of trobositopenia, decreased platelet function and decreased
coagulation factor (protombin and fibrinogen) are the major factors of
bleeding, especially gastrointestinal bleeding in DHF.
Determining the severity of the disease is the increased permeability of blood
vessel walls, decreased plasma volume, occurrence of hypotension,
thrombocytopenia and hemorrhagic diathesis, remjacation occurs acutely.
The hematocrit value increases with the loss of plasma through the endothelial

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 vessel wall.And with the loss of plasma the client has hypovolemik.Apabila
not addressed can occur tissue anoxia, metabolic acidosis and death.

B. Signs and Symptoms

1. High fever suddenly and continuously for 2-7 days.
2. Bleeding manifestations, including at least positive tourniquet test and
other forms of spontaneous bleeding / bleeding (petechia, purpura,
echimosis, epistaxis, gum hemorrhage) and melena hematemesis.
3. Enlarged liver.
4. Shock, characterized by a weak and rapid pulse accompanied by a
decreased pulse pressure (20 mmHg or less), decreased blood pressure
(systolic pressure decreased to 80 mmHg or less), and skin palpable cold
and moist, especially at the tip nose, fingers, and legs. Patients with
anxiety and cyanosis accompanied by mouth.
At baseline, the differential diagnosis includes bacterial, viral or protozoal
infections such as typhoid fever, measles, influenza, hepatitis,
chikungunya fever, leptospirosis, and malaria. The presence of a clear
tombositopenia accompanied by hemoconcentration differentiates DHF
from other diseases. Other differential diagnoses are sepsis, meningitis,
meningocele, idiophatic thrombosytopenic purpura (ITP), leukemia, and
aplastic anemia.
Chikungunya fever (DC) is highly contagious and usually affects entire
families with sudden fever symptoms. Shorter fever, higher temperatures,
and almost always follow with a maculapopular rash, conjunctival
infections, and frequent joint pain. The proportion of positive bending
tests, petechiae, and epistaxis is similar to DHF. In DC there was no
gastroinstestinal bleeding and shock.

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The first days of ITP are different from DHF because in the ITP the fever
quickly disappears and does not encounter hemoconcentration. While in
the healing phase the difference is telepresent to a faster platelet count
back in DHF.
Bleeding can also occur in leukemia or aplastic anemia. In leukemia,
irregular fever, lymph glands can be palpable and the child is very anemic.
While in aplastic anemia, the child is very anemic and fever arises from
secondary infection.
Death by dengue fever is almost absent, whereas in DHF or DSS the
mortality is quite high. Research in adults in Surabaya, Semarang and
Jakarta shows that prognosis and disease travel are generally milder than
in children.
To break the chain of transmission, vector eradication is considered to be
the most adequate way today. Dengue vectors, especially Aedes Aegypti,
are actually easily eradicated because their nests are confined to places
with clean water with a maximum flying range of 100 m. but because the
vector is widespread, for the success of eradication is required total
coverage (covering the whole region) so that mosquitoes can not
reproduce again.

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C. Classification
a. Degree I:
Fever accompanied by other clinical symptoms or spontaneous
hemorrhage, positivity tourniquet test, thrombocytopenia and
hemoconcentration.
b. Degree II:
Clinical manifestations of degree I with spontaneous bleeding
manifestations under the skin such as peteches, hematomas and bleeding
from other places.
c. Degree III:
Clinical manifestations in degree II coupled with found manifestations of
circulatory system failure in the form of rapid and weak pulse,
hypotension with moist skin, cold and anxious patients.
c. Degree IV:
Clinical manifestations in patients with degree III coupled with heavy shirt
manifestations found with marked tension and unpredictable pulse.

A. Diagnostic Examination
a. Blood
1) Platelets decreased.
2) HB increased by 20%.
3) HT increases by 20%.
4) Leucocytes decrease on days 2 and 3.
5) Low blood protein.
6) Ureum PH may increase.
7) NA and CL are low.

b. Serology: HI (hemaglutination inhibition test).

1) Chest X thorax: Pleural effusion.
2) Test test tourniket (+)

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B. Prevention
Dengue prevention which emphasizes that strengthening the
prevention and control of DF, DHF, DSS at both the local and national
levels should be one of the priorities of WHO Member States where
endemic diseases are present. The resolution also calls for: (1)
strategies developed to address the spread and increase of dengue
incidence should be undertaken by the relevant country, (2) increasing
public health education, (3) promoting health promotion, (4)
strengthening research, (5) dengue surveillance, (6) provision of
guidance in terms of vector control, and (7) mobilization of external
resources for disease prevention should be a priority.

C. Treatment
a. Bed rest
b. Giving soft food.
c. Giving fluids through an IV.
d. Intra venous fluid (usually ringer lactate, nacl) ringer lactate is the
most commonly used intra-venous fluid, containing Na + 130 mEq
/ liter, K + 4 mEq / liter, 28 mEq / liter basic binder, Cl 109 mEq /
liter and Ca = 3 mEq / liter.
e. Provision of drugs: antibiotics, antipyretics,
f. Anti-convulsive if seizures occur
g. Monitor vital signs (T, S, N, RR).
h. Monitor the signs of shock
i. Monitor signs of further bleeding
j. Check HB, HT, and Platelets every day.

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 CHAPTER III
COVER

A. Conclusion
There are many ways to reduce the incidence of DHF. Since the vector of
DHF is Aedes a, then there are some things that should be done to break the
chain of diseases:
1. Without insecticide:
a. Draining tub, jars, drums, etc. at least once a week.
b. Closing the water reservoir tightly.
c. clean the yard from cans, used bottles that allow mosquitoes to nest.

2. With insecticide:
a. Malathion to kill adult mosquitoes: usually with fogging / curing.
b. Abate to kill mosquito larvae denan way sown in vessels water
reservoirs with a dose of 1 gram Abate SG 1% per 10 liters of water.

B. Suggestions
The authors hope that the preparation of a paper on Askep on children / babies
with DHF can provide knowledge and knowledge in the field of education and
nursing practice. And also with this paper can be a reference for action process
of nursing.

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 BIBLIOGRAPHY

Mansjoer, arif.2001. Kapita Selekta Kedokteran Edisi III vol. 1.Jakarta : Media
Aesculapius.

Carpenito, Lynda Jual-Moyet.(2008). Buku Saku Diagnosis Keperawatan Edisi

10.Jakarta : EGC.

Ginanjar, Genis. 2008. Demam Berdarah. Yogyakarta : PT Bentang Pustaka

Gibson, John. 2002. Fisiologi dan Anatomi Modern untuk Perawat Edisi 2.
Jakarta ; EGC

Effendi, Christantie. 1995. Perawatan Pasien DHF edisi 1. Jakarta : EGC