REPORT INTRODUCTION DHF ( Dengue Fever Haemoragic )

In the Arrange
By
M.Ridho Hidayatullah
(1614401110052)

STUDY PROGRAM OF INTERNATIONAL CLASS D3 NURSING

FACULTY NURSING AND HEALTH SCIENCES

University of Muhammadiyah Banjarmasin

 A. Understanding

Haemoragic Dengue Fever (DHF) is a contagious disease caused by the dengue virus and

transmitted through mosquito bites Aedes aegyph (Sri Rezeki H. Hadinegoro, Soegeng, et al,

2004).

Haemorrhagic Fever Dengue (DHF) is an acute febrile illness accompanied by bleeding

manifestations, which tend to cause shock that can cause death (Arief Mansjoer & Suprohaita;

2000; 419).

Haemoragic Fever Dengue (DHF) is an acute infection caused by Arbot virus (arthropodborn

virus) and is transmitted through the bite of Aedes Aegypti and Aedes Albopictus mosquitoes.

(Ngastiyah, 1995; 341).

B. Etiology

Causes of Dengue Virus by Age:

Dengue Haemorrhagic Fever (DHF) / DHF is an acute febrile illness attacking both adults

and children but more likely to cause fatalities in children aged>15 years (Thomas Surusa, Ali

Imran Umar, 2004). mosquito Aedes aegyphor Aedesaibopictusis the capability of transmitting the

dengue virus from the research to others through its bite. Female mosquitoes prefer to suck the

blood of their victims during the day, especially in the morning and at dusk (Alan R. Tumbelaka,

2004).

C. Pathophysiology

The main pathophysiological phenomenon in DHF sufferers is the increased permeability of

capillary walls resulting in the occurrence of extra cell plasma infiltration.

The first thing that happens after the virus into the body of the patient is vitemia which causes

the patient to experience fever, headache, nausea, muscle aches, aches throughout the body, rash
or red spots on the skin (petekie), hyperemia throat, clear, enlarged liver (hepatomegli) and

enlarged spleen.

Increased permeability of capillary walls results in reduced plasma volume, hypotension,

hemoconcentration and hypoprotenia and pleural and shock effusions (shock).

The hemostatic disturbance in DHF involves three factors: vascular changes,

thrombocytopenia and coagulation disorders. Hemoconcentration (an increase in hematocrit>

20%) shows or represents a plasma leakage so that the hematocrit value becomes important for the

intravenous fluid intake standard.

D. Pathway

E. Signs and Symptoms

Clinical Criteria DBD / DHF according to WHO (1997)

1. Sudden fever is high for 2-7 days, then falls lysis with non-specific symptoms, such as

anorexia, malaise, back pain, bone, joints and head.

2. Bleeding (including positive weir test) such as petechiae, epistaxis, hematemosis, melene.

3. Hepatomegali

4. Shock: small and rapid pulse with pulse pressure<20 mmHg hypotensi accompanied by

anxiety and cold acral.

5. Concentration (Ht>20% and normal) (Alan R. Tumbelaka, 2004).

In addition to fever and hemorrhage that are characteristic of DHF, other features that are

not typical and commonly encountered in patients with DHF are:

a) respiratory complaints such as cough, colds, pain swallowing.

b) Complaints of the respiratory tract: nausea, vomiting, loss of appetite (anorexia), diarrhea,

konstipasi.

c) Other system complaints: pain or headache, muscle, bone and joint pain, (break bone

fever), abdominal muscle pain, heartburn, body aches, redness of the skin, flushing of the

face, swelling around the eyes, lacrination and photopobia, the muscles around the eyes are

sore when touched and the movement of the eyeball feels sore.

F. Classification DHF

DHF is classified according to degree of severity of disease, clinically divided into: (WHO,

1997).

1. Degree I

Fever with positive weir test.

2. Degree II

Degree I and with spontaneous bleeding on the skin or elsewhere.

3. Degree III

Fast and weak pulse, pulse pressure<20 mmHg, hypotension, cold acral.

4. Degree IV

Severe shock, pulse not palpable, blood pressure irregular. (Alan R. Tumbelaka, 2004).
G. Investigations

In the blood test of DHF patients will be found:

1. Hb and PCV increased (>20%)

2. Thrombocytopenia (<100,000 / ml)

3. Leukopenia (possibly normal or lecositosis)

4. 19 D. Positive dengue

5. Blood chemistry results show hypoproteinemia, hypochloremia, and hyponatremia.

6. Urium and blood PHmay increase

7. metabolic acidosis PCO2<35-40 mmHg and HCO2 low.

8. SGot / SGPT may increase. (Nursalam, 2005).

H. Management of DHF Patients

Management of patients with DHF is as follows:

1. Bed rest or bed rest.

2. Diet, eat soft.

3. Drink plenty (2-2,5 liter / 24 hours) can be juice, milk, syrup, sweet tea and give oralit

patient.

4. Monitor vital signs every 3 hours and if the condition of the patient worsens strict

observation hourly.

5. Check Hb, Ht and platelets daily.

6. Antipyretics or warm compresses granted if necessary to lower the temperature to <39°C,

recommended giving paracetamol, asetosial / salicylate are not recommended (contra

indications) because it can cause gastritis, bleeding or acidosis.

7. In adult patients, analgesics or mild sedatives are sometimes necessary to relieve

headaches, muscle aches or joint pains.

8. If seizures arise can be given diazepam (collaboration with the doctor).

I. Complications

1. Encephalopative

2. Intractranial Bleeding Brainstem

3. Hernia

4. Sepsis

5. Pneumonia

6. Excessive hydration

7. Shock

8. Brain hemorrhage (Monica Ester, 1999).

J. Nursing Diagnosis Nursing

diagnoses that can be found in patients with DHF include the following:

1. Hyperthermi relationship with the disease process.

2. Nutrition imbalance: less than body requirements associated with nausea, vomiting,

anorexia and swallowing pain.

3. The risk of fluid volume deficiency is related to intravascular fluid transfer to the

extravascular. (Nanda Nursing Diagnosis Guide 2009-2011)

 K. NOC and NIC Planning

No NOC NIC

Dx

1 After a 3x24 hour nursing action, NIC - Thermoregulation 0800

patients with hyperthermia are

· Monitor maximum 4 hours temperature

expected to be resolved with the

· Monitor TTV (TD, N. Temperature,

following outcome criteria: RR)

· Monitor intake and fluid output.

NOC - Temperature Regulation

3900 · Blanket the patient

· Temperature in normal range (36-37 ) · Increase air circulation

· Pulse and RR in normal range (pulse 60-

· Record the presence of blood pressure

100x / min.RR: 16-24X / Minutes) fluctation

· No skin discoloration, and no dizziness

not feeling nausea

2 After 3x24 hours of nursing action, NIC - Nutrition Management

patients with nutritional imbalance

· Record the patient's nutritional status on

less than body needs are expected to admission, note skin turgor.BB, oral

be overcome with yield criteria: mucosal integrity, swallowing ability,

NOC - Nutritional Status: history of nausea / vomiting / diarrhea

· Improve nutritional intake according to

· Ensure normal patient diet pattern

diit nutritional input and expenditure and

periodic CHAPTER
 · Food and fluid intake increases
· Observe· Investigate anorexia

according to diet

· Shows changes in behavior / lifestyle to

boost / maintain BB.

3 After 3x24 hours of nursing action, Fluid Management:

patients at risk of fluid volume

· Monitor BB daily

deficiency are expected to be resolved

· Set infusion drip per minute

by the following outcome criteria: · Increase oral intake

Balance Fluid: · Monitor relevant lab results (BUN,

· Normal blood pressure within HMT, albumin)

24 hours Intake output balanced · Monitor hemodynamic status

· No additional breath sound · TTV

· No ascites monitor · Monitor signs and symptoms of

· No there are edema retention liquids

· No anxiety / anxiety · Give diet

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 Banjarmasin, July 2018

Academic Advisor, Clinical Advisor

(Zaqqyah huzaifah, Ns., M.kep) (.....................................)