Dengue fever (UK: /de/, US: /di/), also known as breakbone fever, is an infectious tropical disease caused by the

dengue virus. Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles. In a small proportion of cases the disease develops into the life-threatening dengue hemorrhagic fever, resulting in bleeding, low levels of blood platelets and blood plasma leakage, or into dengue shock syndrome, where dangerously low blood pressure occurs. Dengue is transmitted by several species of mosquito within the genus Aedes, principally A. aegypti. The virus has four different types; infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications. As there is no vaccine, prevention is sought by reducing the habitat and the number of mosquitoes and limiting exposure to bites. Treatment of acute dengue is supportive, using either oral or intravenous rehydration for mild or moderate disease, and intravenous fluids and blood transfusion for more severe cases. Typically, people infected with dengue virus are asymptomatic (80%) or only have mild symptoms such as an uncomplicated fever.
[1][2][3]

Others have more severe illness (5%), and in a small proportion it is life-threatening.

[1][3]

The incubation
[4]

period (time between exposure and onset of symptoms) ranges from 314 days, but most often it is 47 days. Therefore, travelers returning from endemic areas are unlikely to have dengue if fever or other symptoms start more than 14 days after arriving home. Children often experience symptoms similar to those of the common cold and gastroenteritis (vomiting and diarrhea), but are more susceptible to the severe complications.
[6] [5] [5]

Treatment depends on the symptoms, varying from oral rehydration therapy at home with close follow-up, to hospital admission with administration of intravenous fluids and/or blood transfusion.
[28]

A decision for hospital admission is typically

[5]

based on the presence of the "warning signs" listed in the table above, especially in those with preexisting health conditions. Intravenous hydration is usually only needed for one or two days.
[28]

The rate of fluid administration is titrated to a urinary

[5]

output of 0.51 mL/kg/hr, stable vital signs and normalization of hematocrit. Invasive medical procedures such as nasogastric intubation, intramuscular injections and arterial punctures are avoided, in view of the bleeding risk. Paracetamol (acetaminophen) is used for fever and discomfort while NSAIDs such as ibuprofen and aspirin are avoided as they might aggravate the risk of bleeding.
[28] [5]

Blood transfusion is initiated early in patients presenting with unstable vital signs

in the face of a decreasing hematocrit, rather than waiting for the hemoglobin concentration to decrease to some predetermined "transfusion trigger" level.
[29]

Packed red blood cells or whole blood are recommended,

[29]

while platelets and fresh frozen plasma are usually not.

Nursing Care Plan for Bronchial Asthma Nursing Assessment for Bronchial Asthma Past medical history : Assess personal or family history of previous lung disease. Review the history of allergic reaction or sensitivity to the substances / environmental factors. Assess the patient's employment history.

1.

o o o

2.

o o o
3.

o o o o o
4.

o o o o
5.

o o o o
6.

Activity The inability to perform activities because of difficulty breathing. The decline in the ability / improvement needs help doing daily activities. Sleeping in a sitting position higher. Respiratory Dipsnea at rest or in response to activity or exercise. Breath worsened when the patient lay supine in bed. Using the drug ventilator, for example: raising the shoulders, widen the nose. The existence of wheezing breath sounds. The recurrent coughing. Circulation The increasing blood pressure. There is an increasing frequency of heart. The color of skin or mucous membranes normal / gray / cyanosis. Redness or sweating. Ego integrity Anxiety Fear Be sensitive to stimuli Restlessness Nutrition Inability to eat due to respiratory distress. Weight loss due to anorexia. Sosal Relations The limited physical mobility. Difficult to talk or stammering. The existence of dependence on others. Sexuality Decrease in libido. Nursing Diagnosis for Bronchial Asthma Ineffective airway clearance related to the accumulation of mucus. Ineffective breathing pattern related to decreased lung expansion. Impaired nutrition less than body requirements related to inadequate intake. Nursing Intervention for for Bronchial Asthma 1. Ineffective airway clearance related to the accumulation of mucus. Goal : The Way of breath effectively.

o o o
7.

o o o o
8.

o
1. 2. 3.

Result Criteria : Shortness reduced Coughing reduced Clients can issue a sputum Wheezing is reduced / lost. Vital signs within normal limits. Nursing Intervention : Auscultation of breath sounds, record the sound of breath, for example: wheezing, erekeis, ronchi. Rational : Some degree of bronchial spasms occur with airway obstruction. Faint breath sounds with expiratory wheeze (empysema), no breathing function (severe asthma). Review / monitor respiratory frequency, record the ratio of inspiration and expiration. Rational : Tachypnoea usually found in some degree and can be found at the reception during the stress / the process of acute infection. Respiratory frequency can be slowed down and elongated than the expiration of inspiration.

Assess the patient to a safe position, for example: elevation of the head does not sit on the backrest. Rational : Elevation head is not easier for respiratory function by using gravity. Observation of the characteristic cough, persistent, hacking cough, wet. Auxiliary actions to improve effectiveness cough efforts. Rational : The cough can be settled but is not effective, especially on elderly clients, acute pain / weakness. Give warm water. Rational : use of warm fluids can decrease bronchial spasms. Collaboration based drug Spiriva indikasi.Bronkodilator 1 1 (inhalation). Rational : Freeing airway spasm, wheezing and mucus production. 2. Ineffective breathing pattern related to decreased lung expansion. Goal : The pattern of effective breathing.

o o

Result Criteria : effective breathing pattern The sound of normal breathing or net Vital signs within normal limits Coughing reduced. Expansion of the lungs inflate. Nursing Intervention : Assess respiratory frequency and depth of chest expansion. Record the respiratory effort including the use of auxiliary respiratory muscles / nasal dilation. R / velocity usually reaches a depth of respiration varies depending on the degree of respiratory failure. Limited chest expansion associated with atelectasis and / or chest pain. Auscultation of breath sounds and record sounds like crekels breath, wheezing. R / rhonchi and wheezing accompanying airway obstruction / respiratory failure. Elevate the head and help change the position. R/ Sitting high enable lung expansion and eases breathing. Observation of the pattern of coughing and secretions character. R / alveolar congestion often result in cough / irritation. Encourage / assist the patient in breathing and coughing exercises. R / Can increase / number of sputum where the interference plus the lack of comfortable ventilation and breathing effort. Collaboration Provide supplemental oxygen. Provide additional humidifikasi eg nebulizer. R / Maximize breath breathe and reduce labor, provide moisture to the mucous membranes and helps thinning secretions.

Assessment Wheezing Coughing Dysnea Expectoration of sputum shortness of breath Tight feeling in chest Increase respiration Apprehension

Nursing Diagnosis Ineffective airway

clearance related To bronchospasm and increased pulmonary secretion Nursing Intervention Nurse in fowler or semi-fowler position Administer humidified oxygen Administer nebulizer of ventolin / normal saline Observe for: cyanosis, breath sound, wheezing, respiratory rate apical pulse, blood pressure, pea expiratory flow. Administer prescribed drugs: I.V Theophyllin (bolus) then in I.V pump. The characteristic symptoms of dengue are sudden-onset fever, headache (typically located behind the eyes), muscle and joint pains, and a rash. The alternative name for dengue, "break-bone fever", comes from the associated muscle and joint pains.[1][7] The course of infection is divided into three phases: febrile, critical, and recovery.[8] The febrile phase involves high fever, often over 40 C (104 F), and is associated with generalized pain and a headache; this usually lasts two to seven days.[7][8] At this stage, a rash occurs in approximately 5080% of those with symptoms.[7][9] It occurs in the first or second day of symptoms as flushed skin, or later in the course of illness (days 47), as a measles-like rash.[9][10] Some petechiae (small red spots that do not disappear when the skin is pressed, which are caused by broken capillaries) can appear at this point,[8] as may some mild bleeding from the mucous membranes of the mouth and nose.[5][7] The fever itself is classically biphasic in nature, breaking and then returning for one or two days, although there is wide variation in how often this pattern actually happens.[10][11] In some people, the disease proceeds to a critical phase, which follows the resolution of the high fever and typically lasts one to two days.[8]During this phase there may be significant fluid accumulation in the chest and abdominal cavity due to increased capillary permeability and leakage. This leads to depletion of fluid from the circulationand decreased blood supply to vital organs.[8] During this phase, organ dysfunction and severe bleeding, typically from the gastrointestinal tract, may occur.[5][8] Shock (dengue shock syndrome) and hemorrhage (dengue hemorrhagic fever) occur in less than 5% of all cases of dengue,[5] however those who have previously been infected with other serotypes of dengue virus ("secondary infection") are at an increased risk.[5][12] The recovery phase occurs next, with resorption of the leaked fluid into the bloodstream.[8] This usually lasts two to three days.[5] The improvement is often striking, but there may be severe itching and a slow heart rate.[5][8] During this stage, a fluid overload state may occur; if it affects the brain, it may cause a reduced level of consciousness or seizures.[5]