Hyperthermia and Acute Pain related to Dengue Fever Hemorrhagic (DHF)

Nursing Diagnosis : Hyperthermia related to disease process (viremia)

Goal :
Patient 's body temperature can be reduced.

Outcome :

• Comfortable body condition.
• Temperature 36,8⁰C-37,5⁰C.
• Blood pressure : 120/80 mmHg.
• Respiration : 16-24 x / mnt.
• Pulse : 60-100 x / mnt.

Intervention :

• Assess the onset of fever.
• Observation of vital signs (temperature, pulse, blood pressure, respiration) every 3 hours.
• Instruct the patient to drink (2.5 liters / 24 hours).
• Give warm compresses.
• Suggest to not wear thick blankets and clothing.
• Give intravenous fluid therapy and medications as ordered.

Rationale :

• To identify patterns of fever.
• Vital Signs is a reference to determine the patient's general condition.
• The increase in body temperature results in increased evaporation body so it needs to be balanced with a high fluid intake.
• With vasodilation can increase evaporation which accelerates the decline in body temperature.
• Clothing thin body helps reduce evaporation.
• Fluid administration is very important for patients with a high temperature.

Nursing Diagnosis : Acute Pain related to pathological disease process.

Goal :
Patient's pain can be reduced and disappeared.

Outcomes :

• The patient said that the pain was reduced / lost.
• The pain was on a scale of 0-3.
• Blood pressure : 120/80 mmHg.
• Temperature : 36,8⁰C-37,5⁰C.
• Respiration : 16-24 x / mnt.
• Pulse : 60-100 x / mnt.

Intervention :

• Observation of the patient's level of pain (scale, frequency, duration).
• Provide a quiet and comfortable environment and comfort measures.
• Give proper entertainment activities.
• Involve families in nursing care.
• Teach the patient relaxation techniques.
• Collaboration with physicians to analgesic drug delivery.

Rationale :

• Indicates the need for intervention and also the signs of the development / resolution of complications.
• A comfortable environment will help the process of relaxation.
• Refocused attention ; improve the ability to cope with pain.
• Family will help the healing process by training the patient relaxation.
• Relaxation pain will move to other things.
• Provide pain relief.

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Nursing Interventions for Dengue Fever - Hyperthermia

Nursing Diagnosis for Dengue Fever : Hyperthermia


Dengue fever, 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. The incidence of dengue fever has increased dramatically since the 1960s, with around 50–100 million people infected yearly. Early descriptions of the condition date from 1779, and its viral cause and the transmission were elucidated in the early 20th century. Dengue has become a global problem since the Second World War and is endemic in more than 110 countries. Apart from eliminating the mosquitoes, work is ongoing on a vaccine, as well as medication targeted directly at the virus. wikipedia

Hyperthermia

Hyperthermia is an elevated body temperature due to failed thermoregulation. Hyperthermia occurs when the body produces or absorbs more heat than it can dissipate. When the elevated body temperatures are sufficiently high, hyperthermia is a medical emergency and requires immediate treatment to prevent disability or death.

The most common causes are heat stroke and adverse reactions to drugs. Heat stroke is an acute condition of hyperthermia that is caused by prolonged exposure to excessive heat or heat and humidity. The heat-regulating mechanisms of the body eventually become overwhelmed and unable to effectively deal with the heat, causing the body temperature to climb uncontrollably. Hyperthermia is a relatively rare side effect of many drugs, particularly those that affect the central nervous system. Malignant hyperthermia is a rare complication of some types of general anesthesia.

Hyperthermia can be created artificially by drugs or medical devices. Hyperthermia therapy may be used to treat some kinds of cancer and other conditions, most commonly in conjunction with radiotherapy.

Hyperthermia differs from fever in the mechanism that causes the elevated body temperatures: a fever is caused by a change in the body's temperature set-point.

The opposite of hyperthermia is hypothermia, which occurs when an organism's temperature drops below that required for normal metabolism. Hypothermia is caused by prolonged exposure to low temperatures and is also a medical emergency requiring immediate treatment. wikipedia

Nursing Interventions for Dengue Fever - Hyperthermia

Hyperthermia Settings

1. Monitor the temperature as needed
2. Monitor blood pressure, pulse and respiration
3. Monitor the temperature and skin color
4. Monitor and report signs and symptoms of hyperthermia
5. Encourage intake of fluids and adequate nutrition
6. Teach clients how to prevent high heat
7. Give antipyretic drugs
8. Give drugs to prevent or control the shivering

Hyperthermia Treatment

1. Monitor the temperature as needed
2. monitor IWL
3. Monitor the temperature and skin color
4. Monitor blood pressure, pulse and respiration
5. Monitor the degree of impairment of consciousness
6. Monitor the ability of the activity
7. Monitor leukocytes, hematocrit, hemoglobin
8. Monitor intake and output
9. Monitor cardiac arrhythmias
10. Encourage increased fluid intake
11. Give intravenous fluids
12. Increase air circulation with a fan
13. Push or do oral hygiene
14. Give antipyretic drugs to prevent the client shivering / seizures
15. Give antibiotic drugs to treat the cause of fever
16. Give oxygen
17. Cold compress on the groin, forehead and axilla.
18. Encourage clients not to wear a blanket
19. Encourage clients to wear clothes made ​​from cold, thin and absorbs perspiration

Environmental Management

1. Give the room as indicated
2. Give your bed and cloth / linen, clean and comfortable
3. Limit visitors

Infection Control

1. Encourage clients to wash their hands before eating
2. Use soap to wash hands
3. Wash hands before and after doing client care activities
4. Replace the infusion and clean place in accordance with SOP
5. Give your skin care in the area of edema
6. Encourage clients to get enough rest
7. Perform infusion with aseptic technique
8. Encourage clients to take antibiotics according to doctors advice.

Source : http://nursing-diagnosis-intervention.blogspot.com/2012/07/nursing-interventions-for-dengue-fever.html

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6 Nursing Diagnosis - Care Plan for Dengue Fever

6 Nursing Diagnosis for Dengue Fever - Care Plan for Dengue Fever
Dengue haemorrhagic fever (DHF) is a disease caused by dengue virus of a virus belonging to arbovirus and entered into the patient's body through the bite of a mosquito "Aedes aegypty" (Christantie Efendy, 1995).

Dengue haemorrhagic fever (DHF) is a disease found in children and adults with primary symptoms of fever, muscle aches and joint pain accompanied by rash or without a rash. DHF is classified as a type of virus arbo virus and entered into the patient's body through the bite of a mosquito "Aedes aegypty" (female) (Seoparman, 1990).


Signs and Symptoms of Dengue Haemorrhagic Fever (DHF)

High fever for 5-7 days
Nausea, vomiting, no appetite, diarrhea, constipation.
Bleeding, especially bleeding under the skin, ptechie, echymosis, hematoma.
Epistaxis, hematemisis, melena, hematuri.
Sore muscles, joints, abdomen, and heartburn.
Headache.
Swelling around the eyes.
Enlarged liver, spleen, and lymph nodes.
Signs of shock (cyanosis, clammy skin, decreased blood pressure, anxiety, capillary refill of more than two seconds, fast and weak pulse.)


Complication of Dengue Haemorrhagic Fever

The complication of dengue fever include:

Extensive bleeding.
Shock or shock.
Effuse pleural
Impairment of consciousness.


Classification of Dengue Haemorrhagic Fever

a. Degree I:
Fever accompanied by other clinical symptoms or spontaneous bleeding, positive tourniquet test, thrombocytopenia and Hemo concentration.

b. Degree II:
Clinical manifestations of degree I with the manifestation of spontaneous bleeding under the skin like petekhie, hematoma and bleeding from other places.

c. Degree III:
Clinical manifestations of degree II, coupled with the circulation system failure was found manifestation in the form of a rapid and weak pulse, hypotension with moist skin, cold and anxious patients.

d. Degree IV:
Clinical manifestations in patients with degree III coupled with a heavy shock was found manifestations with marked tension was measured and no palpable pulse.


Nursing Assessment Nursing Care Plan for Dengue Fever

• Review the basic data, the need for bio-psycho-social-spiritual patients from various sources (patients, families, medical records and other health team members).
• Identify potential sources and available to meet patient needs.
• Review the history of nursing.
• Assess the increase in body temperature, signs of bleeding, nausea, vomiting, no appetite, heartburn, sore muscles and joints, signs of shock (rapid and weak pulse, hypotension, cold and moist skin, especially on the extremities, cyanosis , restlessness, decreased consciousness).

6 Nursing Diagnosis for Dengue Fever - Care Plan for Dengue Fever

1. Hypovolemic shock related to hemorrhage
2. Imbalanced Nutrition: Less than body requirements related to nausea, vomiting, no appetite.
3. Increased body temperature related to the process of dengue virus infection.
4. Risk for bleeding related to thrombocytopenia.
5. Deficient Fluid Volume related to increased capillary permeability, bleeding, vomiting and fever.
6. Deficient Knowledge: about the disease process related to a lack of information.

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