Dengue

Dengue
Etiologic agent: Dengue Virus types 1, 2, 3, 4 and chikungunya virus
Source of infection:
a. Immediate source is a vector mosquito, the Aedes Aegypti or the common household mosquito.
b. The infected person
Description: An cute febrile infection of sudden onset with clinical manifestations of 3 stages
 First 4 days – febrile or invasive stage starts abruptly as high fever abdominal pain and
headache; later flushing which may be accompanied by vomiting, conjunctival infection and
epistaxis.
 4th – 7th days – toxic or hemorrhagic stage – lowering of temperature, severe abdominal pain,
vomiting and frequent bleeding from gastrointestinal tract in the form of hematemesis or
melena. Unstable BP, narrow pulse pressure and shock. Death may occur. Tourniquet test which
may be positive on 3rd day may become negative due to low or vasomotor collapse.
 7th to 10th day – convalescent or recovery stage generalized flushing with intervening areas of
blanching appetite regained and blood pressure already stable.
CLASSIFICATION:
 Severe, frank type – with flushing, sudden high fever, sever hemorrhage, followed by sudden
drop of temperature, shock and terminating in recovery or death
 Moderate – with high fever but less hemorrhage, no shock
 Milk – with slight fever, with or without petichial hemorrhage but epidemiologically related to
typical cases usually discovered in the course of investigation of typical cases.
MODE OF TRANSMISSION : mosquito bite (Aedes aegypti)
INCUBATION PERIOD: Uncertain. Probably 6 days to 1 week.
PERIOD OF COMMUNICABILITY: Unknown. Presumed to be on the 1 st week of illness when virus is still
present in the blood.
SUSCEPTIBILITY, RESISTANCE AND OCCURRENCE: All persons are susceptible. Both sexes are equally
affected. Age groups predominantly affected are the preschool age and school age. Adults and infants
are not exempted. Peak age affected is 5-9 years.
Sporadic throughout the year, epidemic usually occurs during the rainy seasons from June to
November. The peak months are September and October.
This disease occurs wherever vector mosquitoes exist. Susceptibility is universal. Acquired
immunity may be temporary but usually permanent.
DIAGNOSTIC TESTS
1. Tourniquet test (rumple leads test)

o Inflate the blood pressure cuff on the upper arms to a point midway between the
systolic and diastolic pressure for 5 to 10 minutes
o Release the cuff and make an imaginary 2.5 cm square of inch square just below the cuff
at the antecubital fossa.
o Count the number of petechiae inside the box. A test is positive when 20 or more
petechiae per 2.5 cm square or 1 inch square are observed.
Management
 Supportive
 Symptomatic
Ex. For fever, give paracetamol.
For muscle pains, Give ibuprofen
For headache, give analgesics but do not give aspirin
Rapid replacement of body fluids is the most important treatment

This includes intensive monitoring or follow-up.
- Give oresol to replace fluid as in moderate dehydration at 75 mL/kg in 4-6 hours or p to 2-3
L in adults.
- Continue ORS intake until patient’s condition improves
METHODS OF PREVENTION AND CONTROL

The infected individual, contacts and environment
Recognition of the disease

Isolation of patient by screening or sleeping under the mosquito net
Epidemiological investigation
Case finding and reporting
Health education
CONTROL MEASURES
Eliminate vector by changing water and scrubbing sides of flower vases once a week.
Destroy breeding laces of mosquito by cleaning surrounding, proper disposal of rubber tires,
empty bottles an cans
Keep water containers covered
Avoid too many hanging clothes inside the house
Residual spraying with insecticide
PUBLIC HEALTH NURSING RESPONSIBILITY
Repeat immediately to the municipal health office any known case outbreak
Refer immediately to the nearest hospital, cases that exhibit symptoms of hemorrhage from any
part of the body no matter how slight
Conduct a strong health education program directed towards environmental sanitation
particularly destruction of all known breeding places or mosquitoes
Conduct a strong health education program directed towards environmental sanitation
particularly destruction of all known breeding places of mosquitoes
Assist in the diagnosis of suspect based on the signs and symptoms for those without signs of
hemorrhage, the nurse may do the tourniquet test.
Conduct epidemiologic investigations as a means of contacting families, case finding and
individual as well as community health education.
NURSING CARE
Any disease or condition associated with hemorrhage is enough cause for alarm. Immediate
control of hemorrhage and close observation of the patient for vital signs leading to shock are
the nurses’ primary concern. Nursing measures are directed towards the symptoms as they
occur but immediate medical attention must be sought.
For hemorrhage, jeep the patient at rest during bleeding episodes. For nose bleeding, maintain
an elevated position of trunk and promote vasoconstriction in nasal mucosa membrane through
an ice bag over the forehead. For melena, ice bag over the abdomen. Avoid unnecessary
movement.
If transfusion is given, support the patient during therapy. Observe vital signs of deterioration or
shock such as low pulse, cold clammy perspiration, prostration.
For shock, prevention is the best treatment.
DORSAL RECUMBENT POSITION FACILITATES CIRCULATION
Adequate preparation of the patient, mentally and physically prevents occurrence of shock
Provision of warmth through lightweight covers (overheating causes vasodilation which
aggravates bleeding)
Diet – low fat, fiber, non-irritating, non-carbonated. Noodle soup may be given.
D daily monitoring of patient status
E encourage intake or oresol
N note any dengue signs
G Give paracetamol instead of aspirin
U Use mosquito net
E Early consultation

Dengue

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Dengue

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Dengue

Etiologic agent: Dengue Virus types 1, 2, 3, 4 and chikungunya virus

MODE OF TRANSMISSION : mosquito bite (Aedes aegypti)

INCUBATION PERIOD: Uncertain. Probably 6 days to 1 week.

1. Tourniquet test (rumple leads test)

Rapid replacement of body fluids is the most important treatment

METHODS OF PREVENTION AND CONTROL

Recognition of the disease

PUBLIC HEALTH NURSING RESPONSIBILITY

DORSAL RECUMBENT POSITION FACILITATES CIRCULATION

D daily monitoring of patient status

E encourage intake or oresol

N note any dengue signs

G Give paracetamol instead of aspirin

U Use mosquito net

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