Dengue Fever and Capillary Refill Time

Dengue fever can be caused by any one of four types of dengue virus: DEN-1, DEN-2, DEN-3, and DEN-4. You can be infected by at least two, if not all four types at different times during your lifetime, but only once by the same type.
You can get dengue virus infections from the bite of an infected Aedes mosquito. Mosquitoes become infected when they bite infected humans, and later transmit infection to other people they bite. Two main species of mosquito, Aedes aegypti and Aedes albopictus, have been responsible for all cases of dengue transmitted in this country. Dengue is not contagious from person to person.
Symptoms of typical uncomplicated (classic) dengue usually start with fever within 5 to 6 days after you have been bitten by an infected mosquito and include: • High fever, up to 105 degrees Fahrenheit • Severe headache • Retro-orbital (behind the eye) pain • Severe joint and muscle pain • Nausea and vomiting • Rash
The rash may appear over most of your body 3 to 4 days after the fever begins. You may get a second rash later in the disease. Symptoms of dengue hemorrhagic fever include all of the symptoms of classic dengue plus • Marked damage to blood and lymph vessels • Bleeding from the nose, gums, or under the skin, causing purplish bruises
This form of dengue disease can cause death.
Symptoms of dengue shock syndrome-the most severe form of dengue disease-include all of the symptoms of classic dengue and dengue hemorrhagic fever, plus • Fluids leaking outside of blood vessels • Massive bleeding • Shock (very low blood pressure)
This form of the disease usually occurs in children (sometimes adults) experiencing their second dengue infection. It is sometimes fatal, especially in children and young adults.
ASSESMENT

11 Year old male pedia patient with Dengue Hemorrhagic Fever

SUBJECTIVE :

“ Ang sakit po ng tiyan ko pati mga tuhod ko at binti” as verbalized by the client. [ My stomach hurts, as well as my knees and legs " ]

OBJECTIVE :

+ Diaphoresis
+ Pupillary dilatation
+ Cold Clammy skin
+Apparent loss of appetite

A documented pain scale of 6 on FPSR Pain scale.

Heart rate – 125 bpm
RR - 34 bpm

DIAGNOSIS

Acute Pain R/T Massive endothelial tissue damage Secondary to pyrogenic dissemination.

OBJECTIVES

SHORT TERM : After 2 hours of nursing interventions, Patient will describe the pain as tolerable with minimal and manageable side effects.

Pain scale using FPSR should range from 0 to 4 and patient should show a decreased sign of pain induced parasympathetic stimulation.

LONG TERM : After 1 day of nursing interventions, Patient should exemplify an acceptable sleep-rest pattern as exhibited by statement of being able to obtain a sufficient amount of rest and sleep as well as an increased appetite manifested by an improved eating pattern.

Patient should also exhibit no signs of pain as documented by a score of 0 on the FPSR scale.

Patient should also manifest no sign and symptom of pain.

INTERVENTION

1. Administer Acetaminophen at minimal dosage as ordered.

2. Carefully monitor patient’s response to the medication by assessing the client

3. Provide a quiet environment conducive to resting and sleep.

4. Provide non pharmacological comfort measures like deep breathing exercises, guided imagery, praying and distractions like story telling and listening to a soothing music.

RATIONALE

* Dengue patients experience hepatomagaly which suggests liver overcompensation that impairs drug metabolism, Acetaminophen should be given at minimal therapeutic dose.

* To detect if the condition is improving or worsening, Or if there is a need to increase the dosage of the medication.

* To promote adequate rest and sleep periods that will prevent fatigue and decrease severity of pain.

* To decrease patient’s perception of pain and increase his tolerance to pain. This will also increase the child’s adaptive pain behaviour.

EVALUATION

SHORT TERM : After 2 hours of nursing interventions, The patient verbalized “Hindi na po masyadong masakit ang katawan ko pati yung mata ko at tuhod” [ I dont feel pain on my body as well as on my eyes and knees anymore " ]

Re assessing FPSR revealed a score of 2. Diaphoresis is not anymore evident. Patient skin is now warm to touch.

LONG TERM : After a day of continuous nursing intervention patient verbalized “Tuloy tuloy naman po ang tulog ko kagabi at kumain na po ako kanina pagka gising ko” [ I slept alright last night, I just ate this morning after I woke up " ]

Re assessing FPSR revealed a score of 0.

Re assessing patient’s vital signs revealed no indication of pain occurrence. Physical assessment suggests no pain related stimulation of the parasympathetic nervous system.

this is my 2nd NCP, all about PAIN... hope you could comment again miss suzanne.

ASSESMENT

11 Year old male pedia patient with Dengue Hemorrhagic Fever rushed in the E.R

SUBJECTIVE :

“Nahihilo po ako, Nauuhaw at nanlalata” as verbalized by the client. [ Means, I AM DIZZY, THIRSY AND I FEEL SO WEAK" ]

OBJECTIVE :

+ Sunken, Dry eyes
+ Pale palpebral conjunctiva
+ Dry lips and mouth
+Prolonged Capillary refill time [ 7 seconds ]
+ Poor skin turgor
+ Rapid, Thready Pulse

Heart rate – 110 Bpm
RR – 21 Bpm
BP – 90/60
Temp – 39.2 C

DIAGNOSIS

Fluid Volume Deficit R/T Intravascular to Extravascular Plasma Leakage Secondary to Increase in Vascular Permeability.

OBJECTIVES

SHORT TERM: After an hour of spontaneous fluid replacement, Patient will gradually abate signs and symptoms of fluid volume deficiency as evidenced by increasing blood pressure, decreasing heart rate, improving capillary refill time preferably below 5s and an improving skin turgor.

{ LONG TERM : After 2 days of nursing intervention, Patient will maintain fluid volume at an amount optimum for normal functioning as evidenced by a normal urine output with normal specific gravity, stable vital signs, moist mucus membrane, good capillary refill time and resolution of third spacing.}

INTERVENTION

1. Anticipate fluid replacement by preparing peripheral route for IV transfusion.

2. Obtain doctor’s order for IV therapy As soon as possible to replace fluid volume loss IMMEDIATELY.

3. Encourage fluid intake by placing a glass of juice or water within the patient’s reach.

4. Monitor total fluid intake and output every 2 hours.

5. Watch trends in output for 3 days; include all routes of intake and output and note color and specific gravity of urine.

6. Monitor vital signs of clients with deficient fluid volume every hour. Observe for decreased pulse pressure first, then hypotension, tachycardia, decreased pulse volume, and increased or decreased body temperature

RATIONALE

1. IV transfusion is a dependent nursing function. Anticipate doctor’s order by providing route for IV fluid replacement to save time and decrease risk for complications.

2. IV is considered as MEDICATION. Before initiating IV Replacement therapy, make sure that there is a current standing or verbal order from the doctor.

3. placing a glass of water or juice at patient’s bedside is the best way to encourage fluid intake. DHF patient are always thirsty prior to the defervescence stage.

4. A urine output of .5 ml per kg/hr is insufficient for normal renal function and indicates onset of renal damage

5. Monitoring for trends for 2 to 3 days gives a more valid picture of the client's hydration status than monitoring for a shorter period. Dark-colored urine with increasing specific gravity reflects increased urine concentration.

6. To monitor and assess client’s response and progress in the fluid replacement therapy.

EVALUATION

SHORT TERM : After an hour of intervention, Patient’s BP increased to 100/70, Tachycardia resolved as evidenced by a normal HR of 80bpm. CRT decreased from 7s down to 4s and there is a noticeable improvement in the client’s skin turgor.

{LONG TERM : 2 Days after a series of nursing care, the patient manifested a normal urine output of 30ml per hour with a specific gravity of 1.011. Stable vital signs were monitored and recorded. CRT was recorded normal. Physical assessment revealed no sign of fluid deficit.}

athophysiology of Dengue Hemorrhagic Fever
By Jessica Pestka, eHow Contributor updated: May 25, 2010
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Signs of dengue fever mosquito image by Daniel Wiedemann from Fotolia.com
Dengue fever, a contagious disease transmitted by the Aedes aegypti mosquito, infects between 50 million and 100 million people worldwide each year. Also known as breakbone or dandy fever, dengue fever is found in the tropical and subtropical regions of the world. Exposure to the flavivirus that causes dengue fever results in one of three pathophysiologies: dengue fever, the more severe dengue hemorrhagic fever (DHF) or dengue shock syndrome. Transmission of Dengue Fever 1. Dengue fever is transmitted only through an infected mosquito or by contact with the blood of someone who is actively infected with one of the four viruses responsible for the fever. Infection with one of these viruses generally provides immunity from dengue fever for as much as a year after the illness. A small minority of cases of dengue fever develop into severe forms of the fever, DHF or dengue shock syndrome, which require hospitalization. Symptoms of Dengue Fever 2. Early symptoms of dengue fever include headache, chills, backache, fever, nausea and joint pain. The initial fever may be as high as 104 degrees Fahrenheit at the onset of the illness and individuals may develop severe pain in the legs and behind the eyes. A rash consisting of patchy bright red spots may develop over the body after the first few days of illness. Time Frame:Dengue Infection 3. After five to eight days of incubation, individuals infected with dengue fever develop symptoms abruptly. The initial symptoms of dengue fever last about six to seven days. The fever climbs rapidly in the first 48 to 96 hours of the illness and then may break for a day before elevating rapidly again. This second phase of the fever is often when a rash may appear on the limbs or chest. Diagnosis of Dengue Fever 4. A diagnosis of dengue fever is typically not considered unless the individual has been in a tropical location where the virus is present such as Central America, South America, Africa or Asia. Clinically, individuals with dengue fever may develop a low white blood cell count by the second day of illness. This low white blood cell count, coupled with the "dengue triad" of fever, rash and headache, represent the most common diagnostic criteria for dengue fever. Prevention of Dengue Fever 5. Dengue fever can only be prevented by avoiding travel to those tropical locations where the illness is present. If travel to tropical regions cannot be avoided, travelers should use barrier and chemical methods to prevent mosquito bites. Once contracted, treatment of dengue fever generally includes rest and fever/pain management. Total recovery from dengue fever may take several weeks. Dengue Fever: Tropical and Subtropical Climates 6. Dengue fever is not present in the United States, although the Centers for Disease Control reports that 100 to 200 cases of dengue fever are brought into the United States each year. Dengue fever is considered endemic in tropical and subtropical areas and outbreaks have occurred in the Virgin Islands, the Caribbean and Puerto Rico.

Read more: Pathophysiology of Dengue Hemorrhagic Fever | eHow.com http://www.ehow.com/about_4674809_pathophysiology-dengue-hemorrhagic-fever.html#ixzz0xG4BZ5cN