Dengue Fever Nursing Diagnosis and Nursing Care Plan

Dengue Fever Nursing Care Plans Diagnosis and Interventions

Dengue Fever NCLEX Review and Nursing Care Plans

Dengue fever is a mosquito-borne viral infection. Female mosquitoes, mainly Aedes aegypti and, to lesser chances, Aedes albopictus, transmit the dengue virus. These mosquitoes also transmit the chikungunya, yellow fever, and Zika viruses.

The risk of dengue fever varies with the weather, socioeconomic, and environmental factors throughout the tropics.

Dengue causes a wide range of diseases and can range from subclinical disease (where people are unaware they are infected) to severe flu-like symptoms in those who are infected.

Although less prevalent, severe dengue can cause various complications, such as excessive bleeding, organ dysfunction, and plasma leakage.

A strain of the Flaviviridae family causes dengue, and the virus has four different but strongly related serotypes (DENV-1, DENV-2, DENV-3, and DENV-4). It is presumed that recovering from infection provides long-lasting immunity against that serotype.

Nevertheless, cross-immunity to the other serotypes is only limited and temporary after recovery. Subsequent infections with other serotypes raise the likelihood of developing severe dengue.

Signs and Symptoms of Dengue Fever

Most affected patients have no signs or symptoms of dengue fever. When symptoms appear, they can be confused with other illnesses such as the flu and usually appear between four and ten days after being bitten by an Aedes mosquito.

Dengue fever causes a high fever of 104 degrees Fahrenheit (40 degrees Celsius) as well as any of the clinical manifestations listed below:

  • migraine
  • rashes
  • pain in the muscles, bones, or joints
  • pain behind the eyes
  • vomiting
  • nausea
  • swollen glands

Warning signs of severe dengue fever, a potentially fatal condition, can emerge quickly. The following symptoms may appear within the first day or two after the fever has subsided:

  • severe stomachache
  • constant vomiting
  • bleeding from the nose or gums
  • presence of blood in the vomitus, urine, or stool
  • bleeding beneath the skin, which may appear as bruising
  • difficulty in breathing
  • lethargy
  • irritability or agitation

Causes of Dengue Fever

  • Flavivirus. Dengue fever occurs due to a virus of the Flaviviridae family, the Flavivirus genus, which also causes yellow fever, West Nile, and tick-borne encephalitis. There are four different dengue viruses with no cross-resistance. Dengue fever can infect a person up to four times in their lifetime.
    • DENV-1
    • DENV-2
    • DENV-3
    • DENV-4
  • Virus-infected mosquitoes. These are the mosquitoes that transmit the flavivirus.
    • Aedes aegypti. Aedes aegypti is a female mosquito that has been linked to the transmission of dengue, yellow fever, chikungunya, and Zika viruses.
    • Aedes albopictus. Aedes albopictus, referred to as the tiger mosquito or forest mosquito, is a mosquito native to Southeast Asia’s tropical and subtropical regions. This mosquito also causes dengue fever, but to a lesser extent.
  • Maternal Transmission. Mosquito vectors are the primary transmission mode of DENV between humans. However, there is evidence of the possibility of maternal transmission. While vertical transmission rates appear to be low, the probability of vertical transmission appears to be associated with the timing of dengue infection during pregnancy. When a mother has a DENV infection while pregnant, her newborn may have premature birth, low birth weight, and neonatal complications.

Risk Factors to Dengue Fever

  • Standing water. A water-holding container within and around the household required for mosquito development sustains the dengue reservoir and is considered a risk factor.
  • Geographic risk factors. Living in tropical and subtropical areas increases the likelihood of contracting the dengue fever virus. These areas include:
    • Indonesian archipelago into northeastern Australia
    • South and Central America
    • Southeast Asia
    • Sub-Saharan Africa
  • Secondary Infection. Despite the lack of a commercial Dengue fever vaccine, some studies state that infection with one serotype leads to lifelong immunity for that type but short-term immunity for the other three. Consequently, if someone previously exposed to serotype DENV-1 contracts serotypes DENV-2 or DENV-3, or if someone previously exposed to DENV-3 acquires DENV-2, the risk of severe disease from secondary infection increases.
  • Risk factors for severe cases of dengue fever.
    • Age. A severe case of dengue is more prevalent in newborns and young children.
    • Comorbidities. Patients with comorbidities like diabetes or asthma have higher chances of acquiring a severe dengue fever.
    • Polymorphism. Polymorphisms in specific genes have been associated with a higher risk of severe dengue complications.
    • Other risk factors for severe dengue fever include:
      • High BMI. A large study found that obese children were twice as likely to contract DENV infection than non-obese children.
      • Viral load

Complications of Dengue Fever

  • Abdominal pain. Severe dengue fever is distinguished by abdominal pain and discomfort that might be difficult to manage. The condition is often accompanied by nausea and vomiting.
  • Thrombocytopenia. Dengue fever causes a decrease in platelet count because the flavivirus causes platelet damage to blood cells. During dengue fever, antibodies produced during this phase destroy many platelets, causing thrombocytopenia.
  • Mucosal bleeding. Meanwhile, in dengue patients, most mucosal bleeding (gastrointestinal or vaginal bleeding) is related to prolonged shock and metabolic acidosis. In particular, thrombocytopenia and coagulation disorders are the root causes of dengue fever hemorrhage.
  • Kidney failure. Acute kidney failure is a potentially fatal complication of severe dengue infection, and it is commonly associated with hypotension, rhabdomyolysis, or hemolysis. In 2-5% of cases, acute kidney failure exacerbates severe dengue infection and has a high rate of mortality.
  • Hepatic failure. Abrupt dengue infection frequently involves the liver, resulting in acute liver failure with fatal consequences. Many causes contribute to liver dysfunction, including hypoxia injury from diminished perfusion, virus-induced damage, and immune-mediated disease.
  • Dengue shock syndrome. Significant dengue hemorrhagic fever (formerly dengue shock syndrome and dengue hemorrhagic fever) is distinguished by severe plasma leakage, hemorrhaging, and severe organ involvement shown by increased liver enzymes, compromised sensorium, and myocarditis.

Diagnosis of Dengue Fever

  • Nucleic Acid Amplification Tests (NAATs). NAATs are the preferred diagnostic testing method for patients with probable dengue virus fever. NAATs should be conducted on serum samples taken seven days or less after the onset of symptoms. 
  • CDC DENV-1-4 Real-Time RT-PCR Multiplex Assay. This test detects DENV serotypes 1, 2, 3, or 4 in human plasma or serum from patients with dengue fever signs and symptoms.
    • Dengue Virus Antigen Detection. NS1 test can detect the dengue virus’s nonstructural protein NS1. During dengue fever, this protein is released into the bloodstream.
  • Serologic Tests. This diagnostic test looks for antibodies in the blood to confirm if the patient has a recent or current infection.
  • IgM Antibody Capture Enzyme-Linked Immunosorbent Assay (MAC-ELISA). The dengue MAC-ELISA is used to identify dengue virus IgM antibodies qualitatively. IgM antibodies against the dengue virus are detected 4-5 days after the emergence of symptoms and are dependably detectable for around 12 weeks as the immune response fights the infection. IgM antibody detection, on the other hand, is ineffective for determining the dengue virus serotype.
    • Plaque Reduction Neutralization test (PRNT). PRNT is used to verify the invading virus in an IgM-positive dengue or Zika virus specimen and, in rare situations, to define the infecting dengue virus serotype.
    • iGg Testing. Since IgG stays detectable for life after a dengue virus infection, ELISA analysis in single blood serum is ineffective for diagnostic testing.
  • Other laboratory tests:
  • Complete blood count (CBC). This test looks for low platelet count, which is typical of the later phases of the infection, as well as a reduction in hemoglobin, hematocrit, and red blood cell count caused by blood loss from severe dengue fever.
  • Basic Metabolic Panel (BMP). This procedure checks kidney function and looks for signs of dehydration, which can develop after severe sickness.

Treatments of Dengue Fever

  • Medication
    • Pain relievers. Acetaminophen is an over-the-counter (OTC) medication that can help relieve muscle discomfort and fever. However, if the patient has dengue fever, the doctor should advise them to avoid taking aspirin, ibuprofen, and naproxen sodium. These analgesics have been associated with a higher likelihood of dengue fever wound infection.
    • Oral Rehydration Salts. Patients with mild dehydration from severe fever and vomiting should get oral rehydration treatment. From the third day of sickness until 1-2 days following defervescence, patients with known or suspected dengue fever should have their platelet count and hematocrit checked regularly.
    • Intravenous (IV) fluids. It is critical to administer IV fluids to individuals who cannot take fluids orally to prevent dehydration.
  • Blood transfusions and blood products. Patients suffering from internal or gastrointestinal bleeding may require transfusion, whereas those suffering from coagulopathy may require fresh frozen plasma.
  • Supportive Therapy
    • Rest. During the acute febrile period, bed rest is advised.
    • Fluids. Drink enough oral fluids to avoid dehydration. Over ordinary water, fruit juice or electrolyte replacement solution is recommended.
    • Well-balanced diet. Protein and iron-rich foods such as meat, eggs, and liver) are suggested to help patients to recover from dengue fever.
    • Sponging. In order to keep the body temperature below 40°C, use tepid sponging.
    • Oxygen. Providing oxygen for all patients in shock is necessary to avoid more severe complications of dengue.

Nursing Diagnosis for Dengue Fever

Nursing Care plan for Dengue Fever 1

Risk for Bleeding

Nursing Diagnosis: Risk for Bleeding related to poor liver function, increased hematocrit, thrombocytopenia, ruptured blood vessels, and hypovolemic shock secondary to dengue fever.

Desired Outcomes:

  • The patient will take preventative measures and identify symptoms of bleeding that must be reported immediately to a health care expert.
  • The patient will not encounter bleeding, as evidenced by normal blood pressure, stable hemoglobin and hematocrit levels, and coagulation profiles within desired ranges.
Dengue Fever Nursing InterventionsRationale
Educate the dengue patient at risk of bleeding on precautions to avoid tissue trauma or disturbance of the standard blood clotting mechanisms.Proving the patient with knowledge of preventative actions reduces the danger of bleeding.  
Instruct the patient to examine the color and consistency of his or her stools.  Lower gastrointestinal bleeding is indicated by bright red blood in the stools. Upper gastrointestinal bleeding is associated with stools that are dark greenish-black in color and have a tarry substance. Furthermore, gastrointestinal bleeding is dengue fever’s most prevalent type of severe hemorrhage.
Inform the patient about over-the-counter medications and advise them to avoid items containing aspirin or NSAIDs such as ibuprofen and naproxen.  These medications reduce normal platelet aggregation and the integrity of the gastric mucosa by inhibiting cyclooxygenase (COX)-1, increasing the risk of gastrointestinal bleeding. Instead, give the patient acetaminophen to relieve pain.
Advise the patient and family members on the symptoms of bleeding that must be reported to a medical professional immediately.  The earlier a health care provider evaluates and treats bleeding, the lower the chance of severe consequences from blood loss.  
When the patient’s blood tests show aberrant results, provide blood products as directed.  Blood product transfusions supersede blood clotting factors. RBCs boost oxygen-carrying capability. Fresh Frozen Plasma takes the place of clotting factors and inhibitors. Platelets and cryoprecipitate provide proteins for coagulation.

Nursing Care plan for Dengue Fever 2

Risk for Deficient Volume

Nursing Diagnosis: Risk for Deficient Volume related to vascular leakage, hemorrhage, vomiting,  fever, and enhanced capillary permeability secondary to dengue fever.

Desired Outcomes:

  • The patient will be normovolemic if systolic BP is higher than or equal to 90 mmHg (or the patient’s baseline), there is no orthostasis, HR is 60 to 100 beats/min, urine production is more significant than 30 mL/hr, and skin turgor is acceptable.
  • The patient will exhibit lifestyle adjustments To minimize further dehydration,
  • The patient will know the variables causing the fluid deficit and the actions required to correct it.
  • The patient will be instructed to correct or prevent fluid volume loss.
Dengue Fever Nursing InterventionsRationale
Encourage the patient to drink the recommended amount of fluid.                  Oral fluid replacement is suitable for moderate fluid deficits and is a cost-effective approach to dengue replacement treatment. Older patients who have dengue have a diminished sensation of thirst and may require frequent reminders to drink. Fluid replacement can be facilitated by being innovative in picking fluid sources (e.g., flavored gelatin, frozen juice bars, sports drink). As necessary, oral hydration solutions can be considered.  
In dengue fever patients, monitor and record vital signs, particularly blood pressure and heart rate.  A decrease in circulating blood volume can cause hypotension and tachycardia. Heart rate variation is a compensatory method for maintaining cardiac output. The pulse is usually weak and erratic if there is an electrolyte imbalance. Thus, hypovolemia causes hypotension.  
Assist the patient if they cannot eat independently, and encourage family or significant others to assist the patient as needed.    Dehydration is common among dengue fever patients. As a result, dehydrated patients may be lethargic and unable to reach prescribed consumption independently.
Create an emergency plan for the patient, including when to seek assistance.  Some effects of low fluid volume are life-threatening and cannot be corrected at home. Dengue fever patients who are nearing hypovolemic shock will require immediate care.  
Administer parenteral fluids as directed in severe cases of dengue fever-related dehydration. Consider if individuals with aberrant vital signs require an IV fluid challenge with an urgent infusion of fluids.  Fluids are required to keep the body hydrated. The clinical status will determine the type and amount of fluid to be replaced and the infusion rate.  

Nursing Care plan for Dengue Fever 3

Risk for Shock

Nursing Diagnosis: Risk for Shock related to severe plasma leakage, bleeding, or sudden blood pressure drop secondary to dengue fever.

Desired Outcomes:

  • The patient will be able to recognize signs and complications of bleeding that will possibly lead to shock.
  • The patient will know when to call for medical help to prevent shock.
Dengue Fever Nursing InterventionsRationale
Vital signs, orthostatic blood pressure, mental status, and urine output of the patient should all be monitored.      Cool extremities, feeble thready peripheral pulse, prolonged capillary refill, tachycardia in the absence of infection, and decreasing pulse pressure indicate a dengue fever patient is at risk of shock. Therefore, monitoring the patient’s vital signs is critical to avoid shock.
Give the patient oxygen therapy and mechanical ventilation as necessary.  Shock is a potentially fatal condition that develops when the body does not receive adequate blood flow. Hypotension, fast heartbeat, difficulty breathing, anxiousness, and fatigue are all symptoms of shock. It is vital to provide oxygen to dengue fever patients who are currently in shock.  
Continuously monitor the patient’s renal function.  Patients with dengue fever are at risk of going into shock because their blood pressure drops critically low, changing how blood flows through their bodies. Since blood cannot flow as quickly as it should, it cannot supply nutrients to the body’s organs and tissues.
Monitor the patient for dengue fever symptoms such as recurrent bleeding.  Shock occurs when the body starts to shut down due to excessive blood or fluid loss. Hemorrhagic shock occurs when a hypovolemic shock is induced by blood loss. A person may undergo hemorrhagic shock if significant bleeding is not stopped soon after an injury. Understanding the causes of bleeding during a dengue fever infection is vital.    
Monitor the patient for clinical manifestations of respiratory failure, such as decreased PaO2, high PCO2, and respiratory muscle paralysis.    Patients with dengue fever who are in shock may experience a reduction in blood pressure, which limits the passage of oxygen and nutrients to essential organs such as the brain, heart, and lungs. If blood flow is not restored, the patient may die due to problems caused by a lack of oxygen supply to major organs.

Nursing Care plan for Dengue Fever 4

Pain

Nursing Diagnosis: Pain related to muscle cramps and eye and abdominal discomfort secondary to dengue fever as evidenced by lethargy, excessive sweating, changes in blood pressure, heart and respiratory rate, and pupillary dilation.

Desired Outcomes:

  • The patient will have better well-being, as evidenced by baseline pulse, blood pressure, and breathing levels.
  • The patient will employ both pharmaceutical and nonpharmacological pain-relief techniques.
  • The patient’s mood and coping will improve.
Dengue Fever Nursing InterventionsRationale
Perform a thorough pain assessment. Assess the pain’s location, features, onset, duration, frequency, quality, and intensity.                Most dengue fever patients have headaches, muscle and eye pain, and gastrointestinal discomfort. Therefore, the patient in pain is the most trustworthy source of information concerning their discomfort. Their self-report is the gold standard in pain evaluation.  
Perform a pain history evaluation of the patient with dengue fever.  During the pain assessment, the nurse should  ask questions to determine the history of the pain.  
Every time vital signs are checked, the patient’s pain should be assessed too.  Many health care institutions consider pain evaluation the “fifth vital sign,” and it should be included in regular vital sign assessments.
The nurse must initiate the patient’s pain assessments.  Each person’s pain reaction is unique, and some clients may be hesitant to report or speak about their suffering until requested.  
Patients with dengue have several types of pain; Moreover, investigate the patient’s pain-related signs and symptoms.    An accurate pain evaluation is critical in developing a customized plan of care. Bringing attention to accompanying signs and symptoms may aid the nurse in determining the source of the discomfort. In some cases, the patient disregards the presence of discomfort.  

Nursing Care plan for Dengue Fever 5

Risk for Ineffective Perfusion

Nursing Diagnosis:  Risk for Impaired Tissue Perfusion related to circulatory system failure and diminished arterial blood flow due to BP fluctuations secondary to dengue fever.

Desired Outcomes:

  • The patient will report any changes in feeling or pain at the site of tissue damage.
  • The patient will exhibit knowledge of the plan to repair tissue and prevent harm.
Dengue Fever Nursing InterventionsRationale
Examine variations in body temperature, particularly elevated body temperature. Fever is a systemic symptom of dengue fever that can indicate a viral infection.
If there is any, examine the patient’s location and condition of the damaged tissue.  Inflammation and the immune system’s response to localized tissue trauma or decreased tissue integrity are manifested by redness, swelling, discomfort, burning, and itching.  
At least once daily, check the site of compromised tissue integrity for color changes, redness, swelling, warmth, discomfort, or other indicators of infection.  A systematic examination can detect potential complications of dengue fever earlier.
Examine the patient’s nutritional status; recommend a nutritional consultation or start using dietary supplements.Inadequate nutritional intake puts the patient at risk for skin damage and interferes with healing, resulting in compromised tissue integrity.
Examine the patient’s tissues for signs of impaired perfusion.  Specific clusters of signs and symptoms arise for a variety of reasons. Evaluation of the defining aspects of ineffective tissue perfusion offers a baseline for future comparison.  

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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