Dengue fever is a mosquito-borne viral infection prevalent in tropical and subtropical regions worldwide.
Dengue fever is caused by the dengue virus, which belongs to the Flaviviridae family.
The virus is transmitted to humans through the bite of an infected Aedes mosquito, primarily Aedes aegypti. The following factors can contribute to the development and spread of dengue fever:
- Living in or traveling to dengue-endemic areas
- Poor sanitation and inadequate mosquito control measures
- Lack of immunity to the dengue virus
- Previous dengue infection (increasing the risk of severe dengue)
- Climate conditions favorable for mosquito breeding
Signs and Symptoms (As evidenced by)
Dengue fever can manifest with a variety of signs and symptoms. During a physical assessment, a patient with dengue fever may present with one or more of the following:
Subjective: (Patient reports)
- High fever (40°C/104°F)
- Severe headache
- Pain behind the eyes
- Muscle and joint pain
- Fatigue
- Nausea and vomiting
- Skin rash
- Loss of appetite
Objective: (Nurse assesses)
- Fever (typically biphasic)
- Positive tourniquet test
- Petechiae or ecchymoses
- Bleeding from the mucosa, gastrointestinal tract, or injection sites
- Hepatomegaly
- Tachycardia
- Hypotension (in severe cases)
- Altered level of consciousness
- Laboratory findings:
- Thrombocytopenia (low platelet count)
- Leukopenia (low white blood cell count)
- Elevated hematocrit
- Elevated liver enzymes
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for patients with dengue fever:
- The patient will maintain normal body temperature within 48-72 hours
- The patient will report adequate pain control within 24 hours
- The patient will maintain sufficient hydration status throughout the illness
- The patient will demonstrate improved platelet count and hematocrit levels within 5-7 days
- The patient will show no signs of bleeding or shock
- The patient will verbalize understanding of dengue fever prevention measures upon discharge
Nursing Assessment
The first step in nursing care is the assessment, during which the nurse gathers physical, psychosocial, emotional, and diagnostic data. The following section covers subjective and objective data related to dengue fever.
- Monitor vital signs regularly.
Assess temperature, blood pressure, heart rate, and respiratory rate. Dengue fever typically presents with high fever, and in severe cases, hypotension and tachycardia may occur. - Perform a thorough physical examination.
Look for signs of rash, petechiae, or other bleeding manifestations. Assess for hepatomegaly and signs of fluid accumulation (e.g., ascites, pleural effusion). - Conduct a focused neurological assessment.
Evaluate the patient’s level of consciousness, as altered mental status can be a sign of severe dengue. - Assess fluid status and hydration.
Monitor for signs of dehydration, such as dry mucous membranes, decreased skin turgor, and reduced urine output. - Evaluate pain levels.
Use an appropriate pain scale to assess the severity of headache, muscle pain, and joint pain. - Monitor for warning signs of severe dengue.
Be alert for persistent vomiting, severe abdominal pain, rapid breathing, mucosal bleeding, and lethargy or restlessness. - Obtain blood samples for laboratory tests.
Monitor complete blood count (CBC), liver function tests, and coagulation profile. Pay particular attention to platelet count, hematocrit, and white blood cell count. - Perform the tourniquet test if indicated.
This test can help assess capillary fragility and the risk of bleeding. - Review the patient’s travel history and potential exposure to mosquitoes.
Gather information about recent travel to dengue-endemic areas and mosquito exposure. - Assess the patient’s and family’s knowledge of dengue fever.
Determine their understanding of the disease, its transmission, and prevention measures.
Nursing Interventions
Nursing interventions and care are essential for the patient’s recovery from dengue fever. The following section outlines possible nursing interventions for a patient with dengue fever.
- Administer antipyretics as ordered.
Acetaminophen is preferred for fever reduction. Avoid aspirin and NSAIDs due to the increased risk of bleeding. - Implement fluid management strategies.
Administer intravenous fluids as ordered and encourage oral fluid intake to prevent dehydration and maintain adequate circulation. - Monitor and record fluid intake and output.
Keep an accurate fluid balance chart to assess hydration status and guide fluid therapy. - Provide comfort measures for pain relief.
Use non-pharmacological interventions such as positioning, cool compresses, and relaxation techniques to alleviate pain and discomfort. - Implement bleeding precautions.
Use soft toothbrushes, avoid intramuscular injections, and apply pressure to venipuncture sites for a prolonged period. - Monitor for signs of shock or severe dengue.
Assess for rapid pulse, cold and clammy extremities, delayed capillary refill, and narrowing pulse pressure. - Administer blood products as ordered.
Platelet transfusions may be necessary for severe thrombocytopenia or active bleeding. - Provide adequate rest and limit physical activity.
Encourage bed rest during the acute phase of the illness to conserve energy and reduce the risk of bleeding. - Implement isolation precautions if necessary.
Use standard precautions and mosquito control measures to prevent transmission to healthcare workers and other patients. - Provide patient and family education.
Teach about dengue fever, its course, potential complications, and prevention strategies, including mosquito control measures. - Collaborate with the healthcare team.
Work closely with physicians, infectious disease specialists, and other healthcare professionals to ensure comprehensive care. - Prepare for discharge and follow-up care.
Provide instructions for home care, signs to watch for, and when to seek medical attention.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. The following section presents five Dengue Fever nursing diagnosis.
Care Plan #1: Hyperthermia
Nursing Diagnosis: Hyperthermia related to dengue virus infection as evidenced by body temperature of 40°C (104°F), flushed skin, and tachycardia.
Related factors/causes:
- Viral infection (dengue virus)
- Inflammatory response to infection
Nursing Interventions and Rationales:
- Monitor and record body temperature every 2-4 hours.
Rationale: Frequent monitoring allows for early detection of temperature changes and evaluation of treatment effectiveness. - Administer antipyretics as ordered (preferably acetaminophen).
Rationale: Acetaminophen helps reduce fever without increasing the risk of bleeding, unlike NSAIDs. - Apply cool compresses to the forehead, neck, and extremities.
Rationale: Cool compresses help reduce body temperature through conduction and promote patient comfort. - Encourage increased fluid intake, both oral and intravenous as ordered.
Rationale: Adequate hydration is crucial to prevent complications associated with high fever and support the body’s cooling mechanisms. - Provide a cool, well-ventilated environment.
Rationale: A cool environment facilitates heat loss and improves patient comfort.
Desired Outcomes:
- The patient will maintain body temperature within the normal range (36.5°C – 37.5°C) within 48 hours.
- The patient will report improved comfort and reduced symptoms associated with fever.
Care Plan #2: Acute Pain
Nursing Diagnosis: Acute pain related to inflammatory process and muscle involvement secondary to dengue virus infection as evidenced by patient’s report of severe headache, muscle aches, and joint pain rated 7/10 on the pain scale.
Related factors/causes:
- Inflammatory response to dengue virus infection
- Muscle and joint involvement in dengue fever
Nursing Interventions and Rationales:
- Assess pain characteristics, location, and intensity using a standardized pain scale every 4 hours.
Rationale: Regular pain assessment helps evaluate the effectiveness of pain management strategies and guides further interventions. - Administer prescribed analgesics (acetaminophen) as ordered.
Rationale: Acetaminophen relieves pain without increasing the risk of bleeding associated with dengue fever. - Assist the patient in finding a comfortable position and provide supportive devices.
Rationale: Proper positioning can help alleviate muscle and joint pain and improve comfort. - Apply cold or warm compresses to painful areas as tolerated.
Rationale: Temperature therapy can help reduce pain and discomfort in affected muscles and joints. - Teach and encourage relaxation techniques such as deep breathing and guided imagery.
Rationale: Non-pharmacological pain management techniques can complement medication and improve pain control.
Desired Outcomes:
- The patient will report a pain level reduced to 3/10 or less on the pain scale within 24 hours.
- The patient will demonstrate the use of non-pharmacological pain management techniques.
Care Plan #3: Risk for Deficient Fluid Volume
Nursing Diagnosis: Risk for deficient fluid volume related to increased vascular permeability, fever, and decreased oral intake secondary to dengue fever.
Related factors/causes:
- Increased vascular permeability due to dengue virus infection
- Fever and associated fluid losses
- Decreased oral intake due to nausea and loss of appetite
Nursing Interventions and Rationales:
- Monitor and record fluid intake and output every 4 hours.
Rationale: Accurate fluid balance monitoring helps assess hydration status and guides fluid replacement therapy. - Assess for signs of dehydration (e.g., dry mucous membranes, decreased skin turgor, oliguria) every shift.
Rationale: Early detection of dehydration allows for prompt intervention to prevent complications. - Administer intravenous fluids as ordered, monitoring infusion rate and patient’s response.
Rationale: IV fluid therapy is crucial in maintaining adequate hydration and preventing shock in dengue fever patients. - Encourage oral fluid intake as tolerated, offering small, frequent amounts.
Rationale: Oral hydration complements IV therapy and helps maintain electrolyte balance. - Monitor serum electrolytes and hematocrit levels as ordered.
Rationale: Electrolyte imbalances and hemoconcentration can indicate fluid volume deficits and guide treatment.
Desired Outcomes:
- The patient will maintain adequate hydration, as evidenced by stable vital signs, moist mucous membranes, and urine output >0.5 mL/kg/hour.
- The patient will demonstrate no signs of dehydration or shock throughout the illness.
Care Plan #4: Risk for Bleeding
Nursing Diagnosis: Risk for bleeding related to thrombocytopenia and increased vascular permeability secondary to dengue fever.
Related factors/causes:
- Thrombocytopenia (low platelet count) associated with dengue virus infection
- Increased vascular permeability
- Potential for progression to severe dengue
Nursing Interventions and Rationales:
- Monitor platelet count and coagulation profile as ordered.
Rationale: Regular monitoring helps assess the risk of bleeding and guides interventions. - Assess for signs of bleeding (e.g., petechiae, ecchymoses, mucosal bleeding) every 4 hours.
Rationale: Early bleeding detection allows for prompt intervention and prevention of complications. - Implement bleeding precautions (use a soft toothbrush, avoid intramuscular injections, apply pressure to venipuncture sites).
Rationale: These measures help prevent trauma and reduce the risk of bleeding. - Administer blood products (platelet transfusions) as ordered.
Rationale: Blood product administration may be necessary to correct severe thrombocytopenia and manage active bleeding. - Educate the patient and family about signs of bleeding that should be reported immediately.
Rationale: Patient and family awareness facilitates early detection and reporting of bleeding complications.
Desired Outcomes:
- The patient will demonstrate no signs of active bleeding throughout the illness.
- The patient will maintain a platelet count above 50,000/μL or as targeted by the healthcare team.
Care Plan #5: Knowledge Deficit
Nursing Diagnosis: Knowledge deficit related to unfamiliarity with dengue fever, its management, and prevention, as evidenced by the patient’s questions and expressed confusion about the disease process.
Related factors/causes:
- Lack of exposure to information about dengue fever
- Misunderstandings about disease transmission and management
- Anxiety related to the diagnosis
Nursing Interventions and Rationales:
- Assess the patient’s and family’s current understanding of dengue fever.
Rationale: Identifying knowledge gaps helps tailor education to the patient’s needs. - Provide concise information about dengue fever, its transmission, symptoms, and management.
Rationale: Accurate information empowers the patient and family to participate in care and prevention. - Teach about the importance of hydration and fever management at home.
Rationale: Understanding these key aspects of care promotes better self-management after discharge. - Educate about mosquito control measures and prevention strategies.
Rationale: Knowledge of prevention methods helps reduce the risk of future infections and transmission to others. - Provide written materials and reliable online resources for additional information.
Rationale: Supplementary resources reinforce verbal education and serve as references after discharge.
Desired Outcomes:
- Patient and family will verbalize understanding of dengue fever, its management, and prevention strategies before discharge.
- The patient will be able to identify warning signs requiring immediate medical attention.
Conclusion
Effective nursing care for patients with dengue fever requires a comprehensive approach that addresses the various symptoms and potential complications associated with the disease.
References
- World Health Organization. (2023). Dengue and severe dengue. Retrieved from https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue
- Centers for Disease Control and Prevention. (2023). Dengue. Retrieved from https://www.cdc.gov/dengue/index.html
- Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). NANDA International Nursing Diagnoses: Definitions & Classification 2018-2020. Thieme.
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales. F.A. Davis Company.
- Simmons, C. P., Farrar, J. J., Nguyen, V. V., & Wills, B. (2012). Dengue. New England Journal of Medicine, 366(15), 1423-1432.
- Katzung, B. G., & Trevor, A. J. (Eds.). (2021). Basic & Clinical Pharmacology (15th ed.). McGraw-Hill Education.
- Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2021). Fundamentals of Nursing (10th ed.). Elsevier.
- Gulanick, M., & Myers, J. L. (2017). Nursing Care Plans: Diagnoses, Interventions, and Outcomes (9th ed.). Elsevier.
- World Health Organization. (2009). Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. Retrieved from https://apps.who.int/iris/handle/10665/44188
