Intervention nursing care is necessary teratment also in patients with dengue fever, dengue hemorrhagic fever, or dengue shock syndrome.
NURSING CARE
• Dengue fever is usually a self-limited illness, and only supportive care is required. Acetaminophen may be used to medication patients with symptomatic fever. Such as : Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and Corticosteroids should be avoided. And nurse give medicine every three time days and then giving injection IC boluse 2X1/ days.
• Nurse must known with patient about suspected dengue fever should have their platelet count and hematocrit measured daily from the third day of illness until 1-2 days after defervescence. Patients with a rising hematocrit level or falling platelet count should have intravascular volume deficits replaced. Patients who improve can continue to be monitored in an outpatient setting. Patients who do not improve should be admitted to the hospital for continued hydration.
• Nurse must known condition and monitoring the patient about develop checking vital signs of dengue hemorrhagic fever warrant closer observation. Patients who develop signs of dehydration, such as tachycardia, prolonged capillary refill time, cool or mottled skin, diminished pulse amplitude, altered mental status, decreased urine output, rise in hematocrit levels, narrowed pulse pressure, or hypotension, require admission for intravenous fluid administration.
• Successful management of severe dengue requires careful attention to fluid management and proactive treatment of hemorrhage. Intravascular volume deficits should be corrected with isotonic fluids such as Ringers lactate solution. Boluses of 10-20 mL/kg should be given over 20 minutes and may be repeated. If this fails to correct the deficit, the hematocrit value should be determined, and, if it is rising, limited clinical information suggests that a plasma expander may be administered. Starch, dextran 40, or albumin 5% at a dose of 10-20 mL/kg may be used. One recent study has suggested that starch may be preferable because of hypersensitivity reactions to dextran.If the patient does not improve after this, blood loss should be considered. Patients with internal or gastrointestinal bleeding may require transfusion. Patients with coagulopathy may require fresh frozen plasma.
• After patients with dehydration are stabilized, nurse usually require intravenous fluids for no more than 24-48 hours. Intravenous fluids should be stopped when the hematocrit level falls below 40% and adequate intravascular volume is present. At this time, patients reabsorb extravasated fluid and are at risk for volume overload if intravenous fluids are continued. Do not interpret a falling hematocrit value in a clinically improving patient as a sign of internal bleeding.
• Platelet and fresh frozen plasma transfusions may be required to control severe bleeding. A recent case report demonstrated good improvement following intravenous anti-D globulin administration in two patients. The authors proposed that, similarly to nondengue forms of immune thrombocytopenic purpura, intravenous anti-D produces Fcγ receptor blockade to raise platelet counts.
• And then nurse known the patient are resuscitated from shock rapidly recover. Patients with dengue hemorrhagic fever or dengue shock syndrome may be discharged from the hospital when they meet the following criteria:
o Afebrile for 24 hours without antipyretics
o Good appetite, clinically improved condition
o Adequate urine output
o Stable hematocrit level
o At least 48 hours since recovery from shock
o Absence of respiratory distress
o Platelet count greater than 50,000 cells/μL (Potter, 2005).
NURSING CARE
• Dengue fever is usually a self-limited illness, and only supportive care is required. Acetaminophen may be used to medication patients with symptomatic fever. Such as : Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and Corticosteroids should be avoided. And nurse give medicine every three time days and then giving injection IC boluse 2X1/ days.
• Nurse must known with patient about suspected dengue fever should have their platelet count and hematocrit measured daily from the third day of illness until 1-2 days after defervescence. Patients with a rising hematocrit level or falling platelet count should have intravascular volume deficits replaced. Patients who improve can continue to be monitored in an outpatient setting. Patients who do not improve should be admitted to the hospital for continued hydration.
• Nurse must known condition and monitoring the patient about develop checking vital signs of dengue hemorrhagic fever warrant closer observation. Patients who develop signs of dehydration, such as tachycardia, prolonged capillary refill time, cool or mottled skin, diminished pulse amplitude, altered mental status, decreased urine output, rise in hematocrit levels, narrowed pulse pressure, or hypotension, require admission for intravenous fluid administration.
• Successful management of severe dengue requires careful attention to fluid management and proactive treatment of hemorrhage. Intravascular volume deficits should be corrected with isotonic fluids such as Ringers lactate solution. Boluses of 10-20 mL/kg should be given over 20 minutes and may be repeated. If this fails to correct the deficit, the hematocrit value should be determined, and, if it is rising, limited clinical information suggests that a plasma expander may be administered. Starch, dextran 40, or albumin 5% at a dose of 10-20 mL/kg may be used. One recent study has suggested that starch may be preferable because of hypersensitivity reactions to dextran.If the patient does not improve after this, blood loss should be considered. Patients with internal or gastrointestinal bleeding may require transfusion. Patients with coagulopathy may require fresh frozen plasma.
• After patients with dehydration are stabilized, nurse usually require intravenous fluids for no more than 24-48 hours. Intravenous fluids should be stopped when the hematocrit level falls below 40% and adequate intravascular volume is present. At this time, patients reabsorb extravasated fluid and are at risk for volume overload if intravenous fluids are continued. Do not interpret a falling hematocrit value in a clinically improving patient as a sign of internal bleeding.
• Platelet and fresh frozen plasma transfusions may be required to control severe bleeding. A recent case report demonstrated good improvement following intravenous anti-D globulin administration in two patients. The authors proposed that, similarly to nondengue forms of immune thrombocytopenic purpura, intravenous anti-D produces Fcγ receptor blockade to raise platelet counts.
• And then nurse known the patient are resuscitated from shock rapidly recover. Patients with dengue hemorrhagic fever or dengue shock syndrome may be discharged from the hospital when they meet the following criteria:
o Afebrile for 24 hours without antipyretics
o Good appetite, clinically improved condition
o Adequate urine output
o Stable hematocrit level
o At least 48 hours since recovery from shock
o Absence of respiratory distress
o Platelet count greater than 50,000 cells/μL (Potter, 2005).
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