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1. DENGUE
Presentation on
By MEENAKSHI
BSC. HONS. NURSING 2ND YR.

2. INTRODUCTION
• Dengue is a mosquito-transmitted virus and the
leading cause of arthropod-borne viral disease in
the world.
• It is also known as breakbone fever due to the
severity of muscle spasms and joint pain, dandy
fever, or seven-day fever because of the usual
duration of symptoms.
• Although most cases are asymptomatic, severe
illness and death may occur.
• Aedes mosquitoes transmit the virus and are
common in tropical and subtropical parts of the
world.

3. DEFINITION
• Dengue is a mosquito-borne viral infection.
• a debilitating viral disease of the tropics,
transmitted by mosquitoes, and causing sudden
fever and acute pains in the joints.

5. EPIDEMIOLOGY
• Dengue is found in tropical and sub-tropical
climates worldwide, mostly in urban and semi-
urban areas.
• The global incidence of dengue has grown
dramatically in recent decades. About half of the
world's population is now at risk. There are an
estimated 100-400 million infections each year.
• It is the fastest spreading mosquito-borne viral
disease in the world, affecting greater than 100
million humans annually.

6. CLASSIFICATION
Severe Dengue
With warning signs
Without warning
signs
1.Severe plasma leakage.
2. Severe haemorrhage.
3.Severe organ impairment.
Dengue (with or without
warning signs )

7. ETIOLOGY
• Dengue is caused by a virus of the
Flaviviridae family and there are
four distinct, but closely related,
serotypes of the virus that cause
dengue (DENV-1, DENV-2, DENV-3
and DENV-4).
• It is transmitted in host by female
aedes aegypti mosquito and Aedes
albopictus.

8. VACTOR
Aedes aegypti
Aedes albopictus

10. TRANSMISSION

11. TRANSMISSION
Transmission of virus to mosquito (vector) through
the bites of an infected human(host).
After feeding on an DENV-infected person, the virus
replicates in the mosquito midgut, before it
disseminates to secondary tissues, including the
salivary glands.
The EIP takes about 8-12 days when the ambient
temperature is between 25-28°C.

12. Cont…
• After this extrinsic incubation period, the virus can
be transmitted to other humans during subsequent
probing or feeding.
• The virus then replicates in the second person and
produces symptoms. Symptoms begin to appear an
average of 4-7days after the Mosquito bite.
(Intrinsic incubation period, within human)

13. PATHOPHYSIOLOGY
• Infection through the mosquito bite.
• macrophages and dendritic cells appear to be the first
targets. then move to the lymph nodes and spread through the
lymphatic system to other organs.
• Viremia may be present for 24 to 48 hours before the onset of
symptoms.
• A complex interaction of host and viral factors then occurs and
determines whether the infection will be asymptomatic, typical, or
severe.
• Severe dengue fever with increased microvascular permeability and
shock syndrome.

14. PATHOPHYSIOLOGY

15. Cont…

17. CLINICAL MANIFESTATION
DENGUE
symptoms during the febrile phase:
• High fever
• severe headache
• pain behind the eyes
• muscle and joint pains
• nausea
• vomiting
• swollen glands
• rash.
Patients with dengue fever

18. High fever Severe headache Pain behind the eyes
Muscle and joint pain Nausea and vomiting Rash
Incubation period ranges from 3 – 14 days,
commonly 4 – 7 days
Clinical Features

19. SEVERE DENGUE
A patient enters what is called the critical phase
normally about 3-7 days after illness onset. It is at this
time, when the fever is dropping (below 38°C/100°F)
in the patient, that warning signs associated with
severe dengue can manifest. Severe dengue is a
potentially fatal complication, due to plasma leaking,
fluid accumulation, respiratory distress, severe
bleeding, or organ impairment.
Patients with severe dengue

23. COMPLICATIONS
• Liver injury
• Cardiomyopathy
• Pneumonia
• Seizures
• Encephalopathy
• Encephalitis

24. RISK FACTORS
• Infants and elderly
• Obesity
• Pregnancy
• Peptic ulcer disease
• Haemolytic diseases
• Congenital heart disease

25. COURSE OF
DENGUE

26. FEBRILE PHASE Dehydration; high fever may
cause neurological disturbances
and febrile
seizures in young children.
CRITICAL PHASE Shock from plasma leakage;
severe haemorrhage; organ
impairment.
RECOVERY PHASE Hypervolaemia (only if
intravenous fluid therapy has
been excessive and/or
has extended into this period)

36. LABORATORY FINDINGS
• Thrombocytopenia
• Leukopenia
• Mild moderate elevation of ALT/AST
SEVERE DENGUE
• Increased HCT.
• Hyproprotenemia
• Prolonged PT and APTT
• Decreased fibrinogen

37. MEDICAL MANAGEMENT
• Oral rehydration therapy.
• IV fluids
• Blood transfusion and blood products( Coagulopathy)
• Oral fluids
• Avoid Aspirin

38. NURSING MANAGEMENT
• Assess for signs and symptoms if GI bleeding.
• Check for The secretions.
• Observe for Petechiae ecchymosis, bleeding For one or
more sites.
• Monitor vital signs.
• Note any change in level of consciousness.
• Avoid rectal temperature.
• Encourage the use of soft tooth brush.
• Tapid sponging.

39. Cont…
• Avoid straining for stool and forceful nose blow.
• Apply pressure to veinpunture site for larger than
usual.
• Avoid use of Aspirin.
• Monitor hb, HCT, and clotting factors.

40. NURSING DIAGNOSIS
• Hyperthermia related to viral infection.
• Risk For bleeding related to possible impaired
liver function.
• Deficient fluid volume related to vascular leakage.
• Pain related to abdominal pain and Severe
headache.
• Risk for ineffective tissue Perfusion related to
Failure of circulatory system.

41. Hyperthermia

42. INTERVENTIONS
• Monitor vital signs
• Provide Tapid sponge bath.
• Encourage Adequate bed rest.
• Remove excessive clothing, blanket. Adjust room temperature.
• Administer prescribed anti pyretic medications.

44. INTERVENTIONS
• Explain the different risk for bleeding.
• Limit straining with bowel movements, forceful nose blowing,
coughing, or sneezing.
• Inform the patient to check the color and consistency of
stools.
• Provide psychological and emotional support to the patient.
• Advice patient to use soft bristles toothbrush.

46. INTERVENTIONS
• Urge the patient to drink prescribed amount of fluid.
• Insert and IV catheter to have IV access.
• Administer blood products as prescribed.
• Maintain I/O chart.
• Monitor electrolyte results
• Assess skin turgor and mucous membranes
• Provide oral hygiene.

47. PAIN

48. INTERVENTION
• Monitor pain.
• Assess client’s response to pain.
• Monitor vital signs.
• Provide comfort measures like change in position.
• Provide analgesic as prescribed by physician.

50. INTERVENTION
• Monitor vitals.
• Elevate head of bed about 10 degree.
• Administer Medications as prescribed.
• Administer and regulate IV fluids as ordered.

52. PREVENTION AND CONTROL
• Prevention of mosquito breeding:
• Personal protection from mosquito bites:
• Community engagement:
• Reactive vector control:
• Active mosquito and virus sursurveillance.
• Vaccination

55. TREATMENT
• There is no specific treatment for dengue.
• Supportive care is provided.
• Drugs used to control fever :
Acetaminophen (panadol)
• Avoid use of aspirin.
• Avoid use of NSAIDs
(Ibuprofen)

57. HEALTH EDUCATION
• Advice patient not to use diuretics such as tea, coffee and alcohol.
• Advice patient to isolate himself during the incubation period.
• Follow up appointment : Comply with the recommended medical
and laboratory Follow ups.
• Oral care: Recommend use of soft toothbrush to reduce risk of
injury to the oral mucosa.
• Diet : advice patient to take vitamin k rich Foods.
• Advice patient to take medicine on time as prescribed by physician.

58. SUMMARY
• Dengue is a mosquito born viral infection .It is found in
tropical and subtropical regions. While it can be Mild
illness Like acute flue illness or develop into a
potentially lethal complications. Called severe dengue.
Common symptoms can be headache , fever, rashes.
• There is no specific treatment for dengue. Supportive
treatment is given. Prevention and control measures
should be taken.