OM VERMA ASSISTANT PROFESSOR RELIANCE INSTITUTE OF NURSING DHAMTARI (C.G)

1. PRESENTED BY:-
OM VERMA
ASSISTANT PROFESSOR
RELIANCE INSTITUTE OF NURSING

2. INTRODUCTION
Dengue fever is a
painful debilitating
mosquito born
disease caused by
any one of four
closely related
dengue virus

3. DEFINITION
Dengue fever is transmitted by the bite of an
Aedes mosquito infected with a dengue
virus. The mosquito becomes infected when
it bites a person with dengue virus in
their blood. It can’t be spread directly from
one person to another person.

4. DEFINITION
• Dengue fever is also known as breakbone fever
is a mosquito born tropical disease caused by
the mosquito bite.
• The alternative name for dengue, "breakbone
fever", comes from the associated muscle and
joint pains.
• It is caused by the female aedes aegypti
mosquito bite, which transmit the dengue virus
to human.

5. INCIDENCE
Each year an estimated 100 millions
cases of dengue occur world wide.
• The global incidence of dengue has
grown dramatically in recent decades.
• In INDIA the cases has increase sharply
over past five years there have been
38,000 so far in 2013.

6. Tropical regions are :-
 Indian sub continent
 Mexico
 Africa
 Southern China

9. PHASES

10. Febrile Phase x 7days
High fever 40 °C (104 °F)
headache
generalized arthalgia
myalgia
petechiae
bleeding from mucus membrane.
A rash occurs in 50–80%

11. Critical Phase x 2days
Leukopenia
thrombocytopenia.
Increase capillary permeability
leading to plasma leakage that lead
to metabolic acidosis.
In children febrile phase is common
carries nausea, vomiting,
thrombocytopnea.

12. Recovery phase x 2-3 days
Stabilize hemodynamic status
increase urine output
overall clinical improvement.
Increase in fluid overload can cause
cerebral edema.

14. SIGN & SYMPTOMS
• Fever ( more than 105 )
• Headache
• Muscle, joint pain
• skin rash ( appear 4-5 days after fever )
• Pain behind eyes
• Nausea
• Vomiting
• Mild bleeding

16. WARNING SIGNS
• Severe abdominal pain
• Persistent vomiting
• Vomit with blood
• Drowsiness or irritability
• Dyspnoea
• Swollen lymph node
• Prostration
• diarrhea

17. Dengue with warning signs
• Probable dengue plus one of:
• Abdominal pain or tenderness
• Persistent vomiting
• Signs of fluid accumulation, e.g. pleural effusion or
• ascites
• Mucosal bleed
• Lethargy
• Hepatomegaly > 2 cm
• Rapid increase in haematocrit with fall in platelet
• count
• Needs medical intervention, e.g. intravenous fluid

18. • Severe dengue
• • Severe plasma leakage leading to:
• Shock (dengue shock syndrome)
• Fluid accumulation with respiratory distress
• • Severe haemorrhagic manifestations, e.g. GI
• haemorrhage
• • Severe organ involvement:
• Liver AST or ALT ≥ 1000U/L
• CNS: impaired consciousness
• Cardiomyopathy
• Other organs, e.g. renal impairment
• Needs emergency medical treatment and specialist care with

22. DIAGNOSTIC
TEST

23. WHO-proposed clinical
definition of dengue
PROBABLE DENGUE
• • Exposure in an endemic area
• • Fever
Two of:
• Nausea/vomiting
• Rash
• Aches/pains
• Positive tourniquet test
• Leucopenia
• Any warning sign
• Laboratory confirmation important
• Needs regular medical observation and
instruction in the
warning signs
• If there are no warning signs,
need for hospitalisation is
• influenced by age,
comorbidities, pregnancy and
social factors

25. LABORATORY FEATURES
• include leucopenia, neutropenia, thrombocytopenia
• elevated alanine aminotransferase (ALT) or
aspartate aminotransferase (AST)
• serology or detection of dengue viral material in
blood by RT-PCR

26. • Dengue-specific IgG and IgM ELISA { positive for IgM
antibodies on or after day 5 of the fever}
IgM ELISA has a sensitivity of 83.9–98.4% and
a specificity of 100%
Dengue 2 virus enhancement in asthmatic
and non asthmatic individual.Guzman MG,
Kouri G, Soler M, Bravo J, Rodríguez de
La Vega A, Vazquez S, Mune M

27. • Extravasation of fluid due to vascular leakage can be
detected radiologically (chest radiography for pleural
effusions, echocardiography for pericardial effusions,
ultrasonography for ascites).
[Dengue haemorrhagic fever in children:
ten years of clinical experience].Méndez A,
González G
Biomedica. 2003 Jun; 23(2):180-93.

30. MANAGEMENT
• Bleeding prevention & control.
• Fluid & water replacement.
• Symptoms relief & fever control.

40. NURSING MANAGEMENT
• Increased body temperature related to infection as evidence
by vital sign monitoring.
• Hypovolemic shock related to hemorrhage.
• Fluid volume deficit related to migration of intravascular fluid
into extravascular fluid.
• Impaired nutrition less than body requirement related to
decreased appetite.

42. PROGNOSIS
• For the majority of peoples the people infected with
dengue virus fever the prognosis is excellent.
• Although they are likely to feel very ill during first 1-2
week of acute illness.
• Overall the fatality rate is about 1% for all denge
fever infection.

43. COMPLICATION
• A small percentage of individual who have dengue fever can develop
a more serious form of disease.
• Dengue haemorrhagic fever and disseminated intravascular
• coagulation
• Dengue shock syndrome
• Hepatitis, cerebral haemorrhage or oedema, encephalitis,
• cranial nerve palsies, rhabdomyolysis, myocarditis
• Vertical transmission if infection within 5 wks of delivery