CHAPTER I

INTRODUCTION
1.1 Background
Dengue is a mosquito-borne disease caused by any one of four closely related dengue viruses
(DENV-1, -2, -3, and -4). Infection with one serotype of DENV provides immunity to that
serotype for life, but provides no long-term immunity to other serotypes. Thus, a person can be
infected as many as four times, once with each serotype. Dengue viruses are transmitted from
person to person by Aedes mosquitoes (most often Aedes aegypti) in the domestic environment.
Epidemics have occurred periodically in the Western Hemisphere for more than 200 years. In the
past 30 years, dengue transmission and the frequency of dengue epidemics have increased greatly
in most tropical countries in the American region.

1.2 Formulation Of Problem

Based on the above problems can be formulated as follows :
a. How medical concept DHF ?
b . How DHF nursing process approach ?

1.3 Objective
1.3.1 General Purpose
To know the medical concept of DHF and DHF how nursing process approach .
1.3.2 Special Purpose
To know the nursing process approach DHF
a) Assessment of the client with DHF
b ) Enforcing nursing diagnoses in clients with DHF
c ) Creating intervention in clients with DHF
d ) Evaluating the implementation of interventions in clients with DHF

CHAPTER II
REVIEW OF TEORI
2.1 Definitions
Dengue Haemorrhagic Fever (DHF) is a disease caused by the dengue virus which is
transmitted through the bite of Aedes aegypti and Aedes albopictus which causes disturbances in
capillary blood vessels and the blood clottingsystem, resulting in bleeding. Dengue hemorrhagic
fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. It causes
abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock).
2.2 Etiology
Causes of DHF is Arbovirus (Arthropodborn Virus) through the bite of Aedes mosquitoes
(Aedes aegypti and Aedes Albopictus) Dengue virus is spread from human to human by
mosquitoes of the genus Aedes, such as Aedes aegypti and Aedes albopictus. Aedes aegypti
spread in the tropics and subtropics are the main vectors. This mosquito is small when compared
to other mosquitoes, typically measuring 3-4 mm. Black body color with white spots all over the
body and head, and a white circle on foot. Chest usually have white markings and scaly wings
and translucent
Aedes aegypti female mosquitoes bite during the day with the peak of activity in the
morning and evening. The development of the Aedes aegypti mosquito lives of bed to adult takes
about 10-12 days. Only female mosquitoes bite and suck blood from humans and choose to keep
back the egg. While unusual male mosquitoes suck blood but only herbal extracts. The mosquito
Aedes aegypti females age 2 weeks. Age Aedes aegypti mosquito flying ability 40-100 m.
2.3 Pathophysiology
Dengue virus into the human body through mosquito bites occur viremia, which is
characterized by sudden onset of fever with no apparent cause other symptoms such as headache,
nausea, vomiting, muscle pain, soreness throughout the body, decreased appetite and abdominal
pain, red spots on the skin. The disorder can also occur in the reticulo endothelial system or as
enlargement of lymph glands, liver and spleen. The release of substances anafilaktoksin,
histamine and serotonin as well as the activity of the system kallikrein causes increased
permeability of the capillary / vascular so that fluid from the intravascular out into the
extravascular or the occurrence of plasma leakage due to enlargement of plasma a reduction in
plasma volume led to hypovolemia, decreased blood pressure, hemokonsentrasi, hipoproteinemia,
effusion and shock. In addition reticulo endothelial system could be disrupted causing antigenantibody reaction that could eventually lead anaphylaxia (Price and Wilson, 2000). Plasma
seeping from the beginning of fever and peaked in shock. In patients with severe shock, the
plasma volume can be reduced to 30% or more. When hypovolemic shock caused by loss of
plasma is not immediately addressed, there will be tissue anoxia, metabolic acidosis and death.
The occurrence of shock is usually on the 3rd and 7th.
2

Another consequence of the dengue virus in the blood circulation will cause bone marrow
depression that will happen thrombocytopenia, which continues to be cause bleeding due to
platelet disorders and coagulation disorders, and finally to the bleeding. Reaction bleeding in
patients with DHF caused a disturbance in hemostasis which include vascular changes,
thrombocytopenia (platelet count <100,000 / mm3), decreased platelet function and decreased
coagulation factors (prothrombin, factor V, IX, X and fibrinogen). Bleeding occurs as ptekie,
ecchymosis, purpura, epistaxis, gingival bleeding, until severe bleeding in the gastrointestinal
tract that extends on Intravascular Coagulation (DIC) can also cause occurs when shock.
2.4 Clinical Diagnosis
Some patients with dengue fever go on to develop dengue hemorrhagic fever (DHF), a
severe and sometimes fatal form of the disease. Around the timethe fever begins to subside
(usually 37 days after symptom onset), the patient may develop warningsigns of severe disease.
Warning signs include severe abdominal pain, persistent vomiting, marked changein temperature
(from fever to hypothermia), hemorrhagic manifestations, or change in mental status (irritability,
confusion, or obtundation). The patient also may have early signs of shock, including
restlessness, cold clammy skin, rapid weak pulse, and narrowing of the pulse pressure (systolic
blood pressure diastolic blood pressure). Patients with dengue fever should be told to return to
the hospital if they develop any of these signs.
DHF is currently defined by the following four World Health Organization (WHO) criteria:
Fever or recent history of fever lasting 27 days.
Any hemorrhagic manifestation.
Thrombocytopenia (platelet count of <100,000/mm3).
Evidence of increased vascular permeability.
The most common hemorrhagic manifestations are mild and include a positive tourniquet
test, skin hemorrhages (petechiae, hematomas), epistaxis (nose bleed), gingival bleeding (gum
bleed), and microscopic hematuria. More serious types of hemorrhage include vaginal bleeding,
hematemesis, melena, and intracranial bleeding.
Evidence of plasma leakage due to increased vascular permeability consists of at least one
of the following:
An elevated hematocrit 20% above the population mean hematocrit for age and sex.
A decline in hematocrit after volume-replacement treatment of 20% of the baseline hematocrit.
Presence of pleural effusion or ascites detected by radiography or other imaging method.
Hypoproteinemia or hypoalbuminemia as determined by laboratory test.
3

WHO is currently reevaluating the clinical case definition for dengue fever and DHF.
Studies from different countries have reported life-threatening complications from dengue in the
absence of one or more of the current criteria for DHF. Despite the name, the critical feature that
distinguishes DHF from dengue fever is not hemorrhaging, but rather plasma leakage resulting
from increased vascular permeability.
Dengue shock syndrome (DSS) is defined as any case that meets the four criteria for DHF
and has evidence of circulatory failure manifested by (1) rapid, weak pulse and narrow pulse
pressure (20 mmHg [2.7 kPa]) or (2) hypotension for age, restlessness, and cold, clammy skin.
Patients with dengue can rapidly progress into DSS, which, if not treated correctly, can lead to
severe complications and death.
Fatality rates among patients with DSS can be 10% or higher but, with early recognition
and treatment, can be less than 1%. DHF and DSS can occur in both children and adults.
2.5 What to Look for When You Evaluate Patients for DHF

EVALUATE the patients heart rate, capillary refill, skin color and temperature, peripheral
pulse volume, pulse pressure, and blood pressure. A drop in systolic blood pressure is
usually the last sign and appears only when the patient is in shock.
LOOK FOR evidence of bleeding on the skin and at other sites.
LOOK FOR evidence of increased capillary permeability (e.g., pleural effusions, ascites,
hemoconcentration).
MEASURE and ask about urine output.

2.6 Clinical Management

Even for outpatients, stress the need to maintain adequate hydration. Monitoring for
warning signs of severe dengue and initiating early appropriate treatment are key to preventing
complications such as prolonged shock and metabolic acidosis. Successfulmanagement of DHF
and DSS includes judicious and timely IV fluid replacement therapy with isotonic solutions and
frequent reassessment of the patients hemodynamic status and vital signs during the critical
phase. Health care providers should learn to recognize this disease at an early stage. To
managepain and fever, patients should be given acetaminophen.Aspirin and nonsteroidal, antiinflammatory medications may aggravate the bleeding tendency associated with some dengue
infections and, in children, can be associated with the development of Reyes syndrome.
2.7 How To Treat Dengue Fever

Tell patients to drink plenty of fluids and get plenty of rest.

Tell patients to take antipyretics to control their temperature. Children with dengue are at
risk for febrile seizures during the febrile phase of illness.
Warn patients to avoid aspirin and other nonsteroidal, anti-inflammatory medications
because they increase the risk of hemorrhage.
4

Monitor your patients hydration status during the febrile phase of illness. Educate
patients and parents about the signs of dehydration and have them monitor their urine
output.
If patients cannot tolerate fluids orally, they may need IV fluids. Assess hemodynamic
status frequently by checking the patients heart rate, capillary refill, pulse pressure, blood
pressure, and urine output.
Perform hemodynamic assessments,baseline hematocrit testing, and platelet counts.
Continue to monitor your patients closely during defervescence. The critical phase of
dengue begins with defervescence and lasts 2448 hours.

2.8 Laboratory Diagnosis

Unequivocal diagnosis of dengue infection requires laboratory confirmation, either by
isolating the virus or detecting dengue-specific antibodies. For virus isolation or detection of
DENV RNA in serum specimens by serotype-specific, real-time reverse transcriptase polymerase
chain reaction (RT-PCR), an acute-phase serum specimen should be collected within 5 days of
symptom onset. If the virus cannot be isolated or detected from this sample, a convalescent-phase
serum specimen is needed at least 6 days after the onset of symptoms to make a serologic
diagnosis by testing for IgM antibodies todengue with an IgM antibody-capture enzymelinkedimmunosorbent assay (MAC-ELISA).
Acute-phase and convalescent-phase serum samples should be sent to the state health
department or tothe Centers for Disease Control and Prevention (CDC)for testing. Acute-phase
samples for virus diagnosis may be stored on dry ice (-70C) or, if delivery can be made within 1
week, stored unfrozen in a refrigerator (4C). Convalescent-phase samples should be sent in a
rigid container without ice, if next-day delivery is assured. Otherwise, they should be shipped on
ice in aninsulated container to avoid heat exposure during transit.
Most tests for anti-dengue antibodies yield nonspecificresults for flaviviruses, including
West Nile and St. Louis encephalitis viruses. Because commercial kits may vary in sensitivity and
specificity, test results may need to be confirmed by a reference laboratory.
2.9 Complication
Complications DHF according to Smeltzer and Bare (2002) is bleeding, circulatory
failure, Hepatomegaly, and pleural effusion.
1. Bleeding
Bleeding in DHF due to vascular changes, decreased platelet count (thrombocytopenia)
<100,000 / mm and coagulopathy, thrombocytopenia, associated with the increase in young
megakoriosit in the bone marrow and the short life span of platelets. Bleeding tendencies seen in
a positive tourniquet test, peteke, purpura, ecchymoses and gastrointestinal bleeding,
hematemesis and melena.
2. Failure circulation
5

DSS (Dengue Shock Syndrome) usually occurs after 2-7 days, due to increased vascular
permeability, causing plasma leakage, fluid serous effusion into the pleural and peritoneal cavity,
hypoproteinemia, hemoconcentration and hipovolemi that result in reduced venous return
(venous return), prelod, myocardium stroke volume and cardiac output, resulting in dysfunction
or circulatory failure and decreased circulation network. DSS is also accompanied by the failure
of hemostasis resulting in myocardial perfusion and cardiac output decreased, impaired blood
flow and tissue ischemia and damage cell function progressive and irreversible, damage cells and
organs so that the patient will die within 12-24 hours.
3. Hepatomegaly
Enlarged liver with weakness generally associated with necrosis due to bleeding, which
occurs in the liver lobule cells and capillaries. Sometimes the neutrophil and lymphocyte cells
appear larger and more complex due to the reaction or viral antibody.
4. Pleural effusion
Pleural effusion due to leakage of plasma extravasation resulting intravascular flow cell
that can be evidenced by the presence of fluid in the pleural cavity in case of pleural effusion will
occur dyspnea, breathlessness.

CHAPTER III
6

NURSING CARE
3.1 Assessment
3.1.1 Identity
a) Age ( DHF most often affects children aged less than 15 years ) .
b) Gender overall there was no difference in patients with DHF . But death is more common
in girls than in boys .
c) Place of residence: This disease was originally found only in a few big cities , then spread
to almost all major cities in Indonesia , even in rural areas with a dense population and in
a relatively short time .
3.1.2 Medical History
1) Main complaint
Patients complain of heat, headache, weakness, heartburn, nausea and decreased appetite.
2) History of present illness
Medical history showed headache, muscle aches, the whole body aches, pain on
swallowing, weakness, heat, nausea, and decreased appetite.
3) History of previous illness
There is no a specific illness.
4) Family history of disease
History of Dengue Hemorrhagic Fever disease in other family members is crucial, due to
Dengue Hemorrhagic Fever disease is a disease that can be transmitted through mosquito
bites aigepty aides.
5) Environmental Health History
Usually less than clean environment, many puddles of water like tin cans, old tires, a
water bird that rarely changed the water, the tub is rarely cleaned.
3.1.3 The Pattern of Functional Perception of Health
a) Nutrition and Metabolic Patterns
Signs: Decreased appetite, nausea, vomiting, thirst, pain when swallowing.
Symptoms: dry mouth mucosa, bleeding gums, tongue dirty, tenderness in the gut.
b) Patterns of elimination
Signs: Constipation, decreased urination, melena, hematuria, (advanced stage).
c) The pattern of activity and exercise
Symptoms: weak Complaints
7

Signs: Dyspnea, Ineffective breathing pattern, due to pleural effusion.

d) Pattern rest and sleep
Symptoms: Fatigue, difficulty sleeping, fever / hot / chills.
Signs: Rapid pulse and weakness, dyspnea, shortness due to pleural effusion, epigastric
pain, aching muscles / joints.
e) The pattern of sensory perception and cognitive
Symptoms: Heartburn, aching muscles / joints, aches throughout the body.
Signs: Anxiety and restlessness.
f) Self-perception and self-concept
Symptoms: Anxiety, fear, anxiety.
g) Circulation
Symptoms: Headache / dizziness, restlessness
Signs: Rapid pulse and weak, hypotension, cold extremities, dyspnea, real bleeding (skin
epistaxis, hematuria melena), increased hematocrit of 20% or more, platelets less than
100,000 / mm.
h) Security
Symptoms: A decrease in immunity, because hipoproteinemia.
i) Hygiene
Hygiene: the family attempts to maintain personal hygiene and the environment tend to be
less, especially for cleaning aedes aegypti mosquito breeding places
3.1.4 Supporting Investigation
Investigations to establish the diagnostic DHF needs to be done various investigations,
including laboratory tests and radiology.
Blood tests
DHF patients on blood tests will be found:

IgG positive dengue (dengue blood)

Trombositipenia
Hemoglobin increased by> 20%
Hemoconcentration (increased hematocrit)
8

 Examination of blood chemistry menunjukn hipoproteinema, hyponatremia,

hypokalemia
AST and ALT may increase
urea and blood Ph may be elevated
prolonged bleeding time
AGD showed asidois metabolic arterial PCO2 <35-40 mmHg, low HCO3.
Laboratory tests of urine: the urine test found minor albumin.
Serologic tests
Several serological tests are commonly performed on clients suspected of DHF are: test
hemagglutination inhibition (HI test), complement fixation test (CF test), test neutralisasi
(N test), IgM Elisa (Mac, Elisa), IgG Elisa. Take measurements of patients by HI antibody
test (hemoglobin Inhibiton test) or to test the binding of complement (complement
fixation test) on serology takes two samples, namely in the acute setting and during
healing. To serology 2-5 ml of venous blood drawn.
Examination of radiology
Photo thorax: the thorax may be encountered pleural effusion.
Ultrasound: the ultrasound found hematomegali and 9ypovolemic9.
3.1.5 Data Analysis
a) Subjective data
Weak.
Heat or fever.
Headache.
Anorexia, nausea, thirst, painful swallowing.
Heartburn.
Pain in the muscles and joints.
Stiffness throughout the body.
Constipation.
b) Objective data
High body temperature, shivering, redness of the face looks.
Dry oral mucosa, bleeding gums, tongue dirty.
Red spots appear on the skin (petechiae), 9ypovolemi test (+), epistaxis, ecchymosis,
Hyperemia of the throat.
Epigastric tenderness.
On palpation palpable enlarged liver and spleen.
On shock (degree IV) rapid and weak pulse, hypotension, cold extremities,
restlessness, peripheral cyanosis, shallow breathing.

3.2 Nursing Diagnoses

1. Hypertermy related to the process of dengue virus infection.
2. Risk for Fluid Volume Deficit related to intravascular fluid into the extravascular
migration.
3. Risk for Shock Hypovolemic related to excessive bleeding, intravascular fluid into the
extravascular migration.
4. Risk for imbalanced Nutrition Less Than Body Requirements related to inadequate
nutritional intake due to nausea and decreased appetite.
5. Risk for Bleeding related to decreased blood clotting factors (thrombocytopenia)

10

3.3 Nursing Intervention

No

1.

Nursing Diagnose

Nursing Planning

Objective / Expected
Outcomes (NOC)
Hypertermy related to the Goal:
process
of dengue virus The body temperature
infection.
returned to normal
Expected outcomes:
Vital signs within normal
limits,
especially
temperature (36 C 37
C)
Mucous
membranes
moist.

Interventions (NIC)

Rational

1. Observation of vital signs every

1 hour.

1. Determining the continued

intervention
when
changes.
2. Compress will provide
induction
heat
expenditure.
3. Changing
the body
fluid that
comes
out
because of heat and spur
spending urine.
4. To provide a sense of
comfort and increase
the evaporation heat
5. Detection
of body
fluid volume deficiency.

2. Give a warm water compress

3. Encourage clients to drink lots

of 1500 2000 ml.
4. Suggest to wear thin clothes
and absorb sweat.
5. Observation on the intake and
out put.

2.

Risk for Fluid Volume

Deficit
related
to
intravascular fluid into the
extravascular migration.

After the act of nursing for ...

x ... hour expected not

happening fluid volume

deficit
Expected Outcomes:
Input and output balanced
Vital signs within normal
limits

6. Collaboration for the provision

of antipyretic

6. Antipyretics useful
heat reduction.

1. Monitor vital signs every 3

hours / more often.

1. Vital sign help identify

fluctuations
in
intravascular fluid.
2. Indications adequacy of
peripheral circulation.

2. Observation of capillary refill.

3. Observation of intake and
output. Note the color of

for

3. Decrease in urine output

concentrated
suspected
11

3.

Risk
for
Shock
Hypovolemic related to
excessive
bleeding,
intravascular fluid into the
extravascular migration

There is no sign of preshock

Capilarry refill less than
3 seconds

after the act of nursing for ...

x ... hour expected not

happening
hypovolemic
shock.
Expected Outcomes :
Vital signs within normal
limits

urine / concentration.
4. Suggest to drink 1500-2000 ml
/ day (as tolerated).
5. Collaboration:
intravenous
fluid
administration.
1. Monitor
patients
condition.

2.

3.

4.
5.

4.

Risk
for
imbalanced after the act of nursing for ...
Nutrition
Less
Than x ... hour expected not an
interruption
nutritional

dehydration.
4. To consume body fluids
orally.
5. It can increase the amount
of body fluid, to prevent
shock 12ypovolemic.

1.

general 1. To monitor the condition of

the
patient
during
treatment, especially when
there is bleeding. Nurses
immediately know the signs
of pre-shock / shock.
Observation of vital signs 2. Nurses need to continue to
every 3 hours or more,
observe the vital signs to
ensure there is no pre-shock
/ shock.
Explain to patients and families 3. By involving the patient
sign
of
bleeding,
and
and family, then the signs of
immediately report if there is
bleeding
can
be
bleeding.
immediately identified and
prompt action, and the right
can be given immediately.
Collaboration:
intravenous 4. Intravenous fluids needed
fluid administration.
to cope with the severe loss
of body fluids.
Collaboration: examination:
5. To determine the level of
HB,
PCV,
platelets.
leakage of blood vessels
experienced by patients and
to take further action
reference.
Assess
nutritional history, 1. Identify
deficiencies,
including a preferred food.
suspect the possibility of

12

Body Requirements related needs.

to inadequate nutritional Expected Outcomes:
intake due to nausea and There are no signs of
decreased
appetite.
malnutrition.
Shows a balanced weight

5.

Risk for Bleeding related

to
decreased blood
clotting factors
(thrombocytopenia)

after the act of nursing for ...

x ... hour expected Not

bleeding.
Expected Outcomes:
Normal blood pressure.
Normal pulse.
There is no sign of
further bleeding, platelets
increased.

intervention.
2. Observation and record the 2. Observing caloric intake /
patients food intake.
lack of quality food
consumption.
3. Measure body weight per day 3. Observing weight loss /
(if possible).
observe the effectiveness of
the intervention.
4. Give food a little but often and 4. little food can reduce
or eat between meals.
vulnerabilities and increase
input also prevent gastric
distention
5. Give and Help oral hygiene.
5. Increased appetite and oral
input.
6. Avoid foods that stimulate and 6. Lowering distention and
gassy.
gastric irritation.
1. Monitor signs of decreased 1. Platelet decline is a sign
platelets
accompanied
by
of blood
vessel leakage,
clinical signs.
which at some stage may
cause clinical signs such as
epistaxis, 13ypovolem.
2. Monitor platelets every day.
2. With the platelets are
monitored on a daily basis,
it can be seen the level of
vascular leak and possible
bleeding experienced by
the patient.
3. Instruct the patient to a lot of 3. patient activity can lead to
rest (bed rest).
uncontrolled bleeding.
4. Provide information to clients 4. The
involvement
of
and families to report any signs
patients and families may
of
bleeding
such
as:
help to early treatment if
hematemesis,
melena,
there is bleeding.
epistaxis.

13

5.

Anticipation of bleeding: use a 5. Prevent further bleeding

soft toothbrush, maintain oral
hygiene, apply pressure take 510 minutes after each blood.

14

3.4 Implementation
Implementation, which is a component of the nursing process , is the category of
nursing behavior where the measures necessary to achieve the objectives and expected
outcomes of nursing care undertaken and completed . ( Perry & Potter , 2005) .
a) The act of Nursing Mandiri.
Without the action taken Orders Doctor. Iuris nursing actions performed by nurses . For
example create a peaceful environment , a warm compress when the client fever .
b) Nursing Collaborative action .
Actions taken by nurses when perawata working with other members of the health care in
making decisions together that persist for troubleshooting client.

3.5 Evaluation
Step evaluation of the nursing process to measure the clients responses to nursing
actions and progress towards achieving the clients goals. Evaluation occurs whenever a nurse
in touch with clients. The emphasis is on client outcomes. The nurse evaluates whether the
clients behavior reflects a setback or advancement in nursing diagnoses (Perry Potter, 2005).
Results of nursing care to clients with DHF in accordance with its intended purpose.
This evaluation is based on the expected results or changes in the patient. The targets of
evaluation in patients with dengue hemorrhagic fever as follows:
a. The patients normal body temperature (360C 370C), the patient is free from fever.
b. Patients will reveal the pain is reduced.
c. The clients nutritional needs are met, patients are able to spend on food in accordance with
the portion given or needed.
d. Fluid balance will remain intact and the patients fluid requirements are met.
e. Daily activities of patients can be met.
f. Patients will retain so there is no shock 15ypovolemic with vital signs within normal limits.
g. Infection does not occur.
h. No further bleeding.
i. Reduced patient anxiety and listened to an explanation of the nurses about the disease
process.

15

CHAPTER IV
ENDED
4.1 Conclusion
Dengue Haemorrhagic Fever (DHF) is a disease caused by the dengue virus which is
transmitted through the bite of Aedes aegypti and Aedes albopictus which causes disturbances
in capillary blood vessels and the blood clottingsystem, resulting in bleeding. Dengue
hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years
of age. It causes abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock).
Nursing Diagnoses :
1. Hypertermy related to the process of dengue virus infection.
2. Risk for Fluid Volume Deficit related to intravascular fluid into the extravascular
migration.
3. Risk for Shock Hypovolemic related to excessive bleeding, intravascular fluid into the
extravascular migration.
4. Risk for imbalanced Nutrition Less Than Body Requirements related to inadequate
nutritional intake due to nausea and decreased appetite.
5. Risk for Bleeding related to decreased blood clotting factors (thrombocytopenia)

4.2 Suggestion
The authors hope that the preparation of a paper on Askep in children / infants with
DHF can provide knowledge and know-how in the field of education and nursing practice .
And also with this paper can be a reference to the action of the nursing process.

16

BIBLIOGRAPHY
Doenges, Marilynn E. 2000. Rencana Asuhan Keperawatan. EGC. Jakarta.
Nugroho T. 2011. Asuhan keperawatan: maternitas, anak, bedah, dan penyakit dalam. Nuha
Medika: Yogyakarta
Nanda.2013.Diagnosis Keperawatan Definisi dan Klasifikasi 2012-2014, EGC: Jakarta
Perry, Potter. 2005. Buku Ajar Fundamental Keperawatan. EGC. Jakarta.
Padila. 2013. Asuhan Keperawatan: Penyakit Dalam. Nuha Medika: Yogyakarta
U.S Departement Of Health And Human Service Center For Disease Control and Prevention.
Dengue and Dengue Hemorragic Fever
Wilkinson J,& Ahern N.2014.Diagnosa Keperawatan Ed.9 Diagnosa NANDA, Intervensi
NIC, Kriteria Hasil NOC .EGC.Jakarta
http://digilib.unimus.ac.id/files/disk1/128/jtptunimus-gdl-kusmiatig0-6388-2-bab2.pdf
http://nanda-nursing.blogspot.co.id/2011/02/nursing-diagnosis-and-nursing_27.html

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