Articles nursing children with dengue fever

A. DEFINITIONS
DHF is an acute arbovirus infection that enters the body through the bite of a
mosquito species aides. This disease often strikes children, adolescents, and adults
that is characterized by fever, muscle and joint pain. Dengue Fever Dengue often
called Haemoragic Fever (DHF)
B. Pathophysiology
After dengue virus enters the body, the patient will have complaints and symptoms
because of viremia, such as fever, headache, nausea, muscle aches, the whole body
aches, ditenggorokan hyperemia, rash and disorders that may appear on the
reticuloendothelial system such as enlargement of the glands lymph nodes, liver
and spleen. Rash on DHF is caused due to congestion of blood vessels under the
skin.
The main pathophysiological phenomenon which determines the weight of the
disease and distinguish between DF and DHF is heightened because the capillary
wall permeability anafilaktosin release of the substance, histamine and serotonin
and the activation system kalikreain resulting in extravasation of intravascular fluid.
This resulted in reduced volume of Plama, hypotension, hemoconcentration,
hipoproteinemia, effusion and shock. The leakage of plasma into the extravascular
area ibuktikan with the discovery of serous fluid in the cavity, which is in the
peritoneal cavity, pleural and pericardial. Hypovolemic shock that occurs as a result
of loss of plasma, if not resolved soon there will be tissue anoxia, metabolic acidosis
and death. Another cause of mortality in DHF is severe bleeding. Bleeding is
generally associated with thrombocytopenia, platelet function disorders and
abnormalities of platelet function.
Decreased platelet aggregation function may be due to immunological processes as
evidenced by the presence of immune complexes in the blood circulation.
Coagulation system disorder caused by damage including liver function is proven
disturbed by activation of the coagulation system. The problem occurs whether or
DIC in DHF / DSS, especially in patients with severe bleeding.
C. CLASSIFICATION
DHF WHO, 1986 classifies DHF according to the degree of the disease into four
categories, namely:
Grade I Fever with other clinical symptoms, without spontaneous bleeding. Heat 2-7
days, positive tourniquet test, trombositipenia, and hemo concentration.
Grade II Same with degrees I, coupled with spontaneous bleeding symptoms such
as petechiae, ecchymosis, hematemesis, melena, bleeding gums.

Stage III is characterized by symptoms of circulatory failure as a weak and rapid

pulse (> 120x / mnt) narrow pulse pressure (? 120 mmHg), decreased blood
pressure (120/80? 120/100? 120/110? 90/70? 80 / 70? 80/0? 0/0)
No palpable pulse, irregular blood pressure (heart rate? 140x / mnt) limbs felt cold,
sweating and the skin appears blue.

D. SIGNS AND SYMPTOMS

In addition to the signs and symptoms that are displayed based on the degree of
illness, other dangejala signs are:
- The liver is enlarged, amplified spontaneous pain with palpation reaction.
- Ascites
- Fluid in the pleural cavity (right)
- Ensephalopati: convulsions, anxiety, sopor coma.

E. INSPECTION AND dignosis

Thrombocytopenia (? 100,000 / mm3)
- Hb and PCV increase (? 20%)
- Leukopeni (may be normal or leukocytosis)
- Isolation of virus
- Serology (Test H): secondary antibody response
- In severe shock, check: Hb, PCV repeatedly (every hour or 4-6 hours when it is
showing signs of improvement), Faal hemostasis, FDP, EKG, chest Photo, BUN,
serum creatinine.