• Severe headache
• Retro-orbital (behind the eye) pain
• Severe joint and muscle pain
• Nausea and vomiting
The rash may appear over most of your body 3 to 4 days after the fever begins. You may get a second rash later in the disease. Symptoms of dengue hemorrhagic fever include all of the symptoms of classic dengue plus • Marked damage to blood and lymph vessels
• Bleeding from the nose, gums, or under the skin, causing purplish bruises This form of dengue disease can cause death.
Symptoms of dengue shock syndrome-the most severe form of dengue disease-include all of the symptoms of classic dengue and dengue hemorrhagic fever, plus • Fluids leaking outside of blood vessels
• Massive bleeding
• Shock (very low blood pressure)
This form of the disease usually occurs in children (sometimes adults) experiencing their second dengue infection. It is sometimes fatal, especially in children and young adults. ASSESMENT
11 Year old male pedia patient with Dengue Hemorrhagic Fever
“ Ang sakit po ng tiyan ko pati mga tuhod ko at binti” as verbalized by the client. [ My stomach hurts, as well as my knees and legs " ]
+ Pupillary dilatation
+ Cold Clammy skin
+Apparent loss of appetite
A documented pain scale of 6 on FPSR Pain scale.
Heart rate – 125 bpm
RR - 34 bpm
Acute Pain R/T Massive endothelial tissue damage Secondary to pyrogenic dissemination.
SHORT TERM : After 2 hours of nursing interventions, Patient will describe the pain as tolerable with minimal and manageable side effects.
Pain scale using FPSR should range from 0 to 4 and patient should show a decreased sign of pain induced parasympathetic stimulation.
LONG TERM : After 1 day of nursing interventions, Patient should exemplify an acceptable sleep-rest pattern as exhibited by statement of being able to obtain a sufficient amount of rest and sleep as well as an increased appetite manifested by an improved eating pattern.
Patient should also exhibit no signs of pain as documented by a score of 0 on the FPSR scale.
Patient should also manifest no sign and symptom of pain.
1. Administer Acetaminophen at minimal dosage as ordered.
2. Carefully monitor patient’s response to the medication by assessing the client
3. Provide a quiet environment conducive to resting and sleep.
4. Provide non pharmacological comfort measures like deep breathing exercises, guided imagery, praying and distractions like story telling and listening to a soothing music.
* Dengue patients experience hepatomagaly which suggests liver overcompensation that impairs drug metabolism, Acetaminophen should be given at minimal therapeutic dose.
* To detect if the condition is improving or worsening, Or if there is a need to increase the dosage of the medication.
* To promote adequate rest and sleep periods that will prevent fatigue and decrease severity of pain.
* To decrease patient’s perception of pain and increase his tolerance to pain. This will also increase the child’s adaptive pain...