Nursing intervention for dengue in the baby?

Answer 1

As Dengue Hemmorrhagic Fever (DHF) (or "Bonebreak Feber") is endemic to the Middile East, Far East, Africa and the Carribean, the answer would be a little different than for a colder climate, higher economy hospital. Note that this disorder has the highest M&M rate with infants. Transmission is via the vector, the Aedes mosquito -- a daytime feeder. So epidemiological concerns will focus strongly on vector control. As with so many hemorrhagic fevers, prompt diagnosis is difficult, even in the most well-equipped areas, so I'd focus a lot on the standard prophylacsis one would employ with any blood-born pathogen, and I'd hang access barriers if possible to keep this mosquito out, especially during daylight hours. In addition to this, Aedespasses on 4 variants of DHF (DEN 1, 2,3 and 4) and, as treatment will depend on the accurate isolation of the strain, this makes things more difficult. This disorder is multiphasic. Note that the disease manifests a high fever (39C+), possible convulsions, some low-end tachycardia, vomiting and anorexia in the first phase, which lasts roughly 3 days. Dehydration and hypovolemia are concerns in this phase and throughout. Note that in this phase, the febrile patient will be acidotic and with a (possiblly quite acute ) GI sensitivity so, while antipyretics are called for, stay away from the acids; go more with paracetamol (permitting). Phase 2, occurring on approximately the third day, is characterized by defervescence, accompanied with an increase in the hematocrit/platelet ratio (high crit, low plats). Oliguria, lethargy, coldness of limbs all may be warning signs here. Watch at this point for afebrile shock. Day 3 is often the critical day -- staff accordingly if you can. As with most hemorrhagic disorders, keeping a constant watch on the patient's hydration, concerns for hypovolemic shock, hemoconcentration and hematocrit will all be focii. As DHF induces a fragility to blood vessels accompanied by thrombocytopenia and plentiful petechia injection sites need to be carefully protected. That there is plasma leakage is a given (sometimes even manifesting as ascites) , so we look to hemoconentration and also increases in hematocrit as warning indicators, which may warn of the onset of shock especially in the second, afebrile phase, but through the course as well. In this event, plasma extenders and electrolyte/fluid replacement are critical, and will tend to be a determinent in the prognosis. It goes without saying that hypovolemia induces tissue hypoxia, shock, acidosis and death by these processes, so the nursing intervention will be a juggling act of maintaining vigilence on these factors, acting when they change, and doing all this without poking too many holes in your patient :}. Conditions permitting, you can orally rehydrate your patient with an electrolyte solution reinforced with glucose and a base like sodium bicarb (bicarb is administeration PO only -- IV admin should be held off for later, if diarrhea becomes acute) to offset the acidosis (see the WHO article for one recipe). The CDC article (I think) mentions reinforcement with fruit juice (2 lytes solution to 1 fruit juice). I am somewhat confused by the recommendation to give a base followed by an acid PO to a nauseous, dehydrated, acidotic patient, but that's me -- you may want to check this out yourself. All the expected symptoms of severe dehydration and hypovolemia with plasma loss are bellweathers for commencement of accute care. These include but are not limited to: * Confusion * Tachycardia * Difficulty in detecting peripheral pulse * slowed result to skin rebound test for dehydration * Oliguria * Hypotension * ... in short, the usual suspects. In summary, nursing considerations for DHL, especially in infants constitute a symphony of planning and rapid response to quickly changing indicators. As this problems is more often endemic to areas where the nursing burden is greater, even more effort is required. One answer that's been applied is to treat DHF on an outpatient basis, even if the symptoms would merit hospitalization in the UK, Europe or the US. I would not presume from the comfort of my armchiar to interpret or second-guess the decisions of those in the field, dealing not only with an acute patient, but often many.