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Nursing Diagnosis and Nursing Interventions for Dengue Hemorrhagic Fever

Nursing Diagnosis for Dengue Hemorrhagic Fever (DHF)

  1. The increase in body temperature related to the process of dengue virus infection.
  2. Deficit fluid volume related to the migration of intravascular fluid into extravascular.
  3. Impaired nutrition: less than body requirements related to the decreased appetite.

Nursing Interventions for Dengue Hemorrhagic Fever
  1. The increase in body temperature related to the process of dengue virus infection.

    Goal:
    The body temperature returned to normal

    Expected Results:
    • Vital signs within normal limits, especially temperature (36 C - 37 C)
    • Mucous membranes moist.

    Nursing Intervention:
    • Observation of vital signs every 1 hour
      Rationale: Determining the continued intervention when changes
    • Give a warm water compress
      Rational: Compress will provide induction heat expenditure.
    • Encourage clients to drink lots of 1500 - 2000 ml
      Rationale: Changing the body fluid that comes out because of heat and spur spending urine.
    • Suggest to wear thin clothes and absorb sweat.
      Rational: To provide a sense of comfort and increase the evaporation heat
    • Observation on the intake and out put
      Rational: Detection of body fluid volume deficiency.
    • Collaboration for the provision of antipyretic
      Rational: Antipyretics useful for heat reduction.
  2. Deficit fluid volume related to the migration of intravascular fluid into extravascular

    Goal:
    Nothing happens hypovolemic shock

    Expected results:
    Blood pressure: 120/80 mmHg, Pulse: 80-100x/mnt, Strong pulse

    Nursing Intervention:
    • Observation of vital signs every hour or more. Rationale: Knowing the condition of intra-vascular fluid.
    • Observation of capillary refill
      Rational: Indications of adequate peripheral circulation.
    • Observation on the intake and output, record the number, color / concentration of urine.
      Rational: Decrease in urine output / urine is concentrated with an increased density of suspected dehydration.
    • Encourage to drink plenty of 1500-2000 mL
      Rational: To meet the needs of body fluids
    • Collaboration giving intravenous fluids or plasma or blood.
      Rationale: Increasing the amount of body fluids to prevent hypovolemic shock.
  3. Impaired nutrition: less than body requirements related to the decreased appetite

    Goal:
    Nutrition fulfilled

    Results expected:
    • Increased appetite
    • Meal spent

    Nursing Intervention:
    • Assess complaints of nausea, vomiting or decreased appetite
      Rationale: Determining the next intervention.
    • Give foods that are easy to swallow and easy to digest
      Rationale: Reduce fatigue and prevent gastrointestinal bleeding.
    • Give small portions of food, but often.
      Rational: Avoiding nausea and vomiting
    • Avoid foods that stimulate: spicy, sour.
      Rationale: Prevent the occurrence of distension of the stomach which can stimulate vomiting.
    • Give the client's favorite foods
      Rationale: Allows for more revenue
    • Collaboration parenteral fluid administration
      Rational: Parenteral nutrition is needed if the peroral intake was less.

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