Dengue Hemorrhagic Fever

1. Mild – Client may manifest fever, with or without petechial hemorrhage.
2. Moderate – Client may experience high fever, but with less hemorrhage and no progression to shock.
3. Severe, frank type- Sudden onset of fever may occur with severe hemorrhage; which is accompanied by an abrupt decrease in temperature, shock and termination of recovery.

Grading of Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) According to 2010 Guideline:

1. DHF Grade I: Fever accompanied by non- specific symptoms like anorexia, vomiting, and abdominal pain; the only hemorrhagic manifestation is (+) tourniquet test and/ or easy bruising
2. DHF Grade II: Spontaneous bleeding plus the manifestations with Grade I (usually observed in GIT or mucocutaneous
3. DHF Grade III (DSS): Presence of circulatory failure as evidenced by rapid, weak pulse, narrowing of pulse pressure or hypotension, and cold clammy skin.
4. DHF Grade IV (DSS): Profound shock with undetectable blood pressure or pulse.

• Preventive and control measures that would involve health education and strongly advocating the implementation of 4S, recognition of disease, case finding and reporting for cases in the community.

• Search and destroy the mosquito dengue carrier’s breeding sites (recently pinpointing buko shell orcoconut shells, tires, and bromeliads)

It may also involve frequent changing of water and scrubbing sides of vases and keeping water containers covered at all times, destroying of breeding places stated above by cleaning the surroundings (3O’clock habit) and proper disposal of tires and containers.

• Self protection against mosquito (use of loose clothing with long sleeves and long socks, use of mosquito nets, tested mosquito repellants and the like)
• Seek early consultation (Early detection of condition means treatment could be administered readily to prevent fatal complications of dengue)
• Say NO to indiscriminate fogging (Fogging is not advised nowadays because it does not really eliminate mosquitoes but it only scares them away. It is also not recommended because of its respiratory consequences.)

• Rapid replacement of fluids: clients are encouraged to increase their fluid intakes as much as possible if tolerated; In the community, ORS is given to halt moderate dehydration at 75ml/ kg in 4 -6 hours or up to 2- 3 liters in adults.
• Administration of antipyretic/ analgesics as indicated by the physician
• Close observation and intensive monitoring of vital signs
• Early detection for signs of bleeding and immediate referral
• Use of Tourniquet test (Rumpel Leade test) to detect petechial hemorrhage

• Avoidance of dark colored foods and liquids
• Client is encouraged to prevent from using sharp- bristled toothbrushes, instead advised to gargle with saline solution
• Clients are educated not to use hot liquids for alleviation of chills etc.
• Avoidance of sharp objects like razors are emphasized on adults
• The use of ASPIRIN is strictly prohibited.

• Keep the client at bed rest and ensure safety to prevent from injury
• Client is usually placed in dorsal recumbent position.
• Hourly monitoring noting for narrowing pulse pressure, sudden drop in temperature, decreased blood pressure and pulse rate and other signs of deterioration.
• Administration of blood products and monitoring client for signs of adverse reactions.
• Strict monitoring of fluid intake and output
• Immediate referral for any change in client’s status and proper documentation of procedures given.