Every rainy season in the Philippines, dengue cases go up and so do the questions we get from family. For the NCLEX, the part that matters most is the dangerous moment: when the fever goes away, that is actually when the client can get worse. Let’s go through the notes first, then the practice test.
Table of Contents
What is Dengue?
Dengue is a viral infection caused by the dengue virus (four types). It is spread by the bite of infected Aedes mosquitoes, mainly Aedes aegypti, which bite during the daytime.
- Not spread person to person directly. It spreads through the mosquito.
- Mosquitoes breed in clean, stagnant water (old tires, flower vases, buckets, clogged gutters).
- Second infection with a different type raises the risk of severe disease.
- Watch Out For: plasma leakage, bleeding, shock (severe dengue), and dehydration.
- Safety Precaution: Standard precautions. Protect the febrile client from mosquito bites so they don’t infect others.
Pathophysiology
The virus infects white blood cells and triggers a strong immune response. In some clients the small blood vessels become leaky, so plasma moves out of the vessels into the tissues and body cavities. This causes hemoconcentration (blood becomes more concentrated), low blood pressure, and low platelets, which lead to bleeding.
Dengue happens in three phases:
- Febrile phase (days 1–3 or so): high fever.
- Critical phase (around days 3–7): the fever drops, but plasma leakage and bleeding risk are highest.
- Recovery phase: fluid is reabsorbed and the client improves.
Assessment and Diagnostic Findings
Clinical presentation: Sudden high fever, severe headache, pain behind the eyes, muscle and joint pain (“breakbone fever”), nausea, and rash.
Warning signs of severe dengue: severe abdominal pain, persistent vomiting, bleeding gums or nosebleeds, blood in vomit or stool, lethargy or restlessness, rapid breathing, and cold clammy skin.
Laboratory findings
- Platelets drop (thrombocytopenia).
- Hematocrit rises (hemoconcentration from plasma leakage).
- NS1 antigen (early) and dengue IgM or PCR confirm the diagnosis.
- The tourniquet test can show capillary fragility.
NCLEX Tip: Falling platelets with a rising hematocrit points to plasma leakage. The danger is when the fever breaks.
Medical Management
- There is no specific antiviral. Care is supportive.
- Oral fluids for mild cases, IV fluids with close monitoring for those with warning signs.
- Acetaminophen for fever and pain.
- Blood products only for significant bleeding.
- AVOID: aspirin, ibuprofen, and other NSAIDs because they raise the risk of bleeding.
Nursing Management
Nursing care focuses on fluid balance, bleeding precautions, monitoring, comfort, and prevention.
- MONITOR: vital signs often, hydration, urine output, bleeding, and platelet and hematocrit trends. Watch closely when the fever drops.
- Hydration: Encourage oral fluids. Give IV fluids as ordered. Don’t over-hydrate because leaked fluid returns during recovery.
- Bleeding precautions: soft toothbrush, no unnecessary injections, gentle handling.
- Comfort: Acetaminophen, tepid sponge baths, and rest.
- Prevention and education: Use the 4S from the Department of Health: Search and destroy mosquito breeding sites, use Self-protection (repellent, long sleeves), Seek early consultation, and Say no to indiscriminate fogging. Teach family members to return to the hospital if they notice warning signs.
NCLEX High-Yield Notes
- Spread by the daytime-biting Aedes mosquito.
- Critical phase comes when the fever drops.
- Low platelets plus high hematocrit.
- Acetaminophen only. No aspirin or NSAIDs.
- Teach bleeding precautions and warning signs.
Mnemonic (DENGUE):
- Daytime mosquito bites
- Elevated hematocrit
- No NSAIDs or aspirin
- Gums bleed (watch for bleeding)
- Urine output and fluids are monitored
- Eliminate standing water
