Instructions for Dengue management.

As a ward nurse, dengue patients require strict monitoring and early detection of warning signs. The most important instructions are:

1. Frequent Vital Sign Monitoring

• Check temperature, pulse, blood pressure, respiratory rate, and SpO₂ regularly.
• During critical phase, monitor at least every 1–4 hours according to medical orders.
• Watch for:
  • Tachycardia
  • Narrow pulse pressure (<20 mmHg)
  • Hypotension
  • Cold clammy extremities

These may indicate dengue shock syndrome.

2. Strict Fluid Balance Chart

• Record all oral and IV fluid intake.
• Measure and document all urine output.
• Target urine output:
  • Adults: ≥0.5 mL/kg/hour
• Report:
  • Reduced urine output
  • Dark concentrated urine
  • No urine for several hours

3. Hematocrit (HCT) Monitoring

• Follow HCT results closely.
• Rising HCT with falling platelets may indicate plasma leakage.
• Sudden drop in HCT with unstable vitals may indicate bleeding.

4. Monitor for Bleeding

Check for:

• Gum bleeding
• Nose bleeding
• Hematuria
• Melena (black stools)
• Hematemesis
• Excessive menstrual bleeding
• Petechiae and bruising

Report immediately.

5. Watch for Warning Signs

Immediately inform the medical officer if patient develops:

• Severe abdominal pain
• Persistent vomiting
• Restlessness or irritability
• Drowsiness
• Difficulty breathing
• Cold extremities
• Reduced urine output
• Postural hypotension
• Any bleeding

6. Careful IV Fluid Management

• Follow prescribed fluid rates exactly.
• Avoid both:
  • Under-hydration → shock
  • Over-hydration → pulmonary edema and fluid overload
• Monitor:
  • Lung crepitations
  • Increasing respiratory distress
  • Raised JVP
  • Edema

7. Laboratory Monitoring

Regularly review:

• Full blood count (platelets, WBC, HCT)
• Renal function tests
• Liver function tests if ordered
• Blood glucose in diabetic patients

8. Fever Management

• Use paracetamol only as prescribed.
• Avoid NSAIDs such as ibuprofen, diclofenac, and aspirin unless specifically ordered.
• Encourage tepid sponging if necessary.

9. Bed Rest and Safety

• Encourage adequate rest.
• Assist weak patients during ambulation.
• Prevent falls, especially if hypotensive.

10. Handover Essentials

During each shift handover communicate:

• Current phase of dengue (febrile/critical/recovery)
• Latest vital signs
• HCT trend
• Platelet trend
• Fluid intake/output balance
• Urine output
• Any warning signs or bleeding episodes

Red Flag: Call the Doctor Immediately If

• Pulse pressure <20 mmHg
• Systolic BP falling
• Severe abdominal pain
• Persistent vomiting
• Bleeding
• Urine output <0.5 mL/kg/hr
• Respiratory distress
• Altered consciousness

For a nurse, the three most critical dengue tasks are:

1. Vital signs monitoring
2. Accurate intake-output charting
3. Early recognition of shock and bleeding.

These three actions detect most life-threatening dengue complications before deterioration occurs.