NCLEX-PN® ExaminationPhysiological AdaptationHard
A client is admitted with dengue fever and is being monitored for signs of progression to severe dengue. The nurse should prioritize assessment for which of the following signs, indicating a critical phase and potential for shock?
- ARetro-orbital pain
- BSudden decrease in temperature (defervescence)
- CPetechiae and ecchymoses
- DGeneralized maculopapular rash
Show answer & explanationAnswer & explanation
Correct answer: B. Sudden decrease in temperature (defervescence)
A sudden decrease in temperature (defervescence) after the febrile phase is a critical sign in dengue fever, indicating the transition to the critical phase where plasma leakage, shock, and severe bleeding can occur. While rash, petechiae, and retro-orbital pain are common in dengue, they do not specifically signal the critical phase and impending shock like defervescence does.
Why the other options are wrong
- A. Retro-orbital pain is a common symptom during the febrile phase but does not indicate progression to the critical phase or shock.
- C. Petechiae and ecchymoses (bleeding manifestations) can occur at various stages but are not the primary indicator of the onset of the critical phase.
- D. Generalized maculopapular rash is common during the febrile or convalescent phase but does not specifically signal the critical phase.
Dengue Critical Phase
The critical phase of dengue fever, signaled by defervescence, is when plasma leakage, shock, and severe organ impairment are most likely to occur, requiring vigilant monitoring.
- Dengue has three phases: febrile, critical, and recovery.
- Defervescence marks the transition from febrile to critical phase.
- Plasma leakage leads to ascites, pleural effusion, and hypovolemic shock.
Memory trick: Fever Falls, Fluid Leaks, Fatal Fates.