# Situation: Dengue cases are being reported in a densely populated barangay during the rainy season. The nurse at the Barangay Health Station (BHS) sees febrile children and works with the barangay officials. The nurse prepares a home care plan for a 6-year-old with dengue without warning signs who will be cared for at home. Which measures should she include? 1. Give oral fluids and oral rehydration solution often 2. Give ibuprofen when the temperature exceeds 39 °C 3. Return at once for abdominal pain or vomiting, even as the fever falls 4. Give paracetamol for fever, staying within the maximum daily dose 5. Keep the child under a mosquito net at night, when the mosquitoes bite

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627031  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: Dengue cases are being reported in a densely populated barangay during the rainy season. The nurse at the Barangay Health Station (BHS) sees febrile children and works with the barangay officials.

The nurse prepares a home care plan for a 6-year-old with dengue without warning signs who will be cared for at home. Which measures should she include?
1. Give oral fluids and oral rehydration solution often
2. Give ibuprofen when the temperature exceeds 39 °C
3. Return at once for abdominal pain or vomiting, even as the fever falls
4. Give paracetamol for fever, staying within the maximum daily dose
5. Keep the child under a mosquito net at night, when the mosquitoes bite

## 보기

1. 1, 3 and 4 **✔ 정답**
2. 1, 2 and 4
3. 1, 3 and 5
4. 2, 3 and 4

**정답: 1**

## 해설

Home care for dengue without warning signs includes frequent oral fluids and oral rehydration solution, paracetamol (not NSAIDs) for fever within the maximum daily dose, and immediate return for warning signs, especially when the fever falls. Aedes mosquitoes bite during the day, so a net only at night does not protect the child from passing the virus to mosquitoes.

## 심화 해설

Clinical context

Dengue is a dynamic illness whose severity often becomes apparent only around defervescence—the time when the fever begins to fall. For a child classified as dengue without warning signs, home care is appropriate only when caregivers can maintain adequate oral hydration, manage fever safely, and recognize early indicators of deterioration that require immediate return to a health facility.

Why the correct measures are 1, 3, and 4

The cornerstone of home management is maintaining intravascular volume through frequent oral fluids and oral rehydration solution (ORS). Dengue causes increased capillary permeability, and even without overt plasma leakage, insensible losses from fever and reduced oral intake can rapidly deplete circulating volume. Offering small, frequent amounts of ORS—rather than large volumes at once—improves tolerance and sustains hydration during the febrile phase.

For fever control, paracetamol is the preferred antipyretic. It reduces temperature without impairing platelet function or increasing bleeding risk. The dose must remain within the maximum daily limit because hepatic metabolism of paracetamol can be stressed during an acute viral illness, and overdosing adds a preventable risk of hepatotoxicity.

The most critical home-care instruction is to return immediately if warning signs appear, particularly abdominal pain or persistent vomiting, even as the fever subsides. Defervescence marks the transition from the febrile phase to the critical phase, when plasma leakage peaks. Abdominal pain and vomiting at this point may signal impending plasma leakage or fluid accumulation, and timely recognition can prevent progression to shock.

Why measures 2 and 5 are incorrect

Watch out! Ibuprofen and other NSAIDs are contraindicated in dengue because they inhibit platelet aggregation and irritate the gastric mucosa, increasing the risk of bleeding during a disease already characterized by thrombocytopenia and capillary fragility. Even a single dose for high fever can compound hemorrhagic risk.

Key point! Aedes aegypti and Aedes albopictus are daytime biters, with peak activity in the early morning and late afternoon. Keeping a child under a mosquito net only at night does not prevent daytime mosquito bites. More importantly, during the viremic phase, an infected child can transmit the virus to uninfected mosquitoes that bite during the day, perpetuating the transmission cycle within the household and community.

| Home care measure | Rationale | Inclusion |
| --- | --- | --- |
| Frequent oral fluids and ORS | Maintains intravascular volume against capillary leakage and febrile losses | Correct |
| Ibuprofen for fever over 39 °C | NSAID; increases bleeding risk via platelet inhibition and gastric irritation | Incorrect |
| Return for abdominal pain or vomiting as fever falls | Defervescence coincides with critical phase onset; warning signs demand reassessment | Correct |
| Paracetamol within maximum daily dose | Safe antipyretic that does not impair platelet function | Correct |
| Mosquito net only at night | Aedes mosquitoes bite during the day; night-only netting fails to interrupt transmission | Incorrect |

Pathophysiology link for the licensure exam

Dengue illness progresses through three overlapping phases: the febrile phase, the critical phase around defervescence, and the recovery phase. The clinical decision to manage a child at home rests on the absence of warning signs and the family’s ability to recognize them. Warning signs include abdominal pain, persistent vomiting, mucosal bleeding, lethargy, restlessness, liver enlargement, and a rapid drop in platelet count with rising hematocrit. Teaching caregivers to monitor for these signs—especially during the first 24 to 48 hours after fever subsides—is as important as the fluid and antipyretic instructions themselves.

## 임상 시나리오

Home Care Plan for Pediatric Dengue Without Warning SignsSafe outpatient management and early recognition of deterioration
Maintain intravascular volume by giving oral fluids and oral rehydration solution frequently in small amounts. Dengue increases capillary permeability, and fever-related insensible losses can rapidly deplete circulating volume.

For fever, give paracetamol only, staying within the maximum daily dose. Paracetamol does not impair platelet function or increase bleeding risk.

Instruct caregivers to return immediately if warning signs appear, especially abdominal pain or persistent vomiting, even as the fever falls. Defervescence is the critical transition when plasma leakage often emerges.

CautionDo not give ibuprofen or other NSAIDs because they increase bleeding risk. A mosquito net only at night is insufficient because Aedes mosquitoes bite primarily during the day.

## 핵심 개념

- **Defervescence** — The period when fever begins to fall; in dengue, this is when plasma leakage and warning signs often emerge.
- **Warning signs** — Clinical indicators such as abdominal pain, persistent vomiting, mucosal bleeding, or lethargy that signal progression to severe dengue.
- **Oral rehydration solution (ORS)** — A balanced glucose-electrolyte solution given frequently in small amounts to maintain intravascular volume during dengue.
- **Paracetamol** — The preferred antipyretic in dengue because it reduces fever without impairing platelet function or increasing bleeding risk.
- **Aedes mosquito** — The vector for dengue virus; it bites primarily during daylight hours, so daytime protection is essential.

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