Which of the following clinical features would be seen in a client with dengue haemorrhagic fever, EXCEPT?

NORCET -4 , 2023

Medical Surgical Nursing

Medium

Appeared in: NORCET -4 , 2023

Explanation

Leucocytosis, an increase in the white blood cell (WBC) count, is not a characteristic feature of Dengue Haemorrhagic Fever (DHF).
The typical hematological finding in dengue infections is leukopenia, which is a progressive decrease in the total white blood cell count.
This drop in WBCs, along with a rapid decrease in platelet count, often precedes the critical phase of plasma leakage.
While a rise in WBC count can occur in rare instances of severe bleeding or secondary bacterial infection, it is not a standard feature of the disease itself.

Option A: This is incorrect because Thrombocytopenia (a platelet count below 100,000 cells/mm³) is a hallmark and mandatory criterion for the diagnosis of DHF. It results from bone marrow suppression and immune-mediated destruction of platelets.
Option C: This is incorrect because Lymphadenopathy (swollen lymph nodes) is a common clinical finding during the febrile phase of a dengue infection.
Option D: This is incorrect because a sudden onset of high-grade fever is the primary and initial symptom that defines the febrile phase of dengue infection.

Visual 1: Infographic: A visual guide showing the warning signs of severe dengue, such as severe abdominal pain, persistent vomiting, mucosal bleeding, and lethargy.
Visual 3: Illustration: A diagram showing the pathophysiology of plasma leakage from capillaries in DHF, leading to hemoconcentration and fluid accumulation in body cavities (pleural effusion, ascites).

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical and laboratory features of Dengue Haemorrhagic Fever (DHF) to guide bedside assessment, documentation, and the next nursing action.
Nurses must meticulously monitor the complete blood count (CBC) in patients with suspected dengue. A falling white blood cell and platelet count with a rising hematocrit signals the onset of the critical phase, requiring vigilant fluid management and observation for shock.
A positive tourniquet test is a simple bedside clinical sign of increased capillary fragility and can alert the nurse to the risk of bleeding, prompting the implementation of bleeding precautions.
What if? If a patient with confirmed dengue suddenly develops leucocytosis and a fever spike after the initial febrile phase, the nurse should suspect a secondary bacterial infection (e.g., hospital-acquired pneumonia or sepsis) and promptly notify the physician for further evaluation and possible antibiotic therapy.

How to Approach the Question

First, identify the negative keyword 'EXCEPT'. This means you are looking for the option that is NOT a feature of dengue haemorrhagic fever.
Review each option and evaluate its association with dengue.
Recall the hallmark signs of DHF. Fever is the initial symptom, and thrombocytopenia is a key diagnostic criterion. This eliminates options A and D.
Consider the hematological changes. Dengue virus typically causes a decrease in white blood cells (leukopenia).
Compare 'Leucocytosis' (high WBC) with the known fact of 'leukopenia' (low WBC) in dengue. Leucocytosis is the opposite of what is expected.
Therefore, Leucocytosis is the feature that would not typically be seen, making it the correct answer to this 'EXCEPT' question.

Concept Tested & Keywords

Concept Tested: Clinical and laboratory features of Dengue Haemorrhagic Fever (DHF).
Stem keywords: dengue haemorrhagic fever, clinical features
Lead-in keywords: EXCEPT
Negative lead-in flag: Question asks for the feature NOT seen (EXCEPT).

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