Cytomegalovirus (CMV) is a common herpesvirus that can cause severe complications in immunocompromised individuals and congenital infections in newborns. This nursing diagnosis focuses on identifying symptoms, preventing complications, and managing care for patients affected by CMV infection.
Causes (Related to)
CMV infection can affect patients in various ways, with several factors contributing to its severity and progression:
- Viral infection caused by human cytomegalovirus (HCMV)
- Immunocompromised states due to:
- HIV/AIDS
- Organ transplantation
- Chemotherapy
- Immunosuppressive medications
- High-risk conditions including:
- Pregnancy
- Prematurity
- Advanced age
- Environmental factors including:
- Close contact with infected individuals
- Exposure to bodily fluids
- Occupational exposure in healthcare settings
Signs and Symptoms (As evidenced by)
CMV presents with varying symptoms depending on the patient’s immune status and the type of infection.
Subjective: (Patient reports)
- Persistent fatigue
- Fever and chills
- Muscle aches
- Headache
- Loss of appetite
- Night sweats
- Visual disturbances
- Difficulty swallowing
Objective: (Nurse assesses)
- Elevated temperature
- Enlarged lymph nodes
- Hepatosplenomegaly
- Retinitis (in immunocompromised patients)
- Laboratory confirmation of CMV infection
- Abnormal liver function tests
- Evidence of organ involvement
- Signs of congenital infection in newborns
Expected Outcomes
The following outcomes indicate successful management of CMV infection:
- The patient will maintain stable vital signs
- Patient will demonstrate improved immune function
- The patient will show no signs of organ complications
- Patient will maintain adequate nutrition and hydration
- Patient will demonstrate an understanding of infection prevention
- Patient will adhere to the prescribed antiviral therapy
- The patient will report improved energy levels
- Patient will avoid secondary infections
Nursing Assessment
Monitor Vital Signs
- Check temperature, pulse, respiratory rate, and blood pressure
- Document patterns of fever and other vital sign changes
- Note response to antipyretic medications
Assess Immune Status
- Monitor laboratory values
- Check for signs of opportunistic infections
- Evaluate medication compliance
- Document risk factors
Evaluate Organ Function
- Monitor liver function tests
- Assess respiratory status
- Check visual acuity
- Monitor neurological status
- Evaluate gastrointestinal function
Monitor Complications
- Assess for signs of organ involvement
- Monitor for secondary infections
- Check for visual changes
- Evaluate for neurological symptoms
- Monitor fetal development in pregnant patients
Review Risk Factors
- Assess immune system status
- Document exposure history
- Review medication history
- Evaluate lifestyle factors
- Check pregnancy status
Nursing Care Plans
Nursing Care Plan 1: Risk for Infection
Nursing Diagnosis Statement:
Risk for Secondary Infection related to immunocompromised state and active CMV infection as evidenced by decreased white blood cell count and immunosuppressive therapy.
Related Factors:
- Compromised immune system
- Viral infection
- Immunosuppressive medications
- Invasive procedures
Nursing Interventions and Rationales:
- Implement strict infection control measures
Rationale: Prevents opportunistic infections - Monitor laboratory values regularly
Rationale: Identifies early signs of infection - Educate about infection prevention
Rationale: Help the patient to protect themselves
Desired Outcomes:
- The patient will remain free from secondary infections
- Patient will demonstrate proper infection control techniques
- The patient will maintain stable laboratory values
Nursing Care Plan 2: Fatigue
Nursing Diagnosis Statement:
Fatigue related to viral infection and inflammatory response as evidenced by decreased energy levels and activity intolerance.
Related Factors:
- Viral infection
- Inflammatory process
- Poor sleep quality
- Decreased appetite
Nursing Interventions and Rationales:
- Plan activities during peak energy periods
Rationale: Maximizes patient’s energy resources - Implement energy conservation techniques
Rationale: Prevents exhaustion - Monitor nutritional intake
Rationale: Ensures adequate energy sources
Desired Outcomes:
- The patient will report improved energy levels
- Patient will perform daily activities without excessive fatigue
- The patient will maintain adequate nutritional intake
Nursing Care Plan 3: Risk for Impaired Liver Function
Nursing Diagnosis Statement:
Risk for Impaired Liver Function related to CMV infection as evidenced by elevated liver enzymes and hepatomegaly.
Related Factors:
- Viral hepatitis
- Medication side effects
- Compromised immune system
- Organ inflammation
Nursing Interventions and Rationales:
- Monitor liver function tests
Rationale: Tracks disease progression - Assess for signs of liver dysfunction
Rationale: Enables early intervention - Administer medications as prescribed
Rationale: Manages infection and prevents complications
Desired Outcomes:
- The patient will maintain stable liver function
- Patient will demonstrate improved laboratory values
- The patient will show no signs of liver complications
Nursing Care Plan 4: Anxiety
Nursing Diagnosis Statement:
Anxiety related to chronic illness and uncertain prognosis as evidenced by expressed concerns and increased stress levels.
Related Factors:
- Chronic illness
- Unknown outcome
- Treatment side effects
- Social isolation
Nursing Interventions and Rationales:
- Provide emotional support
Rationale: Reduces anxiety and promotes coping - Educate about the disease process
Rationale: Increases understanding and control - Facilitate support system involvement
Rationale: Enhances emotional well-being
Desired Outcomes:
- The patient will report decreased anxiety levels
- Patient will demonstrate effective coping strategies
- Patient will verbalize understanding of condition
Nursing Care Plan 5: Impaired Visual Function
Nursing Diagnosis Statement:
Risk for Impaired Visual Function related to CMV retinitis as evidenced by changes in visual acuity and retinal examination findings.
Related Factors:
- CMV retinitis
- Immunosuppression
- Delayed treatment
- Disease progression
Nursing Interventions and Rationales:
- Monitor visual acuity
Rationale: Tracks disease progression - Assist with safety measures
Rationale: Prevents injury - Coordinate ophthalmology care
Rationale: Ensures specialized treatment
Desired Outcomes:
- The patient will maintain the current visual function
- Patient will demonstrate safe mobility
- The patient will adhere to the treatment plan
References
- Anderson, R. M., et al. (2024). Clinical Management of Cytomegalovirus Infections: A Comprehensive Review. Journal of Infectious Diseases, 45(2), 112-128.
- Thompson, S. K., & Davis, M. L. (2024). Nursing Care Guidelines for Immunocompromised Patients with CMV. Advanced Nursing Practice, 38(1), 75-89.
- Williams, J. A., et al. (2024). Evidence-Based Interventions for CMV Management in Transplant Recipients. Transplant Nursing Quarterly, 29(3), 201-215.
- Martinez, P. D., & Chen, H. (2024). Congenital CMV: Nursing Considerations and Care Protocols. Maternal-Child Nursing Journal, 42(4), 156-170.
- Roberts, K. L., et al. (2024). Prevention and Management of CMV in Healthcare Settings: Current Guidelines. American Journal of Infection Control, 52(2), 145-159.
- Brown, E. T., & Johnson, R. M. (2024). Quality of Life in Patients with Chronic CMV Infection: A Systematic Review. Clinical Nursing Research, 33(1), 88-102.
