Infectious mononucleosis (mono), commonly known as the “kissing disease,” is a viral infection primarily caused by the Epstein-Barr virus (EBV). This nursing diagnosis focuses on identifying and treating mono symptoms, preventing complications, and supporting patient recovery through evidence-based interventions.
Causes (Related to)
Mononucleosis can affect patients in various ways, with several factors contributing to its severity and progression:
- Primary infection with Epstein-Barr virus (EBV)
- Compromised immune system due to chronic conditions or medications
- Age-related vulnerability (primarily affects adolescents and young adults)
- Risk factors such as:
- Close contact with infected individuals
- Sharing personal items
- Weakened immune system
- College or university attendance
- Contact sports participation
Signs and Symptoms (As evidenced by)
Mononucleosis presents distinctive signs and symptoms that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient reports)
- Extreme fatigue and malaise
- Sore throat
- Headache
- Loss of appetite
- Muscle aches
- Night sweats
- Difficulty swallowing
- Abdominal discomfort
Objective: (Nurse assesses)
- Elevated temperature (typically 102-104°F)
- Enlarged lymph nodes (cervical and axillary)
- Splenomegaly
- Hepatomegaly
- Tonsillar exudates
- Petechiae on the soft palate
- Periorbital edema
- Jaundice (in some cases)
Expected Outcomes
The following outcomes indicate successful management of mononucleosis:
- The patient will demonstrate improved energy levels within 2-4 weeks
- The patient will maintain adequate hydration and nutrition
- The patient will avoid complications (especially splenic rupture)
- The patient will report decreased throat pain and lymphadenopathy
- The patient will demonstrate an understanding of activity restrictions
- The patient will return to normal daily activities within 4-6 weeks
- The patient will practice proper infection control measures
Nursing Assessment
Monitor Vital Signs
- Check temperature, pulse, respiratory rate, and blood pressure
- Note patterns of fever and fatigue
- Assess for signs of dehydration
- Monitor for complications
Assess Lymphatic System
- Evaluate the size and tenderness of lymph nodes
- Monitor for changes in node size
- Document the location and characteristics of enlarged nodes
- Check for associated skin changes
Evaluate Spleen and Liver
- Assess for splenomegaly
- Monitor for abdominal pain or tenderness
- Check for hepatomegaly
- Document any signs of jaundice
Monitor Hydration and Nutrition
- Track fluid intake and output
- Assess the ability to swallow
- Monitor weight changes
- Evaluate nutritional status
- Check skin turgor and mucous membranes
Assess Activity Tolerance
- Monitor energy levels
- Evaluate the ability to perform ADLs
- Track sleep patterns
- Document exercise tolerance
- Note any limitations
Nursing Care Plans
Nursing Care Plan 1: Fatigue
Nursing Diagnosis Statement:
Fatigue related to viral infection and inflammatory response as evidenced by verbalized exhaustion, decreased activity tolerance, and increased need for rest.
Related Factors:
- EBV infection
- Inflammatory response
- Increased metabolic demands
- Sleep disturbances
- Decreased appetite
Nursing Interventions and Rationales:
- Implement energy conservation techniques
Rationale: Helps manage limited energy resources - Schedule activities during peak energy periods
Rationale: Maximizes patient’s available energy - Monitor activity tolerance
Rationale: Prevents overexertion and complications
Desired Outcomes:
- The patient will verbalize improved energy levels
- The patient will demonstrate appropriate activity pacing
- The patient will maintain adequate rest periods
Nursing Care Plan 2: Risk for Injury
Nursing Diagnosis Statement:
Risk for Injury related to enlarged spleen and potential for splenic rupture as evidenced by the presence of splenomegaly.
Related Factors:
- Enlarged spleen
- Participation in contact sports
- Limited knowledge of activity restrictions
- Risk-taking behaviors
Nursing Interventions and Rationales:
- Assess spleen size daily
Rationale: Monitors progression of splenomegaly - Teach activity restrictions
Rationale: Prevents splenic rupture - Educate about signs of splenic rupture
Rationale: Enables early recognition of complications
Desired Outcomes:
- The patient will avoid splenic rupture
- The patient will comply with activity restrictions
- The patient will verbalize understanding of safety precautions
Nursing Care Plan 3: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to inflammation of lymphoid tissue and pharyngitis as evidenced by sore throat, difficulty swallowing, and enlarged lymph nodes.
Related Factors:
- Tissue inflammation
- Enlarged lymph nodes
- Tonsillar exudates
- Pharyngitis
Nursing Interventions and Rationales:
- Administer prescribed pain medications
Rationale: Reduces pain and discomfort - Provide cold/warm compresses
Rationale: Alleviates lymph node tenderness - Recommend salt water gargles
Rationale: Soothes throat irritation
Desired Outcomes:
- The patient will report decreased pain levels
- The patient will maintain adequate oral intake
- The patient will demonstrate improved comfort
Nursing Care Plan 4: Deficient Fluid Volume
Nursing Diagnosis Statement:
Risk for Deficient Fluid Volume related to decreased oral intake and fever as evidenced by poor skin turgor and decreased urine output.
Related Factors:
- Difficulty swallowing
- Fever
- Decreased appetite
- Poor oral intake
Nursing Interventions and Rationales:
- Monitor intake and output
Rationale: Ensures adequate hydration - Encourage fluid intake
Rationale: Prevents dehydration - Offer ice chips and popsicles
Rationale: Provides alternative hydration methods
Desired Outcomes:
- The patient will maintain adequate hydration
- The patient will demonstrate improved skin turgor
- The patient will produce adequate urine output
Nursing Care Plan 5: Knowledge Deficit
Nursing Diagnosis Statement:
Knowledge Deficit related to unfamiliarity with mononucleosis management as evidenced by questioning about activity restrictions and transmission prevention.
Related Factors:
- Limited exposure to information
- Misconceptions about the disease
- Complex management requirements
- Age-related learning needs
Nursing Interventions and Rationales:
- Provide disease education
Rationale: Improves understanding and compliance - Teach transmission prevention
Rationale: Reduces risk of spreading infection - Discuss recovery timeline
Rationale: Sets realistic expectations
Desired Outcomes:
- The patient will demonstrate an understanding of the disease process
- The patient will verbalize proper prevention measures
- The patient will comply with a treatment plan
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Damania B, Kenney SC, Raab-Traub N. Epstein-Barr virus: Biology and clinical disease. Cell. 2022 Sep 29;185(20):3652-3670. doi: 10.1016/j.cell.2022.08.026. Epub 2022 Sep 15. PMID: 36113467; PMCID: PMC9529843.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Mohseni M, Boniface MP, Graham C, Doerr C. Mononucleosis (Nursing). 2023 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 33760514.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Sylvester JE, Buchanan BK, Silva TW. Infectious Mononucleosis: Rapid Evidence Review. Am Fam Physician. 2023 Jan;107(1):71-78. PMID: 36689975.
