Epstein-Barr Virus (EBV) Mononucleosis Nursing Diagnosis Interventions and Care Plans

Epstein-Barr Virus (EBV) Mononucleosis NCLEX Review Care Plans

Nursing Study Guide on Epstein-Barr Virus (EBV) Mononucleosis Infection

Epstein – Barr virus infection, also known as the “kissing disease”, is a viral infection that is spread via direct contact, usually through kissing or using the same utensils with the infected person.

The virus causes glandular fever (mononucleosis) wherein the number of lymphocytes in the blood becomes elevated. This causes enlargement of the spleen and may sometimes enlarge the liver as well.

Although mononucleosis EBV infection is contagious, many people carry the virus without experiencing any symptoms. It may take about 4 to 6 weeks for the symptoms to emerge.

Signs and Symptoms of mono EBV infection

  • Fatigue
  • Fever
  • Lack of appetite
  • Rash
  • Sore throat
  • Swollen lymph nodes in the neck or armpits
  • Headache
  • Myalgia or body weakness
  • Enlarged spleen or enlarged liver
  • White patches on the tonsils

Cause of mono EBV Infection

EBV is a human herpes virus that thrives in saliva, hence why it is called the kissing disease.

Drinking from the same glass, using the same utensils or toothbrush of an infected person can cause the spread of infection.

However, it can also be transferred via other body fluids, such as blood and semen. Sex, blood transfusion, or organ transplant puts a person at risk of EBV infection. Coughing or sneezing can also facilitate the spread of EBV.

Complications of mono EBV Infection

  1. Enlargement of Spleen. Mononucleosis caused by EBV infection may lead to an enlarged spleen. This can result to abnormal filtering of healthy red blood cells and platelets in the spleen, thus reducing the number of healthy RBCs and platelets in the bloodstream thereby causing fatigue and body weakness. Severe enlargement of the spleen may cause anemia and thrombocytopenia. It can also cause rupture of the spleen, as evidenced by a sharp, sudden pain in the left upper quadrant of the abdomen. This requires urgent surgical intervention.
  2. Liver problems. EBV infection may cause liver enlargement, jaundice (yellowish discoloration of the skin or eyes) or hepatitis (inflammation of the liver).

Diagnosis of mono EBV Infection

  • Physical Examination – to check for signs and symptoms of EBV infection
  • History taking- any history of EBV infection of a family member or sexual partner, recent transfusion or organ transplant
  • Blood tests – Mononucleosis antibody testing to check for the immune system’s response to EBV; full blood count to check the amount of white blood cells, particularly lymphocytes, and to check for RBC and platelet counts; blood smear to check for the presence of reactive lymphocytes
  • Imaging – MRI or CT scan to check for any enlargement of spleen or liver

Treatment of mono EBV Infection

As with most viral diseases, mono EBV infection is self-limiting and does not have a specific medical treatment.

Antiviral drugs may sometimes be used by physicians, but they may not be useful in most cases of mono EBV infections.

Treatment includes symptom control such as the treatment of strep throat with antibiotics.

Antipyretics can be given to relieve fever, headache, or body weakness. Plenty of rest is needed to recuperate. 

Swollen tonsils may result to difficulty of breathing in some patients, therefore corticosteroids may be prescribed.

The EBV virus can live up to 18 months in the saliva, therefore the infected patient should be informed to avoid direct contact as much as possible.

Nursing Care Plans for mono EBV Infection

Nursing Diagnosis: Infection related to Epstein-Barr Virus mononucleosis as evidenced by positive EBV blood smear result, temperature of 38.5 degrees Celsius, sore throat, and increased white blood cell count

Desired Outcome: The patient will be able to avoid the development of an infection.

Assess vital signs and monitor the signs of infection.To establish baseline observations and check the progress of the infection as the patient receives medical treatment.
Administer the prescribed antibiotic for strep throat. To treat the strep throat. Antibiotics are used only if the patient has strep throat. They do not treat a viral infection like EBV.
Teach the patient to avoid direct social contact as much as possible, and to perform proper hand hygiene.To reduce the risk of spreading the EBV infection. The EBV virus can live up to 18 months in the saliva.  
Administer corticosteroids as prescribed.EBV infection may cause swollen tonsils, which can block the airways and result to difficulty of breathing. Corticosteroids can help reduce the inflammation.
Obtain a new blood sample for EBV smear.To confirm that the infection has been completely treated.

 Nursing Diagnosis: Hyperthermia related to mono EBV infection as evidenced by temperature of 38.5 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and weak pulse.

Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.

Assess the patient’s vital signs at least every hour. Increase the intervals between vital signs taking as the patient’s vital signs become stable.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs administered.
Remove excessive clothing, blankets and linens. Adjust the room temperature.To regulate the temperature of the environment and make it more comfortable for the patient.
Administer the prescribed antibiotic and anti-pyretic medications.Use the antibiotic to treat strep throat infection, as a complication of weak immune system due to EBV infection. Use the anti-pyretic medication to stimulate the hypothalamus and normalize the body temperature.
Offer a tepid sponge bath.To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.

Nursing Diagnosis: Fatigue related to anemia secondary to mono EBV infection as evidenced by overwhelming lack of energy, verbalization of tiredness, generalized weakness, lack of appetite, and shortness of breath upon exertion

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

Assess the patient’s degree of fatigability by asking to rate his/her fatigue level (mild, moderate, or severe). Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with rest and sleep.To gradually increase the patient’s tolerance to physical activity.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest. To allow enough oxygenation in the room.
Refer the patient to dietitian and physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity and improving nutritional intake / appetite.

Other nursing diagnoses:

  • Activity Intolerance
  • Acute Pain

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon


Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna Curran. RN, BSN, PHN

Anna Curran. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process and help nursing students pass the NCLEX exams.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse.

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