Epstein – Barr virus infection, also known as the “kissing disease”, or Mononucleosis 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 Mononucleosis EBV infection
- Lack of appetite
- Sore throat
- Swollen lymph nodes in the neck or armpits
- Myalgia or body weakness
- Enlarged spleen or enlarged liver
- White patches on the tonsils
Cause of Mononucleosis 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 Mononucleosis EBV Infection
- 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.
- Liver problems. EBV infection may cause liver enlargement, jaundice (yellowish discoloration of the skin or eyes) or hepatitis (inflammation of the liver).
Diagnosis of Mononucleosis 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 Mononucleosis 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 Diagnosis for Mononucleosis
Nursing Care Plan for Mononucleosis Infection 1
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.
|Nursing Interventions for Mononucleosis||Rationales|
|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 Care Plan for Mononucleosis Infection 2
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.
|Nursing Interventions for Mononucleosis||Rationales|
|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 Care Plan for Mononucleosis Infection 3
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.
|Nursing Interventions for Mononucleosis||Rationales|
|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.|
Nursing Care Plan for Mononucleosis Infection 4
Nursing Diagnosis: Fatigue related to poor diet and malnutrition secondary to Epstein –Barr virus infection as evidenced by muscle weakness, slowed reflexes, and body responses.
- The patient will be able to express and verbalize decreased fatigue.
- The patient will be able to participate and engage in daily activities independently and safely.
- The patient will show and display an adequate energy level to help him or her complete daily activities.
- The patient’s vital signs and laboratory values will remain stable and the patient will be free from any potential chronic conditions.
|Nursing Interventions for Mononucleosis||Rationale|
|1. Assess and evaluate the patient’s description of fatigue including the severity, changes in severity, and presence of aggregating factors as well as the alleviating factors.||The nurse should use a quantitative scoring scale that can aid the patient with Epstein-Barr Virus Infection which can help him or her formulate the amount of fatigue he or she is experiencing. The nurse may also use other scoring scales such as using pictures or descriptive language, this will help the nurse weigh changes in the patient’s level of fatigue.|
|2. Identify the possible cause of fatigue including the patient’s last physical illness, pain, emotional stress, depression, and sleep disorders.||It is important to identify the possible related factors that the patient is experiencing that contribute to the patient’s fatigue to help the nurse recognize and formulate a collaborative plan of care.|
|3. Evaluate the patient’s ability to perform activities of daily living and identify the patient’s demands of daily living.||Patient’s with Epstein- Barr Virus Infection who experience fatigue may experience a restricted ability to participate in self-care and he or she may experience restriction when doing his or her responsibilities and activities to his or her family and society.|
|4. Evaluate the patient’s nutritional ingestion of energy sources and the patient’s metabolic demands.||The nurse should evaluate the patient’s nutritional ingestion because patients who are experiencing fatigue may be caused by protein-calorie malnutrition, and iron and vitamin deficiencies.|
|5. Assess and evaluate the patient’s view about fatigue relief and the patient’s eagerness to participate in strategies to decrease fatigue, and assess the level of family and social support.||Evaluating the patient’s outlook on fatigue is important because this will promote active participation in planning, implementing, and evaluating management that will decrease fatigue. Assessing social support is needed because social support may help to decrease fatigue.|
|6. Evaluate the patient’s laboratory results or the patient’s diagnostic test such as blood glucose, hemoglobin, hematocrit, BUN, and oxygen saturation when at rest or with activity.||Assessing the patient’s laboratory result and diagnostic test is important to check for any physiological changes that may affect the patient’s fatigue.|
|7. Evaluate the patient’s vital signs for physiological reactions and changes to activities especially the patient’s blood pressure, respiratory rate, or heart rate.||Evaluating the patient’s vital signs for any changes is useful to detect or monitor the patient’s condition. The patient’s vital signs may be affected due to nutrition situations and fluid balance.|
|8. Evaluate the patient’s sleeping patterns including quality, quantity, and the time the patient takes to fall asleep and feel upon awakening, and observe if the patient experiences alteration in thought processes and behaviors.||Patients with Epstein-Barr Virus infection who experiences a lack of sleep or sleep deprivation may cause fatigue. Sleep deprivation, emotional distress, and side effects of medications may cause fatigue. Encourage and advise the patient to have and maintain adequate rest.|
|9. Avoid and restrict environmental stimuli during the patient’s planned times for rest and sleep.||Environmental stimuli such as vivid lighting, noise, visitors, and numerous distractions should be limited or avoided to promote rest.|
|10. Teach and instruct the patient about the proper energy conservation methods and collaborate with the occupational therapist as needed.||The nurse should teach the patient about useful skills to conserve energy such as delegating tasks to others, setting priorities, and using the available energy to perform desired activities. It is also important to instruct the patient about organization and time management which would help in conserving energy and decreasing fatigue. Collaborating with an occupational therapist is also important can offer and advise assistive devices and may help in educating the patient about different conservation methods.|
Nursing Care Plan for Mononucleosis Infection 5
Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to lack of appetite secondary to Epstein-Barr virus infection as evidenced by unintentional weight loss and not feeling hungry.
- The patient’s weight will remain in its desired goal and normal range.
- The patient will verbalize knowledge and he or she will recognize factors that can affect his or her weight.
- The patient will be able to verbalize understanding and knowledge about his or her appropriate nutritional needs and requirements.
- The patient will be able to consume proper nutrition and will participate in the appropriate weight management that he or she needs.
|Nursing Interventions for Mononucleosis||Rationale|
|1. Check and evaluate the patient’s real and exact body weight and height and avoid doing estimation.||Checking the patient’s weight and height is the first and vital step in an anthropomorphic assessment using a scale. The patient’s weight is used as a basis for the patient’s caloric and daily nutritional requirements. If a patient with Epstein-Barr Virus Infection loses weight, his or her body may experience the inability to fight off infection.|
|2. Check and evaluate the patient’s body mass index (BMI) accurately.||The patient’s body mass index(BMI) is determined and checked by combining two(2) anthropometric variables including the weight in kilograms and height in square meters. The body mass index helps in gauging the patient’s risk for disease and complications with more or less body fat.|
|3. Assess and evaluate the patient’s nutritional status using different tools used to assess malnutrition.||Assessing the patient’s nutritional status is important to help the nurse in collecting information that would help with a nutrition-focused physical examination which would help in identifying problems and nutrition issues.|
|4. Evaluate and identify the patient’s eating pattern thoroughly.||The nurse should evaluate the patient’s eating pattern because this will provide baseline data and this will help the nurse in formulating interventions. After evaluating the patient’s eating pattern the nurse will determine nutrition risk and worsening nutritional status.|
|5. Identify and assess the patient’s food choices and take the patient’s nutritional history with the participation of significant others.||A comprehensive understanding of the patient’s nutritional history is important to help determine accurately the degree of malnutrition. It is also important to check the patient’s usual daily eating habits and nutrition history to heighten the patient’s awareness of nutritional health.|
|6. Identify properly the etiological factors for the patient’s decreased nutritional intake.||It is important to assess the patient’s nutritional intake because several nutritional problems, may be experienced by the patient if he or she lacks nutrition intake.|
|7. Assess for the physical signs of poor nutritional intake such as decreased attention span, pale and dry skin, subcutaneous tissue loss, dull and brittle hair, and swollen tongue and mucous membrane.||Patient’s with Epstein- Barr virus infection should be assessed for physical signs of poor nutrition intake to decrease the risk of complications.|
|8. Evaluate and note the patient’s perspective and feelings toward eating and the type of food.||It is important to assess the patient’s food preference because various psychological, psychosocial, religious, and cultural factors may affect the patient’s nutrition.|
|9. Review and evaluate the patient’s laboratory values that would indicate well-being or deterioration.||The patient’s laboratory tests are important when evaluating the patient with Epstein-Barr virus infection’s nutritional status. An abnormal value in the patient’s diagnostic study may have many possible causes that should be monitored.|
|10. Advise and encourage proper and good oral hygiene and dentition.||Oral hygiene should be emphasized because it may affect the patient’s appetite and the taste of food. If the patient with Epstein Barr-virus infection does not practice good oral hygiene the bacteria may reach levels that may lead to oral infections.|
|11. Determine and identify the time of day when the patient’s appetite is at its peak and give a high-calorie meal at that time.||It is important to determine the peak time of appetite because during this hour the patient will be more likely to eat more than usual.|
|12. Provide and offer energy and vitamin supplements as needed.||Energy and vitamin supplements may result in weight gain for patients. Vitamins and substances are needed in the body because it helps in building energy and helps the patient to stay healthy and helps the body to function properly.|
Nursing Care Plan for Mononucleosis Infection 6
Nursing Diagnosis: Activity Intolerance related to generalized weakness and acute pain secondary to Epstein-Barr virus infection as evidenced by the inability to perform activities of daily living and pain increased during activity.
- The patient will be able to participate in the activities and the vital signs will stay at a normal range.
- The patient will return to his or her baseline activity level and he or she will be able to independently complete activities of daily living.
- The patient will be able to verbalize and show understanding and knowledge about the need to gradually increase activity level and how to accomplish tasks.
|Nursing Interventions for Mononucleosis||Rationale|
|1. Assess and evaluate the patient’s activity level and mobility capacity.||This will provide baseline data and information that would help in the formulation of nursing goals which is very helpful in formulating nursing interventions. When assessing the patient’s response to activities, the nurse should consider the patient’s blood pressure and respiration including the rate, rhythm, and quality of the pulse. Take the vital signs immediately after the activity and advise the patient to rest 3 minutes after the activity then take the vital signs.|
|2. Evaluate the patient’s perception of the cause of activity intolerance and the causative factors.||Factors that cause activity intolerance may be temporary or permanent as well as physical or psychological factors. Identify the cause which can help the nurse during the nursing intervention.|
|3. Evaluate the patient’s level of activity intolerance and track the patient’s progress.||Evaluating the patient’s level of activity intolerance will serve as a baseline for comparison that will help track the patient’s progress after the interventions.|
|4. Check and evaluate the patient’s nutritional status and note for any abnormality that would increase activity intolerance.||The patient with Epstein-Barr virus infection needs adequate energy during activity and he or she should be assessed for nutritional deficiencies that would lead to weakness, fatigue, and decreased endurance that will make it more difficult for the patient to tolerate activity.|
|5. Assess and monitor the patient’s sleep pattern including the amount of sleep that the patient achieved over the past few days.||If the patient experiences sleep deprivation and difficulty during sleep, this can affect the patient’s activity level which needs to be addressed before a successful activity progression can be achieved.|
|6. Identify the patient’s routine of daily living including the patient’s over-the-counter medication.||If a patient experiences fatigue the patient’s ability to perform an activity may be limited. Note any medications that the patient is currently taking that would affect the patient’s activity tolerance.|
|7. Evaluate the patient’s need for ambulation aids such as canes and walker that is very helpful for activities of daily living.||The patient may need assistive devices that would help enhance his or her mobility and assistive devices will also help the patient overcome his or her limitations.|
|8. Evaluate and note the patient’s emotional response to his or her limitations in physical activity.||The patient’s emotions and emotional response to limitations over his or her inability to perform activities can be a source of the patient’s stress and frustration.|
|9. Provide the patient with emotional support and a positive attitude towards the patient’s abilities.||The patient may need supervision during an early effort that can enhance confidence because the patient may experience fear due to overexertion.|
|10. Allow the patient to perform his or her activities more slowly and give enough time with more rest or pauses and give assistance if necessary.||This intervention would help the patient with Epstein-Barr virus infection to increase the tolerance for his or her activity.|
|11. Encourage the patient to verbalize his or her feelings regarding the activity intolerance and limitations and provide a positive atmosphere for the patient.||Encouraging the patient to verbalize feelings about the limitation can help the patient to adapt and minimize frustrations. Acknowledge the patient’s feelings because this can be physically and emotionally difficult for the patient with Epstein-Barr virus infection.|
|12. Teach and encourage the patient to perform range of motion exercises and encourage the patient’s participation during planning activities that would help in building endurance.||Range of motion exercises maintains muscle strength, joint range of motion, and patient’s exercise tolerance. Repetitive exercise can help the patient improve functional capacity over a long time.|
More Mononucleosis nursing diagnoses:
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
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