Respiratory syncytial virus

Respiratory Syncytial Virus RSV Nursing Care Plans Diagnosis and Interventions

Respiratory Syncytial Virus RSV NCLEX Review Care Plans

Nursing Study Guide on Respiratory Syncytial Virus Infection

Respiratory syncytial virus (RSV) infection is one of the most common viral infections affecting children.

It is caused by the virus belonging to the Paramyxoviridae family.

RSV typically causes mild cold-like symptoms, but it can also cause lower respiratory tract infections.

RSV infection is widespread, affecting about 90% of children below 2 years of age.

Reinfection is possible as humans do not develop immunity from RSV. Although it is commonly seen in children, it can also affect adults, especially those with weak immune system.

In children, it is the most common cause of bronchiolitis. Most cases of RSV infection do not require treatment; however, in more serious cases, treatment is supportive and is focused on addressing the symptoms and complications as they arise.

Signs and Symptoms of Respiratory Syncytial Virus Infection

RSV infection often causes mild cold-like symptoms in both adults and children.

The clinical manifestations show about 4 to 6 days after exposure to the virus. In mild cases, the signs and symptoms may include:

  • Congested or runny nose
  • Dry cough
  • Low grade fever
  • Sore throat
  • Mild headache

In other cases, RSV infection can cause serious lower respiratory tract infections such as bronchiolitis and pneumonia.

This is particularly significant especially in children and adults with weak immune system. Manifestations may also include the following:

  • Fever
  • Severe cough
  • Wheezing
  • Rapid breathing or difficulty breathing
  • Cyanosis

Infants may present the following:

  • Short, shallow, and rapid breathing
  • Cough
  • Poor feeding
  • Lethargy
  • Irritability

Causes of Respiratory Syncytial Virus Infection

RSV infection is caused by the family of viruses called Paramyxoviridae with the genus Pneumovirus.

It is contracted in several ways. The main mode of transmission of RSV is through contact with droplets from the nose and throat of an infected person.

It can also be transferred after contact with a surface that has the virus on it, such as on doorknobs or staircase railings.

It can also spread through direct contact like kissing a child who is infected with the virus.

Once the virus is contracted by an individual, signs and symptoms typically appears within 4 to 6 days.

The person will be contagious for about 3 to 8 days after exposure to the virus. However, the virus can continue to spread beyond this point in some cases.

The following are at a higher risk of developing a serious case of RSV infection:

  • Premature infants
  • Children with congenital heart and lung condition
  • Children with compromised immune system
  • Adults with compromised immune system
  • Older adults with underlying heart and lung disease

Complications of Respiratory Syncytial Virus Infection

  1. Pneumonia. Inflammation of the lungs can occur because of the spread of RSV infection. It may start as bronchiolitis, or the inflammation of the airways, and then progress to pneumonia.
  2. Middle ear infection. Otitis media or middle ear infection is quite common in children. It typically occurs as a secondary infection like the presence of RSV infection.
  3. Asthma. Studies suggest that there is a link between RSV infection and asthma developing later in life.
  4. Repeated infection. Reinfection is possible in RSV infection. Once a person contracts the virus, the body does not develop immunity from it.

Diagnosis of Respiratory Syncytial Virus Infection

The diagnosis of RSV infection includes the following procedures:

  • Medical history taking
  • Physical examination- breathing will be assessed through observations and auscultation.
  • Blood tests – a complete blood count is typically done; however, this test is inconclusive as It may yield a normal result.
  • Chest X-rays – imaging of the lungs is performed to check for the spread of infection.
  • Respiratory tests – there are a few tests that can be performed using respiratory secretions. A viral culture may be done to establish the presence of the virus. A Transcription-Polymerase Chain Reaction (RT-PCR) may be performed in some cases as it is more sensitive than a viral culture. Antigen testing may also be performed. Antigen testing is highly sensitive in children but not in adults.  

Treatment for Respiratory Syncytial Virus Infection

Treatment for RSV infection is not typically required in mild cases. However, in more serious cases, treatment options fall into three categories which are as follows:

  1. Supportive Care. Supportive care is the common treatment approach for patients with respiratory syncytial virus infection. Supportive care includes interventions aimed in addressing the needs of the patient as they arise.
    • Nasal suctioning and lubrication to relieve nasal congestion
    • Administration of antipyretics for fever
    • Oxygen support for hypoxia
    • Supplemental hydration and nutrition support
    • Ventilator support for highly compromised patients
  2. Immune prophylaxis. A passive form of immune prophylaxis may be given in some cases of RSV infection. The administration of a humanized murine monoclonal antibody may be performed as it works against RSV protein. It will need to be administered monthly for the duration of the RSV season commonly between September to April. However, the use of this form of treatment is controversial due to the cost-effectivity of it.
  3. Antiviral medication. Currently, an antiviral drug has been approved for use in the U.S. It is a nucleoside analog with proven activity against RSV. It may be administered in aerosolized form. However, it remains controversial due to its cost and efficacy.

Nursing Care Plans for Respiratory Syncytial Virus Infection

Nursing Care Plan 1

Nursing Diagnosis: Infection related to RSV infection as evidenced by positive RSV viral culture result, temperature of 38.2 degrees Celsius, headache, dry cough, and sore throat.

Desired Outcome: The patient will be cured of RSV infection and prevent its spread.

InterventionsRationales
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 antiviral. To treat severe RSV infection.
Teach the patient to avoid direct social contact as much as possible. Ideally, the patient should self-isolate for at least 8 days or as long as symptoms persist.To prevent the risk of spreading the virus. RSV patients are contagious about 3 to 8 days after catching it but can still be contagious for a longer period in some cases.  
Provide symptomatic relief for the patient.Treatment of RSV is not required in most cases. In a healthy individual, recovery is expected after a week. Treatment options for RSV infection is focused on the severity of the signs and symptoms.
Teach the patient and carer how to perform proper hand hygiene.To prevent the risk of spreading the virus.
Obtain a new respiratory culture for RSV.To confirm that the infection has been completely treated.

Nursing Care Plan 2

 Nursing Diagnosis: Hyperthermia related to RSV infection as evidenced by temperature of 38.2 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.

InterventionsRationales
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 antiviral and anti-pyretic medications.Use the antiviral for patients with serious RSV 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 3

Nursing Diagnosis: Fatigue related to body weakness secondary to RSV 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.

InterventionsRationales
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:

  • Ineffective Breathing Pattern
  • 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

Disclaimer:

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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