RSV Pathophysiology Nursing Diagnosis, Interventions & Precautions

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In this blog post, we’ll go over nursing diagnoses commonly associated with a respiratory syncytial virus (RSV), available treatments for those suffering from its effects, interactive care plans including interventions that work towards improving patient outcomes infused with evidence-based research data throughout, plus more vital information a nurse should know when dealing with RSV patients.

What is a Respiratory Syncytial Virus (RSV)?

Respiratory Syncytial Virus (RSV) is one of the most common causes of infection in young children and can cause serious health risks if not properly managed. The diagnosis and care plan for RSV varies depending on the patient’s needs, considering age, medical history, risk factors, and overall physical condition. Nursing care is essential in helping identify and control the symptoms as soon as possible to limit potential complications of RSV infection.

In 75% of cases, Respiratory Syncytial Virus (RSV) is the causative agent when children 2 years old and younger are admitted to the hospital for bronchiolitis. This makes RSV the most commonly identified pathogen in these patients.

Statistics and Incidences

  • Research has identified RSV as the foremost cause of lower respiratory tract infections (LRTI) in infants and young children.
  • It is estimated that 4-5 million children are affected annually by RSV LRT infection, with approximately 125,000 requiring hospitalization for treatment.
  • The clinical manifestations and onset of RSV LRTI are similar throughout the world.
  • Severe RSV cases predominantly affect infants up to 8 months old, with boys about twice as likely to be hospitalized as girls.
  • All races appear equally susceptible to this virus, exhibiting comparable disease patterns.

Respiratory Syncytial Virus (RSV) Pathophysiology

RSV is an enveloped, non-segmented, negative-stranded RNA virus and a member of the Paramyxoviridae family. Two subtypes, A and B, are responsible for most RSV infections. The virus is spread by direct contact with respiratory secretions or fomites, and it can survive on environmental surfaces for several hours.

Upon entry into the body, the virus binds to ciliated epithelial cells in the upper and lower airways, leading to local inflammation and mucus production. This leads to symptoms commonly associated with RSV infection, including cough, wheezing, and difficulty breathing.

Causes and Risk Factors

Direct contact with an infected individual is the most common cause of RSV infection. Other factors that can increase the risk of acquiring RSV include overcrowding, lack of breastfeeding or breastfeeding for a short duration, exposure to environmental tobacco smoke (ETS), and preterm birth.

Diagnosis & Symptoms

RSV infections can be difficult to diagnose, as the symptoms are often similar to those of other respiratory illnesses. The most common symptom in infants and young children is a persistent cough, which may be accompanied by

  • wheezing
  • difficulty breathing
  • fever
  • nasal discharge or congestion
  • decreased appetite
  • irritability.

Treatments

Note- 

  • There is no specific treatment for RSV.
  • Symptoms usually improve within 1-2 weeks.
  • Antibiotics are not helpful for RSV infection.

Treatments for RSV infections vary depending on the severity of the infection and the patient’s needs. Common treatments include home care, such as keeping the air moist with a humidifier, providing extra fluids and rest, avoiding secondhand smoke exposure, administering acetaminophen to reduce fever, and using saline nose drops or saline nasal sprays to help clear mucus from the nose.

In more severe cases where hospitalization is needed, medications such as bronchodilators may help open up airways and relieve wheezing. In addition, supplemental oxygen may be used if necessary to ensure adequate oxygen levels in the blood.

RSV Nursing Diagnosis & Care Plan

Nursing Diagnoses For RSV: Common nursing diagnoses associated with RSV infection include:

  • Impaired gas exchange
  • Activity intolerance
  • Risk for fluid volume deficit
  • Risk of infection
  • Disturbed sleep pattern.

In the community setting, many parameters have been related to an increased risk of acquiring RSV disease, involving the following:

1. Inadequate nutrition: The child may not receive adequate nutrients, resulting in reduced immunity and increased susceptibility to infection.

2. Exposure to environmental tobacco smoke: Second-hand smoke increases the risk of developing RSV respiratory infections in young children and infants.

3. Exposure to other sick individuals: Living in a crowded environment or attending daycare can increase the risk of acquiring RSV.

Interventions

3. Monitor respiratory status: Monitor for any changes in the patient’s breathing, including rate, depth, and effort. Notify the physician if there are any signs of distress or difficulty breathing.

4. Implement preventative measures: Encourage frequent handwashing, cover the mouth and nose when coughing/sneezing, and avoid contact with individuals who are ill.

5. Monitor for signs of dehydration: Assess fluid intake, output, and skin turgor. Administer fluids as the physician orders to replace any loss due to decreased intake or excessive production.

6. Administer medications as ordered: This may include antibiotics, bronchodilators, and fluids, depending on the patient’s condition and severity of symptoms.

7. Provide patient/family with education on RSV: Teach about the signs and symptoms of RSV, how to prevent its spread, and available treatments.

8. Provide psychological support: This is especially important for parents/caregivers of children hospitalized with RSV or at a high risk of infection.

9. Administer immunizations: Vaccines such as the pneumococcal conjugate vaccine (PCV) can reduce the risk of severe respiratory illness caused by RSV in infants and young children.

Outcomes & Evaluation

1. Patient will demonstrate improved respiratory status as evidenced by improved oxygen saturation, decreased wheezing, and increased rate/depth of breathing within 48 hours after initiating interventions.

2. Patient/family will demonstrate knowledge about the disease process and prevention of RSV spread, as evidenced by verbalization/discussion of information provided.

3. Patient/family will demonstrate improved psychological status as evidenced by decreased anxiety and increased coping skills within 24 hours after initiating interventions.

4. Patient will demonstrate a decreased incidence of associated complications due to RSV infection, such as pneumonia or bronchiolitis, as evidenced by physical examination findings and lack of symptoms over time.

Documentation Guidelines

  • Documentation in a child with RSV includes:
  • Patient/family’s knowledge of RSV and understanding of preventive measures
  • Respiratory status, including rate, depth, effort, oxygen saturation levels, and wheezing
  • Ability to maintain adequate hydration as evidenced by intake/output records
  • Medication Administration
  • Patient/family’s response to interventions and psychological support provided.

RSV Precautions Nursing

Precautions are essential for ensuring the health and safety of patients affected by the virus. It’s important to remember that RSV can be spread through contact with respiratory secretions, so nurses should take precautions to prevent further spread, such as wearing gloves when in connection with an infected patient and washing hands thoroughly after each contact.

Nurses should also clean and disinfect any surfaces or objects that may have been contaminated with the virus.

Additionally, nurses should provide patient education about RSV symptoms and how it can be prevented. By taking these measures, nurses can help reduce the risk of spreading this virus and ensure better patient outcomes.

Final Words

Respiratory Syncytial Virus (RSV) is a common virus that can cause severe respiratory infections in young children and infants. Nurses play an essential role in identifying patients at risk and providing appropriate interventions to reduce the severity and duration of the illness. 

Through the implementation of evidence-based preventive measures, nurses can help reduce the spread of this virus and prevent serious complications.

Nurses should also provide patient/family education on RSV prevention, symptoms, and available treatments to ensure they are adequately prepared to manage any subsequent infections. By taking these simple steps, nurses can help improve outcomes for patients affected by RSV and ensure their safety.

References

https://www.ncbi.nlm.nih.gov/books/NBK568705/

https://www.aafp.org/pubs/afp/issues/2011/0115/p141.html#:~:text=%2Fafpsort.xml.-,Pathophysiology,usually%20causes%20more%20severe%20disease.