Nursing Diagnoses

Let's look at possible nursing diagnoses for West Nile virus. I will list 5 and then focus in on one which I feel is the most important or applicable to the person ill with West Nile virus.  The nursing diagnosis is important, because this breaks an illness down beyond the pathophysiology. A medical diagnosis does not take into account the signs and symptoms, the physical risks associated, and the social and mental risks. These are important because these are tangible things we can act on within our nursing scope. With these direct diagnoses and interventions, the well-being of the patient can be directly improved. 

1. Acute Pain related to headache, fever, neck pain secondary to infection.
2. Activity Intolerance related to fatigue and malaise secondary to infection.
3. Acute Pain related to nuchal rigidity, muscle aches, immobility and increased sensitivity to external stimuli secondary to infectious process.
4. Risk for Impaired Skin Integrity related to immobility, dehydration, and diaphoresis.
5. Interrupted Family Process related to critical nature of situation and uncertain prognosis.

Out of these 5, I feel effective pain control is paramount. With untreated pain, many of the other physiologic systems will fall down the cascade of impairment. Untreated pain will increase the efforts of the respiratory system, circulatory system, endocrine system, integumentary system (as mobility is decreased with pain), and obviously the nervous system. 

Lets focus on the first diagnosis, Acute Pain related to headache, fever, neck pain secondary to infection. 

Actual: ACUTE PAIN

Related to: Headache, fever, neck pain

Plan: Reduction of pain by multiple strategies.

Outcome: Pain reduced on numeric scale, patient states improved comfort.

Intervention: Administration of antipyretic and analgesic (ordered per provider). Proper positioning for comfort. Cold or heat packs for muscle analgesia. Proper resting and sleep cycles with activity as tolerated. 

Photo Credit

With proper nursing interventions based on solid and fact based nursing diagnoses, we can reduce patient suffering and improve well-being. These can be difficult at first, but with practice and viewing the patient as a complex interweaving of systems, proper nursing diagnoses can be achieved. 

References:

The Mayo Clinic. (2012). Disease and conditions: West Nile virus.

Retrieved from http://www.mayoclinic.org/diseases-conditions/west-nile-virus/basics/symptoms/con-20023076

Nursing Care of West Nile Virus

Nursing care of those suffering from West Nile virus is definitely a supportive role in the acute care setting. It is comprised of supportive therapy, education, prevention, and palliative support. With no vaccine or cure available, those infected will be treated by the nursing staff with supportive measures, while those at risk should be educated on their risks and how in still preventative measures.

Since we have no vaccine or cure, we must focus on solving the secondary problems inherent with WNV. The common signs and symptoms include headache, arthralgia and myalgia (joint and muscle aches), fever, and sometimes worsening encephalitis. Treating these symptoms is a great way to reduce stress on the body and encourage expedient healing by the patient. First line defense, of course, is reducing any pain. Uncontrolled pain can throw the entire body into a cascade of worsening trends that does not allow for any expedient healing. So by reducing pain, we can allow for greater mobility and function. This is commonly done with NSAIDS, which will also treat the fever concurrently. If pain is worsening beyond the scope of NSAIDS, a stronger pain therapy medication can be prescribed. They will continue though with the fever reduction concurrently to allow for proper healing by reducing the body temperature.

As for the nursing care that I feel is most important, education and prevention, we must be proactive and diligent in our work. Education about the risks and downsides of contracting West Nile virus, fatal to some, should be the focus of encouraging the public to be aware of the prevention methods. It is an easily preventable disease in the United States. We should encourage following the four D's of prevention.

Photo Credit

 

 

By avoiding the outdoors, especially around fresh water pools or in known infected mosquito areas at dusk and dawn, you can easily prevent a bite. By dressing in long sleeves and pants while outdoors, you are offering the mosquito less skin to possibly bite you. By using an insect repellent that contains Feet (N,N dimethyl-m-toluamide) whenever outdoors, especially in mosquito filled areas, you will deter them with this spray. Make sure to always follow the manufacturers directions on insect repellant to prevent any harm. And the last D, that nurses should encourage in education and prevention, is to drain any standing water in your yard or local area. These fresh water puddles, pools, or reservoirs are where mosquitos lay eggs. By reducing the amount of areas that are available to them to lay eggs, you will effectively reduce the amount of mosquitos.

 

These are just several things that a nurse can do to care for or help reduce the prevalence of West Nile virus. As treatments expand and new medications or research emerges, the landscape of the nurse's role in care will also change.

 

 

References:

 

The Mayo Clinic. (2012). Disease and conditions: West Nile virus.

Retrieved from http://www.mayoclinic.org/diseases-conditions/west-nile-virus/basics/symptoms/con-20023076

Virology, Pathology, and Clinical Manifestations of West Nile Virus Disease - Volume 11, Number 8-August 2005 - Emerging Infectious Disease journal - CDC. (n.d.). Retrieved May 4, 2015, from http://wwwnc.cdc.gov/eid/article/11/8/05-0289b_article

 

About West Nile Virus. (n.d.). Retrieved May 12, 2015, from http://access.tarrantcounty.com/en/public-health/disease-control---prevention/west-nile-virus/about-west-nile-virus.html

 



Treatment Options

This topic is extremely important, for those who are unfortunate enough to have contracted this virus, getting it actually treated is essential. This isn't a disease one wants to live with, so treatment must be fast, comprehensive, and without too many complications or adverse side effects.

Unfortunately, at this time, there is no vaccine or anti-viral medications for West Nile Virus. This means that you can not get an injection with a weakened virus in hopes your body will create the proper antibodies for the virus in case infection occurs. Anti-viral medication is not a vaccine, but a medicine that actually will kill the virus and lessen the viral load in the body after being infection. Since neither of these exist currently, treatment must be focused on ways to secondarily heal from infection. This means that supportive modalities must be implemented to encourage the body to fight and heal naturally. This includes keeping hydrated with intravenous fluids, proper pain management, proper nutrition and activity levels, and boosting the immune system.

The most frequent symptoms are headache, fever, arthralgia, and sometimes encephalitis. The headache, fever and arthralgia can be treated suitably with over the counter pain relief and fever reducers. The encephalitis though usually requires hospital stay to reduce infection in the brain, reduce intra-cranial pressure, and prevent further infection throughout the body.

There is current research being done in the field of treatment with interferon. Interferon is a medication that acts as immune cell therapy. This therapy is having preliminary tests with encephalitis caused by specifically West Nile virus. There are early reports that the patients who received interferon healed faster, and with less side effects than those that did not receive the interferon treatment. This will be something that is hopefully explored to its fullest and will lead to a faster and more comprehensive treatment option than natural healing.

The best defense though, is always a good offense. When it comes to a virus, which is notoriously difficult to treat across the spectrum, prevention is the best treatment. If there is never an actual infection present, there is nothing to treat. And since the West Nile virus is transmitted to humans through the vector of carrier mosquitoes, we must fight the bite! This is simple with some easy to follow steps whenever you are outside, this is an easy info-graphic to remember what to do and how to do it.

photo credit

References:

The Mayo Clinic. (2012). Disease and conditions: West Nile virus.
Retrieved from http://www.mayoclinic.org/diseases-conditions/west-nile-virus/basics/symptoms/con-20023076

Virology, Pathology, and Clinical Manifestations of West Nile Virus Disease - Volume 11, Number 8-August 2005 - Emerging Infectious Disease journal - CDC. (n.d.). Retrieved May 4, 2015, from http://wwwnc.cdc.gov/eid/article/11/8/05-0289b_article