Respiratory syncytial virus infection

Respiratory syncytial virus infection: Excerpt from Professional Guide to Diseases (Eighth Edition)

Respiratory syncytial virus (RSV) infection results from a subgroup of the myxoviruses that resemble paramyxovirus. RSV is the leading cause of lower respiratory tract infections in infants and young children. It's the major cause of pneumonia, tracheobronchitis, and bronchiolitis in this age-group and a suspected cause of the fatal respiratory diseases of infancy.

Causes and incidence

The organism that causes RSV is transmitted from person to person by respiratory secretions and has an incubation period of 4 to 5 days. Antibody titers seem to indicate that few children younger than age 4 escape contracting some form of RSV, even if it's mild. In fact, RSV is the only viral disease that has its maximum impact during the first few months of life (incidence of RSV bronchiolitis peaks at age 2 months). School-age children, adolescents, and young adults with mild reinfections are probably the source of infection for infants and young children.

This virus occurs in annual epidemics during the late winter and early spring in temperate climates and during the rainy season in the tropics. It can also be seen in immunocompromised adults, especially patients with bone marrow transplants.

Signs and symptoms

Clinical features of RSV infection vary in severity from mild, coldlike symptoms to bronchiolitis or bronchopneumonia and, in a few patients, severe, life-threatening lower respiratory tract infections. Symptoms usually include coughing, wheezing, malaise, pharyngitis, dyspnea, and inflamed mucous membranes in the nose and throat. Reinfection is common, producing milder symptoms than the primary infection.

Otitis media is a common complication of RSV in infants. RSV has also been identified in patients with a variety of central nervous system disorders, such as meningitis and myelitis.

Diagnosis

Diagnosis is usually based on clinical findings and epidemiologic information.

❑Many facilities can perform rapid tests for the virus using fluid obtained from the nose.

❑Cultures of nasal and pharyngeal secretions may show RSV; however, the virus is labile, so cultures aren't always reliable.

❑Chest X-rays help detect pneumonia.

Treatment

Treatment aims to support respiratory function, maintain fluid balance, and relieve symptoms. Ribavirin in aerosol form may be administered to severely ill patients or those at high risk for complications.

Special considerations

Your care plan should provide support and relief of symptoms.

❑Monitor respiratory status, including rate and pattern. Watch for nasal flaring or retraction, cyanosis, pallor, and dyspnea; listen or auscultate for wheezing, rhonchi, or other signs of respiratory distress. Monitor arterial blood gas levels and oxygen saturation.

❑Maintain a patent airway, and be especially watchful when the patient has periods of acute dyspnea. Perform percussion and provide drainage and suction, when necessary. Use a croup tent to provide a high-humidity atmosphere. Semi-Fowler's position may help prevent aspiration of secretions.

❑Monitor intake and output carefully. Observe for signs of dehydration such as decreased skin turgor. Encourage the patient to drink plenty of high-calorie fluids. Administer I.V. fluids as needed.

❑Promote bed rest. Plan your nursing care to allow uninterrupted rest.

❑Hold and cuddle infants; talk to and play with toddlers. Offer diversionary activities that are appropriate for the child's condition and age. Encourage parental visits and cuddling. Restrain the child only as necessary.

❑Impose droplet precautions. Enforce strict hand hygiene, because RSV may be transmitted from fomites. Avoid hand contact with nose or eyes; wear a surgical mask and eye protection.

❑Make sure that staff members with respiratory illnesses don’t care for infants.

Book Source Details

• Book Title: Professional Guide to Diseases (Eighth Edition)
• Author(s): Springhouse
• Year of Publication: 2005
• Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X

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