Respiratory Syncytial Virus (RSV)

Describe RSV

highly contagious respiratory infection

Affects almost all children before age 2

Asymptomatic or presents as simple cold in individuals older than age 2

May have repeated RSV infections throughout lifespan

Symptoms tend to be less severe with repeated exposures

Pathophysiology of RSV

RSV infects squamous epithelial cells of bronchioles, alveoli

Infected cells merge with adjacent cells, forming syncytia that burst and die -->

Resulting debris clogs minute airways

Cycle repeated throughout both lungs

Airways only partially obstructed

Allow air in

Expulsion of air hindered by mucus and/or airway swelling

Wheezing, crackles in airways

Rhinorrhea, atelectasis, hypoxemia

May lead to apnea, pulmonary edema

RSV is the primary cause of?

Respiratory Infections among children and older adults

What standard precautions does RSV require

Direct precaution - gown and gloves

Risk Factors

Not being breastfed

Secondhand smoke exposure

Attend child care

Live in crowded conditions

Socioeconomically disadvantaged

Prematurity

Chronic lung disease

Acyanotic congenital heart disease

Reduced immunity

Children <2 years of age, older adults have higher risk for complications

Prevention

- Good hand hygiene

- RSV can survive on hard surfaces for several hours

- Medication: palivizumab for infants at high risk for serious RSV infections, complications

Not effective in treatment of acute RSV infection

Not recommended for use in general prevention of healthcare-associated RSV infection

*treat the symptoms and provide comfort*

Clinical Manifestations

- Presentation begins 3-5 days after exposure

Rhinorrhea, cough, irritability

Low-grade fever for 1-3 days

- Copious mucus secretions in lung fields, nasal passages, usually green

- More serious signs, symptoms

increased irritability

Excessive coughing

Wheezing

Call emergency medical services (EMS) for transport for these symptoms-

Marked retractions of ribcage

Nasal flaring

Rapid respiratory rate

Blue skin

Listlessness

Periods without breathing

Collaboration

- Infants with respiratory distress with RSV require hospitalization

- Plan of care

Monitoring breathing patterns

Maintaining patent airway

Maintaining adequate fluid,

caloric intake

- Supporting appropriate developmental behaviors

- Care team

Nurse

Respiratory therapist

Nutritionist

Play therapist (age appropriate

activities for children's play

needs)

Diagnostic Tests

- Rapid diagnostic assays

- Antigen detection tests

May be supplemented with

cell culture

- Real-time polymerase chain

reaction assays

More sensitive than antigen

detection tests

takes a while for definitive

diagnostic test

Chest x-ray

Arterial blood gases (ABGs)

Pharmacologic Therapy

Few medications for RSV

Some medications that were previously recommended no longer are

- Bronchodilators

Most infants do not benefit

Undesirable side effects

- Nebulized epinephrine

Not recommended for general

use in infants and children

May have some benefit as

rescue agent in severe

bronchiolitis

- Corticosteroids

Questionable benefits

Negative side effects

- Antibacterial medications

Unless concurrent bacterial

infection

Nonpharmacologic Therapy

No effective therapy

- Humidified oxygen to maintain

pulse oximetry readings ≥ 90%

- Supportive care

Oral or IV hydration

Suctioning

- Intubation, ventilation for children

with apnea, respiratory failure

which group of adults is at higher risk of RSV infections

individuals who work in healthcare and in childcare

older adults in longterm care facilities and individuals with supposed immune systems - can result in death

Symptoms and how long it lasts

Those of upper respiratory tract infection

Typically resolve within 10 days

what is a different sign that manifests in adults but not in children

headache

what is a good diagnostic test for adults

High-resolution CT scanning is more effective than chest x-ray

what is the nursing care focus for RSV

Maintain airway patency

Promote effective respiratory function and hydration

Support overall physiologic function and hydration

Reduce anxiety for child and family

Prepare family for home care

what are life threatening signs of RSV

central cyanosis, respiratory rat >70, listlessness, apneic episodes, diminished breath sounds

Nursing Diagnosis

Breathing Pattern, Ineffective

Airway Clearance, Ineffective

Gas Exchange, Impaired

Electrolyte Imbalance, Risk for

Imbalanced Fluid Volume, Risk for

Imbalanced Nutrition: Less Than Body Requirements

Activity Intolerance

Assessment of infants

- Lack of play indicates severe

illness

Infants who are premature, have cardiac or respiratory disorders are at greatest risk of severe RSV requiring hospital care

Assess for

Pronounced cough

Wheezing

Fevers to 102°F

Poor feeding

- Signs of increased respiratory

effort

Marked retractions with

nasal flaring

Rapid respiratory rate

Cyanosis

Listlessness

Apnea

Monitor fluid balance

- Teach parents to count diapers per day (to assess dehydration and adequate output)

- Encourage oral intake

- Record intake and output (I&O), including weighing diaper

- Assess for poor skin elasticity, dry mucous membranes, decreased urine output

- Monitor IV fluid rate if ordered

Evaluation

Successful recovery indicated by the following outcomes

Patient's breathing patterns returned to appropriate rate, rhythm, quality

Patient's airways remained clear through suctioning, coughing

Patient had appropriate fluid, electrolyte, caloric intake to meet nutritional needs

Patient returned to appropriate play for developmental age

Continually monitor patient's breathing and nutritional status

Exacerbations may require additional interventions and collaboration

A 6-year-old patient is diagnosed with bronchiolitis. Which assessment should the nurse prioritize for this patient?

A. Observe for labored respirations.

B. Monitor closely for lengthening of paroxysms.

C. Observe for signs of obstruction.

D. Assess for seizures.

A. Observe for labored respirations.

The nurse is teaching the parent of a 9-month-old patient who is diagnosed with respiratory syncytial virus (RSV) about the importance of monitoring dietary intake. Which intervention should the nurse suggest to the parent to accomplish this goal?

A. Offer small meals frequently.

B. Force your child to eat.

C. Encourage one big meal daily.

D. Encourage a high-fat diet.

A. Offer small meals frequently.

The nurse is caring for an adult patient with symptomatic respiratory syncytial virus (RSV). Which description most likely fits this patient?

A. Older adult in a nursing home

B. 6-year-old child in elementary school

C. Psychiatric nurse

D. Parent of a 10-year-old child

A. Older adult in a nursing home

The nurse is speaking to the parents of a patient with bronchiolitis caused by respiratory syncytial virus (RSV).

Which respiratory structure should the nurse identify as being obstructed?

A. Large airways

B. Small airways

C. Pulmonary artery

D. Cilia

B. Small airways

The nurse is teaching the parents of a child with bronchiolitis about care needed at home. Which statement by the parents indicates instructions have been effective?

A. "It is important to give our child extra fluids."

B. "We will provide extra stimulation for our child."

C. "We will administer the prescribed amoxicillin 1 hour before meals."

D. "We should stop the antibiotics once the bronchiolitis symptoms go away."

A. "It is important to give our child extra fluids."

A child with respiratory syncytial virus (RSV) is admitted to a care area. Which action by the nurse will prevent the spread of infection?

A. Avoid use of alcohol-based hand sanitizer.

B. Prohibit contact with patients who do not have RSV.

C. Cover the child's face with a mask.

D. Admit the child to the intensive care unit.

B. Prohibit contact with patients who do not have RSV.

The nurse is teaching the parent of a 5-month-old diagnosed with respiratory syncytial virus (RSV) about what to do if they notice retraction of the child's rib cage.

Which statement from the parent demonstrates that the teaching has been effective?

A. "I will immediately provide a nebulizer treatment with saline."

B. "I will suction my child's nose and watch for their respiratory rate to decrease."

C. "I will take my child to the emergency department."

D. "I will call my healthcare provider and ask what I should do."

C. "I will take my child to the emergency department."

An infant patient with respiratory syncytial virus (RSV) is ordered delivery of nutrition via an intravenous (IV) line. The infant's parent asks why IV nutrition is being ordered. Which response by the nurse is correct?

A. "Your child is vomiting and cannot tolerate oral feedings."

B. "IV nutrition is typical protocol for this type of infection."

C. "Rapid breathing indicates the need for IV nutrition."

D. "Fluid in the lungs indicates the need for IV nutrition."

C. "Rapid breathing indicates the need for IV nutrition.

The nurse suspects that a 9-month-old child has respiratory syncytial virus (RSV).

Which symptom led the nurse to this conclusion?

A. Cool skin

B. Bruising

C. Wheezing

D. Diarrhea

Wheezing

An 11-month-old patient is admitted to the intensive care unit for treatment of severe bronchiolitis and a concurrent pneumonia. Which medication should the nurse anticipate will most likely be prescribed for this patient?

A. Bronchodilator

B. Epinephrine

C. Antibiotic

D. Corticosteroid

C. Antibiotic

The home care nurse is evaluating the care provided to an 18-month-old patient recovering from bronchiolitis caused by respiratory syncytial virus (RSV).

Which observation indicates that the parents have provided adequate care?

A. The child has moderate nasal flaring with respirations.

B. The child's oxygen saturation is 98% on room air.

C. The child has a faint wheeze upon auscultation.

D. The child becomes drowsy while eating lunch.

B. The child's oxygen saturation is 98% on room air.

A child is being seen for a suspected case of respiratory syncytial virus (RSV). During the interview the nurse collects data on the specific symptoms and behavior of the patient from their parents. For which time frame should the specifics of the illness be collected by the nurse?

A. Previous day

B. Current month

C. Last 3 days

D. Previous week

D. Previous week

A 3-year-old patient is admitted with severe bronchiolitis.

Which question should the nurse include when reviewing the patient's health history with the parents?

A. "What type of fluids does the child drink each day?"

B. "When did the child begin to walk without help?"

C. "Did the child have an annual influenza vaccination?"

D. "At what age was the child potty trained?"

C. "Did the child have an annual influenza vaccination?"

The nurse is working with a 1-year-old diagnosed with respiratory syncytial virus (RSV) and their parent on the proper protocol to prevent the spread of the infection. Which statement by the parent demonstrates understanding of this teaching?

A. "I should keep my child isolated in their room for 3 days."

B. "I should not touch my child while they are sick without gloves."

C. "I should make my whole family wear masks."

D. "I should make sure my other child doesn't drink from the same cup as my 1-year-old."

D. "I should make sure my other child doesn't drink from the same cup as my 1-year-old."

The school nurse is teaching a group of daycare teachers about the manifestations of respiratory syncytial virus (RSV). Which teacher statement indicates that additional instruction is required?

A. "Vomiting and diarrhea need to be investigated."

B. "Wheezing is not normal and needs to be checked out."

C. "I have to report any child who has a change in eating pattern."

D. "Most babies are irritable when they miss their parents."

D. "Most babies are irritable when they miss their parents."

The nurse is caring for a 4-month-old patient diagnosed with a mild case of bronchiolitis.

Which action should the nurse take to help the patient at this time?

A. Administer antibiotics as prescribed.

B. Use an inhaled bronchodilator as prescribed.

C. Suction the nose frequently, especially before feeding.

D. Administer palivizumab as prescribed.

C. Suction the nose frequently, especially before feeding

The nurse explains to parents the importance of maintaining fluid balance in their 9-month-old diagnosed with respiratory syncytial virus (RSV). Which statement by the parent demonstrates understanding of how this can be accomplished?

A. "I should restrict my child's dietary intake."

B. "I should offer large feedings spread apart."

C. "I should count my child's diapers."

D. "I should suction my child's nose and write down a description of what I get out."

C. "I should count my child's diapers."

The nurse is providing discharge instruction to the parents of a 7-month-old patient admitted with bronchiolitis. The nurse explains the process of observing breathing patterns as a way to determine respiratory distress.

Which statement by the parent displays understanding of this intervention?

A. "I should observe the pattern while my child is lying on their belly."

B. "If I can see the rib cage retract, I should seek medical attention."

C. "If my child cries, they are most likely in respiratory distress."

D. "I can place my hand on their chest to check for distress."

B. "If I can see the rib cage retract, I should seek medical attention."

The nurse is discussing the pharmacologic treatment of infant patients with bronchiolitis.

Which medication would the nurse identify as having tachycardia and generalized tremors as a side effect?

A. Bronchodilators

B. Nebulizers

C. Antibacterials

D. Corticosteroids

A. Bronchodilators

The nurse is teaching a group of colleagues about who would be considered a high-risk group for a symptomatic respiratory syncytial virus (RSV) infection.

Which group should the nurse include?

A. Customer service workers in a mall

B. Male adolescents

C. Parents of adolescents

D. Healthcare workers

D. Healthcare workers

The parent of a 2-year-old patient with bronchiolitis caused by respiratory syncytial virus (RSV) asks the nurse why the child has been coughing so much.

Which response by the nurse is accurate?

A. "The virus causes dead cells in the lining of the lungs and large amounts of mucus that stimulate the cough reflex."

B. "The bacterial infection forces white blood cells to move into the lungs, which are removed by coughing."

C. "The virus causes body fluids to move into the lungs, which the body tries to remove by coughing."

D. "The bacterial infection irritates the lining of the bronchial tubes and stimulates the cough reflex."

A. "The virus causes dead cells in the lining of the lungs and large amounts of mucus that stimulate the cough reflex."

The parents of a child diagnosed with bronchiolitis ask the nurse how the disorder is treated.

Which response by the nurse is appropriate?

A. "Antibiotics will be given for a period of 10 days."

B. "The focus is on managing symptoms and providing supportive care."

C. "A medication called dexamethasone helps to heal the lungs."

D. "An inhaler will be used and the symptoms will be gone in about 24 hours."

B. "The focus is on managing symptoms and providing supportive care."

The nurse is discussing the etiology of bronchiolitis with a colleague. Which statement by the colleague demonstrates understanding of the etiology?

A. "Asthma leads to bronchiolitis."

B. "Influenza virus is the most common cause of bronchiolitis."

C. "Respiratory syncytial virus is the most common cause of bronchiolitis."

D. "Bacterial pneumonia is the most common cause of bronchiolitis."

C. "Respiratory syncytial virus is the most common cause of bronchiolitis."

The nurse is teaching a parent of an 8-month-old patient infected with respiratory syncytial virus (RSV) the importance of dietary intake and the benefit of maintaining adequate calories.

Which statement by the parent demonstrates understanding of these recommendations?

A. "Calories reduce the fever."

B. "Dietary intake makes them stronger."

C. "Adequate food cures the infection."

D. "Adequate calorie intake supports healing."

D. "Adequate calorie intake supports healing."

An infant presents with coughing, shortness of breath, wheezing, and crackles upon auscultation. Which laboratory test should the nurse expect to be ordered to confirm a diagnosis of respiratory syncytial virus (RSV)?

A. Arterial blood gases (ABGs)

B. Reverse transcription polymerase chain reaction (RT-PCR) assay

C. Antigen detection test

D. Pulmonary function tests (PFT)

C. Antigen detection test

The nurse instructs the parents of a patient with respiratory syncytial virus (RSV) to monitor oral intake and count diapers. The parents ask why this is important. Which response by the nurse is accurate?

A. "This intervention demonstrates whether the child is getting adequate nutrition."

B. "This will reduce the risk of gaining a concurrent infection."

C. "This intervention is to check if the medication is working."

D. "This will help to identify if your child is becoming dehydrated."

D. "This will help to identify if your child is becoming dehydrated."

The nurse is caring for an adult patient with symptomatic respiratory syncytial virus (RSV). Which description most likely fits this patient?

A. Older adult in a nursing home

B. Parent of a 10-year-old child

C. 6-year-old child in elementary school

D. Psychiatric nurse

A. Older adult in a nursing home

The nurse preceptor is discussing diagnostic testing for respiratory syncytial virus (RSV) with a group of new nurses.

Which statement by a new nurse demonstrates understanding of which diagnostic test is used to view atelectasis?

A. Arterial blood gases (ABGs)

B. Pulse oximetry

C. Chest x-ray

D. Bronchoscope

C. Chest x-ray

The nurse is caring for an older adult patient in a nursing home with symptomatic respiratory syncytial virus (RSV). The nurse should expect to see symptoms similar to which condition?

A. Allergies

B. Common cold

C. Pneumonia

D.Asthma

C. Pneumonia

The nurse is discussing nebulizer treatments of hypertonic saline with a parent whose 9-month-old was admitted for bronchiolitis. The parent asks, "Why can't we use a bronchodilator?"

Which response by the nurse is accurate?

A. "Nebulizer treatments with saline will only require a few treatments to be effective."

B. "Bronchodilators are a good choice. Let me call your healthcare provider."

C. "Bronchodilators can cause rapid heart rate and tremors in your child."

D. "Nebulizer treatments with saline will be much less expensive."

C. "Bronchodilators can cause rapid heart rate and tremors in your child."

The nurse is discussing the etiology of bronchiolitis with a colleague. Which statement by the colleague demonstrates understanding of the etiology?

A. "Respiratory syncytial virus is the most common cause of bronchiolitis."

B. "Influenza virus is the most common cause of bronchiolitis."

C. "Asthma leads to bronchiolitis."

D. "Bacterial pneumonia is the most common cause of bronchiolitis."

A. "Respiratory syncytial virus is the most common cause of bronchiolitis."

The nurse is discussing the importance of recognizing the symptoms of respiratory syncytial virus (RSV) in older adult patients. Which statement should the nurse include?

A. "RSV presents with symptoms similar to pneumonia in the older adult."

B. "RSV presents with asthmatic wheezing in older adults."

C. "RSV presents as a common cold in the older adult."

D. "RSV is asymptomatic in older adults."

A. "RSV presents with symptoms similar to pneumonia in the older adult."