Poliomyelitis: Nursing

Poliomyelitis: Nursing

Watch later

Watch later

Infection prevention and control - Precautions and personal protective equipment (PPE): Nursing skills
Urinary tract infections (UTIs): Nursing process (ADPIE)
Modes of infectious disease transmission
Epstein-Barr virus (Infectious mononucleosis)
Pneumonia
Wound healing
Palliative and hospice care: Nursing
Postoperative care: Nursing
Biology of cancer: Nursing
Biliary atresia: Nursing
Cholecystitis: Nursing
Cholelithiasis: Nursing
Colorectal cancer: Nursing
Diarrhea: Nursing
Diverticular disease: Nursing
Esophageal cancer: Nursing
Gastric cancer: Nursing
Hepatitis: Nursing
Inflammatory bowel disease - Crohn disease and ulcerative colitis: Nursing
Intestinal obstruction: Nursing
Irritable bowel syndrome (IBS): Nursing
Jaundice: Nursing
Laryngeal cancer: Nursing
Liver cancer: Nursing
Pancreatic cancer: Nursing
Esophageal atresia and tracheoesophageal fistula: Nursing
Geriatric considerations - Gastrointestinal: Nursing
Hirschsprung disease: Nursing
Hyperemesis gravidarum: Nursing
Necrotizing enterocolitis: Nursing
Omphalocele and gastroschisis: Nursing
Appendicitis: Nursing process (ADPIE)
Celiac disease: Nursing process (ADPIE)
Cirrhosis: Nursing process (ADPIE)
Gastroesophageal reflux disease (GERD): Nursing process (ADPIE)
Hiatal hernia: Nursing process (ADPIE)
Pancreatitis: Nursing process (ADPIE)
Peptic ulcer disease (PUD): Nursing process (ADPIE)
Antacids: Nursing pharmacology
Antidiarrheals: Nursing pharmacology
Antiemetics: Nursing pharmacology
Antispasmodics (GI): Nursing pharmacology
Gallstone-dissolving agents: Nursing pharmacology
Gastric mucosal protective agents: Nursing pharmacology
Histamine H2 antagonists: Nursing pharmacology
Laxatives: Nursing pharmacology
Medications for hepatic encephalopathy: Nursing pharmacology
Pancreatic enzyme replacements: Nursing pharmacology
Proton pump inhibitors (PPIs): Nursing pharmacology
Treatment for Helicobacter pylori: Nursing pharmacology
Weight loss medications: Nursing pharmacology
Bladder tumors: Nursing
Chronic kidney disease (CKD): Nursing
Dialysis care: Nursing
Epididymitis: Nursing
Glomerulonephritis: Nursing
Nephrotic syndrome: Nursing
Polycystic kidney disease (PKD): Nursing
Prostate cancer: Nursing
Pyelonephritis: Nursing
Renal and urinary calculi: Nursing
Renal cancer: Nursing
Testicular cancer: Nursing
Urinary retention: Nursing
Bladder exstrophy: Nursing
Circumcision: Nursing
Cryptorchidism: Nursing
Enuresis: Nursing
Geriatric considerations - Urinary: Nursing
Hypospadias and epispadias: Nursing
Acute kidney injury (AKI): Nursing process (ADPIE)
Benign prostatic hyperplasia (BPH): Nursing process (ADPIE)
Urinary incontinence - Stress: Nursing process (ADPIE)
Antispasmodics (GU): Nursing pharmacology
Cholinergic therapy (GU): Nursing pharmacology
Diuretics - Osmotic and carbonic anhydrase inhibitors: Nursing pharmacology
Diuretics - Thiazide, thiazide-like, loop, and potassium-sparing diuretics: Nursing pharmacology
Anemia - Aplastic: Nursing
Anemia - Iron-deficiency: Nursing
Anemia - Macrocytic: Nursing
Arterial blood gas (ABG) - Overview: Nursing
Arterial blood gas (ABG) - Metabolic acidosis: Nursing
Arterial blood gas (ABG) - Metabolic alkalosis: Nursing
Arterial blood gas (ABG) - Respiratory acidosis: Nursing
Arterial blood gas (ABG) - Respiratory alkalosis: Nursing
Blood cultures: Nursing
Cardiac biomarkers - Creatine kinase (CK): Nursing
Cardiac biomarkers - Troponin: Nursing
Coagulation studies - Partial thromboplastin time (PTT): Nursing
Complete blood count (CBC) - Hemoglobin and hematocrit: Nursing
Complete blood count (CBC) - Platelets: Nursing
Complete blood count (CBC) - Red blood cells (RBC): Nursing
Complete blood count (CBC) - White blood cells (WBC) and differential: Nursing
Complete metabolic panel (CMP) - Blood urea nitrogen (BUN) and creatinine (Cr): Nursing
Complete metabolic panel (CMP) - Chloride: Nursing
Complete metabolic panel (CMP) - Estimated glomerular filtration rate (eGFR): Nursing
Complete metabolic panel (CMP) - Glucose: Nursing
Complete metabolic panel (CMP) - Liver function tests (LFT): Nursing
Complete metabolic panel (CMP) - Potassium: Nursing
Complete metabolic panel (CMP) - Sodium: Nursing
Complete metabolic panel (CMP) - Total protein: Nursing
Disseminated intravascular coagulation (DIC): Nursing
Multiple myeloma: Nursing
Neutropenia: Nursing
Polycythemia: Nursing
Thalassemia: Nursing
Thrombocytopenia: Nursing
Leukemia: Nursing process (ADPIE)
Anticoagulants - Direct thrombin and factor Xa inhibitors: Nursing pharmacology
Anticoagulants - Heparin: Nursing pharmacology
Anticoagulants - Warfarin: Nursing pharmacology
Antihyperlipidemics - Bile acid sequestrants and cholesterol absorption inhibitors: Nursing pharmacology
Antihyperlipidemics - Fibrates: Nursing pharmacology
Antihyperlipidemics - Miscellaneous: Nursing pharmacology
Antihyperlipidemics - Statins: Nursing pharmacology
Antiplatelet agents: Nursing pharmacology
Blood products: Nursing pharmacology
Hematopoietic growth factors: Nursing pharmacology
Hemostatics: Nursing pharmacology
Iron preparations: Nursing pharmacology
Thrombolytics: Nursing pharmacology
Autoimmunity: Nursing
Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS): Nursing
Hypersensitivity reactions - Type I: Nursing
Hypersensitivity reactions - Type II: Nursing
Hypersensitivity reactions - Type III: Nursing
Hypersensitivity reactions - Type IV: Nursing
Immune response - Adaptive: Nursing
Immune response - Innate: Nursing
Immunodeficiency disorders - Primary: Nursing
Immunodeficiency disorders - Secondary: Nursing
Inflammatory process: Nursing
Scleroderma: Nursing
Shock - Anaphylactic: Nursing
Sjögren syndrome: Nursing
Systemic lupus erythematosus (SLE): Nursing
Toxic shock syndrome (TSS): Nursing
Erythema infectiosum (Fifth disease): Nursing
Fever: Nursing
Infectious mononucleosis: Nursing
Mumps (Parotitis): Nursing
Neonatal sepsis: Nursing
Pertussis: Nursing
Poliomyelitis: Nursing
Postpartum infections: Nursing
Roseola (Exanthem subitum): Nursing
Rubella (German measles): Nursing
Rubeola (Measles): Nursing
Smallpox: Nursing
Zika virus: Nursing
Anaphylaxis: Nursing process (ADPIE)
Lyme disease: Nursing process (ADPIE)
Rheumatoid arthritis (RA): Nursing process (ADPIE)
Antirejection immunosuppressants: Nursing pharmacology
Biologic agents: Nursing pharmacology
Disease-modifying therapy for multiple sclerosis: Nursing pharmacology
Immunoglobulins: Nursing pharmacology
Immunomodulators: Nursing pharmacology
Immunosuppressants for autoimmune diseases: Nursing pharmacology
Non-biologic disease-modifying antirheumatic drug (DMARD) therapy: Nursing pharmacology
Vaccines: Nursing pharmacology
Acne: Nursing
Animal and snake bites: Nursing
Burn injury: Nursing
Cutaneous fungal infections: Nursing
Erysipelas and cellulitis: Nursing
Folliculitis, carbuncles, and furuncles: Nursing
Herpes simplex virus (HSV): Nursing
Herpes zoster: Nursing
Impetigo: Nursing
Insect stings and bites: Nursing
Pediculosis and scabies: Nursing
Psoriasis: Nursing
Rocky Mountain spotted fever (RMSF): Nursing
Skin cancer - Basal cell carcinoma, squamous cell carcinoma, and melanoma: Nursing
Urticaria: Nursing
Geriatric considerations - Integumentary: Nursing
Atopic dermatitis: Nursing process (ADPIE)
Frostbite: Nursing process (ADPIE)
Methicillin-resistant Staphylococcus aureus (MRSA): Nursing process (ADPIE)
Pressure injury: Nursing process (ADPIE)
Antibiotics - Topical: Nursing pharmacology
Antifungals - Topical: Nursing pharmacology
Corticosteroids - Topical: Nursing pharmacology
Debridement agents: Nursing pharmacology
Keratolytics: Nursing pharmacology
Medications for acne vulgaris: Nursing pharmacology
Osteoarthritis: Nursing
Osteomyelitis: Nursing
Osteoporosis: Nursing
Hip fractures: Nursing
Developmental dysplasia of the hip: Nursing
Acute compartment syndrome: Nursing process (ADPIE)
Fractures: Nursing process (ADPIE)
Gout: Nursing process (ADPIE)
Musculoskeletal injuries: Nursing process (ADPIE)
Buerger disease: Nursing
Raynaud phenomenon: Nursing
Peripheral arterial disease (PAD): Nursing process (ADPIE)
Peripheral venous disease (PVD): Nursing process (ADPIE)
Atelectasis: Nursing
Geriatric considerations - Respiratory: Nursing
Venous thromboembolism (VTE): Nursing process (ADPIE)
Asthma: Nursing process (ADPIE)
Bacterial pneumonia: Nursing process (ADPIE)
Bronchiolitis and respiratory syncytial virus (RSV): Nursing process (ADPIE)
Carbon monoxide poisoning: Nursing process (ADPIE)
Chronic obstructive pulmonary disease (COPD): Nursing process (ADPIE)
Epiglottitis: Nursing process (ADPIE)
Foreign body aspiration and upper airway obstruction: Nursing process (ADPIE)
Laryngotracheobronchitis (LTB) and croup: Nursing process (ADPIE)
Smoke inhalation injury: Nursing process (ADPIE)
Papulosquamous and inflammatory skin disorders: Pathology review

Notes

POLIOMYELITIS

KEY POINTS
NOTES
DEFINITION
  • Highly contagious viral infection that leads to severe nerve injury

PHYSIOLOGY
  • Upper GI system 
    • Mouth
    • Pharynx
    • Esophagus
    • Stomach
    • Duodenum
  • Walls of GI tract made up of 4 layers
    • Serosa
    • Muscular 
    • Submucosa
    • Mucosa
      • Contains lamina propria
        • Acts as a barrier to pathogens
        • Houses immune cells

CAUSES AND RISK FACTORS
  • Causes
    • Poliovirus
  • Risk factors
    • Immunodeficiency
    • Age < 5 years
    • Being unvaccinated or undervaccinated
    • Living in poor sanitary conditions
    • Traveling to endemic area

PATHOPHYSIOLOGY
  • Virus enters GI tract 
    • Binds to epithelial cell receptors 
    • Enters cells in upper GI tract
    • Viral replication inside epithelial cells
    • Cells lyse, releasing new viruses
    • Viruses spread to lymph and blood stream
    • Viruses target motor neurons 
    • Leave blood vessels and go into muscle tissue 
    • Invade motor neurons, travel to spinal cord 
    • Reach anterior horn of spinal cord 
    • Immune response and neuron damage 
    • Neutrophils, macrophages cause inflammation 
    • Motor neurons die, muscles weaken 
    • Loss of brain signals causes atrophy
  • Complications
    • Bulbar paralysis 
    • Post-polio syndrome

SIGNS AND SYMPTOMS
  • Flu-like symptoms 
  • Abdominal pain
  • Soreness/stiffness of the neck, trunk, and limbs
  • Loss of muscle reflexes
  • Acute flaccid paralysis; asymmetric

DIAGNOSIS
  • History 
  • Physical assessment 
  • Poliovirus-specific IgM and IgG antibodies
  • RT PCR
  • Diagnostic imaging

TREATMENT
  • Supportive care
    • Pain medication
  • Urinary catheter
  • Respiratory support
  • Surgical treatment 
  • Physical therapy
  • Prevention
    • Vaccination
    • Inactivated polio vaccine (IPV) used in the US
    • Live-attenuated oral polio vaccine (OPV)
  • Post-exposure
    • Wash exposed skin 15 minutes with soap 
    • Use antiseptic scrub on exposed areas 
    • Irrigate eyes, nose, mouth if exposed 
    • Remove garments, double-bag in red bags

MANAGEMENT OF CARE
  • Goals of care
    • Prevent spread of the virus to others
    • Monitor for complications
    • Provide supportive care 
  • Use standard and contact precautions 
  • Maintain bed rest and body alignment 
  • Position for comfort, prevent contractures
    • Check for skin breakdown
    • Reposition often
    • Range of motion exercises
  • Assess pain and anxiety
    • Administer analgesics, anxiolytics, antipyretics as needed
  • Assess vital signs
    • Respiratory assessment and support 
      • Turn cough, deep breathe
      • Monitor for respiratory paralysis
        • Move to high Fowler position
        • Administer oxygen
        • Prepare for mechanical ventilation
  • Reporting 
    • Notify local health department 
  • Notify HCP
    • Ineffective cough
    • Difficulty talking
    • Rapid or shallow respiratory rate
    • Constipation 
    • Urinary retention

PATIENT AND FAMILY TEACHING
  • Explain condition, plan of care, and safe medication administration
  • Infection control
    • Frequent hand hygiene 
    • Cover mouth/nose when coughing or sneezing
    • Don’t share utensils or cups
    • Wash toys regularly
    • Avoid touching eyes, nose, mouth
    • Encourage vaccination
  • Recovery
    • Offer fluids and healthy snacks 
    • Encourage rest and quiet activities
    • Use ibuprofen or acetaminophen 
    • Avoid aspirin to prevent Reye syndrome
    • Use assistive and orthopedic devices 
    • Participate in rehab and follow-up care
  • Notify HCP
    • New trouble breathing or swallowing 
    • Excessive fatigue
    • Worsening weakness

Transcript

Watch video only

Poliomyelitis is a highly contagious viral infection that leads to severe nerve injury. It is caused by the poliovirus, which moves from the gut to the central nervous system. This can cause irreversible paralysis, breathing difficulties, and even death.

Let’s start with a quick review of the physiology of the upper gastrointestinal system, which consists of the mouth, pharynx, esophagus, stomach, and the first part of the small intestine, called the duodenum.

Now, let’s zoom into the wall of the gastrointestinal tract, which is made up of four layers. The outermost layer is called serosa or adventitia. Next is the muscular layer, which contracts to move food through the bowel. After that is the submucosa, which consists of a dense layer of tissue that contains blood vessels, lymphatics, and nerves. And finally, there’s the innermost layer, called the mucosa, which consists of a layer of epithelium covering the lamina propria.

The epithelium acts as a physical barrier that prevents harmful pathogens from entering the body. Additionally, the lamina propria houses immune cells, like dendritic cells and macrophages, that react to harmful pathogens. Additionally, round accumulations of lymphatic cells, called Peyer’s patches, can sometimes be found in the mucosa of the duodenum.

Now, the main cause of poliomyelitis is the poliovirus, which is an RNA virus that belongs to the Enterovirus genus, and the Picornaviridae family. Important risk factors for poliomyelitis include immunodeficiency; age below 5, being unvaccinated or undervaccinated; and finally, living in poor sanitary conditions, or traveling to an endemic area.

Alright, now the pathology of poliomyelitis starts with acquiring the virus through the fecal-oral route through contaminated water or food. In some cases, it could also be transmitted through droplets produced by a sneeze or cough.

Once in the gastrointestinal tract, the virus binds to receptors on the membrane of epithelial cells in the upper gastrointestinal tract and enters the cell.

Inside the cell, the virus creates new viral particles and creates new viral particles and starts to replicate. Within days, these cause the epithelial cell to lyse, meaning the cell breaks down, releasing the newly formed viruses, which then make their way to nearby lymph nodes and eventually into the bloodstream.

Poliovirus prefers to infect motor nerves, so oftentimes it will leave a blood vessel and get into the interstitial tissue of muscle tissue. From there, poliovirus invades the motor neuron and travels retrograde to the anterior horn of the spinal cord, which houses lower motor neurons.

Infected motor neurons attract immune cells like neutrophils and macrophages which cause inflammation and damage to the spinal cord. As infected motor neurons die, the muscles of the trunk and limbs no longer receive signals from the brain or trophic factors which causes the muscles to start to atrophy and become weak.

When it comes to complications of poliomyelitis, these include paralysis with bulbar involvement. This occurs when the poliovirus affects a part of the brainstem that houses cranial nerves involved in speaking and swallowing. This part of the brain stem also regulates breathing and heart rate, so it can lead to blood pressure fluctuation, or fatal respiratory and cardiovascular collapse.

Finally, some clients develop post-polio syndrome or PPS for short, which is characterized by new-onset or progressive muscle weakness that can show up in polio survivors years or decades after the initial infection.

Clients with poliomyelitis initially present with flu-like symptoms, including fever, malaise, headache, anorexia, and sore throat. Other signs and symptoms include abdominal pain, as well as soreness and stiffness of the neck, trunk, and limbs, and eventually loss of muscle reflexes, and acute flaccid paralysis. Usually the paralysis develops over a few days and is asymmetric; most often affecting larger proximal muscles, especially in the thighs.

The diagnosis of poliomyelitis starts with the client’s history and physical assessment, followed by detection of poliovirus-specific IgM and IgG antibodies. Additionally, a reverse transcription polymerase chain reaction, or RT PCR, can be used to detect viral RNA in the stool, throat, blood, or cerebrospinal fluid. Also, samples of these bodily fluids can be used to prepare viral cultures and look for infected cells. Finally, imaging tests, like an MRI of the spinal cord, might be performed to assess the extent of the disease.

There’s no specific treatment for polio, but the key is supportive care. Typically this includes pain medication to help with muscle spasms. Clients might also need respiratory support if they have trouble breathing. Bladder weakness or paralysis can be managed by placing a urinary catheter.

Surgical management can also be done to prevent deformities and regain mobility. Lastly, rehabilitation is provided to maintain range of motion, improve strength, and prevent limb deformities and contractures.

Fortunately, it’s possible to prevent infection with a vaccine. The polio vaccine comes in two forms; inactivated polio vaccine, or IPV, which is the only form of vaccine available in the US, in addition to live-attenuated oral polio vaccine, or OPV for short.

Now, for clients who were exposed to the virus, certain measures should be taken to minimize the risk of infection. These include washing the area of the skin exposed to the virus with water and soap for at least 15 minutes. Additionally, the exposed area should be decontaminated with antiseptic scrub solution. When the mucous membrane of the eyes, nose, or mouth are exposed to the virus, these should be vigorously irrigated. Garments exposed to the virus should also be removed and placed in a double red plastic bag to avoid further exposure.