Zika virus: Nursing

Definitions & Key takeaways

Zika virus is a mosquito-borne virus that is typically transmitted by the Aedes mosquito. It can also be transmitted through sexual contact and from mother to child during pregnancy. Most people infected with the Zika virus do not develop symptoms, but some may experience muscle and joint pain, headaches, conjunctivitis, rash, and red eyes. In rare cases, the virus can cause more severe complications, including Guillain-Barre syndrome and birth defects in babies born to infected mothers.

Diagnosis begins with the client's history and physical assessment and is confirmed by PCR testing and serology. Treatment usually just involves treating the symptoms, things like getting plenty of rest, drinking fluids to prevent dehydration, and taking medicine like acetaminophen to help reduce pain and fever. The goals of nursing care are to reduce fever and pain, prevent dehydration, and monitor for complications. Client and family education centers on preventing future infections, specific care for pregnant clients, self-care at home, and when to contact the healthcare provider.

Chapters:

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Introduction0:00–0:22

Zika fever, also known as Zika disease, Zika infection, or just Zika, is an infectious disease caused by the Zika virus.
This is a vector-borne infection that is transmitted by the bite of an infected Aedes mosquito.Let’s start by discussing the physiology of the immune system, which is subdivided into innate and adaptive immunity.

Physiology0:22–2:04

Innate immunity consists of natural barriers, like skin and mucous membranes; natural killer cells, which help fight virus-infected and tumor cells; and phagocytes, such as macrophages, neutrophils, and dendritic cells.
When a pathogen breaches the natural barriers and enters the body, the innate immune system reacts quickly. Some of the first cells on the scene are macrophages and neutrophils, which directly fight the pathogen.
At the same time, they also secrete small molecules called cytokines to increase the permeability of local blood vessels and message other immune cells that there’s an active fight in the body.
Additionally, cytokines induce the production of acute inflammatory proteins and cause systemic effects, such as fever. Simultaneously, dendritic cells engulf and digest the pathogen, eventually presenting small fragments of it on their surface.
At this point, the adaptive immune system, which relies on B and T cells, can come to the rescue. Specifically, T helper cells recognize these fragments and help activate B cells, which eventually produce antibodies.
These antibodies circulate throughout the body and bind to affected cells that express the antigen on their surface, thereby enabling NK cells and cytotoxic T cells to recognize and destroy them.The cause of Zika fever is the Zika virus, which is a small single-stranded RNA virus that belongs to the Flaviviridae family.

Causes & risk factors2:04–2:54

The most important risk factor for getting Zika fever is traveling to or living in endemic parts of the world where Zika fever is highly present.
These include Central and South America, the Caribbean, Africa, as well as south and southeast Asia and the Pacific region.
Historically, it looks like the Zika virus has also been transmitted through mosquito bites in continental United States regions, like Florida and Texas.
Finally, since the Zika virus can also be passed through sexual intercourse, another important risk factor is having unprotected sex with individuals who live in or have returned from a high-risk region.Now, let’s switch gears and move on to pathology.

Pathology2:54–4:08

Once an infected Aedes mosquito bites a person, the virus infects the skin and starts to replicate. As the virus replicates, it’s picked up by the surrounding dendritic cells, which then travel to regional lymph nodes.
But here, the infection is not contained, instead, the virus enters the bloodstream and spreads throughout the body. Now, the most important complication of Zika infection is congenital Zika syndrome, which occurs in pregnant clients when the virus crosses the placenta and infects the fetus.
Newborns with congenital Zika syndrome typically present with microcephaly or an abnormally small head; vision, hearing, and cognitive deficits; as well as seizures.
On the other hand, adults and older children can develop neurologic complications, such as Guillain Barre syndrome, which is an autoimmune condition associated with the destruction of peripheral nerves; myelitis, or inflammation of the spinal cord; and finally, meningoencephalitis, which refers to the inflammation of the meninges and brain.Clinical manifestations of Zika fever are usually mild and self-limiting, and include fever; headache; eye redness, pain behind the eyeballs; pruritic rash as well as muscle and joint pain.

Clinical manifestations4:08–4:24

Diagnosis of Zika fever is typically based on the client’s history, and physical assessment, followed by PCR testing, and serology.

Diagnosis4:24–5:03

PCR testing is used to detect viral RNA in clients who have experienced symptoms for less than 2 weeks. On the flip side, serology is used to detect specific antibodies against the Zika virus in clients who have experienced symptoms for more than 2 weeks.
Additionally, pregnant clients, who were at risk or exposed to a Zika virus, require ultrasound checkups to detect possible fetal abnormalities, such as growth restriction and microcephaly.
As far as the treatment goes, there’s no cure for Zika fever. Usually, treatment includes supportive care, such as rest, hydration, and the use of medications like analgesics and antipyretics.

Treatment5:03–5:37

Of note, aspirin as well as other NSAIDs, like ibuprofen, should be avoided until dengue fever, an infection with similar presentation, has been ruled out.
That’s because using NSAIDs in dengue infections can increase the risk of hemorrhage. Okay, now let’s talk about the nursing care you’ll be providing for a client infected with Zika.

Management and care5:37–7:30

Your priority nursing goals are to reduce fever and pain, prevent dehydration, and monitor for complications.Begin by assessing your client’s vital signs, noting the presence of fever.
Then ask about their pain, including its location and quality. Provide cooling measures such as cool compresses and administer the prescribed antipyretic and analgesic medications to reduce fever and pain.Then, reduce your client’s risk for dehydration by encouraging oral fluid intake, and monitoring their intake and output.Be sure to regularly monitor for changes in your client’s neurological status by checking their level of consciousness and assess the feeling in their fingers and toes, as well as muscle strength, and facial movements.
Immediately report to the healthcare provider if you note the presence of tingling or numbness in their fingers or toes, or signs of muscle weakness, including, difficulty walking, chewing, or swallowing, as these may indicate the development of Guillain-Barre syndrome.
Now, if you are caring for a pregnant client, report to the healthcare provider right away. Monitor fetal heart tones and arrange for diagnostic tests, including amniocentesis to check for Zika RNA in amniotic fluid and serial fetal ultrasounds to monitor fetal growth and neuroanatomy, as ordered.
Finally, ensure the case has been reported to your facility’s infection control department as well as local and state public health agencies.Alright, let’s move on to client and family teaching.

General client and family teaching7:30–9:04

First, explain to your client that Zika fever is a viral illness transmitted by infected mosquitoes, and there are certain parts of the world where there is a greater risk of this happening.
Explain that living in or traveling to these areas is a risk factor for contracting Zika fever, but they can avoid reinfection in the future by taking precautions.
These precautions include not traveling to areas where Zika transmission is high, or if that is not possible, using insect repellent, wearing long-sleeves and long-pants, and sleeping under a mosquito bed net to reduce the chance of being bitten by an infected mosquito.
Also talk about eliminating areas around their house where mosquitoes tend to breed, such as plant pots or other containers that hold standing water.Next, if your client is pregnant, talk to them about the risks to their fetus that are associated with Zika infections during pregnancy.
Emphasize the importance of follow-up obstetrics appointments for additional monitoring. Because Zika fever can also be sexually transmitted, also instruct them to have their partners use condoms or abstain from sex for the duration of the pregnancy.
Finally, instruct your client to get plenty of rest, take their prescribed medications as directed. Stress the importance of drinking enough fluids to keep their urine light yellow.
Instruct them to seek emergency medical treatment immediately if they experience any tingling, numbness, or muscle weakness.Alright, as a quick recap… Zika fever is a vector-borne viral infection transmitted by an infected Aedes mosquito.

Review9:04–10:11

Risk factors include traveling to or living in areas of the world where Zika fever is highly present, and having unprotected sex with individuals who live in or have recently traveled to a high risk area.
Clinical manifestations of Zika fever include fever, headache, pain behind the eyes, muscle and joint pain, and pruritic rash.
Diagnosis begins with the client’s history and physical assessment and is confirmed by PCR testing and serology. Treatment for Zika fever is supportive care, including rest, hydration, and medication for fever and pain.
Goals for nursing care are to reduce fever and pain, prevent dehydration, and monitor for complications. Client and family education centers on preventing future infections, specific care for pregnant clients, self-care at home, and when to contact the healthcare provider.