Sabello, Aihia BSN 4 NCM106

Zika Virus

Definition

a virus transmitted by mosquitoes which typically causes asymptomatic or mild infection (fever and rash) in
humans, identified originally in Africa and later in other tropical regions, including South America, where it may
be associated with an increased incidence of microcephaly in babies born to mothers infected during pregnancy.

Zika virus is similar to dengue fever, yellow fever and West Nile virus. Carried by infected Aedes
aegypti mosquitos, Zika is largely transmitted through bites, but can also occur through intrauterine infection.

If a woman is bitten by an infected mosquito and becomes infected, Zika can cross into the placenta and affect
the fetus.

Signs & Symptoms

The incubation period (the time from exposure to symptoms) of Zika virus disease is estimated to be 3–14 days.
The majority of people infected with Zika virus do not develop symptoms. Symptoms are generally mild including
fever, rash, conjunctivitis, muscle and joint pain, malaise, and headache, and usually last for 2–7 days.

Pathophysiology
Zika virus is well-adapted to grow in various hosts, ranging from arthropods to vertebrates.

Viral attachment to unidentified cellular receptors is mediated by the E (envelope) glycoprotein.

This is followed by endocytic uptake and then uncoating of the nucleocapsid and release of viral
RNA into the cytoplasm.

A viral polyprotein is produced and modified by the endoplasmic reticulum.

Immature virions collect both in the endoplasmic reticulum and in secretory vesicles before
being released.

Causes

Zika virus is transmitted to people primarily through the bite of an infected Aedes species mosquito (Ae.
aegypti and Ae. albopictus).

Mosquitoes. A mosquito gets infected with a virus when it bites an infected person during the
period of time when the virus can be found in the person’s blood, typically only through the first
week of infection; infected mosquitoes can then spread the virus to other people through bites.

Infected pregnant mother to child. A pregnant woman already infected with Zika virus can
pass the virus to her fetus during the pregnancy or around the time of birth.

Through sex. Zika can be passed through sex from a person who has Zika to his or her
partners; Zika can be passed through sex, even if the infected person does not have symptoms
at the time.
 Through blood transfusion. There have been multiple reports of possible blood transfusion
transmission cases in Brazil.

Through lab and healthcare setting exposure. There are reports of laboratory acquired Zika
virus infections, although the route of transmission was not clearly established in all cases.

Clinical Manifestations
Many people infected with Zika virus won’t have symptoms or will only have mild symptoms. The most
common symptoms of Zika are:

Fever. One of the most common and early signs of Zika is fever, which may occur within the
first week of illness.

Rash. The rash in Zika virus infection is usually a fine maculopapular rash that is diffusely

distributed; it can involve the face, trunk, and extremities, including palms and soles;
occasionally, the rash may be pruritic.

Headache. Retroocular headache is a symptom of zika virus.

Joint pain. Arthralgia involving the small joints of the hands and feet is also a common
symptom of Zika virus.

Conjunctivitis (red eyes). Viral conjunctivitis in Zika is also self-limiting.

Muscle pain. Muscle pain may last for 2 to 7 days just like the other symptoms.

Assessment and Diagnostic Findings

Diagnostic testing for Zika virus infection can be accomplished using both molecular and serologic
methods.

Nucleic acid amplification test. Nucleic acid amplification test, or NAAT, is a generic term
referring to all molecular tests used to detect viral genomic material; NAAT assays are the
preferred method of diagnosis because they can provide confirmed evidence of infection.

Zika virus antibody testing. IgM levels are variable, but generally become positive starting in
the first week after onset of symptoms and continuing for up to 12 weeks post symptom onset
or exposure, but may persist for months to years.

Plaque reduction neutralization tests (PRNT). Plaque reduction neutralization tests (PRNT)

are quantitative assays that measure virus-specific neutralizing antibody titers. PRNTs can
resolve false-positive IgM antibody results caused by non-specific reactivity and at times help
identify the infecting virus.

Nursing Assessment
Assessment of a patient with Zika virus include:

History. The incubation period is likely 3-12 days; owing to the mild nature of the disease, more
than 80% of Zika virus infection cases likely go unnoticed; the spectrum of Zika virus disease
 overlaps with other that of arboviral infections, but rash (maculopapular and likely immune-
mediated) typically predominates.

Physical exam. The WHO recommends that newborns born to mothers with Zika virus
infection undergo head circumference measurement between 1 and 7 days after birth; ahead
circumference of more than 2 standard deviations below the mean is considered microcephaly;
a circumference of more than 3 standard deviations below the mean is classified as severe
microcephaly, which should prompt neuroimaging.

Nursing Diagnosis

Based on the assessment data, the following are the nursing diagnosis for a patient with Zika virus:

Acute pain related to severe retroocular headaches. and joint pain.

Hyperthermia related to increased metabolic rate and dehydration.

Fluid volume deficit related to excessive sweating and dehydration.

Knowledge deficit related to lack of exposure and information about the disease process, its
treatment, and prognosis.

Nursing Interventions
Below are the nursing interventions for a patient with Zika virus:

Relieve pain. Acknowledge reports of pain immediately; get rid of additional stressors or

sources of discomfort whenever possible; provide rest periods to promote relief, sleep,
and relaxation; determine the appropriate pain relief method; provide analgesics as ordered,
evaluating the effectiveness and inspecting for any signs and symptoms of adverse effects.

Decrease fever. Eliminate excess clothing and covers; give antipyretic medications as

prescribed; encourage ample fluid intake by mouth; provide high caloric diet or as indicated by
the physician; and educate patient and family members about the signs and symptoms of
hyperthermia and help in identifying factors related to occurrence of fever; discuss importance
of increased fluid intake to avoid dehydration.

Provide adequate fluid volume. Urge the patient to drink prescribed amount of fluid;
emphasize importance of oral hygiene; provide comfortable environment by covering patient
with light sheets; administer parenteral fluids as prescribed; consider the need for an IV fluid
challenge with immediate infusion of fluids for patients with abnormal vital signs; provide
measures to prevent excessive electrolyte loss (e.g., resting the GI tract, administering
antipyretics as ordered by the physician); taach family members how to monitor output in the
home; instruct them to monitor both intake and output.

Educate patient and folks. Grant a calm and peaceful environment without interruption;
provide an atmosphere of respect, openness, trust, and collaboration; include the patient in
creating the teaching plan, beginning with establishing objectives and goals for learning at the
 beginning of the session; provide clear, thorough, and understandable explanations and
demonstrations; when presenting a material, start with the basics or familiar, simple, and
concrete information to less familiar, complex ones; and allow repetition of the information or
skill.

References:

https://www.hopkinsmedicine.org/zika-virus/what-is-zika-virus.html

https://bestpractice.bmj.com/topics/en-us/1302/aetiology

https://nurseslabs.com/zika-virus/#clinical_manifestations