INFECTIOUS MONONUCLEOSIS

Predisposing Factors -Fatigue Epstein-Barr virus -Complete blood count Precipitat

-Age group (infants, -Sore throat (EBV) -White blood cell count ing
children and teenagers) -Fever -The monospot test Factors
-Sex (male and female) -Swollen lymph nodes in transmitted via body -
-EBV antibody test
-State of neck and armpits secretions, including Weakene
immunodeficiency -Swollen tonsils saliva, blood and semen d
-Headache immune
-Skin rash system-
-Acute pain r/t disruption of Close
-Soft, swollen spleen virus replicates first
skin, tissue and muscle proximity
within epithelial cells in
integrity to
the pharynx individual
-Imbalanced nutrition less
than body requirements r/t -Analgesics (e.g (s)
Infected B lymphocytes
loss of appetite acetaminophen or trigger infected
cellular-mediated
circulate all through the
-Disturbed body image later primarily within B and with
antibody-mediated
nonsteroidal anti- body spreading the infection Rubulavir
related to the lesions and cells immune system
inflammatory drugs) throughout the reticular
skin structure changes responsesus-
-Corticosteroid endothelial system Internatio
medication nal travel
to
countries
with no
-Assess vital signs Lymphocytosis Pharyngitis mumps
-Assess mouth and throat vaccinati
-Assess for signs of dehydration on
-Assess for pain using appropriate pain scale for age (FLACC / FACES) program
and provide non-pharmacological pain relief methods
caused by an increased called by EBV-infected B
-Encourage patient to eat and drink; avoid dairy products
number of circulating activated lymphocyte proliferation within the
-Provide patient and parent education for home care and prevention
B and T lymphocytes lymphatic tissue of the oropharynx

LEGEND
Predisposing Medical management
factorsPrecipitating Clinical manifestations
factors Nursing considerations
Disease process Diagnostic test
ELISHA ASLI C. SURATOS Nursing diagnosis
BSN – II NA
 INFECTIOUS MONONUCLEOSIS
Infectious mononucleosis is a clinical entity characterized by pharyngitis, cervical
lymph node enlargement, fatigue and fever, which results most often from a primary
Epstein–Barr virus (EBV) infection. EBV, a lymphocrytovirus and a member of the γ-
herpesvirus family, infects at least 90% of the population worldwide, the majority of whom
have no recognizable illness. The virus is spread by intimate oral contact among
adolescents, but how preadolescents acquire the virus is not known.
Most people are initially exposed to EBV during childhood and the symptoms are not
distinguishable from any other mild childhood illness (CDC, 2014). EBV infection in
adulthood may result in more severe and long-lasting symptoms, especially fatigue which
can last up to several months (CDC, 2014).
The virus replicates first within epithelial cells in the pharynx (which causes
pharyngitis, or sore throat), and later primarily within B cells (which are invaded via their
CD21). The host immune response involves cytotoxic (CD8-positive) T cells against infected
B lymphocytes, resulting in enlarged, atypical lymphocytes (Downey cells). When the
infection is acute (recent onset, instead of chronic), heterophile antibodies are produced.
Cytomegalovirus, adenovirus and Toxoplasma gondii (toxoplasmosis) infections can cause
symptoms similar to infectious mononucleosis, but a heterophile antibody test will test
negative and differentiate those infections from infectious mononucleosis.
Mononucleosis is sometimes accompanied by secondary cold agglutinin disease, an
autoimmune disease in which abnormal circulating antibodies directed against red blood
cells can lead to a form of autoimmune hemolytic anemia. The cold agglutinin detected is of
anti-i specificity.
The signs and symptoms of infectious mononucleosis vary with age. Before puberty,
the disease typically only produces flu-like symptoms, if any at all. When found, symptoms
tend to be similar to those of common throat infections (mild pharyngitis, with or without
tonsillitis). In adolescence and young adulthood, the disease presents with a characteristic
triad: fever – usually lasting 14 days; often mild, sore throat – usually severe for 3–5 days,
before resolving in the next 7–10 days, and swollen glands – mobile; usually located around
the back of the neck (posterior cervical lymph nodes) and sometimes throughout the body.
Another major symptom is feeling tired. Headaches are common, and abdominal
pains with nausea or vomiting sometimes also occur. Symptoms most often disappear after
about 2–4 weeks. However, fatigue and a general feeling of being unwell (malaise) may
sometimes last for months. Fatigue lasts more than one month in an estimated 28% of
cases. Mild fever, swollen neck glands and body aches may also persist beyond 4 weeks.
Most people are able to resume their usual activities within 2–3 months.
The most prominent sign of the disease is often the pharyngitis, which is frequently
accompanied by enlarged tonsils with pus—an exudate similar to that seen in cases of strep
throat. In about 50% of cases, small reddish-purple spots called petechiae can be seen on
the roof of the mouth. Palatal enanthem can also occur, but is relatively uncommon.
A small minority of people spontaneously present a rash, usually on the arms or
trunk, which can be macular (morbilliform) or papular. Almost all people given amoxicillin or
ampicillin eventually develop a generalized, itchy maculopapular rash, which however does
not imply that the person will have adverse reactions to penicillins again in the future.

ELISHA ASLI C. SURATOS

BSN – II NA
Occasional cases of erythema nodosum and erythema multiforme have been reported.
Seizures may also occasionally occur.
1. Complete blood count: sometimes doctors will request a complete blood count.
This blood test will help determine how severe the illness is by looking at the
levels of various blood cells. For example, a high lymphocyte count often
indicates an infection.
2. White blood cell count: a mono infection typically causes the body to produce
more white blood cells as it tries to defend itself. A high white blood cell count
can’t confirm an infection with EBV, but the result suggests that it’s a strong
possibility.
3. The monospot test: lab tests are the second part of a doctor’s diagnosis. One of
the most reliable ways to diagnose mononucleosis is the monospot test (or
heterophile test). This blood test looks for antibodies —these are proteins your
immune system produces in response to harmful elements. However, it doesn’t
look for EBV antibodies. Instead, the monospot test determines your levels of
another group of antibodies your body is likely to produce when you’re infected
with EBV. This test isn’t always accurate, but it’s easy to do, and results are
usually available within an hour or less.
4. EBV antibody test: if monospot test comes back negative, the doctor might order
an EBV antibody test. This blood test looks for EBV-specific antibodies. This test
can detect mono as early as the first week you have symptoms, but it takes
longer to get the results.
No medications treat mono. Antibiotics and antivirals don’t work on EBV. Things that
may help you feel better include lots of rest, lots of fluids, over-the-counter pain relievers, like
acetaminophen or nonsteroidal anti-inflammatory drugs, for fever and pain, corticosteroid
medication for swelling in your throat
There’s no vaccine to prevent mono. EBV can stay in the saliva for months after they’re
infected, so even if they don’t have symptoms or feel sick, they may be able to spread it. To
lower chances of getting mono, wash hands often and try not to share things like drinks,
silverware, or toothbrushes with other people.
Nursing management includes: getting baseline data to determine if interventions are
effective. Assess for fever which can lead to tachycardia, tachypnea and elevated blood
pressure. Loork for erythema, pustules or petechiae that may indicate infection. Assess for
adequate airway. Note any post-nasal drip that could cause throat pain. Throat pain in
children often causes them to refuse food and drink because swallowing is painful. Note
mucous membranes.Throat pain is the most common symptom of tonsillitis, but patients may
not be able to verbalize complaints. Note nonverbal cues such as crying, mouth breathing,
irritability or refusal to eat or drink. Viral tonsillitis requires only symptom management and
will resolve on its own. Give analgesics such as acetaminophen orally or rectally as
appropriate for age, for pain relief. It is important to maintain adequate nutrition to help the
immune system fight off disease. Dairy products coat the throat and may cause the patient
to cough which will further irritate the throat and cause pain, especially after surgery. Provide
patient and parent education for home care and prevention.

ELISHA ASLI C. SURATOS

BSN – II NA
REFERENCE
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mononucleosis. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346501/.
Wolff, Goldsmith, Katz, Gilchrest, Paller, & Leffell. (2007). Pathophysiology and
clinical presentation – correct diagnosis. Retrieved from
https://u.osu.edu/infectiousmononucleosis2/pathophysiology-and-clinical-
presentation-correct-diagnosis/
WebMD. (2019). Retrieved from https://www.webmd.com/a-to-z-
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AskMayoExpert. Epstein-Barr virus infection. Rochester, Minn.: Mayo Foundation for
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Sullivan JL. Clinical manifestations and treatment of Epstein-Barr virus infection.
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Aronson MD, et al. Infectious mononucleosis in adults and adolescents.
http://www.uptodate.com/home. Accessed Oct. 26, 2015.
Epstein-Barr virus and infectious mononucleosis. Centers for Disease Control and
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Infectious mononucleosis. Merck Manual Professional Version.
http://www.merckmanuals.com/professional/infectious-
diseases/herpesviruses/infectious-mononucleosis. Accessed Oct. 26, 2015.
Reye's syndrome information page. National Institute of Neurological Disorders and
Stroke. http://www.ninds.nih.gov/disorders/reyes_syndrome/reyes_syndrome.htm.
Accessed Oct. 26, 2015.
Aronson MD, et al. Infectious mononucleosis.
https://www.uptodate.com/contents/search. Accessed Aug. 10, 2018.
Steckelberg JM (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 16, 2018.

ELISHA ASLI C. SURATOS

BSN – II NA