Infectious Mononucleosis
Key Points
- Infectious mononucleosis is usually caused by Epstein-Barr virus (EBV), though other viral causes exist.
- Transmission is primarily via infected saliva (“kissing disease”).
- Typical diagnosis age range is adolescence/young adulthood, while very young children may be asymptomatic.
- Early hallmark findings include fever, sore throat, and enlarged cervical lymph nodes.
- Complication surveillance must include airway obstruction, splenic rupture, and prolonged fatigue.
Pathophysiology
EBV is transmitted through saliva contact and initially infects cells in the salivary glands, mouth, and throat. The virus replicates locally and then spreads through the lymphatic system with tropism for B lymphocytes.
Although antibodies are produced, EBV persists as a lifelong infection with possible reactivation, especially in immunodeficient clients.
Classification
- EBV infectious mononucleosis: Primary focus in this section and the most common cause.
- Non-EBV mono-like illness: Can be associated with cytomegalovirus, adenovirus, rubella, and other viral pathogens.
- Age-pattern class: Often recognized in ages 15 to 24; very young children may show limited symptoms.
Nursing Assessment
NCLEX Focus
In early assessment, prioritize fever-throat-lymph-node patterns while screening for intake and fatigue decline.
- Assess for fever, sore throat, and enlarged cervical lymph nodes.
- Check for associated pharyngeal findings such as tonsillar exudate and palatal petechiae.
- Screen for fatigue, headache, reduced oral intake, diffuse rash, and possible splenic enlargement.
- Obtain exposure history to saliva contact.
- Establish vital-sign baseline and trend for complications such as splenic rupture or dehydration.
- Use a mild-to-severe fatigue scale at baseline and during follow-up.
- Assess nutritional intake because poor intake can worsen fatigue and delay recovery.
- Monitor for complications: airway obstruction from severe lymph-node enlargement, splenic rupture, anemia, and CNS spread.
- Trend fatigue severity because fatigue can persist for months.
- Use diagnostic workflow cues: Monospot testing (rapid but may be false negative early), EBV antibody testing, CBC trend (often increased WBC and possible platelet decrease), and imaging when splenomegaly is suspected.
Nursing Interventions
- Prioritize supportive symptom monitoring and hydration/nutrition trend assessment.
- Reassess frequently for evolving complications and airway/swallowing tolerance.
- Support provider-ordered fever and throat-pain management, oral fluid intake, and rest promotion.
- Encourage oral hygiene to support appetite during recovery.
- If splenomegaly is present, reinforce activity restriction (avoid contact sports/high-impact activity for about 4 to 6 weeks).
- Support steroid therapy when ordered for partial airway obstruction related to lymph-node swelling.
- Elevate head of bed to promote breathing comfort and lung expansion when throat/lymph-node swelling is present.
- Assist graded activity progression to improve tolerance as fatigue starts to recover.
- Track outcome targets such as fever normalization within about 48 hours, improved energy/activity tolerance over one week, and maintenance of healthy weight trajectory.
- Teach splenic-rupture emergency cues: abdominal pain, shoulder pain, and hypotension symptoms.
- Teach transmission reduction: avoid sharing food/drinks/utensils/toothbrushes, avoid kissing, and perform consistent hand hygiene.
- Educate that EBV may remain in saliva for up to about 18 months.
- Teach energy-conservation strategies such as scheduled rest periods and prioritizing essential activities.
- Reevaluate outcomes after each reassessment/new diagnostic data/interdisciplinary update and revise the care plan when goals are partially met or unmet.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| analgesics/antipyretics | Acetaminophen, ibuprofen | First-line supportive treatment for fever and sore-throat pain. |
| corticosteroids | Short-course anti-inflammatory regimens (ordered) | Used in selected cases with partial airway obstruction from severe lymph-node swelling. |
Clinical Judgment Application
Clinical Scenario
A 17-year-old presents with sore throat, fever, cervical-node swelling, and profound fatigue after close saliva-contact exposure.
- Recognize Cues: Classic mononucleosis pattern with viral-exposure history.
- Analyze Cues: EBV-associated infectious mononucleosis is a leading hypothesis.
- Prioritize Hypotheses: Immediate priorities are symptom support, airway-safety surveillance, and splenic-complication prevention.
- Take Action: Begin focused assessment, monitor hydration/airway status, and coordinate Monospot/CBC and splenic-risk precautions.
- Evaluate Outcomes: Fever trend improves, intake and activity tolerance recover, and no complication progression occurs.
Related Concepts
- pharyngitis-tonsillitis-and-adenoiditis - Overlapping sore-throat and cervical-node findings in differential assessment.
- abdominal-organ-enlargement-and-vascular-red-flags - Splenic enlargement monitoring and activity-restriction implications.
- active-and-passive-immunity - EBV antibody response context and long-term viral persistence concept.
Self-Check
- Why can infectious mononucleosis present mildly in very young children?
- Which early assessment findings distinguish mono from uncomplicated URI patterns?
- Why does EBV require long-term reinfection/reactivation counseling?