Primary Nursing Diagnosis

Risk for ineffective airway clearance related or oropharyngeal swelling

622 Mononucleosis, Infectious

OUTCOMES. Respiratory status: Gas exchange and ventilation; Safety status: Physical injury; Comfort level

INTERVENTIONS. Airway insertion; Airway management; Airway suctioning; Oral health promotion; Respiratory monitoring; Ventilation assistance; Surveillance; Pain management; Analgesic administration; Anxiety reduction

H PLANNING AND IMPLEMENTATION Collaborative

Most patients require nothing more than supportive therapy, such as acetaminophen for fever and bedrest for fatigue. Pain relief is essential if the patient is to maintain fluid intake to prevent fluid volume deficit and dehydration.

To prevent upper airway obstruction from severe tonsillar enlargement, treatment with corticosteroids (prednisone 40 mg/day for 5 to 7 days) is sometimes indicated. If the patient is at risk for airway obstruction (a rare complication), endotracheal intubation may be necessary. About 20% of patients also need a 10-day course of antibiotic therapy because of streptococcal pharyngotonsil-litis. Ruptured spleen is an unusual but serious complication that causes sudden abdominal pain and is managed surgically by removal of the spleen.

Pharmacologic Highlights

No specific pharmacologic therapy treats mononucleosis; antiviral medications do not limit the EBV infection. Patients usually require analgesia with acetaminophen, propoxyphene (Darvon), or even oral narcotics. Some patients may also be placed on corticosteroids or antibiotics for complications.

Independent

Most patients do not require hospitalization for IM. Focus on supportive care and teaching. Encourage the patient to use anesthetic lozenges or warm saline gargles for pharyngitis. A soft diet such as milkshakes, sherbets, soups, and puddings provides additional liquid and nutritional supplements. Teach patients to avoid strenuous activities and contact sports until liver and spleen enlargement subsides.

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