The World Health Organization recently had an emergency meeting to explore the recent outbreak of the Zika virus in Central America. It is imperative that obstetrical and gynecology nurses are aware of the transmission, treatment and education of the patients diagnosed with the virus.
Scientists first discovered the virus during research into the epidemiology of yellow fever in the 1940’s. 6 Initially, the virus was found in the rhesus monkeys in the forest of Zika near Entebbe, Uganda. 2 Later it was also found in the Aedes aegypti species mosquitoes. An infected mosquito also may carry dengue fever, chikungunya, and yellow fever viruses. 2, 6 Usually, the mosquito could be found in stagnant water. These mosquitos thrive in indoors and outdoors areas. Additionally, they often attack and bite during the day time. To date, they are not vaccines for the virus. The mosquitoes are the vectors of the virus, hence, could not be transmitted from a person-to-person. 1
SEE ALSO: AWHONN Develops Risk Assessment Tool for Maternal Mortality
Clinical Diagnosis/ Symptoms
Most people with the virus may be asymptomatic. Sometimes, the symptoms of Zika virus may be mistaken for other illnesses. Symptoms include acute onset of fever, maculopapular rash, arthralgia (joint pains) or conjunctivitis (red eyes). 1 Per Literatures, there is a high probability that the Zika virus is responsible for congenital deformities such as “brain abnormalities: intracranial calcifications, ventriculomegaly, and neuronal migration disorders (lissencephaly and pachygyria). Other anomalies included congenital contractures and clubfoot” 5 and neurological impairments such as Guillain-Barre diseases.1 Per literature, pregnant women could be infected during any trimester. 1,3
If an infection is suspected, there will be a blood test to detect the virus. CDC lab will analyze the blood specimen. Ultrasound may show findings consistent with fetal microcephaly or intracranial calcifications.1
FIGURE. Interim guidance: testing algorithm for a pregnant woman with history of travel to an area with Zika virus transmission, with or without clinical illness consistent with Zika virus disease. Retrieved from Morbidity and Mortality Weekly Report 4
Nursing Assessment/Clinical Intervention
1. Assess any recent overseas travel of prenatal patients during or within two weeks of travel
2. Since there are no antiviral treatments for the virus, supportive care should be given for any symptoms such as rest, antipyretics, pain management, and fluids.
3. Patient Education
4. Per CDC, teach: 1, 4
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Pregnant patients or patients who want to get pregnant to avoid visiting countries with high incidence of Zika virus
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If a patient must travel, teach them how to avoid getting mosquito bites such as using bed nets, window and door screens, staying in air-conditioned rooms and not exposing skin
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If the patient thinks that they have the virus and feels sick, they should contact their provider and continue using repellent and protective clothing to avoid transmission of the virus to another person.
Nursing interventions should also include thorough travel assessment, education, and provision of comfort measures, safety and pain management. The nurses should make every effort to use available resources to deliver and incorporate bereavement support to the patients and their families. 1
Nursing Diagnosis
Some NANDA nursing diagnosis are:
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Risk for Ineffective Relationship
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Ineffective protection
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Fatigue
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Activity intolerance
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Deficient knowledge
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Readiness for enhanced knowledge
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Hopelessness
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Disturbed body image
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Stress overload
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Decreased intracranial adaptive capacity
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Risk for impaired parenting
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Risk for impaired attachment
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Interrupted family processes
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Ineffective relationship
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Risk for ineffective relationship
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Risk for ineffective activity planning
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Anxiety
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Compromised family coping
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Defensive coping
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Disabled family coping
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Ineffective coping
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Grieving
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Complicated grieving
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Readiness for enhanced power
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Powerlessness
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Risk for sudden infant death syndrome
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Social isolation
References
1. CDC. CDC health advisory: recognizing, managing, and reporting Zika virus infections in travelers returning from Central America, South America, the Caribbean and Mexico. Atlanta, GA: US Department of Health and Human Services, CDC; 2016. http://emergency.cdc.gov/han/han00385.asp.
2.Dick, G. W. A., Kitchen, S. F., & Haddow, A. J. (1952). Zika virus (I). Isolations and serological specificity. Transactions of the Royal Society of Tropical Medicine and Hygiene, 46(5), 509-520.
3. Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol 2016;47:6-7.
4. Petersen EE, Staples JE, Meaney-Delman, D, et al. Interim Guidelines for Pregnant Women During a Zika Virus Outbreak – United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:30-33. DOI: http://dx.doi.org/10.15585/mmwr.mm6502e1
5. QA: Infants and Zika Virus Infection | Zika virus | CDC. (n.d.). Retrieved from http://www.cdc.gov/zika/hc-providers/qa-pediatrician.html
6. Weinbren, M. P., & Williams, M. C. (1958). Zika virus: further isolations in the Zika area, and some studies on the strains isolated. Transactions of the Royal Society of Tropical Medicine and Hygiene, 52(3), 263-268.
Chinazo Echezona-Johnson is director of Nursing/Women and Children Nursing Education at Metropolitan Hospital Center in New York, NY.
