Ebola Nursing Diagnoses

Common EVD Associated Nursing Diagnoses 

1.) Risk for Deficient Fluid Volume: 

Definition: Patient is at risk for experiencing vascular, cellular, or intracellular dehydration. Fluid volume deficit is defined as "Fluid volume deficit, or hypovolemia, occurs from a loss of body fluid or the shift of fluids into the third space, or from a reduced fluid intake. Common sources for fluid loss are the gastrointestinal (GI) tract, polyuria, and increased perspiration. Fluid volume deficit may be an acute or chronic condition managed in the hospital, outpatient center, or home setting. The therapeutic goal is to treat the underlying disorder and return the extracellular fluid compartment to normal."(Nanda).

Evidenced By:  Individuals with Ebola have a huge risk of hypovolemia or dehydration from vomiting, diarrhea, sweating, and blood loss. 

Nursing Interventions: Closely monitor the patient’s fluid and electrolyte imbalance. Monitor intake and output. Check the results of complete blood count and coagulation studies for signs of blood loss and coagulopathy. Test stools, urine and vomitus for occult blood; watch for frank bleeding.

Goals/Outcomes: Patient experiences adequate fluid volume and electrolyte balance as evidenced by urine output >30 ml per hr, normotensive blood pressure (BP), heart rate (HR) 100 beats per min, consistency of weight, and normal skin turgor.

2.) Anxiety, Death

Definition: "Vague uneasy feeling of discomfort or dread generated by perceptions of a real or imagined threat to one’s existence"(Nanda). 

Evidenced By: As patients become symptomatic or aware that they are infected with Ebola they may have anxiety from perceptions of a very real threat to their life.

Nursing Interventions: Assess the level of anxiety and the patients current coping mechanisms. Reassure patient that they are safe and maintain a calm demeanor. Assist in developing problem solving skills and anxiety-reducing skills.

Goals/Outcomes: Verbalization of feeling less anxious, normal sleep patterns, stable vital signs, relaxed facial expression and body movements.

3.) Risk for Shock: 

Definition: At risk for an inadequate blood flow to the body’s tissues which may lead to life-threatening cellular dysfunction"(Nanda).



Evidenced By: Risk for Ebola patients as disease progresses and symptoms worsen, is usually associated with deterioration of health and death. 

4.) Risk for Impaired Comfort: 

Definition: "Perceived lack of ease, relief and transcendence in physical, psychospiritual, environmental and social dimensions" (Nanda).

Evidenced By: Symptoms such as muscle pains, vomiting, dehydration etc. that can cause pain and discomfort as well as anxiety and emotional stress that a person can experience with this disease. 

5.) Social Isolation: 

Definition: "Aloneness experienced by the individual and perceived as imposed by others and as a negative or threatened state"(Nanda). 

Evidenced By: The highly infectious nature of the Ebola virus making infected person have to be quarantined with total disruption of life and minimal interaction with anyone and when there is interaction it is through heavy protective gear. 

Links for Nursing Diagnoses: 

http://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-ebola-virus-infection.html

http://faculty.mu.edu.sa/public/uploads/1380604673.6151NANDA 2012.pdf

References:

1.) Centers for Disease Control and Prevention. (2015, April 10).  Ebola Virus Disease. Retrieved April 15, 2015 from http://writingcenter.waldenu.edu/706.htm#sthash.ONwAhsD4.dpuf

2.) Mayo Clinic (2014, August 6) Ebola Virus and Marburg Virus. Retrieved April 14, 2015 from http://www.mayoclinic.org/diseases-conditions/ebola-virus/basics/causes/con-20031241

3.) MedShare. (2014, July 1). Retrieved April 3, 2015, from http://www.medshare.org/donate/urgent-relief/ebola-basics

4.) National Nurses United. (2014, November 5). US Nurses Plan Widespread Strike Over Lack of Ebola Prep. Retrieved May 14, 2015 from http://www.nationalnursesunited.org/news/entry/us-nurses-plan-widespread-strike-over-lack-of-ebola-prep/

5.) The Complete list of NANDA Nursing Diagnosis for 2012-2014, with 16 new diagnoses. (2012, February 1). Retrieved February 26, 2015, from http://faculty.mu.edu.sa/public/uploads/1380604673.6151NANDA 2012.pdf

6.)  UpToDate (2014, October 27).  Ebola Virus Disease. Retrieved April 9, 2015, from http://jama.jamanetwork.com/article.aspx?articleid=1915432

7.)  WHO (2015, April) Ebola Virus Disease. Retrieved April 14, 2015 from http://www.uptodate.com/contents/epidemiology-and-pathogenesis-of-ebola-virus-disease

Nursing Care of Ebola Afflicted Patients

Ebola Nursing Care

Nurses Waging War on Ebola from the Front Lines: 

Nurses are mounting the main caregiving response to the deadly virus in West Africa and in the United States, according to Sheila Davis, DNP, ANP-BC, FAAN, a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow (2012-2015). Nurses play a vital role in direct care for patients with Ebola, shaping health policy, and raising awareness about the deadly virus.The Ebola outbreak is shining an international spotlight on the critical but often unseen work of nursing in the United States and abroad, nurse leaders say.

In addition to providing direct care, nurses are also influencing national health policy, said Cole Edmonson, DNP, RN, FACHE, NEA-BC, an RWJF Executive Nurse Fellow (2012-2015) and chief nursing officer at Texas Health Presbyterian Hospital in Dallas, where Thomas Eric Duncan was treated for Ebola. In October, Duncan, a Liberian citizen, became the first person ever to die of Ebola in the United States, and two of his nurses contracted the disease while caring for him. “The nurses at Texas Health Dallas have helped shape the national care and personal protection guidelines and protocols related to Ebola and are now sharing their learnings,” Edmonson said.

Nurses are also helping to educate the public and reducing panic about Ebola and how it is transmitted. They are also speaking through the media to raise awareness and even some taking legal actions to make sure nurses and other healthcare providers rights are protected. 

Because there is no cure for Ebola, most of the care patients are getting is supportive care which is nursing care. 

"Nurses are doing the difficult and dangerous work of providing intravenous hydration and oral nutrition, managing diarrhea and nausea, cleaning and feeding patients, and monitoring their overall status" (NNU). Ebola care is, in short, nursing care, she said, adding: “Nurses are the ones who are providing the care in Ebola tents and who are wearing those space suits you see on TV.” 

Unhappy Nurses:

Nurses play a vital role in the Education, Treatment, and Prevention of Ebola but they are also in the direct line of fire. For some U.S. nurses the outbreak and possible inflow of Ebola patients causes outrage due to the lack of preparations for them and the risk to their own safety due to this.

This picture is from the National Nurses United webpage in the link below and explains why nurses are going on strike due to lack of Ebola preparations. 

http://www.nationalnursesunited.org/news/entry/us-nurses-plan-widespread-strike-over-lack-of-ebola-prep/

References:

1.) Centers for Disease Control and Prevention. (2015, April 10).  Ebola Virus Disease. Retrieved April 15, 2015 from http://writingcenter.waldenu.edu/706.htm#sthash.ONwAhsD4.dpuf

2.) Mayo Clinic (2014, August 6) Ebola Virus and Marburg Virus. Retrieved April 14, 2015 from http://www.mayoclinic.org/diseases-conditions/ebola-virus/basics/causes/con-20031241

3.) MedShare. (2014, July 1). Retrieved April 3, 2015, from http://www.medshare.org/donate/urgent-relief/ebola-basics

4.) National Nurses United. (2014, November 5). US Nurses Plan Widespread Strike Over Lack of Ebola Prep. Retrieved May 14, 2015 from http://www.nationalnursesunited.org/news/entry/us-nurses-plan-widespread-strike-over-lack-of-ebola-prep/

5.)  UpToDate (2014, October 27).  Ebola Virus Disease. Retrieved April 9, 2015, from http://jama.jamanetwork.com/article.aspx?articleid=1915432

6.)  WHO (2015, April) Ebola Virus Disease. Retrieved April 14, 2015 from http://www.uptodate.com/contents/epidemiology-and-pathogenesis-of-ebola-virus-disease

Ebola Treatment Options

Treatment Options for Ebola 

The video below is from the inside of an Ebola treatment center:

This video shows an infected U.S. healthcare worker and the reality of not having treatment options for Ebola: 

Unfortunately, there is not much to be said on this topic due to there not really being any treatment options for Ebola thus far besides symptomatic treatment. 

"There is No FDA-approved vaccine or medicine (e.g., antiviral drug) is available for Ebola. Symptoms of Ebola and complications are treated as they appear. The following basic interventions, when used early, can significantly improve the chances of survival:

• Providing intravenous fluids (IV) and balancing electrolytes (body salts).

• Maintaining oxygen status and blood pressure.

• Treating other infections if they occur.

Experimental vaccines and treatments for Ebola are under development, but they have not yet been fully tested for safety or effectiveness" (CDC).

Here is a link to the Center for Disease Control website article on Ebola treatment: http://www.cdc.gov/vhf/ebola/treatment/index.html

As stated previously, recovery from Ebola really depends on supportive care as well as the patient’s own immune response. Although previously infected people maintain antibodies for 10 years it is not yet known if these people who recover are immune for life or if they can become infected with a different species of Ebola. "Some people who have recovered from Ebola have developed long-term complications, such as joint and vision problems" (WHO).

The main thing we can gather from all this is the need to find a plausible vaccine or treatment option to better manage this awful viral disease and try to lower the mortality rate. Many people are funding this effort as for example in the below video.

This video illuminates the work being done to try and find treatment options for Ebola with three possible options that are not quite a reality yet.

References:

1.) Centers for Disease Control and Prevention. (2015, April 21).  Ebola Virus Disease. Retrieved April 29, 2015 from http://writingcenter.waldenu.edu/706.htm#sthash.ONwAhsD4.dpuf

2.) Mayo Clinic (2014, August 6) Ebola Virus and Marburg Virus. Retrieved April 14, 2015 from http://www.mayoclinic.org/diseases-conditions/ebola-virus/basics/causes/con-20031241

3.) MedShare. (2014, July 1). Retrieved April 3, 2015, from http://www.medshare.org/donate/urgent-relief/ebola-basics

4.)  UpToDate (2014, October 27).  Ebola Virus Disease. Retrieved April 9, 2015, from http://jama.jamanetwork.com/article.aspx?articleid=1915432

5.)  WHO (2015, April) Ebola Virus Disease. Retrieved April 14, 2015 from http://www.uptodate.com/contents/epidemiology-and-pathogenesis-of-ebola-virus-disease

How to Recognize Signs & Symptoms of Ebola

Signs & Symptoms of EVD

After a person is infected with Ebola, symptoms may appear anywhere from 2 to 21 days after with the average being 8 to 10 days. This is why people with possible infections are quarantined/assessed for at least 21 days after. Recovery from an Ebola infection depends mainly on good supportive care as well as the persons specific immune response.

The good news is that "people who recover from Ebola infection develop antibodies that last for at least 10 years" (CDC).

Common Disease Progression: 

Day 7-9 After Infection: Headache, Fatigue, Fever, Muscle soreness. 

Day 10 After Infection: Sudden high fever, Vomiting blood, Passive behavior

Day 11 After Infection: Bruising, Brain damage, Bleeding from mouth, eyes, anus, and nose. 

Day 12 After Infection: Final stages of the disease: Loss of consciousness, Seizures, Massive 

internal bleeding, DEATH. 

Signs and symptoms of Ebola can be very hard to differentiate from other common viral infections like influenza, typhoid fever, malaria etc. This is due to the early symptoms having a nonspecific nature.  

Unfortunately once a person becomes symptomatic the viruses progression is rapid and severe and can cause complete deterioration and death in as little as 10-12 days. This is a terrifying prognosis for a disease that has no real treatment or cure with a 50% fatality rate. 

Below is a good article to gain more insight into Ebola signs and symptoms: 

http://www.cdc.gov/vhf/ebola/symptoms/index.html

Below is a good video illuminating in real life detail the signs and symptoms of an Ebola infection: 

References:

1.) Centers for Disease Control and Prevention. (2015, April 10).  Ebola Virus Disease. Retrieved April 15, 2015 from http://writingcenter.waldenu.edu/706.htm#sthash.ONwAhsD4.dpuf

2.) Mayo Clinic (2014, August 6) Ebola Virus and Marburg Virus. Retrieved April 14, 2015 from http://www.mayoclinic.org/diseases-conditions/ebola-virus/basics/causes/con-20031241

3.) MedShare. (2014, July 1). Retrieved April 3, 2015, from http://www.medshare.org/donate/urgent-relief/ebola-basics

4.)  UpToDate (2014, October 27).  Ebola Virus Disease. Retrieved April 9, 2015, from http://jama.jamanetwork.com/article.aspx?articleid=1915432

5.)  WHO (2015, April) Ebola Virus Disease. Retrieved April 14, 2015 from http://www.uptodate.com/contents/epidemiology-and-pathogenesis-of-ebola-virus-disease

Dx of Ebola

Diagnosing Ebola

Distinguishing the Ebola virus from other infectious diseases such as malaria, typhoid fever and meningitis. Ways to confirm that symptoms are being caused by the Ebola virus and not anything else are made using the following:

• "antibody-capture enzyme-linked immunosorbent assay (ELISA)
• antigen-capture detection tests
• serum neutralization test
• reverse transcriptase polymerase chain reaction (RT-PCR) assay
• electron microscopy
• virus isolation by cell culture.
• Samples from patients are an extreme biohazard risk; laboratory testing on non-inactivated samples should be conducted under maximum biological containment conditions" (1). 

Here is a good article to read more on the diagnosis of Ebola:

http://www.who.int/mediacentre/factsheets/fs103/en/

What the symptoms probably look like and some ways to distinguish Ebola between different common similar sicknesses are shown in the diagrams below.

Below is an excellent video showing how Ebola is diagnosed in just 10 minutes. 

Making a accurate Ebola diagnosis in a person who has been recently infected for only a few days is very difficult. This is because the early symptoms they most likely experience most commonly fever are not specific to being infected with the Ebola virus. These symptoms are usually seen from more common diseases like malaria and typhoid fever as stated previously in the above section. 

"However, a person should be isolated and public health authorities notified if they have the early symptoms of Ebola and have had contact with

• blood or body fluids from a person sick with or who has died from Ebola,
• objects that have been contaminated with the blood or body fluids of a person sick with or who has died from Ebola,
• infected fruit bats and primates (apes and monkeys), or
• semen from a man who has recovered from Ebola

Samples from the patient can then be collected and tested to confirm infection" (CDC).

The Ebola virus can be detected in blood only after the person becomes symptomatic. This is especially true for fevers "which accompany the rise in circulating virus within the patient's body, it may take up to three days after symptoms start for the virus to reach detectable levels" (CDC). 

The table below is from the CDC website and shows more laboratory tests used in the diagnosis process. 

Timeline of Infection	Diagnostic tests available
Within a few days after symptoms begin	Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing IgM ELISA Polymerase chain reaction (PCR) Virus isolation
Later in disease course or after recovery	IgM and IgG antibodies
Retrospectively in deceased patients	Immunohistochemistry testing PCR Virus isolation

References:

1.) Centers for Disease Control and Prevention. (2015, April 10).  Ebola Virus Disease. Retrieved April 15, 2015 from http://writingcenter.waldenu.edu/706.htm#sthash.ONwAhsD4.dpuf

2.) Mayo Clinic (2014, August 6) Ebola Virus and Marburg Virus. Retrieved April 14, 2015 from http://www.mayoclinic.org/diseases-conditions/ebola-virus/basics/causes/con-20031241

3.) MedShare. (2014, July 1). Retrieved April 3, 2015, from http://www.medshare.org/donate/urgent-relief/ebola-basics

4.)  UpToDate (2014, October 27).  Ebola Virus Disease. Retrieved April 9, 2015, from http://jama.jamanetwork.com/article.aspx?articleid=1915432

5.)  WHO (2015, April) Ebola Virus Disease. Retrieved April 14, 2015 from http://www.uptodate.com/contents/epidemiology-and-pathogenesis-of-ebola-virus-disease

Etiology/Pathophysiology of Ebola Virus

Etiology/Pathophysiological basis of Ebola

Etiology/Transmission: 

The Ebola virus causes an acute, serious illness which is often fatal if untreated. It is thought that fruit bats are natural Ebola hosts. 

"Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest, Ebola then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids" (1). 

"No formal evidence exists of sexual transmission, but sexual transmission from convalescent patients cannot be ruled out. There is evidence that live Ebola virus can be isolated in seminal fluids of convalescent men for 82 days after onset of symptoms. Evidence is not available yet beyond 82 days. There is no evidence of live Ebola virus in vaginal secretions." (1). 

The videos below do a great job of explaining what exactly Ebola is and how it infects and affects us humans. 

A good article to look at for more etiological/pathophysiological information on ebola is: 

http://www.mayoclinic.org/diseases-conditions/ebola-virus/basics/causes/con-20031241

This article contains lots of easy to read and understand material on just what exactly is Ebola.

Major cause of Ebola is from infected animal to humans then human-human transmission can occur. At risk individuals are those traveling or living in infected areas, especially healthcare workers. This virus is highly contagious so healthcare workers need to be extra careful and diligent in implementing their precautionary measures. 

Because there is no real treatment or cure, only symptomatic treatment it is essential to begin early supportive care when infection occurs or has been thought to occur, specifically rehydration. 

References:

1.) Ebola Virus and Marburg Virus (2014, August 6) Retrieved from http://www.mayoclinic.org/diseases-conditions/ebola-virus/basics/causes/con-20031241

2.) Ebola Virus Disease (2014, October 27). UpToDate. Retrieved April 3, 2015, from http://jama.jamanetwork.com/article.aspx?articleid=1915432

3.) Ebola Virus Disease. WHO (2015, April) Retrieved April 10, 2015 from http://www.uptodate.com/contents/epidemiology-and-pathogenesis-of-ebola-virus-disease

4.) MedShare. (2014, July 1). Retrieved April 3, 2015, from http://www.medshare.org/donate/urgent-relief/ebola-basics

Ebola Epidemiology

Epidemiology

United States: Only a handful of documented cases in the United States, currently there are none. On September 30, 2014, the first travel-associated case of Ebola was reported in the United States from an asymptomatic man going from Liberia to Dallas, Texas. He began being symptomatic about 5 days later and soon passed away.

Worldwide Epidemiology: "Ebola virus was first recognized when two outbreaks occurred in Zaire and in Sudan in 1976. Outbreaks of Ebola virus disease have been confined to Sub-Saharan Africa. An epidemic caused by the Zaire species caused several hundred cases in 1995 in Kikwit, Democratic Republic of the Congo, and the Sudan virus infected more than 400 people in Gulu, Uganda in 2000. The 2014-2015 Ebola epidemic, caused by the Zaire species of virus, is not only the first to occur in West Africa, but is far larger than all previous outbreaks combined" (UpToDate). 

2014-2015 outbreak in West Africa, "Although all previous Ebola outbreaks occurred in Central Africa, an epidemic began in the West African nation of Guinea in late 2013 and was confirmed by the World Health Organization (WHO) in March 2014. The initial case was a two-year-old child who developed fever, vomiting, and black stools, without other evidence of hemorrhage. The outbreak subsequently spread to Liberia, Sierra Leone, Nigeria, Senegal, and Mali. Sequence analysis of viruses isolated from patients in Sierra Leone indicated that the epidemic resulted from sustained person-to-person transmission, without additional introductions from animal reservoirs (UpToDate). 

As of May 10, 2015, the cumulative number of probable, suspected, and laboratory-confirmed cases attributed to Ebola virus is 26,759, including 11,080 deaths. These cases include over 860 infected healthcare workers, of whom approximately 60 percent have died. The magnitude of the outbreak, especially in Liberia and Sierra Leone, has probably been underestimated, due in part to individuals with Ebola virus disease being cared for outside the hospital setting.

In some previously infected areas ebola has been eliminated such as Liberia on May 9, 2015 but it is still a serious problem. Mortality rate is about 50% for this disease.

References: 

1.) Ebola Virus Disease (2014, October 27). UpToDate. Retrieved April 3, 2015, from http://jama.jamanetwork.com/article.aspx?articleid=1915432

2.) Ebola Virus Disease. WHO (2015, April) Retrieved April 10, 2015 from http://www.uptodate.com/contents/epidemiology-and-pathogenesis-of-ebola-virus-disease

3.) MedShare. (2014, July 1). Retrieved April 3, 2015, from http://www.medshare.org/donate/urgent-relief/ebola-basics

The Basics

THE BASICS ABOUT EBOLA

What Is Ebola? 

Ebola is a name originating from the Ebola River where one of the first outbreaks occurred. Ebola is a virus that causes a fever. This fever is called hemorrhagic fever or VHF. Hemorrhage is basically another term for bleeding and so this means that this virus and fever affect many body organ systems usually accompanied by bleeding. 

Where Does It Come From?

The most recent and largest Ebola outbreak was located in West Africa in 2014 with over 3,000 deaths. With no vaccine currently available. 

You CANNOT get it through water, air, or food! Only through touching blood or body fluids from an infected individual, this includes animals. 

Am I at Risk?.....What Are The Symptoms...? Is There Treatment?

These are very common questions from a scared population. Ebola presents most of the time with either flu like symptoms, headache, vomiting, muscle pains and/or it can cause severe illness with symptoms like bruising, bleeding, organ failure, and death. There is about a 50% survival rate but the chance of anyone in the US getting Ebola is very low. 

References: 

Ebola Virus Disease. (2014, October 27). Retrieved April 3, 2015, from http://jama.jamanetwork.com/article.aspx?articleid=1915432

MedShare. (2014, July 1). Retrieved April 3, 2015, from http://www.medshare.org/donate/urgent-relief/ebola-basics