Mononucleosis Paper 2
Mononucleosis is a viral infection that affects the heart, lymphatic system, spleen and throat and is commonly known as the “kissing disease” or “Mono”. It mainly affects children and adolescents and does not have a specific treatment. Here we will discuss the virus, the signs and symptoms, causes and the determinants of health. We will also discuss as the role of the community nurse and efforts made by the World Health Organization (WHO) to educate and prevent the spread of the virus.
Mononucleosis is a viral infectious disease that produces lymph node enlargement that is commonly known as hyperplasia (Bryant, 2013). Symptoms are like most viruses and can include, fever, malaise, lymph node swelling, sore throat, chills, rash, bleeding gums, red spots on the tongue and can last four to six weeks. Mononucleosis is caused by the Epstein-Barr Virus (EBV) and is transmitted through infected saliva or by blood transfusions (Bryant, 2013). Transmission can also occur with exposure to a cough or sneeze or by sharing a glass or food utensils of an infected individual (Mayo Clinic Staff, 2012). There is an incubation period of four to six weeks and the saliva can remain infective for as long as eighteen months (Bryant, 2013). The virus may be present in nasal secretions that shed periodically for the rest of the host’s life (Bryant, 2013). Cases commonly occur in adolescence and incidence varies seasonally among high school and college students. The virus is common in the United States, Europe and Canada and in both sexes (Bryant, 2013).
Treatment includes supportive therapy, limited activity including bed rest at times, increased fluid intake and acetaminophen. Activity is limited in the first two months to prevent rupture of the spleen, as it can be enlarged with the virus. Physicians may use corticosteroids to lesson the severity of symptoms in some cases (Bryant, 2013). Complications are uncommon but can include secondary pneumonia, meningitis, rupture of the spleen, Guillain-Barre syndrome, orchitis, encephalitis and hemolytic anemia (Bryant, 2013). Other complications that can be seen are Hepatitis, jaundice, anemia, thrombocytopenia, heart problems like myocarditis and swollen tonsils that can block breathing (Mayo Clinic Staff, 2012).
The incidence of cases in the United States is 500 per 10,000 persons per year (Singer-Leshinsky, 2012). The number of children affected by mononucleosis in the United States is approximately 50%, but does not commonly cause death. Those that do succumb to the disease generally do not seek the appropriate amount of medical treatment and may have been suffering from a secondary medical condition that exacerbated the symptoms of mononucleosis (healthresearchfunding.org). According to the WHO there were only 78 deaths associated to mononucleosis, 13 of which were in the United States. The prevalence of the disease is quite high. Over 95% of adults over the age of 30 have been infected with EBV and approximately 35-50% of adults in their 20’s have been infected (healthresearchfunding.org).
According to the WHO the determinants of health include ones social and economic environment, physical environment and the person’s individual characteristics and behavior. Other factors may include, income and social status, education, physical environment, support networks, genetics, health services and gender. These can contribute to the development of mononucleosis in many ways. Lack of education can lead to the spread of the disease and seeking necessary treatment. The physical environment can also affect the spread of the virus. Unsanitary conditions, no access to clean water and air can contribute to poor health and put individuals at a greater risk for developing illnesses from viruses like mononucleosis. Access to healthcare is also a concern. Lack of care can lead to complications including death in some cases.
The epidemiologic triangle is a model that scientists have developed for studying health problems. The triangle has three factors, the agent, the host and the environment (Maurer, 2009). Mononucleosis can be studied with this as well. The agent, what causes the disease, is the EBV virus. The host, what or who is harboring the disease, is the human body. Males as well females can be infected. Adolescents and children are more susceptible as they tend to have more intimate contact with each other without using proper hygiene techniques. The environment, factors that cause or allow the disease transmission, are direct contact with body fluids. Adolescents are in love and want to be accepted and are starting to develop relationships, this includes kissing. Children share everything this can include drinks and food such as candy and ice cream. The goal of an epidemiologist is to break at least on of these factors to prevent the spread of the disease. For example educating the public on the signs and symptoms of mononucleosis and how it is spread can help prevent others from being infected. The community health nurse can use the same concepts of breaking the triangle in health education and the prevention of the spread of disease.
The role of the community heath nurse can be defined as providing comprehensive care to patients within their homes; health fairs and at agencies and institutions serving people who have particular needs. They address complex challenges within the community (Meadows, 2009). Community health nurses are adaptable and are willing to provide care in many settings. They identify common health problems in the community while treating patients, and work to create intervention plans to correct or prevent the health and safety of the issues that are found. Projects can be developed to help find and improve care within the community by developing a research team, conducting a community and environmental assessment, evaluating the effectiveness of prevention programs and finally testing the intervention (Kulbok, Thatcher, Park, & Meszaros, 2012). The data can then be analyzed periodically to ensure the projects are effective and if there is a need for follow-up or further intervention. Primary prevention for mononucleosis can start with the nurse going into schools and educate adolescents. They are most at risk for developing the virus and could be educated on the spread of mononucleosis and how to prevent themselves on being infected. Secondary prevention is educating the community especially parents of adolescents and children on early detection, signs and symptoms of the virus and the need to seek treatment. Tertiary prevention would be managing an outbreak and minimizing the impact of the virus on the children. This could be identifying a school with an outbreak and notifying the students and parents of this and the need for precautions in place.
The World Health Organization is the authority for health within the United Nations. They provide leadership, health research, set normal and standards, provide evidence based policy, provide support to countries and monitor and assess health trends. Like any virus education on prevention is the key to success. Proper hand hygiene and signs and symptoms to watch for are communicated to the communities. Proper treatment is also addressed. There are no current specific efforts being made for mononucleosis just an overall prevention of the spread of viruses within communities in general.
Overall mononucleosis is a common disease that has very minimal adverse affects. Communities need to be educated on the virus, the causes of the virus and how the virus is spread. Education in the schools should be focused on the prevention of the spread of any virus. These can include but not limited to proper hand hygiene, refraining from sharing drinks and food and respiratory etiquette such as sneezing and coughing into the armpit and not on the hands. With the high number of adults that have been affected by HPV they also need to be educated on how the virus is transmitted to prevent from infected adolescents around them. The community health nurse and the WHO play very important roles in helping in the education and the prevention of these and many other viruses.
Bryant, M. (2013). Mononucleosis. Magill’s Medical Guide (Online Edition).
Kulbok, P. A., Thatcher, E., Park, E., & Meszaros, P. (2012). Evolving public health nursing roles: Focus on community participatory health promotion and prevention. The Online Journal of Issues in Nursing, 17. http://dx.doi.org/10.3912/OJIN.Vol17No02Man01
Mayo Clinic Staff. (2012). Mononucleosis. Retrieved October 10, 2014, from www.mayoclinic.org/diseases-conditions/mononucleosis/basics/definition/con-20021164
Meadows, P. (2009). Community Health Nursing. American Journal of Nursing, 109(7), 19. http://dx.doi.org/10.1097/01.NAJ.0000343102.62178.80
Singer-Leshinsky, S. (2012). Pathogens, diagnostic testing, and management of mononucleosis. JAAPA: Journal Of The Academy Of Physician Assistants (Haymarket Media, Inc.), 25(5), 58-63. Retrieved from http://dx.doi.org/ http://www.who.int Maurer and Smith, Community/Public Health Nursing Practice: Health for Families and Populations. 4th Edition. W.B. Saunders Company, 2009. VitalBook file. Pageburst. Retrieved from http://pageburstls.elsevier.com/books/9781416050049/id/B978141605004900007X_b0030
References: Bryant, M. (2013). Mononucleosis. Magill’s Medical Guide (Online Edition). Kulbok, P. A., Thatcher, E., Park, E., & Meszaros, P. (2012). Evolving public health nursing roles: Focus on community participatory health promotion and prevention. The Online Journal of Issues in Nursing, 17. http://dx.doi.org/10.3912/OJIN.Vol17No02Man01 Mayo Clinic Staff. (2012). Mononucleosis. Retrieved October 10, 2014, from www.mayoclinic.org/diseases-conditions/mononucleosis/basics/definition/con-20021164 Meadows, P. (2009). Community Health Nursing. American Journal of Nursing, 109(7), 19. http://dx.doi.org/10.1097/01.NAJ.0000343102.62178.80 Singer-Leshinsky, S. (2012). Pathogens, diagnostic testing, and management of mononucleosis. JAAPA: Journal Of The Academy Of Physician Assistants (Haymarket Media, Inc.), 25(5), 58-63. Retrieved from http://dx.doi.org/ http://www.who.int Maurer and Smith, Community/Public Health Nursing Practice: Health for Families and Populations. 4th Edition. W.B. Saunders Company, 2009. VitalBook file. Pageburst. Retrieved from http://pageburstls.elsevier.com/books/9781416050049/id/B978141605004900007X_b0030