Polio (Poliomyelitis) Nursing Care Management

No drug kills poliovirus. In paralytic polio your job is to protect the airway, manage pain, prevent the complications of immobility, and support nutrition while the patient rides out the infection. Most cases are mild and self-limiting. The ones that turn neurotropic are the ones that hurt the patient.

What is Poliomyelitis?

Polio (poliomyelitis) is a highly infectious viral disease that mostly affects young children. The virus spreads person to person, mainly by the fecal-oral route and less often through contaminated food or water. It multiplies in the intestine, then can invade the nervous system and cause paralysis. Evidence of the disease goes back nearly 6,000 years, seen in the withered limbs of Egyptian mummies, and it was epidemic in the United States and worldwide through the 20th century, especially the 1940s and 1950s.

Initial symptoms include fever, fatigue, headache, vomiting, neck stiffness, and limb pain.

Pathophysiology

Poliovirus is an RNA virus transmitted by the oral-fecal route or by ingestion of contaminated water.

• 3 serotypes can cause human infection.
• The incubation period is 5 to 35 days.
• Viral particles first replicate in the nasopharynx and GI tract, then invade lymphoid tissue and spread through the blood.
• After viremia, the virus turns neurotropic and destroys the motor neurons in the anterior horn and brainstem.
• That destruction produces flaccid paralysis, bulbar or spinal in distribution.

Statistics and Incidences

No cases of wild-type poliovirus infection have been reported in the United States since 1979.

• Global incidence has dropped more than 99% since 1988.
• Wild poliovirus type 2 (WPV2) was eradicated in 2015, which prompted the switch from trivalent oral poliovirus vaccine to OPV containing only types 1 and 3.
• Most cases (90-95%) are inapparent; 5-10% of those infected develop symptoms.
• Polio mainly affects children, but anyone, especially the immunocompromised, can develop it.

Etiology

Polioviruses are enteroviruses in the Picornaviridae family.

• Direct contact. Spread through direct contact with an infected person.
• Ingestion. Less commonly, through contaminated food and water.

Clinical Manifestations

Most people infected with poliovirus stay asymptomatic.

• Nonspecific symptoms. Fever, headache, nausea, vomiting, abdominal pain, and oropharyngeal hyperemia in mild cases, usually resolving within a few days.
• Nonparalytic poliomyelitis. The symptoms above plus nuchal rigidity, more severe headache, back and lower extremity pain, and meningitis with lymphocytic pleocytosis.

Assessment and Diagnostic Findings

Confirm the diagnosis by testing throat secretions, stool, or cerebrospinal fluid (CSF) for poliovirus.

• Viral cultures. Obtain CSF, stool, and throat specimens for viral culture in suspected cases.
• Serum antibody. Draw acute and convalescent serum for antibody titers against the 3 polioviruses.
• IgG titer. A 4-fold rise in immunoglobulin G (IgG) titers, or a positive anti-immunoglobulin M (IgM) titer during the acute stage, is diagnostic.

Medical Management

Treatment is supportive.

• Physical therapy. In paralytic disease, mobilize frequently to prevent chronic decubitus ulcers; active and passive range-of-motion exercises during convalescence.
• Total hip arthroplasty. A surgical option for paralytic patients who develop hip dysplasia and degenerative disease.
• Diet. Patients are prone to constipation, so a high-fiber diet is indicated.

Pharmacologic Management

No antiviral agents work against poliovirus.

Nursing Management

Nursing Assessment

• History. Get vaccination history, travel, and contact with recently returned travelers.
• Physical assessment. Watch for the signs and symptoms listed above.

Nursing Diagnosis

• Imbalanced nutrition: less than body requirements related to anorexia, nausea, and vomiting.
• Ineffective thermoregulation related to the infection.
• Ineffective airway clearance related to muscle paralysis.
• Ineffective breathing pattern related to muscle paralysis.
• Acute pain related to nerve involvement.
• Impaired physical mobility related to paralysis.
• Anxiety in children and families related to the disease.

Nursing Care Planning and Goals

• Maintain a nutritious diet.
• Maintain adequate thermoregulation.
• Keep the airway clear and breathe effectively.
• Control pain.
• Mobilize effectively.

Nursing Interventions

• Nutrition. Offer frequent small meals; maintain nasogastric tube feeding if ordered; hyperalimentation may be needed; clear unpleasant odors from the room at mealtimes.
• Thermoregulation. Reduce heat loss in infants and monitor body temperature.
• Airway clearance. Assess respiratory rate, rhythm, depth, effort, and breath sounds; elevate the head of the bed for better lung expansion.
• Pain. Give analgesics as prescribed and teach diversional activities.

Evaluation

Goals are met when the patient maintains a nutritious diet and adequate thermoregulation, keeps a clear airway and breathes effectively, controls pain, and mobilizes effectively.

Documentation

• Individual findings: factors affecting the patient, interactions, social exchanges, specifics of behavior.
• Cultural and religious beliefs and expectations.
• Plan of care.
• Teaching plan.
• Responses to interventions, teaching, and actions performed.
• Attainment or progress toward desired outcomes.