Nursing Guide to Monkey Pox: Nursing Diagnosis, Interventions, & Care Plans

Monkeypox is a rare viral disease caused by the monkeypox virus, a member of the Orthopoxvirus genus, which also includes the variola virus (responsible for smallpox). Monkeypox is zoonotic, meaning it can spread from animals to humans and between humans.  

Symptoms are similar to those of smallpox but are generally milder, with a characteristic rash that evolves from macules to vesicles and pustules, eventually forming scabs. Human-to-human transmission occurs through direct contact with skin lesions, bodily fluids, or respiratory droplets. Monkeypox can cause severe illness in some cases, particularly in individuals with weakened immune systems. 

Etiology and epidemiology 

Monkeypox virus is primarily found in central and western Africa, but recent outbreaks have been reported in non-endemic regions due to international travel and human-to-human transmission. The disease was first discovered in 1958 in monkeys used for research, but rodents and other small mammals are the primary carriers of the virus. 

Transmission: 

• Animal-to-human transmission: Occurs through contact with infected animals, including rodents, monkeys, and other wildlife. This may happen through bites, scratches, or consumption of inadequately cooked meat from infected animals.
• Human-to-human transmission: Close contact with lesions, respiratory secretions, or contaminated objects like bedding and clothing can spread the virus. Prolonged face-to-face contact may also result in transmission through respiratory droplets. 

Risk factors: 

• Close contact with infected individuals: Healthcare workers, family members, or individuals in close contact with an infected person are at higher risk.
• Travel to endemic areas: People traveling to regions in central and western Africa where monkeypox is endemic may be at increased risk.
• Weakened immune system: Individuals with compromised immune systems are more likely to develop severe disease. 

Epidemiology: 

Monkeypox was historically confined to Africa, but in recent years, cases have been reported in non-endemic regions, including Europe, North America, and Asia, often linked to travel or imported animals. The recent rise in human-to-human transmission has caused public health concerns, especially during outbreaks. 

Monkeypox ICD-10 code 

The ICD-10 code for monkeypox is B04 – Monkeypox. 

Monkey Pox Diagnosis 

Diagnosis of monkeypox is based on clinical presentation, history of potential exposure, and laboratory testing. Early identification is essential for managing the disease and preventing outbreaks. 

1. Clinical presentation:
2. Prodromal phase: Fever, headache, muscle aches, and swollen lymph nodes (a key feature differentiating monkeypox from smallpox). These symptoms typically appear within 1 to 3 days before the onset of the rash.
3. Rash: Begins as macules (flat lesions) and progresses to papules, vesicles, pustules, and scabs. The rash often starts on the face and spreads to other parts of the body, including the palms and soles. The rash is painful and can involve mucous membranes in the mouth and genitals.
4. Laboratory tests:
5. Polymerase chain reaction (PCR): The most reliable test for confirming monkeypox, PCR detects viral DNA in lesion samples.
6. Viral culture: The virus can be isolated from clinical specimens, but this is less commonly performed due to the availability of molecular methods.
7. Serology: Antibody testing can help in later stages, but it is less useful for early diagnosis.
8. Differential diagnosis: Monkeypox may be confused with other rash-causing illnesses, such as smallpox, chickenpox, measles, or syphilis. Careful assessment of the rash's progression and associated symptoms (e.g., lymphadenopathy) is crucial for diagnosis. 

Management 

There is no specific antiviral treatment for monkeypox, but supportive care can help manage symptoms. In severe cases, antiviral medications, such as brincidofovir and tecovirimat, may be considered. Prevention of transmission is a key aspect of management. 

Supportive care: 

1. Symptom management:
2. Fever and pain control: Administer antipyretics (e.g., acetaminophen) and analgesics (e.g., ibuprofen) to relieve fever, headache, and muscle pain.
3. Hydration: Encourage adequate fluid intake to prevent dehydration, especially in patients with oral lesions that make eating or drinking difficult.
4. Skin care: Keep the lesions clean and dry to prevent secondary infections. In some cases, topical antibiotics may be used if bacterial superinfection occurs.
5. Antiviral therapy:
6. Tecovirimat: An antiviral drug approved for the treatment of smallpox; it may be used under an expanded access protocol for monkeypox during outbreaks. It inhibits the Orthopoxvirus and has been shown to be effective in reducing the severity of symptoms.
7. Vaccinia immune globulin (VIG): This may be considered for severe cases, especially in immunocompromised patients. 

Prevention of transmission: 

1. Isolation: Patients with confirmed or suspected monkeypox should be isolated to prevent transmission. Healthcare workers should use personal protective equipment (PPE), including gloves, gowns, eye protection, and N95 respirators.
2. Vaccination: The smallpox vaccine (ACAM2000) and a newer vaccine, JYNNEOS (Imvamune or Imvanex), have been shown to provide protection against monkeypox. Post-exposure vaccination is recommended for individuals at high risk of infection, such as healthcare workers or close contacts of an infected person.
3. Infection control: Surfaces and objects that come into contact with an infected patient should be disinfected, and bedding or clothing should be handled carefully to prevent contamination. 

Monkey Pox nursing care plan 

Nursing considerations 

Nurses play a critical role in identifying monkeypox, managing symptoms, and preventing the spread of infection. Care involves both clinical management and education on isolation practices and hygiene. 

Assessment 

• Monitor vital signs: Regularly check temperature, respiratory rate, and blood pressure to identify early signs of complications, such as dehydration or secondary infection.
• Assess skin integrity: Monitor the progression of the rash and check for signs of secondary bacterial infections, such as increased redness, warmth, or purulent discharge.
• Lymph node evaluation: Palpate lymph nodes to assess for enlargement, which is common in monkeypox.
• Fluid balance: Monitor intake and output to assess hydration status, particularly in patients with mouth lesions or significant discomfort. 

Nursing diagnosis/risk for 

• Risk for infection related to open skin lesions and viral shedding.
• Impaired skin integrity related to the vesicular and pustular rash.
• Risk for dehydration related to fever, difficulty swallowing due to oral lesions, and fluid loss through the skin.
• Social isolation related to infectious disease precautions and fear of spreading the virus to others. 

Interventions 

• Infection control measures: Implement airborne and contact precautions, including isolation in a single room, and ensure proper use of PPE to prevent the spread of monkeypox.
• Skin care: Clean lesions with gentle antiseptic solutions and cover them with sterile dressings if necessary to reduce the risk of secondary infections.
• Hydration support: Encourage oral fluids or administer intravenous fluids if necessary to maintain hydration, especially in patients with significant oral discomfort.
• Psychosocial support: Provide emotional support to patients who may be experiencing anxiety or fear due to isolation and visible skin lesions. Involve family members through virtual communication if necessary. 

Expected outcomes 

• The patient will maintain intact skin, free from secondary infections.
• The patient will remain hydrated, as evidenced by stable vital signs and adequate urine output.
• The patient will follow infection control protocols to prevent the spread of the virus.
• The patient will demonstrate an understanding of home isolation practices and infection prevention measures. 

Individual/caregiver education 

• Isolation at home: Teach patients and caregivers the importance of isolation until all lesions have crusted over and fallen off. Educate them on how to clean and disinfect surfaces to prevent transmission.
• Skin care: Instruct on proper wound care, including keeping lesions clean and covered if necessary. Advise against scratching to avoid secondary infections.
• Symptom management: Educate patients on how to manage fever and pain with over-the-counter medications and the importance of staying hydrated.
• Vaccination information: Inform patients about the smallpox vaccine for post-exposure prophylaxis if they are eligible. Explain the benefits and potential side effects of the vaccine. 

References 

1. Centers for Disease Control and Prevention: Monkeypox Information
2. World Health Organization: Monkeypox Factsheet
3. Mayo Clinic: Monkeypox Overview
4. ICD-10 Data: B04 Monkeypox
5. Mpox (Monkeypox) - StatPearls - NCBI Bookshelf 

  Resources 

• Centers for Disease Control and Prevention (CDC): Provides up-to-date information on monkeypox outbreaks, prevention, and treatment guidelines.
• World Health Organization (WHO): Offers global guidance on monkeypox surveillance, diagnosis, and management.
• Public Health England (PHE): Shares resources and guidelines on managing monkeypox in healthcare settings.
• National Institute of Allergy and Infectious Diseases (NIAID): Supports research and clinical trials for monkeypox treatment and vaccines.