Nursing Guide to RSV: Nursing Diagnosis, Interventions, & Care Plans

Respiratory syncytial virus (RSV) is a common, highly contagious virus that primarily affects the respiratory tract. It’s a leading cause of respiratory infections, particularly in infants, young children, older adults, and individuals with compromised immune systems. 

RSV is responsible for conditions like bronchiolitis and pneumonia, especially in infants under one year old. While most healthy adults and children experience mild, cold-like symptoms, this condition can cause severe respiratory distress in high-risk populations. 

RSV season peaks in fall, winter, and early spring. Early detection and proper management are essential to preventing severe complications, especially in vulnerable groups. 

Etiology and epidemiology 

RSV is a single-stranded RNA virus classified within the Paramyxoviridae family. It is transmissible through respiratory droplets when an infected person coughs or sneezes, or through direct contact with contaminated surfaces. RSV can survive on surfaces like doorknobs or hands for several hours, which increases transmission risk in child care settings, hospitals, and nursing homes. 

RSV infection is most prevalent in infants and young children, particularly those under two years old. It’s estimated that nearly all children will have been infected by RSV by their second birthday, according to the National Foundation for Infectious Diseases. However, it also remains a prominent cause of illness in older adults, especially those with chronic heart or lung conditions or weakened immune systems. 

Key risk factors: 

• Premature birth 
• Chronic lung disease 
• Congenital heart disease 
• Weakened immune systems 
• Older individuals (especially those in long-term care) 

ICD-10 code for RSV 

• ICD-10 code for respiratory syncytial virus (RSV): J21.0 (Acute bronchiolitis due to RSV) 

Source: ICD-10 Data 

RSV symptoms & diagnosis  

RSV diagnosis is based on clinical presentation, especially during peak season. Diagnostic methods include: 

• Physical examination: Wheezing, crackles, or decreased breath sounds can be observed in severe cases. 
• Laboratory tests: 
• Rapid RSV antigen testing: This is commonly used in children. 
• RT-PCR testing: This is more sensitive and widely used in hospital settings. 
• Chest X-ray: This is used to rule out complications like pneumonia. 

Differential diagnosis should include influenza, parainfluenza, and other viral or bacterial causes of respiratory illness. 

Management 

RSV has no specific antiviral treatment and is managed with supportive care. Mild cases often resolve with symptomatic care, while severe cases may require hospitalization. 

RSV treatment options: 

• Oxygen therapy: This is for patients with hypoxia or respiratory distress. 
• Nebulized hypertonic saline: This can be used to improve mucus clearance in severe bronchiolitis. 
• Mechanical ventilation: This is used in cases of respiratory failure. 
• Antipyretics: This is used for fever management. 
• Hydration: Ensuring adequate fluid intake is crucial, especially in infants. 

Medications like bronchodilators and corticosteroids are not routinely recommended unless there is an underlying condition like asthma. 

Preventive measures: 

• Palivizumab: This monoclonal antibody is administered as prophylaxis to high-risk infants, such as those who are premature or have chronic lung disease or congenital heart disease, during the RSV season. 
• Infection control: Hand hygiene, mask-wearing, and disinfection of surfaces help reduce transmission. 

Respiratory syncytial virus nursing care plan 

Nursing considerations 

Nurses help with monitoring and managing RSV patients, especially those at high risk for complications. The focus is on supporting respiratory function, preventing dehydration, and providing family education. 

Assessment 

• Respiratory status: Monitor for increased work of breathing, nasal flaring, retractions, and cyanosis. 
• Vital signs: Monitor heart rate, respiratory rate, and oxygen saturation. 
• Fluid status: Monitor intake/output for signs of dehydration. 
• Neurological status: Watch for signs of fatigue, lethargy, or irritability. 

Nursing diagnosis/risk for 

• Ineffective airway clearance due to increased mucus production 
• Impaired gas exchange related to bronchiolar inflammation and mucus obstruction 
• Risk for dehydration related to fever and decreased oral intake 
• Anxiety (parental) related to the child’s illness and hospitalization 

Interventions 

• Maintaining a patent airway: Encourage suctioning of nasal secretions in infants to improve breathing. Use nebulized treatments as ordered. 
• Positioning: Raise the head of the bed to promote easier breathing. 
• Oxygen therapy: Administer supplemental oxygen to maintain adequate oxygen saturation levels (>92%). 
• Fluid management: Encourage oral fluids in mild cases or administer IV fluids in severe cases to prevent dehydration. 
• Monitoring for complications: Closely observe for signs of worsening respiratory distress, such as decreased breath sounds, cyanosis, or apnea. 

Expected outcomes 

• The patient will maintain adequate oxygenation with oxygen saturation >92%. 
• The patient will demonstrate improved respiratory effort with reduced work of breathing. 
• The patient will remain well-hydrated with balanced intake/output. 
• Caregivers will verbalize understanding of home care and infection control measures. 

Individual/caregiver education 

Education is essential to ensure optimal home care and reduce the risk of transmission. Consider the following when providing patient education: 

• Hand hygiene: Instruct caregivers and family members to wash their hands frequently to reduce transmitting RSV. 
• Infection control: Advise on minimizing contact with other children, especially in childcare settings, and sanitizing surfaces regularly. 
• Symptom monitoring: Teach parents/caregivers to recognize signs of respiratory distress (rapid breathing, retractions, or color changes). 
• Follow-up care: Stress the importance of follow-up appointments, especially for high-risk infants, and provide guidance on when to seek immediate medical care. 

Resources 

• Centers for Disease Control and Prevention (CDC) — RSV Information 
• American Academy of Pediatrics — RSV Prophylaxis Recommendations 

References 

1. Centers for Disease Control and Prevention. (2023). RSV (Respiratory syncytial virus) overview. Retrieved from https://www.cdc.gov/rsv/index.html 
2. ICD-10 Data. (2023). J21.0 - Acute bronchiolitis due to RSV. Retrieved from https://www.icd10data.com/ICD10CM/Codes/J00-J99/J20-J22/J21-/J21.0 
3. Jain H, Schweitzer JW, Justice NA. (June 2023). Respiratory syncytial virus infection in children. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459215/