Infectious Mononucleosis Screen

Infectious Mononucleosis Screen

Synonym/acronym: Monospot, heterophil antibody test, IM serology.

Common use

To assess for Epstein-Barr virus and assist with diagnosis of infectious mononucleosis.

Specimen

Serum (1 mL) collected in a gold-, red-, or red/gray-top tube. Place separated serum in a standard transport tube within 2 hr of collection.

Normal findings

(Method: Agglutination) Negative.

Description

Infectious mononucleosis is caused by the Epstein-Barr virus (EBV). The incubation period is 10 to 50 days, and the symptoms last 1 to 4 wk after the infection has fully developed. The hallmark of EBV infection is the presence of heterophil antibodies, also called Paul-Bunnell-Davidsohn antibodies, which are immunoglobulin M (IgM) antibodies that agglutinate sheep or horse red blood cells. The disease induces formation of abnormal lymphocytes in the lymph nodes; stimulates increased formation of heterophil antibodies; and is characterized by fever, cervical lymphadenopathy, tonsillopharyngitis, and hepatosplenomegaly. EBV is also thought to play a role in Burkitt’s lymphoma, nasopharyngeal carcinoma, and chronic fatigue syndrome. If the results of the heterophil antibody screening test are negative and infectious mononucleosis is highly suspected, EBV-specific serology should be requested.

This procedure is contraindicated for

    N/A

Indications

  • Assist in confirming infectious mononucleosis

Potential diagnosis

Positive findings in:

  • Infectious mononucleosis
N/A

Critical findings

    N/A

Interfering factors

  • False-positive results may occur in the presence of narcotic addiction, serum sickness, lymphomas, hepatitis, leukemia, cancer of the pancreas, and phenytoin therapy.
  • A false-negative result may occur if treatment was begun before antibodies developed or if the test was done less than 6 days after exposure to the virus.

Nursing Implications and Procedure

Potential nursing problems

ProblemSigns & SymptomsInterventions
Infection (Related to Epstein-Barr viral infection secondary to exposure through kissing, cough, sneeze, sharing food utensils of an infected person)Fatigue, malaise, sore throat, fever, enlarged lymph nodes in the neck and armpits, swollen tonsils, headache, rash, swollen spleenRest, drink plenty of fluids (water and fruit juice), administer prescribed antibiotics to treat strep throat; administer prescribed steroids to treat swollen throat or tonsils; discuss gargling with warm saltwater to decrease pain of sore throat; discuss using over-the-counter ibuprofen or acetaminophen; discuss the importance of avoiding at-risk activities that may cause trauma and spleen rupture
Fatigue (Related to Epstein-Barr viral infection secondary to exposure through kissing, cough, sneeze, sharing food utensils of an infected person)Decreased concentration; increased physical complaints; unable to restore energy with sleep; reports being tired; unable to maintain normal routine Monitor and trend mononucleosis screening results; pace activities to preserve energy stores; rate fatigue on a numeric scale to trend degree of fatigue over time; identify what aggravates and decreases fatigue; assess for related emotional factors such as depression; evaluate current medications in relation to fatigue; assess for physiologic factors such as anemia
Knowledge (Related to recent diagnosis; complexity of treatment; poor understanding of provided information; cultural or language barriers; anxiety; emotional disturbance; unfamiliarity with medical management)Lack of interest or questions; multiple questions; anxiety in relation to disease process and management; verbalizes inaccurate information; lack of follow-through with directionsIdentify patient’s, family’s, and significant others’ concerns about disease process; discuss the importance of fluids and rest for recovery; discuss the importance of avoiding vigorous activities, heavy lifting, roughhousing, or contact sports for at least 1 mo or as recommended by the health-care provider (HCP)

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this test can assist with diagnosing a mononucleosis infection.
  • Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex. Obtain a history of exposure.
  • Obtain a history of the patient’s hepatobiliary and immune systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Note any recent therapies that can interfere with test results.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • Potential complications: N/A
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
  • Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
  • Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • Recognize anxiety related to test results, and inform the patient that signs and symptoms of infection include fever, chills, sore throat, enlarged lymph nodes, and fatigue. Self-care while the disease runs its course include adequate fluid and nutritional intake along with sufficient rest. Activities that cause fatigue or stress should be avoided. Advise the patient to refrain from direct contact with others because the disease is transmitted through saliva.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Advise the patient to refrain from direct contact with others because the disease is transmitted through saliva. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
  • Patient Education

    • Inform the patient that approximately 10% of all results are false-negative or false-positive.
    • Inform the patient that signs and symptoms of infection include fever, chills, sore throat, enlarged lymph nodes, and fatigue.
    • Emphasize the importance of self-care while the disease runs its course, which includes adequate fluid and nutritional intake along with sufficient rest.
  • Expected Patient Outcomes

    • Knowledge
    • Verbalizes understanding of how to pace activities to conserve energy and manage fatigue in relation to activities of daily living
    • States the importance of lengthy rest periods for recovery from mononucleosis
    • Skills
    • Follows the recommendation to increase fluid intake (water and juice)
    • Follows the recommendation to take over-the-counter ibuprofen or acetaminophen for comfort as needed
    • Attitude
    • Complies with the request to get plenty of rest to facilitate the recovery process
    • Complies with the recommendation to avoid kissing to prevent infection of another individual with mononucleosis

Related Monographs

  • Related tests include CBC with peripheral blood smear evaluation and US abdomen.
  • Refer to the Hepatobiliary and Immune systems tables at the end of the book for related tests by body system.
References in periodicals archive ?
The groups' own list eliminates the following: spun microhematocrit, microscopic exam of urine sediment, vaginal wet mount preparation, whole blood clotting time, ASO screen, CRP screen, rheumatoid factor screen, Gram stain, infectious mononucleosis screen, KOH preparation on cutaneous scrapings, and semen analysis.

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