Ebola Virus Disease (EVD)

In this nursing study guide, learn about the ebola virus and the Ebola Virus Disease (EVD), its pathophysiology, causes, signs and symptoms, nursing care management, and interventions.

Ebola Virus Disease (EVD) is a highly contagious disease that is caused by five different strains of the Ebola virus; these viruses have affected humans and animals such as pigs, monkeys, chimpanzees, and gorillas. First discovered in 1976, the ebola virus has been a cause of several outbreaks in Africa where it also reached other countries including Italy, Spain, Russia, Philippines, USA, and United Kingdom.

What is Ebola Virus Disease (EVD)?
Classification
Pathophysiology
Causes
Statistics and Incidences
Clinical Manifestations
Assessment and Diagnostic Findings
Medical Management
- Pharmacological Management
Nursing Management
Summary
References

What is Ebola Virus Disease (EVD)?

Ebola Virus Disease (EVD) is a highly contagious disease that causes fever, weakness, diarrhea, and unexplained bleeding.

It was previously called ‘Ebola Hemorrhagic Fever’ because the virus circulates throughout the body and harms the immune system and organs. Eventually, leads to severe uncontrollable bleeding.
Ebola virus was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of Congo.
The viruses that cause EVD are located mainly in sub-Saharan Africa.
In patients who have Ebola virus infection, exposure to the virus may be either primary (involving presence in an Ebolavirus -endemic area) or secondary (involving human-to-human or primate-to-human transmission).

Classification

The five ebolavirus species were named for the locations where they caused documented human or animal diseases.

Sudan ebolavirus & Zaire ebolavirus. Two African species, Sudan ebolavirus and Zaire ebolavirus (most lethal of all species of the ebola virus) have been responsible for most of the reported deaths.
Ivory Coast ebolavirus. Clinical disease due to African-derived Ebola virus is severe and, with the exception of a patient who survived infection with a third African species, Ivory Coast ebolavirus, is associated with a mortality ranging from 65% (Sudan, 1979) to 89% (Democratic Republic of the Congo [DRC], December 2002 to April 2003).
Reston ebolavirus. A fourth Ebolavirus species, Reston ebolavirus, was first isolated in 1989 in monkeys imported from a single Philippine exporter; a virtually identical isolate imported from the same Philippine exporter was detected in 1992 in Siena, Italy.
Bundibugyo ebolavirus. The fifth Ebolavirus species, also of African lineage, is Bundibugyo ebolavirus, which caused an outbreak in Uganda in 2007-2008, with a mortality of 25%.

Pathophysiology

Ebola virus has a nonsegmented negative-stranded RNA genome containing 7 structural and regulatory genes.

After infection, human and nonhuman primates experience an early period of rapid viral multiplication that, in lethal cases, is associated with an ineffective immunologic response.
Viral replication is accompanied by widespread and severe focal necrosis.
The most severe necrosis occurs in the liver, and this is associated with the formation of Councilman-like bodies similar to those seen in yellow fever.
In fatal infections, the host’s tissues and blood contain large numbers of Ebola virions, and the tissues and body fluids are highly infectious.

Causes

Scientists think people are initially infected with Ebola virus through contact with an infected animal, such as a fruit bat or nonhuman primate; this is called a spillover event; after that, the virus spreads from person to person, potentially affecting a large number of people.

Contaminated blood or body fluids. Blood or body fluids (urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with or has died from Ebola virus disease (EVD).
Contaminated objects. Objects (such as clothes, bedding, needles, and medical equipment) contaminated with body fluids from a person who is sick with or has died from EVD.
Vectors. Infected fruit bats or nonhuman primates (such as apes and monkeys).
Contaminated semen. Semen from a man who recovered from EVD (through oral, vaginal, or anal sex). The virus can remain in certain body fluids (including semen) of a patient who has recovered from EVD, even if they no longer have symptoms of severe illness. There is no evidence that Ebola can be spread through sex or other contact with vaginal fluids from a woman who has had Ebola.

Statistics and Incidences

Ebola virus disease (EVD), one of the deadliest viral diseases, was discovered in 1976 when two consecutive outbreaks of fatal hemorrhagic fever occurred in different parts of Central Africa.

The first outbreak occurred in the Democratic Republic of Congo (formerly Zaire) in a village near the Ebola River, which gave the virus its name.
The second outbreak occurred in what is now South Sudan, approximately 500 miles (850 km) away.
On May 8, 2018, a new outbreak of Ebola virus disease (EVD) was declared in the Democratic Republic of the Congo following laboratory confirmation of two cases of EVD.
Before confirmation of the outbreak, 21 patients with signs of hemorrhagic fever had recently been reported in the country, 17 of whom died.
As of September 17, 2019, 3,034 confirmed cases had been reported and 111 probable cases, including 2,103 attributable deaths.
The 2014-2016 Ebola virus outbreak was significant and primarily involved 3 African countries—Guinea, Liberia, Sierra Leone.

Clinical Manifestations

Symptoms may appear anywhere from 2 to 21 days after contact with the virus, with an average of 8 to 10 days.

“Dry” symptoms. The course of the illness typically progresses from “dry” symptoms initially such as fever, aches and pains, and fatigue.
“Wet” symptoms. Then, it progresses to “wet” symptoms such as diarrhea and vomiting as the person becomes sicker.
Late-stage. Other symptoms may include red eyes, skin rash, and hiccups.

Assessment and Diagnostic Findings

The US Food and Drug Administration (FDA) has granted emergency authorization for two new tests for detecting Ebola in humans. The tests, which can detect Ebola in blood or urine samples in 1 hour, can be performed on-site in hospitals with the proper lab equipment from the tests’ manufacturer, BioFire Defense.

Basic blood tests. The early phase of infection is characterized by thrombocytopenia, leukopenia, and a pronounced lymphopenia; neutrophilia develops after several days, as do elevations in aspartate aminotransferase and alanine aminotransferase; bilirubin may be normal or slightly elevated.
Studies for isolating virus. Definitive diagnosis rests on isolation of the virus by means of tissue culture or reverse-transcription polymerase chain reaction (RT-PCR) assay.
IgM-capture ELISA. IgM-capture ELISA uses Zaire ebolavirus antigens grown in Vero E6 cells to detect IgM antibodies to this strain. Results become positive in experimental primates within 6 days of infection but do not remain positive for extended periods.
IgG-capture ELISA. IgG-capture ELISA uses detergent-extracted viral antigens to detect IgG anti-Ebola antibodies. It is more specific than the IFAT, and it remains positive for long periods.

Medical Management

When used early, basic interventions can significantly improve the chances of survival; these include:

Fluids and electrolytes. Providing fluids and electrolytes (body salts) through infusion into the vein (intravenously).
Oxygen therapy. Offering oxygen therapy to maintain oxygen status.
Prescribing medications. Using medication to support blood pressure, reduce vomiting and diarrhea and to manage fever and pain.

Pharmacological Management

There is currently no antiviral drug licensed by the U.S. Food and Drug Administration (FDA) to treat EVD in people. However, a vaccine is approved in the United States and Europe for the prevention of disease caused by Zaire ebolavirus in patients aged 18 years or older.

Ebola Zaire vaccine (Ervebo). Recombinant vesicular stomatitis virus-Zaire ebolavirus (rVSV-ZEBOV; V920) is a replication-competent vaccine; it is genetically engineered to express a glycoprotein from Zaire ebolavirus to provoke a neutralizing immune response to the Ebola virus; it is indicated for the prevention of disease caused by Zaire ebolavirus.

Nursing Management

Nursing care of a patient with ebola virus disease includes the following:

Nursing Assessment

Nursing assessment of a patient with ebola virus includes:

History. In patients who have Ebola virus infection, 2 types of exposure history are recognized: primary and secondary:
- Primary. A history of primary exposure usually involves travel to or work in an Ebola-endemic area, such as the Democratic Republic of Congo (DRC; formerly Zaire), Sudan, Gabon, or Côte d’Ivoire; a history of exposure to tropical African forests is more common in patients with primary exposure to Ebola than is a history of working within cities in the same region.
- Secondary. Secondary exposure refers to human-to-human or primate-to-human exposures; in each major outbreak, medical personnel or family members who cared for patients or those who prepared deceased patients for burial were at very high risk.
Physical exam. Physical findings depend on the stage of disease at the time of presentation; early in the disease, patients may present with fever, pharyngitis, and severe constitutional signs and symptoms; a maculopapular rash, more easily seen on white skin than on dark skin, may be present around day 5 of infection and is most evident on the trunk.

Nursing Diagnosis

Based on the assessment data, the major nursing diagnosis for a patient with ebola virus are:

Risk for bleeding related to impaired clotting factors.
Risk for electrolyte imbalance related to decreased oral intake, vomiting and diarrhea.
Risk for shock related to progressive multi-organ failure.
Pain related to musculoskeletal and abdominal aches.
Risk for fluid volume deficit related to restricted oral intake, bleeding, vomiting and diarrhea.

Nursing Care Planning and Goals

The major nursing care planning goals for a patient with Ebola virus disease include the following:

Prevention of bleeding.
Restoration of normal fluid and electrolyte balance.
Prevention of shock.
Relief from pain.
Restoration of normal body fluid volume.

Nursing Interventions

Nursing interventions for a patient with ebola virus are:

Prevent bleeding. Instruct the patient to use a soft-bristled toothbrush and nonabrasive toothpaste, limit straining with bowel movements, forceful nose blowing, coughing, or sneezing, and be careful when using sharp objects like scissors and knives; when laboratory values are abnormal, administer blood products as prescribed.
Restore normal fluid and electrolyte balance. Administer electrolyte replacements as prescribed; monitor intake and output; note decreased urinary output and positive fluid balance on 24-hour calculations; and administer oral fluids with caution.
Prevent shock. Monitor daily weight for sudden decreases, especially in the presence of decreasing urine output or active fluid loss; and monitor the patient closely for cardiovascular overload, signs of difficulty of breathing, pulmonary edema, jugular vein distention, and laboratory results.
Relieve pain. Provide rest periods to promote relief, sleep, and relaxation; determine the appropriate pain relief method; get rid of additional stressors or sources of discomfort whenever possible; and provide analgesics as ordered, evaluating the effectiveness and inspecting for any signs and symptoms of adverse effects.
Restore normal fluid volume. Urge the patient to drink the prescribed amount of fluid; if the patient can tolerate oral fluids, give what oral fluids the patient prefers; provide fluid and straw at bedside within easy reach; provide fresh water and a straw; emphasize the importance of oral hygiene; and emphasize the relevance of maintaining proper nutrition and hydration.

Evaluation

Goals are met for a patient with ebola virus as evidenced by:

Prevented progression of bleeding.
Restored normal fluid and electrolyte balance.
Prevented occurrence of shock.
Relief from pain.
Restored normal body fluid volume.

Documentation Guidelines

Documentation in a patient with Ebola virus includes:

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

Summary

Here are some of the most important points about the Ebola Virus disease:

Ebola Virus Disease (EVD) is a rare and deadly disease in people and nonhuman primates.
Two African species, Sudan ebolavirus, and Zaire ebolavirus, have been responsible for most of the reported deaths.
After infection, human and nonhuman primates experience an early period of rapid viral multiplication that, in lethal cases, is associated with an ineffective immunologic response.
Scientists think people are initially infected with Ebola virus through contact with an infected animal, such as a fruit bat or nonhuman primate; this is called a spillover event; after that, the virus spreads from person to person, potentially affecting a large number of people.
Symptoms such as fever, aches and pains, and fatigue may appear anywhere from 2 to 21 days after contact with the virus, with an average of 8 to 10 days.
Two tests approved by FDA, which can detect Ebola in blood or urine samples in 1 hour, can be performed on-site in hospitals with the proper lab equipment from the tests’ manufacturer, BioFire Defense.
Basic interventions such as fluid and electrolytes, oxygen therapy, and medications can significantly improve the chances of survival.

References

Sources and references for ebola virus disease nursing study guide:

Centers for Disease Control and Prevention. Ebola (Ebola virus disease).
Feldmann, H., & Geisbert, T. W. (2011). Ebola haemorrhagic fever. The Lancet, 377(9768), 849-862.
King, J.W., MD (2020, Jan 02). Ebola Virus Infection.
World Health Organization (WHO). Ebola virus disease.