Polio (Poliomyelitis)

A terrifying, highly communicable disease resulting in devastating paralysis, polio continues to be prevalent in much of the developing world. This study guide describes the pathophysiology, nursing assessment, nursing care management and treatment of polio and addresses the vital role of nurses.

What is Poliomyelitis?

Polio or poliomyelitis is first known to have occurred nearly 6,000 years ago, as evidenced by the withered and deformed limbs of certain Egyptian mummies.

• Polio was epidemic in the United States and the world in the 20th century, especially in the 1940s and 1950s.
• Poliomyelitis is a highly infectious viral disease, which mostly affects young children; the virus is transmitted by person-to-person spread mainly through the fecal-oral route, or, less frequently, by a common vehicle (e.g. contaminated food or water) and multiplies in the intestine, from where it can invade the nervous system and can cause paralysis.
• Initial symptoms of polio include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs.

Pathophysiology

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

• Three serotypes are able to cause human infection.
• The incubation period for poliovirus is 5 to 35 days.
• The viral particles initially replicate in the nasopharynx and GI tract and then invade lymphoid tissues, with subsequent hematologic spread.
• After a period of viremia, the virus become neurotropic and produces destruction of the motor neurons in the anterior horn and brainstem.
• The destruction of motor neurons leads to the development of flaccid paralysis, which may be bulbar or spinal in distribution.

Statistics and Incidences

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

• The global incidence of poliovirus infection has decreased by more than 99% since 1988.
• Wild poliovirus type 2 (WPV2) was officially eradicated in 2015 which prompted the replacement of trivalent oral poliovirus vaccine with OPV containing only types 1 and 3.
• Although most cases of poliomyelitis (90-95%) are inapparent, 5-10% of patients who acquire this infection develop symptoms.
• Poliovirus affects mainly children; however, individuals of any age (especially those who are immunocompromised) may also develop the disease.

Etiology

Polioviruses are enteroviruses within the Picornaviridae family.

• Direct contact. Poliovirus can be transmitted through direct contact with someone infected with the virus.
• Ingestion. Less commonly, it can be transmitted through contaminated food and water. 

Clinical Manifestations

Most patients infected with poliovirus develop inapparent infections and are frequently asymptomatic.

• Nonspecific symptoms. Fever, headache, nausea, vomiting, abdominal pain, and oropharyngeal hyperemia are observed in mild cases and usually resolve within a few days.
• Nonparalytic poliomyelitis. Nonparalytic poliomyelitis is characterized by the symptoms described above in addition to the following: nuchal rigidity, more severe headache, back, and lower extremity pain, and meningitis with lymphocytic pleocytosis (usually).

Assessment and Diagnostic Findings

To confirm the diagnosis, a sample of throat secretions, stool or a colorless fluid that surrounds your brain and spinal cord (cerebrospinal fluid) is checked for poliovirus.

• Viral cultures. Obtain specimens from the cerebrospinal fluid (CSF), stool, and throat for viral cultures in patients with suspected poliomyelitis infection.
• Serum antibody. Obtain acute and convalescent serum for antibody concentrations against the 3 polioviruses.
• IG titer. A 4-fold increase in the immunoglobulin G (IgG) antibody titers or a positive anti-immunoglobulin M (IgM) titer during the acute stage is diagnostic.

Medical Management

The treatment of poliomyelitis is mainly supportive.

• Physical therapy. Physical therapy is indicated in cases of paralytic disease; in paralytic disease, it provide frequent mobilization to avoid the development of chronic decubitus ulcerations; active and passive motion exercises are indicated during the convalescent stage.
• Total hip arthroplasty. Total hip arthroplasty is a surgical therapeutic option for patients with paralytic sequelae of poliomyelitis who develop hip dysplasia and degenerative disease.
• Diet. Because patients with poliomyelitis are prone to develop constipation, a diet rich in fiber is usually indicated.

Pharmacologic Management

No antiviral agents are effective against poliovirus.

Nursing Management

Nursing management for a client with polio include the following: 

Nursing Assessment

Nursing assessment in a client with polio include:

• History. Obtain a history of vaccination, travel. and contact with recently returned travelers.
• Physical assessment. Observe the client for possible signs and symptoms of polio as listed above.

Nursing Diagnosis

Based on the assessment data, the major nursing interventions for polio:

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

Nursing Care Planning and Goals

The nursing care planning goals for a patient with polio include:

• The client will be able to improve and maintain a nutritious diet.
• The client will be able to maintain adequate thermoregulation.
• The client will be able to clear the airway and breathe effectively.
• The client will be able to reduce the pain.
• The client will be able to mobilize effectively.

Nursing Interventions

The following are the nursing interventions for a patient with polio:

• Nutrition. Encourage frequent small meals to promote nutritional and fluid intake; maintain nasogastric tube feeding, if ordered; hyperalimentation may be necessary to ensure adequate nutrition, and eliminate unpleasant odors from the environment during meals.
• Thermoregulation. Reduce or eliminate the sources of heat loss in infants, and monitor the body temperature.
• Airway clearance. Assess respiratory rate, rhythm, depth, effort, and breath sounds; and elevate the head of the bed to promote the optimum level of activity for best possible lung expansion.
• Pain. Administer analgesics as prescribed, and educate the patient on diversional activities to reduce the pain.

Evaluation

The goals are met as evidenced by:

• The client was able to improve and maintain a nutritious diet.
• The client was able to maintain adequate thermoregulation.
• The client was able to clear the airway and breathe effectively.
• The client was able to reduce the pain.
• The client was able to mobilize effectively.

Documentation and Guidelines

Documentation in a client with polio include:

• Individual findings, including factors affecting, interactions, nature of social exchanges, 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.

Practice Quiz: Poliomyelitis

Nursing practice questions for poliomyelitis. For more practice questions, visit our NCLEX practice questions page.

References

Sources and references for this study guide for polio:

• Black, J. M., & Hawks, J. H. (2005). Medical-surgical nursing. Elsevier Saunders,. [Link]
• Kimberlin, D. W. (2018). Red Book: 2018-2021 report of the committee on infectious diseases (No. Ed. 31). American academy of pediatrics.
• Oshinsky, D. M. (2005). Polio: an American story. Oxford University Press. [Link]
• Willis, L. (2019). Professional guide to diseases. Lippincott Williams & Wilkins. [Link]