Rabies is one of the scariest things you can learn about as a nursing student, because once symptoms start, it’s almost always fatal. But the good news is that it’s also almost completely preventable. That’s why the NCLEX asks about what to do right after the bite. Here are my notes, and then a practice test.
Table of Contents
What is Rabies?
Rabies is a viral disease of the nervous system caused by the rabies virus (a lyssavirus). It is spread through the saliva of an infected animal, usually by a bite, though a scratch or saliva on broken skin or mucous membranes can also spread it.
- In the Philippines and many other countries, dogs are the main source. Bats, cats, and other animals can carry it too.
- Incubation is usually 1 to 3 months, but can be shorter or much longer, depending on the bite location and amount of virus.
- Once symptoms appear, rabies is nearly 100% fatal.
- Watch Out For: hydrophobia, agitation, paralysis, respiratory failure.
- Safety Precaution: Standard precautions. Wear gloves, a gown, and eye and face protection when saliva may splash.
Pathophysiology
The virus enters the wound, multiplies in muscle, then travels along peripheral nerves to the spinal cord and brain. Once in the brain it causes severe inflammation (encephalitis), then spreads to the salivary glands, which is why saliva is infectious.
Assessment and Diagnostic Findings
Clinical presentation
- Early: fever, headache, malaise, and tingling, itching, or pain at the bite site.
- Furious form: agitation, confusion, hallucinations, excessive salivation, and spasms of the throat with swallowing or even the sight of water (hydrophobia) or a breeze (aerophobia).
- Paralytic form: gradual weakness and paralysis.
- Finally: coma, respiratory failure, death.
Diagnosis: Done by lab tests on saliva, skin biopsy from the neck, spinal fluid, and serum. In animals, the brain is tested.
NCLEX Tip: Treatment must begin before symptoms appear. Don’t wait for confirmation after a high-risk exposure.
Medical Management
Post-exposure prophylaxis (PEP)
- Wash the wound immediately with soap and water for at least 15 minutes, then apply an antiseptic such as povidone-iodine.
- Rabies immune globulin (RIG) is given once, with as much as possible infiltrated around the wound.
- Rabies vaccine series (for previously unvaccinated people, typically on days 0, 3, 7, and 14).
- A tetanus booster and antibiotics may be needed for the wound.
- The animal, if it’s a dog or cat, should be observed for 10 days. If it stays healthy, the person is considered not exposed.
- Pre-exposure vaccination is given to high-risk groups such as veterinarians and animal handlers.
- AVOID: closing the wound with sutures (if possible), and delaying wound washing.
Nursing Management
Nursing care focuses on immediate wound care, ensuring PEP is completed, and education.
- First action: Wash the wound thoroughly with soap and running water for 15 minutes.
- Assess: Location and depth of the bite, type of animal, whether it was provoked, vaccination status of the animal, and whether the animal can be observed.
- Make sure the whole vaccine series is completed on schedule. Missing a dose can mean the series is incomplete.
- Infection control: Standard precautions with extra protection for splashes of saliva.
- For symptomatic clients: Provide a quiet, dimly lit room, minimize stimulation, protect from injury, and give comfort and support to the family.
- Education: Vaccinate pets, avoid stray animals, report all bites right away, and never ignore a “small” scratch.
NCLEX High-Yield Notes
- First action after an animal bite: wash the wound with soap and water for 15 minutes.
- RIG and vaccine are both part of PEP for unvaccinated people.
- Once symptoms start, it’s almost always fatal, so prevention is key.
- Hydrophobia and aerophobia are classic.
- Observe a healthy-appearing dog or cat for 10 days.
Mnemonic (BITE):
- Big priority: wash the wound
- Immune globulin around the wound
- Three-to-four dose vaccine series on schedule
- Expose? Don’t wait for symptoms
