Cytomegalovirus, Immunoglobulin G, and Immunoglobulin M

Cytomegalovirus, Immunoglobulin G, and Immunoglobulin M

Common use

Specimen

Normal findings

Description

This procedure is contraindicated for

N/A

Indications

• Assist in the diagnosis of congenital CMV infection in newborns
• Determine susceptibility, particularly in pregnant women, immunocompromised patients, and patients who recently have received an organ transplant
• Screen blood for high-risk-category transfusion recipients

Potential diagnosis

Positive findings in:

• CMV infection

Critical findings

N/A

Interfering factors

• False-positive results may occur in the presence of rheumatoid factor.
• False-negative results 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

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 in identification of the organism causing infection.
• Obtain a history of the patient’s complaints and history of exposure. Obtain a list of known allergens, especially allergies or sensitivities to latex.
• Obtain a history of the patient’s immune and reproductive systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
• 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 multiple specimens may be required. Any individual positive result should be repeated in 7 to 14 days to monitor a change in titer. 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 health-care provider (HCP), who will discuss the results with the patient. Some HCPs may take additional precautions in the case of CMV antibody negative immunocompromised or pregnant patients by requesting CMV antibody negative blood products or organs in the event those interventions are required.
• Instruct the patient in isolation precautions during time of communicability or contagion.
• Emphasize the need to return to have a convalescent blood sample taken in 7 to 14 days.
• Warn the patient that there is a possibility of false-negative or false-positive results.
• Recognize anxiety related to test results if the patient is pregnant, and offer support. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services.
• Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. 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

  • Provide emotional support if the patient is pregnant and if results are positive.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP.
  • Answer any questions or address any concerns voiced by the patient or family.

• Expected Patient Outcomes

  • Knowledge
  • States understanding that it may take up to 6 wk for full recovery from the diagnosed viral infection
  • States understanding that once CMV virus is in an individual, it will remain present for the rest of his or her life.
  • States emergency response number and understands to call for severe abdominal pain that could indicate a ruptured spleen requiring emergency surgery.
  • Skills
  • Demonstrates proficiency in using warm saltwater gargles for comfort with sore throat
  • Attitude
  • Complies with the recommendation of infected persons to refrain from kissing or other sexual contact to prevent infecting others
  • Complies with the request to stay at home while infectious to avoid exposing others

Related Monographs

• Related tests include β₂-microglobulin, bronchoscopy, Chlamydia group antibody, culture viral, cytology urine, HIV-1/2 antibodies, Pap smear, rubella antibody, and Toxoplasma antibody.
• Refer to the Immune and Reproductive systems tables at the end of the book for related tests by body system.