Hantavirus Nursing Care Plan

Evidence-based nursing care plan for Hantavirus Pulmonary Syndrome (HPS): pathophysiology, common labs, medications, and 5 nursing diagnoses with action-rationale interventions, authored to the NurseBrain scope-of-practice standard.

Last reviewed May 20, 2026

Nursing Care Plan

Nursing Diagnosis 1: Impaired Gas Exchange

Gas Exchange Impairment related to Hantavirus Pulmonary Syndrome (HPS) from New World hantavirus infection (Sin Nombre virus is most common in the United States; Andes virus, found in South America, is the only hantavirus known to spread person-to-person) as evidenced by SpO₂ < 90% despite increasing FiO₂; Bilateral infiltrates on chest imaging consistent with non-cardiogenic pulmonary edema; PaO₂/FiO₂ < 200 (moderate-to-severe ARDS per Berlin definition); Tachypnea (RR > 30/min) with accessory-muscle use; Pink frothy sputum or copious clear pulmonary edema fluid.

Interventions

Monitor SpO₂ continuously and document the trend per facility protocol, with closer attention during the cardiopulmonary phase.
Assess respiratory rate, depth, effort, accessory-muscle use, and breath sounds at intervals matched to clinical acuity and facility protocol.
Monitor and report ABG values per provider order; flag pH < 7.30, PaO₂ < 60 mmHg, or P/F < 150.
Calculate and trend PaO₂/FiO₂ ratio with each ABG; report worsening trend to the provider team.
Observe for signs that may reflect worsening cerebral hypoxia: restlessness, confusion, behavioral change, decreased LOC.
Review serial chest imaging when available and correlate with vent settings and oxygenation.
Administer supplemental oxygen as ordered and titrate within provider parameters to support SpO₂ within the ordered range; escalate stepwise (NC, high-flow NC, non-rebreather, BiPAP, intubation) per facility protocol.
Anticipate and prepare for possible intubation: confirm airway cart at bedside, draw induction medications per provider order, and request the senior airway operator when clinical trajectory raises concern.
Coordinate with respiratory therapy and the provider team to support lung-protective ventilation per ARDSnet protocol and provider orders. Monitor tidal volume, plateau pressure, PEEP, and patient-ventilator synchrony.
Prepare for and assist with prone positioning per facility protocol when ordered (commonly considered at P/F < 150 despite optimized vent settings). Cluster the team, secure airway and lines, and provide eye and skin protection.
Maintain HOB at 30° when supine; provide oral care with chlorhexidine per facility VAP-prevention protocol.
Coordinate early ECMO consultation per facility protocol when severe respiratory failure, shock, or combined cardiopulmonary collapse is developing. VV-ECMO may be considered when refractory hypoxemia predominates; VA-ECMO may be needed when myocardial depression and shock predominate. Follow institutional ECMO-center criteria.
When the patient is alert (prodromal phase or recovery), teach pursed-lip and diaphragmatic breathing techniques.
Educate the family on the rapid trajectory possible in the cardiopulmonary phase, what intubation will look like, and the role of sedation and paralysis if used.
Educate the patient and family on what to expect during proning, including how the team will protect eyes, lines, and pressure points.
Notify the provider for SpO₂ below ordered parameters, PaO₂ < 60 on ABG, new pink frothy sputum, a sustained drop in PaO₂/FiO₂ (per facility protocol, commonly > 50 over 4 hours), or any rapid clinical change.
Coordinate ECMO transfer when local resources are exhausted and ECMO criteria are met per institutional protocol and provider direction.

Outcome: Patient maintains SpO₂ within ordered parameters with the lowest support that meets the goal; Respiratory rate stays within ordered parameters with no accessory-muscle use; ABG findings, including PaO₂/FiO₂ trend, are monitored and reported per facility protocol.

Nursing Diagnosis 2: Impaired Cardiac Output

Cardiac Output Alteration related to Hantavirus Pulmonary Syndrome (HPS) from New World hantavirus infection (Sin Nombre virus is most common in the United States; Andes virus, found in South America, is the only hantavirus known to spread person-to-person) as evidenced by Persistent hypotension (MAP < 65 mmHg or below ordered parameters) despite ordered fluid resuscitation; Lactic acidosis (lactate > 2.0 mmol/L) failing to clear; CDC notes > 4.0 is a poor prognostic indicator; Cardiac index < 2.2 L/min/m² on echo or PiCCO (poor prognostic indicator per CDC); Cool, mottled, or pale extremities with capillary refill > 3 seconds; Decreased urine output (< 0.5 mL/kg/hr).

Interventions

Maintain continuous arterial line monitoring per facility protocol and document MAP at intervals matched to titration activity.
Monitor cardiac rhythm continuously and document any new arrhythmias.
Assess skin color, temperature, mottling, and capillary refill at intervals matched to clinical acuity.
Monitor urine output hourly via Foley catheter; notify the provider for UOP < 0.5 mL/kg/hr for 2 consecutive hours.
Trend serial lactate per provider order during resuscitation; calculate lactate clearance and report findings, including lactate > 4.0 mmol/L.
Review echocardiogram findings and cardiac index trend; report CI < 2.2 L/min/m².
Establish central venous access early when feasible, but do not delay vasopressor initiation in shock. If central access is not yet available, administer norepinephrine as ordered through an appropriate peripheral IV per facility policy while central access is being obtained.
Administer norepinephrine and vasopressin as ordered per provider direction and facility protocol; monitor MAP, rhythm, urine output, peripheral perfusion, and signs of extravasation.
Administer dobutamine as ordered when the provider team determines inotropic support is indicated by echocardiogram or clinical assessment.
Administer ordered crystalloid in the volumes and at the intervals directed by the provider; monitor MAP, lactate trend, lung exam, and urine output after each bolus and escalate worsening pulmonary edema per facility protocol.
Strict hourly intake and output measurement; calculate and document net 24-hour balance per facility protocol.
Anticipate and prepare for mechanical circulatory support (VA-ECMO) per facility protocol when myocardial depression and shock predominate.
When the patient is alert, explain in plain language what the lines, drips, and monitors are doing.
Educate the family on the goals of vasopressor support and what improvement looks like (warm extremities, urine output, falling lactate).
Teach the family what cardiac monitor alarms mean and what is routine noise vs. concerning.
Findings such as rising lactate, decreasing urine output, hypotension, new mental-status change, or CI < 2.2 should prompt urgent reassessment and provider notification.
Coordinate with cardiology and critical care for ECMO consultation when refractory shock is the dominant problem; VV vs VA configuration depends on the dominant failure pattern and institutional criteria.

Outcome: MAP, urine output, and perfusion indicators are monitored and reported within ordered parameters; Lactate trend is documented and reported to the provider team; Cardiac index (when available) is monitored and changes are reported.

Nursing Diagnosis 3: Fluid Imbalance

Fluid Volume Alteration related to Hantavirus Pulmonary Syndrome (HPS) from New World hantavirus infection (Sin Nombre virus is most common in the United States; Andes virus, found in South America, is the only hantavirus known to spread person-to-person) as evidenced by Hemoconcentration (Hct > 55%) on admission CBC; Hypotension consistent with intravascular volume depletion; Worsening pulmonary edema on chest imaging despite low CVP; Capillary leak physiology (third-spacing into alveoli and interstitium); Active crystalloid resuscitation in progress without a clear endpoint.

Interventions

Trend Hct, hemoglobin, and platelet count per provider order during the cardiopulmonary phase.
Auscultate breath sounds at intervals matched to clinical acuity; correlate with serial chest imaging when available.
Maintain strict hourly I&O; calculate cumulative net balance per facility protocol.
Monitor pulmonary artery catheter or PiCCO parameters when placed (CVP, CO, CI, EVLW, GEDV).
Perform serial lung ultrasound to count B-lines per zone when available and per scope/competency.
Weigh patient daily on the same scale, same garments, same time when stable enough.
Administer ordered crystalloid (commonly small reassessed boluses) per provider direction; monitor MAP, lactate trend, lung exam, and urine output after each bolus.
Monitor MAP, lactate clearance, and urine output as the resuscitation surrogates ordered by the provider, rather than fixed preload or CVP targets.
Coordinate with the provider team when pulmonary edema is worsening: reassess the need for additional fluid and consider vasopressor-supported perfusion targets per critical-care protocol and provider order.
When large-volume resuscitation is ordered, lactated Ringer’s is commonly preferred over 0.9% NaCl per facility protocol.
Administer ordered fluids only; do not give albumin or hypotonic fluids reflexively. Confirm orders and clarify with the provider as needed.
Support a conservative fluid strategy (FACTT-style net even-to-negative) per ARDSnet and provider order once the patient stabilizes on vasopressors.
When the patient is alert, explain why the team may be giving smaller volumes than the patient or family expects.
Educate the family on what ‘aggressive supportive care’ looks like in HPS and why it does not include flooding the patient with fluids.
Notify the provider for new bilateral crackles, rising peak inspiratory pressures, P/F drop > 50 in 4 hours, or rapid weight gain during resuscitation.
Coordinate critical care, pharmacy, and respiratory therapy huddles per facility protocol during the cardiopulmonary phase to align on fluid, vasopressor, and ventilator targets.

Outcome: Perfusion indicators are monitored and reported within ordered parameters with the smallest ordered crystalloid volume; Pulmonary findings are monitored and worsening is reported promptly; Urine output is monitored and reported per facility protocol.

Nursing Diagnosis 4: Risk for Disease Transmission to Contacts

Risk for Disease Transmission to Contacts related to Hantavirus Pulmonary Syndrome (HPS) from New World hantavirus infection (Sin Nombre virus is most common in the United States; Andes virus, found in South America, is the only hantavirus known to spread person-to-person) as evidenced by Suspected or confirmed Andes virus exposure (only hantavirus known to spread person-to-person); Recent travel to South America or contact with a returned traveler with HPS-compatible symptoms; Exposure history on the May 2026 Andes virus cruise-ship outbreak per CDC contact-tracing notification; Close-contact household members or healthcare workers without N95-or-higher respiratory protection during the symptomatic phase; Aerosolizing procedures (intubation, open suctioning, bronchoscopy, CPR) in a non-AIIR room.

Interventions

On admission, obtain a focused exposure history: rodent contact, travel, sick contacts, cruise-ship or healthcare exposure, and any CDC outbreak notifications.
Screen close contacts and household members for HPS-compatible symptoms (fatigue, fever, large-muscle myalgia, headache, GI symptoms) on admission and on follow-up.
Document staff entries and PPE compliance for the duration of isolation precautions.
Identify aerosolizing procedures on the plan of care and pre-brief the team on PPE.
For confirmed non-Andes hantavirus infection without concern for person-to-person transmission, follow Standard Precautions per facility infection-prevention policy and current CDC Appendix A guidance.
If Andes virus is suspected based on travel, exposure, outbreak linkage, or public-health guidance, support AIIR placement and use gown, gloves, eye protection, and an N95 respirator (or higher) per facility infection-prevention policy and current CDC Appendix A guidance (Sept 2024 update).
For PAPR-trained staff and extended bedside time, prefer PAPR over N95 per facility policy.
Coordinate dedicated supplies and equipment for the room (stethoscope, BP cuff, thermometer); avoid shared use without decontamination per facility policy.
Support family contact through window visits, video, and phone; in-person visits per facility policy with required PPE and brief education before entry.
Coordinate with infection prevention and the local or state health department per facility reportable-disease workflow.
Educate the patient and family on how the virus spreads and why precautions are in place, in plain language without alarmism.
Teach household contacts hand hygiene, avoidance of shared utensils and personal items, and what symptoms to watch for through the 42-day monitoring window per CDC outbreak guidance.
Educate staff entering the room on the rationale for each PPE element and the safe doffing sequence per facility protocol.
Notify infection prevention and the local or state health department promptly for suspected hantavirus infection.
Coordinate referral of identified exposed contacts to public health for 42-day monitoring per CDC outbreak guidance and facility policy.

Outcome: No secondary transmission to household contacts or healthcare workers during admission; Staff entering the room demonstrate donning and doffing of gown, gloves, eye protection, and N95 (or higher) respirator per facility protocol when Andes virus is suspected or confirmed; Patient placement in AIIR (negative-pressure airborne isolation room) is supported per facility infection-prevention policy when Andes virus is suspected or confirmed.

Nursing Diagnosis 5: Anxiety

Anxiety related to Hantavirus Pulmonary Syndrome (HPS) from New World hantavirus infection (Sin Nombre virus is most common in the United States; Andes virus, found in South America, is the only hantavirus known to spread person-to-person) as evidenced by Patient verbalization of fear of dying, family separation, or the unknown; Restlessness or hypervigilance disproportionate to the clinical state; Tachycardia disproportionate to clinical state and vasopressor dose; Isolation in an airborne-precaution room with N95-level PPE when Andes virus is suspected; Standard Precautions otherwise; Rapid clinical deterioration witnessed by patient and family.

Interventions

Assess anxiety level using a 0–10 scale at the start of every shift and PRN.
Identify the patient’s stated triggers (breathlessness, monitor alarms, isolation, fear of family separation, fear of dying).
Observe for physical signs of anxiety: tachycardia out of proportion to clinical state, restlessness, hand-wringing, hypervigilance.
Assess sleep quality and contributors (alarms, lighting, frequent interventions, dyspnea, anxiety) daily.
Provide a calm, reassuring presence; speak clearly and at a measured pace.
Explain procedures and findings in plain, patient-friendly terms before performing them.
Cluster cares to allow uninterrupted rest periods when clinical state allows.
Limit non-essential nighttime stimuli (overhead lights, loud conversations, unnecessary alarms) per facility protocol.
Facilitate family visits within isolation precautions, including window or video visits when in-person is restricted.
Coordinate with chaplaincy, social work, or interpreter services per patient preference and facility policy.
Teach diaphragmatic breathing and grounding techniques the patient can use independently.
Educate the patient and family on hantavirus: how it spreads (rodent contact for most U.S. cases; close contact for Andes virus), why isolation precautions are in place, and what supportive care addresses.
Teach the family what each ICU alarm means and what is and is not clinically concerning.
Coordinate with chaplaincy, social work, or psych services if anxiety persists or worsens despite non-pharmacologic measures.
Notify the provider for severe or persistent anxiety unresponsive to non-pharmacologic measures.

Outcome: Patient verbalizes decreased anxiety; Patient demonstrates at least one coping strategy (diaphragmatic breathing, grounding, music); Patient sleeps in 4-hour blocks when clinical state allows.

Pathophysiology

Hantavirus Pulmonary Syndrome (HPS) is a rapidly progressive zoonotic illness caused by New World hantaviruses. In the United States, the hantavirus most commonly causing HPS is spread by the deer mouse (Peromyscus maniculatus), historically identified as Sin Nombre virus. Andes virus, found in South America, can also cause HPS and is the only hantavirus known to spread person-to-person through close contact (prolonged direct physical contact, prolonged time in close or enclosed spaces, or exposure to a sick person’s saliva, respiratory secretions, or other body fluids). Rodent-to-human transmission occurs primarily through inhalation of aerosolized excreta (urine, droppings, saliva) disturbed during cleaning, sweeping, or working in rodent-infested spaces. The CDC reported an Andes virus outbreak on an Atlantic-Ocean cruise ship on 2026-05-02; the current public-health risk to the American public remains low.

Incubation is 4 to 42 days (broadly, 1 to 8 weeks; 4 to 42 days is the range cited for Andes virus by the CDC, 2026). The disease unfolds in two phases. The early or prodromal phase is flu-like: fatigue, fever, and large-muscle myalgia (thighs, hips, back, sometimes shoulders) are the dominant early symptoms. About half of patients also have headache, dizziness, chills, and abdominal symptoms (nausea, vomiting, diarrhea, abdominal pain). This presentation overlaps with influenza, Mycoplasma, leptospirosis, Legionnaires’, and Q fever; HPS is difficult to identify at onset, so a careful rodent-exposure or sick-contact history is essential.

The late or cardiopulmonary phase begins abruptly. Within 24 hours of initial evaluation, most HPS patients develop some degree of hypotension and progressive pulmonary edema and hypoxia, frequently requiring mechanical ventilation. Increased pulmonary capillary permeability drives non-cardiogenic pulmonary edema; the cardiopulmonary dysfunction appears to be mediated by circulating inflammatory mediators rather than direct tissue damage. Patients with fatal infections often show severe myocardial depression that can progress to sinus bradycardia and then electromechanical dissociation, ventricular tachycardia, or ventricular fibrillation. Poor prognostic indicators reported by the CDC include plasma lactate > 4.0 mmol/L or cardiac index < 2.2 L/min/m². HPS is fatal in nearly 4 in 10 people who are infected (CDC, 2026); without adequate intensive care, most deaths occur within 24 to 48 hours of cardiopulmonary phase onset.

There is no specific antiviral therapy currently established for HPS. Care is supportive and coordinated by the critical-care team: early ICU-level monitoring and cardiopulmonary support, careful fluid administration (the patient is intravascularly depleted from capillary leak yet aggressive resuscitation can worsen pulmonary edema), oxygenation with stepwise escalation as ordered, and empiric broad-spectrum antibiotics per provider direction while diagnosis is pending. Per the CDC Clinician Brief, initiating ECMO at the earliest sign of decompensation has been associated with roughly 65–80% survival in published case series, despite cardiopulmonary collapse; VV-ECMO may be considered when refractory hypoxemia predominates, and VA-ECMO may be needed when myocardial depression and shock predominate, per institutional ECMO-center criteria. Ribavirin has been tested and was not shown to be effective for HPS (CDC, 2026).

Quick Reference

Mortality: ~38–40% (CDC: nearly 4 in 10)
Incubation: 4–42 days post-exposure
Phases: Prodromal flu-like → cardiopulmonary
Person-to-person: Andes virus only; not Sin Nombre
ECMO timing: Early consult; ~80% survival per CDC

Common Labs

Lab	Normal range	Significance in Hantavirus
Hantavirus IgM serology	Negative in healthy adults	Diagnostic test of choice. The CDC ELISA detects IgM in acute infection (HPS and HFRS). Specimens and consultation are coordinated through infection prevention and the local, state, tribal, or territorial health department; CDC Viral Special Pathogens Branch may be consulted via public-health channels. Supportive care should not be delayed while awaiting confirmation.
CBC with differential	WBC 4.5–11.0 ×10⁹/L; Plt 150–400; Hct M 41–53% / F 36–46%	Classic HPS hematologic pattern (Duchin et al. 1994; widely referenced in clinical practice): hemoconcentration (Hct > 55%), thrombocytopenia (Plt < 150 × 10⁹/L), and left-shifted leukocytosis with immunoblasts (atypical lymphocytes). Together, these findings in the late prodrome can support HPS suspicion before serology returns.
Lactate	< 2.0 mmol/L	Tissue hypoperfusion when > 2 mmol/L; per CDC, > 4.0 is a poor prognostic indicator. Nurses monitor lactate trend during resuscitation; failure to clear can support escalation discussions with the critical-care team.
Cardiac index (echo or PiCCO / PA cath)	2.5–4.0 L/min/m²	Per CDC, CI < 2.2 L/min/m² is a poor prognostic indicator. Reflects myocardial dysfunction in the cardiopulmonary phase. Nurses report trend and absolute values to the provider team to support inotrope and ECMO decisions.
BUN / Cr	BUN 7–20 mg/dL / Cr 0.6–1.2 mg/dL	Patients sometimes have mildly impaired renal function; multiorgan dysfunction syndrome is rarely seen in HPS per CDC. Survivors frequently become polyuric during convalescence and improve rapidly.
ABG	pH 7.35–7.45 / PaO₂ 80–100 mmHg / PaCO₂ 35–45 mmHg	Hypoxemic respiratory failure (PaO₂ < 60) with mixed metabolic acidosis from lactic acidosis. PaO₂/FiO₂ < 200 meets moderate-to-severe ARDS criteria per the Berlin definition; < 100 is severe ARDS and should prompt urgent reassessment and discussion with critical care and an ECMO-capable center, per facility protocol.
PT / aPTT / INR	PT 11–13.5 sec / aPTT 25–35 sec / INR 0.8–1.1	Coagulopathy can develop in the late cardiopulmonary phase. Prolonged PT/aPTT with falling platelets and fibrinogen may signal consumptive coagulopathy; nurses trend serial values and report concerning patterns.
Fibrinogen	200–400 mg/dL	< 150 mg/dL can be consistent with DIC. Nurses report values outside reference range and prepare to administer ordered blood products (cryoprecipitate or MTP components) per facility protocol.
Type & screen	ABO/Rh typed; antibody screen negative	Obtain on admission per provider order. Transfusion may be needed for bleeding, thrombocytopenic hemorrhage, or surgical procedures (central line, ECMO cannulation).
CRP / procalcitonin	CRP < 10 mg/L; procalcitonin < 0.25 ng/mL	Help support assessment of bacterial co-infection or superinfection. Per CDC and IDSA, procalcitonin alone should not be used to start or stop antibiotics in suspected HPS; the CDC recommends empiric broad-spectrum coverage while awaiting diagnosis.

Common Medications

Class	Examples	Mechanism of action	Key side effects	Nursing considerations
Empiric broad-spectrum antibiotic	Per facility CAP / severe-sepsis protocol (examples: ceftriaxone + azithromycin; antipseudomonal ± anti-MRSA in ICU)	Covers the broad differential of severe community-acquired pneumonia and sepsis while hantavirus testing is pending.	Allergy, C. difficile, transaminitis, QT prolongation (macrolides, FQs); class-specific toxicities.	Per the CDC Clinician Brief, suspected HPS patients should receive appropriate broad-spectrum antibiotic therapy even while diagnosis is pending. Administer as ordered per provider direction, pharmacy guidance, and facility protocol; first dose ≤ 1 hour if sepsis criteria are met. Monitor for response, allergy, and adverse effects; support de-escalation with the provider team when HPS is confirmed and bacterial co-infection is excluded.
Vasopressor (commonly first-line)	Norepinephrine	Alpha-1 agonist with mild beta-1 activity. Vasoconstriction (raises SVR and MAP) with modest inotropic support.	Tachyarrhythmia, peripheral and digit ischemia, extravasation tissue necrosis if peripheral, reflex bradycardia.	Administer as ordered. Per the 2021 Surviving Sepsis Campaign, vasopressor initiation should not be delayed while central venous access is being obtained; short-term peripheral administration (commonly < 24 hours via a large-bore IV in a proximal upper-extremity vein, with active monitoring for extravasation) is acceptable per facility policy. Nurses monitor continuous arterial line MAP, urine output, peripheral perfusion, IV site for extravasation, and rhythm; escalate concerns per provider parameters and facility protocol.
Vasopressor (commonly add-on)	Vasopressin	Non-catecholamine V₁ agonist. Adds vasoconstriction at fixed low dose without further beta stimulation; spares catecholamine receptor desensitization.	Hyponatremia, digital and mesenteric ischemia, decreased cardiac output at higher doses.	Administer as ordered per provider direction. Typically a fixed-dose infusion is selected by the provider; nurses do not titrate vasopressin as a primary vasopressor. Monitor MAP, sodium, peripheral and abdominal perfusion.
Inotrope	Dobutamine	Selective beta-1 agonist. Increases myocardial contractility and stroke volume; mild beta-2 vasodilation can lower SVR.	Tachyarrhythmia, hypotension at higher doses, increased myocardial oxygen demand.	Administer as ordered per provider direction when echocardiogram or clinical assessment supports inotropic support. Nurses monitor rhythm, MAP, urine output, and lactate trend; escalate new tachyarrhythmia or hypotension per facility protocol.
Crystalloid (cautious)	Lactated Ringer’s; 0.9% NaCl	Volume expansion to restore intravascular volume in the setting of capillary leak.	Pulmonary edema (the HPS paradox), hyperchloremic metabolic acidosis with large-volume NaCl, hemodilution.	Administer as ordered. Capillary leak in HPS makes resuscitation endpoints provider-team decisions; nurses monitor MAP, lactate trend, lung exam, peak inspiratory pressures, and urine output after each ordered bolus and escalate worsening pulmonary edema per facility protocol.
Antipyretic / analgesic	Acetaminophen	Central COX inhibition; antipyresis and analgesia.	Hepatotoxicity (> 4 g/day or with EtOH/liver disease).	Per the CDC Clinician Brief, care should include fever reducers and pain relievers. Administer as ordered; nurses verify total daily dose stays within ordered limits and screen for occult acetaminophen in combination products. Lower ceiling in chronic liver disease.
Sedation / analgesia	Propofol, Fentanyl	Propofol = GABA-A agonist, rapid-onset sedation; Fentanyl = mu-opioid agonist, analgesia and synergy.	Propofol: hypotension, propofol infusion syndrome at prolonged high dose, hypertriglyceridemia. Fentanyl: respiratory depression (acceptable on vent), chest-wall rigidity, ileus.	Administer as ordered for ventilated patients. Nurses monitor RASS score per facility sedation protocol, hemodynamics, triglyceride level on prolonged propofol, and pain scores. Daily sedation interruption is implemented per ABCDEF bundle and provider order when clinical state tolerates.
Neuromuscular blockade	Cisatracurium	Non-depolarizing NMB. Eliminates patient-ventilator dyssynchrony in severe ARDS; allows lower transpulmonary pressures.	Prolonged paralysis if accumulated in renal/hepatic failure (cisatracurium is least affected by organ failure); ICU-acquired weakness with prolonged use.	Administer as ordered for refractory hypoxemia or as ECMO bridge per provider direction and facility protocol. Always paired with deep sedation; nurses verify sedation depth (RASS or BIS per facility), eye care, skin care, and DVT prophylaxis. Ribavirin is not recommended for HPS per the CDC Clinician Brief and is intentionally not on this list.

References

Centers for Disease Control and Prevention. (2026, May 8). Clinician Brief: Hantavirus Pulmonary Syndrome (HPS). U.S. Department of Health & Human Services. Retrieved 2026-05-13 from cdc.gov/hantavirus/hcp/clinical-overview/hps.html.
Centers for Disease Control and Prevention. (2026, May 9). About Andes Virus. Retrieved 2026-05-13 from cdc.gov/hantavirus/about/andesvirus.html.
Centers for Disease Control and Prevention. (2026, May 12). Andes Virus Outbreak on a Cruise Ship: Current Situation. Retrieved 2026-05-13 from cdc.gov/hantavirus/situation-summary/index.html.
Centers for Disease Control and Prevention. (2025, Feb 7; Andes virus update Sept 2024). Guideline for Isolation Precautions, Appendix A: Type and Duration of Precautions Recommended for Selected Infections and Conditions. Retrieved 2026-05-13 from cdc.gov/infection-control/hcp/isolation-precautions/appendix-a-type-duration.html.
Evans, L., Rhodes, A., Alhazzani, W., et al. (2021). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Critical Care Medicine, 49(11), e1063–e1143.
Acute Respiratory Distress Syndrome Network (ARDSnet). (2000). Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. New England Journal of Medicine, 342(18), 1301–1308. Protocol updates at ardsnet.org.
Combes, A., Hajage, D., Capellier, G., et al. (2018). Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome (EOLIA). New England Journal of Medicine, 378(21), 1965–1975.
Guérin, C., Reignier, J., Richard, J. C., et al. (2013). Prone Positioning in Severe Acute Respiratory Distress Syndrome (PROSEVA). New England Journal of Medicine, 368(23), 2159–2168.
Makic, M. B. F., & Martinez-Kratz, M. R. (Eds.). (2023). Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care (13th ed.). Elsevier.