- Gain knowledge about the pathophysiology, transmission, and clinical manifestations of influenza to provide effective nursing care.
- Learn strategies for preventing and controlling influenza, including vaccination promotion, infection control measures, and patient education.
- Develop the ability to recognize the common symptoms of influenza, such as fever, cough, and body aches, for prompt identification and intervention.
- Understand the potential complications associated with influenza, such as pneumonia, and learn how to manage and monitor patients at risk for severe outcomes.
- Acquire skills in educating patients and communities about influenza, emphasizing preventive measures, symptom recognition, and when to seek medical attention.
Pathophysiology of Influenza
- Viral Origin:
- Influenza is caused by influenza viruses, primarily influenza A and B. These viruses belong to the Orthomyxoviridae family and are known for their ability to undergo frequent genetic changes.
- Influenza is primarily a respiratory infection transmitted through respiratory droplets when an infected person coughs or sneezes. It can also spread by touching surfaces contaminated with the virus.
- The virus enters the respiratory epithelial cells lining the airways, where it replicates. The replication process leads to the destruction of infected cells, causing the characteristic symptoms of the flu.
- The immune response is activated to combat the virus, involving both innate and adaptive immunity. However, the virus can evade immune surveillance due to its ability to mutate, leading to recurrent infections.
- In addition to respiratory symptoms, influenza can have systemic effects, causing fever, malaise, muscle aches, and fatigue. Severe cases may lead to complications such as pneumonia, exacerbation of underlying conditions, and, in some cases, death.
Etiology of Influenza
- Influenza Virus Types:
- Influenza is primarily caused by influenza viruses, with the two main types being influenza A and influenza B. These viruses undergo frequent genetic changes, contributing to the variability of the flu.
- Influenza viruses can infect various species, including humans, birds, and pigs. Interspecies transmission, particularly from animals to humans, can lead to the emergence of novel strains with pandemic potential.
- Influenza exhibits a seasonal pattern, with outbreaks commonly occurring during the colder months. The virus is more stable in cold, dry air, and people tend to be in closer proximity indoors during colder seasons, facilitating its spread.
- Influenza viruses undergo genetic changes through antigenic drift (minor changes in the virus over time) and antigenic shift (major changes resulting from reassortment of genetic material). These changes contribute to the need for regular updates in influenza vaccines.
- The primary mode of transmission is through respiratory droplets expelled when an infected person coughs or sneezes. Additionally, the virus can spread by touching surfaces contaminated with the virus and then touching the face.
Desired Outcome for Influenza Nursing Care
- Symptom Alleviation:
- Relief of influenza symptoms, including fever, cough, sore throat, and body aches, to enhance patient comfort and well-being.
- Minimization of complications such as pneumonia, bronchitis, and secondary bacterial infections, reducing the severity and duration of illness.
- Limiting the spread of the influenza virus to prevent further cases and outbreaks within the community.
- Improved patient understanding of preventive measures, including vaccination, hand hygiene, and respiratory etiquette, to reduce the risk of influenza transmission.
- Facilitation of a timely recovery, enabling patients to return to their normal activities and daily routines as quickly as possible.
Influenza Nursing Care Plan
Subjective Data:
- Shortness of breath
- Fatigue
- Muscle aches
- Headache
- Reports cough, runny nose, sore throat
- Reports sudden onset
- Reports vomiting
Objective Data:
- High fever (102-104°F)
- Productive cough
- Vomiting
- Positive flu swab
Nursing Assessment for Influenza
- Patient History:
- Obtain a detailed medical history, including recent exposure to individuals with influenza, travel history, and any pre-existing health conditions.
- Evaluate the presence and severity of influenza symptoms, including fever, cough, sore throat, body aches, fatigue, and respiratory distress.
- Monitor vital signs regularly, paying close attention to temperature, respiratory rate, heart rate, and blood pressure to identify signs of systemic involvement.
- Assess respiratory status, including the presence of cough, chest pain, and any signs of respiratory distress, such as increased work of breathing or decreased oxygen saturation.
- Evaluate fluid balance by assessing the patient’s oral intake, output, and signs of dehydration, especially in vulnerable populations such as the elderly and children.
- Screen for potential complications such as pneumonia or secondary bacterial infections by assessing lung sounds, chest X-rays, and conducting laboratory tests if necessary.
- Evaluate the patient’s mental health status, assessing for signs of confusion, altered consciousness, or any neurological symptoms, which may indicate severe influenza or complications.
- Identify the patient’s understanding of influenza, its transmission, and the importance of adherence to prescribed medications and preventive measures. Address any misconceptions and provide education as needed.
Implementation for Influenza
- Isolation Precautions:
- Implement appropriate infection control measures to prevent the spread of influenza. This may include placing the patient in a private room and using personal protective equipment (PPE) as needed.
- Administer antiviral medications as prescribed by the healthcare provider. Ensure timely and accurate administration to enhance the effectiveness of treatment.
- Provide supportive care to alleviate symptoms, such as fever reducers (e.g., acetaminophen), cough suppressants, and adequate hydration. Monitor for any adverse reactions to medications.
- Monitor respiratory status closely and provide respiratory support as needed. This may include administering supplemental oxygen, encouraging deep breathing exercises, and ensuring proper positioning to facilitate breathing.
- Promote patient comfort by ensuring a comfortable environment, providing warm blankets, and encouraging adequate rest. Emphasize the importance of maintaining good hygiene practices to prevent the spread of infection.
Nursing Interventions and Rationales
- Screen patients for vaccine necessity and administer as appropriate
- No contraindications
- Provide VIS sheet
- Document if received or declined
- The best method for managing influenza is to prevent it in the first place. The flu vaccine is the best method to prevent the flu.
- Ensure they meet indications and have no contraindications (allergy to eggs or latex, history of Guillain-Barre, recent bone marrow or organ transplant) to avoid complications.
- Always educate the patient on the possible side effects (injection site pain, runny nose) and provide the VIS sheet so they can read it.
- Always document the details of the vaccine (lot number, expiration, etc.). OR document if they declined.
- Maintain droplet precautions if hospitalized
Influenza is spread via droplets. Should wear gloves and a simple mask and use good hand hygiene
- Assess lung sounds
Influenza primarily affects the respiratory system. Monitor for any changes in lung sounds that might indicate decompensation.
- Monitor oxygenation and give supplemental O2 as needed
Influenza primarily affects the respiratory system. Patients may struggle to oxygenate appropriately because of mucus buildup. Support oxygenation as appropriate (caution in COPD patients).
- Monitor for signs of sepsis or septic shock (increasing fever, decreasing blood pressure)
Influenza can escalate quickly, especially in immunocompromised patients. Monitor vital signs frequently to detect and signs of sepsis. Catching it early can improve outcomes
- Encourage nutrition – small, frequent meals if needed – or nutrient dense options
Patients may lose their appetite or be too fatigued to eat. Proper nutrition can promote faster healing. It’s important to encourage them to eat, even if small meals.
Nutrient dense options like Boost shakes or Magic Cups can provide more protein in a smaller amount
- Administer IV fluids and/or encourage PO intake
Because of the high fever and poor PO intake, patients can often get dehydrated. Providers may order maintenance IV fluids. If not, encourage PO intake of fluids to maintain proper hydration.
- Educate patient and family on prevention of spread
- Hand-hygiene
- Cover cough
- Don’t touch eyes, nose, mouth
- Avoid public gatherings if symptomatic
Influenza is highly contagious. Preventing the spread to other patients is the purpose of our droplet precautions. However, it is important to educate the patient and family so that friends and family members don’t contract the flu or spread it to others.
Hand hygiene is the #1 way to prevent spread of influenza.
- Administer antivirals as ordered
Oseltamivir (Tamiflu) is most effective when given within 48 hours of onset of symptoms. Educate patients on possible side effects.
Evaluation for Influenza
- Symptom Resolution:
- Assess the patient’s response to antiviral medications and other interventions by monitoring for resolution of influenza symptoms, including fever, cough, and body aches.
- Evaluate for any potential complications of influenza, such as respiratory distress, pneumonia, or secondary bacterial infections. Promptly address and treat any emerging complications.
- Gauge the patient’s overall comfort and well-being, considering factors such as improved sleep, reduction in pain and discomfort, and the ability to perform daily activities.
- Monitor for any adverse effects related to antiviral medications or other interventions. Address and report any unexpected reactions promptly.
- Assess the effectiveness of infection control measures in preventing the spread of influenza to others. Ensure that isolation precautions are maintained as needed, and educate the patient on appropriate measures to protect others.
References
- https://emedicine.medscape.com/article/219557-overview
- https://www.aaaai.org/conditions-and-treatments/library/immune-deficiencies-library/flu-vaccine-for-patients-with-immune-deficiency
- http://nclexpreceptor.com/combat-the-flu-season-with-influenza-core-measures/
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Transcript
All right. Today, we are going to be talking about influenza. The flu is pretty much caused by the influenza virus. It is easily spread with droplets in the air and also picks up droplets from a surface like a tabletop or counter. Most of its symptoms are respiratory. So you're gonna think about coughing, sneezing, fevers. One thing that we want to take into consideration as nurses is we want to make sure that we encourage fluids; PO fluids, if possible. Because these patients are sick, they don't want to drink, and they tend to get dehydrated. We want to make sure that we administer medication. So any antivirals that are ordered antibiotic or any insets, and then we want to make sure that we place these patients on droplet precautions because the flu is very contagious. Our desired outcome is to prevent respiratory distress and we want to support the symptoms so that the patient can return to their baseline.
When a patient comes in with the flu, one of the main things that they are going to complain about is shortness of breath and fatigue. The flu is known for causing weakness. So we want to say weakness and fatigue. Okay. The next thing that the patient is going to complain about is muscle aches. You hear a lot of fullness in the head, cough, runny nose, sore throat, and vomiting, are some things that we're going to notice. Some objective data that we're going to notice as we're going to notice a fever, but not just a fever, a high fever, ranging from one or two to 1 0 4. We're going to also see a productive cough. So there's going to be some sputum produced as well. And the definitive diagnosis for the flu is going to come from a positive flu swab. And typically those are done in the emergency room once they present with these symptoms.
Some nursing interventions that we want to be mindful of are right when we find out that the patient or we suspect that the patient has flu, we want to initiate contact droplet precautions, because the flu is spread via droplets. So we want to make sure that we wear gloves and a face mask and make sure we use really good hand hygiene. The next thing that we want to focus on is we want to look at the vital signs, but more importantly, we want to take a look at their oxygenation because often times we may have to administer O2 because the patient may start to decline, especially those patients who are in those high risk categories, such as COPD patients or PE patients with asthma, any other type of pre-existing conditions. We want to be mindful of them too, because they may find it difficult to breathe.
There are some medications that we can give to kind of help shorten the flu, the most known one that we're going to talk about. It's an antiviral and it's called Tamiflu. And that just pretty much, I think they said, it shortens it to like five days, which is great, but you want to make sure to just give them within 48 hours. And then we want to make sure we educate patients on any possible side effects. Next we want to educate the patient and the family on how to stop the spread because the flu is so contagious. We want to make sure we can end the spreading as soon as possible. And that's going to include measures such as hand hygiene. And then we also want to make sure if the patient is sick, that they avoid public gatherings, and use the coughing into the elbow method if they are coughing.
And, finally we want to encourage nutrition. Oftentimes these patients do not have to be hospitalized, but if you're taking care of someone that's hospitalized, whether they're discharged, we want to encourage nutrition. So we want to make sure that they are drinking and if they can't eat, maybe, maybe they can have some supplements such as a boost shake or magic cups just to provide more nutrients that's calories, just in a smaller amount. Okay, some of the key points that we are going to focus on here is that remember influenza is spread by respiratory droplets. So anything coughing, those droplets can land on the table. So you want to make sure that you're doing some really good hand hygiene, okay. Shortness of breath, fatigue, weakness, muscle aches. Those are some of the things that the patients will tell you.
Some of the subjective data, some of the objective things that we're going to see is a high fever, a one or two to 1 0 4, a positive flu swab, and also a productive cough. Antivirals are going to need to be administered within 48 hours of the onset of symptoms. So the one that is most widely used is Tamiflu, and then we go to one to prevent the spread. The number one way to prevent the spread of the influenza virus is by washing your hands. Okay. I hope that this presentation was really good for you. We love you guys; go out and be your best self today and, as always, happy nursing.
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