Influenza NRS 200 Fall 2024 Student.pdf

INFECTION: INFLUENZA Heather Endy DNP, MSN, RN NRS 200 Fall 2024 Influenza ◦ The “flu” is highly contagious viral respiratory disease ◦ Characterized by coryza, fever, cough, and systemic symptoms (headache and malaise) ◦ Usually occurs as an epidemic or pandemic ◦ Other str...

INFECTION: INFLUENZA Heather Endy DNP, MSN, RN NRS 200 Fall 2024 Influenza ◦ The “flu” is highly contagious viral respiratory disease ◦ Characterized by coryza, fever, cough, and systemic symptoms (headache and malaise) ◦ Usually occurs as an epidemic or pandemic ◦ Other strains include avian influenza (bird flu) and H1N1 (swine flu) ◦ Tends to be mild and self limited ◦ Older adults, immunocompromised, and people with chronic heart or pulmonary disease have a high incidence of complications and high mortality rates Pathophysiology and Etiology ◦ Incubation period is short only 24 – 72 hours. ◦ Peak transmission approx. 1 day before onset of symptoms and continues for 5-7 days after. ◦ Infects respiratory epithelium ◦ Rapidly replicates in infected cells and is released to infect neighboring cells. ◦ Inflammation leads to necrosis and shedding of serous and ciliated cells of the respiratory tract ◦ Extracellular fluid escapes, producing rhinorrhea ◦ Epithelial necrosis increases the risk for secondary bacterial infections ◦ Sinusitis and otitis media are frequent complications ◦ Increased risk for pneumonia – progresses rapidly and can cause hypoxemia and death within a few days (elderly) ◦ Other rare complications - Reye’s syndrome, myositis, myocarditis, central nervous system disorders, such as encephalitis and Guillain-Barre syndrome Etiology ◦ Transmitted by airborne droplets and direct contact ◦ Three major strains A, B, and C ◦ Strain A ◦ Most common ◦ Alter surface antigens, bypassing defense systems ◦ Found in birds, pigs, whales and humans ◦ Caused 3 pandemics: 1918, 1957, and 1968 Strain B & C ◦ Strain B ◦ Generally less extensive and less severe ◦ Found among humans ◦ Responsible for outbreaks not pandemics ◦ Strain C ◦ Mild and unrecognizable, mild respiratory infections ◦ Found in humans, pigs, and dogs Risk Factors ◦ Infants ◦ Young Children ◦ Age 50 or older ◦ Residents of Long Term Care Facility ◦ Chronic Disorders ◦ Diabetes Mellitus ◦ Cardiac Disease ◦ Renal Disease ◦ Pulmonary Disease ◦ Pregnant Women ◦ Immunocompromised Clinical Manifestations ◦ Infection with influenza virus produces one of three syndromes; ◦ Uncomplicated nasopharyngeal inflammation ◦ Viral upper respiratory infection followed by bacterial infection ◦ Viral pneumonia – onset is rapid; profound malaise may develops in a matter of minutes Clinical Manifestations ◦ Chills Dry mouth ◦ Fever Non-productive cough ◦ Malaise Sore throat ◦ Muscle aches Sub sternal burning ◦ Headaches Coryza Diagnostic Tests ◦ Based on history ◦ Clinical findings ◦ Knowledge of outbreak in community ◦ Chest x-ray Pharmacologic Therapies ◦ Two influenza vaccine formulations based on predictions of what strains will likely circulate, are released ◦ Trivalent vaccine is composed of three strains ◦ Two type A influenza and one type B influenza ◦ Quadrivalent vaccine is composed of four strains ◦ Two of type A and two of type B ◦ The vaccine is given as an injection with inactivated virus or as a nasal spray with live attenuated virus. ◦ The nasal spray is recommended for those between 2 and 49 years of age Pharmacologic Therapies ◦ Amantadine (Symmetrel) ◦ Rimantadine (Flumadine) ◦ Used for prophylaxis for people who have not been vaccinated but are exposed to the virus ◦ Given before or within 48 hours ◦ Inhibits viral shedding ◦ Prevents or decreases the symptoms of influenza ◦ Zanamvir (Relenza) – inhalation ◦ Can precipitate bronchospasm – asthma/COPD ◦ Oseltamivir (Tamiflu) ◦ Ribavirin (Virazole) – inhalation ◦ Used to reduce duration and severity of flu symptoms Nursing Diagnoses ◦ Ineffective Breathing Pattern ◦ Ineffective Airway Clearance ◦ Disturbed Sleep Patterns ◦ Risk for infection Plan ◦ Temperature remains within normal limits ◦ Patient maintains normal fluid balance ◦ O2 Pulse Ox remain within acceptable limits ◦ Patient maintains a patent airway ◦ Risk of infection to self and others is decreased Interventions ◦ Assessment of vital signs ◦ Assessment of lung sounds and breathing patterns – atelectasis ◦ Cluster care activities to provide periods of rest ◦ Elevate head of bed ◦ Encourage fluids ◦ Keep O2 Pulse Ox > 92% ◦ O2 if necessary ◦ Medicate for symptoms