Week 12 - Topic 3: Lower Respiratory Tract Infections Flashcards
Name 5 viruses that cause bronchiolitis or viral pneumonia…
- Respiratory syncytial virus
- Human metapneumovirus
- Parainfluenza virus
- Adenovirus
- Influenza A/B
- Epstein-Barr virus (mononucleosis)
What is the most common cause of bronchiolitis or viral pneumonia in children?
Respiratory syncytial virus RSV
How do you treat someone with RSV?
Supportive care
Nasal/oral suctioning, cardio+resp+T° monitoring, hydration
What is given to high risk infants/children to prevent RSV?
Monthly palivizumab (RSVIg) IM during season
What are symptoms of influenza?
Fever + cough AND 1 or more of:
sore throat, arthralgia (joint pain), myalgia (muscle pain), weakness
Who may experience GI symptoms during influenza?
Children <5 y.o.
What are the two influenza strains that circulate during flu season?
A and B
C is very uncommon and thus not found in vaccines
Which influenza strain causes the most outbreaks and why?
A
It is highly contagious and mutates a lot
What virus belongs to the orthomyxoviridae family?
influenza
What are 4 element of influenza morphology?
1) Surface proteins (M1 and M2)
2) Hemagglutinin antigen
3) Neruaminidase antigen
4) Viral RNA
How do we identify the influenza viruses?
Based on the 18 hemagglutinin antigen sub-types and the 11 neuraminidase antigen sub-types
What is an antigenic shift?
Major shift in a virus from mutations –> causes pandemics
What is an antigenic drift?
Small mutations in a virus –> why there is a new influenza vaccine every year
What is the ecological cycle of influenza A viruses?
Birds share it amongst each other -> give it to chickens -> give it to pigs (mixing vessel) –> give it to humans
Why are there no influenza B pandemics?
No shifts recorded (doesn’t mutate) and no known animal reservoirs
How are the viruses selected for the seasonal influenza vaccine?
Labs from 5 WHO centers around the world gather to determine which virus is circulating in February to have the vaccine available in November for flu season (Northern Hemisphere)
How long does it take to build up immunity from the influenza vaccine? With this in mind, what must you do ideally?
2 weeks
So you might still get the flu within 2 weeks after vaccine administration
Get immunized as early as possible during flu season!
How long are you protected with the flu vaccine?
5-6 months
True or False: The flu vaccine protects 100% against influenza.
False
Most effective in healthy individuals
High risk people and elderly only have 50-60% effectiveness
Who are people at high risk of dying of influenza due to lower protection from the vaccine?
- People with chronic conditions
- Pregnant women
- > 65 y.o.
- Residents in nursing homes
- Children on long periods with ASA
What is the danger of having influenza while taking aspirin?
Reye’s syndrome
Rare but serious brain and liver disease
Who are target groups for flu vaccination?
- HCW
- Those providing care to young babies/children
- Ship crew
- First responders, police, fire fighters
Who should not get the flu vaccine?
People with a serious acute febrile illness
Your friend Karen is 24 weeks pregnant. She doesn’t want to get the flu vaccine, because she says it will hurt her baby. What do you say to her?
Pregnancy is not a contraindication for the vaccine
On the contrary, it is highly recommended you get it!
True or False: We give the regular flu vaccine to elderly.
False, we give them a high-dose vaccine that offers 24% better protection
What is the main side effect of the flu vaccine?
Arm soreness
What is particular with Guillan-Barré Syndrome with regards to infections?
It occurs often after an infection, especially Campylobacter jejuni
Your friend Karen does not want to get the flu vaccine, because she says it increases her risk of developing Guillain-Barré syndrome. What do you say to her?
She is more likely to get GBS from the influenza itself than from the vaccine
What is the mode of transmission for influenza?
Droplet+contact
True or False: Influenza survives on surfaces.
True
How do you manage an outbreak of influenza on your hospital unit?
- Relieve PT’s sx
- Treat all high-risk patients with antiviral agents
- Give prophylactic antiviral agents to all high risk patients and HCW up to 10 days from last positive case
What two antivirals do we give for prophylaxis and influenza treament?
Zanamivir
Oseltamivir
Why is amantadine no longer given as prophylaxis or treatment against influenza?
It has developed resistance against it since the H1N1 pandemic
When can you discontinue precautions/isolation for influenza?
Sick PT: symptom free for 24h
Exposed PT with prophylaxis rx: 48h after receiving prophylaxis with no sx
Exposed PT with no rx: remains on precautions for 14 days and monitored for sx
What are complications of influenza illness?
Respiratory failure
Pneumonia
Septic shock (low BP and organ failure)
Bc not enough oxygens get to lungs and body tissues
What must you make a patient do before and during sputum collection?
Rinse mouth with water to eliminate normal flora of the mouth so it doesn’t contaminate the culture.
Have them cough deeply or use suctioning.
What must you avoid when collecting sputum?
Collecting saliva instead
What must you keep in mind with regards to sputum sample transportation?
Transport to lab within 2h or keep sample refrigerated for 24h
How do you know a sputum culture was contaminated with saliva/oropharyngeal secretions?
> 10 epithelial cells
Lab results come back onto the oncology unit and shows Aspergillus fumigatus in the sample. What must you do as a nurse?
Check to see if your patient’s room is disorganized and dusty
How do you collect a nasal swab for viruses?
With the swab, go all the way to the nasopharyngeal area and rotate for 10 sec.
Put the swab in pink viral media.
Send to lab in 2h or refrigerate.
You are caring for a PT with a RTI by using a humidifier. How do you manage the equipment?
You must make sure the water is sterile, disinfect and clean it regularly and make sure it is dry in between uses.
What are some prevention strategies to avoid bacterial aspiration pneumonia (3)?
1) Remove all devices in contact with the airways as soon as possible (tracheostomies, oro/nasogastric tubes)
2) For enteral feeds, verify the placement of the tube at regular intervals, particularly before feeds
3 Head of bed elevation to 30-45° to decrease aspiration risk, improve lung volumes and ventilation
What must you chart with regards to bacterial aspiration pneumonia?
- HOB elevation every shift
- Frequency of suctioning
- Consistency and color of secretion
Of the following illnesses, which are bacterial and would require Abx for treatment?
- Cold/runny nose
- Bronchitis/chest cold in healthy people
- Whooping cough
- Flu
- Strep thorat
- Sore throat (not strep)
- Fluid in the middle ear (otitis media)
- UTI
- Whooping cough
- Strep throat
- UTI
