Week 6: Influenza Virus Flashcards
Pathophysiology of Influenza
- aerosolization of small droplets from an infected individuals sneezing or coughing
- direct contact with fomites (stethoscope, scissor, pen) inhaled and deposited on upper respiratory tract epithelial cells
Epidemiology of Influenza
- highly contagious
- rapidly spread
- virus invaded respiratory epithelium
Fomite
inanimate objects that can carry organisms and facilitate their transfer from one person to another
(Scissors, stethoscope, pen)
Epidemic
localized outbreaks that affect more than the expected populations
Pandemic
Global outbreaks or outbreaks that are limited to smaller geographical area but affect more people than expected
-occur less frequently than local outbreaks
How many types of Influenza are there?
3 types:
- A
- B
- C
What Influenza types are responsible for epidemics of respiratory illness that occur mostly during the winter months and are often associated with increased hospitalizations and death?
Type A and B
Expected Findings
more severe than the common cold; rapid onset
-fever, headache, sore throat, severe nasal congestion, cough, myalgia or muscle aches and pains, malaise, and fatigue
Influenza is what type of isolation precaution?
droplet precautions
-gown, mask, gloves, goggles (if in contact with fluids)
Risk Factors
- Age (young children and older adults >65)
- occupation
- environmental
- immune system compromise
- chronic illness
- pregnancy
Laboratory Tests
- hemagglutination inhibition
- complement-fixation
- enzyme-linked immunosorbent assay
Diagnostic Procedures
- sampling of respiratory secretions for viral culture
- rapid influenza diagnostic tests (RIDTs)
- consider symptoms and history
Therapeutic Procedures
- adequate fluid intake
- adequate nutritional intake
- humidified supplemental oxygen
- high-fowlers position
Disease Prevention
Vaccination
Medications
directed toward relief of symptoms
- antipyretics/analgesics for fever and aches
- antiviral for prophylaxis or treatment if severe
Client Education
- egg allergy should avoid vaccine
- good hand hygiene
- limit contact with others
- disinfect frequently used objects and surfaces
- flu vaccine
Complications
- primary influenza viral pneumonia
- dyspnea with negligible sputum production that may be visibly bloody streaked
- sinus and middle ear secondary bacterial infections
Antiviral Medications
-Zanamivir (Relenza)
-Oseltamivir (Tamiflu)
-Peramivir (Rapivab)
-Baloxavir (Xofluza)
-Rimantadine (Flumadine)
>does not “cure”; shorten duration and severity of symptoms and may prevent serious complications
>initiate within 24 to 48 hours
Nursing Interventions: Assessment
- vital signs
- neurological functions
- breath sounds
- general appearance
- cough, nasal congestion, sneezing, rhinorrhea
- peripheral pulses, and skin temperature and color
- laboratory values
Assessment: Vital Signs
-Tachypnea: the bodys first compensatory mechanism to a decreased oxygen delivery is increased respiratory rate and depth
-Tachycardia: the bodys second compensatory mechanism for a continued impairment of oxygen delivery is to raise the heart rate
-decreased oxygen saturation: impaired gas exchange at the alveolar level results in hypoxia
>tachypnea and tachycardia decrease cardiac output, reducing perfusion and peripheral oxygen saturation
-fever occurs as a part of the inflammatory response
Assessment: Neurological Functions
agitation, restlessness, anxiety, lethargy, and fatigue are the result of decreased tissue perfusion from altered alveolar gas exchange
Assessement: Breath sounds
adventitious breath sounds such as rhonchi, crackles, and rales may be audible on lung assessment from fluid and exudates filling the alveoli
-audible wheezing is a result of airway reactivity due to inflammation and/ or bronchospasm
Assessment: General Appearance
sudden onset of fever, chills, muscle aches, and fatigue in a generally ill-appearing patient
Assessment: Cough, nasal congestion, sneezing, and rhinorrhea
primary viral pneumonia from influenza can cause coughing that lasts up to 2 weeks
- secretions that are white in color are consistent with viral infection
- purulent nasal discharge/ sputum indicates a secondary bacterial infection
Assessment: peripheral pulses and skin temperature and color
diminished tissue perfusion causes blood to be shunted away from peripheral areas to the main core body organs
- peripheral pulses diminish, and skin becomes moist and pale
- peripheral cyanosis is a late sign of tissue hypoxia
Assessment: Laboratory Values
-ABGs: primary respiratory infections may initially cause a respiratory alkalosis (increased pH, decreased CO2), in response to tachypnea; as condition progresses a respiratory acidosis (decreased pH, increased CO2) will develop
Nursing Actions
- initiate droplet precautions
- administer humidified supplemental oxygen
- position patient to a semi- to high fowlers (30 degrees)
- medication administration
- adequate fluid intake
- adequate nutritional intake
- obtain cultures before antiviral medications
Nursing Actions: Droplet precautions
to avoid viral transmission
- mask, gown, gloves, and eye protecting if there is a risk of splashing bodily fluids
- patient should wear a mask when outside the room
- visitors should wear a mask while in the room
- private room is desirable unless patients with similar infections are cohorted
Nursing Actions: Administer humidified supplemental oxygen
improving oxygen delivery, reversing hypoxia, and maintaining moist respiratory mucosa are essential to avoid complications
Actions: Position patient in a semi-to high fowlers (30 degrees)
sitting up or elevating the head of the bed can provide for relief of nasal drainage, promoting optimal lung expansion, preventing atelectasis, and preventing aspiration that can lead to secondary bacterial pneumonia
Actions: Administer antipyretic as ordered
fever reduction can help reduce hyperdynamic effects on the respiratory and cardiovascular systems and increase patient comfort
Actions: Administer antiviral medications if ordered
early administration of antiviral medications (24-48 hours) offers the most favorable outcome for shortening the severity and duration of symptoms and decreasing the incidence of respiratory complications in high risk patient population
Actions: Administer analgesics as ordered
pain relief can increase comfort and allows for mobilization and effective coughing/ expectoration of respiratory secretions
Actions: Provide adequate fluid intake
replacing insensible losses from fever and tachypnea allows for optimal cardiovascular performance and liquefication of respiratory secretions
Actions: Provide adequate nutritonal intake
adequate caloric intake is essential for cell recovery
-frequent small meals high in protein are recommended
Actions: Obtain cultures (nasal swabs, throat swabs, sputum culture, blood, and urine) before administration of antivirals
to assess for the presence of bacterial infection before presence is masked by medication administration
Nursing Diagnosis
- ineffective breathing pattern r/t infection of the lung
- decreased activity tolerance r/t hypoxia
- alteration in gas exchange- decreased r/t impaired alveolar-capillary interface
- fluid volume deficit r/t insensible losses from fever and tachypnea
