Week 6: Influenza Virus

Question 1

Pathophysiology of Influenza

Answer 1

• 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

Question 2

Epidemiology of Influenza

Answer 2

• highly contagious
• rapidly spread
• virus invaded respiratory epithelium

Question 3

Fomite

Answer 3

inanimate objects that can carry organisms and facilitate their transfer from one person to another
(Scissors, stethoscope, pen)

Question 4

Epidemic

Answer 4

localized outbreaks that affect more than the expected populations

Question 5

Pandemic

Answer 5

Global outbreaks or outbreaks that are limited to smaller geographical area but affect more people than expected
-occur less frequently than local outbreaks

Question 6

How many types of Influenza are there?

Answer 6

3 types:

• A
• B
• C

Question 7

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?

Answer 7

Type A and B

Question 8

Expected Findings

Answer 8

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

Question 9

Influenza is what type of isolation precaution?

Answer 9

droplet precautions

-gown, mask, gloves, goggles (if in contact with fluids)

Question 10

Risk Factors

Answer 10

• Age (young children and older adults >65)
• occupation
• environmental
• immune system compromise
• chronic illness
• pregnancy

Question 11

Laboratory Tests

Answer 11

• hemagglutination inhibition
• complement-fixation
• enzyme-linked immunosorbent assay

Question 12

Diagnostic Procedures

Answer 12

• sampling of respiratory secretions for viral culture
• rapid influenza diagnostic tests (RIDTs)
• consider symptoms and history

Question 13

Therapeutic Procedures

Answer 13

• adequate fluid intake
• adequate nutritional intake
• humidified supplemental oxygen
• high-fowlers position

Question 14

Disease Prevention

Answer 14

Vaccination

Question 15

Medications

Answer 15

directed toward relief of symptoms

• antipyretics/analgesics for fever and aches
• antiviral for prophylaxis or treatment if severe

Question 16

Client Education

Answer 16

• egg allergy should avoid vaccine
• good hand hygiene
• limit contact with others
• disinfect frequently used objects and surfaces
• flu vaccine

Question 17

Complications

Answer 17

• primary influenza viral pneumonia
• dyspnea with negligible sputum production that may be visibly bloody streaked
• sinus and middle ear secondary bacterial infections

Question 18

Antiviral Medications

Answer 18

-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

Question 19

Nursing Interventions: Assessment

Answer 19

• vital signs
• neurological functions
• breath sounds
• general appearance
• cough, nasal congestion, sneezing, rhinorrhea
• peripheral pulses, and skin temperature and color
• laboratory values

Question 20

Assessment: Vital Signs

Answer 20

-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

Question 21

Assessment: Neurological Functions

Answer 21

agitation, restlessness, anxiety, lethargy, and fatigue are the result of decreased tissue perfusion from altered alveolar gas exchange

Question 22

Assessement: Breath sounds

Answer 22

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

Question 23

Assessment: General Appearance

Answer 23

sudden onset of fever, chills, muscle aches, and fatigue in a generally ill-appearing patient

Question 24

Assessment: Cough, nasal congestion, sneezing, and rhinorrhea

Answer 24

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

Question 25

Assessment: peripheral pulses and skin temperature and color

Answer 25

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

Question 26

Assessment: Laboratory Values

Answer 26

-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

Question 27

Nursing Actions

Answer 27

- 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

Question 28

Nursing Actions: Droplet precautions

Answer 28

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

Question 29

Nursing Actions: Administer humidified supplemental oxygen

Answer 29

improving oxygen delivery, reversing hypoxia, and maintaining moist respiratory mucosa are essential to avoid complications

Question 30

Actions: Position patient in a semi-to high fowlers (30 degrees)

Answer 30

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

Question 31

Actions: Administer antipyretic as ordered

Answer 31

fever reduction can help reduce hyperdynamic effects on the respiratory and cardiovascular systems and increase patient comfort

Question 32

Actions: Administer antiviral medications if ordered

Answer 32

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

Question 33

Actions: Administer analgesics as ordered

Answer 33

pain relief can increase comfort and allows for mobilization and effective coughing/ expectoration of respiratory secretions

Question 34

Actions: Provide adequate fluid intake

Answer 34

replacing insensible losses from fever and tachypnea allows for optimal cardiovascular performance and liquefication of respiratory secretions

Question 35

Actions: Provide adequate nutritonal intake

Answer 35

adequate caloric intake is essential for cell recovery | -frequent small meals high in protein are recommended

Question 36

Actions: Obtain cultures (nasal swabs, throat swabs, sputum culture, blood, and urine) before administration of antivirals

Answer 36

to assess for the presence of bacterial infection before presence is masked by medication administration

Question 37

Nursing Diagnosis

Answer 37

- 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