Influenza: Concept Map
Influenza Diagnostics Studies/Tests
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Nursing and Interprofessional Management and Treatments: Influenza
Etiology and Pathology:Influenza
Signs and Symptoms
Two types of flu vaccines are available
Administration of the flu vaccine results in the production of antibodies against the viruses contained in the vaccine.
The most effective method for managing influenza is prevention
Inactivated attenuated
Live attenuated
The influenza vaccine is changed on a yearly basis, depending on the virus strains identified by the Centers for Disease Control and Prevention (CDC) as being most likely to cause illness in the upcoming flu season.
However, the vaccine can be administered at any time during the flue season.
The best time to receive the vaccine is in September (before flu exposure) because it takes 2 weeks for full protection to occur.
For some patients, it may be difficult between the common cold and flu
Common complications of influenza include
The onset of flu is typically abrupt, with systemic systemic symptoms:
Physical examination findings are usually minimal, with normal assessment on chest auscultation
Pneumonia
Primary influenza (primary) (viral) pneumonia
Secondary bacterial pneumonia
Fever
Generalized Myalgia
Chills
These signs and symptoms are often accompanied by:
Cough
Sore throats
Headache
Fatigue
Dyspnea and diffuse crackles are signs of pulmonary complications
Some patients, particularly older adults, experience weakness or lethargy that may persist for weeks.
In uncomplicated cases, symptoms often subside within 7 days
The patient who develops secondary bacterial pneumonia usually experiences gradual improvement of influenza symptoms, then worsening cough and purulent sputum
Treatment with antibiotics is usually effective if started early.
Types of Influenza Immunization
Live Attenuated Influenza Vaccine (LSIV)
Trivalent Inactivated Influenza Vaccine (TIV)
Given by nasal spray (Approved for healthy people ages 2-49 years
SHOULD NOT be used in
People with known immunodeficiency
Children or adolescents receiving aspirin or other salicylates
Pregnant women
People who have medical conditions that place them at increased risk for complications from influenza (chronic cardiovascular, pulmonary, or neurologic diseases; diabetes mellitus; renal or hepatic dysfunction; hemoglobinopathies).
Children <2 years or adults >50 years
HCPs of high-risk patients because of risk of viral transmission from vaccine (should not care for high-risk patients for 7 days after vaccination).
Most common side effects:
Runny nose and nasal congestion in all ages
Fever in children ages 2-6 years old and sore throat in adults
Given by injection (Approved for use in people greater than or equal to 6 months of age
Can be used in people at increased risk:
Residents of nursing homes and long-term care facilities
People who are immunocompromised
People of any age with chronic medical conditions
Pregnant women
Safety Alert:
Advocate for vaccination of all people older than 6 months of age, but especially for those at high risk
Give high priority to groups, such as health care workers, who can transmit influenza to high-risk persons
Health care workers
Residents of long-term care facilities
Vaccination of healthy people decreases the incidence and risk of transmitting influenza to those who have less ability to cope with the effects of this illness.
Current vaccinations are highly purified.
And reactions are rare.
To treat influenza
3 antiviral medications are use:
Oseltamivir (Tamiflu)
Peramivir (Rapivab)
Zanamivir (Relenza)
Peramivir is given IV
Oseltamivir is available as an oral capsule
Zanamivir is administered using an inhaler
These antiviral drugs are neuraminidase inhibitors that prevent the virus from being released and spreading to other cells
These drugs shorten the duration of influenza symptoms and reduce the risk of complications
Treatment should be initiated as soon as possible in patients who are hospitalized with influenza symptoms
Nursing Considerations: The primary nursing goals in influenza are relief of symptoms and prevention of secondary infection.
Unless the patient with influenza is at high risk for complications develop, only supportive therapy is necessary.
Rest, hydration, analgesics, and antipyretics can provide symptom relief.
Older adults and those with a chronic illness may require hospitalization.
Complementary and Alternative Therapies:
Zinc
Nursing Implication:
Scientific Evidence:
When administered within 24 hours of onset of symptoms, zinc reduces the duration and the severity of cold symptoms
When zinc supplementation is taken in low doses for at least 5 months, the incidence of colds is reduced
Zinc is available in two forms:
Oral zinc (e.g. lozenges, tablets, and syrup).
Intranasal zinc (e.g. swabs and gels)
Zinc lozenges are more apt to cause adverse (bad taste, nausea) than syrup or tablets
Oral zinc should not be taken with foods that will reduce its absorption, such as caffeine and diary products.
Zinc is regarded as relatively safe when taken at recommended doses.
Zinc may interact with drugs, including antibiotics and penicillamine
Intranasal zinc has small linked to a severe side effect (irreversible loss of the sense of smell) and should not be used.
Comparison of Common Cold and Influenza:
Common Cold (Viral Rhinitis): Manifestations and Treatment
Influenza: Manifestations and Treatment
General aches and pains:
Stuffy nose:
Headache:
Sneezing:
Fever:
Sore throat:
Symptoms Onset:
Chest discomfort, Cough:
Stuffy Nose:
Appear gradually
Rare
Uncommon
Slight
Common
Common
Common
Common. Mild to moderate hacking cough
Prevention:
Complications:
Treatment:
Sinus congestion. Earache
Handwashing. Avoid close contact with anyone who has a cold
Temporary relief of symptoms; rest, hydration,decongestants, acetaminophen or ibuprofen for headache, aches, and pains
Sneezing:
Exhaustion:
Sore Throat:
Fatigue and Weakness:
Chest discomfort, cough:
General aches and pains:
Complications:
Headache:
Prevention:
Fever:
Treatment:
Complications:
Abrupt onset. Within 3 to 6 hours.
Characteristically high 102-104 F (38.9-40 C). Lasts 3-4 days.
Common (can be severe).
Usual. Often severe.
Usual. Starts early and can last up to 2-3 weeks.
Usual. at the beginning of illness.
Sometimes.
Sometimes.
Sometimes.
Common.
Bronchitis, pneumonia, acute respiratory failure. Can be life-threatening.
Handwashing. Annual vaccination. Antiviral drugs. Avoid close contact with anyone who has the flu.
Antiviral drugs if given within 24-48 hours of onset. Rest, hydration, acetaminophen or ibuprofen for headache, aches, and pain.
Viral cultures may be obtained from a
Viral culture has the advantage of identifying which virus and which strains of virus are present.
"Gold standard test"
Rapid flu test can help the diagnosis by detecting the virus in nasal secretions.
Influenza is commonly diagnosed based on the patient's health history, clinical findings, and the knowledge in the community.
Viral cultures are considered the "gold standard" for diagnosing influenza.
These tests may take up to 3 to 10 days for results.
Nasopharyngeal swab.
Expectorated sputum.
Throat swab.
ET tube sample.
Bronchoscopy (bronchial wash).
B,
or another respiratory virus.
A,
These data are used in the formulation of the following season's flu vaccine.
The test can help differentiate influenza from other viral and bacterial infections with similar manifestations that may be serious and must be treated differently.
Rapid flu tests are best used within the first 48 hours of onset of symptoms
Depending on the method, the test may be completed in the HCP's office in less than 30 minutes or be sent to a laboratory, with results available the same day.
This helps diagnose influenza
Determines whether antiviral drugs are a treatment option
The main disadvantages of rapid flu test:
The test will miss some cases.
Occasionally has a positive result when a person does not actually have the flu.
Influenza A
Influenza viruses are classified into 3 serogroups (A, B, and C).
What is influenza?
Statistics:
The flu season begins in September and continues through April of each year, peaking anywhere from November to March.
Influenza (flu) is a highly contagious respiratory illness that causes significant morbidity and mortality.
Millions of Americans (about 5% to 20% if the U.S. population) contract influenza each year.
More than 225,000 people are hospitalize each year for flu-related complications.
On average, influenza is responsible for 20,000 deaths annually.
Vaccinations of high-risk groups can prevent many of the deaths.
Only A and B cause significant illness in humans
The H antigens enable the virus to enter the cell.
The N antigens facilitate cell-to-cell transmission.
Influenza is subtyped based on the presence of two surface proteins:
Hemagglutinin (H).
Neuraminidase (N).
As a result, influenza A viruses are named according to their H and N type.
Influenza A is the most common and most virulent flu virus and can infect a variety of animals as well as humans
More than 100 types of influenza A are found in
Horses.
Seals.
Pigs.
Dogs.
Birds.
Avian flu.
Swine flu.
The virus mutates (changes) to allow it to infect different species.
Epidemics are more localized outbreaks, usually occurring yearly, caused by variants of already circulating strains
When a new viral strain reaches humans, people do not have immunity, and the virus can spread quickly around the globe.
(Example): Type A H1N1 influenza (swine flu) emerged in 2009 and had never been seen in humans before.
Pandemics can also occur by the reemergence of a viral strain that has not circulated for many years.
Causing a pandemic.
A worldwide pandemic resulted.
Influenza B and C:
Influenza B and C viruses are not divided into subtypes and only affect humans.
Influenza C causes mild illness and does not cause epidemics or pandemics.
Outbreaks of influenza B can also cause regional epidemics , but the disease it produces is generally milder than that caused by influenza A.
Every flu season is different.
Fewer cases of influenza result in minor change in the virus occurs.
Several different strains of influenza viruses exist, and the viruses are able to mutate over time.
This explains the need for annual vaccination.
This is because most people have partial immunity.
Transmission of Influenza:
Influenza is communicable between humans primarily through
The virus has an incubation period of 1 to 4 days.
Influenza is transmitted from animals to humans by direct or indirect contact with infected animals.
(e.g., animal feces).
Inhalation of aerosolized particles.
To a lesser extent through direct contact with contaminated surfaces.
Infected droplets.
The virus has a peak transmission risk starting approximately 1 day before onset of symptoms.
Continuing for 5 to 7 days after a person first becomes sick.
Nursing Diagnosis: Influenza (found in the Nursing Diagnosis Handbook 10th Edition; pg. 65)
Ineffective thermoregulation r/t infectious process.
Acute pain r/t inflammatory changes in joints.
Ineffective self-health management r/t lack of knowledge regarding preventive immunizations.
Readiness for enhanced knowledge: about information to prevent or treat influenza.
Deficient fluid volume r/t inadequate fluid intake.