Course INFECTION CONTROL NURSE

CASE STUDIES: INFLUENZA

PATIENT BACKGROUND:A 10 year old client has been admitted to a clinic with the influenza virus and
has a fever, persistent productive cough, and a runny nose. The client is lethargic and has not ate since
yesterday morning due to nausea. symptoms began approximately 1 day ago and are continuous,
steadily getting worse. he is having significant nasal discharge but minimal cough. he has no significant
past medical history, and takes no routine medications. he reports receiving the flu vaccine.

VITALS:

PARAMETERS NORMAL VALUE PATIENT VALUE REMARK

Temperature 98.6° F 102°F Increased

Pulse 60-120 beats per min 100 beats per min Normal

Respiration 16-24 breaths per min 30breaths per minute Abnormal

Blood pressure 120/80mmhg 100/70 Normal

SpO2 95-100% 95% Normal

LAB INVESTIGATIONS-

 HISTORY COLLECTION

 PHYSICAL EXAMINATION

 X-RAY

 SPUTUM CULTURE
  BLOOD CULTURE

 IMMUNOFLUORESCENCE
ASSAYS

 VIRAL CULTURE

 POLYMERASE CHAIN
REACTION (RT-PCR)

DIAGNOSIS:

Patient .was diagnosed with influenza.The patient was admitted to the hospital for
respiratory support and started on the antiviral .he was not started onantibiotics for bacterial
pneumonia, as the patient did not demonstrate typical symptoms of bacterial pneumonia (a
notable lack of cough).Also, he had no explanationfor hersymptomsandclinicalfindings.

The diagnosis of influenza has been problematic to our healthcare system for quite some
time.The gold standard for flu testing has been viral culture; however, this process can have a
3-10 day turnaround.A shell vial culture can reduce the time to results down to 48hours,with
similar accuracy to viralcultures.However, even if received only 48 hours after presentation, a
shell vial culture for flu is of limited value to practicing clinicians, since the mainstay of
treatment.Therefore, rapid flu testing provides significant advantages over
traditionaldiagnostics.

OVERVIEW:Influenza is a viral infection that attacks your respiratorysystem —your nose,

throat and lungs. Influenza is commonly called the flu, but it's not the same as stomach
"flu"viruses that cause diarrhea and vomiting.

For most people, the flu resolves on its own. But sometimes, influenza and its complications
can be deadly. People at higher risk of developing flu complications complication include

Young children under age 5and especially those under 6 months.

Adults older than age 65.
Residents of nursing homes and other long-term care facilities.
Pregnant women and women People with weakened immune systems.
Native Americans.
People who have chronic illnesses, such as asthma, heart disease, kidney disease, liver
disease and diabetes.
People who are very obese, with a body mass index (BMI) of 40 or higher.
Though the annual influenza vaccine isn't 100% effective, it's still your best defense against
the flu.

SYMPTOMS:

At first, the flu may seem like a common cold with a runny nose, sneezing and sore throat.
But colds usually develop slowly, whereas the flu tends to come on suddenly. And although a
cold can be a bother, you usually feel much worse with the flu.
 Common signs and symptoms of the flu include:
 Fever
 Aching muscles
 Chills and sweats
 Headache
 Dry, persistent cough
 Shortness of breath
 Tiredness and weakness
 Runny or stuffy nose
 Sore throat
 Eye pain
 Vomiting and diarrhea, but this is more common in children than adults.

If you have flu symptoms and are at risk of complications, see your doctor right away. Taking
antiviral drugs may reduce the length of your illness and help prevent more-serious problems

SIGNS AND SYMPTOMS IN CHILDREN CAN INCLUDE:

 Difficulty breathing
 Blue lips
 Chest pain
 Dehydration
 Severe muscle pain
 Seizures
 Worsening of existing medical conditions

CAUSES:
Influenza viruses travel through the air in droplets when someone with the infection coughs,
sneezes or talks. You can inhale the droplets directly, or you can pick up the germs from an
object — such as a telephone or computer keyboard — and then transfer them to your eyes,
nose or mouth. People with the virus are likely contagious from about a day before
symptoms appear until about five days after they start. Children and people with weakened
immune systems may be contagious for a slightly longer time.Influenza viruses are constantly
changing, with new strains appearing regularly. If you've had influenza in the past, your body
has already made antibodies to fight that specific strain of the virus. If future influenza
viruses are similar to those you've encountered before, either by having the disease or by
getting vaccinated,those antibodies may prevent infection or lessen its severity. But antibody
levels may decline over time.Also, antibodies against influenza viruses you've encountered in
the past may not protect you from new influenza strains that can be very different viruses
from what you had before.

RISK FACTORS:
 Age
 Living or working conditions.
 Weakened immune system
 Race
 Aspirin use under age 19
 Pregnancy
 Obesity

complications that may include:

 Pneumonia
 Bronchitis
 Asthma flare-ups
 Heart problems
 Ear infections
 Acute respiratory distress syndrome
 Pneumonia is one of the most serious complications. For older adults and people with a
chronic illness, pneumonia can be deadly.
ELEMENTS TO PREVENT INFLUENZA TRANSMISSION
Preventing transmission of influenza virus and other infectious agents within healthcare
settings requires a multi-faceted approach. Spread of influenza virus can occur among
patients, HCP, and visitors; in addition, HCP may acquire influenza from persons in their
household or community.

The core prevention strategies include:

 administration of influenza vaccine
 implementation of respiratory hygiene and cough etiquette
 appropriate management of ill HCP
 adherence to infection control precautions for all patient-care activities and aerosol-
generating procedures
 implementing environmental and engineering infection control measures.Successful
implementation of many, if not all, of these strategies is dependent on the presence of clear
administrative policies and organizational leadership that promote and facilitate adherence
to these recommendations among the various people within the healthcare setting, including
patients, visitors, and HCP. These administrative measures are included within each
recommendation where appropriate. Furthermore, this guidance should be implemented in
the context of a comprehensive infection prevention program to prevent transmission of all
infectious agents among patients and HCP.

Recommendations
1. Promote and administer seasonal influenza vaccine .
2. Take Steps to Minimize Potential Exposures
3. Monitor and Manage Ill Healthcare Personnel
4.personal equpment
 Hand Hygiene
 Gloves
 Gowns
5. Adhere to Droplet Precautions
6. Use Caution when Performing Aerosol-Generating Procedures
7. Manage Visitor Access and Movement Within the Facility8. Monitor Influenza Activity
9. Implement Environmental Infection Control
10. Implement Engineering Controls Consider designing and installing engineering controls to
reduce or eliminate exposures by shielding HCP
11. Train and Educate Healthcare Personnel Use of engineering controls and work practices
including infection control proceduresto reduce exposure.
12. Administer Antiviral Treatment and Chemoprophylaxis of Patients and Healthcare
Personnel when Appropriate
13. Considerations for Healthcare Personnel at Higher Risk for Complications of Nursing
Diagnosis

NURSING DIAGNOSIS
1. Impaired respiratory function related to airway obstruction from secretions and
inflammation.
2. Ineffective airway clearance related to disruption of normal ciliary action.
3. Imbalanced nutrition, less than body requirement related to decreased oral intake due
to nausea and/or vomiting.
4. Risk for ineffective coping due to overwhelming stress of illness.

Outcomes
 The patient will maintain patent airway during the course of the illness.
 The patient will have normal oxygen saturation throughout treatment.
 The patient will be able to take in adequate nutrition.
 The patient will utilize effective coping methods.

INTERVENTIONS
 The interventions for nursing care plan for influenza include:
 Maintain adequate hydration with oral or intravenous fluids as ordered.
 Monitor vital signs and oxygen saturation regularly.
 Administer specified medications as ordered, such as bronchodilators, antivirals,
analgesics and antibiotics.
 Encourage the patient to rest and good nutrition.
 Provide physical and psychological support.
 Assist the patient with coughing and deep breathing exercises.

RATIONALES
 Adequate hydration helps to reduce edema and prevent bronchospasm.
 Monitoring vital signs and oxygen saturation gives an insight into the progress of the
illness.
 Medications provide relief from symptoms and can hasten recovery.
 Rest and proper nutrition promotes healing.
 Physical and psychological support helps reduce stress and improve coping skills
associated with the illness.
 Coughing and deep breathing exercises help loosen and expel mucus more effectively.
EVALUATION
Assess the patient’s response to the nursing interventions and documented subjective and
objective data. Observe the patient’s condition and take note of symptoms of improvement,
such as a decrease in fever, improved respiratory status and improved oral intake.