INFLUENZA - one of the most common infectious aerosol; if not neutralized by secretory

diseases, is a highly contagious airborne disease that antibodies, the virus invades airway and
occurs in seasonal epidemics and manifests as an acute respiratory tract cells.
febrile illness with variable degrees of systemic Contact with contaminated objects.
symptoms. • Contact with excrement from infected birds or
contaminated surfaces or water are also
PATHOPHYSIOLOGY: considered mechanisms of infection.
• Influenza viruses are enveloped, negative-sense,
single-stranded RNA viruses of the family CLINICAL MANIFESTATIONS:
Orthomyxoviridae. The core nucleoproteins are The presentation of influenza virus infection varies;
used to distinguish the 3 types of influenza however, it usually includes many of the symptoms
viruses: influenza A, B, and C (IAV, IBV, and ICV). described below.
• Hemagglutinin and neuraminidase are critical for • Cough. Cough and other respiratory symptoms
virulence, and they are major targets for the may be initially minimal but frequently progress
neutralizing antibodies of acquired immunity to as the infection evolves; patient may report
influenza. nonproductive cough, cough-related pleuritic
• Hemagglutinin binds to respiratory epithelial chest pain, and dyspnea.
cells, allowing cellular infection. • Fever. Fever may vary widely among patients,
• Neuraminidase cleaves the bond that holds with some
newly replicated virions to the cell surface, • having low fevers and other developing fevers as
permitting the infection to spread. high as
• The species specificity of influenza strains is • 1040F; some patients report feeling
partly due to the ability of a given hemagglutinin • feverish and feeling chills.
to bind to different sialic acid receptors on • Sore throat. Sore throat may be severe and may
respiratory tract epithelial cells. last 3-5 days; the sore throat may be a significant
reason why patients seek medical attention.
CAUSES: • Myalgia. Myalgias are common and range from
Influenza results from infection with 1 of 3 basic types of mild to severe.
influenza virus: A, B, or C. • Weakness. Weakness and severe fatigue may
Direct contact. prevent patients from performing their normal
• Transmission of influenza from poultry or pigs to activities or work; patients report needing
humans appears to occur predominantly as a additional sleep; in some cases, patients with
result of direct contact with infected animals. influenza may be bedridden.
Unhygienic food preparation.
• The risk is especially high during slaughter and ASSESSMENT AND DIAGNOSTIC FINDINGS:
preparation for consumption; eating properly Rapid diagnostic tests for influenza are available and are
cooked meat poses nor risk. becoming more widely used.
Aerosol transmission. • Rapid diagnostic tests. The US FDA waived
• Influenza viruses spread from human to human federal. Clinical Laboratories Improvement Act
via aerosols created when an infected individual (CLIA) requirements and cleared for marketing 7
coughs or sneezes; infection occurs after an rapid influenza diagnostic tests that directly
immunologically susceptible person inhales the detect influenza
• A or B virus-associated antigens or enzyme in MEDICAL MANAGEMENT:
throat swabs, nasal swabs, or nasal washes; Prevention is the most effective management strategy
these tests can produce results within 30 for influenza.
minutes; some these include: QuickVue • Vaccines. To prevent seasonal flu
Influenza A+B test (Quidel), ZstatFlu (ZymeTx), • Surveillance. Enhanced surveillance with daily
and QuickVue Influenza test (Quidel). temperature taking and prompt reporting with
• Viral culture. Culture may require 3-7 days, isolation through home medical leave and
yielding results long after the patient has left the segregation of smaller subgroups decrease the
clinic, office, or emergency department and well spread of influenza.
past the time when drug therapy could be • Bed rest. Patients with influenza generally
efficacious. benefit from bed rest; most patients with
• Polymerase chain reaction testing. RT-PCR influenza recover in 3 days; however, malaise
testing of nasopharyngeal throat secretions is may persist for weeks.
the criterion standard for confirming influenza • Hospitalization. Patients most often require
virus infection. it is the only in vitro diagnostic hospitalization when influenza exacerbates
test for influenza that is cleared by the FDA for underlying chronic diseases; some patients,
use with lower respiratory tract specimens. especially elderly individuals, may be too weak to
• Direct immunofluorscent tests. Some care for themselves alone at home; on occasion,
laboratories offer direct immunofluorescent the direct pathologic effects of influenza may
tests on fresh specimens, but these tests are necessitate hospitalization.
labor– and personnel-intensive and are less • Prehospital care. Prehospital care is
sensitive than culture methods. predominantly supportive; supplemental
• Serologic testing. In order to overcome the oxygenation to manage respiratory symptoms or
expensive and time-consuming obstacle of objective hypoxia may be needed; ventilatory
culturing, several serologic tests have become support with a bag-valve-mask device or with
available in reality, many of these are not bedside field intubation may be required if the patient is
tests; generally, 30-60 minutes are required to in respiratory failure; intravenous access should
perform the test’s multiple steps.; test be obtained, and a bolus of a crystalloid can be
sensitivities generally range from 60-70%. administered to support hemodynamic stability.
• Testing for Avian infuenza. A rapid test from • Consultations. Consultation with an infectious
nasopharyngeal swab specific to H5N1 influenza disease specialist is prudent in some cases of
(Arbor Vita Corporation) was approved by the seasonal influenza; for management of severe
FDA in 2009. disease, intensive care specialists must be
• Chest radiography. In elderly or high-risk involved.
patients with pulmonary symptoms, chest
radiography is indicated to exclude pneumonia PHARMACOLOGICAL MANAGEMENT:
with avian influenza, pulmonary infiltrates are The goals of pharmacotherapy for influenza are to reduce
seen in almost all patients; the widely varied morbidity and to prevent complications.
radiographic characteristics range from diffuse or • Antivirals. The antiviral drugs indicated for the
patchy infiltrates to lobar multilobar treatment and chemoprophylaxis of influenza
consolidation. are the neuraminidase inhibitors (ie, oseltamivir
and zanamivir) and the cap-dependent
endonuclease inhibitor, baloxavir marboxil
 (treatment only); neuraminidase inhibitors act NURSING DIAGNOSIS:
directly on the viral proteins, decreasing the Based on the assessment data, the major nursing
virulence of infection.; baloxavir marboxil diagnosis for influenza are as follows:
inhibits cap-dependent endonuclease, which • Ineffective airway clearance related to
leads to inhibition of viral replication. tracheobronchial and nasal secretions.
• Vaccines, inactivated. Influenza vaccine is • Ineffective breathing pattern related to
administered each year before flu season; inflammation from viral infection.
typically, 3 virus strains (2 influenza A and 1 • Hyperthermia related to exposure to infection.
influenza B), which antigenically represent the • Acute pain related to influenza virus.
influenza strains likely to circulate the next flu • Deficient knowledge related to lack of knowledge
season, are included in the formulation each about the disease process (Influenza).
year; quadrivalent vaccines that included 2
influenza A strains and 2 influenza B strains are NURSING CARE PLANNING AND GOALS:
available. The major nursing care planning goals for influenza are:
• Vaccines, live. The Advisory Committee on • Patient will achieve and maintain a patent
Immunization Practices (ACIP) recommends airway.
return of intranasal flu vaccine in the United • Patient will achieve and maintain normal
States for the 2018-2019 season; the respiratory pattern and rate, with no
recommendation was based on positive results adventitious breath sounds to auscultation.
from a US study in children aged 2 years to • Patient will achieve and maintain a normal
younger than 4 years that evaluated the temperature.
shedding and antibody responses of the H1N1 • Patient will achieve relief from aches and pain.
strain in the live attenuated influenza vaccine • Patient will be able to understand and verbalize
(LAIV). appropriate treatment and care for influenza.
• Uricosuric agents. Agents that inhibit the tubular
secretion of the active metabolite of oseltamivir NURSING INTERVENTIONS:
may be used as adjunctive therapy with this The following are the nursing interventions for a patient
antiviral drug. with influenza:
Maintain patent airway.
NURSING MANAGEMENT • Administer oxygen as ordered; monitor oxygen
Nursing management of a patient with influenza include saturation by pulse oximetry, and notify the
the following: physician of readings <90% or as prescribed by
Nursing Assessment. Assessment of the patient the physician;
with influenza include: • Position patient in high Fowler’s or semi-Fowler’s
• History. Assess the patient’s travel history, if any. position, if possible; administer bronchodilators
• Physical examination. Assess respiratory status as ordered; perform postural drainage and
for rate, depth, ease, use of accessory muscles, percussion, as ordered;
and work of breathing; auscultate the lung fields • Encourage fluids, up to 3-4 L/day unless
for the presence of wheezes, crackles (rales), contraindicated; and encourage deep breathing
rhonchi, or decreased breath sounds. exercises and coughing exercises every 2 hours.
Maintain normal breathing pattern. • Pharyngitis can also cause scratchiness in the
• Perform chest physiotherapy, chest percussion, throat and difficulty swallowing. Pharyngitis-
and postural drainage as ordered; induced sore throat is one of the most common
• Encourage patient to change position every 2 reasons for doctor visits.
hours and as needed, and assist as needed; and • More cases of pharyngitis occur during the
provide colder months of the year.
• Encourage fluid intake of at least 2 L/day unless • It’s also one of the most common reasons people
contraindicated. stay home from work. In order to properly treat
Achieve normal temperature. a sore throat, it’s important to identify its cause.
• Monitor VS especially temperature, every 2-4 • Pharyngitis may be caused by bacterial or viral
hours and as needed; utilize the same methods infections.
of temperature reading with each measurement;
• administer antipyretics as ordered; CAUSES OF PHARYNGITIS
• provide tepid sponge baths; and instruct There are numerous viral and bacterial agents that can
patient/family in use of hypothermia blanket, cause pharyngitis. They include:
reasons for use, signs, and symptoms of • measles adenovirus, which is one of the causes
complications, etc. of the common cold
Achieve relief from pain. • chickenpox croup, which is a childhood illness
• Administer analgesics as ordered; distinguished by a barking cough
• provide warm baths or heating pad to aching • whooping cough group A streptococcus
muscles; encourage gargling with warm water;
provide throat lozenges as necessary; ❖ Viruses are the most common cause of sore throats.
• instruct patient or SO in deep breathing, ❖ Pharyngitis is most commonly caused by viral
relaxation techniques, guided imagery, massage, infections such as the common cold, influenza, or
and other nonpharmacologic aids. mononucleosis.
Educate patient and folks ❖ Viral infections don’t respond to antibiotics, and

• Use limited amounts of time for teaching, with treatment is only necessary to help relieve symptoms.
the provision of a quiet environment; Less commonly, pharyngitis is caused by a bacterial

• inform people receiving the vaccine of the infection.

possible adverse effects and report them ❖ Bacterial infections require antibiotics. The most

immediately; common bacterial infection of the throat is strep

• instruct patient and/or SO about influenza types, throat, which is caused by group A streptococcus.

when typical outbreaks occur, and methods to ❖ Rare causes of bacterial pharyngitis include

avoid infection; and instruct patient and/or SO gonorrhea, chlamydia, and corynebacterium.

about newer antiviral drugs, their effects, when

to seek immediate medical attention, and side WHAT ARE THE SYMPTOMS OF PHARYNGITIS?

effects of medications. The incubation period is typically two to five days.

Symptoms that accompany pharyngitis vary depending on

PHARYNGITIS is inflammation of the pharynx, which is in the underlying condition.

the back of the throat. It’s most often referred to simply In addition to a sore, dry, or scratchy throat, a cold or

as “sore throat.” flu may cause:

• Sneezing
 • runny nose DIAGNOSIS:
• headache ❖ Physical exam
• cough • your doctor will look at your throat. They’ll

• fatigue check for any white or gray patches, swelling, and

• body aches redness.

• chills • Your doctor may also look in your ears and nose.

• fever (a low-grade fever with a cold and higher- To check for swollen lymph nodes, they will feel

grade fever with the flu) the sides of your neck.

❖ Throat culture

In addition to a sore throat, the symptoms of • If your doctor suspects that you have strep

mononucleosis include: throat, they will likely take a throat culture. This

• swollen lymph nodes involves using a cotton swab to take a sample of

• severe fatigue the secretions from your throat.

• fever ❖ Most doctors are able to do a rapid strep test in the

• muscle aches office.

• general malaise • This test will tell your doctor within a few

• loss of appetite minutes if the test is positive for streptococcus.

In some cases, the swab is sent to a lab for
• rash
further testing and results are not available for at
least 24 hours.
Strep throat, another type of pharyngitis, can also
❖ Blood tests
cause:
• This test can determine whether you have
• difficulty in swallowing
mononucleosis.
• red throat with white or gray patches
• A complete blood count (CBC) test may be done
• swollen lymph nodes
to determine if you have another type of
• fever
infection.
• chills
• loss of appetite
HOME CARE:
• nausea
If a virus is causing your pharyngitis, home care can help
• unusual taste in the mouth
relieve symptoms. Home care includes:
• general malaise
• drinking plenty of fluids to prevent dehydration
• eating warm broth
The length of the contagious period will also depend on
• gargling with warm salt water (1 teaspoon of salt
your underlying condition. If you have a viral infection,
per 8 ounces of water)
you will be contagious until your fever runs its course. If
• using a humidifier
you have strep throat, you may be contagious from the
• resting until you feel better
onset until you’ve spent 24 hours on antibiotics. The
common cold usually lasts less than 10 days.
For pain and fever relief, consider taking over-the-
counter medication such as acetaminophen (Tylenol) or
Symptoms, including fever, may peak around three to
ibuprofen (Advil). Throat lozenges may also be helpful in
five days.
soothing a painful, scratchy throat.
MEDICAL TREATMENT:
For such instances, your doctor will prescribe antibiotics.
• Amoxicillin and Penicillin are the most
commonly prescribed treatments for strep
throat. An entire course of these antibiotics
usually lasts 7 to 10 days.

PHARYNGITIS PREVENTION:
Maintaining proper hygiene can prevent many cases of
pharyngitis.
To prevent pharyngitis:
• avoid sharing food, drinks, and eating utensils
• avoid individuals who are sick
• wash your hands often, especially before eating
and after coughing or sneezing
• use alcohol-based hand sanitizers when soap and
water aren’t available
• avoid smoking and inhaling secondhand smoke

However, there are some symptoms that require a

doctor visit for further evaluation. You should see your
doctor if:
• you have had a sore throat for more than a week
• you have a fever greater than 100.4°F
• your lymph nodes are swollen
• you develop a new rash
• your symptoms do not improve after completing
• your full course of antibiotics
• your symptoms return after completing your
course of antibiotics