Influenza (flu) is an acute, highly contagious viral respiratory infection that is caused by one of three types of myxovirus influenzae. Influenza occurs all over the world and is more common during winter months. The incubation period is 24 to 48 hours. Symptoms appear approximately 72 hours after contact with the virus, and the infected person remains contagious for 3 days. Influenza is usually a self-limited disease that lasts from 2 to 7 days. The disease also spreads rapidly through populations, creating epidemics and pandemics. Annual estimates are that approximately 20,000 deaths occur as a result of influenza virus and 250,000 to 500,000 new cases occur each year in the United States. Complications of influenza include pneumonia, myositis, exacerbation of chronic obstructive pulmonary disease (COPD), and Reye’s syndrome. In rare cases, influenza can lead to encephalitis, transverse myelitis, myocarditis, or pericarditis.
Infection with a specific strain of virus produces immunity only to that specific virus strain. Therefore, each year an influenza vaccine is developed to provide immunity against influenzavirus strains that are projected to be prevalent for that season. Elderly persons, those with chronic diseases, and healthcare workers are advised to get influenza vaccinations annually in October or November.
Nursing care plan assessment and physical examination
Determine if the patient has had contact with an infected person within the past 72 hours. Ask about immunization. Establish a history of fever and chills, hoarseness, laryngitis, sore throat, rhinitis, or rhinorrhea. Elicit a history of myalgia (particularly in the back and limbs), anorexia, malaise, headache, or photophobia. Ask if the patient has a nonproductive cough; in children, the cough is likely to be croupy. Determine if the patient has experienced gastrointestinal symptoms, such as vomiting and diarrhea.
Observe the patient for a flushed face and conjunctivitis. When you inspect the patient’s throat, you may note redness of the soft palate, tonsils, and pharynx. Palpate for enlargement of the anterior cervical lymph nodes. The patient’s temperature usually ranges from 102°F to 103°F and often rises suddenly on the first day before falling and rising again on the third day of illness. Check if influenza has produced respiratory complications. Note the patient’s rate of respirations, which may be increased. Auscultate the patient’s lungs for rales.
The patient who feels very ill and is unable to continue with normal activities should be assured that the illness is self-limiting and that improvement occurs with rest and time.
Nursing care plan primary nursing diagnosis: Infection related to the presence of virus in mucus secretions.
Nursing care plan intervention and treatment plan
Medical treatment does not cure influenza but is aimed at controlling the symptoms and preventing complications. Bedrest and increased intake of fluids are prescribed for patients in the acute stage of infection. For persons who are not immunized but are exposed to the virus, amantadine may prevent active infection. Amantadine is usually prescribed for outbreaks of influenza A within a closed population, such as a nursing home.
The most important nursing intervention is prevention. Encourage all patients over 65 years or those with chronic conditions to receive annual influenza vaccinations. Teach the patient about potential side effects of vaccination, such as fever, malaise, discomfort at the injection site, and in rare instances, Guillain-Barré syndrome. Note that influenza vaccine is not recommended for pregnant women unless they are highly susceptible to influenza. Instruct patients and families to cover the mouths and noses when coughing, to dispose of used tissues appropriately, and to wash their hands after patient contact to prevent the virus from spreading. Limit visitors when necessary. Encourage a fluid intake of 3000 mL/day for adults. Explain that warm baths or the use of a heating pad may relieve myalgia. Provide cool, humidified air; maintain bedrest; and monitor vital signs to detect any change in the rhythm or quality of respirations.
Nursing care plan discharge and home health care guidelines
To prevent complications, emphasize to the patient the need to maintain bedrest and high fluid intake for 2 to 3 days after the temperature returns to normal. Instruct the patient and family about the dosage, route, action, and side effects of all medications. Instruct the patient and family to report any chest pain, ear pain, or change in respirations to the physician.