a mini case presentation on influenza virus

7/31/2019 A Mini Case Presentation on Influenza Virus

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By:Baran, Delia V.

Concepcion, John Angelo L.

BSN IIINCM 104


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Viruses

a small infectious agent that can replicate only inside theliving cells of organisms. Viruses infect all types oforganisms, from animals and plants to bacteria and

archaea.

Virus particles (known as virions) consist of two or threeparts: the genetic material made from either DNAor RNA,long molecules that carry genetic information;

a proteincoat that protects these genes; and in some casesan envelope oflipids that surrounds the protein coat whenthey are outside a cell. The shapes of viruses range fromsimple helical and icosahedral forms to more complex

structures. The average virus is about one-hundredth thesize of the average bacterium. Most viruses are too small tobe seen directly with a light microscope.
http://en.wikipedia.org/wiki/Pathogenhttp://en.wikipedia.org/wiki/Animalhttp://en.wikipedia.org/wiki/Planthttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Archaeahttp://en.wikipedia.org/wiki/Genetic_materialhttp://en.wikipedia.org/wiki/DNAhttp://en.wikipedia.org/wiki/RNAhttp://en.wikipedia.org/wiki/Moleculehttp://en.wikipedia.org/wiki/Proteinhttp://en.wikipedia.org/wiki/Viral_envelopehttp://en.wikipedia.org/wiki/Lipidhttp://en.wikipedia.org/wiki/Helixhttp://en.wikipedia.org/wiki/Icosahedronhttp://en.wikipedia.org/wiki/Optical_microscopehttp://en.wikipedia.org/wiki/Optical_microscopehttp://en.wikipedia.org/wiki/Icosahedronhttp://en.wikipedia.org/wiki/Helixhttp://en.wikipedia.org/wiki/Lipidhttp://en.wikipedia.org/wiki/Viral_envelopehttp://en.wikipedia.org/wiki/Proteinhttp://en.wikipedia.org/wiki/Moleculehttp://en.wikipedia.org/wiki/RNAhttp://en.wikipedia.org/wiki/DNAhttp://en.wikipedia.org/wiki/Genetic_materialhttp://en.wikipedia.org/wiki/Archaeahttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Planthttp://en.wikipedia.org/wiki/Animalhttp://en.wikipedia.org/wiki/Pathogen


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Introduction

Influenza is an acute viral infectious disease that affectsthe respiratory system also known as flu. Inf luenza is amyxovirus belonging to the family of viruses known as

Orthomyxoviridae. The virus is spread readily in aerosoldroplets produced by coughing and sneezing, which aresymptoms of the illness. Other symptoms include fatigue,muscle and joint pains and fever. Influenza as a disease has

been recognised for centuries, even though the viruseswhich cause it were not correctly identified until the early1930s, first in the UK and then in the USA. Indeed thename itself is derived from an Italian word meaninginfluence.


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Three types of myxoviruses.1.) Type A - is the most prevalent, it strikes every year with

new serotypes causingepidemics every 3 years.2.)Type B - also strikes annually but only causes epidemics

every 4-6 years.3.)Type C - is endemic and causes only sporadic causes.

Incubation period is 24-58 hours.Period of communicability- 5th day of illness up to 7

days.Mode of transmission:

>Infection is transmitted by inhaling a respiratory dropletfrom an infected person or indirect contact such asdrinking a contaminated glass.


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Clinical Manifestations:

>Client history reveals recent exposure to a person with influenza. ( no influenza vaccine

receive during the past season.

> After an incubation period of 24-48 hours, flu symptoms appear.

>Sudden onset of chills

>fever,

> headache

> malaise

>myalgia (particularly in the back and limbs)

> photophobia>nonproductive cough

>occasionally laryngitis

>hoarseness

> rhinitis

>rhinorrhea

> Signs usually subsides in 3-5 days, but cough and weakness may persist.

>Inspection may reveal clear nasal discharge, erythema of the nose and throat without exudates,

and red watery eyes.

>If client has pneumonia, breathsounds may be diminished over areas of consolidation.


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Complications:

Directly related to viral infection

>hemorrhagic pneumonia>encephalitis

>Reyes syndrome

>myocarditis which may lead to cardiac failure

>sudden infant death syndrome>myoglobinuria

>super imposed infection due to Streptococci pneumonia,haemophilus influenza,

Streptococcus pyrogens, and Staphylococcus aureus>otitis media

>sinusitis

>pneumonia


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Pharmacologic Management:

>Antipyretic drugs : Paracrtamol

prevent Reyes syndrome, a severe illness characterizedby acute encephalophaty and

fatty liver.

>Anti-inflammatory drugs or ibuprofen

In influenza complicated by pneumonia, the clientneeds supportive care (including fluid and

electrolyte replacement, oxygen and assisted

ventilation).


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Diagnostics:

1.) Nose and throat culture and increase serum antibodytiters-

2.) White Blood Cells count

>decreased WBC with an increased level oflymphocytes show uncomplicated cases.


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Prevention and Control:

1.) Immunization to children.

2.) Immunization of influenza vaccine annually for thefollowing categories:

a. The elderly

b. People who have poor immunity

c. Those with conditions like diabetes, lung diseases,

kidney diseases, heart and liverdiseases.

3.) Avoidance with crowded places.

4.) Educate the public and health care personnelregarding the basic personal hygiene.


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Drug Study


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Generic Name Brand Name Classification Mechanism of

Action

Adverse Effects Nursing

Implication

Ibuprofen Paracetamol Non-opioid

analgesic, Anti-

pyretic

It inhibits the

synthesis of

prostaglandin

Gastrointestinal

problems, allergic

skin reactions

Check that the

patient is not

taking any othermedication

containing

paracetamol.

- For children who

may refuse

medicine off a

spoon try using a

medicine syringe

to squirt liquidslowly into the

side of the child's

mouth or use

soluble

paracetamol mixed

with a drink.

Paracetamol can

be take in with or

without food.- Alcohol increases

the risk of liver

damage that can

occur if an

overdose of

paracetamol is

taken.


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Generic Name Brand Name Classification Mechanism of

Action

Adverse Effects Nursing

Implication

Aspirin Aspirin Non-opioid

analgesic, Anti-

pyretic

Blocks pain

impulses in the

central nervoussystem, inhibits

prostaglandin

synthesis, causes

peripheral

vasodilation

resulting in

antipyretic

properties,

decreases platelet

aggregation.

heartburn; nausea;

stomach upset,

Severe allergicreactions: (rash;

hives; itching;

difficulty

breathing;

tightness in the

chest; swelling of

the mouth, face,

lips, or tongue);

black or bloody

stools; confusion;

diarrhea; dizziness;

drowsiness;

hearing loss;

ringing in the ears;

severe or persistent

stomach pain;

unusual bruising;vomiting.

For patients who

have had oral or

dental surgery ortonsillectomy in the

last seven days avoid

chewable or

dispersible aspirin

tablets, or aspirin in

crushed tablets or

gargles.

- Assess pain and/or

pyrexia one hour

before or after

medication.

- In long-term

therapy monitor

renal and liver

function and

ototoxicity.

- Assess other

medication for

possible interactions- especially warfarin

which is a special

hazard.

- Be aware that

aspirin is a common

constituent of a

variety of over-the-

counter medications.


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Pathophysiology


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Influenza virus travels by air

Man inhales microorganism

Virus invades respiratory mucosa (i.e.., nasal, tracheal, and bronchial tree)

Client becomes vulnerable to secondary infections

Pneumococci staphylococci steptococci other agents

Edema of the respiratory tree

Passage of serosanguinous discharge

Ineffective Airway Clearance R/T Hyperthermia R/T Risk for fluidvolume

bronchial edema infectious process deficit


15/22Prioritization of Nursing Diagnosis

1. Hyperthermia R/T infectious process- This is our first prioritybecause temperature is one of the basic vital signs of a man andelevation of it means that there is an infection in the body. Also,infection is the main problem of the client.

2. Ineffective Airway Clearance R/T bronchial edema- This is oursecond priority because it is only the result of the Influenza virusinvading the respiratory system of the client.

3. Risk for Fluid Volume deficit- This is our last priority because itis a potential nursing diagnosis, meaning that it will only occur ifthe manifesting signs and symptoms or manifesting problems

were not able to give much attention.


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Nursing Care Plan


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ASSESSMENT EXPLANATION

OF THE

PROBLEM

OBJECTIVES INTERVENTION

S

RATIONALE EVALUATION

S>

O>Febrile,

>T = 38.8C

>Weak inappearance

>palpable lymph

nodes

>body malaise

>Diaphoretic

Nsg. Dx:>

Hyperthermia

R/T infectiousprocess

Fever is considered

the hallmark

symptom

of infection.Pyrogenic agents

that act on the

hypothalamus to

produce fever

during infection

include

interleukin-1 (IL-

1),interleukin-6

(IL-6), interferon,tumor

necrosisfactor

(TNF), and

othercytokines.

STO: After 8 hours

of nursing

intervention, the

client will be ableto:

Decrease body

temperature from

38.8oC to 38oC

Enumerate ways

on preventing

further elevation of

temperature

LTO: After 24hours of nursing

intervention, the

client will be able

to:

Normalize body

temperature from

38.8oC to 36.5-

37.5oC

Manifest signs ofabsence of

infection

Dx:> Monitor and

record temperature

q 30min1 hour

> Note presence

or absence of

sweating as body

attempts to

increase heat

loss by

evaporation.

Tx:> Perform TSB

with warm water.

> Minimize

clients clothing

>To assess the

need for intensive

nursing

management> Evaporation is

decreased by

environmental

factors of high

humidity and high

ambient

temperature as

well as body

factors producingloss of ability to

sweat.

> Alcohol baths

are contraindicated

because they

increase peripheral

vascular

constriction and

CNS depression;cold water

sponges/immersion

can increase

shivering,

producing heat.

> Minimizing

clients clothing

helps he body in

releasing heat


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> Administer

analgesic

medications as

ordered (ie.,

Paracetamol q

4hrs)

Edx: > Encourage

the patient to

maximize fluid

intake.

> Stress the

importance of drug

compliance.

>Recommend the

avoidance of hot

tubs / saunas as

appropriate

inside.

> Administering

analgesic

medications helps

the body in

lowering down the

body temperature.

> Maximizing

fluid intake

replaces body fluid

the escape the

body throughexpiration.

> To maximize the

wellness of the

client.

> It may cause

other

complications


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ASSESSMENT EXPLANATION OF

THE PROBLEM

OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

S>

O> Coarse crackles

heard over left lung

field peripherally

>coughing attimes

>productive

cough

>secretion

characterized as

yellowish in color

>(+) use of

accessory muscle

when breathing

>pale in

appearance

>increased RR of

26 cpm

>restlessness

>with goodcapillary refill of 2

secs.

>with good

appetite

Influenza virus

invades the clients

respiratory system

when he inhales the

microorganisms,causing the virus to

invade the

respiratory system,

then having the

accumulation of

fluid (edema) on

the respiratory tree

causing now the

patient to have

difficulty in

breathing, leading

to Ineffective

Airway Clearance.

STO: > after 8

hours of nursing

interventions, the

client will be able

to: Maintain a

normal

respiration

rate of 12-20

cpm;

Demonstrate

behaviors in

maintaining

clear airway;

Demonstrate

absence/reduc

tion of

congestion

with breath

sound clear,respiration

noiseless.

Dx: > assess

respiration rate

> Monitor and noterespirations, breath

sound, rate, and

presence of

adventitious

sounds.

> Evaluate clients

cough, gag reflex

and swallowing

ability.

Tx:> Elevate

clients head

> Perform chest

physiotherapy

> Provide cool,

humidified air,

change water daily

>Administer

prescribed

medication.

> Changes in

respiration rate

indicates

respiratory distress

> monitoring andnoting changes in

respirations, breath

sound, rate, and

presence of

adventitious sounds

reflects the

effectiveness of

interventions done.

> To determine

ability to protect

own airway.

>To provide

maximum lung

expansion>To help in

secreting secretion

>To prevent

pseudomones

infection.

>To help in

effective

therapeutic

regimen.

STO: Goal met.

The client was able

to:

Maintain a

normalrespiration

rate of 12-20

cpm;

Demonstrate

behaviors in

maintaining

clear airway;

Demonstrate

absence/reduc

tion of

congestion

with breath

sound clear,

respiration

noiseless.


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Nsg. Dx>

Ineffective AirwayClearance R/Tbronchial edema

>Assist with

procedures such as

suctioning if

necessary

Edx:> Encourage

to verbalize

feelings.

>Encourage clientto increase fluid

intake to atleast

2000mL/day as

tolerated.

> Teach and

advise to perform

deep breathing

exercise and deep

coughing exercise.

>To clear/maintain

open airway

>Verbalization of

feelings may help

the nurse and other

health care

members for an

effective

intervention.

> Hydration can

help to liquefy

secretions and to

improve secretion

clearance.

> To help in

clearing/

maintaining open

airway


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ASSESSMENT EXPLANATION

OF THE

PROBLEM

OBJECTIVES INTERVENTION

S

RATIONALE EVALUATION

S>

O> Coarse

crackles heard

over left lung field

peripherally

>coughing at

times

>productive

cough

>secretion

characterized as

yellowish in color

>(+) use of

accessory muscle

when breathing

>pale in

appearance

>increased RR of

26 cpm

>restlessness

>with good

capillary refill of 2secs.

>with good

appetite

>Febrile,

>T = 38.8C

>Weak in

appearance

>palpable lymph

nodes

When a client is

having fever, fluid

from the body

escapes outsidecausing now the

patient to be

diaphoretic. When

the client reports

body malaise, he

dont have the

energy to give

himself a drinktherefore, he will

not drink to replace

fluid loss causing

now imbalance

between fluid

intake and output

leading now the

patient to be risk on

fluid volume

deficit.

STO: After 8 hours

of nursing

intervention, the

patient will be able

to:

Identify individual

risk factors and

appropriate

interventions;

Demonstrate

behaviors or

lifestyle changes to

prevent

development of

fluid volume

deficit

LTO: After 24

hours of nursing

intervention, the

patient will be able

to:

Not exhibit signsof dehydration

Maintain an

adequate intake,

either orally or IV

Maintain a normal

fluid volume, as

evidenced by

normal vital signs

and I and O.

Dx:

>Monitor I and O

> Assess clients

weight

>Assess clients

level of

consciousness

Tx:

>Assist in IV

placing

>Provide

maximum fluid

intake

Edx:

> Stress the

importance of drug

compliance

>Advise to

verbalize feelings

>To ensure

accurate picture of

fluid status

>To determine

trends

>To evaluate

ability to express

needs

> IV fluids

replaces loss fluids

from the body.

> For replacement

of fluid loss

>For healing

process

>Verbalization of

feeling can help

the health careteam in effective

management of the

disease


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>Diaphoretic

Nsg. Dx:> Risk for

Fluid Volume

Deficit

a mini case presentation on influenza virus

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