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03.02 Influenza (Flu)

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Overview

  1. Influenza = virus (multiple strains), increasing severity
  2. Spread through droplet contact
  3. Influenza management is now Joint Commission Core Measure

Nursing Points

General

  1. Prevention is key
    1. Cover cough
    2. Don’t touch nose, mouth, eyes
    3. Avoid public if symptomatic
    4. Hand hygiene

Assessment

  1. Symptoms
    1. Sudden onset
    2. Last 6-7 days
    3. Aches – head, muscles, body
    4. Fatigue
    5. Runny nose, sore throat, cough
    6. Vomiting
    7. High fever (102-104°F)

Therapeutic Management

  1. Vaccine
    1. Annually for:
      1. Healthcare workers
      2. Elderly
      3. Children > 6 mo
      4. Pregnant
      5. Immunocompromised
        1. NOT nasal spray
    2. Contraindications:
      1. Severe allergy to flu vaccine, eggs, or latex
      2. History of Guillain-Barre
      3. Recent bone marrow or organ transplant (< 6 mo)
    3. Side Effects:
      1. Injection site pain
      2. Runny nose
  2. Anti-Virals
    1. Oseltamivir (Tamiflu)
      1. Within 48 hours of onset
      2. Best within 24 hours
      3. Seeing resistance and increased adverse effects
  3. Supportive Care
    1. Bedrest & isolation
    2. Increase fluids
    3. Ensure proper nutrition
    4. Oxygen/respiratory support as needed

Nursing Concepts

  1. Immunity
    1. Encourage Vaccine if not contraindicated
    2. Document if patient refuses
  2. Infection Control
    1. Droplet precautions
    2. Hand-hygiene
  3. Health Promotion
    1. Educate community on importance of prevention practices
  4. Oxygenation
    1. Support airways and give O2 as needed
  5. Evidence-Based Practice
    1. Guidelines For Administering Vaccines
      1. Review history
      2. Assess need
      3. Contraindications / precautions
      4. Educate (provide VIS sheet)
      5. Prepare and administer
      6. Document vaccine or declined vaccine

Patient Education

  1. Provide VIS sheet if vaccinated
  2. Educate on importance of hand hygiene & prevention of spread

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Video Transcript

So we’re going to talk about Influenza, or the Flu. I guarantee you you’ve either had the flu or know someone who’s had it, right? This is a very common seasonal virus that affects millions of Americans and is actually getting more and more severe every year. Since you’re probably very familiar with it, we won’t get too deep in the symptoms and management, but what we WILL talk about is prevention and the major things you’re going to need to know for the NCLEX and when you’re working on the floor as a new nurse.

So let’s review the main symptoms of flu. The big thing to note is that the flu tends to have a sudden onset of symptoms (whereas other viruses may come on gradually). You’ll get aches everywhere – headache, muscle aches, body aches. You’ll have upper respiratory symptoms – runny nose, sore throat, and a productive cough. Some flus can even cause gastroenteritis so you’ll see vomiting – we call that the ‘stomach flu’. And then the flu tends to come with a high fever – usually between 102 and 104 degrees Fahrenheit.

Now, because it’s a virus, there’s often very little we can do pharmacologically for these patients. We do have antivirals that we can give within 48 hours of the onset of symptoms. Even better if we can get it within 24 hours. The most common one is oseltamivir, better known as Tamiflu. But, these medications have more and more adverse effects these days and the flu virus is starting to show some resistance. The best thing we can do is promote bedrest and lots of fluids – and encourage them to eat good nutritious meals. Sometimes when they’re that fatigued, they lose their appetite – but we know that proper nutrition can help with healing, right? So we need to encourage them to eat. Now, because it affects the respiratory system – we may see patients requiring oxygen and in extreme cases even ventilatory support.

But the MOST important thing we can do is prevent the flu from spreading. Both from patient to patient within the hospital and from the patient to the rest of the community. The number one method we can use to prevent the spread of an infection is to wash our hands. This is huge. Influenza is spread through droplets, so once someone sneezes, those droplets are all over everything we touch. You guys have you ever seen this? Someone sneezes and it’s like a cloud of snot coming out? It’s awful. So we make sure they cover their cough or their sneeze to keep those droplets contained. We want to protect our mucus membranes – meaning don’t touch your eyes, nose, or mouth unless you’ve thoroughly washed your hands – that’s the quickest way to contract these infections because from those mucus membranes it goes straight into the bloodstream. We talk about isolation both inside and out of the hospital. We stress that patients with symptoms should not be going out in public and should avoid having lots of visitors over. In the hospital they’ll be on Droplet isolation precautions – what does that entail? That’s gloves and a simple mask. And GOOD HAND HYGIENE – I really can’t stress that enough – especially with droplet transmission.

Now, let’s talk quickly about the flu vaccine. This is something you’re going to play a huge role in as the nurse. In fact, many times doctors aren’t part of this decision-making process at all. At the facility where I work, we have a standing order for the whole hospital. If they are eligible without contraindications, it automatically gets ordered under the hospital’s medical director. So who should get a flu vaccine – well anyone who is significantly susceptible to it. It would be ideal if everyone got it, but we prioritize those at risk. That includes healthcare workers, the elderly and children older than 6 months – remember their immune systems are a bit weaker than the average adult. And then anyone who is immunocompromised. A big point here is that if they are immunocompromised they can NOT receive the nose spray – it is a live virus and can cause problems in immunocompromised patients.

So now let’s review who CAN’T receive the vaccine. First is anyone with a severe allergy to eggs or latex – these two things are used extensively in the development of the flu vaccine. The flu vaccine in rare cases can cause Guillain-Barre syndrome, so anyone who has had it in the past should not receive the vaccine. Anyone who has had a recent transplant – bone marrow, or organ transplant – shouldn’t get this vaccine. Their immune systems will not be able to tolerate it, usually because of all the anti-rejection meds they’re taking. And finally anyone who is currently ill with a fever should not receive it – again this has to do with their immune system being a bit preoccupied – it won’t be able to create the antibodies like it’s supposed to.

Make sure you educate your patient before giving the vaccine – most facilities have a VIS or Vaccine information sheet you can give them. And if they refuse, make sure you document that as well.

As usual, there is a careplan attached to this lesson for detailed interventions, but let’s review priority nursing concepts for a patient with the flu. First, remember that prevention is the most important so we want to promote health in our patients by educating them on how to prevent the spread. Infection control because we also want to prevent the spread to other patients and keep the virus from getting any worse. And finally oxygenation – this virus affects the respiratory system and can escalate quickly so we need to monitor our patients’ oxygenation status.

So remember that prevention is key when it comes to the flu. Patients should cover their cough, avoid contact with lots of people, and use good hand hygiene. Remember the flu is spread by droplets so we will wear a mask and gloves and be sure to wipe down surfaces really well. Vaccinations should be given during flu season, especially to any vulnerable populations. And finally remember that most of our care is supportive while the virus runs its course. We encourage bedrest, fluids and good nutrition, and monitor their oxygenation.

The flu is so common you might even find yourself implementing these interventions on yourself or your roommate! Whatever you do, wash your hands! And, as always, happy nursing!

  • Question 1 of 10

The nurse is caring for a client diagnosed with influenza. Which of the following personal protective equipment does the nurse need to wear when entering this client’s room?

  • Question 2 of 10

The parents of a 4-year-old child with cerebral palsy have brought him in for a routine physical exam. The parents ask the nurse about vaccinations for their child and if the child should get the annual flu shot. Which response from the nurse is correct?

  • Question 3 of 10

A 68-year-old client has been diagnosed with chronic monocytic leukemia. The nurse is teaching the client about the best methods of staying healthy. Which information should the nurse provide about influenza vaccination related to leukemia?

  • Question 4 of 10

A 6-year-old is being discharged from the hospital following an appendectomy. The parents have asked to have the flu vaccine administered via nasal spray, prior to discharge. The nurse knows that which of the following are contraindications for administering this immunization? Select all that apply.

  • Question 5 of 10

The nurse is administering a pneumococcal conjugate vaccine to a client. Which of the following is true regarding this type of vaccine? Select all that apply.

  • Question 6 of 10

A nurse is preparing to enter the room of a 13-year-old client with influenza. The nurse is gathering all supplies and medications for the client before entering the room. Which medication would be appropriate for the nurse to retrieve?

  • Question 7 of 10

The parent of a 12-year-old who has been diagnosed with Influenza type A demonstrates understanding of the benefits of the child taking oseltamivir (Tamiflu) with which of the following statements?

  • Question 8 of 10

You are the nurse of a child who has been diagnosed with Influenza type C and the parents ask what this means. As the nurse, you accurately explain influenza C with which of the following statements?

  • Question 9 of 10

The nurse is providing education to the parents of a 10-year-old who has been diagnosed with the flu and is experiencing high temperatures. The nurse knows to include which of the following in teaching regarding how to treat the fever? Select all that apply.

  • Question 10 of 10

A nurse is caring for a client with influenza who requires droplet precautions. Which of the following activities is part of maintaining droplet precautions?

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