Assessing And Managing The Health Of A Patient With Influenza: A Nursing Care Plan

Primary Diagnosis and Presenting Complaints

Discuss about the Patient assessment Case Study Of Jim.

Jim was last well a day prior to ad admission, an assessment is done. Primary diagnosis indicates a case of influenza. His presenting complaints are indicative of an emergency, crucial steps need to be undertaken especially on the patency and clearance of the airway, an ineffective breathing pattern and the high body temperature.

The airway is not patent, on inspection it is evident that there is nasal discharge and tonsillar inflammation. Assessment of rhinorrhoea and inflammation serves resulted in respiratory depression. The patency of the airway in the case as vital. A backflow of the nasal discharge could cause fluid aspiration into the lungs causing aspiration pneumonia.

Temperature is a crucial indicator of internal processes and should be adequately assessed.  It is previously shown that the patient had hyperthermia with a body temperature of 38.3°C. This is an evidence of fever and validated by the pulse rate of 105 bpm. Hyperhidrosis is also indicated. This assessment is necessary to ensure that appropriate measures are taken on admission including fluid and electrolyte replacement and ensure there is adequate hydration.  Unmonitored hyperthermia can cause accelerated reduction in the metabolism and the level of consciousness (Hildebrandt et al, (2015)). There is also a possibility of an increased cardiac output, heart rate and eventually risk of a myocardial infarction.

The breathing pattern is also a crucial assessment focus. His airways should be inspected, the chest palpated, inspected then auscultation done to rule on the indication of bilateral wheezing. Adequate objective data to this account provide the on the necessities admission especially on the oxygen administration and monitoring. In spite having good air entry, there is a possibility of pulmonary oedema and reduced oxygen perfusion secondary to the admission status. The initial oxygen saturation is at 94% of recommended (90-100%). Ineffective analysis of this vital could end up in dyspnoea and eventually culminate in respiratory distress.

Nursing Care Plan: Jim

Nursing problem: Risk of spread of infection
Underlying cause or reason: Influenza is a highly contagious virus spread via airborne droplets and direct contact. Immunocompromised patients in the hospital setting are at higher risk of contracting disease resulting in adverse events.
Goal of care	Nursing interventions/actions	Rationale	Indicators your plan is working
To prevent and control the spread of influenza within the healthcare facility and the community.	·          Close contact with the sick person should be avoided and hence isolate the client in a room where they can closely be monitored ·         Wear protective clothing like face masks when handling the patient ·          Clean hands thoroughly with soap and water before and after handling the patient. Also inform relatives to wash hands before and after visiting the patient. possibly teach them proper hand washing technique. ·         Limit the number of visitors coming to see the client.	·         This will prevent spread of infection to other clients through skin transmission and airborne transmission (La Rosa, G., Fratini, M., Libera, S. D., Iaconelli, M., & Muscillo, M. (2013).) ·         Faces masks prevent airborne transmission (Bin?Reza, F., Lopez Chavarrias, V., Nicoll, A., & Chamberland, M. E. (2012).) ·         This will help to prevent transmission of infection when providing care for the sick (Mathur, P. (2011).) ·         Limiting visitors reduce the number of organisms in the patient environment.( Cohen, B., Hyman, S., Rosenberg, L., & Larson, E. (2012).)	The patient remained isolated and there were no signs of infections identified. The numbers of people visited Jim remains limited.
Nursing problem: Self-care deficit
Underlying cause or reason: difficulty in performing task of daily living such as dressing, feeding due to myalgia, malaise and fatigue
Goal of care	Nursing interventions/actions	Rationale	Indicators your plan is working
The patient will safely perform self-care activities	·                     Assess the ability of the patient to carry out activities of daily living like feeding and dressing in order to determine the self-care that has a problem to the patient ·                     Encourage the patient to carry out independence activities but assist where he / she can’t perform	·         Assessing help in determining where the client needs assistance (Soriano, F. I. (2012).) ·         Encouraging the patient will help prevent frustration and makes him motivated.( Baumann, L. C., & Dang, T. T. N. (2012).)	The patient could perform duties to his capability and where possible he was assisted.
Nursing problem: Risk of imbalanced fluid volume
Underlying cause or reason: increased metabolic rate due to fever, diaphoresis which leads to active fluid loss.
Goal of care	Nursing interventions/actions	Rationale	Indicators your plan is working
	·         Assess mucous membranes and skin turgor for any signs of dehydration. Assess the amount and colour of urine ·          Assess weight daily and note if there are any changes ·         Monitor and document vital signs ·         Monitor the fluid intake and output and chart appropriately. Encourage the patient to take fluids orally and explain the advantages of maintaining proper nutrition and hydration	·         This helps to find out if there are any signs of dehydration. Highly concentrated urine shows signs of dehydration. (Shimizu, M., Kinoshita, K., Hattori, K., Ota, Y., Kanai, T., Kobayashi, H., & Tokuda, Y. (2012.)) ·         Monitoring helps to figure out for any fluid volume imbalance and hence the need of appropriate actions. Taking appropriate amount of fluids daily also help maintain adequate fluid volume.( Nair, M. (2014).)	The client fluid volume remains within the normal range and was monitored appropriately.
Nursing problem: ineffective breathing pattern
Underlying cause or reason: inflammation of pharynx and tonsils and also general weakness and fatigue
Goal of care	Nursing interventions/actions	Rationale	Indicators your plan is working
Normal breathing pattern and rate will be maintained and there will be no adventitious sounds on auscultation	·         Asses the skin colour and capillary refill; note central and peripheral cyanosis ·         Assess the ability to clear secretions on the airway ·         Auscultate every 2-4 hours and notify the physicians of any changes. ·         Monitor the pulse oximetry reading and notify the physician if < 90% ·         Position patient with proper body alignment.	·         Delayed capillary refill and abnormal skin colour may indicate compromised breathing. (Jevon, P. (2010).) ·         Positioning appropriately provide optimal breathing and chest expansion. (Frownfelter, D. (2014).) ·         Changes may show early signs of respiratory compromise and insufficiency (Chien, Y. S., Su, C. P., Tsai, H. T., Huang, A. S., Lien, C. E., Hung, M. N., … & Chang, S. C. (2010).)	Patient breathing pattern is maintained as evidenced by normal skin colour and regular respiratory rate.
Nursing problem: Ineffective airway clearance
Underlying cause or reason: copious clear nasal discharge
Goal of care	Nursing interventions/actions	Rationale	Indicators your plan is working
Secretions of the patient are mobilized and airway is maintained free of secretions.	·         Assess respiratory rate, depth, ease, use of accessory muscles, and work of breathing ·         Monitor patient for cough and any production of sputum, noting amount, colour, character, and patient’s ability to expectorate secretions, and ability to cough. ·         Suction if warranted	·         Abnormality may indicate respiratory compromise (Ackley, B. J., & Ladwig, G. B. (2010). ) ·         Mucus colour from yellow to green may indicate presence of infection. Tenacious, thick secretions require more effort and energy to expectorate through coughing, and may actually create an obstruction stasis that leads to infection and respiratory changes. ( Guion, L. (2010).) ·         Suction helps to clear the patient’s secretions if fatigued (Sole, M. L., Penoyer, D. A., Bennett, M., Bertrand, J., & Talbert, S. (2011).)

 

Influenza is suspected upon Jim’s admission. Viral replication and budding peaks earlier than the manifestation of clinical symptoms and the effectiveness of treatment depends on the initiation of the medication.  Jim is given oseltamivir, a neuraminidase inhibitor. Being an analogue of sialic acid it interferes with the budding of the influenza virus and limiting the spread in the respiratory tract. The 75mg Bd dose is favourable because the half-life of 6-10 the drug hours. Drug administration should be as prescribed, given at the right intervals and dosage. The patient response well documented and assessed frequently. Adverse drug reactions associated with Oseltamivir are nausea, vomiting and abdominal pain. The side effects should be clearly dissociated from the presenting complaints.

Assessing the Airway, Temperature, and Breathing Pattern

Paracetamol is a central acting antipyretic and analgesic that acts by weakly inhibiting COX enzymes thus eliciting anti-inflammatory actions (Sin, B; Wai, M; Tatunchak, T; Motov, 2016). The drug is administered 6 hourly to maintain the concentration of the acetaminophen. The administration of paracetamol should be at the regular intervals and at the right dosage to minimise the lethargy caused the fever and alleviate the pain secondary to the muscular pain. Acetaminophen is also dispensed for the fever avoid any propensity of an overdose. It is indicated in Sin et al (2016) that acetaminophen overdose causes depletion of glutathione and hepatic damage. Dose adjustments should be made after consultation.

Fluvax is an influenza vaccine. Fluvax is administered in a trivalent dosage to adults’ intramuscularly. This is to avoid the risk of the complications of the flu. Inoculation of the antigen in the attenuated influenza virus activates the immune system to produce anti-influenza antibodies. The immunity to antigens expressed on the surface especially haemagluttin reduces the possibility of infection and severity of recurrent infection. The subsequent vaccinations should then be scheduled and documentation made. The vaccination may be associated with hyperthermia, malaise, and headache and may increase the sweating. In this case all the temperature has to be recorded frequently.

Jim is a known smoker with an average smoking standard rate of 5-10 cigarettes per day. His health education focus has to be centred on how smoking causes hypertension and the health implications of the smoking lifestyle. The possible courses to complete rehabilitation and a suitable behavioural change model elucidated for him to decide. The effect of the hypertension on his response to infection should also made lucid.

Study indicates that smoking increases the risk to hypertension and vascular malfunction. The vascular endothelium becomes fibrous resulting in increased arterial pressure. This increase results is a cumulative increase in the blood pressure and the manifestation of hypertension. Cigarette smoke has toxic compounds that increase cardiovascular inflammation, cause oxidation of low-density lipoprotein cholesterol (Ambrose, J. A., & Barua, R. S. (2010).

Furthermore, it should be clear that smoking causes the loss of life expectancy and sexual virility. The numerous toxins in cigarette smoking accelerate the aging process. It should also be shown that the exposure of the lungs to the toxins increase the risk of developing throat and lung cancer respectively. The tar also causes toot discolouration and occurrences of bad breath.

Nursing Care Plan for Influenza: Preventing Infection Spread, Managing Self-Care Deficits, and Maintaining Fluid Balance

Additionally, smoking is a possible basis of unexplained weight gain. Supplementary to this, the overall decrease in libido and increase in the predisposition to erectile dysfunction should be made avid. The benefits of living free of smoking should also be set verses the effects of avoidable smoking habits.

Initiatives towards cessation of the code should be initiated with cigarette reduction therapy and counselling. Jim has to take on healthy living. He has to stick on a good diet, with all the necessary nutrients. Undergo psychosocial therapy and specified health education. On his lifestyle he has to embrace physical exercise and change attitudes towards smoking as a recreational activity. He also has to be referred to social welfare agencies to provide care and food since he is homeless.

The fever is caused by the possible occurrence of a bacterial infection after completion of the antiviral therapy. In many occasions, the influenza virus is co-transmitted with bacteria. The initial line of treatment was focused on the virus alone but no prophylaxis was given for a bacterial infection.

Proliferation of bacterial colonies result in the hyper activation of the immune system. Both the adaptive and the innate immune systems are activated. Inflammatory cytokines are released into circulation and initiate the attack to clear bacteria. This immune system response result in the elevation of the body temperature hence the resurgence of the fever. The multiplier effect of the fever culminated in a hyperventilation state and increased heart rate. Jim should be given sponge baths and antipyretics as ordered. The physician should be notified of the change.

Shift handover:

Jim is a 58-year-old homeless Indigenous male of no fixed address. He presented to the Emergency Department with dyspnea, myalgia, fatigue, malaise, rhinorrhea and headache.  His symptoms began approximately 3 day ago and he has tested positive for Influenza A and his influenza symptoms have improved over the past 24 – 48 hours with continued medications. He has a past medical History of asymptomatic hypertension though he is not currently on any antihypertensive because he did not take his previous medication when prescribed. On assessment he was found to be febrile and has shortness of breath. He is allergic to chickens but has no known drug allergies. He states he used to smoke but not so much anymore as he cannot afford them however he does smoke up to 5 – 10 per day if he can get them. Jim is set for discharge after completing his antivirals therapy.

Vital signs
Temperature	39.6oC
Heart rate	125 beats per min
Respiratory rate	24 resps per min
Blood pressure	124/79 mmHg
O2 saturations	86% on room air

 

Drug Administration Guidelines for Oseltamivir and Paracetamol

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