Influenza (Flu) Nursing Management

Table of Contents

Introduction

Influenza, commonly known as the flu, is a contagious respiratory illness caused by influenza viruses. Nursing management of influenza aims to alleviate symptoms, prevent complications, and reduce transmission to others. Key components of nursing management include:

Nursing Problem Priorities

Nursing problem priorities involve identifying and addressing the most urgent and significant issues affecting the patient’s health and well-being. These priorities guide nursing interventions and care planning to ensure optimal patient outcomes. Common nursing problem priorities include:

Airway Management: Prioritizing the maintenance of a patent airway is crucial, especially in patients with respiratory distress, airway obstruction, or compromised respiratory function due to conditions like pneumonia or asthma.
Oxygenation: Ensuring adequate oxygenation is essential to support cellular function and prevent hypoxemia. Monitoring oxygen saturation levels and providing supplemental oxygen as needed are key interventions.
Fluid and Electrolyte Balance: Maintaining fluid and electrolyte balance is critical for optimal physiological function. Monitoring fluid intake and output, electrolyte levels, and signs of dehydration or fluid overload are important nursing priorities.
Pain Management: Addressing pain promptly and effectively is essential for patient comfort and well-being. Assessing pain intensity, implementing pharmacological and non-pharmacological pain management strategies, and evaluating their effectiveness are nursing priorities.
Infection Control: Preventing healthcare-associated infections and controlling the spread of infectious diseases are priorities in nursing practice. Implementing appropriate infection control measures, including hand hygiene, isolation precautions, and environmental cleaning, is crucial.
Safety: Ensuring patient safety is paramount in nursing care. Identifying and mitigating risks for falls, injury, or other adverse events, maintaining a safe environment, and promoting patient and caregiver education on safety measures are nursing priorities.
Nutritional Support: Providing adequate nutrition and hydration is essential for promoting healing and maintaining overall health. Assessing nutritional status, implementing appropriate dietary interventions, and monitoring nutritional intake are nursing priorities.
Medication Management: Ensuring safe and effective medication administration is a key nursing responsibility. Verifying medication orders, administering medications correctly, monitoring for adverse effects, and providing patient education on medication use are priorities.
Psychosocial Support: Addressing the psychosocial needs of patients and their families is essential for holistic care. Providing emotional support, facilitating communication, and connecting patients with appropriate resources for counseling or support groups are nursing priorities.
Rehabilitation and Mobility: Promoting optimal mobility and functional independence is important for patients’ physical and psychological well-being. Implementing rehabilitation strategies, facilitating early mobilization, and preventing complications related to immobility are nursing priorities.

Nursing Assessment

Assessment for influenza involves gathering both subjective and objective data to comprehensively evaluate the patient’s condition. Key signs and symptoms to assess for include:

Subjective and Objective Data:
- Rhinorrhea or “runny nose”
- Irritating nonproductive cough
- Decreased breath sounds
- Adventitious breath sounds
- Production of sputum
- Coughing
- Sputum
- Erythema (redness) to tonsils, soft and hard palate, and pharyngeal wall
- Abnormal chest X-rays
- Increased temperature
- Tachycardia (rapid heart rate)
- Tachypnea (rapid breathing)
- Dry mucous membranes
- Dehydration
- Hemoptysis (coughing up blood)
- Cyanosis (bluish discoloration of the skin)
- Dyspnea (shortness of breath)
- Pulmonary edema
- Fever
- Weakness
- Diaphoresis (excessive sweating)
- Fatigue
- Leukopenia (low white blood cell count)
- Oliguria (decreased urine output)
- Seizure
- Changes in mentation (mental status)
- Increased blood urea nitrogen (BUN) and creatinine
- Electrolyte imbalances
Factors Related to the Cause of Influenza:
- Pneumonia
- Inflammation from viral infection
- Hemorrhagic bronchitis
- Tracheobronchial and nasal secretions
- Increased peripheral airway resistance caused by drug therapy

By conducting a thorough assessment, nurses can identify relevant symptoms and potential complications of influenza, allowing for timely intervention and management to improve patient outcomes.

Symptom Management:

Administer antipyretic medications (e.g., acetaminophen) to reduce fever and alleviate discomfort.
Encourage adequate hydration to prevent dehydration, especially if fever is present.
Provide antiviral medications (e.g., oseltamivir) as prescribed by healthcare providers, particularly for high-risk individuals or those with severe symptoms.
Offer over-the-counter cough suppressants or expectorants to relieve cough symptoms.
Recommend rest and symptom relief measures, such as warm saline gargles for sore throat.

Nursing Implementations

To effectively manage patients with influenza, nurses employ various therapeutic interventions and actions aimed at promoting airway clearance and improving respiratory function. These interventions are crucial for optimizing patient outcomes and preventing complications associated with respiratory tract infections like influenza.

Promoting Effective Airway Clearance:

- Assess respiratory status, including rate, depth, ease, use of accessory muscles, and work of breathing, to monitor for changes indicative of respiratory distress.
- Auscultate lung fields for wheezes, crackles (rales), rhonchi, or decreased breath sounds to identify abnormalities in lung function.
- Monitor oxygen saturation by pulse oximetry and notify the healthcare provider of readings below 90% or as prescribed.
- Assess for pallor or cyanosis, particularly in nail beds and around the mouth, as potential signs of hypoxemia.
- Monitor cough and sputum production, noting the amount, color, character, and the client’s ability to expectorate secretions.
- Monitor vital signs, including temperature and heart rate, to assess for fever and tachycardia, which may indicate infection or respiratory distress.
- Assess skin and mucous membrane changes for signs of dehydration or poor perfusion.
- Observe the client’s general appearance and strength, noting any signs of weakness or fatigue.
- Position the client in a high Fowler or semi-Fowler position, if possible, to optimize lung function and ventilation.
- Turn the client every two hours and as needed to promote drainage of pulmonary secretions and prevent atelectasis.

Improving Breathing Pattern and Breathing Exercises

Influenza viruses spread through aerosols when an infected person coughs or sneezes, leading to respiratory tract infection. Once inside the body, the virus causes cellular dysfunction and degeneration, resulting in symptoms like dyspnea or tachypnea due to inflammatory mediators’ release.

Assess vital signs and monitor respiratory status:
- Monitor baseline respiratory rate, rhythm, and character to detect changes indicating respiratory distress or shock.
- Use pulse oximetry to track oxygen saturation levels, particularly in severe cases where hypoxemia is likely.
Auscultate breath sounds regularly:
- Listen for wheezes, crackles, or decreased breath sounds, which may indicate abnormalities in lung function or the presence of respiratory infection.
Address pain management:
- Assess for pain complaints and provide appropriate medication to alleviate discomfort, as pain can impair respiratory effort and chest expansion.
Foster a calm environment:
- Encourage slower, deeper breathing to help the client manage hypoxia-related anxiety or fear and maintain control over their respiratory function.
Optimize positioning:
- Encourage the client to maintain a semi-Fowler or high-Fowler position to promote chest expansion and respiratory effort, which can improve lung function.
Support the use of respiratory aids:
- Assist the client in utilizing incentive spirometry, nebulizers, or other prescribed devices to prevent atelectasis and ensure proper respiratory function.
Implement chest physiotherapy techniques:
- Perform chest percussion, postural drainage, and other physiotherapy interventions as ordered to promote airway clearance and lung function.
Encourage frequent position changes:
- Assist the client in changing positions every two hours or as needed to enhance comfort and mobilize pulmonary secretions.
Maintain isolation precautions:
- Adhere to prescribed isolation techniques for clients with suspected or confirmed influenza to prevent transmission and ensure safety.
Educate the client and family:
- Instruct on proper isolation procedures, respiratory hygiene, and hand hygiene to minimize the risk of infection spread.
Teach coughing techniques:
- Demonstrate the use of a pillow to splint the chest during cough efforts and instruct on the “quad cough” technique to maximize effectiveness while minimizing discomfort.
Introduce relaxation techniques:
- Educate on relaxation, guided imagery, muscle relaxation, and breathing exercises to reduce pain, anxiety, and improve respiratory effort and oxygenation.

Managing Pain and Discomfort

Influenza commonly causes various symptoms that result in pain and discomfort for the client. Myalgias, or muscle aches, can range from mild to severe, while headaches, often frontal or retro-orbital, are typically severe. Additionally, a sore throat, which can be severe and last several days, is a significant reason why clients seek medical attention.

Assess for symptoms of pain and discomfort.
- Evaluate complaints of headaches, sore throats, general malaise, weakness, muscle aches, and pain, which are common manifestations of influenza.
- Recognize that these symptoms result from inflammation, elevated temperature, and the body’s immune response to infection, potentially exacerbated by dehydration.
Monitor vital signs:
- Note changes in heart rate and blood pressure, which may increase due to the autonomic response to pain and discomfort.
Observe for signs of irritability and sleep disturbances:
- Recognize nonverbal cues indicating the presence or severity of pain, such as restlessness or difficulty sleeping despite exhaustion.
Create a restful environment.
- Provide a quiet atmosphere and schedule regular rest periods to minimize stimuli that may exacerbate pain and promote healing and recovery.
Offer methods to alleviate muscle discomfort:
- Suggest warm baths or heating pads to relax tight muscles and relieve muscle aches, taking precautions to avoid burns, especially if a fever is present.
Provide cooling measures for headaches.
- Apply a cool compress to the forehead to reduce headache discomfort and promote vasoconstriction, which can help alleviate pain.
Offer soothing backrubs.
- Perform gentle massages to help relieve muscle aches and headaches, potentially reducing cortisol levels and supporting the immune system.
Encourage throat relief measures:
- Recommend gargling with warm water and providing throat lozenges or hard candies to keep the throat moist and alleviate soreness, especially during the morning when symptoms may worsen.

Managing Hyperthermia

During acute infections, the body often responds with a febrile reaction. While a mild fever may enhance host defense mechanisms and diminish viral replication, higher temperatures can have detrimental effects on cellular and tissue function. Monitoring vital signs, noting symptoms such as shaking chills or diaphoresis, and assessing intake and output are crucial in managing hyperthermia.

Monitor vital signs regularly, especially temperature, using consistent methods:
- Assessing temperature every two to four hours helps evaluate treatment efficacy and detect complications. Fever varies among clients, with some experiencing low-grade fevers and others developing high temperatures.
Note shaking chills or profuse diaphoresis:
- Chills often precede temperature spikes and are the body’s response to generating more heat. Diaphoresis, or sweating, is another physiological response to fever and helps dissipate heat.
Monitor intake and output.
- Regular monitoring identifies fluid imbalances, particularly in clients with poor fluid intake during fever. Dehydration can exacerbate hyperthermia and compromise tissue perfusion.
Monitor for seizures.
- High temperatures can lead to seizures due to hyperactivity in the brain. Acute encephalopathy, characterized by altered mental status and seizures, has been associated with influenza A virus infection.
Assess the environmental temperature:
- Ensure the room temperature and linens are adjusted to maintain a near-normal body temperature. Excessive heat in the environment can contribute to elevated body temperature.
Provide tepid sponge baths.
- Tepid baths aid in heat loss through evaporation and help prevent chilling. Avoid using ice water or alcohol, as they can induce shivering and skin dehydration.
Use a cooling blanket if temperature remains elevated.
- Cooling blankets facilitate heat loss through conduction and can be effective if other methods fail to reduce temperature. Monitor closely to prevent hypothermia and skin tissue injury.
Adjust environmental temperature and bedding:
- Manipulate room temperature to promote heat dissipation from the body. Adjust blankets according to the client’s temperature to maintain a comfortable and safe environment.

Promoting Optimal Fluid Balance

Influenza virus infection can lead to dehydration due to increased fluid losses and decreased intake, potentially resulting in severe complications. Effective management of fluid balance is essential to prevent dehydration and associated complications.

Assess vital signs for changes:
- Monitor for elevated temperature, prolonged fever, tachycardia, and orthostatic hypotension. Elevated temperature and prolonged fever increase fluid loss through evaporation, while orthostatic changes may indicate systemic fluid deficit.
Evaluate skin turgor and mucous membrane moisture:
- Assess skin turgor and moisture of oral mucous membranes, such as lips and tongue. Dry oral mucous membranes may result from mouth breathing and supplemental oxygen. Skin warmth and dryness may indicate volume depletion due to poor fluid intake.
Monitor for nausea and vomiting:
- In severe cases of influenza, especially in children, nausea and vomiting may occur, leading to fluid loss and dehydration.
Monitor intake and output, noting urine color and character:
- Track fluid intake and output to assess fluid balance. Concentrated urine with increasing specific gravity suggests dehydration and indicates the need for increased fluid intake.
Encourage increased fluid intake:
- Promote fluid intake of at least 3,000 ml daily, adjusting based on individual needs. Estimate daily maintenance fluid requirements based on weight and add to fluid deficit as needed.

Providing Patient Education & Health Teachings

Annual influenza vaccination has proven effective in reducing morbidity and mortality, particularly among high-risk individuals. Educating clients about influenza and the importance of vaccination is crucial for prevention, and healthcare professionals play a vital role in this effort.

Assess the client’s understanding of the disease process:
- Identify any misconceptions or gaps in knowledge about influenza to tailor education effectively. Correcting misconceptions can positively impact preventative practices and vaccine acceptance.
Ensure the client’s readiness to receive information:
- Consider the client’s current condition and willingness to engage in learning. Respect the client’s decision if they are unable or unwilling to participate actively in education.
Review normal lung function and the pathology of the condition:
- Use clear and appropriate language to explain normal lung function and how influenza affects the respiratory system. This helps clients understand the importance of following treatment recommendations.
Assess for allergic reactions to vaccines:
- Determine if the client has any allergies, particularly to eggs, which are used in some vaccines. Ensure that vaccines are administered safely according to guidelines, especially for individuals with egg allergies.
Use brief teaching sessions in a quiet environment:
- Optimize learning by providing information in short, focused sessions, especially for older adults. Keep the environment quiet to minimize distractions and enhance concentration during teaching sessions.

Infection Control:

- Implement standard precautions, including hand hygiene, respiratory etiquette (covering coughs and sneezes), and wearing personal protective equipment (PPE) when providing care to patients with suspected or confirmed influenza.
- Advise patients to stay home from work, school, or public gatherings until they are no longer contagious (typically 24 hours after fever resolution without the use of fever-reducing medications).
- Educate family members and close contacts about the importance of hand hygiene and avoiding close contact with infected individuals to prevent transmission.

Patient Education:

Provide education about influenza transmission, symptoms, and management strategies.
Emphasize the importance of vaccination, especially for high-risk populations such as older adults, young children, pregnant women, and individuals with chronic medical conditions.
Discuss strategies for preventing the spread of influenza within the household and community, including hand hygiene, environmental cleaning, and respiratory hygiene practices.

Complications Prevention:

Monitor for signs of respiratory distress, pneumonia, or worsening symptoms that may indicate complications.
Educate patients about the importance of seeking prompt medical attention if symptoms worsen or new symptoms develop.
Encourage vaccination against influenza to prevent future infections and reduce the severity of symptoms if exposure occurs.