Influenza (Flu)

Description

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 Reyes syndrome.
In rare cases, influenza can lead to encephalitis, transverse myelitis, myocarditis,
or pericarditis.

Signs and symptoms

People who have the flu often feel some or all of these signs and symptoms:

Fever* or feeling feverish/chills

Cough
Sore throat
Runny or stuffy nose
Muscle or body aches
Headaches
Fatigue (very tired)
Some people may have vomiting and diarrhea, though this is more common in children
than adults.

*Its important to note that not everyone with flu will have a fever.

Diagnostic Examination

Rapid diagnostic tests for influenza can help in the diagnosis and management
f patients
who present with signs and symptoms compatible with influenza. They also are useful for
helping to determine whether outbreaks of respiratory disease, such as in nursing homes and
other settings, might be due to influenza.

No specific diagnostic tests are used because diagnosis is made by the history of symptoms and
onset. If the patient has symptoms of a bacterial infection that complicates influenza, cultures
and sensitivities may be required.

Primary Nursing Diagnosis

Infection related to the presence of virus in mucus secretions
OUTCOMES. Immune status; Knowledge: Infection control; Risk control; Risk detection; Nutrition status;
Treatment behavior: Illness or injury; Hydration; Knowledge: Infection control
INTERVENTIONS. Infection control; Infection protection; Surveillance; Fluid/electrolyte management;
Medication management; Temperature regulation

Complications of flu
Complications of flu can include bacterial pneumonia, ear infections, sinus infections, dehydration, and
worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.

Mode of Transmission
Influenza virus shedding (the time during which a person might be infectious to another person) begins
the day before symptoms appear and virus is then released for between 5 to 7 days, although some
people may shed virus for longer periods. People who contract influenza are most infective between the
second and third days after infection.The amount of virus shed appears to correlate with fever, with

higher amounts of virus shed when temperatures are highest.Children are much more infectious than
adults and shed virus from just before they develop symptoms until two weeks after infection.

Influenza virus may be transmitted among humans in three ways:

1. by direct contact with infected individuals;
2. by contact with contaminated objects (called fomites, such as toys, doorknobs); and
3. by inhalation of virus-laden aerosols.
The contribution of each mode to overall transmission of influenza is not known. However, CDC
recommendations to control influenza virus transmission in health care settings include measures that
minimize spread by aerosol and fomite mechanisms.

Medical Management

People with the flu are advised to get plenty of rest, drink plenty of liquids, avoid using alcohol
and tobacco and, if necessary, take medications such as acetaminophen (paracetamol) to relieve
the fever and muscle aches associated with the flu.
Children and teenagers with flu symptoms (particularly fever) should avoid taking aspirin during
an influenza infection (especially influenza type B), because doing so can lead to Reye's
syndrome, a rare but potentially fatal disease of the liver.
Since influenza is caused by a virus, antibiotics have no effect on the infection; unless prescribed
for secondary infections such as bacterial pneumonia.
Antiviral medication may be effective, but some strains of influenza can show resistance to the
standard antiviral drugs and there is concern about the quality of the research.
Phenylephrine and antitussive agents such as terpin hydrate with codeine are often prescribed
to relieve nasal congestion and coughing. In patients with influenza that is complicated by
pneumonia, antibiotics may be administered to treat a bacterial superinfection.

Medication or Drug Class

Dosage

Description

Rationale

Antipyretics

Varies with drug

Aspirin,
acetaminophen

Control fever and discomfort; generally

aspirin is avoided to reduce the risk of
Reyes syndrome

Amantadine

Provides antiviral action against influenza

100200 mg PO
(prophylaxis and symptomatic); usually
qd, bid for several Antiviral infective prescribed for outbreaks of influenza A
days
within a closed population, such as a
nursing home

Other Drugs: Neuraminidase inhibitors (oseltamivir and zanamivir) for use in treatment and
prophylaxis of influenza A and B; rimantadine for treatment and prophylaxis of influenza A only;

antiviral treatment should be initiatied within 48 hours of the onset of symptoms to be

effective.

Nursing Interventions
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Administer analgesics, antipyretics, and decongestants, as ordered.

Follow droplet and standard precautions.
Provide cool, humidified air but change the water daily to prevent pseudomonas superinfection.
Encourage the patient to rest in bed and drink plenty of fluids.
Administer I.V. fluids as ordered.
Administer oxygen therapy if warranted.
Regularly monitor the patients vital signs, including his temperature.
Monitor the patients fluid intake and output for signs of dehydration.
Watch for signs and symptoms of developing pneumonia.
Advise the patient to use mouthwash or warm saline gargles to ease sore throat.
Teach the patient the importance of increasing fluid intake to prevent dehydration.
Suggest a warm bath or heating pad to relieve myalgia.
Review prevention of future influenza episodes with patient and the community.

Prevention
Vaccination

The influenza vaccine is recommended by the World Health Organization and United States Center for
Disease Control and Prevention for high-risk groups, such as children, the elderly, health care workers,
and people who have chronic illnesses such as asthma, diabetes, heart disease, or are immunocompromised among others.
There are two types of vaccines:

The "flu shot" is an inactivated vaccine (containing killed virus) that is given with a needle. It
can be given in the muscle or just under the skin. The flu shot that is given in the muscle is
approved for use in people older than 6 months, including healthy people and people with
chronic medical conditions. The flu shot that is given below the skin is for those 18-64 years of
age.

The nasal-spray flu vaccine is a vaccine (sometimes called LAIV for "Live Attenuated
Influenza Vaccine") made with live, weakened flu viruses that do not cause the flu. LAIV is
approved for use in healthy people 2 years to 49 years of age who are not pregnant.

Infection control

Reasonably effective ways to reduce the transmission of influenza include good personal health
and hygiene habits such as: not touching your eyes, nose or mouth;frequent hand washing (with

soap and water, or with alcohol-based hand rubs);covering coughs and sneezes; avoiding close
contact with sick people; and staying home yourself if you are sick.
Although face masks might help prevent transmission when caring for the sick, there is mixed
evidence on beneficial effects in the community.
Smoking raises the risk of contracting influenza, as well as producing more severe disease
symptoms.
Since influenza spreads through both aerosols and contact with contaminated surfaces, surface
sanitizing may help prevent some infections.
Alcohol is an effective sanitizer against influenza viruses, while quaternary ammonium
compounds can be used with alcohol so that the sanitizing effect lasts for longer.
In hospitals, quaternary ammonium compounds and bleach are used to sanitize rooms or
equipment that have been occupied by patients with influenza symptoms.At home, this can be
done effectively with a diluted chlorine bleach.

References:

http://www.virology.ws/2009/04/29/influenza-virus-transmission/
http://www.phac-aspc.gc.ca/influenza/index-eng.php
http://en.wikipedia.org/wiki/Influenza#Transmission
http://www.health.ny.gov/diseases/communicable/influenza/fact_sheet.htm
http://www.cdc.gov/flu/keyfacts.htm