INFLUENZA (The Flu) What Nurses Should Know. Felissa R. Lashley, RN, PhD, FAAN, FACMG Professor, College of Nursing, and Interim Director, Nursing Center for Bioterrorism and Infectious Disease Preparedness, College of Nursing Rutgers, The State University of New Jersey
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Felissa R. Lashley, RN, PhD, FAAN, FACMG
Professor, College of Nursing, and
Interim Director, Nursing Center for Bioterrorism and Infectious Disease Preparedness, College of Nursing
Rutgers, The State University of New Jersey
This module is designed to highlight important information about influenza. The influenza virus, in addition to being the cause of influenza, an important infectious disease, is also considered to be a potential agent for bioterrorism and is considered as a possible Category C bioterrorism agent by the Centers for Disease Control and Prevention (CDC). This module was supported in part by USDHHS, HRSA Grant No. T01HP01407.
At the conclusion of this module, the
participant should be able to:
Abrupt onset of constitutional and respiratory symptoms complications of influenza
Fever, duration typically 1 to 5 days, with an average of 3 days and peak within 12 hours after symptoms. Typical temperatures are 38 to 40 deg. C.
Cough, usually unproductive
May have eye tearing, burning, photophobia or eye pain
Children may have otitis media and nausea and vomiting as well as febrile convulsions in addition to other symptoms
Elderly persons may present with minimal respiratory symptoms but show lassitude, high fever and confusion
Respiratory symptoms may increase as fever decreasesClinical Manifestations
The following symptoms are more commonly seen in influenza rather than the common cold:
High fever lasting 3 to 4 days
Fatigue and weakness
Severe chest discomfort and cough
The following symptoms are more commonly seen in the common cold rather than influenza:
Stuffy nose is common
Sneezing is common
Cough is generally mild to moderate
Symptoms such as fever, headache, aches and pains and exhaustion are rare in those with colds.Clinical Differentiation Between the Common Cold and the Flu(see Table 1 at end of module)
Major respiratory complications include:
Major non-respiratory complications include:
Laboratory diagnostic methods include:
Certain antiviral agents may be used
Infection Control Measures
Infection Control Measures cont.
Health care workers with respiratory infection symptoms should be excluded from work for the duration of the illness
In health care settings, influenza testing should be done early in the outbreak to obtain the type and subtype of virus responsible
Droplet Precautions with suspected or confirmed influenza should be implemented and authority to do so should be decided with nursing staff inclusion
As detailed further under Droplet Precautions, suspected or confirmed influenza patients should be separated from asymptomatic patientsManagement including Infection Control Measures cont.-4
Antiviral agents may be used for prophylaxis,
often in combination with the flu vaccine in an
Recommendations for 2008-2009 Influenza season are given below
Source: CDC, MMWR 57, 2008 pg 2
For adults for the 2008-2009 flu season recommendations are for any adult and for and for all adults in the following groups because of higher risk:
Avian influenza viruses refers to those that are carried by birds, usually wild birds that when infected, shed virus in saliva, nasal secretions and feces. Birds or fowl become infected when they come into contact with secretions or excretions from infected birds most often through fecal-oral transmission. Transmission also occurs through contact with surfaces or materials such as feed, water, cages or dirt that are contaminated with the virus. Contaminated cages, for example, can carry the virus from one place to another.
Avian influenza viruses vary in their degree of pathogenicity
First documented direct transmission of an avian influenza (influenza A) virus (H5N1) to humans occurred in 1997 in Hong Kong
Severe respiratory disease occurred in 18 healthy young adults and children and 6 died
The outbreak was controlled by slaughter of the poultry population. More than 1.2 million chickens and 0.3 million other poultry were killed and imports of chickens from Hong Kong and China were banned by other countries. Quarantine and depopulation or culling of birds are common ways of control for the outbreak
Live poultry markets were source of the avian influenza virus strain H5N1 in this outbreak. In both influenza and SARS, the so-called “wet-markets” have been implicated as sources. This illustrates a cultural influence on emergence of infectious diseases since the preference of many Asian people for buying fresh foods at these markets have resulted in an increase in these types of markets. In New York City, these increased in number from 44 in 1994 to 80 in 2002.
In 1999, avian influenza viruses, H9N2, were isolated in Hong Kong from children with mild influenza
In 2003, the avian influenza virus strain, H5N1, again emerged in 2 family members in Hong Kong after traveling in China. One died.
In 2003, the avian influenza virus strain H7N7 occurred in poultry farms in the Netherlands, spreading to Germany and Belgium. Infection, mainly conjunctivitis occurred in 83 humans with 1 death. The outbreak was controlled by destroying over 30 million domestic poultry
In 2003, the avian influenza virus, H9N2 was identified in a child in Hong Kong with influenza who recovered
In 2003, an outbreak of avian influenza virus, H5N1, occurred in South Korea, and in 2004 emerged in Vietnam and Thailand. Human cases presented with severe respiratory infection and out of 23 known and confirmed cases, 18 died. Many countries banned the import of poultry products from the Asian countries affected. Other countries in which poultry were infected included Japan, Laos, China, Cambodia, and Indonesia.
In 2004, an outbreak of avian influenza, H7N7 occurred in British Columbia, Canada. Infection has been reported in 5 humans whose major illness was conjunctivitis.
In 2004-2005, east Asia again saw an outbreak of H5N1, particularly in Thailand, Cambodia, and Vietnam.
By June 19, 2008, there were 385 reported human cases of avian flu and 243 reported deaths.
Concern about pandemic flu has resulted in global efforts at prevention.
Documented human-to-human transmission of H5N1 has been noted but is limited. Of concern is that the virus could mutate to allow sustained person-to-person transmission.
Direct exposure to infected birds/poultry
Exposure to surfaces contaminated with infected bird/poultry excretions, mostly through fecal-oral transmission
Rare human-to-human transmission
Fever, over 38 deg. C or 100.4 deg. F
Shortness of breath
Laboratory testing should be prompted for a hospitalized or ambulatory patient with
temperature over 38 deg. C AND
with any one or more of the above symptoms AND
a history of contact with domestic poultry such as a visit to a poultry farm or bird market
Laboratory testing should be prompted for hospitalized patients
with radiologically confirmed acute respiratory distress syndrome, pneumonia or other severe respiratory illness for which an alternate diagnosis has not been established AND
history of travel to an area with documented H5N1 avian influenza within 10 days of the beginnings of symptoms.
For hospitalized patients who have or are suspected of having avian influenza A (H5N1), isolation precautions are same as for severe acute respiratory syndrome (SARS). These include:
Careful hand hygiene before and after all patient contact
Use gloves and gown for all patient contact
Wear eye protection when within 3 feet (and perhaps 6 feet) of the patient
Place patient in an airborne infection isolation room (AIIR).
When entering the patient's room, use a fit tested respirator at least as protective as an N95 filtering-facepiece respirator approved by the National Institute for Occupational Health and Safety (NIOSH)
Outpatients or hospitalized patients discharged in less than 14 days should be isolated in the home setting on the basis of principles for home isolation of SARS patients
These precautions should be continued for 14 days after onset of symptoms until an alternative diagnosis is established or diagnostic test results indicate that the patient is not infected with inflenza A virus (CDC, 2004). Also see: http://www.cdc.gov/flu/avian/index.htm, and http://www.cdc.gov/ncidod/dhgp/pdf/isolation2007.pdf