Nursing critique
bellavitaa333
Influenza.pptx
Influenza
Overview
Case Study
Pathophysiology
Symptoms
Potential Barriers
Medication management
Image retrieved from : https://micro.magnet.fsu.edu/cells/viruses/influenzavirus.html
Case Study
67yr old female presents with reported productive cough and congestion, fever and chills, muscle aches, nausea, decreased appetite and sore throat for two days. She has been in contact with a family member who had similar symptoms five days ago. She has a history of diabetes and hypertension.
Medications:
Metformin 850mg once daily with breakfast
Amlodipine 5 mg once daily
Allergies: Penicillin
Case Study Cont.
Physical exam
Skin is warm and moist
Lungs are clear bilaterally
Throat is mildly red
Sputum is tan/greenish color
ABD is soft and nontender
Vital Signs:
Oral temp- 101.7
heart rate- 103
Resp- 20
BP- 138/82
O2-98%
Labs:
Glucose: 145
PCR: Positive for Influenza A virus
Creat: 0.8
Influenza
Respiratory Virus
Immune response
Replication: transcription
Sign and symptoms
Image retrieved from:https://upload.wikimedia.org/wikipedia/commons/9/9e/Symptoms_of_influenza.svg
Symptoms of the influenza virus are caused by the bodies immune response. The virus enters the body when a person comes in contact and breathes in aerosols from an infected person. The virus begins to infected epithelial cells of the respiratory tract where they replicate via transcription in the host cells nucleus and continue to infect other cells. The body detects the virus as being foreign and attempts to get rid of it. It does so by bringing immune cells to the area of the infection causing inflammation. The body also attempts to rid the virus by secreting mucous through goblet cells causing congestion. Influenza can cause severe symptoms and lead to pneumonia is the virus reached the lungs and infects the cells lining the alveoli. Common signs and symptoms include cough, sore throat, runny nose, fever, chills, myalgia, and headache. More severe symptoms include shortness of breath, tachycardia, and hypotension (Kalil, & Thomas, 2019).
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Potential Barriers
Vaccinations
Disbelief
Untrustworthy of officials
Social Determinants
Access to healthcare
Health insurance
Education
Crowding
Possible Solutions
Continue to educate public
Increase access to healthcare
Participate in free vaccine clinics
Image retrieved from: https://www.managedhealthcareexecutive.com/view/health-disparities-persist-flu-vaccines
Vaccinations have shown t decrease the likelihood of people getting infected with the influenza virus and if they do become infected, they usually have very mild symptoms. It is strongly encouraged for those over the age of 65 to receive and annual influenza vaccine because they are at the highest risk of developing severe symptoms if they become infected with the virus. There are a few barriers to why people don’t get the flu vaccine each year. Some people do not believe that the flu vaccine prevents the flu, some have had flu like symptoms when they receive the vaccine and do not want to experience them again, some people lack access to to the vaccine, some may lead an unhealthy lifestyle and do not follow with a healthcare professional. There is a large number of people who wish to not receive any vaccination and sometimes keep their children from receiving vaccinations as well. Some reasons for this may be that they do not see that the virus is a threat to the them, some don’t see the vaccine as being effective, some do not trust the vaccine and authorities that control it (Kalil, & Thomas, 2019).
Social determinants also affect influenza incidence. There is a decreased uptake of vaccinations in lower socioeconomic areas due to access to healthcare, insurance status, and language barriers. It can also be assumed that these patients are living in more crowded areas and therefore the virus can spread easier. Education may be lacking in regards to prevention of the virus. Patients in this group are also among the highest risk to be hospitalized due to influenza (Chandrasekhar et al., 2017) .
Some possible solutions to decreasing the incidence rate of influenza is to continue to educate patients and the public on prevention methods as well as the benefits to getting vaccinated annually. In lower socioeconomic areas, it would be beneficial to assist in providing better access to healthcare through government funded clinics and vaccination clinics.
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First Line Medication
Oseltamivir (Tamiflu)
Dose: 30mg, 45mg, or 75mg
Mechanism of action
Adverse Effects
Major contraindications
Major Drug interactions
Image retrieved from: http://www.chm.bris.ac.uk/motm/tamiflu/how_work.htm
Image retrieved from:https://emedz.net/tamiflu-oseltamivir/
Oseltamivir commonly known as Tamiflu, is the first drug of choice for patients with influenza infection. It is recommended to start within 48 hours of symptoms to have the best effect. Doses vary depending on the age of the patient. Adults should be prescribed 75mg two times daily for 5 days. For children 1 year and older, the dose varies depending on weight and ranges from 30mg to 75 mg two times daily. Children lass than 15kg should be prescribed 30mg twice daily, 15-23kg should be prescribed 45mg twice daily, 24-40kg should be prescribed 60mg twice daily, and greater than 40kg should be prescribed 75mg twice daily. Doses come in capsule form and oral suspension, (Uyeki, et al., 2019).
Oseltamivir is taken in the form of oseltamivir phosphate which is quickly metabolized into oseltamivir carboxylate. The Influenza virus contains neuraminidase enzymes which are needed to release the virus from the infected host cells. The OC binds to these enzymes and the progeny virions are no longer able to release from the host cell which slows the viruses ability to replicate. This helps to decrease the viral load, slowing the progression and preventing serious complications in patient such as pneumonia.
The most common adverse drug reactions to Tamiflu are nausea, vomiting, and diarrhea. Very rare symptoms include severe skin reaction and neuropsychiatric events such as hallucinations. There are no reported major contraindications for oseltamivir. The only drug interaction reported is the live attenuated influenza vaccine. Oseltamivir may alter the immune response and therefore the vaccine should not be given within 48 hours after administration of oseltamivir, and oseltamivir should not be administered within two week’s after receiving the live attenuated influenza vaccine (Han, Oh, & Kim, 2020).
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Alternative
Baloxavir marboxil (Xofluza)
Dose: 40mg, 80mg
Mechanism of action
Adverse Effects
Major contraindications
Major Drug interactions
Image retrieved from: https://www.xofluza.com/hcp/why-xofluza/mechanism-of-action.html
The second line medication that can be used if the patient is allergic to Tamiflu is baloxavir marboxil, brand name is Xofluza (CDC,2020). which just became FDA approved in 2018 in the United States. It is not approved for patients under the age of 12 years old. It is an antiviral as well and should be administered within 48 hours of the onset of symptoms but works a little bit differently than Tamiflu (Uyeki et al., 2019) The recommended dose for patients who weigh 40-80kg is 40mg and for patients weighing over 80kg is 80mg. Doses come in tablet form of 20mg or 40mg each but it is prescribed as a one time dose. Xofluza is a polymerase acidic (PA) endonuclease inhibitor which inhibits the ability of the virus to replicate. The most common adverse effects include nausea, diarrhea, headache, and bronchitis although all side effects are rare (O'Sullivan, Torres, Rodriguez, & Martin-Loeches, 2020). There are no major contraindications for Xofluza but it should not be taken with any dairy products, calcium-fortified beverages, polyvalent cation-containing laxatives, antacids, or oral supplements like calcium, iron, magnesium, selenium, or zinc. The only drug interaction is the same as Tamiflu, a live attenuated influenza vaccine should not be administered within 48 hours after baloxavir and baloxavir should not be given within two week’s after the administration of a live attenuated influenza vaccine as it would decrease the immune response (Ng, 2019).
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Outcomes
Relief of Symptoms
Prevention of serious complications
Follow up if symptoms worsen
Emergency room
The optimal outcome of both medications is for flu symptoms to resolve and prevent serious complications of influenza such as pneumonia. Patients should follow up with their provider if they do not have any relief of symptoms after the 5 day course of oseltamivir or after the one time dose of Xofluza. Tamiflu may need to be prolonged or other treatment options may need to be evaluated such as antibiotic treatment for possible pneumonia. There is no need to follow up with a provider if symptoms resolve and there are no serious reactions to the medications. If patients experience increased shortness of breath, chest pain, uncontrollable fever, prolonged vomiting or diarrhea, they should seek emergency medicine. Just like antibiotics, antivirals can cause an increase in mutations and resistance to medications (Uyeki, et al.,2019)
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References
Center for Disease Control and Prevention (2020, November) Influenza Antiviral Medications: Summary for Clinicians. Retrieved November 28, 2020 from https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#Table1
Chandrasekhar, R., Sloan, C., Mitchel, E., Ndi, D., Alden, N., Thomas, A., et al. (2017). Social determinants of influenza hospitalization in the United States. Influenza and Other Respiratory Viruses, 11(6). p.479-488.
Han, N., Oh, J.M. & Kim, I.W. (2020) Assessment of adverse events related to anti-influenza neuraminidase inhibitors using the FDA adverse event reporting system and online patient reviews. Scientific Reports 10(3116) p 1-8. https://doi.org/10.1038/s41598-020-60068-5
Kalil, A.C., & Thomas, P.G. (2019). Influenza virus-related critical illness: Pathophysiology and epidemiology. Critical Care, (23), p 258. doi: https://doi.org/10.1186/s13054-019-2539-x
Ng, K.E. (2019). Xofluza (Baloxavir Marboxil) for the treatment of acute uncomplicated influenza. Pharmacy and Therapeutics, 44(1) p 9-11. Doi: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336199/pdf/ptj4401009.pdf
O'Sullivan, S., Torres, A., Rodriguez, A., & Martin-Loeches, I. (2020). Influenza management with new therapies. Current Opinion in Pulmonary Medicine, 26(3), p 215-221. Doi: 10.1097/MCP.0000000000000667
Uyeki, T.M. Bernstein, H.H., Bradley, J.S., Englund, J.A., File, T.M., et al. (2019). Clinical practice guidelines by the infectious diseases society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza. Clinical Infectious Disease, 68(6), e1-e47. Doi: https://doi.org/10.1093/cid/ciy866
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Nasopharynx - Runny or stuffy nose - Sore throat - Aches Systemic - Fever (usually high) Central - Headache Respiratory - Coughing Gastric - Vomiting Symptoms of Influenza Muscular - (Extreme) tiredness Joints - Aches
