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Unit V Promoting Health in Patients With Oxygenation Disorders
Complications Primary influenza viral pneumonia is the least common but severest complication of influenza infection and occurs more frequently in individuals over the age of 65 years with or without chronic underlying illness. This complication is marked by progressive shortness of breath, persistent fever, and cardiovascular compromise. Dyspnea with negligible sputum production that may be visibly blood-streaked is also associated with the onset of a secondary bacterial pneumonia. Frequent bacterial organisms linked to sec- ondary pneumonia are Streptococcus pneumoniae, Staphylo- coccus aureus, and Haemophilus influenzae . These organisms are resident “normal flora” within the nasopharynx that become pathological when the respiratory defenses are altered. Secondary bacterial pneumonia classically presents as improvement in viral symptoms followed by an acute recurrence of symptoms and purulent nasal and tracheal secretions. Sinus and middle ear secondary bacterial infec- tions may also accompany an influenza viral illness. Nursing Management Assessment and Analysis The clinical manifestations observed in the patient with influenza—cough, headache, nasal congestion, sore throat, and fever—are typically the result of the inflam- matory response once the virus has invaded the respira- tory epithelium. Nursing Diagnoses/Problem List l Ineffective breathing pattern related to infection/ inflammation of the lung l Decreased activity tolerance related to hypoxia l Alteration in gas exchange—decreased related to impaired alveolar-capillary interface l Fluid volume deficit related to insensible losses from fever and tachypnea l Malaise l Fever l Fatigue Nursing Interventions ■ Assessments l Vital signs Tachypnea: The body’s first compensatory mechanism to a decreased oxygen delivery is increased respiratory rate and depth. Tachycardia: The body’s second compensatory mechanism for a continued impairment of oxygen delivery is to raise the heart rate. Decreased oxygen saturation: Impaired gas exchange at the alveolar level results in hypoxia. Tachypnea and tachycardia decrease cardiac output, reducing perfusion and peripheral oxygen saturation. Fever occurs as a part of the inflammatory response. l Neurological function Agitation, restlessness, anxiety, lethargy, and fatigue are the result of decreased tissue perfusion from altered alveolar gas exchange.
l Breath sounds Adventitious breath sounds such as rhonchi, crackles, and rales may be audible on lung assessment from fluid and exudates filling the alveoli. Audible wheezing is a result of airway reactivity due to inflammation and/or bronchospasm. l General appearance Sudden onset of fever, chills, muscle aches, and fatigue in a generally ill-appearing patient l Cough, nasal congestion, sneezing, rhinorrhea Primary viral pneumonia from influenza can cause cough- ing that lasts up to 2 weeks. Secretions that are white in color are consistent with viral infection. Purulent nasal discharge/ sputum indicates a secondary bacterial infection. l Peripheral pulses and skin temperature and color Diminished tissue perfusion causes blood to be shunted away from peripheral areas to the main core body organs. Peripheral pulses diminish, and skin becomes moist and pale. Peripheral cyanosis (bluish color to the nailbeds) is a late sign of tissue hypoxia. l Laboratory values Arterial blood gases (ABGs): Primary respiratory infections may initially cause a respiratory alkalosis (increased pH, decreased carbon dioxide [CO 2 ]) in response to tachypnea. As the condition progresses, a respiratory acidosis (decreased pH, increased carbon dioxide [CO 2 ]) will develop. Positive RIDTs: These tests are sensitive, so a positive test is indicative of the presence of flu, but a negative test needs to be evaluated taking into account the patient’s clinical presentation—a potential false negative. ■ Actions l Initiate appropriate isolation precautions (Table 24.4). Place patient on droplet precautions to avoid viral transmission . Personal protective equipment required includes a mask, gown, gloves, and eye protection if there is a risk of splashing of bodily fluids. The patient should wear a mask when outside the room. Visitors should wear a mask while in the room. A private room is desirable unless patients with similar infections are cohorted. l Administer humidified supplemental oxygen. Improving oxygen delivery, reversing hypoxia, and maintaining moist respiratory mucosa are essential to avoid complications. l Position patient in semi- to high Fowler’s (head of bed raised to 30 degrees). Sitting up or elevating the head can provide for the relief of nasal drainage, promoting optimal lung expansion, prevent- ing atelectasis, and preventing aspiration that can lead to secondary bacterial pneumonia. l Medication administration • Administer antipyretics as ordered/indicated. Fever reduction can help reduce hyperdynamic effects on the respiratory and cardiovascular systems and increase patient comfort. • Administer antiviral medications if ordered/ indicated. Early administration of antiviral medications (within 24–48 hours of symptom onset) offers the most favorable
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