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Unit V Promoting Health in Patients With Oxygenation Disorders
outcome for shortening the severity and duration of symptoms and decreasing the incidence of respiratory complications in high-risk patient populations. • Administer analgesics as ordered/indicated. Pain relief can increase comfort and allow for mobiliza- tion and effective coughing/expectoration of respiratory secretions. l Provide adequate fluid intake. Replacing insensible losses from fever and tachypnea allows for optimal cardiovascular performance and liquefaction of respiratory secretions. l Provide adequate nutritional intake. Adequate caloric intake is essential for cell recovery. Frequent small meals high in protein are recommended. l Obtain cultures (nasal swabs, throat swabs, sputum, blood, and urine) before the administration of antiviral medications. To assess for the presence of bacterial infection before presence is masked by medication administration ■ Teaching l Practice good hand hygiene. Hand washing is essential to prevent the spread of the virus to others. l Disinfect frequently used objects and surfaces. Household cleaning products or soap and warm water are sufficient. Hospital-approved cleaners are to be used to disinfect horizontal surfaces during inpatient care. l Limit contact with others for up to 10 days after the first symptoms appear or for at least 24 hours after fever has gone. Viral shedding continues from 10 days up to several weeks. l Report worsening shortness of breath; change in amount, color, and viscosity of pulmonary secretions; and recurrent fever. Viral infections can be mild at first, rapidly progressing to primary viral pneumonia or secondary bacterial pneumonia. l Maintain adequate fluid intake. Insensible losses from tachypnea and fever can lead to dehy- dration and thickening of pulmonary secretions with difficult expectoration. l Perform medication teaching for expected/desired effects, potential side effects, and expected duration of treatment. Take antiviral medications if they are prescribed for you. Make sure to take all of the medication—even if you begin to feel better. Explain that the addition of antibiotics may become necessary for the occurrence of a secondary bacterial infection. Antiviral medications do not “cure” the flu; they just shorten the duration and severity of symptoms and may prevent serious complications. The antiviral choice should be based on local community patterns and susceptibility. l Be sure to get a flu vaccination every year. Vaccination is the best method of preventing the flu. As part of the national hospital performance measures, the Centers for Medicare and Medicaid Services (CMS) and The Joint
Commission (TJC) require all inpatients to be screened for the influenza vaccine and offered the vaccine before discharge if appropriate.
Safety Alert
During the flu season, antiviral medications have the best effect if taken within 2 days of
symptom onset. Although antiviral medications do not offer a cure, lessening of symptom duration and prevention of severe illness and hospitalization are the major benefits.
Evaluating Care Outcomes Influenza may be avoided with flu vaccination. Mild cases of influenza usually resolve without complications. Indicators of resolving viral influenza infection are vital signs within the patient’s normal limits, absence of fever for 24 hours after completion of antiviral medications (if prescribed), even and unlabored respirations, oxygen saturation above 92% or return to patient’s baseline without oxygen admin- istration, absence of nasal drainage, no sputum production, and a clear chest x-ray. Connection Check 24.1 The nurse understands adequate teaching has been done by which of the following statements? A. “I got a flu shot last year; I’m covered for a while.” B. “I don’t need a flu shot; I never get sick.” C. “I guess it’s important to get a flu shot every year.” D. “I don’t get a flu shot, but I make sure my kids get one.”
COVID-19 Epidemiology
In late December 2019, an obscure group of viral pneu- monia cases (without an identified causative organism) was reported in Wuhan, Hubei Province, China. A novel (new) coronavirus was identified as severe acute respiratory syn- drome coronavirus 2 (SARS-CoV-2) as the cause of the outbreak. Coronavirus disease 2019 (COVID-19) is used to describe the symptomatic infection in humans. The exact source of the original outbreak has yet to be deter- mined and clinical investigative research continues. Rapid spread of the new virus throughout China and later worldwide called for the World Health Organization (WHO) to declare a pandemic in March 2020. As of June 2022, over 545 million confirmed cases of COVID-19 had been reported globally with more than 6.3 million deaths. COVID-19 can manifest as asymptomatic to critical. Factors that place individuals at risk for developing severe COVID-19 disease include age (greater than 65 years), long-term care resident, immunocompromise, cardiovas- cular disease, hypertension, diabetes, obesity (body mass
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