5 Influenza (Flu) Nursing Care Plans

5 Influenza (Flu) Nursing Care Plans

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Influenza (also known as flu, or grippe) is an acute inflammation of the nasopharynx, trachea, and bronchioles, with congestion, edema and possibility of necrosis of these respiratory structures. Influenza is a highly-contagious infection of the respiratory tract caused by three different types of Myxovirus influenzae. It occurs sporadically or in epidemics which peaks usually during colder months.

Nursing Care Plans

Unless complications occur, influenza doesn’t require hospitalization and patient care usually focuses on the relief of symptoms.

Here are six (5) nursing care plans (NCP) for Influenza (Flu):

1. Ineffective Airway Clearance

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Ineffective Airway Clearance: Inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway.

May be related to

• - Tracheobronchial and nasal secretions
• - Increased peripheral airway resistance caused by drug therapy
• - Pneumonia

Possibly evidenced by

• - Rhinorrhea or “runny nose”
• - Changes in respiratory rate and depth
• - Irritating nonproductive cough
• - Decreased breath sounds
• - Adventitious breath sounds
• - Production of sputum
• - Restlessness
• - Orthopnea

Desired outcomes

• - Patient will achieve the return of and ability to maintain patent airways and respiratory status baselines.
• - Patient will achieve and maintain patent airway.
• - Patient will have clear breath sounds to auscultation, and will have respiratory status parameters with optimal air exchange.
• - Patient will be compliant and be able to accurately administer medications on a daily basis, preventing exacerbations of disease process.
• - Patient will be able to cough up secretions and perform coughing and deep-breathing exercises.

Nursing Interventions	Rationale
Assess respiratory status for rate, depth, ease, use of accessory muscles, and work of breathing	Changes may vary from minimal to extreme caused by bronchial swelling, increased mucus secretions caused by oversecretion of goblet cells and tracheobronchial infection, narrowing of air passageways, and presence of other disease states that complicates the current condition.
Auscultate the lung fields for the presence of wheezes, crackles (rales), rhonchi, or decreased breath sounds.	Wheezing is caused by squeezing of air past the narrowed airways during expiration which is caused by bronchospasms, edema and secretions obstructing the airways.Crackles or rales, result from consolidation of leukocytes and fibrin in the lung causing an infection or by fluid accumulation in the lungs. Decreased breath sounds may indicate alveolar collapse with little to no air exchange in the lung area being auscultated, and usually results in poor ventilation.
Administer oxygen as ordered. Monitor oxygen saturation by pulse oximetry, and notify physician of readings <90% or as prescribed by physician.	Providing supplemental oxygen benefits the patient.High level oxygen can cause severe damage to tissues, oxygen toxicity, increases in A-a gradients, microatelectasis, and ARDS. Oximetry readings of 90 correlate with PaO2 of 60 mmHg and levels below 60 mmHg do not allow for adequate perfusion to tissues and vital organs.
Assess patient for pallor or cyanosis, especially to nail beds and around mouth.	Although not a reliable indicator of the loss of airway patency, this may indicate hypoxemia. Cyanosis does not occur until a level of 5 grams of reduced hemoglobin/100 ml of blood in the superficial capillaries is reached.
Monitor patient for cough and production of sputum, noting amount, color, character, and patient’s ability to expectorate secretions, and ability to cough.	Mucus color from yellow to green may indicate presence of infection. Tenacious, thick secretions require more effort and energy to expectorate through coughing, and may actually create an obstruction stasis that leads to infection and respiratory changes.
Position patient in high Fowler’s or semi-Fowler’s position, if possible.	To promote maximal lung expansion.
Turn patient every 2 hours and prn.	Repositioning promotes drainage of pulmonary secretions and enhances ventilation to decrease potential for atelectasis.
Administer bronchodilators as ordered	Promotes relaxation of bronchial smooth muscles to decrease spasms, dilates airways to improve ventilation, and maximizes air exchange.
Perform postural drainage and percussion, as ordered.	Postural drainage utilizes gravity to help raise secretions and clear sputum. Percussion and/or vibration may assist with movement of secretions away from bronchial walls and enable patient to cough them up and increase the force of expiration. Some positions utilized during chest physiotherapy may be contraindicated in elderly patients as they may not tolerate intense percussion because of fragility of bones and skin.
Encourage fluids, up to 3-4 L/day unless contraindicated.	Provides hydration and helps to thin secretions for easier mobilization and removal.
Encourage deep breathing exercises and coughing exercises every 2 hours.	Assists in lung expansion, as well as dislodgement of secretions for easier expectoration.
Suction patient if warranted.	Patient may be too weak or fatigued to remove own secretions.
Teach patient or SO regarding splinting abdomen with pillow during cough efforts.	Promotes increased expiratory pressure and helps to decrease discomfort.
Instruct patient and/or SO on alternative types of coughing exercises, such as quad thrusts, if patient has difficulty during coughing.	Minimizes fatigue by assisting patient to increase expiratory pressure and facilitates cough.
Instruct patient on deep-breathing exercises and use of incentive spirometry.	Promotes full lung expansion and decreases anxiety.
Instruct patient and/or SO to avoid using milk, milk products, caffeinated drinks, and alcohol.	Milk and milk products thicken mucus, caffeine reduces the effects of some bronchodilators and alcohol increases cell dehydration and bronchial constriction.
Instruct patient to avoid excessively hot or cold fluids or environmental temperature extremes.	May predispose patient to coughing spells, creating dyspnea, and bronchospasms.
Instruct patient to seek help and stop smoking if patient is a smoker.	Smoking causes increased mucus production, vasoconstriction, increased blood pressure, inflammation of the lung lining, and decreased numbers of macrophages in the airways and mucociliary blanket.
Instruct patient/family to avoid crowds and persons with upper respiratory infections when possible.	Prevents possible transmission of an infection to the patient who already is immunocompromised.
Instruct patient/family in the use of inhalers, nebulizers, and medications.	To provide supporting knowledge, and promotes the correct administration of medication for optimal effect.

2. Ineffective Breathing Pattern

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Ineffective Breathing Pattern: Inspiration and/or expiration that does not provide adequate ventilation.

May be related to

• - Inflammation from viral infection
• - Pneumonia
• - Hemorrhagic bronchitis

Possibly evidenced by

• - Coughing
• - Tachypnea
• - Hemoptysis
• - Cyanosis
• - Dyspnea
• - Pulmonary edema
• - Fever
• - Weakness
• - Diaphoresis
• - Fatigue
• - Leukopenia
• - Sputum
• - Warm flushed skin
• - Erythema to tonsils, soft and hard palate and pharyngeal wall
• - Abnormal chest X-rays

Desired Outcomes

• - Patient will achieve and maintain normal respiratory pattern and rate, with no adventitious breath sounds to auscultation.
• - Patient will be able to expectorate secretions effectively.
• - Patient will maintain and adhere to isolation precautions.
• - Patient will be able to utilize relaxation techniques to improve pain and facilitate breathing.

Nursing Interventions	Rationale
Assess vital signs, carefully monitoring respiratory status for baseline rate, rhythm, and character, and notify physician or significant changes.	Changes may reflect early signs of respiratory compromise and insufficiency.
Monitor pulse oximetry readings and notify physician if <90%	Oximetry approximates arterial blood gas oxygen saturation, and helps to identify oxygenation dysfunction and respiratory status changes.
Auscultate breath sounds q 2-4 hours and prn. Notify physician of changes.	Assists with identification of changes in respiratory status, presence of adventitious breath sounds or decreased breath sounds. The elderly patient may have infiltrates in the interstitium, bilateral lobes, and anterior and lower lung fields.
Administer oxygen as ordered.	Provides supplemental oxygen and helps alleviate respiratory distress caused by hypoxemia.
Assess patient for complains of pain and medicate as needed.	Pain decreases respiratory effort and chest excursion, which decreases ventilation and perfusion. Analgesia, relieves pain and promotes improved respiratory effort.
Encourage patient to maintain semi-Fowler’s or high Fowler’s position as tolerated.	Promotes chest expansion and enhances respiratory effort.
Encourage patient and assist with use of incentive spirometry, nebulizers, etc., as ordered	Assists to prevent atelectasis or lung collapse and ensures proper use of equipment.
Perform chest physiotherapy, chest percussion and postural drainage as ordered.	Helps improve airway clearance and respiratory effort. Helps clear secretions.
Encourage patient to change position every 2 hours and prn, and assist as needed.	Facilitate comfort and mobilizes pulmonary secretions.
Provide and encourage fluid intake of at least 2 L/day unless contraindicated.	Maintain hydration and helps to liquefy secretions to enable patients to expectorate sputum.
Maintain ordered isolation techniques.	Prevents cross contamination and exposure to pathogens.
Instruct patient and/or SO regarding isolation requirements and ensure that they adhere to the proper techniques.	Provides knowledge, decreases fear, and helps prevent further spread of infection.
Teach patient how to use pillow to split chest with cough efforts.	Assists to reduce pain associated with cough.
Instruct patient in relaxation techniques, guided imagery, muscle relaxation, and breathing exercises.	Assist in pain reduction and alleviates anxiety which may improve respiratory effort and oxygenation.

3. Hyperthermia

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Hyperthermia: Body temperature elevated above normal range.

May be related to

• - Influenza viral infection
• - Exposure to infection
• - Alterations in fluid and electrolyte balance

Possibly evidenced by

• - Fever
• - Warm, flushed skin
• - Tachycardia
• - Tachypnea
• - Dry mucous membranes
• - Dehydration
• - Oliguria
• - Seizure
• - Changes in mentation
• - Increased BUN and creatinine
• - Electrolyte imbalances

Desired Outcomes

• - Patient will achieve and maintain normal temperature.
• - Patient will achieve and maintain balanced intake and output with adequate hydration.
• - Patient will be afebrile with stable vital signs.

Nursing Interventions	Rationale
Monitor VS especially temperature, every 2-4 hours and prn. Utilize the same methods of temperature reading with each measurement.	Helps to evaluate efficacy of treatment and monitors for complications that may occur as a result of increased temperature. Consistency in methods allows for accurate data collection and correlation. Increased temperature is a response to the inflammatory process associated with the disease.
Administer antipyretics as ordered.	This type of drug affects the hypothalamic control center to reduce elevated temperature.
Provide tepid sponge baths prn.	Increases heat loss by evaporation. Tepid baths help prevent chilling that may aggravate and increase temperature.
Utilize cooling blanket if temperature will not decrease with use of other methods and if temperature is above 102.5ºF (39.1º C)	Hypothermia blankets remove heat by conduction via the cool solution that is circulated in the mattress placed above and/or below the patient. The cooling blanket must be covered to prevent skin tissue injury and burns. They may also lower the temperature quickly and should be monitored to ensure that a hypothermic condition does not occur. Shivering actually increases the patient’s metabolic rate and temperature.
Decreases environmental temperature and remove extra blankets as warranted.	Helps reduce temperature
Encourage increase in fluid intake to 3-4 L/day, unless contraindicated.	Increase in body temperature multiply insensible fluid losses by 10% for every 1 degree C of increase in body temperature, which may result in dehydration.
Monitor intake and output every 2-4 hours and prn.	Helps to identify fluid status changes and imbalances, and allows for prompt treatment.
Notify physician of temperature increases that do not respond to any measure used.	May indicate other source of temperature aberration and may cause permanent organ damage.
Monitor patient for seizures.	Seizure may occur with high temperatures because of hyperactivity within the brain, which can cause further impair tissue perfusion.
Instruct patient/family in use of hypothermia blanket, reasons for use, signs and symptoms of complications, etc.	Provides knowledge and helps to involve the patient and the family in care.
Instruct patient/family on medications, side effects, and symptoms to report to nurse.	Involves patient and family in care and provide knowledge that facilitates compliance.

4. Acute Pain

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Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.

May be related to

• - Influenza virus
• - Pneumonia
• - Coughing

Possibly evidenced by

• - Verbalization of pain
• - Fever
• - Cough with or without production
• - Body aches
• - Malaise

Desired Outcomes

• - Patient will achieve relief from aches and pain
• - Patient will report pain is controlled or eliminated

Nursing Interventions	Rationale
Assess patient for complaints of headaches, sore throat, general malaise or body weakness, muscle aches and pain.	Caused by inflammation or elevated temperature.
Assess VS for changes from baselines	VS are usually increased as result of autonomic response to pain.
Administer analgesics as ordered.	Pharmacologic therapy to control pain and aches by inhibiting brain prostaglandin synthesis.
Provide restful, quiet environment.	Reduces stimuli that may increase pain.
Provide warm baths or heating pad to aching muscles.	Warmth causes vasodilation and decreases discomfort.
Provide cool compress to head prn.	Promotes comfort and treats headache.
Provide backrubs prn.	Promotes relaxation and relieves aches.
Encourage gargling with warm water; provide throat lozenges as necessary.	Reduces throat discomfort.
Instruct patient or SO in deep breathing, relaxation techniques, guided imagery, massage and other nonpharmacologic aids.	Helps patient to focus less on pain, and may improve efficacy of analgesics by decreasing muscle tension.
Instruct patient or SO regarding use of acetaminophen and to avoid use of aspirin.	Acetaminophen may relieve pain and headache, but should be used cautiously in patients with liver dysfunction because of acetaminophen metabolism in the liver. Aspirin can potentially cause hemorrhage and ulceration, therefore, must be avoided.

5. Deficient Knowledge

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Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.

May be related to

• - Lack of knowledge about the disease process (Influenza)
• - Inability to avoid complications
• - Recurrence of disease

Possibly evidenced by

• - Verbalization of misconceptions, questions about disease
• - Request for information
• - Presence of avoidable complications

Desired Outcomes

• - Patient will be able to understand and verbalize appropriate treatment and care for influenza.
• - Patient and/or SO will be able to accurately verbalize understanding of the influenza disease and methods to use to avoid contracting illness.
• - Patient and/or SO will be able to notify physician immediately during flu season if patient begins to have symptoms of influenza in order to be treated with antivirals.
• - Patient will suffer no complications, such as pneumonia, requiring hospitalization.
• - Patient will be compliant with obtaining annual influenza vaccination.

Nursing Interventions	Rationale
Assess patient’s understanding of disease process.	Patient may have misconceptions about the disease that should be corrected. Identifying baseline knowledge helps to facilitate and establish plan of care for patient and family education.
Ensure that patient is willing and able to listen to information about the disease.	Patient may be in too much pain or too ill to understand and comprehend information. If patient is unwilling to listen to information, accept decision, which will help to facilitate acceptance of right as a patient to choose level of self-participation in care.
Use limited amounts of time for teaching, with provision of a quiet environment.	Helps the elderly patient to remember information being discussed without distracting stimuli. Limiting sessions of instruction helps to avoid overstimulation and overload.
Educate about influenza immunizations.	For high-risk patients and healthcare personnel, suggest annual inoculations at the start of the flu season. Note that some vaccines are made from chicken embryo and should not be given to people who are hypersensitive to eggs. Vaccine administered is based on the previous year’s virus and is usually about 75% effective.
Inform people receiving the vaccine of the possible adverse effects and report them immediately.	Adverse effects include: discomfort at the vaccination site, fever, malaise, and rarely, Guillain-Barre syndrome. Recommend the inactivated variant of the vaccine to women who are pregnant and who will be in the second or third trimester during influenza season.
Teach the proper disposal of tissues and proper hand-washing technique.	To prevent the virus from spreading.
Use appropriate teaching aids for patient’s abilities.	Teaching aids such as written in large font for impaired patient, and so forth helps to provide information in a manner that will be more easily understood by patient and remembered. Normal aging changes may cause memory loss, sensory deficits, and the need for slower, more repetitive teaching.
Instruct patient and/or SO about influenza types, when typical outbreaks occur, and methods to avoid infection.	Influenza occurs every year, normally from November through April, and virus is spread via direct contact or aerosol droplets.Elder people usually have other disease process, are especially prone to infection and should avoid others who have upper respiratory symptoms when possible.
Instruct patient and/or SO that those who are at risk for influenza should always be immunized with the flu vaccine.	Vaccination should be given around October prior to the start of the outbreak of influenza season, but can be given throughout this time until late winter. Prevention of influenza is considered optimal in order to prevent complications, such as pneumonia.
Instruct patient and/or SO about newer antiviral drugs, their effects, when to seek immediate medical attention, and side effects of medications.	Caution should be used if patients have other respiratory diseases or renal insufficiency.Tamiflu(oseltamivir phosphate) and Relenza (zanamivir) are effective for influenza types A and B. Rimantadine and amantadine are effective for influenza A. These drugs are given within 48 hours of onset of symptoms for maximum efficacy. Patients should be also be advised these drugs are not replacement for their annual vaccination.

References and Sources : nurseslabs