6 Influenza (Flu) Nursing Care Plans

Ineffective Breathing Pattern

Influenza viruses spread from human to human via aerosols created when an infected individual coughs or sneezes. If not neutralized by secretory antibodies, the virus invades airway and respiratory tract cells. Once the virus is within host cells, cellular dysfunction and degeneration occur. As in other viral infections, systemic symptoms such as dyspnea or tachypnea result from the release of inflammatory mediators (Nguyen & Stuart, 2022).

Nursing Diagnosis

• Ineffective Breathing Pattern

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

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

Nursing Assessment and Rationales

1. Assess vital signs and carefully monitor respiratory status for baseline rate, rhythm, and character.
Respiratory distress and changes in vital signs occur because of physiological stress or may indicate developing shock due to hypoxia. A review of avian influenza cases in four countries found that the clinical course progressed to ARDS and respiratory failure in 70 to 100% of clients (Nguyen & Stuart, 2022).

2. Monitor pulse oximetry readings.
Oximetry approximates arterial blood gas oxygen saturation and helps to identify oxygenation dysfunction and respiratory status changes. In severe cases of influenza, the client is likely to have hypoxemia, and the alveolar-arterial gradient may be increased (>35 mm Hg) (Nguyen & Stuart, 2022).

3. Auscultate breath sounds every four hours and as needed.
This assists with the identification of changes in respiratory status, the presence of adventitious breath sound or decreased breath sounds. The older adult client may have infiltrates in the interstitium, bilateral lobes, and anterior and lower lung fields. Generally, pulmonary findings may include dry cough with clear lungs or rhonchi, as well as focal wheezing (Nguyen & Stuart, 2022).

4. Assess the client for complaints 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. Cough-related pleuritic chest pain is a common manifestation of respiratory infections. Additionally, any type of infection has the potential to spread to the pleura, but viral infections are usually responsible.

Nursing Interventions and Rationales

1. Maintain a calm attitude, assisting the client to “take control” by using slower, deeper respirations.
This assists the client in dealing with the physiological effects of hypoxia, which may be manifested as anxiety or fear. Breathing may no longer be an involuntary activity but require conscious effort, depending on the involvement of respiratory muscles.

2. Encourage the client to maintain a semi-Fowler or high-Fowler position as tolerated.
This promotes chest expansion and enhances respiratory effort. Standing and sitting have been shown to lead to the highest lung volumes. At higher lung volumes, the elastic recoil of the lungs and the chest wall is greater. In addition, the expiratory muscles are capable of generating higher intrathoracic pressure, pushing air through narrow airways at high speed, which results in higher peak expiratory flow (PEF) and FVC (Katz et al., 2018).

3. Encourage the client and assist with the use of incentive spirometry, nebulizers, etc., as ordered.
These interventions assist in preventing atelectasis or lung collapse and ensure proper use of equipment. Incentive spirometry has been widely used to prevent pulmonary complications and to improve lung function in clients with respiratory disorders. Flutter and Acapella devices combine positive expiratory pressure therapy and high-frequency oscillations in the airway. They can reduce airway collapse and improve mucus discharge, enhancing lung function and oxygenation (Shin, 2019).

4. Perform chest physiotherapy, chest percussion, and postural drainage as ordered.
In percussion, cupped hands or the palm cup are used to manually clap the affected lung and perform postural drainage. This allows the shifting of secretions from the peripheral airway to the central airway, enhancing airway clearance. Vibrations can be performed manually or using mechanical devices (Shin, 2019).

5. Encourage the client to change position every two hours and as needed, and assist as needed.
This facilitates comfort and mobilizes pulmonary secretions. Although there is a lack of evidence for the interval of position change, it is generally performed at two to four-hour intervals, which can help reduce the incidence of pulmonary complications such as nosocomial pneumonia and atelectasis (Shin, 2019).

6. Maintain ordered isolation techniques.
Place the client with suspected or confirmed influenza for seven days after illness onset or until 24 hours after the resolution of fever and respiratory symptoms, whichever is longer, while the client is in a healthcare facility (Centers for Disease Control and Prevention, 2021).

7. Instruct the client and/or family members regarding isolation requirements and ensure that they adhere to the proper techniques.
Clients under droplet precautions should wear a facemask and follow respiratory hygiene and cough etiquette and hand hygiene during transport outside of the isolation room. Before discharge, communicate the client’s diagnosis and current precautions with post-hospital care providers as well as transporting personnel (Centers for Disease Control and Prevention, 2021).

8. Teach the client how to use a pillow to split the chest with cough efforts.
Splinting assists in reducing pain associated with cough. Supporting the chest and abdominal muscles makes coughing more effective and less traumatic. Additionally, instruct the client to place hands below the diaphragm and push upward as the client exhales. This is called a “quad cough”. This technique is generally reserved for clients with stable injuries once they are in the rehabilitation stage.

9. Instruct the client in relaxation techniques, guided imagery, muscle relaxation, and breathing exercises.
These interventions assist in pain reduction and alleviate anxiety which may improve respiratory effort and oxygenation. Deep breathing exercises introduce air into the lungs using negative air pressure generated by the client’s diaphragm instead of the accessory respiratory muscles. This can restore atelectasis, improve oxygenation and lung recruitment, increase functional residual capacity and tidal volume, and potentially help clear secretions (Shin, 2019).

10. Administer oxygen as ordered.
This provides supplemental oxygen and helps alleviate respiratory distress caused by hypoxemia. Supplemental oxygenation is given to manage respiratory symptoms or objective hypoxia. Ventilatory support with a bag-valve-mask device or field intubation may be required if the client is in respiratory failure (Nguyen & Stuart, 2022).