Primary Diagnosis and Presenting Complaints

Discuss about the Patient assessment Case Study Of Jim.

Jim was last well a day prior to ad admission, an assessment is done. Primary diagnosis indicates a case of influenza. His presenting complaints are indicative of an emergency, crucial steps need to be undertaken especially on the patency and clearance of the airway, an ineffective breathing pattern and the high body temperature.

The airway is not patent, on inspection it is evident that there is nasal discharge and tonsillar inflammation. Assessment of rhinorrhoea and inflammation serves resulted in respiratory depression. The patency of the airway in the case as vital. A backflow of the nasal discharge could cause fluid aspiration into the lungs causing aspiration pneumonia.

Temperature is a crucial indicator of internal processes and should be adequately assessed.  It is previously shown that the patient had hyperthermia with a body temperature of 38.3°C. This is an evidence of fever and validated by the pulse rate of 105 bpm. Hyperhidrosis is also indicated. This assessment is necessary to ensure that appropriate measures are taken on admission including fluid and electrolyte replacement and ensure there is adequate hydration.  Unmonitored hyperthermia can cause accelerated reduction in the metabolism and the level of consciousness (Hildebrandt et al, (2015)). There is also a possibility of an increased cardiac output, heart rate and eventually risk of a myocardial infarction.

The breathing pattern is also a crucial assessment focus. His airways should be inspected, the chest palpated, inspected then auscultation done to rule on the indication of bilateral wheezing. Adequate objective data to this account provide the on the necessities admission especially on the oxygen administration and monitoring. In spite having good air entry, there is a possibility of pulmonary oedema and reduced oxygen perfusion secondary to the admission status. The initial oxygen saturation is at 94% of recommended (90-100%). Ineffective analysis of this vital could end up in dyspnoea and eventually culminate in respiratory distress.

Nursing Care Plan: Jim

Influenza is suspected upon Jim’s admission. Viral replication and budding peaks earlier than the manifestation of clinical symptoms and the effectiveness of treatment depends on the initiation of the medication.  Jim is given oseltamivir, a neuraminidase inhibitor. Being an analogue of sialic acid it interferes with the budding of the influenza virus and limiting the spread in the respiratory tract. The 75mg Bd dose is favourable because the half-life of 6-10 the drug hours. Drug administration should be as prescribed, given at the right intervals and dosage. The patient response well documented and assessed frequently. Adverse drug reactions associated with Oseltamivir are nausea, vomiting and abdominal pain. The side effects should be clearly dissociated from the presenting complaints.

Assessing the Airway, Temperature, and Breathing Pattern

Paracetamol is a central acting antipyretic and analgesic that acts by weakly inhibiting COX enzymes thus eliciting anti-inflammatory actions (Sin, B; Wai, M; Tatunchak, T; Motov, 2016). The drug is administered 6 hourly to maintain the concentration of the acetaminophen. The administration of paracetamol should be at the regular intervals and at the right dosage to minimise the lethargy caused the fever and alleviate the pain secondary to the muscular pain. Acetaminophen is also dispensed for the fever avoid any propensity of an overdose. It is indicated in Sin et al (2016) that acetaminophen overdose causes depletion of glutathione and hepatic damage. Dose adjustments should be made after consultation.

Fluvax is an influenza vaccine. Fluvax is administered in a trivalent dosage to adults’ intramuscularly. This is to avoid the risk of the complications of the flu. Inoculation of the antigen in the attenuated influenza virus activates the immune system to produce anti-influenza antibodies. The immunity to antigens expressed on the surface especially haemagluttin reduces the possibility of infection and severity of recurrent infection. The subsequent vaccinations should then be scheduled and documentation made. The vaccination may be associated with hyperthermia, malaise, and headache and may increase the sweating. In this case all the temperature has to be recorded frequently.

Jim is a known smoker with an average smoking standard rate of 5-10 cigarettes per day. His health education focus has to be centred on how smoking causes hypertension and the health implications of the smoking lifestyle. The possible courses to complete rehabilitation and a suitable behavioural change model elucidated for him to decide. The effect of the hypertension on his response to infection should also made lucid.

Study indicates that smoking increases the risk to hypertension and vascular malfunction. The vascular endothelium becomes fibrous resulting in increased arterial pressure. This increase results is a cumulative increase in the blood pressure and the manifestation of hypertension. Cigarette smoke has toxic compounds that increase cardiovascular inflammation, cause oxidation of low-density lipoprotein cholesterol (Ambrose, J. A., & Barua, R. S. (2010).

Furthermore, it should be clear that smoking causes the loss of life expectancy and sexual virility. The numerous toxins in cigarette smoking accelerate the aging process. It should also be shown that the exposure of the lungs to the toxins increase the risk of developing throat and lung cancer respectively. The tar also causes toot discolouration and occurrences of bad breath.

Nursing Care Plan for Influenza: Preventing Infection Spread, Managing Self-Care Deficits, and Maintaining Fluid Balance

Additionally, smoking is a possible basis of unexplained weight gain. Supplementary to this, the overall decrease in libido and increase in the predisposition to erectile dysfunction should be made avid. The benefits of living free of smoking should also be set verses the effects of avoidable smoking habits.

Initiatives towards cessation of the code should be initiated with cigarette reduction therapy and counselling. Jim has to take on healthy living. He has to stick on a good diet, with all the necessary nutrients. Undergo psychosocial therapy and specified health education. On his lifestyle he has to embrace physical exercise and change attitudes towards smoking as a recreational activity. He also has to be referred to social welfare agencies to provide care and food since he is homeless.

The fever is caused by the possible occurrence of a bacterial infection after completion of the antiviral therapy. In many occasions, the influenza virus is co-transmitted with bacteria. The initial line of treatment was focused on the virus alone but no prophylaxis was given for a bacterial infection.

Proliferation of bacterial colonies result in the hyper activation of the immune system. Both the adaptive and the innate immune systems are activated. Inflammatory cytokines are released into circulation and initiate the attack to clear bacteria. This immune system response result in the elevation of the body temperature hence the resurgence of the fever. The multiplier effect of the fever culminated in a hyperventilation state and increased heart rate. Jim should be given sponge baths and antipyretics as ordered. The physician should be notified of the change.

Shift handover:

Jim is a 58-year-old homeless Indigenous male of no fixed address. He presented to the Emergency Department with dyspnea, myalgia, fatigue, malaise, rhinorrhea and headache.  His symptoms began approximately 3 day ago and he has tested positive for Influenza A and his influenza symptoms have improved over the past 24 – 48 hours with continued medications. He has a past medical History of asymptomatic hypertension though he is not currently on any antihypertensive because he did not take his previous medication when prescribed. On assessment he was found to be febrile and has shortness of breath. He is allergic to chickens but has no known drug allergies. He states he used to smoke but not so much anymore as he cannot afford them however he does smoke up to 5 – 10 per day if he can get them. Jim is set for discharge after completing his antivirals therapy.

Drug Administration Guidelines for Oseltamivir and Paracetamol

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