Have you ever experienced a combination of these symptoms: sore throat, coughing, rhinorrhea, body aches and a fever? The answer for most people would be yes, this means that for some they have contracted the disease known as influenza or as most commonly put, ‘the flu.’ The aim of this essay is to discuss what influenza is and mode of spread. Also, to identify knowledge of infection control practices, risk assessments, health team involvement and cultural safety. The essay will discuss these points through a case study of an elderly patient by the name of Jimmy Holden who has contracted influenza. This paper will point out that older residents have an increased likelihood of individuals contracting influenza and other health risks.
The influenza virus is an acute respiratory illness that causes an infection in the respiration tract. (Paules & Subbarao, 2017) There are three types of influenza viruses; A, B, and C, these occur through local outbreaks or seasonal epidemics. Even though the influenza virus can sometimes present similar symptoms to a common cold like sore throat, rhinorrhoea, cough, fever, and muscle aches, (Bartok,2014) it also can cause a more severe illness or death. (Barnett, 2019) Just over 100 years ago an epidemic went on to contaminate a billion people and killed at least 50 million. (Barnett, 2019) In the early 21st century to now, influenza remains an extensive cause of mortality. (Barnett, 2019) Influenza viruses are believed to be spread between people through a couple of modes of transmission, (Cowling et al., 2014) although primary influenza or any human respiratory disease is mainly transmitted through droplet transmission (CHENG et al., 2015) that contain the infectious virus. The upper respiratory tract such as the nose, mouth, throat is the primary location of droplet formation. (CHENG et al., 2015) Droplets containing microorganisms are generated when a person is coughing and sneezing, (CHENG et al., 2015) this is why most lung infections result in droplet transmission by which the larger particles from the cough are transmitted and do not remain suspended in the air. (Seto, 2015) As discovered earlier Jimmy who is an elderly man has been diagnosed with influenza, so what does that mean for his wellbeing. According to a study by H. Keipp Talbot, when an elderly person becomes infected by influenza 67% of them become at least temporarily housebound, and 25% become temporarily bedbound. (Talbot, 2017) The study also found that even though the elderly have been exposed to many influenza viruses in the past, the occurrence of this illness and mortality due to influenza continues to surge with age. This is likely because of immune system deterioration with age as it becomes slightly less effective at protecting from diseases, with a higher number of already existing health conditions that are present in older adults. (Talbot, 2017)
With Mr Holden being diagnosed with influenza there are certain infection control precautions that his aged care facility will need to implement to reduce the risk of transmission of infectious agents. This is to ensure the safety of others and stop or minimize the influenza virus from spreading to other vulnerable residents. Some precautions need to be considered, these include the promotion and administration of the influenza vaccine and the following of standard contact and droplet precautions. (Blanco, Eisenberg, Stillwell & Foxman, 2016) As has been previously discussed as people grow older their immune system doesn’t function like it used to. This means that an elderly person could be more prone to catching infections, the best way of protecting them from serious infections is to be vaccinated against them. A study that observed elderly patients who received the influenza vaccine found that “Older adults receiving the influenza vaccine may have a lower risk of influenza (from 6% to 2.4%) … compared with those who do not receive a vaccination over the course of a single influenza season.” (Demicheli et al., 2018) Vaccination is also highly recommended for health care workers. (Blanco et al.,2016) With the additional use of standard contact, droplet precautions reduce influenza virus transmission amongst patients. (Blanco et al.,2016) Droplet precautions involve wearing surgical masks for staff, restricting access to visitors in the unit and in forcing hand hygiene before entering the room and after leaving the room. (Bal et al., 2015) An aged care facility residence is already allocated a single patient room with en suite, to further enforce precautions limiting resident movement outside the room to only when medically necessary is advised. It is also important to educate residents about respiratory hygiene and cough etiquette to reduces spread of droplet particles. (Department of Health and Human Services, 2014)
Aside from the infection risk, while in an aged care facility Mr Holden will also need to have other risk assessments performed by a nurse. The first risk assessment that should be performed is a Fall Risk Assessment. This is because Mr Holden is stated to be “unsteady when mobilising and uses a walking frame,” this puts Mr Holden at a risk for falling. Fall risk assessments have been determined as the best practice for preventing falls and injury obtained from falls in residential aged care. (Department for Health and Ageing, 2015) Risk assessments are used to identify residents who are most at risk for falling and to identify essential factors that contribute to their increased risk of falling. (Barker, Nitz, Low Choy & Haines, 2009) The second risk assessment that should be considered is a Pressure Injury Assessment. A pressure injury is defined as a: “Localised injury to the skin, and/or underlying tissue, usually over a bony prominence, as a result of pressure.” (Charalambous, Koulori, Vasilopoulos & Roupa, 2018) A person who is most at risk of developing a pressure injury are those who have: reduced mobility, are over the age of 65, have a low BMI, and have underlying medical conditions. (Charalambous et. al., 2018) By identifying these factors it is safe to say that Mr Holden is at risk of developing a pressure injury. Another assessment would be a fluid balance chart. The aim of an FBC is to keep an accurate record of a patient’s fluid input and output and to identify any deficits. (Scales & Pilsworth, 2008) Fluids in any patient are vital to their health, especially for Jimmy who needs to have an adequate amount of fluids due to having influenza. The last assessment is a pain assessment, by observing Jimmy’s condition such as decreased mobility and suffering symptoms of influenza such as aching joints, a pain assessment would be appropriate. This assessment will be used to diagnose the cause of his pain, understand the effect, recognize appropriate pain relief strategies and evaluate their success. (Briggs, 2010) With Jimmy also being an Aboriginal elder there are cultural safety aspects the need to be recognized. Cultural safety is defined as a nurse’s ability to deliver care in a way that the patient considers culturally safe. (Crisp, Douglas, Rebeiro & Waters 2017, p.35) Cultural aspects that need to be recognized with caring for Jimmy is indigenous patients value talk, health professionals taking time to speak with him personally or to the community will demonstrate respect and care, this allows Jimmy and his community to feel valued when information about his care is shared. (Jennings, Bond & Hill, 2018) It is also vital to avoid asking him questions about ceremonial business, bereavement, sexuality, fertility, domestic habits and other similar issues that may be considered sensitive. (Daly, Speedy & Jackson, 2014)
After reviewing Jimmy’s risk assessments and overall health it may be in his best interest to notify other health teams about his condition for an assessment of their own. Due to Jimmy’s risk of falling he may need to be referred to a physiotherapist to not only treat an injury from a fall but to also help prevent one from happening. A physiotherapist may prescribe a fall prevention intervention such as exercise. Exercise is shown to improve impaired muscle strength and poor postural control and decrease the risk of falling. (Sherrington & Tiedemann, 2015) If Jimmy is experiencing a high level of pain a Doctor may also need to be consulted to discuss and provide an intervention for the pain. Jimmy’s Doctor should consider his pain perception and establish a wide range of treatments that co-exist in the presence of multiple health problems. (Kruschinski et al., 2016)
Health professionals who understand how influenza spreads and the precaution that musted be followed will decrease the likelihood of elderly residence contracting or spreading the disease which could be fatal due to a low immune system. Knowing which risk assessments would be appropriate for a patient and interdisciplinary team involvement also result in improved patient care. Understand the importance of these skills such as professional client-centred nursing care, infection control practices and specifically cultural safety are important knowledge that will ensure a patient is always given the best care available and ultimately increase their wellbeing and satisfaction with the care of given by a nurse.
- Bal, A., Schuffenecker, I., Casalegno, J., Josset, L., Valette, M., & Armand, N. et al. (2015). Enterovirus D68 nosocomial outbreak in elderly people, France, 2014. Clinical Microbiology And Infection, 21(8), e61 e62.http://dx.doi.org/10.1016/j.cmi.2015.05.008
- Barker, A., Nitz, J., Low Choy, N., & Haines, T. (2009). Measuring Fall Risk and Predicting Who Will Fall: Clinimetric Properties of Four Fall Risk Assessment Tools for Residential Aged Care. The Journals Of Gerontology Series A: Biological Sciences And Medical Sciences, 64A(8), 916-924. http://dx.doi.org/10.1093/gerona/glp041
- Barnett, R. (2019). Influenza. The Lancet, 393(10170), 396. http://dx.doi.org/10.1016/s0140-6736(19)30148-5
- Bartok, V. (2014). The common cold: Treatment algorithms: Relief is available for common cold symptoms. Pharmacy Times, 80(11), 66.
- Blanco, N., Eisenberg, M., Stillwell, T., & Foxman, B. (2016). What Transmission Precautions Best Control Influenza Spread in a Hospital?. American Journal Of Epidemiology, 183(11), 1045-1054.http://dx.doi.org /10.1093/aje/kwv293
- Briggs, E. (2010). Assessment and expression of pain. Nursing Standard (Royal College of Nursing (Great Britain) : 1987), 25(2), 35-38.http://dx.doi.org/10.7748/ns2010.09.25.2.35.c7986
- Charalambous, C., Koulori, A., Vasilopoulos, A., & Roupa, Z. (2018). Evaluation of the Validity and Reliability of the Waterlow Pressure Ulcer Risk Assessment Scale. Medical Archives, 72(2), 141. http://dx.doi.org/10.5455/medarh.2018.72.141-144
- CHENG, Y., WANG, C., YOU, S., HSIEH, N., CHEN, W., CHIO, C., & LIAO, C. (2016). Assessing coughing-induced influenza droplet transmission and implications for infection risk control. Epidemiology and Infection, 144(2), 333-345. http://dx.doi.org /10.1017/S0950268815001739
- Cowling, B., Ip, D., Fang, V., Suntarattiwong, P., Olsen, S., & Levy, J. et al. (2014). Modes of Transmission of Influenza B Virus in Households. Plos ONE, 9(9), e108850. http://dx.doi.org /10.1371/journal.pone.0108850
- Crisp, J., Douglas, C., Rebeiro, G. & Waters, D, (2017). Potter & Perry’s Fundamentals of Nursing – Australian Version (5th ed.). Chatswood, NSW. Mosby
- Daly, J., Speedy, S., & Jackson, D. (2014). Contexts of Nursing (4th ed., p. 343). Victoria Avenue.
- Department of Health and Human Services, Tasmania Government. (2014). Transmission Based Precautions: A guide for healthcare workers. Retrieved from https://www.dhhs.tas.gov.au/__data/assets/pdf_file/0007/75715/Transmission_Based_Precautions_Guide_V2_2014.pdf
- Department for Health and Ageing, Government of South Australia. (2015). When and how to do fall risk screening, assessment, care planning and discharge planning. Retrieved from https://www.sahealth.sa.gov.au/wps/wcm/connect/2d841f804b7bda65b903f97c1f47d846/15093.7+-+Tool+2%28v3%29WebS.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-2d841f804b7bda65b903f97c1f47d846-mN5MMkm
- Demicheli, V., Jefferson, T., Di Pietrantonj, C., Ferroni, E., Thorning, S., Thomas, R., & Rivetti, A. (2018). Vaccines for preventing influenza in the elderly. Cochrane Database Of Systematic Reviews.http://dx.doi.org /10.1002/14651858.cd004876.pub4
- Jennings, W., Bond, C., & Hill, P. (2018). The power of talk and power in the talk: a systematic review of Indigenous narratives of culturally safe healthcare communication. Australian Journal Of Primary Health, 24(2), 109.http://dx.doi.org/10.1071/py17082
- Kruschinski, C., Wiese, B., Dierks, M., Hummers-Pradier, E., Schneider, N., & Junius-Walker, U. (2016). A geriatric assessment in general practice: prevalence, location, impact and doctor-patient perceptions of pain. BMC Family Practice, 17(1).http://dx.doi.org/10.1186/s12875-016-0409-z
- Paules, C., & Subbarao, K. (2017). Influenza. The Lancet, 390(10095), 697-708. http://dx.doi.org/10.1016/S0140-6736(17)30129-0
- Scales, K., & Pilsworth, J. (2009). The importance of fluid balance in clinical practice. Nursing Standard, 22(47), 50-57. http://dx.doi.org/10.7748/ns2008.07.22.47.50.c6634
- Seto, W. (2015). Airborne transmission and precautions: facts and myths. Journal Of Hospital Infection, 89(4), 225-228.https://doi.org/10.1016/j.jhin.2014.11.005
- Sherrington, C., & Tiedemann, A. (2015). Physiotherapy in the prevention of falls in older people. Journal Of Physiotherapy, 61(2), 54-60.https://doi.org/10.1016/j.jphys.2015.02.011
- Talbot, H. (2017). Influenza in Older Adults. Infectious Disease Clinics Of North America, 31(4), 757-766. https://doi.org/10.1016/j.idc.2017.07.00