RESPIRATORY PANDEMICS
1. INFLUENZA
- one of the most common infectious diseases, is a highly contagious airborne disease that occurs
in seasonal epidemics and manifests as an acute febrile illness with variable degrees of systemic
symptoms.
- although the seasonal strains of influenza virus that circulate in the annual influenza cycle
constitute a substantial public health concern, far more lethal influenza strains than these have
emerged periodically.
- Influenza is an acute respiratory illness that produced four global pandemics in the last century,
the worst of which occurred in 1918. Known as “Spanish Flu”, the 1918 pandemic was
considered as a global disaster where 500 million people were believed to be infected and an
estimated death toll reached at least 50 million worldwide.
- Besides humans, influenza also infects a variety of animal species; some of these influenza
strains are species-specific, but new strains may spread from other animals to humans
- Influenza results from infection with 1 of 3 basic types of influenza virus: A, B, or C.
Causes
• Direct contact
• Unhygienic food preparation
• Aerosol transmission
• Contact with contaminated object
Clinical Manifestations
- Cough
- Fever
- Sore throat
- Myalgia
- Weakness
Influenza: Assessment and Diagnostic Findings
Rapid diagnostic tests.
Viral culture.
Polymerase chain reaction testing (RT-PCR).
Testing for Avian influenza.
Chest radiography.
Influenza: Medical Management
• Vaccines.
• Surveillance.
• Bed rest.
• Hospitalization.
• Consultations.
Influenza: Pharmacologic Management
• Antivirals.
• neuraminidase inhibitors
• cap-dependent endonuclease inhibitor,
• Vaccines, inactivated.
• Vaccines, live.
• Uricosuric agents.
2. Middle East Respiratory Syndrome (MERS)
- is a viral respiratory disease caused by a novel coronavirus (Middle East respiratory syndrome
coronavirus, or MERS‐CoV).
- Middle East respiratory syndrome (MERS) is caused by a novel coronavirus (Middle East
respiratory syndrome coronavirus, or MERS‐CoV).
- Through first reported in Saudi Arabia, it was later identified that the first known cases of MERS
occurred in Jordan in April 2012.
- Most MERS patients developed severe respiratory illness with symptoms of fever, cough and
shortness of breath.
- A large MERS outbreak occurred in the Republic of South Korea linked to a traveler from the
Arabian Peninsula in 2015.
- Travel-associated cases have been identified in Algeria, Austria, China, Egypt, France, Germany,
Greece, Italy, Malaysia, Netherlands, Philippines, Republic of Korea, Thailand, Tunisia, Turkey,
United Kingdom (UK), and United States (US).
- CDC has published guidance for health departments and healthcare infection control programs
for investigating potential cases of MERS and preventing its spread.
Causes:
o Betacoronavirus.
o Dromedary camels.
Coronaviruses are the largest of all RNA viruses, with positive-sense single-stranded RNA
genomes of 26-32 kb.
Betacoronavirus. MERS-CoV is a recently discovered betacoronavirus of lineage C that was first
reported in Saudi Arabia in 2012; the exact origin of this novel coronavirus is still unknown;
MERS-CoV is closely related to two coronaviruses of the same lineage found in bats, which may
indeed be its wild reservoir.
Dromedary camels. Specific mechanisms for transmission from animals are unclear but appear
to involve contact with dromedary camels or their urine, as well as the consumption of their
undercooked meat or unpasteurized dairy products.
MERS: Clinical Manifestations
• Fever
• Rhinorrhea, mostly clear
• Pulmonary findings, Tachycardia
• Hypotension
• Physical examination findings associated with MERS-CoV infection are similar to those
presenting with any flu -like symptoms, including the following:
• Fever
• Rhinorrhea, mostly clear
• Pulmonary findings, including hypoxemia, rhonchi, and rales (some patients may have a
normal auscultation)
• Tachycardia
• Hypotension may occur with severe illness, reflecting systemic inflammatory response
syndrome
MERS: Assessment and Diagnostic Findings
• rRT-PCR assay.
• Laboratory studies.
• Imaging studies.
Most state laboratories are approved to test for Middle East Respiratory Syndrome Coronavirus (MERS-
CoV) using CDC’s rRT-PCR assay.
• rRT-PCR assay. real-time reverse transcription–PCR assay to test for MERS-CoV in clinical
respiratory, serum, and stool specimens.
• Laboratory studies. Laboratory findings at presentation may include leukopenia, lymphopenia,
thrombocytopenia, and elevated lactate dehydrogenase levels; these are most likely with
increasing severity of illness.
• Imaging studies. Chest imaging findings are abnormal in more than 80% of MERS cases; ground-
glass opacity (GGO) is found in over 60% of chest radiographs, with about 20% incidence of
consolidation; some infiltrates may be nodular.
CORONAVIRUS DISEASE 2019 (COVID-19)
- is a disease caused by a new strain of coronavirus called severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) that can cause symptoms from common cold to more severe
disease such as pneumonia and eventually it may lead to death especially those in vulnerable
groups such as the elderly, the very young, and people with an underlying chronic health
condition.
CORONAVIRUS DISEASE 2019: Clinical Manifestations
• Fever
• Dry cough
• Shortness of breath
• Other symptoms may include:
• Sore throat
• Runny nose
• Diarrhea
• Fatigue/tiredness
• Difficulty of breathing (in severe cases)
Coronavirus Disease 2019 (COVID-19): Medical Management
• Hand hygiene.
• Keep hands off your face.
• Maintain social distancing.
• Proper cough and sneeze etiquette.
• Supportive care.
• Severe cases.
Coronavirus Disease 2019 (COVID-19): Nursing Management
• History. Travel
• Physical examination.
Coronavirus Disease 2019 (COVID-19): Nursing Diagnosis
• Ineffective airway clearance
• Ineffective breathing pattern
• Hyperthermia
• Acute pain
• Deficient knowledge
• Infection
• Anxiety
Coronavirus Disease 2019 (COVID-19): Nursing Care Planning and Goals
• Patient will achieve and maintain a patent airway.
• Patient will achieve and maintain normal respiratory pattern and rate, with no adventitious
breath sounds to auscultation.
• Patient will achieve and maintain a normal temperature.
• Patient will achieve relief from aches and pain.
• Patient will be able to understand and verbalize appropriate treatment and care for influenza.
Coronavirus Disease 2019 (COVID-19): Nursing Interventions
• Maintain patent airway.
• Administer oxygen as ordered
• Monitor oxygen saturation by pulse oximetry
• Position patient in high Fowler’s or semi-Fowler’s position, if possible
• Administer bronchodilators as ordered
• Perform chest physiotherapy, chest percussion, and postural drainage as ordered;
• Encourage deep breathing exercises and coughing exercises every 2 hours.
• Maintain normal breathing pattern.
• Encourage patient to change position every 2 hours and as needed, and assist as needed
• Provide and encourage fluid intake of at least 2 L/day unless contraindicated.
• Achieve normal temperature.
• Monitor VS especially temperature, every 2-4 hours and as needed
• Administer antipyretics as ordered
• Provide tepid sponge baths
• Instruct patient/family in use of hypothermia blanket, reasons for use, signs, and
symptoms of complications, etc.
• Achieve relief from pain.
• Administer analgesics as ordered
• Provide warm baths or heating pad to aching muscles
• Encourage gargling with warm water; provide throat lozenges as necessary
• Instruct patient or SO in deep breathing, relaxation techniques, guided imagery,
massage, and other nonpharmacologic aids.
• Educate patient and folks.
• Use limited amounts of time for teaching, with the provision of a quiet environment
• Inform people receiving the vaccine of the possible adverse effects and report them
immediately
• Instruct patient and/or SO about influenza types, when typical outbreaks occur, and
methods to avoid infection
• Instruct patient and/or SO about newer antiviral drugs, their effects, when to seek
immediate medical attention, and side effects of medications.
