Nurse Action Needed to Manage H1N1 Flu
Monday May 4, 2009
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Guidelines For Treating Possible Swine Flu
The three primary symptoms of swine flu — fever, sore throat, a cough — are identical to those of other respiratory illnesses. The only way to know for sure whether someone has swine flu at this time is through a laboratory test administered through the Centers for Disease Control and Prevention or, in some cases, state health departments.
The CDC list three types of possible swine flu cases:
A confirmed case is a person whose acute febrile respiratory illness has been confirmed as swine influenza A (H1N1) by a laboratory test;
A probable case is a person with an acute febrile respiratory illness who is —
• Positive for influenza A, but negative for H1 and H3 by influenza RT-PCR
A suspected case a person with acute febrile respiratory illness with onset —
• Within seven days of close contact with a person who is a confirmed case of swine influenza A (H1N1) virus infection
• Within seven days of travel to a community either within the United States or internationally where there are one or more confirmed swine influenza A(H1N1) cases
• Resides in a community where there are one or more confirmed swine influenza cases
What do you do if you are seeing someone with symptoms of an upper respiratory illness — coughing, fever, sore throat, body aches (based on information from the CDC and health practitioners).
• If the patient is coughing or sneezing, ask the person to put a mask on to protect others. A common method of flu virus transmission is through droplets, expelled through sneezing or coughing.
• Take a nasal swab or wash for testing to confirm whether the patient has swine flu or another kind of flu or respiratory illness. Follow your facility’s guidelines for submitting the test, or use CDC guidelines, found at www.cdc.gov/swineflu/specimencollection.htm
• Ask questions about whom the patient has been in contact with, whether the person has traveled outside the country or to areas where swine flu has been reported, whether the person has visited crowded areas, whether the patient knows anyone who might have swine flu.
• Flu can also be transmitted by touching a surface with a virus on it, then by touching one’s mouth or nose, so be sure to wipe down surfaces thoroughly after the patient leaves. Be sure maintenance workers know to clean chairs and tables in waiting rooms. All patients should be offered anti-bacterial creams or gels for their hands.
• If symptoms are mild, tell the patient to go home, take a fever-reliever, such as Tylenol, and rest, and to return if the person develops a severe cough or uncontrolled fever.
If you have a suspected, probable, or confirmed case of swine flu —
• Have the patient sit in a single-patient room with the doors closed. Ask the person to wear a mask when outside the patient room, and to wash hands frequently.
• Healthcare workers caring for the patient or taking samples should wear disposable non-sterile gloves, gowns, and eye protection such as goggles, and N95 respirators
• Take a swab or wash for testing, if this has not been done
• Ask questions about whom the patient has been in contact with in the last seven days. This information should be provided to local health departments for investigations of other possible swine flu cases.
• Check CDC guidelines for offering antiviral medications. www.cdc.gov/swineflu/recommendations.htm The virus is susceptible to Tamiflu (oseltamivir) and Relenza (zanamivir) Current guidelines recommend antivirals for known, probable, and suspected cases of swine flu.
• Urge the patient and family members to stay calm. Almost all cases of swine flu in the United States have resolved themselves, even without antiviral treatment.
• The CDC currently recommends that healthcare workers or pubic health workers who were not using appropriate protective equipment (gloves, gowns, masks, eye-protection) while in close contact with a suspected or confirmed case of swine flu should take antiviral medications as prophylactics.
• Healthcare workers and first-responders who are at high-risk for complications of influenza, such as those with certain chronic conditions, those who are 65 or older, and pregnant women in facilities or areas with confirmed swine flu, or those caring for any patients with febrile respiratory disease, should consider taking antiviral medications, according to CDC guidelines.
The CDC list three types of possible swine flu cases:
• A confirmed case is a person whose acute febrile respiratory illness has been confirmed as swine influenza A (H1N1) by a laboratory test
• A probable case is a person with an acute febrile respiratory illness who is positive for influenza A, but negative for H1 and H3 by influenza RT-PCR
• A suspected case a person with acute febrile respiratory illness with onset within seven days of close contact with a person who is a confirmed case of swine influenza A (H1N1) virus infection; or within seven days of travel to community either within the United States or internationally where there are one or more confirmed swine influenza A(H1N1) cases; or resides in a community where there are one or more confirmed swine influenza cases
What To Do
The CDC and practioners are offering recommendations for what to do when patients present with symptoms of an upper respiratory illness-coughing, fever, sore throat, body aches.
If you have a suspected, probable, or confirmed case of swine flu —
• Have the patient sit in a single-patient room with the doors closed. • Ask the person to wear a mask when outside the patient room, and to wash hands frequently.
• Healthcare workers caring for the patient or taking samples should wear disposable non-sterile gloves, gowns, and eye protection such as goggles, and N95 respirators.
• Take a swab or wash for testing, if this has not been done;
• Ask questions about whom the patient has been in contact with in the last seven days. This information should be provided to local health departments for investigations of other possible swine flu cases.
• Check CDC guidelines for offering antiviral medications. http://www.cdc.gov/swineflu/recommendations.htm The virus is susceptible to Tamiflu (oseltamivir) and Relenza (zanamivir) Current guidelines recommend antivirals for known, probable and suspected cases of swine flu.
• Urge the patient and family members to stay calm. Almost all cases of swine flu in the United States have resolved themselves, even without antiviral treatment.
The CDC currently recommends that healthcare workers or pubic health workers who were not using appropriate protective equipment (gloves, gowns, masks, eye-protection) while in close contact with a suspected or confirmed case of swine flu should take antiviral medications as prophylactics.
Healthcare workers and first-responders who are at high-risk for complications of influenza, such as those with certain chronic conditions, those who are 65 or older, and pregnant women) in facilities or areas with confirmed swine flu, or those caring for any patients with febrile respiratory disease, should consider taking antiviral medications, according to CDC guidelines.
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At this point, nurses should keep practicing and taking the same precautions as they would with an outbreak of any other kind of influenza, as well as keeping themselves up-to-date about the new virus and national and state guidelines for dealing with it, says Elda Ramirez, RN, PhD, FNP-BC, FAANP, and assistant professor of nursing and head of emergency care in the department of acute and continuing care at the University of Texas School of Nursing at Houston.
These include asking patients who are coughing or sneezing to wear a mask, wiping down surfaces and chairs, frequent hand-washing, and offering anti-bacterial creams or gels to patients.
The federal government has issued a public health emergency, and health officials say they expect to see many more cases in coming weeks.
“The normal flu season will be extended at least six-to-eight weeks,” says Bonnie Sorensen, MD, chief deputy director of the California Department of Public Health. The new flu may eventually disappear for good, or it may return, she says.
The illness has hit hardest in Mexico. So far, most cases of swine flu reported in the United States have been mild, though health officials say they expect to see more moderate and severe cases and deaths as the disease progresses. Reports of hospitalizations and deaths are “not necessarily an indication of how severe this is going to end up to be,” says Gil Chavez, MD, deputy director of the Center for Infectious Disease for the California health department. “It’s behaving, on average, like what we see with seasonal influenza.”
The CDC is asking clinicians to take nasal swabs or washes of patients with symptoms of upper respiratory illness to be tested for the swine flu virus. Nurses should also ask detailed questions, such as whether the patient has traveled outside the country, if they’ve been in a crowded place, or if they’ve come into contact with anyone who might have swine flu, Ramirez says.
State health officials are currently working with hospitals, clinics, and private practitioners to identify patients who may have more severe cases of swine flu. The CDC is also distributing tests that will allow states to identify the virus at their own laboratories rather than waiting for a CDC confirmation of swine flu.
CDC guidelines currently say treatment with antiviral medication should be considered for patients who test positive for the flu, or positive for a virus strain that cannot be identified as another type of flu. The swine flu virus has proven susceptible to Tamiflu (oseltamivir) and Relenza (zanamivir), but resistant to some other antivirals.
As the outbreak progresses, nurses have a responsibility to inform themselves as much as possible about swine flu, even if they live in areas where no cases have been reported, says Nancy Berlinger, PhD, MDiv, deputy director and research scholar at the Hastings Center in New York, and an adjunct lecturer in health care ethics at the Yale School of Nursing.
“This is really a call to duty for nurses,” says Berlinger, co-author of "The Five People You Meet in a Pandemic—and What They Need from You Today," which presents an ethical framework for pandemic planners: www.thehastingscenter.org/Publications/SpecialReports/Detail.aspx?id=1320 “Nurses may be in the role of educators and myth-busters. They need to know the facts, be calm, and not hypothesize on the facts.”
Nurses need to constantly check not only national sources such as the CDC: www.cdc.gov/swineflu and WHO: www.who.int/csr/disease/swineflu/en/index.html
Web sites, but also state and local sources, including state health department Web sites, to find out whether or how the virus has presented itself in their area. As health experts and first responders, nurses will be expected to answer questions from relatives, neighbors, and friends as well as patients, she says, and they should be prepared.
Nurses also need to be aware of the plans their own institutions have for dealing with public health emergencies, such as how antivirals are stockpiled and who will they be given to, she says, and of how their institutions will communicate those plans to them.
“It’s a situation where nurses need clear guidelines on what needs to be done,” she says. Hospitals should also be planning what they can provide for their workers if schools are closed or transportation systems are shut down, she says, and communicate this to their staffs. “Nurses should feel backed up on these points, and they should press for it.”
Part of the nurse’s job is helping patients keep calm in the midst of a potentially frightening situation, Ramirez says. “People get viruses. They usually resolve themselves without any treatment whatsoever. I believe that nurses understand the microbiology of a virus. What nurses really have to do is to be able to communicate what symptoms are severe and not severe to the patient.”
A dedicated U.S. government site is set up at: www.pandemicflu.gov.
For school nurses, refer to the Family Educational Rights and Privacy Act: www.ed.gov/policy/gen/guid/fpco/ferpa/index.html.
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Cathryn Domrose is a senior staff writer at Gannett Healthcare Group.
To comment, e-mail editorNTL@gannetthg.com.
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