NUR 635 Topic 13 DQ 2

Sample Answer for NUR 635 Topic 13 DQ 2 Included After Question

Mary is a 37-year-old female who suddenly presents with onset of fever, chills, fatigue, body aches, dry cough, sore throat, and headache. After performing the necessary diagnostics, the FNP confirms Mary has influenza. Mary avoids getting a flu shot as she has an egg allergy. Use the guidelines and relevant literature in your topic Resources to discuss the following:

  • Due to similar presentations, how would a clinician decipher if the patient has the flu or COVID-19?
  • Determine a treatment strategy for Mary. Include the drug, dose, frequency, and treatment length, and explain your rationale for choosing this medication, including spectrum of coverage and mechanism of action. 
  • Determine monitoring, side effects, and drug-drug interactions associated with each medication.
  • In the event Mary experienced these symptoms for 48 hours prior to coming to the clinic, how would this change your treatment strategy. Explain your rationale.
  • Are there any flu vaccine options for Mary even though she has an egg allergy?
  • In general, are there any racial or ethnic disparities in influenza-associated hospitalizations?

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competencies 1.2, 2.2, 2.5. 4.2, 6.4, 9.2

A Sample Answer For the Assignment: NUR 635 Topic 13 DQ 2

Title: NUR 635 Topic 13 DQ 2

Differentiating Between Flu and COVID-19:

Differentiating between influenza (flu) and COVID-19 can be challenging due to their overlapping symptoms. Both illnesses can be present with fever, chills, fatigue, body aches, dry cough, sore throat, and headache. However, certain features can help distinguish them. COVID-19 often involves a sudden loss of taste or smell, shortness of breath, and gastrointestinal symptoms, which are less common in influenza. Diagnostic testing, including PCR or rapid antigen tests, is crucial for accurate identification (Lee et al., 2020).

Treatment Strategy for Influenza (Flu):

For Mary, considering her flu diagnosis, the preferred antiviral medication is oseltamivir (Tamiflu). The recommended dose is 75 mg orally twice daily for five days. Oseltamivir is a neuraminidase inhibitor, disrupting the release of virus particles from infected cells and inhibiting the spread of influenza within the respiratory tract (Rosenthal & Burchum, 2020).

Monitoring, Side Effects, and Drug Interactions:

Monitoring: Mary’s symptoms, especially fever and respiratory distress, should be closely monitored during treatment.

Side Effects: Common side effects of oseltamivir include nausea and vomiting. Monitoring gastrointestinal symptoms is essential.

Drug Interactions: Oseltamivir has minimal drug interactions. However, caution is advised when co-administered with probenecid, which may increase oseltamivir levels (Rosenthal & Burchum, 2020).

Delayed Presentation (>48 hours):

If Mary presents more than 48 hours after symptom onset, oseltamivir can still be beneficial, although its effectiveness decreases with delayed initiation. The treatment rationale remains, aiming to reduce symptom duration and severity.

Flu Vaccine Options for Egg Allergy:

Individuals with egg allergies can still receive influenza vaccines. The CDC recommends two options: a) a standard-dose influenza vaccine that is egg-based, with appropriate precautions, or b) a recombinant influenza vaccine (Flublok) that is not produced in eggs.

Racial or Ethnic Disparities in Influenza Hospitalizations:

Racial and ethnic disparities exist in influenza-associated hospitalizations. Studies within the past five years indicate that Black and Hispanic populations experience higher rates of hospitalization compared to White individuals. Socioeconomic factors, access to healthcare, and underlying health disparities contribute to these differences (Alexander et al., 2020).

References:

Alexandre, M. M. M., Adamian, C. M. C., de Menezes Galvão, L., Lopes, I. M. P., de Carvalho Gomes, P. E. A., de Almeida, C. A., … & de Francesco Daher, E. (2022). Current status of influenza: What do we know so far? Research, Society and Development11(13), e517111335808-e517111335808.

Centers for Disease Control and Prevention: Sexually Transmitted Infections Treatment Guidelines, 2021: Gonococcal Infections Among Adolescents and Adults.

Lee, K., Jalal, H., Raviotta, J. M., Krauland, M. G., Zimmerman, R. K., Burke, D. S., & Roberts, M. S. (2022, January). Estimating the impact of low influenza activity in 2020 on population immunity and future influenza seasons in the United States. In Open Forum Infectious Diseases (Vol. 9, No. 1, p. ofab607). US: Oxford University Press.

Rosenthal, L. D., & Burchum, J. R. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants – e-book (2nd ed.). Elsevier Health Sciences.

A Sample Answer For the Assignment: NUR 635 Topic 13 DQ 2

Title: NUR 635 Topic 13 DQ 2

Although coronaviruses mostly cause respiratory tract infections, they may also cause multisystem infections in humans, according to Bai, Y., & Tao, X. (2021). Because S proteins bind with the human angiotensin converting enzyme 2 (ACE2) receptor complex, enabling the virus to infect human respiratory epithelial cells, SARS-CoV-2 poses a significant risk of human infection. Conversely, influenza, which is caused by the virus itself, is a dangerous respiratory illness. SARS-CoV-2 and influenza have a number of characteristics, such as high incidence, rapid onset, high infectivity, and ease of mutation. The three parts of the structure of the influenza virus, an RNA virus as well, are the envelope, matrix proteins, and core.

Thus, based on antigenic variations in the nucleoprotein and matrix protein, influenza viruses may be categorized as influenza A, B, C, and D. Humans are susceptible to influenza A, B, and C; influenza C, on the other hand, is rare and often only results in mild upper respiratory infections (World Health Organization, 2014). Similar to SARS-CoV-2, the majority of human influenza viruses replicate in the respiratory tract’s epithelium, where they begin to create viral proteins. Data show that early signs of a mild upper respiratory tract infection, similar to a common cold, are often experienced by those infected with COVID-19. Most cases with mild symptoms go away on their own, and most patients recover in two weeks.

However, severe instances progress rapidly, resulting in acute respiratory distress syndrome (ARDS) and septic shock, which in turn cause multiple organ failure. Numerous in-depth studies have shown that one of the most common signs of influenza is fever. In addition to respiratory symptoms including coughing, congestion, and sore throats, other common symptoms include chills, headaches, myalgia, sore throats, high fever, and anorexia. The two most common symptoms are fever and coughing. Influenza may cause fever, but it can also cause symptoms that affect the eyes, such photophobia, conjunctivitis, crying, and pain while moving the eyes (Bai, Y., & Tao, X. (2021).

Mary manifested signs and symptoms and confirmed with diagnosis of flu, as we all know Influenza infection is self-limited and mild in most healthy individuals who do not have other comorbidities. No antiviral treatment is needed during mild infections in healthy individuals. Antiviral medications can be used to treat or prevent influenza infection. According to Boktor SW, & Hafner JW. (2023), Oseltamivir, zanamivir, and peramivir belong to the neuraminidase inhibitors family and can be used for the treatment of influenza A and B. Oseltamivir is an antiviral medication that is appropriate for treating acute, uncomplicated influenza A or B illness in adults and pediatric patients, including neonates older than two weeks of age. Oseltamivir is an antiviral neuraminidase inhibitor with potent and selective competitive inhibition of the influenza virus neuraminidase, an enzyme necessary for viral replication. Oseltamivir reduces the duration of shedding and the viral titer and can shorten the length of symptoms by 0.5 to 3 days ( Treanor JJ, et.al. 2000). 

Oseltamivir (tamiflu) seasonal Influenza A and B treatment (five-day oral course) according to Sur, et.al. 2022. 

  • Adults: 75 mg BID
  • Infants 0 to 8 months: 3 mg/kg/dose BID
  • Infants 9 to 11 months: 3.5 mg/kg/dose BID
  • Children 1 to 12 yrs old:
    • Less than 15 kg: 30 mg BID
    • Greater than 15 kg to less than 23 kg: 45 mg BID
    • Greater than 23 kg to less than 40 kg: 60 mg BID
    • Over 40 kg: 75 mg PO BID

In most cases, oseltamivir is well tolerated. The most typical adverse effects are vertigo, headache, nausea, vomiting, diarrhea, stomach discomfort, and sleeplessness. The most often reported adverse effect in youngsters is vomiting. Conjunctivitis, epistaxis, allergies, arrhythmia, GI bleeding, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, disorientation, seizures, and neuropsychiatric events are some adverse effects that happen less often than 1% of the time. There have also been reports of cutaneous adverse medication responses, including toxic epidermal necrolysis, erythema multiforme, and Steven Johnson syndrome. rises in serum aminotransferase, however the patients’ enzyme levels were momentary and asymptomatic. Hepatotoxicity may have an immunoallergic mechanism. Although rare reports of liver damage and jaundice exist, jaundice and elevated blood enzymes may also result from influenza illness. For individuals with inherited fructose intolerance, the commercially available oral suspension of oseltamivir should be taken with caution since it includes sorbitol and saccharin sodium. Given that the solution includes sodium benzoate, newborns should be monitored for gasping syndrome (Sur, et al., 2022).

Drug-Drug Interactions: If taken 48 hours to 14 days after the live attenuated influenza vaccination (LAIV4), influenza antiviral drugs may reduce the vaccine’s effectiveness. As an ester prodrug, oseltamivir carboxylate enhances the antiviral effect of the drug. Human carboxylesterase is the mediator of hydrolytic activation (HCE). Reduced antiviral effectiveness results from clopidogrel’s inhibition of oseltamivir’s hydrolysis. Observing Neuropsychiatric problems such as self-harm, disorientation, and delirium should be closely observed, particularly in youngsters, and the viral load in critically sick patients may be ascertained by repeat RT-PCR or viral culture (Sur, et.al. 2022).

When administered within the first 24 to 30 hours and to patients who exhibit fever, neuramindase inhibitor antiviral therapy is most beneficial; in Mary’s case, since she experienced these symptoms 48 hours before visiting the clinic, this can shorten the duration of influenza symptoms by approximately 1.5 to 3 days (Pantone, H. & Baker, B. 2015). Baloxavir marboxil is recommended for oral, single-dose administration, with or without meals, within 48 hours after the beginning of influenza symptoms, according to Baker, D.E. (2019). For patients 12 years of age and above, the suggested dosage varies according to weight: a single dose of 40 mg is advised for those weighing 40 kg to less than 80 kg, while a single dose of 80 mg is advised for those weighing 80 kg or more. Avoid using this medication together with dairy products, drinks enriched with calcium, laxatives containing polyvalent cations, antacids, or oral supplements (such as those containing calcium, iron, magnesium, selenium, or zinc).  During clinical studies, frequent side effects of baloxavir marboxil treatment included headaches, nausea, bronchitis, and nasopharyngitis. The patient has to be kept an eye out for any possible bacterial infections. 

Most influenza vaccines are made from embryonated eggs that have been rendered inactive. On the other hand, the trivalent inactivated influenza vaccine (IIV3) often contains two strains of the influenza virus type A and one strain of the influenza virus type B. For example, strain H1N1 is the sole influenza type A strain included in the monovalent vaccination. The quadrivalent inactivated influenza vaccine (IIV4) contains two strains of the A and two strains of the B influenza virus. Each person received a shot. The quadrivalent live attenuated influenza vaccine (LAIV4) is the last live intranasal immunization. It was not recommended to give the influenza vaccine to people who are allergic to eggs because of Mary’s egg allergy. This is because the vaccine can cause anaphylaxis if the patient receives an injection containing leftover egg proteins, which causes the body to produce IgE antibodies against egg proteins. Some of the methods that were shown to work, such skin testing, progressive vaccination, and the use of a vaccine with low-level oval-bumin, made it possible for those who are allergic to eggs to safely receive inactivated influenza vaccine.

In an effort to remove any remaining egg proteins from influenza shots, two brand-new, non-egg-based vaccines have been created recently. Using influenza viruses grown in mammalian cell culture, the trivalent cell culture inactivated influenza vaccine (ccIIV3) is one. The alternative vaccination, called trivalent recombinant influenza vaccine (RIV3), is made in an insect cell line using hemagglutinin protein that has been recombinant with the influenza virus. However, in countries where egg-free influenza vaccines are not routinely administered, people with egg allergies may receive the IIV3 vaccine with caution. IIV3 was safe for those with egg allergies, and getting the influenza shot didn’t need any additional safety precautions (Tozandehjani, et al. 2019).

References:

Bai, Y., & Tao, X. (2021). Comparison of COVID-19 and influenza characteristics. Journal of Zhejiang University. Science. B22(2), 87–98. https://doi.org/10.1631/jzus.B2000479

Baker D. E. (2019). Baloxavir Marboxil. Hospital pharmacy54(3), 165–169. https://doi.org/10.1177/0018578719841044

Boktor SW, & Hafner JW. (2023).  Influenza. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459363/

Sur M, Lopez MJ, Baker MB. (2022). Oseltamivir. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.https://www.ncbi.nlm.nih.gov/books/NBK539909/#

Tozandehjani, S., Nasiri Kalmarzi, R., Khodabandehloo, M., & Kashefi, H. (2019). Safety of Inactivated Influenza Vaccine in Patients with Egg Allergy in Kurdistan Province, Iran. Iranian journal of public health48(4), 758–763.

Treanor JJ, Hayden FG, Vrooman PS, Barbarash R, Bettis R, Riff D, Singh S, Kinnersley N, Ward P, Mills RG. (2000). Efficacy and safety of the oral neuraminidase inhibitor oseltamivir in treating acute influenza: a randomized controlled trial. US Oral Neuraminidase Study Group. JAMA. 283(8):1016-24.

World Health Organization , 2014. Influenza (seasonal). https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal) [Google Scholar]