Question

Frances Yin is a 78-year-old patient who has a history of chronic obstructive pulmonary disease. She has come to the medical clinic for a routine visit to monitor her respiratory status. Her medical history also includes rheumatoid arthritis. Her drug therapy for the arthritis includes disease- modifying antirheumatic drugs (DMARDs), which inhibit her immune system. Currently, an epidemic of influenza A is occurring in her geographic area. Mrs. Yin's age, chronic pulmonary disease, and immunodeficiency place her in the high-risk category. Her primary care provider has recommended that she take the influenza A vaccine and a prophylactic course of oseltamivir. (Learning Objectives 6 and 14) 1. Mrs. Yin asks why she needs the influenza vaccine. She states, “I took one last year. Won't that be enough? Why do I need one every year? Those things aren't 100% effective anyway." How should the nurse respond? 2. Describe the indications and nursing considerations related to the oseltamivir that has been prescribed for Mrs. Yin.

Answer 1

1) Vaccines and antiviral drugs are essential means for control of influenza . The fast spread and frequent mutation rate of influenza viruses contribute to high incidence and variability of these viruses in seasonal, epidemic, and pandemic influenza. For epidemic condition, medical condition COPD and Rheumatoid arthritis treatment, annual immunization is needed for influenza prevention.

2) INDICATIONS: Postexposure prophylaxis for at-risk adults and adolescents who are not protected by influenza immunisation, and treatment of at-risk adults for whom medication can be started within 48 hours of close contact exposure, are recommended by the National Institute for Health and Clinical Excellence (NICE). NICE recommendations include prophylaxis in residential care homes, regardless of immunisation status, if commenced within 48 hours, when influenza-like illness is present in the establishment.

NURSING CONSIDERATIONS
For treatment to be most effective it should be started within a few hours of the onset of symptoms and continued for at least seven days (up to six weeks during an epidemic).  NICE recommends that oseltamivir is not used for seasonal prophylaxis of influenza, postexposure prophylaxis or treatment in otherwise healthy individuals. Oseltamivir will not prevent the transmission of the influenza virus, therefore good hygiene and infection control practice should be maintained when in contact with infected individuals. he most effective method of preventing influenza infection is by annual immunisation and oseltamivir should not be seen as a substitute for vaccination.

PATIENT TEACHING
Advise patients to take a missed dose as soon as remembered. If it is two hours or less until the next dose, skip the missed dose and continue regular dosing schedule. Ensure patients are aware of the importance of continuing their medication, even if they start to feel better, until they have completed the course. Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines.