AVIAN INFLUENZA (AI)

Avian influenza (bird flu) is an infection caused by influenza viruses

that chiefly infect birds and poultry. The H5N1 strain (named for the
characteristics

of

the

viral

surface

proteins

hemagglutinin

and

neuraminidase) is of particular concern. It has caused a number of

outbreaks in poultry since 2003, and the problem is ongoing; flocks of
migratory birds have rapidly disseminated the virus throughout much of
the world. Although many avian influenza viruses are natural and
nonpathogenic in birds, H5N1 is unusual because of its high mortality rate
in birds and because it has shown a limited ability to be transmitted from
a bird source to mammals, including humans. The human mortality rate
from H5N1 avian influenza has been more than 60% (WHO, 2008a).
The majority of human cases of H5N1 are attributed to direct contact
with poultry, but there are rare instances that suggest occasional humanto-human transmission. Scientists are especially concerned that avian
influenza H5N1 may change, either through mutation or reassortment, to
become easily transmitted from human to human. If H5N1 were easily
transmissible to humans, it would be likely to cause a severe pandemic
because the human population has no immunity to the virus and because
development of an appropriate vaccine would take too long to effectively
stop the pandemic (U.S. Department of Health and Human Services
[USDHHS], 2008).
Nursing Care Plan
1. ASSESSMENT

The symptoms associated with H5N1 avian influenza in humans

have ranged from the symptoms typically seen with seasonal influenza
(cough, fever, and muscle aches) to
severe pneumonia and multiorgan failure. Symptoms of flu include
abrupt onset of fever, chills, myalgia, sore throat, cough, general
malaise, and headache. It can last for 2 to 5 days, with malaise lasting
up to several weeks.
2. NURSING DIAGNOSIS, OUTCOME AND INTERVENTION

a. Diagnosis : Risk for Deficient Fluid Volume, risk factor :

Inadequate intake of fluids

Expected Outcome : Fluid Balance, adequate intake of fluids
Intervention :
b. Impaired Gas Exchange
c. Deficient knowledge

SEVERE ACUTE RESPIRATORY SYNDROME

Severe acute respiratory syndrome (SARS) is a viral respiratory
illness caused by a coronavirus, called SARS-associated coronavirus. It
was first reported in Asia in 2003 and quickly spread to countries in North
America, South America, Europe, and Asia. The World Health Organization
(WHO) reported that 8422 people worldwide became sick with SARS
during the 2003 outbreak, and 916 died (Hirsch, 2007). SARS develops in
people who either have close contact with a person who has been
diagnosed with the disease or a history of travel or residence in an area
with known cases. The SARS-associated coronavirus is transmitted via
respiratory droplets when an infected person coughs or sneezes; the
droplets may be deposited on the mucous membranes (mouth, nose,
eyes) of a nearby person. The virus may also be spread when a person
touches a surface or object contaminated by the droplets and then
touches his or her mucous membranes. The virus may be transmitted in
other ways, including sewage and water, but these methods of
transmission are unclear at this time (Hirsch, 2007).
Nursing Care Plan
1. ASSESSMENT

Characteristic symptoms of SARS are a fever (greater than

38.0_C [100.4_F]), coughing, and difficulty breathing. The incubation
period is usually 2 to 7 days; however, longer periods have been
reported. About 95% of patients develop symptoms within 10 days
(Hirsch, 2007).
2. NURSING DIAGNOSIS, OUTCOME AND INTERVENTION
a. Impaired Gas Exchange

b. Ineffective self-health management

c. Risk for chronic low self - esteem