Symptoms reported from Avian Influenza usually include fever, severe cough, headache, sore throat, dehydration, with some reports of diarrhea, vomiting, and bleeding from mouth or throat. Some cases do not show all these symptoms. Severe cases may include pneumonia (may be bacterial, viral, or both) and acute respiratory distress syndrome (ARDS). The exchange of carbon dioxide and oxygen is reduced due to inflammation and the accumulation of fluid in the air sacs (aveoli) in the lungs. A high percentage of patients who experience ARDS die even with mechanical ventilation and supplemental oxygen.
You may want to buy a clock or watch with a second hand, blood pressure gauge, a stethescope and a thermometer to measure vital signs.
If you use a humidifier, be certain to sanitize it every few days. Bacteria can grow in water and that could create a respiratory infection. Use 1 teaspoon of bleach to 1 gallon of water. Let the solution soak for 20 minutes. Rinse the tank until you can no longer smell bleach.
Good HomeTreatment of Influenza 35 pages *
A practical guide to home care of mild to severely ill patients that relies on a simple common sense approach.
Grattan Woodson, MD, FACP An edited excerpt from The Bird Flu Manual, BookSurge Publishing, Charleston, SC, reprinted with permission.
ftp://wikimember:wiki123@singtomeohmuse.com/Good%20Home%20Treatment%20of%20Influenza%2016pt.pdf
WHO interim guidelines on clinical management of humans infected by influenza A(H5N1) 5 pages
- Objectives
- General considerations
- Infection control and prevention of nosocomial spread of influenza A(H5N1)
- Case management
- Discharge policy
- Public health measures
- Annex 1 - Summary of preliminary clinical features of humans infected by influenza A(H5N1)
- Annex 2 - Exposures that may have put a person at risk of becoming infected with influenza A(H5N1)
World Health Organization (WHO)
http://www.who.int/csr/disease/avian_influenza/guidelines/clinicalmanage/en/index.html
WHO Rapid Advice Guidelines on pharmacological management of humans infected with avian influenza A (H5N1) virus 138 pages
Human cases of avian influenza A(H5N1) infection have remained rare and sporadic, but the disease is very severe and the case fatality is high. With the H5N1 virus now confirmed in birds in more than 50 countries, additional sporadic human cases should be anticipated. Using innovative guideline development methods based on the best available evidence, the WHO assembled an international panel of experts in March 2006 to develop rapid advice for the pharmacological management of patients with H5N1 infection. The recommendations are classified as strong or weak and cover several specific patient and exposure groups for the treatment and chemoprophylaxis of H5N1 virus infection. All recommendations are specific to the current pre-pandemic situation and are based on careful consideration of the current evidence about benefits, harms, burdens and cost of interventions. As there are currently no clinical trials in patients with avian influenza H5N1 disease, the overall quality of evidence on which to base judgments is very low.
World Health Organization (WHO)
http://www.who.int/csr/disease/avian_influenza/guidelines/pharmamanagement/en/index.html
Advice on use of Oseltamivir (Tamiflu) 3 pages
World Health Organization (WHO)
http://www.who.int/csr/disease/avian_influenza/guidelines/useofoseltamivir2006_03_17A.pdf
Influenza *
Therapeutic Research Center provides scientifically reliable advice on drug therapy to physicians, pharmacists, nurse practitioners, physician assistants, dietitians, hospitals, universities, pharmacies, government agencies, and others, who use it to make clinical decisions.
http://www.naturaldatabase.com/ce/ceCourse.aspx?pm=5&pc=06-27
The Management of Fever in Young Children with Acute Respiratory Infections 21 pages
World Health Organization (WHO)
http://www.who.int/child-adolescent-health/New_Publications/CHILD_HEALTH/WHO.ARI.93.30.PDF
Fever from the FluWiki *
Flu Wiki
http://www.fluwikie.com/Index.php?n=Consequences.Fever
Cough and Cold Remedies For The Treatment of Acute Respiratory Infections In Young Children 43 pages
This document reviews the efficacy and safety of cough and cold medicines in young children (under 5 years of age) with an acute respiratory infection.
World Health Organization (WHO)
http://www.who.int/child-adolescent-health/New_Publications/CHILD_HEALTH/WHO_FCH_CAH_01.02.pdf
Cough from Merck Manual of Diagnosis and Therapy *
Merck & Co. Inc. pharmaceutical company and publisher
http://www.merck.com/mrkshared/mmanual/section6/chapter63/63b.jsp
Cough from the FluWIki
Flu Wiki
http://www.fluwikie.com/Index.php?n=Consequences.Cough
Sore Throat *
Mayo Clinic
http://www.mayoclinic.com/print/sore-throat/DS00526/DSECTION=all&METHOD=print
Common analgesics, throat lozenges, warm salt-water (1/2 teaspoon per glass) gargling, drinking honey and lemon in warm water, using a humidifier can relieve throat discomfort. Increasing your fluid intake and getting extra sleep can help speed your recovery.
The Treatment of Diarrhoea 50 pages
World Health Organization (WHO)
http://www.who.int/child-adolescent-health/New_Publications/CHILD_HEALTH/ISBN_92_4_159318_0.pdf
World listing of Oral Rehydration Salts and Solutions (ORS)
Rehydrate.org
http://www.rehydrate.org/resources/suppliers.htm
It is strongly recommended to have a supply of ORS as part of any emergency preparedness kit. Brands include CeraLyte, Infalyte, and Pedialyte.
Vomiting
Gastroenteritis quoted from Merck Manual of Diagnosis and Therapy.
Merck & Co. Inc. pharmaceutical company and publisher
http://www.merck.com/mrkshared/mmanual/section3/chapter28/28a.jsp#A003-028-0654
"Supportive treatment is most important. Bed rest with convenient access to a toilet or bedpan is desirable. When nausea or vomiting is mild or has ended, oral glucose-electrolyte solutions (see Diarrhea in Ch. 27), strained broth, or salted bouillon may prevent dehydration or treat mild dehydration. Even if vomiting, the patient should take frequent but small sips of such fluids because the vomiting may resolve with volume replacement. Children may become dehydrated more quickly and should be given an appropriate rehydration solution (several are available commercially). Commonly used liquids, such as carbonated beverages or sports drinks, lack the correct ratio of glucose to sodium and thus are not appropriate for children < 5 yr old."
Vomiting
Gastroenteritis quoted from Mayo Clinic
Mayo Clinic
http://www.mayoclinic.com/print/viral-gastroenteritis/DS00085/DSECTION=all&METHOD=print
To help keep yourself more comfortable and prevent dehydration while you recover, try the following:
- Let your stomach settle.
- Stop eating and drinking for a few hours.
- Try sucking on ice chips or taking small sips of water.
- You might also try drinking clear soda such as 7UP or Sprite, clear broths, or noncaffeinated sports drinks such as Gatorade.
- Affected adults should try to drink at least eight to 16 glasses of liquid every day, taking small, frequent sips.
- Ease back into eating. Gradually begin to eat bland, easy-to-digest foods such as soda crackers, toast, gelatin, bananas, rice and chicken. Stop eating if your nausea returns.
- Avoid certain foods and substances until you're feeling better. These include dairy products, caffeine, alcohol, nicotine, and fatty or highly seasoned foods.
- Get plenty of rest.
- The illness and dehydration may have made you weak and tired.
- Use medications such as ibuprofen (Advil, Motrin, others) sparingly, if at all. They can make your stomach more upset. Use acetaminophen (Tylenol, others) cautiously. It sometimes can cause liver toxicity, especially in children.
Pneumonia
Mayo Clinic
http://www.mayoclinic.com/print/pneumonia/DS00135/DSECTION=all&METHOD=print
If you have pneumonia, the following measures can help you recover more quickly and decrease your risk of complications:
- Get plenty of rest. Even when you start to feel better, be careful not to overdo it.
- Drink lots of fluids, especially water. Liquids keep you from becoming dehydrated and help loosen mucus in your lungs.
- Take the entire course of any prescribed medications. Stopping medication too soon can cause your pneumonia to come back and contributes to the development of antibiotic-resistant bacteria.
- Keep all of your follow-up appointments. Even though you feel better, your lungs may still be infected. It's important to have your doctor monitor your progress.
Acute Respiratory Distress Syndrome (ARDS)
Merck & Co. Inc. pharmaceutical company and publisher
http://www.merck.com/mrkshared/mmanual/section6/chapter67/67a.jsp
Acute Respiratory Distress Syndrome (ARDS) Diagnosis and Management 11 pages
Acute Respiratory Distress Syndrome (ARDS), an intense form of hypoxemic respiratory failure, may be one of the most elusive diagnoses encountered in the intensive care unit. Increasing the knowledge base of the critical care nurse is imperative to prevent and diagnose ARDS, as well as to generate and implement evidence-based clinical interventions. This article presents a thorough examination of the many facets of ARDS, including its definition, etiology, pathophysiology, presentation, diagnosis, and management.
Nursing Center
http://www.nursingcenter.com/prodev/ce_article.asp?tid=610385
An Introduction To Postural Drainage and Precussion 8 pages
*
Cystic Fibrosis Foundation
http://www.cff.org/UploadedFiles/living_with_cf/Files/An%20Introduction%20to%20Postural%20Drainage%20and%20Percussion%201-2006.pdf
Nursing patients with ARDS in the prone position 7 pages
Nursing Standard
http://www.nursing-standard.co.uk/archives/ns/vol18-19/pdfs/v18n19p3341.pdf
This article examines the main features of acute respiratory distress syndrome (ARDS),
including the pathophysiology, clinical manifestations, complications and treatment.
Patients with ARDS are critically ill and require close monitoring and mechanical
ventilation in an intensive care unit. The benefits of prone positioning, one of
the main treatment options for these patients, are discussed in detail. By understanding
the physiological principles that underpin the prone position, the critical care
nurse will be more effective in identifying patients who might benefit from this
treatment.
ARDS Foundation
internet connection required
The ARDS Foundation is a National Not for Profit Organization composed of a group
of individuals who have been personally affected by ARDS (acute respiratory distress
syndrome). We are dedicated to increasing public awareness, education, and financial
assistance to those engaged in medical research. There is also a
discussion forum.
Infection Control for Viral Haemorrhagic Fevers
210 pages
How to set up a patient isolation area, see chapter 3 and annex 3. A very useful
publication.
Centers for Disease Control and Prevention (CDC)
and World Health Organization (WHO)
http://www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual.htm
Available in french and portuguese.
Changing The Bedsheets
Strength for Caring is an online
resource and community for family caregivers.
http://www.strengthforcaring.com/daily-care/110/154/changing-the-bedsheets.html
Personal Care Skills Development for the Informal Caregiver internet connection required
Caregiver skills for bedridden patients including moving a patient, bathing
a patient, toileting.
Normal Vital Signs
EMSResource.net
http://emsresource.net/downloads/vitals.pdf
Monitoring the patient and recording nursing care
How to check vital signs- temperature, breathing, pulse, blood pressure.
World Health Organization. Regional Office for the
Western Pacific
http://www.wpro.who.int/internet/files/pub/85/15-32.pdf
The Pulmonary Exam
12 minute video
University of North Carolina
http://oisvideo2.med.unc.edu/mpac/pulmonaryexm.ram
Lung Sounds Online
Emory University School of Medicine
http://www.emory.edu/WHSCL/grady/inetgrp/hplung.html
Crackles are frequently heard with a stethoscope in patients with H5N1 infection.
Fine Crackles
example 1 example
2 example 3
Crackles
example 1 example
2 example 3
Coarse Crackles
example 1
example 2 example 3
Inspiratory Crackles, Expiratory Wheeze
example 1
Pneumonia Severity Index
Calculator internet connection required
Agency for Healthcare Research and Quality, US Dept of
Health and Human Services
You need a clock or watch with a second hand, blood pressure gauge, a stethescope
and a thermometer.
Does the patient have any of the following abnormalities on physical examination?
• Altered mental status
• Pulse ≥ 125/minute
• Respiratory rate ≥ 30/minute
• Systolic blood pressure < 90 mm Hg
• Temperature < 35°C or ≥ 40°C
Faces of Pain Scale
Pain Sourcebook
http://painsourcebook.ca/pdfs/pps92.pdf
Recommended books include...
Caregiving at Home, by William Leahy M.D
The Comfort of Home: An Illustrated Step-By-Step Guide for Caregivers, by Maria
M. Meyer, available in spanish.