Medical history: Asymptomatic hypertension. The patient presents a history of asymptomatic hypertension, and smoking habit. He does not take the prescribed anti-hypertension medication management. The history of smoking could accentuate the condition, and present as a causative factor for primary hypertension. Currently the patient does not show any cerebral or cardiac irregularities which could lead to any long term damage due to hyper tension. However, if left unaccounted for it could assume severe form, which enhances the patient’s chances of suffering from end organ damage.
Physical assessment: The primary assessment includes inspection of airways, circulation, breathing, and the vital signs of temperature, heart rate, blood pressure, oxygen saturation and pain. All these baseline observations are necessary to make the relevant clinical decisions for patient’s condition. If not recorded properly it could result in uninformed decisions proving to be dangerous for patient’s health.
Focused assessment: As the patient reports tenderness and soreness in the joints it is necessary to perform the focused assessment for musculoskeletal system. The limbs need to be checked for muscle mass strength, and tone, besides the location of pain and tenderness. This is necessary to provide the patient with necessary support management. If not assessed the focused pain may go unnoticed and accentuate malaise.
Oseltamivir 75mg orally bd – Ostelamivir is an antiviral medication. The active ingredient ostelmaivir carboxylate is known to block the action of influenza virus by affecting the release of viral particles. It is prescribed for patients presenting symptoms of flu for 2 days or less (FDA, 2008). The dosage of 75 gm is the recommended dosage for prophylaxis of flu in adults. As Jim shows symptoms of Influenza hence he has been prescribed the respective medication, to be taken twice a day,
Paracetamol 4/24 orally prn – Paracetamol is a commonly used analgesic, and used as a first line medication for mild to moderate pain, especially in soft tissue and musculoskeletal system of body (Department of health, 2014). As Jim reports muscle tenderness and soreness, and headache. As it is an analgesic, hence its intake has been directed as when required when necessary (PRN).
Fluvax IM stat dose – Fluvax has been prescribed to Jim to help treat the preliminary diagnosed condition of influenza. It is a vaccine which containes the inactivated influenza split viron. Therefore, it induces antibodies to the viral surface of neuraminidase, haemagglutinin, and glycoproteins, thereby preventing natural infection (Seqirus, 2017). It is known for prevention of influenza virus, and therefore prescribed to Jim. Also, it has to be given immediately to strengthen the immune system of the body.
The nursing responsibilities associated with the administration of each medication involve adherence to five rights of medication administration. These rights include right patient, right drug, right dose, right route, and right time (Brotto & Rafferty, 2011). The nurse also needs to check the patient for any known allergies and previous adverse reactions to drug. In the given case Jim has no known drug allergies. Yet another responsibility involves monitoring the patient for any possible side and adverse effects. Jim needs to be monitored for the perceived efficacy of medication after the first dosage. He needs to be monitored for the effect of medication on his clinical condition. The lab results for blood count, liver and renal functions management, besides the other key parameters of physiologic functioning need to be monitored as well (Tiziani, 2013).
Jim needs to be informed about his medical condition, as influenza is an acute respiratory disease which in high risk patients could result in severe complication or death as well. Therefore it is essential for Jim to manage his condition through proper intake of medication, as he has also exhibited non adherence to medication regime in the past. The topic is also important as influenza is a contagious disease which could infect multiple people in a short period of time, leading to public health or socioeconomic issues in a community. After imparting relevant teachings to Jim, he should be observed to ensure that he is following the necessary precautions, and instructions to ensure his own well being and avoid the spread of virus. He needs to avoid touching his eyes, nose and mouth to prevent the spread of germs, cover his mouth while coughing, and practice hand hygiene (American thoracic society, 2018).
Jim upon admission was diagnosed with febrile illness, which was later on ascribed as influenza. The increased chills and shivering, malaise, and diaphoresis can be possible side effects of Fluvax. The medication has contraindications of administration in case of febrile illness. Postponing administration is preferred in such cases. Also, hypersensitive reactions can occur in case of patients allergic to egg. As Jim is allergic to chicken, it might be possible that the reported side effects are a result of identification of egg protein as chicken by the body. In the view of the respective findings, Jim needs to be removed from Fluvax administration. The patient can be administered Flucelvax, which is a cell culture vaccine and not made in eggs (FDA, 2016). This will help counter the side effects of Fluvax.Identify – Patient information: Jim, 58 yr old, Male, Indigenous, No fixed address.
Situation – The patient is currently showing intense shivering, chills, low level of alertness, malaise, and laboured breathing.
Background - The patient was presented to the emergency department with symptoms of influenza. He has a medical history of asymptomatic hypertension, no known drug allergies, and chicken allergy. The physical assessment showed normal respiration, cardiac rhythm; however he reported overall muscle and joint tenderness. Skin was hot and diaphoretic.
Assessment – The patient seems to be showing side effects to egg based Fluvax vaccine, which has possibly resulted in the present situation.
Request- The patient has been started on Flucelvax . It is requested of the current person in charge of shift to monitor the patient for efficacy on the drug on the clinical condition, and further side or adverse effects.
American thoracic society. (2018). Influenza - The Flu. Retrieved April 6, 2018, from
Brotto, V., & Rafferty, K. (2011). Clinical dosage calculation for Australia and New Zealand. Cengage Learning.
Department of health. (2014). Safe paracetamol use. Retrieved April 6, 2018, from
FDA. (2008). Tamiflu. Retrieved April 6, 2018, from
FDA. (2016). Flucelvax. Retrieved April 3, 2018, from
Seqirus. (2017). Fluvax. Retrieved April 6, 2018, from
Tiziani, A. P. (2013). Harvard’s nursing guide to drugs. Elsevier Health Sciences.