Viral Respiratory Season Is Officially Here

As we near the winter months, the CDC has warned of a higher-than-normal prevalence of viral upper respiratory illnesses (URI), impacting all populations from newborns to the elderly. As Registered Nurses, we can expect the 2022/23 URI season to be busy with a sudden influx of patients presenting in hospitals all across the USA. URIs that most often exhibit a pattern of seasonal peaks during the winter months include:

1. Influenza

2. RSV

3. Human Coronavirus

Common URI Symptoms And At Risk Populations

The most common URI symptoms include a sore throat, loss of appetite, chills, fever, sneezing, rhinorrhea, nasal congestion, cough, headache, fatigue, and sinus pain. The symptoms and prognosis of a URI can become more severe when they affect the very young, elderly, or immunocompromised. Those with other comorbidities may also experience worsening symptoms of those conditions as a result of having a URI, such as worsening asthma, COPD, or congestive heart failure.

In newborn or young pediatric patients, it is important to remember that their airway will be much smaller in diameter and length than an adult patient. Any restriction or narrowing can severely impact a young patient’s ability to breathe and any warning signs of impending respiratory distress should be addressed immediately, to prevent respiratory or cardiac arrest. Young children also have underdeveloped immune systems, which can increase their risk for contracting an illness, such as a URI.

In the elderly population, a different set of challenges can present as their diaphragms may be weaker than that of a young adult, impairing their ability have full lung inspiration and expiration when breathing. The elderly may also experience weakened coughs that may not be sufficient to adequately clear any mucous or secretions that a young adult would normally be able to with a strong cough. The elderly may also present with a weakened immune system, increasing the risk of contracting a URI. It is not uncommon for an elderly patient to present in a hospital for a non-respiratory related issue during the winter months and contract a hospital-acquired respiratory infection as a result of being admitted.

Why Are URIs More Prevalent During The Winter Months?

URIs often peak during the winter months for variety of reasons, including schools and universities being open, changes in humidity and temperature, as well as less exposure to the sun and reduced Vitamin D levels. Interventions such as mask mandates and shelter-in-place orders likely contributed to a lower prevalence of non-Covid related URIs in 2020 and parts of 2021. However, with these restrictions being lifted, we are now experiencing pre-pandemic levels again. As people spend more time together indoors during the winter months, there is likely to be an increased transmission risk for URIs, which we are seeing across the USA today. Preventing the spread of infection through vaccinations, cleaning surfaces and high use areas, having those who are sick stay at home, and performing proper hand hygiene, can significantly reduce the risk of transmission for infections.

Treatment Of URIs

For Registered Nurses who treat patients with a URI, it is important to remember that the treatment of viral respiratory infections differs from those of bacterial infections, as antibiotics do not provide a benefit against viruses. Often treatment in the hospital or community setting will be based on addressing symptoms and include respiratory support (supplemental oxygen) and fluid management (oral or intravenous fluids), as well as fever and pain management (acetaminophen or ibuprofen).

Nursing Assessment For A Patient With A URI

When caring for a patient with a URI it is important for the nurse to assess and monitor the following:

• Fluid Status (intake, output, mucous membranes, skin temperature and dryness; sunken fontanels in infants)

• Temperature (fever, chills)

• Respiratory System Assessment (adventitious lung sounds, SPO2 and oxygen demand, work of breathing, accessory muscle use, lung expansion/contraction, difficulty breathing or shortness of breath, cough)

• Pain (chest, throat, etc.)

• Nutritional Status

• Comorbidities And Health History (immunizations, previous or current infections, tobacco use, recent travel, recurrent health issues)

• Vital Signs (monitor changes in the heart rate and respiratory rate closely and this can be an early warning sign for dehydration)

Sources:

• CDC warns of tough winter as flu, RSV and covid collide. Fenit Nirappil; The Washington Post. As covid, flu and RSV cases collide, CDC warms of a tough winter ahead - The Washington Post. Accessed November 2022

• COVID-19 vs. Flu vs. RSV: How to tell the difference between respiratory infections | Labcorp. https://www.labcorp.com/coronavirus-disease-covid-19/covid-news-education/covid-19-vs-flu-vs-rsv-how-tell-difference. Accessed November 2022

• Loren Rodgers, Michael Sheppard, Amanda Smith, Stephanie Dietz, Praveena Jayanthi, Yan Yuan, Lara Bull, Samantha Wotiz, Tessa Schwarze, Roseric Azondekon, Kathleen Hartnett, Jennifer Adjemian, Hannah L Kirking, Aaron Kite-Powell, Changes in Seasonal Respiratory Illnesses in the United States During the Coronavirus Disease 2019 (COVID-19) Pandemic, Clinical Infectious Diseases, Volume 73, Issue Supplement_1, 15 July 2021, Pages S110–S117, https://doi.org/10.1093/cid/ciab311