Clinical Pearl Wednesday #15

Flu season is in full swing. Here is the Elite NP strategy for influenza:

You should be thinking influenza when you hear a patient complaining of body aches during influenza season. It is the most common and resounding symptom among people who have influenza. Nobody aches? Probably not flu. I would estimate that 90% of individuals I swab that test positive for influenza have body aches. Other common symptoms are cough, congestion, sore throat, fever, rhinorrhea, and headache.

Influenza A = URI symptoms.

Influenza B = A mixture of URI and GI symptoms (usually).

When I am practicing in the heat of flu season and every clinic in town has a 2-3 hour wait, I will typically forgo testing for influenza. If a patient has the symptoms, with NEGATIVE exam findings for pneumonia or other bacterial infections (THIS IS KEY), and flu is widespread, I will begin treating for influenza clinically.

Treatment is predominately symptomatic, but in this day and age, most people want Tamiflu if it is within the first 48 hours of symptom onset. I have found naproxen to work best for the body aches and fever compared to Tylenol and ibuprofen. Ensure fluid intake is maintained. Dehydration is a common complication.

Make sure to educate the patient about how long they can expect to be symptomatic. Typically, flu will peak by day 3 and then resolve by day 5-6. I always tell my flu patients that if symptoms are not improving or worsening by day 3-4, they need to return immediately for reevaluation. This could mean they have a secondary infection and it is critical you treat this promptly.

For those nurse practitioners working the front lines during this flu season, I am right there with you. Stay strong, stay SHARP, and keep trucking on. The light at the end of the tunnel is near.

6 Responses

  1. I work in a retail clinic and have been seeing a lot of patients testing positive for Influenza A or B. I did not know the difference in symptoms had anything to do with the strain of the Flu… I learned something new. Thank you for all you do, I am enjoying your ebook and articles; gaining necessary information from them.

  2. Hey there. Great info! Please know that In pediatrics a fever above 101f is the predominant indicator of the flu. In my experience, most kids tell me they don’t have body aches.

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