Case Studies: Influenza

Lisa Bridwell Robinson, DNP, CCRN, CNE, NP-C
Thursday December 28, 2017
An estimated 9.2 million to 35.6 million Americans are infected with influenza annually.Influenza results in hospitalization for 40,000 to 710,000 of those infected and is the cause of death for 12,000 to 56,000 Americans annually.1 The annual disease burden is dependent on several factors, including the efficacy of a vaccine, the number of individuals receiving the vaccine, the timing of influenza, and the characteristics of the virus.

The only way to prevent infection is to get an annual flu vaccine.2 The flu typically presents with a sudden onset of symptoms, including fever, chills, cough, sore throat, stuffy nose, body aches, headache, and fatigue.2 Some cases may include vomiting and diarrhea.2 A person with the flu can be contagious from 1 day prior to the onset of symptoms to up to 7 days after the start of symptoms.2 The period from 3 to 4 days after the illness begins is when patients are most contagious.2 After a person is exposed, the onset of symptoms usually occurs within 1 to 4 days.Complications related to the flu are more frequently seen in individuals with chronic health conditions, the young, and those over age 65 years.

Primary prevention of the flu is through an annual flu vaccine. It is also recommended that those who are infected stay home to avoid spreading the virus and that healthy individuals avoid contact with those who are sick or appear to be sick.2 Flu diagnosis can be made with many available rapid diagnostic tests.3 Although false positives are rare, false negatives are a possibility,3 so, some providers may diagnose flu based on the patient’s presentation of symptoms. State public health laboratories and some hospitals have more accurate and sensitive flu tests, with results available within a few hours.

Influenza Case Study

Eli, a 19-year-old college freshman, presents to the clinic complaining of fever, malaise, and nausea. He says he came in because he feels too weak to go to class. Additionally, he reports having no appetite. For symptom relief, Eli has taken ibuprofen. 


Discussion Question: What additional information would you want to know about Eli’s history and current presentation? 

Answer: Eli has no previous health conditions to report except that he was told that as a small child, he had reactive airway disease. He works part time while attending college. His only sibling is alive and well. Both parents are alive, and Eli’s father takes medication for hypertension. Eli lives in a college dorm with 1 roommate, and his dorm houses about 150 students. 

Discussion Question: What additional questions related to Eli’s symptoms are relevant? 

Answer: He denies having a cough. Additionally, Eli says that his throat is slightly sore, but he is not sure whether it is because he has been vomiting. He also says that his nose is somewhat stuffy. Eli says that he does not know of anyone around who is ill but that he takes classes in lecture halls with about 100 other students several days a week. 

His temperature in the office is 101.2°F. Eli’s ears are clear upon examination, and his throat is mildly red. His blood pressure is within the normal range, his pulse rate is 104, and his respiratory rate is 20. Eli’s lungs are clear to auscultation. A rapid flu test is completed with a nasal swab. The flu test is positive. 

Discussion Question: What are the follow-up recommendations for Eli? 

Answer: With his onset of symptoms being less than 24 hours, Eli is prescribed oseltamivir to be taken twice daily for 5 days.4 Additionally, he should continue to take OTC medications for body aches and fever. He is also advised to avoid contact with others for the next several days. 

Summary

Health care providers need to highlight prevention. An annual flu vaccination is the primary way to prevent contracting influenza.5 Anyone over 6 months can get a yearly flu vaccine. The vaccine is especially important for individuals at a higher risk of complications, such as those with compromised immune systems and elderly individuals. Vaccination of health care providers is also encouraged, because they are more likely to be exposed to infected individuals and could also spread the virus.5 The timing of the vaccine should occur prior to the onset of the typical flu season. The CDC recommends that everyone receive a vaccine by the end of October each year. 
 


Lisa Bridwell Robinson, DNP, CCRN, CNE, NP-C, is a family nurse practitioner and certified nurse educator who practices as a work-site health coach. She has practiced in a convenience care clinic and a family medical practice. Dr. Robinson also serves as a faculty member for graduate nursing students in both master’s and doctoral programs. 



References

1.     Disease burden of influenza. CDC website. cdc.gov/flu/about/disease/burden.htm. Updated May 16, 2017. Accessed November 1, 2017.
 
2.     Key facts about influenza (flu). CDC website. cdc.gov/flu/keyfacts.htm. Updated October 3, 2017. Accessed November 1, 2017.
 
3.     Diagnosing flu. CDC website. cdc.gov/flu/about/qa/testing.htm. Updated October 3, 2017. Accessed November 1, 2017.
 
4.     What you should know about flu antiviral drugs. CDC website. cdc.gov/flu/antivirals/whatyoushould.htm. Updated January 5, 2017. Accessed November 1, 2017.
 
5.     Preventive steps. CDC website. cdc.gov/flu/consumer/prevention.htm. Updated September 12, 2017. Accessed November 1, 2017.


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