So the signs and symptoms of the flu.
Now, the flu has a reputation.
It is known for hitting
hard and hitting fast.
A patient will feel like they were
hit by a truck of sickness and pain
after feeling fine in the days and
hours preceding their symptoms.
They have a very rapid onset.
The symptoms of influenza
typically last 4-5 days,
but they can last anywhere from 2-10 days.
A classic symptom is a very high fever
and this really makes
your patient feel lousy.
Central symptoms involve a headache
and patients will come in with a wicked
headache when they have influenza.
In the nasopharynx, the patient
will have a runny nose
and possibly, a sore throat that can
also be from the post-nasal drip.
In the respiratory system the
patient will have a cough
and this is a deep, deep cough.
It causes pain with deep breathing.
It is deep and it is forceful.
In the muscular system, the patients
will have extreme tiredness.
They will want to lay in their bed,
and may spend a good portion of
their day actually in their bed.
They will have severe body aches
and their joints will ache.
Patients may also have some GI symptoms,
including vomiting or diarrhea.
But these are not guaranteed
in the influenza infection,
like they are with gastroenteritis.
So, when a patient checks into your clinic
and says they're there for flu-like
symptoms, you really want to clarify
because some patients think of the stomach
flu as the real flu, and it's not.
That's actually gastroenteritis.
Now, let's compare the common cold with
influenza, based on signs and symptoms.
With a common cold, the patients
typically don't have a fever,
but with influenza, patients will have
a fever and it will be a high fever.
Sometimes, 37.7°C or even 103°F or
104°F for 5, 6, or 7 days straight.
Patients will usually have a
severe headache with influenza,
but not usually with a common cold.
These will keep your patient in bed.
They will be shaking.
They will want to wear all the blankets,
and this is very common in influenza,
but chills are not common
with a common cold.
The patient, again, will feel like they've
been hit by a Mack truck with influenza.
This is uncommon with a cold.
A sore throat.
They share this symptom.
The patient may have the sore
throat from the post nasal drip
and the runny nose that
occurs in both conditions.
Sneezing and congestion.
This is really common with a cold.
Sometimes, the patient will experience
these symptoms in influenza.
It's usually mild or moderate with a cold,
and in influenza, again,
it's forceful, it's deep,
and it lasts a long time because
that virus really irritates the airway.
The patient may have severe weakness
in the setting of influenza.
Again, they can spend 2, 3, or 4 days in
their bed, and this is uncommon with a cold.
Typically, a cold is self-limiting.
The patient may have 1-3
days of mild discomfort.
But with influenza, the patient
can have multiple complications,
including bronchitis, secondary pneumonias,
and may even require hospitalization.
So, during the exam for influenza,
we want to collect a full
history of the present illness.
You're going to obtain the
full history to determine
if the patient is in a high
risk group for complications.
So, this is a very specified
group of patients
and this is going to determine
the rest of your clinical course
and your workup of your patient.
The CDC has identified criteria as
adults 65 and older, pregnant women,
young children who are < 5 years old,
but mostly that < 2 year-old group.
Patients with asthma, heart disease or a
history of stroke, patients with diabetes,
or patients who are immunocompromised
due to HIV/AIDS or cancer,
and children with neurologic conditions.
These are the patients that are
expected to have severe complications
or even die from influenza.
You should also clarify with your patient
if they've had the seasonal flu vaccine.
Next, you're going to look at
your patient's vital signs.
When you have a patient with
influenza sitting in front of you,
their vital signs will probably be abnormal.
This is expected.
The patient will likely have a
very high fever and, in turn,
they're going to have an elevated heart
rate and an elevated respiratory rate.
Because remember, as the patient
is trying to cool the body,
right, they're going to pant, almost,
increase their respiratory rate
to try to cool the body
through the breathing.
And as you bring the patient's fever down
and hydrate the patient, they should improve.
Assess the patient's pulse
oximeter to be sure
that they're not hypoxic and
needing supplemental oxygen.
And also, you want to be sure that
your patient is not going into
any form of shock by assessing
their blood pressure.
Next, the clinician will do
a full respiratory exam,
as well as an inspection of
the head, eyes, ears, nose,
throat, cardiac, abdomen, and skin.