Influenza: Signs and Exam (Pediatric Nursing)

00:01 So the signs and symptoms of the flu.

00:03 Now, the flu has a reputation.

00:05 It is known for hitting hard and hitting fast.

00:08 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.

00:16 They have a very rapid onset.

00:18 The symptoms of influenza typically last 4-5 days, but they can last anywhere from 2-10 days.

00:25 A classic symptom is a very high fever and this really makes your patient feel lousy.

00:31 Central symptoms involve a headache and patients will come in with a wicked headache when they have influenza.

00:37 In the nasopharynx, the patient will have a runny nose and possibly, a sore throat that can also be from the post-nasal drip.

00:45 In the respiratory system the patient will have a cough and this is a deep, deep cough.

00:50 It causes pain with deep breathing.

00:52 It is deep and it is forceful.

00:55 In the muscular system, the patients will have extreme tiredness.

00:59 They will want to lay in their bed, and may spend a good portion of their day actually in their bed.

01:04 They will have severe body aches and their joints will ache.

01:08 Patients may also have some GI symptoms, including vomiting or diarrhea.

01:13 But these are not guaranteed in the influenza infection, like they are with gastroenteritis.

01:19 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.

01:29 That's actually gastroenteritis.

01:32 Now, let's compare the common cold with influenza, based on signs and symptoms.

01:37 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.

01:45 Sometimes, 37.7°C or even 103°F or 104°F for 5, 6, or 7 days straight.

01:52 Patients will usually have a severe headache with influenza, but not usually with a common cold.

01:58 Chills.

02:00 These will keep your patient in bed.

02:01 They will be shaking.

02:02 They will want to wear all the blankets, and this is very common in influenza, but chills are not common with a common cold.

02:09 Body aches.

02:10 The patient, again, will feel like they've been hit by a Mack truck with influenza.

02:14 This is uncommon with a cold.

02:17 A sore throat.

02:18 They share this symptom.

02:20 The patient may have the sore throat from the post nasal drip and the runny nose that occurs in both conditions.

02:26 Sneezing and congestion.

02:28 This is really common with a cold.

02:30 Sometimes, the patient will experience these symptoms in influenza.

02:35 A cough.

02:36 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.

02:47 Weakness.

02:48 The patient may have severe weakness in the setting of influenza.

02:52 Again, they can spend 2, 3, or 4 days in their bed, and this is uncommon with a cold.

02:58 Complications.

02:59 Typically, a cold is self-limiting.

03:01 It's mild.

03:02 The patient may have 1-3 days of mild discomfort.

03:05 But with influenza, the patient can have multiple complications, including bronchitis, secondary pneumonias, and may even require hospitalization.

03:15 So, during the exam for influenza, we want to collect a full history of the present illness.

03:21 You're going to obtain the full history to determine if the patient is in a high risk group for complications.

03:26 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.

03:33 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.

03:44 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.

03:57 These are the patients that are expected to have severe complications or even die from influenza.

04:04 You should also clarify with your patient if they've had the seasonal flu vaccine.

04:09 Next, you're going to look at your patient's vital signs.

04:12 When you have a patient with influenza sitting in front of you, their vital signs will probably be abnormal.

04:17 This is expected.

04:18 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.

04:25 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.

04:35 And as you bring the patient's fever down and hydrate the patient, they should improve.

04:39 Assess the patient's pulse oximeter to be sure that they're not hypoxic and needing supplemental oxygen.

04:45 And also, you want to be sure that your patient is not going into any form of shock by assessing their blood pressure.

04:51 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.