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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Identify the clinical signs and symptoms associated with influenza

  • Develop an appropriate treatment plan for influenza using patient-specific information

  • Create a monitoring plan for a patient with influenza using patient-specific information

  • Educate patients about influenza and vaccination

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PATIENT PRESENTATION

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Chief Complaint

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"My son has a fever, headache, and a cough. I'm worried he might need antibiotics."

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History of Present Illness

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Matthew Jackson is a 9-year-old boy who presents with his father to the pediatrician with complaints of fever, headache, and cough for 3 days. He began feeling ill 3 days ago when he developed a fever of 102.6°F (39.2°C) and chills. He has had an intermittent headache for 2 days that is worse when he coughs. His cough is nonproductive and dry. He is more tired than usual and he has not been eating or drinking as much as usual. His fever has been constant over the past 3 days, spiking to 103.5°F (39.7°C) yesterday, but it is responsive to "cold medicine." He also complains of achy muscles in his legs and wants to remain in bed most of the time. His father wants to know if his son needs antibiotic treatment and why Echinacea is not working.

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Past Medical History

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Exercise-induced asthma diagnosed 2 years ago

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Sinusitis at age 4 and 6 years

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Febrile seizure at age 2 years

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Family History

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Father's family has strong history of diabetes, heart disease, and lung cancer. Father has HTN and seasonal allergic rhinitis. Mother is deceased but was healthy.

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Social History

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The patient lives with father and a 3-year-old sister. Father smokes cigarettes in the house and car. Sister is healthy. The patient is in fourth grade at private elementary school. No pets at home.

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Allergies/Intolerances/Adverse Drug Events

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Amoxicillin—(rash)

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Medications (Current)

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Children's Triaminic Multi-Symptom Fever (acetaminophen 160 mg/5 mL; chlorpheniramine 1 mg/5 mL; dextromethorphan 7.5 mg/5 mL) 10 mL q 6 h as needed

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Echinacea purpurea 180 mg daily

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Albuterol MDI one puff as needed

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Review of Systems

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(+) Fatigue, fever, headache, chills; (−) rhinorrhea, nasal congestion, sneezing, neck stiffness, or ear pain; (+) intermittent dry cough; (−) difficulty breathing or wheezing; (+) reduced appetite; (−) abdominal pain, vomiting, constipation, or diarrhea; (+) reduction in urinary frequency

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Physical Examination

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General
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Generally well-appearing, mixed-race boy in no acute distress

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Vital Signs
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BP 84/58 mm Hg, P 116, RR 18, T 101.1°F (38.4°C)

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Weight 87.8 lb (39.9 kg)

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