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
"My son has a fever, headache, and a cough. I'm worried he might need antibiotics."
History of Present Illness
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.
Exercise-induced asthma diagnosed 2 years ago
Sinusitis at age 4 and 6 years
Febrile seizure at age 2 years
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.
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.
Allergies/Intolerances/Adverse Drug Events
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
Echinacea purpurea 180 mg daily
Albuterol MDI one puff as needed
(+) 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
Generally well-appearing, mixed-race boy in no acute distress
BP 84/58 mm Hg, P 116, RR 18, T 101.1°F (38.4°C)
Weight 87.8 lb (39.9 kg)