StacyICU-RN

Whilst sitting at home with newly diagnosed influenza A and beginning my Tamiflu, prednisone, and jacked up cough syrup regimen, I thought, “what a perfect opportunity to share a some tips on patient education with regards to the flu!”

A patient comes into the ED c/o body aches, chills, fever, cough, etc., and you shove gently ease the flu swab down their nose and tickle their brain. You send it to the lab and 15 to 30 minutes later you get a call from the lab with a critical value: influenza type A. So you tell your patient, “Sorry, you have the flu.” Then your patient throws you a curve and asks, “Which one?”

After reading this post, you’ll be ready to dazzle them with your medical knowledge. Are you ready to learn some shit? Hell yeah, you are! Let’s do this!

There are four types of influenza viruses: A, B, C, and D. Human influenza A and B are the seasonal viruses that cause epidemics each winter. Influenza C is a milder virus typically causing respiratory illness, but not on the epidemic scale. Lastly, there is influenza D, which is primarily found in cattle, so, yeah, we can skip that one.

Influenza A is further divided into two subtypes corresponding to a pair of proteins on the surface of the virus; H (hemagglutinin) and N (neuraminidase). Starting to sound familiar? H1N1?

There are 18 subtypes of hemagglutinin and 11 subtypes of neuraminidase. According to the CDC, there are currently two strains of influenza A found in humans: H1N1 and H3N2.

Influenza B is not broken down into subtypes. Instead, it is categorized by lineage and strain. The CDC reports there are currently two flu B lineages: B/Yamagata and B/Victoria.

Which is worse, flu A or flu B? Your patient is sure to ask you this question at some point. The conventional wisdom is that flu B has always been milder because it’s slower to mutate than flu A. But, new research suggests that there is no difference in severity between flu A and flu B in hospitalized adult patients.

How do you treat the flu? Zanamivir (Relenza) and oseltamivir (Tamiflu) are antivirals that work against flu A or B. They essentially shorten the duration of flu symptoms by a day, maybe two. Typically, you must begin these drugs within the first 48 hours of onset of symptoms.

For flu B, there are rimantadine (Flumadine) and amantadine (Symmetrel). Rimantadine, like the flu A meds, is most effective if given during the first 48 hours. I couldn’t find information about timing for amantadine, though.

And, of course, lots of rest and fluids.

Lastly, patients will often ask how long does it take to get sick and how long are they contagious?

Typical incubation time for the flu is 1 to 4 days. Adults may be contagious 1 day prior to showing symptoms and 5 to 7 days after symptoms appear. Younger people, and those with weakened immune systems may be contagious for longer.

There you have it. Your edFLUcation from your flu A positive ER nurse. If you found this useful, please share it, with attribution, of course!

Edit: As my fellow ER nurse and friend @maryvansteenberghe (on Instagram) pointed out, getting your yearly flu vaccine, while not offering 100% protection from the flu, can help lessen the virulence of the virus. Thanks, Mary!

Sources:

https://www.cdc.gov/flu/about/viruses/types.htm

https://www.cdc.gov/flu/professionals/acip/clinical.htm

https://www.cdc.gov/flu/news/flu-study-viruses.htm

Re-posting this because I finally got to scan it in high-res.

Betty Bates is a goddamn hero.