Pediatric Clinical Encounter Poster Presentation.pptx

1. Pediatric Clinical Encounter: Influenza B
Laura Sparks
University of Arkansas for Medical Sciences, College of Nursing
 Definition: Contagious respiratory illness that is caused by influenza
viruses that infect the lungs, nose, and throat (CDC, 2021b).
 Three types are known to infect humans: Type A, B, & C
 Outbreaks occur annually worldwide and are more commonly seen
during the winter months in temperate climates (Munoz, 2021)
 Infection can range from asymptomatic or mild symptoms to severe
illness associated with morbidity and mortality (Munoz, 2021)
Introduction
Chief complaint: Mother states “He developed a fever, runny nose, and
cough on Sunday night.”
HPI: 6-month-old Marshallese male presents to the clinic with his
mother for c/o subjective tactile fever, runny nose, congestion, and
cough that started 2 days ago. She denies rash, vomiting, or diarrhea.
She does not have a thermometer at home, but states that he has felt
hot like he has a fever. She gave him Tylenol this morning at 8AM. She
reports that he is eating and drinking well.
Physical Exam: General appearance: awake, alert, no acute distress.
HEENT: AT/NC, anterior fontanelle flat, eyes and ears unremarkable,
nose with clear nasal drainage, audible congestion, mouth
unremarkable with moist mucous membranes
Neck: supple, no lymphadenopathy
Cardiovascular: Regular rate and rhythm, no murmurs, gallops, rubs.
Respiratory/Thorax: Lungs clear to auscultation bilaterally. No
wheezes, rales, or rhonchi
Abdomen: Unremarkable. Soft, bowel sounds active x4 quads
Skin: Unremarkable. No rashes or lesions. Good turgor
Peripheral pulses: Femoral pulses 2+ and equal.
Family/Social History:
No pertinent family history.
Lives at home with parents, grandparents, and two siblings. Does not
attend daycare. Grandfather smokes outside of the house. No pets in
the home.
Case Report
Labs & Diagnostics
 Etiology/Epidemiology: Caused by the influenza B virus
 Classified into Lineages: B(Victoria) & B(Yamagata) (CDC, 2021b)
 Influenza is a single-stranded helical RNA virus in the
orthomyxovirus family (CDC, 2021a)
 Affects individuals of all ages worldwide & peaks in temperate
climates during the winter months (October-March) (Dolin, 2022)
 Disease Burden in US in 2019-20: 35 million illnesses, 16 million
medical visits, 380, 000 hospitalizations, & 20,000 deaths (CDC,
2021b).
 Transmission/Pathogenesis/Virology:
 Droplet transmission:
 Droplets can spread to others up to 6 feet away
 Droplets enter through the nose or mouth and can be
inhaled into the lungs
 May also be transmitted by touching an infected object or surface
and then touching nose, mouth, or eyes (CDC, 2018)
 Virus attaches and penetrates respiratory epithelial cells in the
trachea and bronchi (CDC, 2021a)
 Virus replicates in respiratory epithelium and destroys host cells
 Infectious 1 day prior to onset of symptoms
 Most contagious in the first 3-4 days after onset of symptoms
 Healthy adults are contagious up to 5 to 7 days after onset of
symptoms
 Children and immunocompromised individuals can spread the
virus for longer than 7 days (CDC, 2018)
 Clinical Findings:
 Symptoms start 2 days after infection
 Fever, headache, myalgia, malaise, cough, sore throat, rhinitis
 Diagnosis:
 Molecular assay: RT-PCR & Rapid molecular assay
 Antigen detection assay: Traditional antigen detection RIDT,
digital immunoassay,& direct and indirect immunofluorescence
assay
Pathophysiology & Epidemiology
Centers for Disease Control and Prevention. (2018, August 27). How flu spreads. Centers for Disease Control and
Prevention. https://www.cdc.gov/flu/about/disease/spread.html
Centers for Disease Control and Prevention. (2019). Influenza Virus. Images of Influenza.
Centers for Disease Control and Prevention. (2020). Influenza Symptoms. Influenza. Retrieved from
https://www.cdc.gov/flu/resource-center/freeresources/graphics/infographics.htm.
Centers for Disease Control and Prevention. (2021a, August 18). Pinkbook: Influenza. Centers for Disease Control and
Prevention. Retrieved July 5, 2022, from https://www.cdc.gov/vaccines/pubs/pinkbook/flu.html
Centers for Disease Control and Prevention. (2021b, November 18). About flu. Centers for Disease Control and
Prevention. https://www.cdc.gov/flu/about/index.html
Dolin, R. (2022, March 24). Influenza: Epidemiology and pathogenesis. UpToDate. https://www-uptodate-
com.libproxy.uams.edu/contents/influenza-epidemiology-and-
pathogenesis?search=Influenza+b&topicRef=5973&source=see_link#H2373721546
Flomenberg, P., & Kojaoghlanian, T. (2022, March 11). Pathogenesis, epidemiology, and clinical manifestations of
adenovirus infection. UpToDate. om https://www-uptodate-com.libproxy.uams.edu/contents/pathogenesis-epidemiology-
and-clinical-manifestations-of-adenovirus-
infection?search=adenovirus&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H14
Military Health System. (n.d.). Fight the Flu. Retrieved from
https://www.health.mil/News/Gallery/Infographics/2021/03/08/3ActionstoFightTheFlu_Twitter.
Munoz, F. M. (2021, November 5). Seasonal influenza in children: Clinical features and diagnosis. UpToDate.
https://www-uptodate-com.libproxy.uams.edu/contents/seasonal-influenza-in-children-clinical-features-and-
diagnosis?search=Influenza+b&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H3
Munoz, F. M., & Edwards, M. S. (2021, November 19). Seasonal influenza in children: Management. UpToDate.
Retrieved July 5, 2022, from https://www-uptodate-com.libproxy.uams.edu/contents/seasonal-influenza-in-children-
management?search=influenza&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4#H34
Willis, G. A., Preen, D. B., Richmond, P. C., Jacoby, P., Effler, P. V., Smith, D. W., Robins, C., Borland, M. L., Levy, A.,
Keil, A. D., Blyth, C. C., & WAIVE Study Team (2019). The impact of influenza infection on young children, their family
and the health care system. Influenza and other respiratory viruses, 13(1), 18–27. https://doi.org/10.1111/irv.12604
World Health Organization. (2022). Coronavirus. World Health Organization. https://www.who.int/health-
topics/coronavirus
References
Differential Diagnosis
Discussion-Potential Effects on family
Evidence Based Guidelines
Medical Management Interprofessional Team Management
Outcomes & Recommendations
 COVID-19: Infectious disease caused by the SARS-CoV-2 virus that is
spread by respiratory droplets. It can cause mild to severe symptoms
including fever, cough, fatigue, myalgia, headache, sore throat, rash,
diarrhea, ageusia, and anosmia (World Health Organization, 2022).
 Adenovirus: Infectious respiratory virus that commonly infect young
children. Symptoms include fever, pharyngitis, cough, conjunctivitis,
and cough (Flomenberg & Kojaoghlanian, 2022).
 Rhinovirus: AKA the “common cold”. Infectious respiratory virus that is
transmitted through nasal secretions and seen commonly in children.
Symptoms include cough, nasal discharge and obstruction, fever, sore
or scratchy throat (Pappas, 2021).
 Pharmacologic:
 Oseltamivir (Tamiflu) suspension reconstituted, 6mg/mL. Give
4mL orally twice a day for 5 days. Dispense 40 mL,
 Antipyretics- acetaminophen & ibuprofen
 Nonpharmacologic:
 Rest
 Fluids
 Saline nasal spray
 Humidifier
 Specific Education:
 He is considered contagious for 7 days and until 24 hours after his
last fever
 Wash hands often with soap and water
 Teat fever over 100.4 with ibuprofen or acetaminophen
 Flu vaccination can help prevent some cases of flu and lessen
severity of symptoms
 Call or go to ER for trouble or fast breathing, does not produce
tears when crying, will not wake up easily, develops rash.
 Return to clinic if he develops new symptoms, symptoms do not
improve, or fever lasts > 5 days.
 Antiviral medications should be used for groups at high risk for
complications including children < 2 years of age
 Preferred antiviral: oral Oseltamivir
 Dosing for 6-month-old: 3 mg/kg twice daily for 5 days
 Should be started ideally <48 hours of symptom onset
 Symptomatic treatment
 Acetaminophen or ibuprofen for fever and myalgia
 Nasal saline & suction, humidifier
 Increased fluids (Munoz & Edwards, 2021)
 Influenza antigen detection RIDT
 Influenza B: Positive
 Influenza A: Negative
 COVID Rapid antigen test: Negative
 Influenza is highly contagious. Limit exposure to siblings and other
family members that are not in direct care & wash hands frequently.
 Child must stay home from day care. Avoid contact with others.
 Family that become symptomatic, should stay home from work for 7
days or until fever free for at least 24 hrs
 Risk of absenteeism, increased healthcare visits, hospitalization,
secondary infections, & medication usage. (Willis et al., 2019).
 Provider/APRN
 Prevention: Encourage vaccination for patient & family
 Early symptom recognition & appropriate diagnostic testing for
influenza and possible coinfections
 Prescribe antiviral medication to reduce duration and severity of
symptoms
 Educate family on symptomatic treatment, warning signs, &
infection control measures. (Munoz & Edwards, 2021).
 Nurse/MA:
 Education, prevention, testing, infection control
 Tamiflu twice a day x 5 days to decrease duration and severity of
symptoms
 Supportive care: increased fluids, rest, treat fever with
acetaminophen or ibuprofen, nasal saline and suctioning, humidifier
 Go to ER if he becomes lethargic, not tolerating fluids, has less than 3
wet diapers in 24 hrs, or any signs of respiratory distress
 Keep him isolated away from siblings and grandparents.
 Keep him at home and avoid contact with others.
 Wash hands frequently and disinfect surfaces
 When holding him, place his chin on your shoulder to keep him from
coughing in your face
 To prevent future infections, everyone in the household should be
vaccinated annually & avoid contact with sick people when possible.
Figure 1: Influenza symptoms (CDC, 2020)
Figure 2: Influenza Virus (CDC, 2019)
Figure 3: Fight the Flu (Military Health System, n.d.)