2016’s Late-Hitting Flu
Influenza, more commonly referred to as “The Flu”, arrives late Fall to early Winter each year, but this year the Flu arrived late and is still lingering through the Spring months. The symptoms of Influenza can be as mild as a minor cough and having mild aches, or patients can have symptoms that are so severe they require hospitalization. Saying the word “influenza” in public can cause a reaction similar to saying “bomb” in an airport. People tend to run for the face masks, Lysol wipes and hand sanitizer.
Influenza, a virus that causes a respiratory illness, has 3 types: Types A and B are the ones that are responsible for causing seasonal influenza each year, and Type C is much more mild and not as contagious.
While no one is immune to the influenza virus, there are certain groups of people that are considered high risk populations. These populations include people with Asthma, Diabetes, Heart Disease, those that have had a Stroke, elderly people 65 or older, pregnant women and children younger than 5 years old. Patients with low immune systems, such as those suffering with HIV, AIDS or Cancer are also at high risk for complications from Influenza.
Flu season is also one of the busiest seasons for telephone triage nurses. The call volume is typically more than double in any given call center starting in late November, peaking in December through February and slowly declining again starting in March.
Let’s look at an Influenza call and see how the triage nurse will determine the safest disposition for her caller.
Patient Scenario: Jim Smith
It’s 8:00 pm on a Friday night in mid-December, Jim (names have been changes to protect the identity of the patient) has just came home from a long day at work. Jim is a 30-year-old male that works retail in a large shopping mall. He recently was hospitalized for a respiratory illness, that was subsequently diagnosed as Asthma. He is being seen twice in the last 2 months by a pulmonologist to regulate his medication regime.
Jim was feeling fine when he went to bed last night, but in the last 3 hours he has developed body aches, sore throat, headache, has a congested cough, and feeling feverish and fatigued. Upon checking his temperature, he finds he is febrile at 101 degrees F orally.
Normally Jim would take Acetaminophen, grab a cup of warm soup and head to bed but he was recently diagnosed with Asthma which required hospitalization not even 2 months ago.
While Jim’s symptoms might not trigger red flags for a healthy 30-year-old, he decides to call the nurse triage line for advice for reassurance.
The nurse asks Jim a series of questions about the onset of his symptoms, any known influenza exposure, his respiratory status. While Jim did have any known exposure to influenza, he does work in a high traffic area where he could easily have come in contact with the virus and it is the middle of December, the peak of Influenza season. The nurse also goes over his past medical history where she learns about his newly diagnosed Asthma and that he is still working with a pulmonologist to get his medication regime regulated.
Jim assures the nurse that he has no chest pain nor a stiff neck and while he is coughing, he has no short of breath or have any breathing issues.
The nurse feels Jim is stable and does not need to be seen in an Emergency Room, but because it is Friday evening and his PCP will not be open until Monday, she decides to call his doctor to discuss if a RX medication is warranted because of his unstable Asthma. The doctor agrees with the nurse’s assessment and recommendations and gives her a verbal order for Tamiflu. The nurse calls this medication into the pharmacy and lets Jim know it will be ready in 1 hour for pickup. She advised him that he should start the medication this evening and she would call in 24 hours to check on him.
Calling nurse triage allowed Jim to receive much needed comfort measures and saved him a trip to the Emergency Room. His physician was agreeable to calling in a RX and Jim was heading to bed to rest for the remainder of the weekend.
The nurse did call Jim back the next day to see how he was feeling and he reported that, while he still was having many of the symptoms from yesterday, his energy was better and his fever controlled with Acetaminophen. The nurse took a few minutes to go over the symptoms that would warrant a callback to the nurse this weekend and offered to email these instructions to Jim to keep in case he had questions.
Jim is a good example of how nurse triage is able to offer patients an alternative to sitting long hours in an Emergency Room and risk exposing others or their selves to other illnesses. The nurse gave him home care and comfort measures to make him more comfortable while battling the suspected influenza virus, and she even contacted his physician and called in the medication to the pharmacy for him.
Lastly, the nurse educated Jim on the symptoms that he should watch out for and emailed his care advice so he could refer to it later if needed. The nurse was able to save Jim the hassle of making numerous phone calls and allowed him to focus on getting well.
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