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Our project is set up to translate and adapt the Good Home Treatment of Influenza, a 17-page booklet anyone can download and print, into as many languages as possible. The booklet is © Dr Grattan Woodson MD, and the translation (a cooperative effort) is hosted by Flu Wiki. A big THANK YOU to all involved!
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Treatment of common flu symptoms
Caring for a flu patient is something everyone is capable of doing. The basic goals are to keep the patient clean, dry, warm, and well hydrated. Patients need a soft place to lie down, be comforted, told that they are going to be OK, and reassured that you will be there for them. The most important medical treatment is to make sure they have plenty of fluids. Dehydration must be prevented because it can quickly lead to death or contribute to stroke or heart attack. Keeping the patient hydrated is the best treatment for the flu and the one that is most likely to save lives. The same treatment advice applies to other viral and bacterial illnesses that might be confused with influenza. So, don’t worry so much about whether or not you have made the correct diagnosis or not. The treatment will be about the same anyway.
Treatment of adults with fever
The first consideration when treating a patient with fever is fluid therapy. It is very difficult to bring a fever down in a patient low on fluids. Both ibuprofen and acetaminophen are good ways to lower fever and help the patient feel better. The therapeutic dose of ibuprofen for adults is 2 to 4 tablets (400mg to 800mg) every four to six hours as needed8. For acetaminophen, the dose is two 500mg tablets up to four times daily as needed. Try one or the other at the dose recommended. Wait 45 minutes. If the response is insufficient, add a full dose of the other drug. In adults, acetaminophen and ibuprofen can be used in full doses at the same time, because they are in different drug classes and have different drug side effects. Combination treatment with both has an additive effect of benefit without increasing risk. Do not exceed these doses for either drug. This is the maximum for both. Acetaminophen is a very safe drug as long as you do not exceed the daily dose limit for it.
Many cold and flu preparations sold in drug stores include acetaminophen or ibuprofen along with antihistamines and or decongestants. These are fine to use for flu. Just remember to include the dose of acetaminophen and ibuprofen found in these drugs in your daily limit calculation to avoid exceeding it for any of the drugs listed.
A high fever (103°F) is hard on the patient, but most folks can tolerate it well. A fever above 104°F is the upper safe limit for most people and anything above 105°F is a temperature emergency. Fevers this high can cause seizures and above this point brain damage can develop if prolonged. This must be avoided. The mainstays of therapy are keeping the patient well-hydrated, tepid water sponge baths, acetaminophen, ibuprofen, and dressing the patient lightly.
If the fever resists these techniques, sponge bathe the patient with cool water and fan the patient to increase the cooling effect of evaporation from the skin. As a last resort, if you have access to either ice or snow, make cold packs and place them under each arm, on the right and left sides of the groin, and around the neck. These cold packs cool the blood passing under them helping to reduce the patient’s temperature.
Treatment of chills and body aches and pains
Chills cause shivering and are often associated with body aches and later fever. Treat chills by keeping the patient warm; give them an extra blanket or a hot water bottle. Body aches respond to acetaminophen, and ibuprofen used separately or together.
Treatment for respiratory conditions and headache
Gargling with a hot salt and soda water solution is a good treatment for sore throat. To make this treatment, add 1 tsp of salt and ¼ tsp of baking soda to a cup of hot but not scalding water. Ibuprofen and acetaminophen used in full doses either individually or together if needed have good pain relieving effects.
Nasal, sinus and ear congestion and pain respond to hot packs placed on the face and by inhaling steamy air. Use of a salt and soda saline solution to wash the sinuses helps remove mucus and inflammatory chemicals that build up in the area and is very useful. The solution is made by adding ¼ level teaspoon of table salt plus ¼ level teaspoon of baking soda to 1-cup of clean water. Instill the solution into the nose with an ear bulb syringe or by other means and gently blow your nose. Repeat this process until the nasal passage is clear. Nasal washing can be repeated as often as needed. Antihistamines and decongestants are also useful for treatment of this condition. The salt and soda saline solution makes an excellent non-burning eye wash too. It is a great way to provide a comforting bath to sore runny eyes and lids.
Inhaling steamy air is a time-honored therapy for chest, sinus, ear and throat infections. The easiest way to create steam is by heating water in a teakettle or a pot. Once the water is boiling, drape a towel over your head and bend over near but not too close to the steam. Inhale the steamy air through the nose and mouth getting it deep into the lungs.
From the therapeutic standpoint, we want to encourage patients with a wet cough to clear the mucus from their lungs. The health of the patient is unaffected if the phlegm brought up with a wet cough is swallowed or deposited in a handkerchief. Hydrating the patient with the ORS, feeding them a hot or cold caffeine-containing beverage like tea, coffee, or cola, or eating chocolate encourages a wet cough.
Reasons and remedies for common flu patient signs and symptoms I
|Symptom or Sign||Likely Assessment||Remedy|
|Low urine output||Dehydration||Give the patient ORS|
|High pulse rate > 90)||Dehydration or fever||Give the patient ORS|
|Shaking chills and shivers||The virus is swarming in the blood stream.||Keep the patient warm|
|Nausea/Vomiting||The virus is affecting stomach or indirectly the brain.||Give sips of clear liquid diet. Use the ORS. Use meclizine 25mg every 4 hours as needed.|
|Diarrhea||The virus is affecting intestine.||Push ORS fluids, clear liquid diet|
|Severe stomach cramps||The virus is affecting the intestine. Expect nausea, vomiting and diarrhea soon.||Switch to clear liquid diet. Use diphenhydramine and/or loperamide for cramps.|
|Bloody diarrhea but no bleeding from any other site.||The virus has infected the intestinal lining.||Push ORS fluids and use the clear liquid diet. Give loperamide and/or diphenhydramine for cramps.|
The cough reflex is effectively suppressed with dextromethorphan, the drug found in many OTC cough products with the “DM” notation on their label. If the patient has a wet cough and is coughing a lot, you still should suppress it to prevent the cough from damaging the chest wall or lung structures. Too much coughing, even when bringing up phlegm, can cause damage and should be lessened. Inhaling warm humidified air helps patients with infections of the nose, sinus, ears, throat, bronchial pathways, and lungs especially during winter when the air is dry. Caffeinated tea and coffee and chocolate contain an herb with well known medicinal effects on the lungs. The herb help keep the breathing tubes open, increase heart rate and blood flow, and encourage urination. The effect is to move more fluid through the lungs thinning the mucus and making it easier to cough up. The herb is also effective for relieving headache, lifting a depressed mood and for enhancing awareness.
Chest pain during flu is often due to the effect of coughing on the muscles, ribs, and cartilages that surround and support the lungs. An indication of this cause is when pressing on the chest wall, upper flanks, or upper abdomen brings out the pain. Treatment is to suppress the cough as explained above, allowing these injured tissues to heal. Pain can be controlled using a full dose acetaminophen and/or ibuprofen every six hours. Muscle spasm can play a role in this pain, and when it does, consider applying an icepack, heating pad, or hot water bottle to the chest wall. Chest pain can be excruciatingly painful and difficult to control.