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[1309 words]

Reasons and remedies for common flu patient signs and symptoms II

Symptom or SignLikely AssessmentRemedy
HeadacheDue to fever or coughing. Also can be directly or indirectly due to the viral infection.Ibuprofen and/or acetaminophen. Lower temperature if fever present. Use icepack on neck.
FeverDue to the virus stimulating the bodies immune system to release chemicals that fight the infection.Ibuprofen, acetaminophen, push fluids, keep warm or cool, consider tepid water baths if > 102 F. OK if <101 as this may help kill virus.
Sore throatDirect viral infection of the posterior throat tissue. Caused by inflammation of tissue breakdown in the area.Gargle with hot salt water; drink hot tea or hot water, ibuprofen and or acetaminophen.
CoughViral infection and irritation of the tissue lining the breathing tubes and/or the lung tissue.Push the ORS fluids, drink hot tea for effect on breathing tubes, use a dextromethorphan (DM) containing cough syrup to suppress cough if needed.
Facial painSinus congestion or infectionUse salt and soda nasal solution frequently, hot packs or cold packs on face help, diphenhydramine 25–50mg four times daily as an antihistamine and ibuprofen and/or Tylenol for pain. Push fluids including tea.
Runny noseVirus infecting noseUse salt and soda nasal solution frequently, diphenhydramine 25–50 mg four times daily to reduce runny nose.

Headache with influenza can come from several sources. Coughing shakes the head back and forth and can strain the neck muscles causing headache. Chemicals released by the viral infected cells and the immune system can trigger headaches. Bacterial sinusitis complicating flu causes facial pain and headache. Treat headaches using ibuprofen with or without acetaminophen. If neck stiffness or soreness is present, apply an ice pack, heating pad, or hot water bottle to the back of the neck or head.

Treatment of nausea, vomiting, diarrhea, and abdominal pain

The first step in treatment for these four symptoms is to place the patient on a clear liquid diet using the ORS. It will not provoke vomiting or diarrhea as easily as other fluids or foods do, but it can still cause these reactions in severely affected people. Nausea is responsive to meclizine 25 to 50 mg every 4 to 6 hours as needed for this symptom. Diarrhea and abdominal cramping can be treated with diphenhydramine 25 to 50mg every 4 to 6 hours and/or loperamide 2 to 4mg every 4 to 6 hours. Since diphenhydramine and meclizine are both antihistamines, their side effects are additive. If you have already given the patient one of these drugs and want to try the other, wait four hours before doing so to allow the first drug to clear the system.

Patients with an intestinal presentation of flu often will experience abdominal cramping, gas, and diarrhea. In some patients, the diarrhea can be bloody. Diarrhea often causes irritation around the anus. Treat this by gently cleaning the area using a moistened tissue, soft cloth, or baby wipe. Apply a small amount of petroleum jelly or cocoa butter on and around the anus to protect and heal the tissue. Repeat this process after each loose stool. Abdominal cramps respond to the anticholenergic effects of diphenhydramine 12.5 to 25 mg every four to six hours.

Diet and Exercise with Influenza

Since flu commonly takes away the appetite, most patients won’t be hungry. Eating is not as important as drinking fluids because the patient will be breaking down muscle and fat for energy. The clear liquid diet is best for patients sick with flu who are not particularly hungry, but it is mandatory for patients with diarrhea due to influenza. If a flu patient wants to eat, feed them as long as they don’t have diarrhea. In most cases, patients with diarrhea can tolerate a clear liquid diet without making matters worse. The small intestine can absorb water, minerals, and sugars well even when infected. If the patient has not been sick long or had a mild non-diarrheal presentation of the flu, you can start with step 2 of the clear liquid diet and quickly move up the steps as tolerated by the patient. At any time during re-feeding, should the patient suffer abdominal problems, especially pain or diarrhea, drop back a step or two on the clear liquid diet. Rest in that step for a while before trying the next step again. This strategy will work well for almost every patient.

The clear liquid diet

  • Step 1: Oral Rehydration Solution (ORS), water, fruit juice, Jell-O, Gatorade®, Popsicles, PowerAde®, ginger ale, cola, tea, and bouillon.
  • Step 2: To step 1 add white toast (no butter or oils), white rice, cream of wheat, soda crackers, and potatoes without the skin.
  • Step 3: To Step 2 add canned fruit and chicken noodle soup.
  • Step 4: To Step 3 add a source of protein like canned meat, fish or egg.
  • Step 5: To Step 4 add milk and other dairy products, vegetable oils, butter, raw fruits and vegetables and high-fiber whole grain products.

Once the patient is eating a normal diet without any stomach problems, it is important to increase the intake of high quality protein, especially eggs, meat, fish, or poultry. This nutrition is needed to rebuild the muscle and organ tissue, which were broken down for energy during the illness. Carbohydrates and fats are also important as an energy source for the recovering body and to help replace lost fat stores broken down for energy during the infection.

Exercise during and after recovery

Even moderate influenza causes a breakdown of muscle tissue and physical weakness. If a patient was critically ill with the flu, even more muscle, organ tissue, and fat was broken down by the body for support. Acute influenza symptoms can be expected to last at least five days but usually seven to 10 days. Most people need another week or two of rest for recovery. A return to limited normal activities is usually possible at this time, but full recovery will not be complete for a month, or even two, after the infection. Of course, no exercise of any type is possible or desirable during the acute phase of the illness. During the recovery period, passive stretching and massage helps a weakened patient recover. These activities help bring the dormant joints, tendons, and muscles back to life and work out the soreness that builds up in these tissues. Gentle passive range of motion (ROM) exercise is accomplished by slowly and repeatedly moving all the joints of the limbs, including fingers and toes, through their entire normal range of movement. Each finger and toe, ankles, knees, hips, wrists, elbows, shoulders, and the neck should be bent, rotated, and extended slowly and repeatedly. Gentle massage is also comforting to the patient’s sore muscles and helps in their recovery.

Patients who have been at bed rest for a long time will have trouble with balance and weakness. If they have not been eating, they will not have enough energy to resume normal activity. A prerequisite for getting up is to get the patient past step 3 of the clear liquid diet before even trying to encourage the patient to walk again.

When the time comes to help a patient return to normal, take it easy. Try sitting the patient upright in bed first. If this goes well, the patient can next try sitting on the side of the bed with his feet on the floor. Dizziness and weakness are the two problems that most people have trouble overcoming. Take it slowly. Dizziness usually goes away after a while in the new position, so be patient. The next step is to get the patient up and sitting in a chair. Standing with limited assisted walking comes next. At first, have the patient walk with assistance around the room or in the halls.

Page last modified on October 15, 2009, at 07:19 PM by pogge