What should be documented in daily progress notes for a child admitted with influenza A?

Daily Progress Notes for Children Admitted with Influenza A

Daily progress notes for children hospitalized with influenza A should follow a structured format documenting vital signs, respiratory status, treatment response, complications, and discharge readiness criteria to optimize outcomes and reduce mortality.

Essential Components of Daily Progress Notes

Subjective Assessment

• Document fever pattern (presence, duration, maximum temperature)
• Record respiratory symptoms (cough, rhinorrhea, breathing difficulties)
• Note gastrointestinal symptoms (vomiting, diarrhea, oral intake)
• Document neurological symptoms (drowsiness, irritability, seizures)
• Record parent/caregiver observations about symptom changes

Objective Assessment

Vital Signs

• Temperature, heart rate, respiratory rate, blood pressure, oxygen saturation
• Compare with age-appropriate norms and previous readings
• Document oxygen requirements (L/min, FiO2, delivery method)

Physical Examination

• Respiratory: Document work of breathing, presence of grunting, intercostal retractions, nasal flaring, auscultation findings 1
• Neurological: Level of consciousness, irritability, signs of encephalopathy
• Hydration status: Mucous membranes, skin turgor, urine output
• Other systems: Document any abnormalities in cardiovascular, abdominal examination

Laboratory and Diagnostic Updates

• Document results of any new investigations (CBC, electrolytes, liver enzymes)
• Record blood culture results if obtained 1
• Note chest X-ray findings if performed (particularly for hypoxic patients or those with deteriorating status) 1
• Document viral load measurements if serial testing is being performed 2

Assessment

Disease Progression

• Note improvement or deterioration in clinical status
• Document response to antiviral therapy (typically oseltamivir)
• Record any new complications:
  • Respiratory: pneumonia, respiratory failure
  • Secondary bacterial infections
  • Neurological: seizures, encephalopathy
  • Dehydration

Treatment Response

• Document response to oseltamivir (typically 3-5 mg/kg twice daily for infants <12 months; weight-based dosing for older children) 1
• Note effectiveness of supportive care (oxygen, hydration)
• Document response to antibiotics if prescribed for suspected bacterial co-infection 1

Plan

Medications

• Document continued antiviral therapy (oseltamivir) with appropriate dosing 1
  • For children >12 months: Weight-based dosing
    • ≤15 kg: 30 mg twice daily
    • 15-23 kg: 45 mg twice daily
    • 23-40 kg: 60 mg twice daily

    • 40 kg: 75 mg twice daily

  • For infants 3-12 months: 3 mg/kg twice daily
  • For infants <3 months: 3 mg/kg twice daily (if clinically indicated) 1
• Document antibiotic therapy if prescribed (co-amoxiclav is first-line for children <12 years with severe illness) 1
• Record antipyretic administration (acetaminophen/ibuprofen, avoiding aspirin) 1

Supportive Care

• Document fluid management plan (oral/IV, rate, type)
• Note oxygen therapy requirements and changes
• Document nutritional support

Monitoring Plan

• Specify vital sign frequency
• Note parameters requiring immediate notification
• Document planned laboratory or imaging follow-up

Discharge Planning

• Document progress toward discharge criteria 1:
  1. Clear clinical improvement
  2. Physiological stability
  3. Ability to tolerate oral feeds
  4. Respiratory rate <40/min (<50/min in infants)
  5. Oxygen saturation >92% in room air

Special Considerations

High-Risk Patients

For children with underlying conditions (asthma, cardiac disease, immunocompromise), document:

• Specific impact of influenza on underlying condition
• Additional monitoring requirements
• Consultation with subspecialists 1, 3

Complications Monitoring

Document assessment for common complications:

• Secondary bacterial pneumonia
• Otitis media
• Dehydration
• Neurological complications
• Respiratory failure 1, 4

Treatment Timing Considerations

Document when oseltamivir was initiated relative to symptom onset, as earlier treatment (within 48 hours, ideally within 24 hours) maximizes efficacy 3, 5

Common Pitfalls to Avoid

1. Failing to document specific respiratory parameters and oxygen requirements
2. Omitting assessment of hydration status and oral intake
3. Not documenting response to antiviral therapy
4. Overlooking signs of secondary bacterial infection
5. Inadequate documentation of discharge readiness criteria
6. Failing to adjust oseltamivir dosing based on weight or age 3

Remember that daily documentation should clearly show the clinical trajectory and response to interventions, allowing for prompt recognition of deterioration or readiness for discharge.