Urgent Care Management for Influenza and Patient Education
Patients with influenza should receive prompt antiviral treatment with oseltamivir 75 mg twice daily for 5 days if presenting within 48 hours of symptom onset, along with supportive care including antipyretics, adequate hydration, and rest. 1
Initial Assessment and Triage
Assessment Criteria
- Evaluate illness severity based on:
- Vital signs (temperature, respiratory rate, heart rate, blood pressure, oxygen saturation)
- Presence of respiratory distress
- Hydration status
- Mental status
- Risk factors for complications 2
High-Risk Patients
- Prioritize assessment of:
Diagnostic Approach
Clinical Diagnosis
- Diagnosis is primarily clinical during influenza season 3
- Look for:
- Abrupt onset of fever (>38°C)
- Respiratory symptoms (cough, nasal congestion, sore throat)
- Systemic symptoms (myalgia, headache, fatigue, chills) 3
Testing Considerations
- Rapid molecular assays are preferred when testing is indicated 3
- Testing particularly useful for:
- Hospitalized patients
- High-risk patients
- When diagnosis will change management decisions 3
Treatment Protocol
Antiviral Therapy
- Initiate oseltamivir 75 mg twice daily for 5 days if within 48 hours of symptom onset 1, 4
- Dose adjustments for renal impairment:
- Reduce to 75 mg once daily if creatinine clearance <30 ml/min 2
- Greatest benefit when started within 24 hours of symptom onset 5
- Reduces illness duration by approximately 24 hours 1, 5
Supportive Care
- Oxygen therapy for hypoxic patients (aim for SaO2 ≥92%) 2
- Acetaminophen or ibuprofen for fever and pain relief 2, 1
- Ensure adequate hydration 2, 1
- Consider symptomatic treatments:
- Dextromethorphan for non-productive cough
- Guaifenesin for productive cough
- Short-course topical decongestants for nasal congestion
- Throat lozenges for sore throat 1
Management of Complications
Respiratory Complications
- Monitor for signs of pneumonia:
- Worsening dyspnea
- Persistent fever
- Abnormal chest examination 6
- Consider antibiotics for suspected bacterial co-infection:
Other Complications
- Be alert for:
Discharge Criteria and Follow-up
Safe Discharge Criteria
- Review patients 24 hours prior to discharge
- Do not discharge if two or more of the following are present:
- Temperature >37.8°C
- Heart rate >100/min
- Respiratory rate >24/min
- Systolic blood pressure <90 mmHg
- Oxygen saturation <90%
- Inability to maintain oral intake
- Abnormal mental status 2
Follow-up Recommendations
- Arrange follow-up for patients with:
- Significant complications
- Worsening of underlying disease
- High-risk conditions 2
Patient Education
Self-Care Instructions
- Rest and limit activities until fever resolves
- Maintain adequate fluid intake
- Take antipyretics as directed for fever and pain
- Avoid smoking and alcohol 2, 1
When to Seek Further Medical Care
Instruct patients to return if they experience:
- Difficulty breathing or shortness of breath
- Pain or pressure in chest or abdomen
- Sudden dizziness or confusion
- Severe or persistent vomiting
- Symptoms that improve but then return with fever and worse cough 2, 1
Prevention Measures
- Cover coughs and sneezes
- Wash hands frequently
- Stay home until fever-free for 24 hours without fever-reducing medication
- Annual influenza vaccination for future seasons 3, 7
Special Considerations
Pediatric Patients
- Adjust medication dosing by weight
- Avoid aspirin in children under 16 years (risk of Reye's syndrome) 2, 1
- Children under one year and those at high risk should be assessed by a physician 2
Elderly Patients
- May present with atypical symptoms (confusion, exacerbation of underlying conditions)
- More prone to complications
- May require longer recovery period 1
Common Pitfalls to Avoid
- Delaying antiviral treatment while waiting for test results
- Failing to recognize secondary bacterial infections
- Inadequate monitoring of high-risk patients
- Discharging patients too early before clinical stability is achieved 1