How to Answer Patient Flu FAQs

Upper respiratory infections (URIs) account for some of the most common condi

tions presenting in outpatient settings According to a Rand Corp. paper published in 2016, “Acute respiratory infections, such as bronchitis and rhinosinusitis, are the most common reason that patients seek care in the United States and account for 60% of all retail clinic visits.”

3

With this frequency, it is essential for nurse practitioners to be able to properly identify and treat URIs and to be prepared to answer questions from patients.

Here is a list of frequently asked questions from patients and how to properly respond to them:

Q:What is the difference between the flu and colds?

A:Generally speaking, the flu and colds have many overlapping symptoms, but flu symptoms tend to be much more severe. Both may present with cough, sore throat, congestion, fatigue, headaches, sneezing, body aches, and fever, but the flu tends to come on more suddenly, with key symptoms of body aches, fever, and intense fatigue.

4

Occasionally, some people, especially children, will also have symptoms of vomiting and diarrhea with the flu.

4

Conversely, the common cold typically presents with key symptoms of sore throat, congestion, runny nose, cough, low-grade fever, and mild fatigue.

5

However, it is impossible to truly differentiate between the 2 by symptoms alone.

The only way to confirm that a URI is caused by an influenza virus is by testing for it, such as with rapid influenza diagnostic tests or rapid molecular assays—but their ability to detect the flu varies. Therefore, just because a patient may have a negative flu test does not mean that they do not have the flu. Therefore, diagnosis needs to be made solely on clinical judgment.

4

More important than knowing which specific flu or cold virus the patient may have is knowing which patients are most at risk for developing complications and then treating and monitoring them

accordingly. Testing is most often unnecessary, as

he key treatment for most URIs is symptomatic

care,⁶prevention of secondary bacterial infection,

and infection control. The common cold, which is the leading cause of patient visits and work and school absenteeism,

6

is frequently caused by the rhinovirus, which has more than 100 serotypes. It is not necessary to determine which virus is causing the cold, as this will not change the plan of care.

4

Testing should only be performed if the diagnosis is unclear and/or would change the plan of care.

Q:

When should I get the flu shot?

7

7

7

8

New England Journal of Medicine

8

A:Patients often assume that later in the season is better due to the possibility of decreasing antibodies. While it is true that antibodies decline over time, research has shown that the seasonal flu shot should provide most patients with protection for the entire flu season.However, patients over age 65 may be more likely to have antibodies that decrease faster,which is why it is recommended that older persons receive the high-dose flu shot.This shot contains 4 times more antigens than the regular flu shotto create a stronger immune response in the recipient. One study published in thedemonstrated that those who received the high-dose vaccine had a 24% increase in effectiveness.

In summary, there is no clear-cut specific way, but rather a weighing of the pros and cons for each individual. Flu season generally starts around October and peaks between December and February, but it can persist until May.

7

The downside of getting the vaccine too early is the chance that some immunity will disappear by the time peak flu season arrives, but the downside of waiting until flu season arrives is getting exposed before receiving the shot. It takes about 2 weeks to develop immunity after receiving the vaccine, so patients who wait until September or October may get exposed before developing immunity. The

9

Q:Is the flu shot safe?

Advisory Committee on Immunization Practices recommends that patients receive the flu vaccine as soon as it becomes available in order to increase vaccination rates.

A:

10

11

12

Over the past 50 years, hundreds of millions of Americans have received the flu shot, and there has been extensive research supporting its safety.Not only is the flu shot safe, but the CDC recommends that all people 6 months and older receive the annual flu shot, with rare exceptions.It is especially important that those at high risk of developing complications from the flu receive the shot. This includes children under 5, adults 65 and older, pregnant women, people with chronic health conditions, those who live in long-term-care facilities, and Native Americans and Alaskan natives.The following are the chronic health conditions of concern: asthma, neurological or neurodevelopmental disease, kidney disorders, liver disorders, chronic lung disease (eg, cystic fibrosis or chronic obstructive pulmonary disease), heart disease (eg, congestive heart failure, coronary artery disease, or congenital heart disease), endocrine disorders (eg, diabetes), metabolic disorders (eg, mitochondrial disorders), immunosuppresion (eg, HIV, AIDS, cancer, chemotherapy, or chronic steroids), pediatric patients on long-term aspirin therapy, and patients with extreme obesity (eg, body mass index greater than 40).

10

13

13

The most common adverse effects of the flu shot are soreness, redness, or swelling at the injection site; headache; fever; nau- sea; and muscle aches.If adverse effects occur, they usually appear shortly after the vaccine has been administered, are mild in nature, and may last 1 or 2 days.Any medication has the potential to cause a severe allergic reaction, but the odds of such an event happening are about 1 in 1 million.

Conclusion

Health care providers know that each year, cold and flu season inevitably arrives. Therefore, one of the best ways to keep patients healthy during cold and flu season is preventing them from getting sick in the first place. That means making sure that patients are up-to-date on all their vaccinations, teaching them about proper hygiene and infection control, and doing appropriate follow-up care. Offering to review vaccinations at each visit might just take a few seconds or minutes but could potentially prevent serious future illnesses.

Sara Marlow, MSN, RN, PHN, FNP-C,

is a licensed and board-certified family nurse practitioner, public health nurse, and adjunct assistant professor of health policy. She was the spring 2015 health policy fellow at the American Association

of Nurse Practitioners’ government affairs office in Washington, DC.

References

1. Meneghetti A. Upper respiratory tract infection. Medscape website. emedicine.medscape.com/article/302460-overview?pa=se6Yerdwehs44sgz6s9XvlsQzLPSkZp1t1s3N4Lh4qe1TQrAh6U%2FfdwW%2BPMaDVPeqPnM3JPX9IzCiDDroQRJ5jRbGMQ7s%2F89oYHt2gMBBbM%3D. Updated February 17, 2017. Accessed November 3, 2017.

2. Mehrotra A, Wang MC, Lave JR, Adams JL, McGlynn EA. Retail clinics, primary care physicians, and emergency departments: a comparison of patients’ visits.Health Aff (Millwood).2008;27(5):1272-1282. doi: 10.1377/hlthaff.27.5.1272.

3. RAND Corp. The evolving role of retail clinics. The RAND Corporation website. rand.org/pubs/research_briefs/RB9491-2.html. Accessed November 1, 2017.

4. CDC. Cold versus flu. CDC website. cdc.gov/flu/about/qa/coldflu.htm. Updated August 11, 2016. Accessed November 1, 2017.

5. Mayo Clinic Staff. Common cold. Mayo Clinic website. mayoclinic.org/diseases-conditions/common-cold/symptoms-causes/syc-20351605. Accessed November 1, 2017.

6. Dasaraju PV. Infections of the respiratory system. In: Baron S, ed.Medical Microbiology.4th ed. Galveston, TX: University of Texas Medical Branch at Galveston; 1996.

7. CDC. Misconceptions about seasonal flu and flu vaccines. CDC website. cdc.gov/flu/about/qa/misconceptions.htm. Updated September 18, 2017. Accessed November 3, 2017.

8. CDC. Fluzone high-dose seasonal influenza vaccine. CDC website. cdc.gov/flu/protect/vaccine/qa_fluzone.htm. updated August 21, 2017. Accessed November 3, 2017.

9. CDC. Recommendations for the use of influenza vaccines, 2013-14 influenza season. CDC website. cdc.gov/mmwr/preview/mmwrhtml/rr6207a1.htm#RecommendationsUseInfluenzaVaccines201314InfluenzaSeason. Published September 20, 2013. Accessed November 3, 2017.

10. CDC. Flu vaccine safety information. CDC website. cdc.gov/flu/protect/vaccine/general.htm. Updated October 5, 2017. Accessed November 3, 2017.

11. CDC. Vaccination: who should do it, who should not and who should take precautions. CDC website. cdc.gov/flu/protect/whoshouldvax.htm. Updated October 3, 2017. Accessed November 3, 2017.

12. CDC. People at high risk of developing flu-related complications. CDC website. cdc.gov/flu/about/disease/high_risk.htm. Updated October 5, 2017. Accessed November 3, 2017.

13. CDC. Vaccine information statement: influenza (flu) vaccine (inactivated or recombinant): what you need to know. CDC website.cdc.gov/vaccines/hcp/vis/vis-statements/flu.pdf. Published August 7, 2015. Accessed November 3, 2017.