Source: Manual of Ambulatory Pediatrics 2010
SOAP Note – Influenza
A viral illness, also called “flu,” characterized by a sudden onset of fever and myalgias.
I. Etiology
A. Influenza A, that is divided into subtypes by two surface antigens, and Influenza B.
II. Incidence
A. Most prevalent in the winter months and generally peaks in February
B. Highest prevalence among school-aged children
C. Common among household contacts
III. Incubation: 1–4 days
IV. Communicability
A. Highly contagious
B. Infectious during the 24 hours prior to the onset of symptoms
C. Spread by respiratory droplet and direct contact
V. Subjective data
A. Fever with chills or rigors
B. Headache
C. Malaise
D. Diffuse myalgias
E. Nonproductive cough
F. Sore throat
G. Rhinitis
H. Nausea and vomiting
I. Anorexia
J. History of exposure, or flu prevalence in community
VI. Objective data
A. Fever above 38.8C
B. Tachypnea
C. Conjunctival erythema
D. Rhinorrhea
E. Cervical adenopathy
VII. Assessment
A. Diagnosis is generally made based on clinical presentation.
B. Viral culture should be considered if a child has a chronic medical problem, is seriously ill, or is immunocompromised.
C. A nasopharyngeal specimen obtained within the first 96 hours of illness is preferred.
D. Rapid diagnostic tests have variable sensitivity and specificity, so a viral culture is preferred.
E. Serologic testing is rarely helpful as it requires obtaining two specimens 10–14 days apart.
F. Differential Diagnosis
1. Respiratory syncytial virus: Wheezing; cough is prominent
2. Parainfluenza virus: Barking cough, retractions
VIII. Plan
A. Antiviral agents
1. Zanamivir: Approved for use in children 7 years or older
a. Useful in treating both influenza A and B
b. Administer within 48 hours of the onset of illness
c. 10 mg (2 inhalations) twice a day for 5 days
2. Amantadine and rimantidine are not recommended due to widespread resistance
B. Acetaminophen for fever control
C. Antibiotics to treat concurrent bacterial infection
D. Encourage fluid intake to prevent dehydration
IX. Education
A. Prevention: Influenza vaccination
1. Available annually
a. Inactivated: For children 6 months or older
(1) Initial vaccination for child < 9 years: Give 2 doses a month apart
(2) Do not give vaccine to child with allergic reaction to egg protein
b. Live attenuated nasal spray: For children 5 years or older
B. Avoid close contact with people who are sick.
C. Avoid aspirin products if under 18 years of age.
D. Practice good handwashing.
E. Drink plenty of fluids especially if fever is present.
F. Do not return to work or school until temperature has been normal for 24 hours and symptoms have subsided.
G. Avoid contact with elderly and people with chronic disease.
H. Zanamivir
1. Complete full course of therapy
2. Does not reduce risk of transmission
3. Demonstrate diskhaler delivery system
4. If child on bronchodilators, administer prior to zanamivir
I. Period of communicability is 24 hours prior to onset of symptoms and up to 7 days after becoming ill.
J. Flu is a respiratory illness and although gastrointestinal symptoms can be related to the flu, acute gastroenteritis is not flu.
K. Flu is transmitted by both droplet infection and indirect contact (from droplets deposited on door knob, toys, or other inanimate objects).
X. Follow-up: If no improvement of symptoms in 5 days, or if symptoms worsen
XI. Complications
A. Pneumonia
B. Otitis media/sinusitis
C. Croup
D. Bronchiolitis
E. Acute myositis
XII. Consultation/referral
A. Severe illness
B. Dehydration
C. Neonates or infants
D. Children with chronic illness or who are immunocompromised