Is it Cold, Flu, or Gastroenteritis: Explaining the Difference to Patients

How many times have nurses heard, "Oh, it's just a little cold"? Or how about the patient who complains of the flu when the only symptoms they have are vomiting and diarrhea? In the general public, cold, flu, and gastroenteritis are often confused, and this can lead to poor diagnosis, especially when a patient is calling over the telephone into a doctor's office. In addition, it is important for patients and nurses to understand the difference between these three common winter maladies. They all have different symptoms, requiring different treatments.

Patient education is important, but so is nurse education. Would every nurse be able to definitively tell the difference between flu and a cold? Probably not, and that's why it helps to have a refresher about what each problem is. This will help us educate patients better, but it will also help us to treat them more effectively.

Cold

A cold usually starts with the symptoms you might imagine: a sore throat, stuffy nose, and cough. Nasal secretions tend to be clear, but they could get darker as time goes on. This is not typically a sign that an infection has occurred. Fevers are uncommon with the cold, but some children may have a slight fever when they have a simple cold. Body aches are another uncommon symptom, but they are not as severe as in other conditions. Many different viruses can cause the common cold, and most doctors take a wait and see approach to treating it. However, some doctors prescribe antibiotics for simple colds whether an infection is present or not. This has led to resistant strains of bacteria due to the overuse of antibiotics in inappropriate situations. Over 200 different viruses can cause the common cold, but the most common among these is the rhinovirus.

In addition, the cold does not last as long as the flu. It tends to cause symptoms for about a week and then improve. Patients are contagious in the first three days of the cold, so it is important to isolate them from other patients to prevent the spread of the viral infection. Although it is not common, colds can lead to chest and sinus infections. If the symptoms do not improve after a week, this is likely the case. However, medical practitioners must be very careful to assess the presence of an infection before writing out the script for an antibiotic.

Flu

To complicate matters, flu often presents as a more severe cold. Cough, congestion, sore throat, muscle aches, and soreness are common. One symptom that is different about flu is the presence of a fever, usually, around 101 degrees F. These symptoms are far more severe than with the common cold, and they tend to hang on for weeks instead of clearing up in days. It is highly contagious, depending on the strain, and can easily infect those in a community with little difficulty. Flu is spread through large-particle respiratory droplets. This means that it is an airborne contagion, and can thus spread very fast through a population.

Some flu strains, such as bird flu, also include nausea and vomiting. These symptoms are not commonly associated with colds and flu, so it is important to distinguish between a GI flu and gastroenteritis. Unfortunately, the flu can often lead to pneumonia, especially in the very young and the very old. Common colds do not tend to get this dangerous or involved. This is one reason why the CDC recommends the flu shot for everyone, but most importantly for those young, old, or chronically ill. However, the flu shot does have limitations and downsides which means that flu is still a problem in the general public, and nurses have to be ready to screen for it when they encounter it.

Gastroenteritis

Gastroenteritis goes by a great deal of names by the layperson. The 24-hour bug and the flu are the most common, but these can be misleading. Stomach flu, or gastroenteritis, is not the same as respiratory flu, and patients can often become confused by this. You may tell them they have gastroenteritis, and this can scare them into thinking they have something potentially serious. If you explain that it is the stomach flu, though, then they are more likely to understand that it is a passing phenomenon. This condition is usually caused by the norovirus or the rotavirus. Norovirus tends to arise from eating contaminated food and is considered very contagious. Rotavirus tends to spread in fecal material and can arise particularly as a result of not washing hands after having a bowel movement.

The symptoms of gastroenteritis are nausea, vomiting, stomach cramps, diarrhea, and muscle cramps. These symptoms usually last only 24 hours, but residual fatigue can last for a few more days. Some gastroenteritis is severe, resulting in frequent vomiting and explosive diarrhea. For patients who are chronically ill, gastroenteritis puts them squarely at risk for becoming dehydrated, having electrolyte imbalances, and all the resulting symptoms from those. For this reason, it is important to keep an eye on patients with the stomach flu, encourage rest and clear fluids, and follow up with them as necessary. Even gastroenteritis could be deadly in the right population.

References

Norovirus (2014) Retrieved January 6, 2015 from Norovirus | Home | CDC

Rotovirus (2014) Retrieved January 6, 2015 from Rotavirus | Home | Gastroenteritis | CDC

Clinical Signs and Symptoms of the Flu (2009) Retrieved January 6, 2015 from Clinical Signs and Symptoms of Influenza | Health Professionals | Seasonal Influenza (Flu)

Get Smart; Know When Antibiotics Work (2013) Retrieved January 6, 2015 from CDC - Get Smart: Common Cold and Runny Nose