Module 2: Direct Comprehensive Primary Care in the LTC Setting
Module 2: Direct Comprehensive Primary Care in the LTC Setting
33 2.4.1 Early Signs & Symptoms of Illness
Acute Changes of Condition (ACoC)[1]:
- Sudden, clinically important deviation from patient’s baseline
- Without intervention may result in complications or death
Signs & Symptoms of concern:
- Vital signs
- Weakness and falls
- Cognitive/behavioural status
- Diarrhea and vomiting
- Chest pain
- Constipation
- Pain
- Urinary symptoms
- Bleeding
- Weight and intake
- Level of consciousness
- Edema
- Vision and speech
- Investigations
Temperature:
- Temp > 37.8 C or > 1.5 above baseline (febrile)
- Chronic disease + age = compromised immunity
- Absence of typical S/S
- Blunted febrile response (altered thermoregulation)
- Fever can be absent
Pulse
- > 120 or < 50 at rest
- >100-110 combined with symptoms
- Sustained change from normal
- Change from usual rhythm/regularity
Respirations:
- >28 or <10 (>24 pneumonia likely)
- Change from usual patterns
- Audible sounds
Oxygen Saturation:
- Reading is misleading
- Need adequate peripheral blood flow (influenced by factors such as tremor, HF, anemia, vasoconstriction)
Blood Pressure:
- PB 110-140/60-90 (SBP/DBP)
- Sustained elevation with neurological S/S
- Orthostatic hypotension
- Hypotension with other S/S (elevated HR/bleeding)
Look for changes in function and compare to baseline
- Deterioration in health status
- Weakness, loss of balance, dizziness, unsteadiness
- New and/or repeated falls in 24h
- Injury related to unwitnessed events
- Confusion, agitation, lethargy
- Pallor, diaphoresis
- Sudden onset of visual disturbance
- Loss or changes in speech
- Diminished oral intake and/or urine or stool output/frequency
- Pain: ocular, HA, MSK, GI, GU
- Recent survey/instrumentation
- Slow recovery from illness or procedures
- Bleeding and risk factors for anticoagulopathy
- New or worsening edema with associated S/S
- High index of suspicion with unilateral distribution or acute abdominal pain
- Loose stools (>3 BMs/24 hrs with associated S/S)
- Intractable vomiting
- Are symptoms getting worse despite interventions?
- New changes in lab values
- American Medical Directors Association, 2005 ↵