II. Symptoms

  1. Functional Decline
  2. Altered Level of Consciousness
  3. Confusion or Delirium
  4. Decreased Appetite or reduced food intake
  5. Incontinence
  6. Behavior Change
  7. Uncooperative with Nursing Home staff
  8. Falls

III. Signs: Fever

  1. Single Temperature >100.0 F (37.8 C)
  2. Repeated Oral Temperatures >99.0 F (37.2 C)
  3. Repeated Rectal Temperatures >99.5 F (37.5 C)
  4. Increase in Temperature > 2.0 F (1.1 C)

IV. Labs: Initial Testing

  1. Complete Blood Count with platelets and differential
    1. White Blood Cell Count >14,000 cells/mm3 or
    2. Total Band Neutrophil Count >1500 cells/mm3 (or 6%)

V. Labs: As indicated

  1. Urinalysis and Urine Culture
  2. Influenza nasal swab
  3. Gastrointestinal illness
    1. Giardia Antigen
    2. Clostridium difficile Toxin

VI. Imaging: As Indicated

VII. Management

VIII. Precautions

  1. Review Advanced Directives (e.g. POLST, Living Will) prior to evaluation and treatment
  2. Many conditions (e.g. uncomplicated Pneumonia) may be treated without hospitalization

IX. Prevention

  1. Influenza Vaccine annually
    1. Associated with a 43% reduction in Influenza-associated Pneumonia
    2. Monto (2001) Am J Epidemiol 154(2): 155-60 [PubMed]
  2. Pneumococcal Vaccine (Pneumovax 23 AND Prevnar)
    1. Both Pneumovax 23 and Prevnar 13 are recommended for age over 65 years old

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