32 2.4 Acute Episodic Illness

Common Episodic Conditions

LTC Pearls for differential diagnosis during an acute change:

• Differential diagnosis will be often based on your physical exam and subjective information
• Medications, delirium, review of intake and output, falls, vitals, LOC, etc.
• Atypical presentation is common, behavioural changes are common
• Availability of labs in your LTC
• Responsibility of potential recognition of an outbreak

LTC Treatment Plan Pearls:

• Availability of medications
• Goals of care conversations
• Prognostication
• Medications
• Level of Consciousness (LOC)
• Hypodermoclysis
• Oral intake
• Hypodermoclysis
• Consider pain control, symptoms of delirium, fall risk, impact of isolation
• Monitor for exacerbation of underlying chronic condition
• Skin/wound

Respiratory

• Influenza Like Illness (ILI)
• COVID-19
• Influenza
• Pneumonia/Aspiration Pneumonia
• COPD Exacerbation^{[1][2][3][4][5]}

Musculoskeletal

• Falls +/- fractures

Neurological

• Seizure: new onset seizures vs know seizure disorder
• Cerebrovascular Accident (CVA)^[6]

Cardiovascular

• CHF exacerbation
• DVT
• Acute Coronary Syndrome^[7]

Skin & Wound

• Cellulitis
• Wound infection
• Herpes Zoster^[8]

ENT

• Conjunctivitis
• Acute glaucoma

Genitourinary/Gastroinestinal

• UTI: Cloudy urine or smelly urine does not = UTI. Only collect and treat for UTI if symptomatic
• Urinary retention: Bladder scanners or catheterization to evaluate.
• Dehydration
• Vomiting & Obstination/Constipation^[9]

Endocrine

• Diabetes: With acute illness, hold SADMANS meds^[10]
  • S:sulfonylureas, other secretagogues/
  • A: ACE-inhibitors
  • D: diuretics, direct renin inhibitors
  • M: metformin
  • A :angiotensin receptor blockers
  • N :non-steroidal anti-inflammatory
  • S: SGLT2 inhibitors