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