Module 2: Direct Comprehensive Primary Care in the LTC Setting
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