{"id":971,"date":"2024-04-10T09:38:43","date_gmt":"2024-04-10T13:38:43","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/?post_type=chapter&#038;p=971"},"modified":"2024-04-10T09:50:41","modified_gmt":"2024-04-10T13:50:41","slug":"2-4-1","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/chapter\/2-4-1\/","title":{"raw":"2.4.1 Early Signs &amp; Symptoms of Illness","rendered":"2.4.1 Early Signs &amp; Symptoms of Illness"},"content":{"raw":"Acute Changes of Condition (ACoC)[footnote]American Medical Directors Association, 2005[\/footnote]:\r\n<ul>\r\n \t<li>Sudden, clinically important deviation from patient\u2019s baseline<\/li>\r\n \t<li>Without intervention may result in complications or death<\/li>\r\n<\/ul>\r\nSigns &amp; Symptoms of concern:\r\n<ul>\r\n \t<li>Vital signs<\/li>\r\n \t<li>Weakness and falls<\/li>\r\n \t<li>Cognitive\/behavioural status<\/li>\r\n \t<li>Diarrhea and vomiting<\/li>\r\n \t<li>Chest pain<\/li>\r\n \t<li>Constipation<\/li>\r\n \t<li>Pain<\/li>\r\n \t<li>Urinary symptoms<\/li>\r\n \t<li>Bleeding<\/li>\r\n \t<li>Weight and intake<\/li>\r\n \t<li>Level of consciousness<\/li>\r\n \t<li>Edema<\/li>\r\n \t<li>Vision and speech<\/li>\r\n \t<li>Investigations<\/li>\r\n<\/ul>\r\nTemperature:\r\n<ul>\r\n \t<li>Temp &gt; 37.8 C or &gt; 1.5 above baseline (febrile)<\/li>\r\n \t<li>Chronic disease + age = compromised immunity<\/li>\r\n \t<li>Absence of typical S\/S<\/li>\r\n \t<li>Blunted febrile response (altered thermoregulation)<\/li>\r\n \t<li>Fever can be absent<\/li>\r\n<\/ul>\r\nPulse\r\n<ul>\r\n \t<li>&gt; 120 or &lt; 50 at rest<\/li>\r\n \t<li>&gt;100-110 combined with symptoms<\/li>\r\n \t<li>Sustained change from normal<\/li>\r\n \t<li>Change from usual rhythm\/regularity<\/li>\r\n<\/ul>\r\nRespirations:\r\n<ul>\r\n \t<li>&gt;28 or &lt;10 (&gt;24 pneumonia likely)<\/li>\r\n \t<li>Change from usual patterns<\/li>\r\n \t<li>Audible sounds<\/li>\r\n<\/ul>\r\nOxygen Saturation:\r\n<ul>\r\n \t<li>Reading is misleading<\/li>\r\n \t<li>Need adequate peripheral blood flow (influenced by factors such as tremor, HF, anemia, vasoconstriction)<\/li>\r\n<\/ul>\r\nBlood Pressure:\r\n<ul>\r\n \t<li>PB 110-140\/60-90 (SBP\/DBP)<\/li>\r\n \t<li>Sustained elevation with neurological S\/S<\/li>\r\n \t<li>Orthostatic hypotension<\/li>\r\n \t<li>Hypotension with other S\/S (elevated HR\/bleeding)<\/li>\r\n<\/ul>\r\nLook for changes in function and compare to baseline\r\n<ul>\r\n \t<li>Deterioration in health status<\/li>\r\n \t<li>Weakness, loss of balance, dizziness, unsteadiness<\/li>\r\n \t<li>New and\/or repeated falls in 24h<\/li>\r\n \t<li>Injury related to unwitnessed events<\/li>\r\n \t<li>Confusion, agitation, lethargy<\/li>\r\n \t<li>Pallor, diaphoresis<\/li>\r\n \t<li>Sudden onset of visual disturbance<\/li>\r\n \t<li>Loss or changes in speech<\/li>\r\n \t<li>Diminished oral intake and\/or urine or stool output\/frequency<\/li>\r\n \t<li>Pain: ocular, HA, MSK, GI, GU<\/li>\r\n \t<li>Recent survey\/instrumentation<\/li>\r\n \t<li>Slow recovery from illness or procedures<\/li>\r\n \t<li>Bleeding and risk factors for anticoagulopathy<\/li>\r\n \t<li>New or worsening edema with associated S\/S<\/li>\r\n \t<li>High index of suspicion with unilateral distribution or acute abdominal pain<\/li>\r\n \t<li>Loose stools (&gt;3 BMs\/24 hrs with associated S\/S)<\/li>\r\n \t<li>Intractable vomiting<\/li>\r\n \t<li>Are symptoms getting worse despite interventions?<\/li>\r\n \t<li>New changes in lab values<\/li>\r\n<\/ul>\r\n&nbsp;","rendered":"<p>Acute Changes of Condition (ACoC)<a class=\"footnote\" title=\"American Medical Directors Association, 2005\" id=\"return-footnote-971-1\" href=\"#footnote-971-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a>:<\/p>\n<ul>\n<li>Sudden, clinically important deviation from patient\u2019s baseline<\/li>\n<li>Without intervention may result in complications or death<\/li>\n<\/ul>\n<p>Signs &amp; Symptoms of concern:<\/p>\n<ul>\n<li>Vital signs<\/li>\n<li>Weakness and falls<\/li>\n<li>Cognitive\/behavioural status<\/li>\n<li>Diarrhea and vomiting<\/li>\n<li>Chest pain<\/li>\n<li>Constipation<\/li>\n<li>Pain<\/li>\n<li>Urinary symptoms<\/li>\n<li>Bleeding<\/li>\n<li>Weight and intake<\/li>\n<li>Level of consciousness<\/li>\n<li>Edema<\/li>\n<li>Vision and speech<\/li>\n<li>Investigations<\/li>\n<\/ul>\n<p>Temperature:<\/p>\n<ul>\n<li>Temp &gt; 37.8 C or &gt; 1.5 above baseline (febrile)<\/li>\n<li>Chronic disease + age = compromised immunity<\/li>\n<li>Absence of typical S\/S<\/li>\n<li>Blunted febrile response (altered thermoregulation)<\/li>\n<li>Fever can be absent<\/li>\n<\/ul>\n<p>Pulse<\/p>\n<ul>\n<li>&gt; 120 or &lt; 50 at rest<\/li>\n<li>&gt;100-110 combined with symptoms<\/li>\n<li>Sustained change from normal<\/li>\n<li>Change from usual rhythm\/regularity<\/li>\n<\/ul>\n<p>Respirations:<\/p>\n<ul>\n<li>&gt;28 or &lt;10 (&gt;24 pneumonia likely)<\/li>\n<li>Change from usual patterns<\/li>\n<li>Audible sounds<\/li>\n<\/ul>\n<p>Oxygen Saturation:<\/p>\n<ul>\n<li>Reading is misleading<\/li>\n<li>Need adequate peripheral blood flow (influenced by factors such as tremor, HF, anemia, vasoconstriction)<\/li>\n<\/ul>\n<p>Blood Pressure:<\/p>\n<ul>\n<li>PB 110-140\/60-90 (SBP\/DBP)<\/li>\n<li>Sustained elevation with neurological S\/S<\/li>\n<li>Orthostatic hypotension<\/li>\n<li>Hypotension with other S\/S (elevated HR\/bleeding)<\/li>\n<\/ul>\n<p>Look for changes in function and compare to baseline<\/p>\n<ul>\n<li>Deterioration in health status<\/li>\n<li>Weakness, loss of balance, dizziness, unsteadiness<\/li>\n<li>New and\/or repeated falls in 24h<\/li>\n<li>Injury related to unwitnessed events<\/li>\n<li>Confusion, agitation, lethargy<\/li>\n<li>Pallor, diaphoresis<\/li>\n<li>Sudden onset of visual disturbance<\/li>\n<li>Loss or changes in speech<\/li>\n<li>Diminished oral intake and\/or urine or stool output\/frequency<\/li>\n<li>Pain: ocular, HA, MSK, GI, GU<\/li>\n<li>Recent survey\/instrumentation<\/li>\n<li>Slow recovery from illness or procedures<\/li>\n<li>Bleeding and risk factors for anticoagulopathy<\/li>\n<li>New or worsening edema with associated S\/S<\/li>\n<li>High index of suspicion with unilateral distribution or acute abdominal pain<\/li>\n<li>Loose stools (&gt;3 BMs\/24 hrs with associated S\/S)<\/li>\n<li>Intractable vomiting<\/li>\n<li>Are symptoms getting worse despite interventions?<\/li>\n<li>New changes in lab values<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-971-1\">American Medical Directors Association, 2005 <a href=\"#return-footnote-971-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":517,"menu_order":30,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-971","chapter","type-chapter","status-publish","hentry"],"part":3,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/pressbooks\/v2\/chapters\/971","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/wp\/v2\/users\/517"}],"version-history":[{"count":3,"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/pressbooks\/v2\/chapters\/971\/revisions"}],"predecessor-version":[{"id":974,"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/pressbooks\/v2\/chapters\/971\/revisions\/974"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/pressbooks\/v2\/parts\/3"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/pressbooks\/v2\/chapters\/971\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/wp\/v2\/media?parent=971"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/pressbooks\/v2\/chapter-type?post=971"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/wp\/v2\/contributor?post=971"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/wp\/v2\/license?post=971"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}