Infection in the Nursing Home Resident

Aka: Infection in the Nursing Home Resident, Signs of Infection in the Nursing Home Resident

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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. GiardiaAntigen
    2. Clostridium difficile Toxin

VI. Imaging: As Indicated

  1. Chest XRay

VII. Management

  1. See Pneumonia in the Nursing Home
  2. Urinary Tract Infection
    1. See UTI in Older Adults
    2. Treat for 7 days in women (10-14 days for men)
  3. Miscellaneous causes
    1. See Infections in Older Adults
    2. See Intra-Abdominal Infection in Older Patients

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

X. References

  1. Casey (2015) Am Fam Physician 92(7): 612-20 [PubMed]
  2. High (2009) Clin Infect Dis 48(2): 149-71 [PubMed]

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