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

VI. Imaging: As Indicated

VII. Management

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

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