Practical Suggestions for Evaluation of Nursing Home Residents
with Non-Localizing Signs or Symptoms
is table provides suggestions regarding the components for evaluation for infection in
nursing home residents with non-localizing signs or symptoms.
is table was created to help clinicians implement the expert guidance document's
1
recommendations; however, some of the content in this table exceeds the scope set for
the expert guidance
1
and this document therefore is not endorsed by SHEA.
is is not meant to be a substitute for individual clinical judgment by qualified
professionals.
New-onset
symptom,
presenting
in isolation
Evaluate
further
for
infection?
Potential
non-infectious
causes
Next steps
and/or active
monitoring
Components of
evaluation for
infection
Fever Yes • High
environmental
temperature,
including
clothing/
blankets
• Medications
that trigger
febrile episode
(e.g., selective
serotonin
reuptake
inhibitors)
• Take
temperature
again using the
same method
• Avoid
indiscriminate
diagnostic
testing
• Offer increased
hydration and,
when possible,
antipyretics
• Complete blood
count (CBC) and
differential
• Diagnostic testing
based on whether
resident has
additional signs
and symptoms
that support
a diagnosis at
a particular
anatomic location
(e.g., urine, blood,
and chest images)
• Broader
diagnostic
evaluation in
residents with
isolated fever, and
particularly those
with advanced
dementia
Hypothermia Yes • Low
environmental
temperature
• Diabetes
• Hypothyroidism
• Head injury
• Drug ingestions
Take temperature
again using the
same method
within several
hours.
Sepsis is a
commonly
identified trigger
of hypothermia.
Clinicians
should perform
a diagnostic
evaluation to
identify the cause
of hypothermia.
