Practical Suggestions for Evaluation of Nursing Home Residents
with Non-Localizing Signs or Symptoms
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
Hypotension Yes • Post-prandial
orthostatic
hypotension
• Medication-
induced
orthostatic
hypotension
Assess if
hypotension may
be post-prandial
or medication-
induced.
Several studies
associate low-blood
pressure with
poor outcomes.
Clinicians
should perform
a diagnostic
evaluation to
identify the cause
of hypotension.
Hyperglycemia
Yes • Changes to
medication
• Changes to diet
• Baseline pattern
of glycemic
control
Individualized
approach to
assess whether
hyperglycemia
is abnormal,
including
assessing
medication
regimen, recent
dietary patterns,
and baseline
pattern of
glycemic control.
Because a
relationship
exists between
physiological stress
and hyperglycemia
in patients with
known diabetes and
critically ill patients
with relative
underlying insulin-
resistance, evaluate
for infection if
non-infectious
causes are not
otherwise explained
by medication and
diet.
Delirium Yes • Medications
• Metabolic
disorders
Not applicable
to delirium
identified by
CAM.
Residents who
develop delirium
have higher
risk of loss of
functional status,
hospitalization, and
death; therefore,
evaluate for
infection especially
if another trigger
for delirium is not
readily identified.
(cont'd)
