Management
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 (not exhaustive)
Next steps and/or active
monitoring
Behavior
changes
exclusive of
delirium
No Numerous possible
infectious and non-
infectious causes for myriad
potential manifestations,
e.g., functional decline,
loss of appetite, "not being
one's self," agitation, weight
loss, weakness, letharg y,
apathy, etc.
A change in behavior in
and of itself is not specific
enough to trigger a work-
up for infection.
• CAM to rule out delirium
• Active monitoring for
hemodynamically stable
patients
• Attempt hydration
• Evaluate medications for
possible interactions or
adverse effects
• Further evaluation if
additional, more specific
signs and symptoms
develop
Functional
decline
No Decline in activities of
daily living (ADLs) can
be both risk factors and
consequences of infection.
Non-infectious reasons for
functional decline include
stroke, hip fracture, and
congestive heart failure.
Actively monitor residents
with abrupt functional
decline
Falls No Insufficient evidence
exists to link infectious
conditions, e.g. pneumonia,
to falls.
Patients cultured for
UTI following a fall are
as likely to have positive
urine as those who did not
experience a fall.
Not applicable
Anorexia No
Medication Actively monitor residents
with new-onset anorexia
(cont'd)
