Clinical Pearl Wednesday #100

Woman Old Retirement Home Dementia  - geralt / Pixabay

Wow… I have done a 100 of these so far. Time flies when you are helping nurse practitioners start their own practice and break free! I hope everyone has enjoyed these 🙂 Now, lets get to it:

Have an elderly patient with mild presenting symptoms such as a cough or dysuria? Maybe there is no fever present? Did you obtain a CBC to be on the safe side and there was no leukocytosis? Do not chalk it up to a simple acute etiology so fast…

In the elderly, fever and leukocytosis can be absent when a serious infection such as pneumonia or pyelonephritis are present. I have seen elderly patients decline within 12 hours of presenting to an urgent care earlier that day and being diagnosed with a “simple UTI” or “bronchitis.” For this reason, you want to ensure you perform a thorough evaluation and consider doing additional testing such as a chest x-ray or more labs. Even consider treating a “UTI” more aggressively with antibiotics that cover the upper urinary tract just to err on the side of caution. It is critical these infections are treated early to prevent serious complication in the elderly.

4 Responses

  1. Thank you Justin. I appreciate all these pearls you have given. As much as I would love to be reading health books everyday, its not always easy due to work, family, and life. But these tips stay in mind especially when the situation arises. Thank you for all you do. We appreciate it your dedication.

    1. Happy to hear they have helped your practice. Thank you for the comment and the support. Always a pleasure 🙂

  2. This is so true. Also subtle mental status changes may be indicative of the same issues, particularly a UTI which often does not present with dysuria in the elderly.

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