Spot these signs of infection at triage
[This is the first part of a two-part series on identifying and caring for patients with infections. In this month's issue, we tell you how to improve assessment. In next months' issue, we'll give you tips for how to protect yourself and your patients when an infection has been identified.]
During your initial nursing assessment on any given patient, do you always look closely for signs or symptoms of respiratory, urinary, or skin infections?
"Basic vitals should include temperature, respiratory rate, heart rate, blood pressure, and oxygen saturation," says Brian W. Selig, RN, BSN, MHA, CEN, NE-BC, ED nurse manager at the University of Kansas Hospital in Kansas City.
Teresa Mancuso, RN, an ED nurse at Baptist Hospital Miami, says, "Effective triage and early identification of infection not only protects the patient, but the uninfected patients and staff as well."
Mancuso says that while some symptoms that can alert you to the possibility of infection are obvious, such as fever greater than 100.4, tachycardia, hypotension, and tachypnea, it is also important to look for new rashes, pallor, fatigue, decreased appetite, unexplained swelling, new onset altered mental status, decreased urine output, and normotensive or hypotensive blood pressure, especially in a normally hypertensive individual. "Note that the presentation of symptoms can be vague, especially in the geriatric population," says Mancuso. "It is important to remember the elderly population often have normally lower body temperatures even in the case of infection."
Cynthia Horn, BSN, ANM, CEN, an ED nurse at Singing River Hospital in Pascagoula, MS, says that although a patient is not routinely kept in the triage area for an extended period of time, "we do get enough information to suspect if the patient has an infection." Horn says these are all warning signs that your ED patient might have an infection:
- abnormal vitals including elevated temperature, rapid heart rate, rapid respiratory rate, or low pulse oximetry;
- complaints of poor appetite, cough, changes in mental status, urinary frequency, pain, nausea, diarrhea, or seizures;
- history of antibiotics, steroids, or insulin;
- pale, flushed, hot, warm, moist, or cold skin;
- a history of diabetes, a non-ambulatory or bed-bound patient, or patients with dialysis lines, catheters, gastric tubes, or tracheostomy tubes;
- abnormal lung sounds or diminished lung sounds;
- a catheter or gastrostomy tube in place.
If your patient is incapacitated, a full head-to-toe examination should be performed to identify any outward signs of infection, Selig says. "In most cases, any acutely incapacitated patient would receive a Foley catheter due to their inability to appropriately void on their own," says Selig. "These patients should then be tested for urinary tract infections as their Foleys are inserted."
[This is the first part of a two-part series on identifying and caring for patients with infections. In this month's issue, we tell you how to improve assessment. In next months' issue, we'll give you tips for how to protect yourself and your patients when an infection has been identified.]You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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