Nursing assistants spend a great deal of time with clients, so it is important to recognize early signs and symptoms of infection and report them to the nurse. While there are specific symptoms associated with specific types of infection, there are some general symptoms that can occur with all infections. These general symptoms include a feeling of malaise (i.e., a feeling of discomfort, illness, or lack of well-being), headache, fever, and lack of appetite.
A fever is a common sign of inflammation and infection. A temperature of 38 degrees Celsius (100.4 degrees F) is generally considered a low-grade fever, and a temperature of 38.3 degrees Celsius (101 degrees F) is considered a fever. Fever is part of the body’s nonspecific immune response and can be beneficial in destroying pathogens. However, extremely elevated temperatures can cause cell and organ damage, and prolonged fever can cause dehydration.
Infection raises the metabolic rate, which causes an increased heart rate. The respiratory rate may also increase as the body rids itself of carbon dioxide created during increased metabolism. If either of these conditions are noted, they should be reported to the nurse right away.
As an infection develops, the lymph nodes that drain that area often become enlarged and tender. The swelling indicates the lymph nodes are fighting the infection.
If a skin infection is developing, general signs of inflammation, such as redness, warmth, swelling, and tenderness, will occur at the site. As white blood cells migrate to the site of infection, yellow or green drainage (i.e., purulent drainage) may occur.
Some viruses, bacteria, and toxins cause gastrointestinal inflammation, resulting in loss of appetite, nausea, vomiting, and diarrhea.
See Table 4.7 for a comparison of expected findings in body systems versus unexpected findings that can indicate an infection and require notification of the nurse and/or health care provider.
Table 4.7 Expected Versus Unexpected Findings Related to Infection[1]
| Assessment | Expected Findings | Unexpected Findings to Report to the Nurse |
|---|---|---|
| Vital Signs | Within normal range | New temperature over 100.4 F or 38 C or lower than the patient’s normal. |
| Neurological | Within baseline level of consciousness | New confusion and/or worsening level of consciousness. |
| Wound or Incision | Progressive healing of a wound with no signs of infection | New redness, warmth, tenderness, or purulent drainage from a wound. |
| Respiratory | No cough or production of sputum | New cough and/or productive cough of purulent sputum. New shortness of breath. |
| Genitourinary | Urine clear and light yellow without odor | Malodorous, cloudy, or bloody urine, with increased frequency, urgency, or pain with urination. |
| Gastrointestinal | Good appetite and food intake; feces formed and brown | Loss of appetite. Nausea, vomiting, or diarrhea. Discolored or unusually malodorous feces. |
| *CRITICAL CONDITIONS indicating a possible life-threatening infection (called sepsis) requiring immediate notification of the nurse:
Two or more of the following criteria in a patient with an existing infection:
|
Other Considerations
The effectiveness of the immune system gradually decreases with age, making older adults more vulnerable to infection. Early detection of infection can be challenging in older adults because they may not have a fever, but instead develop subtle changes like new confusion or weakness that may result in a fall. The most common infections in older adults are urinary tract infections (UTI), pneumonia, influenza, and skin infections.[2]
- Office of Infectious Disease and HIV/AIDS Policy. (n.d.). Health care-associated infections. U.S. Department of Health & Human Services. https://www.hhs.gov/oidp/topics/health-care-associated-infections/index.html ↵
- Office of Infectious Disease and HIV/AIDS Policy. (n.d.). Health care-associated infections. U.S. Department of Health & Human Services. https://www.hhs.gov/oidp/topics/health-care-associated-infections/index.html ↵
A feeling of being uneasy or uncomfortable.
A common sign of inflammation and infection.
