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.