SIGNS

1
SIGNS SYMPTOMSOF ILLNESS

• There are certain signs and symptoms of a
  persons health status that may be indicators of
  illness. Observing these symptoms in the persons
  that you serve, and reporting any noticed signs
  and symptoms to your supervisor and the health
  care provider, will help the physician to
  appropriately treat any illness that the person
  might have.
• The health care provider needs to understand what
  is normal for that person and what is different
  now. It is critical for case managers to get to
  know the persons they serve well and to carefully
  observe them for any changes in their physical
  status or behavior.

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Signs are what a doctor sees. Symptoms are what
other observers see and report to health care
providers, as appropriate. Some common symptoms
of illness include ABDOMINAL PAIN may indicate
appendicitis, food allergies, food poisoning,
gastrointestinal disorders, hiatal hernia or
pre-menstrual syndrom. ABNORMAL VAGINAL
DISCHARGE may indicate yeast infection
(candidiasis) or a sexually transmitted disease.
BACKACHE may indicate back strain, degenerative
disc disease, lack of exercise, obesity, female
disorders, spinal injury or pancreatic
disorders. BLOOD IN THE URINE, STOOL, VOMIT,
VAGINA OR PENIS may indicate hemorrhoids,
infections, polyps, bowel tumors, ulcers, cancer
of the kidneys, colon or bladdar. DIFFICULTY
SWALLOWING may indicate emotional stress, hiatal
hernia, or cancer of the esophagus.
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EXCESSIVE SWEATING may indicate thyroid disorder,
menopause, stress, food allergies, fever,
infection or Hodgkin's disease. FREQUENT
URINATION - may indicate bladder infection, a
diuretic effect, excessively taking in liquid,
and/or not emptying the bladder in a timely
fashion or cancer. PERSISTANT COUGH may indicate
lung disorders, pneumonia, emphysema, bronchitis,
influenza, food allergies, or cancer. PERSISTANT
FEVER may indicate influenza (flu),
mononucleosis, rheumatic disorders, bronchitis,
colds, meningitis, diabetes or chronic
infection. PERSISTANT HEADACHE may indicate
migraines, eyestrain, need for glasses,
allergies, asthma, drugs, glaucoma, high blood
pressure, brain tumor, vitamin deficiencies,
sinusitis or stress due to personal life
experiences.
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RASH WITH BLISTERS may indicate Herpes Zoster or
Shingles. SUDDEN WEIGHT GAIN may indicate
over-eating, lack of exercise, thyroid condition
(underactive) or edema (swelling). SUDDEN WEIGHT
LOSS (UNEXPLAINED) may indicate cancer, diabetes,
overactive thyroid, hepatitis, mononucleosis,
parasites, infection or mal-absorption
syndrome. SWELLING IN THE APPENDAGES OR ABDOMEN
may indicate edema, heart condition, kidney
dysfunction, medication, food allergies, oral
contraceptives or steroids. SWOLLEN LYMPH NODES
may indicate chronic infection, lymphoma, various
cancers, toxic metals, toxic build-up or
Hodgkin's disease. EXCESSIVE THIRST - may
indicate diabetes, infection, excessive exercise
or fever.
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• Severe mental illnesses are generally seen to be
  those in which psychosis is likely to occur.
• Psychosis is the medical term used to identify
  symptoms where the individual experiences a loss
  of a sense of reality, where they cease to see
  and respond appropriately to the everyday world
  they are used to.
• People with mental illnesses or disorders may
  experience a wide range of symptoms which can
  vary in severity. Some of the signs and symptoms
  of psychosis include
• Hallucinations means that someone may hear their
  own thoughts as if they are coming from a source
  outside their own body. They may see, smell or
  taste things that appear to be real, but which
  are not being experienced at that time by anyone
  else.

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Delusions type of psychosis in which a person
suffers from (fixed, false beliefs) of
persecution or grandeur. Either alone or in
combination with hallucinations, delusions are
strong indicators of mental illness.
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Types of psychotic illness Incidences of
psychotic illness may or may not be triggered by
an event in the person's life. Over the years, a
great deal of blame has been attributed to both
people who are mentally ill and their families.
It is important that the illnesses are seen as
real and that the symptoms are recognized. It
may take time for psychiatrists to reach a firm
diagnosis. Some are reluctant to 'label' people
because of the stigma and adverse social effects
that surround the illness. What really matters,
though, is not the diagnosis itself, but that the
symptoms are identified and treated promptly
using medication and psychological therapies.
Involving the ill person in decisions often has a
very positive effect on the person's self esteem.
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Psychosis may also involve 'mania', a term used
when someone's mood is very over active or
'heightened', There will be increased energy and
physical activity, racing thoughts and speech,
which may be confused and irrational. The
opposite may also happen. The individual may
become extremely withdrawn, inactive, perhaps
neither moving nor speaking for long periods.
This is called catatonia. Professionals may
identify groups or clusters of symptoms enabling
them to recognize particular disorders, like
schizophrenia or bi-polar disorder. Sometimes an
individual may have symptoms of both these
conditions together, involving episodes of
psychosis during which the person affected loses
touch with reality and experiences very high or
low mood that affects the way they behave. In
general terms the signs and symptoms of psychosis
are having hallucinations or delusions or certain
types of abnormal behavior. Hallucinations mean
that someone can hear their own thoughts as if
they are coming from an external source, or can
see, smell or taste things which appear to be
real but are not experienced by other people.
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There are several illnesses of which psychosis
is a symptom. These include schizophrenia
bipolar disorder (manic depression) clinical
depression personality disorder There is a
great deal of overlap in these illnesses and it
is not always possible to distinguish clearly
between them.
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HEALTH STATUS INDICATORS

• SLEEP
• Information regarding changes in a persons sleep
  patterns can be helpful for the health care
  provider to know, whether it is an increase in
  the amount of time sleeping or a decrease.
• Having trouble falling asleep may be a symptom
  of depression.
• Having trouble getting comfortable may mean a
  person has a new health problem.
• Many trips to the bathroom may mean a person has
  prostate problems or a urinary tract infection.
• Waking up several times and going back to sleep
  may mean a person has sleep apnea, which means
  the person stops breathing for short periods of
  time while sleeping which causes him to wake up
  briefly.

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• EATING/WEIGHT
• Usually a persons weight does not change much
  without a reason. Things that can affect weight
  include
• A change in activity level or home
• Medications prescribed for behavior can make
  people gain weight.
• Weight loss when someone is not trying to lose
  weight is a concern. It can mean that a person is
  seriously ill or having dental pain or painful
  swallowing.
• The health care provider needs to know if these
  symptoms are occurring as they provide
  information needed for accurate diagnosis.

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CARDIAC Heart conditions can occur in many
individuals from birth or develop as they age.
Swelling of the feet and ankles, or being cold
to the touch, may be a sign of a change in
circulation for an individual. A grayish/bluish
color to the lips or nails may mean poor
circulation as a result of heart problems. When a
person has this symptom while exercising or
develops chest, jaw or left arm pain, it is a
more urgent situation that the health care
provider needs to know about. Continuation of
these symptoms can be a life-threatening
emergency. THEY SHOULD NOT BE IGNORED.
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RESPIRATORY It is not normal to have frequent
colds, coughs, sneezes or trouble breathing.
Some chronic conditions may increase the
frequency of these symptoms. These include
asthma, cardiac disease, allergies and
aspiration. It is important to report such
symptoms to the health care provider.
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GASTROINTESTINAL Gastrointestinal /bowel
complaints can mean a chronic problem is getting
worse or that a person has a new problem.
Sudden abdominal problems are often the cause
of a person being admitted to the hospital. The
key is to know whats normal for the person.
Significant abdominal pain is not normal and
should be considered an urgent problem. Frequent
vomiting, burping and heartburn may indicate a
developing problem with the stomach or esophagus
(food tube). Medication, illness, diet, and
fluid intake may all change the pattern of a
persons bowel movements. An unexplained change
may be important. Increased constipation may
result in a bowel obstruction. Frequent loose
stools (diarrhea) may be caused by infectious
bacteria. Prolonged diarrhea can result in
dehydration. Blood in the bowel movement may be a
sign of hemorrhoidal bleeding or cancer. A change
in bowel pattern, consistency, and frequency may
be an important sign.
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NEUROLOGICAL Many individuals have known seizure
disorders. The symptoms may vary. Seizures may
affect the entire body and result in an
individual trembling and losing consciousness.
They may also be minor eye blinking with no loss
of contact with activity. Please refer to the
training module on Seizure Identification and
Management for additional information about
seizures and how to respond to persons
experiencing seizures.
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• SKIN and NAILS
• Skin protects the body. It can also tell us about
  what is happening in the body.
• Skin should be in good repair, soft and elastic
  without rash and irritation.
• Dry skin may be the result of inadequate fluid
  intake or exposure to harsh conditions or
  products.
• Rashes could be signs of many things like,
  allergy to a medication or substance, a skin
  condition like eczema or a serious illness like
  chicken pox.
• Changing or growing moles and new lumps need to
  be reported and investigated as possible signs of
  skin or other cancers.
• Frequently the faster a symptom becomes a problem
  the more urgent the problem. The occurrence of a
  new rash or a severely itchy rash needs
  reporting.

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• MOUTH
• Poor oral health will result in sensitive teeth,
  gum and tooth infections, and tooth loss. Good
  dental health is vital to overall good nutrition
  and good health.
• Bad breath may be a sign of oral infections.
• Certain medications may cause a person to have
  bleeding gums, which can cause mouth pain and
  infections.
• Medications that treat seizures can cause the
  gums to swell and grow too much. Good oral care
  is vital when a person is on these medications.
• Infections that start in the mouth can get into
  the blood and cause infections in other parts of
  the body.

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• VISION/HEARING
• Any sudden change in vision and/or hearing is an
  urgent situation. It is important to watch
  carefully and be aware of any of the following
  symptoms
• Redness or drainage from the eye may be a sign
  of an infection.
• Redness and pain may be a sign of a glaucoma.
• Squinting, needing to move into better light or
  sitting closer to the TV may well indicate a
  change in eyesight and a need for glasses or new
  glasses.
• Drainage from the ear is always a problem that
  must be referred to the health care provider.
• A buildup of earwax may affect hearing or
  decrease the ability of a hearing aid to work.
• Loss of hearing can cause a person to have
  unusual behavior, including depression.
• Any change in vision or hearing, it should be
  reported to the physician with a description of
  how and how much it affects the persons daily
  activities.

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GENITOURINARY It is important to note the normal
pattern for a person regarding their urinary or
reproductive system. A change from the normal
pattern needs to be reported to the health care
provider. Urinary tract infections (UTI) are a
common problem seen in many people especially if
they are incontinent and wear protective
underwear. Strong, foul odor, going to the
bathroom frequently and burning on urination are
all signs of a UTI. Increased accidents may also
be a sign of a UTI. Womens menstrual cycles
generally have a pattern to them. Pain during a
womans cycle may affect her ability to enjoy
certain activities. Changes in the cycle may be
normal or indicate a new problem. Unusual vaginal
bleeding or discharge requires reporting to the
health care provider.
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• Depression
• Depression is an illness marked by symptoms that
  may include
• Sadness, anxiety or irritability
• Thoughts of suicide
• Frequent crying or tearfulness
• Isolating, spending lots of time alone
• A loss of interest or pleasure in usual
  activities
• Feelings of helplessness, hopelessness, or
  worthlessness
• Trouble concentrating, remembering things or
  making
• decisions
• A change in sleeping or eating habits
• Feeling slowed down, restless, no energy
• Feeling tired all the time

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• The Warning Signs of Suicide
• Talk of suicide
• Preparation for death by making a will
  unexpectedly, or giving away personal possessions
  
• Deep depression
• Personality changes
• A sudden lift in spirits or mood which may mean
  that the person is relieved that his/her problems
  will soon be over

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• Anxiety
• Anxiety is excessive worry that is difficult to
  control, usually accompanied by restlessness,
  feeling keyed up or on edge, difficulty
  concentrating, irritability, or muscle tension. 
• Symptoms of anxiety may include
• Confusion and or disorientation
• Inability to care for self
• Forgetfulness and/or memory loss

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• Stroke
• Sudden, severe headache
• Sudden weakness or numbness of face, arm or leg
  on one side
• Dizziness, confusion, difficulty understanding
  speech
• Difficulty speak or swallowing
• Vision problems
• Changing levels of responsiveness or
  unresponsiveness

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If you suspect someone is having a stroke, don't
hesitate. Rapid diagnosis and treatment can
improve the person's chance of survival and
decrease his risk of permanent disability. To
help remember what to look for in persons who may
be having a stroke, think F.A.S.T. Face, Arms,
Speech, Time.
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F.A.S.T. F Face Does one side of the face
drop when asked to smile? A Arms When raising
both arms, does one arm drift downward? S
Speech When trying to repeat a simple sentence,
are words slurred or incorrect? T Time Rush
to emergency care immediately
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• Symptoms of impending heat illness
• Weakness
• Chills
• Goose pimples on the chest and upper arms
• Nausea
• Headache
• Faintness
• Disorientation

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Influenza (Flu) Uncomplicated influenza is
characterized by the abrupt onset of respiratory
signs and symptoms (e.g., fever, body aches and
pains, headache, mild depression, nonproductive
cough, sore throat, and rhinitis). Uncomplicated
influenza typically resolves after 3--7 days for
the majority of persons, although cough and
depression can persist for up to 2 weeks. Flu
virus infections can cause primary influenza
viral pneumonia and/or lead to secondary
bacterial pneumonia, sinusitis, or otitis media
(eye infections). Influenza virus infection
also has been uncommonly associated with more
serious conditions such as encephalopathy,
transverse myelitis, myositis, myocarditis,
pericarditis, and Reye syndrome. If symptoms
persist, contact the persons physician.
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BEHAVIOR How a person is acting can be an
indication of how they are feeling. The most
important key is to note change from a normal
pattern. If someone begins having difficulty
sleeping or is very anxious and argues easily,
this may indicate a new behavioral/psychiatric
problem.
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It is not critical that case managers have a
medical background or memorize all of the signs
and symptoms of illness and the illnesses
indicated by those symptoms. It is, however,
critical to know the persons with whom you work
so well that you can easily observe any changes
in their physical or mental status. Symptoms
that may not appear important could be indicators
of a serious illness and need to be reported to
the persons physician. Being aware of common
symptoms of illness could save someones life.