Cough
Also Consider: Common Cold, Dyspnea, Fever, Hypoxia, Respiratory Rate, Shortness of Breath
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Causes
Acute: bronchitis, common cold, postnasal drip, asthma
Chronic: COPD, asthma, esophageal reflux, ACE-inhibitor medications
Goals of Care
Make sure the patient doesn’t have a more serious illness such as COVID-19, influenza or pneumonia. Be aware of other, serious viruses spreading in your community.
Prevent complications like falls or dehydration while the patient is weak
Prevent the spread to others.
1. Take Vital Signs
Temperature:
Blood Pressure:
Heart Rate:
Respiratory Rate:
Oxygen Saturation:
2. Evaluate Symptoms and Signs
Acute mental status change
Not eating or drinking as much as usual
Acute decline in ADL abilities
Signs of dehydration
Sputum production
Respiratory: New cough, abnormal lung sounds, Accessory muscle breathing, pursed lip breathing, Respiratory distress
Cardiovascular: edema
GI: Nausea, vomiting, diarrhea, constipation
Neurologic changes: consciousness/alertness, orientation, weakness, gait changes (unsteadiness, loss of coordination or balance)
Skin: sweats (diaphoresis), cold/clammy/pale skin; rash, infection/cellulitis
Fingerstick glucose (patients with diabetes)
3. Take Action using SBAR Report:
Presence of other, significant symptoms or signs of illness
Refer to appropriate Situation-Specific Evaluation for the identified symptoms and signs.
Notify medical staff & resident representative within the next 16 hours.
Symptoms concerning for a serious virus spreading in your community.
Distressing symptoms despite implementing supportive measures
SBAR Report
Situation: "Distressing cough associated with:" (acute symptoms)
Background:
Reason the patient is in the nursing home (rehab for___, long term care for __).
When the problems started, how severe they are, getting worse or staying the same, what treatments have been used.
Abnormal Vital Signs
General observation of patient condition
Sputum production
Diuretic use & recent dose changes
Diet restrictions, fluid restriction, thickened liquids
Similar symptoms in other patient on unit or in facility
Assessment: I am concerned about: __________
Recommendations/Requests:
Labs: CBC with diff, CMP/Chem14, Lactic Acid, Procalcitonin
Chest X-ray with lateral view if possible
COVID-19 / Influenza / RSV or other viral testing
Acetaminophen, additional analgesics
Avoid cough medicines as they are not effective and can have side effects.
Sputum gram stain and culture
Ipratropium inhaler
Nasopharyngeal swab for Influenza and RSV testing for more severe symptoms
Opiate if patient receives comfort measures only
Hospitalization if patient requires Airborne isolation
Other:
Clarify expectations for care, interventions, and illness course/prognosis. Repeat any telephone orders back to the provider to ensure that they are correct and complete
4. Implement Management Plan
Implement infection prevention measures if patient may be contagious - contact the infection prevention nurse for isolation & precaution recommendations.
Monitor meal acceptance
Monitor vital signs, fluid intake/urine output every 4-8 hrs for 2-3 days
Offer fluids frequently
Place on Intake & Output monitoring
Place on 24-hour report for 2-3 days
Obtain lab results (if ordered), and notify medical as needed of:
Significantly abnormal values in blood count or metabolic panel (refer to appropriate Situation)
WBC > 12,000 or neutrophils > 90%
Infiltrate or pneumonia on chest x-ray
Positive virus result on swab - also notify infection prevention nurse
Only give acetaminophen, if ordered, for discomfort, fever > 103°F, or if chronic cardiopulmonary problems are present
Update care plan regarding fall risk, pressure ulcer prevention, assistance needed with ADLs, supervision for safety, restorative needs
Review status and plan of care with designated representative
Update advance directives if appropriate
2025-04-26
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