WBC (White Blood Cell) Count (lab test) abnormal, leukopenia, leukocytosis

Also Consider:  Abnormal lab result, Fever 

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

• Chills, Rigors

• Diaphoresis: Cold, clammy, pale skin

• Respiratory: New cough, abnormal lung sounds, Accessory muscle breathing, pursed lip breathing, Respiratory distress

• Cardiovascular:  Chest pain, new irregular pulse, cyanosis, mottling, edema

• GI: Nausea, vomiting, diarrhea, constipation, heartburn, abdominal distention or tenderness, rebound tenderness, bowel sounds

• GU: New or worsened incontinence, pain with urination, blood in urine, urinary retention / bladder scan

• Neurologic  changes: consciousness/alertness, orientation, weakness, gait changes (unsteadiness, loss of coordination or balance)

• Very low urinary output (<30cc/hr)

• Skin: any new skin condition, i.e., bruising (including potential head trauma), rash, cellulitis, wound infection

• 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. 

  • Immediately notify the medical staff & resident representative

  • Greater than 12,000 with any change in condition or fever, OR 

  • Greater than 30,000 without symptoms and above baseline, OR  

  • Less than 4,000 with any change in condition or fever, OR 

  • Less than 1,500 without symptoms and below baseline

• Notify medical staff on the next business day 

  • WBC abnormal and different from patient’s baseline

• Notify medical staff at the next regular rounds 

  • Normal WBC or unchanged from patient’s baseline

4. Implement Management Plan

• Monitor vital signs every 4-8 hrs for 2-3 days

• Offer fluids frequently

• Oral, IV, or subcutaneous fluids if needed for hydration

• 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 lab tests (refer to appropriate Situation)

  • WBC > 12,000 or neutrophils > 90%

  • Infiltrate or pneumonia on chest x-ray

  • Positive C. Diff

  • Positive flu result on swab

  • Urine results suggest infection and symptoms or signs present (Refer to “UTI” Situation)

• Only give acetaminophen, if ordered, for discomfort, fever > 103°F, or if chronic cardiopulmonary problems are present

• Implement infection control measures if indicated

• 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 daily

• Update advance directives if appropriate

2025-04-27