SIGNS SYMPTOMS OF ILLNESS There are certain signs

SIGNS & SYMPTOMS OF ILLNESS There are certain signs and symptoms of a person’s 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.

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.

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.

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.

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.

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.

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.

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.

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.

HEALTH STATUS INDICATORS SLEEP: Information regarding changes in a person’s 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.

EATING/WEIGHT Usually a person’s 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.

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.

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.

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 what’s 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 person’s 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.

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.

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.

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.

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 person’s daily activities.

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. Women’s menstrual cycles generally have a pattern to them. Pain during a woman’s 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.

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

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

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

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

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.

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

Symptoms of impending heat illness: • Weakness • Chills • Goose pimples on the chest and upper arms • Nausea • Headache • Faintness • Disorientation

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 person’s physician.

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.

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 person’s physician. Being aware of common symptoms of illness could save someone’s life.