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:
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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.