رجل عمره ٨٤ سنة في دار رعاية، عنده خرف خفيف، صار مشوشاً أكثر من المعتاد فجأة منذ يوم ويأكل قليلاً وسقط مرة. حرارته ٣٧٫٤، وتنفسه ٢٦، والنبض ١٠٢، والتشبع ٩١٪، ولا يكح كثيراً. ما الذي يجب أن يشك فيه الممرض؟

An 84-year-old care-home resident with mild dementia has been more confused than usual since yesterday, is eating less and has fallen once. T 37.4 °C, RR 26, HR 102, SpO2 91%; he is not coughing much. What should the nurse suspect?

1. Mild dehydration needing only water
2. Pneumonia with atypical presentation
3. Depression from loneliness alone
4. Advanced dementia normal for his age

Answer: B) Pneumonia with atypical presentation. Older adults with pneumonia may present with confusion, poor appetite and falls without clear fever or cough. A raised respiratory rate is a key clue. Chest and saturation are assessed and the prescriber informed.