An elderly client with pneumonia may appear with which of the following symptoms first?
A. Altered mental status and dehydration
B. Fever and chills
C. Hemoptysis and dyspnea
D. Pleuritic chest pain and cough
Correct Answer: A. Altered mental status and dehydration
Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response. A small fraction of patients may have an altered mental status, abdominal pain, chest pain, and other systemic findings.
Option B: Historically, the chief complaints in case of pneumonia include systemic signs like fever with chills, malaise, loss of appetite, and myalgias. These findings are more common in viral pneumonia as compared to bacterial pneumonia.
Option C: Pulmonary findings include cough with or without sputum production. Bacterial pneumonia is associated with purulent or rarely blood-tinged sputum. Viral pneumonia is associated with watery or occasionally mucopurulent sputum production.
Option D: There may be an associated pleuritic chest pain with the concomitant involvement of the pleura. Dyspnea and a diffuse heaviness of the chest are also seen occasionally. The cough may be either nonproductive or productive with mucoid, purulent, or blood-tinged sputum.
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