一位 82 歲病人因尿路感染（UTI）接受治療。護理師最可能在此高齡病人身上觀察到哪種臨床表現？
An 82-year-old client is being treated for a urinary tract infection (UTI). Which clinical manifestation is the nurse most likely to observe in this older adult client?
- ASevere flank pain and hematuria嚴重的側腹痛與血尿
- BHigh fever and chills高燒與寒顫
- CAcute confusion and altered mental status✓ 正解急性意識混亂與精神狀態改變
- DFrequency and urgency of urination排尿頻率和急迫感
高齡病人的感染表現通常是『非典型』的。與年輕人表現出的發燒（B）或典型尿路刺激症狀（D）不同，老年人因免疫反應減弱，往往不發燒，取而代之的是中樞神經系統的變化，表現為急性意識混亂（Delirium）、跌倒增加或食慾不振。這種現象是因為感染導致的系統性發炎反應影響了本就脆弱的血腦屏障。護理師若發現高齡病人突然變得胡言亂語或嗜睡，應第一時間懷疑感染（尤其是 UTI）。臨床安全原則要求護理師具備識別老年非典型症狀的能力，以避免延誤治療引發敗血症。
In older adults, infections often present with atypical symptoms rather than classic signs like fever or localized pain. Acute confusion or delirium is a hallmark indicator of systemic infection, such as a UTI, due to the impact of inflammation on the central nervous system. Nurses must recognize these subtle changes to prevent delays in treatment and potential sepsis.
美國 NCLEX 非常強調『譫妄（Delirium）』是老年感染的首徵；台灣臨床教育也開始重視此點，但實務中家屬常誤以為是『老番顛』或失智惡化，護理師需精準區分急性與慢性變化。