1.5 million patients had a primary diagnosis of pneumonia in 2018 according to the Center for Disease Control and Prevention, aka the CDC. While pneumonia is not always deadly, it is important to understand the symptoms and labs to be able to treat patients accordingly.
What is Pneumonia?
Pneumonia is defined by the CDC as, “an infection of the lungs that can cause mild to severe illness in people of all ages.” The infection then causes the lungs to produce an excess amount of fluid in the alveoli. While there is a vaccination to prevent pneumonia, it cannot completely prevent all types.
Causes
Pneumonia can be a primary diagnosis or a complication of another disease. For example, influenza, aka the flu, can lead to a lung infection which can then trigger pneumonia. On the other hand, one can aspirate, or inhale food or liquid, and that aspiration can lead to pneumonia.
Symptoms
Because pneumonia is an infection of the lungs, we can expect typical symptoms of infection, including fever, chills, confusion, and weakness. In addition to the traditional signs of infection, this patient is going to present with difficulty breathing and shortness of breath along with tachypnea (fast and shallow breathing). They will likely have a productive cough with purulent, yellow, or blood-tinged sputum. Because of the inflammation and cough, the patients’ lungs are not adequately exchanging oxygen, which means decreased oxygen levels, chest discomfort, and subsequential anxiety. Upon auscultation, you will likely hear wheezing and crackles in the lungs.
Some symptoms of pneumonia may also be associated with asthma and COPD. For more information, visit What is Asthma? Risk Factors, Symptoms, and Treatments and What is COPD? Risk Factors, Symptoms, and Treatments.
Labs
Blood or sputum can be collected to form a diagnosis of pneumonia. In a blood panel, the WBC’s (white blood cells) will be elevated and a decreased level of PaO2 (oxygen) will be detected. The electrolyte panel will indicate dehydration. A blood culture may also be performed to see what organisms are in the blood. If the patient has a productive cough, there may also be an order for a sputum sample collection for a culture. If the patient has pneumonia, the culture will come back positive.
Images
A chest X-ray, aka CXR, will likely be done for a patient with presumptive pneumonia. The image will show solidification of lung tissue, appearing more white than normal, if positive.
Treatment – Medications
Antibiotics are one of the first lines of treatment for pneumonia, as it’s an infection in the lungs. Penicillins and cephalosporins are most commonly given via IV. Bronchodilators, including albuterol, ipratropium, and theophylline, are given to help open the airways, making breathing easier. Anti-inflammatories such as prednisone and fluticasone are also given to decrease airway inflammation.
Treatment – Non-Pharmaceuticals
Supplemental oxygen will be given to patients with low oxygen supply (aka hypoxia). Placing the patient 90 degrees upright (aka in a high-Fowlers) position will help with breathing. In addition to positioning, always have a suction device and an incentive spirometer at the bedside to help keep your patients’ airway clear and their lungs open. A respiratory therapist will also be assigned to the patient to help administer breathing treatments as needed.
Patient Education
To prevent pneumonia, educate your patients on getting the vaccine if they are younger than 2 or older than 64.
For patients who have been diagnosis with pneumonia, educate on various resources. Let them know when to call you, for example if they have increased difficulty breathing. Keep the respiratory therapists’ name and number handy for this reason. Educate each patient on proper incentive spirometer use. Keep the suction device on and at the bedside table for the patient to use independently if applicable. Encourage rest periods in between suctioning and incentive spirometer use. Additionally, be sure to educate on the importance of good nutrition and increased fluid intake.
If Left Untreated…
When pneumonia is left untreated, it can lead to extreme airway inflammation, acute respiratory distress, and eventual blockage. The alveoli in the lungs may collapse, causing atelectasis. If the infection becomes severe enough, it can lead to full body sepsis. Which is why knowing the signs, getting an early diagnosis, and proper treatment is so important.
For more information on sepsis, visit Identifying Sepsis and Understanding its Care and Treatment.
Do you treat patients with Pneumonia? Comment below!
Plus be sure to check out the rest of the Patient Education Series:
- How to Spot a Stroke and Save a Life
- A Guide to Treating and Managing Type 1 Diabetes
- A Guide to Treating and Managing Type 2 Diabetes
- How to Effectively Manage Acute and Chronic Pain
- What is Hypertension? Causes, Symptoms, and Treatments
- What is Heart Failure? Risk Factors, Symptoms, and Treatments
- What are Urinary Tract Infections? UTI Prevention and Treatments
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