How does dehydration affect pneumonia outcomes in the elderly. What are the key symptoms of pneumonia in older adults. Can proper hydration reduce pneumonia mortality rates in seniors. How does pneumonia differ from the flu in presentation and treatment.

Understanding Pneumonia: Causes, Symptoms, and Risk Factors

Pneumonia is a serious respiratory infection that affects the lungs, causing inflammation and fluid buildup in the air sacs. While it can affect people of all ages, older adults are particularly vulnerable to severe complications and higher mortality rates. To fully grasp the impact of pneumonia on seniors, it’s crucial to understand its causes, symptoms, and risk factors.

What Causes Pneumonia?

Pneumonia can be caused by various pathogens, including:

• Bacteria (most common cause)
• Viruses
• Fungi

The infectious organisms colonize the lungs, triggering an immune response that can interfere with normal lung function and oxygen flow. This process leads to the characteristic symptoms of pneumonia.

Recognizing Pneumonia Symptoms in Older Adults

Pneumonia symptoms can vary between younger and older patients. In seniors, the presentation may be more subtle or atypical, making diagnosis challenging. Common symptoms include:

• Persistent cough (often producing thick, yellow or green sputum)
• Difficulty or pain when breathing
• Fever and chills
• Fatigue and weakness
• Confusion or altered mental state
• Loss of appetite

In some cases, older adults may not exhibit the typical signs of pneumonia. Instead, they might experience:

• Sudden weakness
• Unexplained confusion
• Falls or unsteadiness

Risk Factors for Pneumonia in the Elderly

Several factors increase the likelihood of developing pneumonia in older adults:

1. Chronic health conditions (e.g., COPD, heart disease, diabetes)
2. Weakened immune system
3. History of smoking
4. Recent hospitalization
5. Poor nutrition
6. Difficulty swallowing
7. Limited mobility

Understanding these risk factors can help healthcare providers and caregivers implement preventive measures and early interventions to reduce the impact of pneumonia on older adults.

The Critical Role of Hydration in Pneumonia Management

Proper hydration plays a crucial role in managing pneumonia, particularly in older adults. Dehydration can exacerbate pneumonia symptoms and lead to complications that increase mortality risk. Let’s explore the relationship between fluid intake and pneumonia outcomes in seniors.

Why is Hydration Important for Pneumonia Patients?

Adequate fluid intake is essential for pneumonia patients for several reasons:

• Helps thin mucus secretions, making them easier to expel
• Supports immune function
• Maintains proper blood volume and circulation
• Assists in regulating body temperature
• Helps prevent complications like kidney problems

The Impact of Dehydration on Pneumonia Outcomes

Dehydration can significantly worsen pneumonia symptoms and increase the risk of complications in older adults. Some effects of dehydration include:

• Increased difficulty breathing
• Worsened fatigue and weakness
• Heightened confusion and disorientation
• Elevated risk of falls and injuries
• Increased likelihood of hospitalization
• Higher mortality rates

Research has shown that proper hydration can improve outcomes and reduce mortality rates in elderly pneumonia patients. A systematic review and meta-analysis have revealed a significant association between fluid intake and reduced pneumonia-related deaths in older adults.

Differentiating Pneumonia from the Flu: Key Distinctions

Pneumonia and influenza (flu) are both respiratory illnesses that can cause similar symptoms, leading to confusion in diagnosis. However, understanding the differences between these conditions is crucial for proper treatment and management, especially in older adults.

Pneumonia vs. Flu: Comparing Symptoms

While pneumonia and flu share some common symptoms, there are notable differences:

Diagnostic Approaches

Distinguishing between pneumonia and flu often requires medical evaluation. Diagnostic methods may include:

• Physical examination
• Chest X-ray (definitive for pneumonia diagnosis)
• Blood tests
• Sputum culture
• Rapid flu tests

Treatment Differences

The treatment approaches for pneumonia and flu differ significantly:

• Pneumonia: Often requires antibiotics (for bacterial cases), supportive care, and sometimes hospitalization
• Flu: Typically managed with rest, hydration, and over-the-counter medications; antiviral drugs may be prescribed in some cases

Understanding these distinctions can help caregivers and healthcare providers make informed decisions about treatment and care for older adults experiencing respiratory symptoms.

Strategies for Improving Hydration in Elderly Pneumonia Patients

Ensuring proper hydration in older adults with pneumonia can be challenging due to various factors such as reduced thirst sensation, mobility issues, and cognitive impairment. However, implementing effective strategies can significantly improve fluid intake and potentially reduce mortality rates.

Practical Tips for Increasing Fluid Intake

1. Offer a variety of beverages: Water, herbal tea, clear broths, and caffeine-free drinks
2. Serve fluids at preferred temperatures
3. Use easily accessible cups or containers with handles
4. Encourage small, frequent sips throughout the day
5. Incorporate fluid-rich foods: Soups, fruits, and vegetables with high water content
6. Set reminders or create a hydration schedule
7. Use visual cues like partially filled water bottles to track intake

Addressing Barriers to Hydration

Common obstacles to proper hydration in elderly pneumonia patients include:

• Difficulty swallowing
• Fear of incontinence
• Medications that increase fluid loss
• Cognitive impairment affecting thirst perception

To address these barriers, consider:

• Consulting with a speech therapist for swallowing difficulties
• Using thickened liquids when necessary
• Offering smaller, more frequent fluid servings
• Providing assistance with toileting to alleviate incontinence concerns
• Monitoring medication side effects and adjusting as needed

The Role of Caregivers and Healthcare Providers

Caregivers and healthcare professionals play a crucial role in promoting hydration among elderly pneumonia patients. Their responsibilities may include:

• Educating patients and families about the importance of hydration
• Regularly assessing hydration status
• Implementing and monitoring hydration strategies
• Recognizing early signs of dehydration
• Collaborating with other healthcare team members to address hydration needs

By focusing on these strategies and addressing potential barriers, caregivers and healthcare providers can significantly improve hydration status in elderly pneumonia patients, potentially leading to better outcomes and reduced mortality rates.

Pneumonia Prevention Strategies for Older Adults

While proper hydration is crucial in managing pneumonia, prevention remains the best approach to reduce the risk of infection and associated complications in older adults. Implementing comprehensive prevention strategies can significantly decrease the incidence of pneumonia among seniors.

Vaccination: A Key Defense Against Pneumonia

Vaccines play a vital role in preventing pneumonia and its complications. For older adults, the following vaccinations are recommended:

• Pneumococcal vaccines: PCV13 and PPSV23
• Annual flu vaccine
• COVID-19 vaccine and boosters

These vaccines can help protect against common pathogens that cause pneumonia and reduce the severity of infections if they occur.

Lifestyle Modifications for Pneumonia Prevention

Encouraging healthy habits can strengthen the immune system and reduce pneumonia risk:

1. Quit smoking and avoid secondhand smoke
2. Maintain good oral hygiene
3. Practice regular hand washing
4. Stay physically active
5. Eat a balanced, nutritious diet
6. Manage chronic health conditions effectively
7. Get adequate sleep

Environmental Considerations

Creating a healthy living environment can help prevent pneumonia in older adults:

• Ensure proper ventilation in living spaces
• Minimize exposure to air pollutants
• Maintain clean and dust-free surroundings
• Use air purifiers if necessary

By implementing these prevention strategies, older adults can significantly reduce their risk of developing pneumonia and its potentially life-threatening complications.

The Impact of Stress and Exhaustion on Pneumonia Recovery

Stress and exhaustion can significantly influence the course of pneumonia, especially in older adults. Understanding the relationship between these factors and pneumonia recovery is crucial for effective management and improved outcomes.

How Stress Affects Pneumonia Recovery

Chronic stress can have detrimental effects on pneumonia recovery:

• Weakens the immune system, making it harder to fight infection
• Increases inflammation in the body
• Elevates cortisol levels, which can interfere with healing processes
• May lead to poor sleep quality, further impacting recovery

The Role of Exhaustion in Pneumonia Complications

Exhaustion can exacerbate pneumonia symptoms and lead to complications:

• Reduces the body’s ability to clear secretions from the lungs
• Increases the risk of dehydration
• May lead to poor nutrition intake, affecting recovery
• Can cause weakness and increased fall risk

Strategies to Manage Stress and Exhaustion During Recovery

To mitigate the negative impacts of stress and exhaustion on pneumonia recovery, consider the following approaches:

1. Encourage adequate rest and sleep
2. Implement stress-reduction techniques (e.g., deep breathing, meditation)
3. Provide emotional support and reassurance
4. Ensure a calm and comfortable recovery environment
5. Gradually introduce light activities as recovery progresses
6. Maintain social connections while minimizing exhaustion

By addressing stress and exhaustion, caregivers and healthcare providers can support more effective pneumonia recovery in older adults, potentially reducing complications and improving overall outcomes.

Recognizing Pneumonia in Public Settings: What to Look For

Identifying pneumonia symptoms in public settings can be challenging, especially when observing older adults who may present with atypical symptoms. However, being aware of subtle signs can help in early detection and prompt medical attention.

Observable Symptoms in Public

When observing someone who may have pneumonia in a public setting, look for the following signs:

• Persistent coughing, especially if it sounds wet or productive
• Visible difficulty breathing or shortness of breath
• Flushed appearance or excessive sweating
• Slower than usual walking pace or unsteady gait
• Frequent pauses while speaking or walking to catch breath
• General appearance of fatigue or weakness
• Confusion or disorientation, particularly in older adults

Differentiating Pneumonia from Other Conditions

It’s important to note that these symptoms can also be associated with other health conditions. Factors to consider when differentiating pneumonia from other illnesses include:

• Duration and progression of symptoms
• Presence of fever (though not always apparent in older adults)
• Recent exposure to others with respiratory illnesses
• Known risk factors or underlying health conditions

When to Seek Medical Attention

If you observe someone exhibiting multiple pneumonia symptoms, especially an older adult, it’s crucial to encourage them to seek medical attention. Signs that warrant immediate medical care include:

• Severe difficulty breathing
• Chest pain
• High fever with shaking chills
• Confusion or altered mental state
• Bluish tint to lips or fingernails (cyanosis)

By being aware of these observable symptoms and knowing when to seek help, individuals can play a crucial role in early detection and treatment of pneumonia, particularly in vulnerable populations like older adults.

No Big Deal or Deadly?

Hillary Clinton contracted pneumonia, and everyone wondered: What did it mean? Was this serious or not?

When presidential candidate Hillary Clinton fell prey to pneumonia recently, questions about the seriousness and implications of her illness permeated the media. We also wondered if we knew as much about the illness as we thought we did.

We sought answers from Katharine DeGeorge, MD, MS, a UVA family medicine physician voted “Best General Practitioner” in C-Ville Weekly’s Best of C-Ville 2015 and 2016, who gave us some insight.

What were your first thoughts when you heard Clinton had pneumonia? “Oh dear” or “no big deal”? Or “of course, she’s probably exhausted”?

No big deal.

Why?

Because pneumonia is fairly common, and the vast majority of otherwise healthy patients will recover and be able to go about their business within a few weeks.

What exactly is pneumonia?

Regardless of whether it’s a viral or bacterial organism causing the infection, pneumonia occurs when the infectious organisms group together in the lungs along with immune cells that are trying to fight the infection and interfere with normal lung function and can block the flow of oxygen.

Sometimes people get the flu and pneumonia confused – Bill Clinton called his wife’s condition the flu, for instance. What’s the difference, and which is worse?

It’s easy to get them confused. Both are common respiratory illnesses that:

• May cause fever, cough and excessive fatigue
• Have the potential to cause serious illness or even death, though most people fully recover

A simple chest X-ray can help us make the correct diagnosis if we aren’t certain after a good history and physical exam. Making the right diagnosis is important because it often affects our treatment plans.

Flu vs. Pneumonia

The flu:

• Caused by a virus – so antibiotics won’t help
• Infects nose, throat and lungs
• Symptoms vary but can include fever, chills, cough, headache, muscle and joint pain, sore throat, nasal congestion, general fatigue, and even diarrhea or vomiting (mainly in kids) and last about 3-7 days
• No shortness of breath in uncomplicated cases
• More contagious than pneumonia
• People usually get better on their own with rest, fluids and over the counter medications
• Can develop into pneumonia in more serious cases

Pneumonia:

• Most often caused by a bacteria
• Affects the lower respiratory tract and lungs
• Symptoms that distinguish it from the flu include difficulty or pain with breathing and a persistent cough productive of thick yellow/green sputum
• Most people need antibiotics to get better
• More likely to require hospitalization than the flu

Who Gets Pneumonia?

Are some people more prone?  Does getting pneumonia mean someone has a weak immune system or something?

Getting pneumonia doesn’t necessarily mean that your immune system is weak. Lots of perfectly healthy people get pneumonia.

However, the risk of developing pneumonia is higher for people with certain conditions such as:

• Asthma
• Chronic obstructive pulmonary disorder (COPD)
• Diabetes
• Chronic respiratory disease
• Dementia
• Excessive alcohol use
• Heart disease
• Smoking
• Stroke

Pneumonia can also have serious complications or even be deadly, especially for people who:

• Are very young (0-4 years old)
• Are age 65 and older
• Have immune systems weakened by other serious illnesses or medications

In the United States, about 10 percent of people over the age of 65 who are hospitalized for pneumonia will die within 30 days, so this can be very serious stuff. 

Do symptoms present differently in older people?

They sure can. The typical symptoms of pneumonia can be more subtle in older people, or they can present differently altogether, with the only sign of illness being weakness, confusion or collapsing.

Do stress and exhaustion make it worse?

Stress and exhaustion can most definitely lead to worse symptoms or complicating conditions, most notably dehydration, in people with pneumonia. Dehydration itself can lead to weakness and confusion, and can also cause low blood pressure, which again can lead to weakness, being unsteady on your feet, and collapse. It sounds trite, but our grandmothers were right when they told us to rest and drink plenty of fluids when we are sick! Our bodies need to conserve every bit of energy they can to fight pneumonia and get on the road to a full recovery.

Is it obvious if someone has it? As in, if you were watching Clinton, or a colleague at work, would their symptoms be obvious or not?

Most people with pneumonia will appear at least a little sick. You might notice them:

• Coughing a lot
• Looking flushed or like they are sweating
• Walking more slowly or unsteadily
• Having a hard time speaking or walking without having to pause to catch their breath

Some people, however, have mild cases of pneumonia that can go unnoticed altogether or be mistaken for a simple cold, cough or allergies.

Types of Pneumonia

Some people find the difference between viral and bacterial pneumonias confusing. Which is more severe?

Often, but not always, viral pneumonia is less severe than bacterial pneumonia and requires only rest, fluids and, for some, supplemental oxygen. People with bacterial pneumonia need treatment with antibiotics without which there is a much greater risk of a prolonged or more severe disease course and complications.

Is there such a thing as ‘double’ or ‘triple’ pneumonia? Why is it called walking pneumonia?

Walking pneumonia is a colloquialism that generally refers to a mild case of pneumonia, often caused by an “atypical” bacterial organism (because it’s not the typical agent that causes pneumonia), called Mycoplasma pneumoniae. This mild form of pneumonia can be so mild that people don’t even know they have it, or if they do, the symptoms don’t preclude participation in normal activities (including walking, thus the term “walking pneumonia”).

Double pneumonia (sometimes called bronchial pneumonia) simply refers to infections in two (of the three) lobes of the lungs, and generally indicates a more severe infection that often requires hospitalization.

Triple pneumonia is a little more complicated. Basically it occurs when a person with pneumonia (often double pneumonia) is treated and clears the original infection, but then gets a subsequent case of pneumonia affecting one or both lungs. Triple pneumonia carries a much worse prognosis than uncomplicated lobar pneumonia (affecting only 1 lobe).

Treatment & Prevention

How easy it is to get rid of it or stop it in its tracks?

When appropriate antibiotics for bacterial pneumonia are started right away, many people with pneumonia can be back to their normal state of health within a couple weeks, although some will have a lingering cough or fatigue that can last for a month or more.

Smokers or people with underlying lung conditions like asthma or chronic bronchitis may have a harder time getting back to baseline. The key to stopping pneumonia in its tracks is prompt diagnosis and treatment. 

Is there a vaccine?

There are two types of pneumonia vaccines available. They protect against the most common and aggressive serotypes of Streptococcus pneumoniae, the organism most often responsible for bacterial pneumonia. However, pneumonia can be caused by other organisms, including viral, bacterial, fungal and parasitic species, so the vaccines do not prevent against all forms of pneumonia. Getting pneumonia once doesn’t mean you can’t get it again.

We recommend these vaccines as part of routine childhood immunizations and for people aged 65 years and older, or those with certain medical problems that increase the risk of pneumonia or its complications. The pneumonia vaccines are only given a few times during your life, which is different than flu shots, which you should get yearly.

Concerns to Consider

As a doctor, what are your main concerns when you discover a patient has pneumonia?

The first thing that goes through my head when seeing a patient with suspected pneumonia is “sick or not sick.” Infections like this can lead to a severe systemic response that you don’t want to miss called sepsis, which requires prompt action. Vital signs such as body temperature, heart rate, respiratory rate, oxygen level and blood pressure help determine just how sick the patient is and whether or not they need to be hospitalized.

Do You Have Pneumonia Symptoms?

Find a family medicine or primary care doctor near you.

Another essential piece of the puzzle is determining if the infection may have been picked up from a hospital or other health-care facility like a nursing home. Pathogens that live in these places have a greater chance of being antibiotic resistant and require different treatment considerations.

For most people, especially those without other serious medical conditions, a simple course of antibiotics along with rest and fluids will do, and they’ll be back on their feet in no time.

Tags: Healthy Aging: Expert Advice & Insights on Aging Gracefully

Pneumonia: Symptoms, causes, and treatments

Pneumonia is an inflammation of one or both lungs, typically due to a bacterial, viral, or fungal infection. With pneumonia, the tiny air sacs inside the lungs fill with fluid or pus, leading to coughing, chest pain, and breathing difficulties.

Anyone can develop pneumonia. The people most at risk of developing pneumonia are young children, older adults, and people with preexisting medical conditions that weaken the immune system. These same groups of people are also at increased risk of developing complications of pneumonia.

This article outlines the symptoms of pneumonia in adults and children and its causes, diagnosis, and treatment. We also provide information on pneumonia risk factors, complications, and prevention.

Fast facts on pneumonia

• Pneumonia is an infection of the lungs that can cause mild to severe illness in people of all ages.
• It is the leading cause of death due to infection in children younger than 5 years of age worldwide.
• Pneumonia and influenza together are ranked as the eighth leading cause of death in the United States.
• Those at high risk of pneumonia include older adults, the very young, and people with underlying health problems.

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The first symptoms of pneumonia usually resemble those of a cold or flu. A person may then develop other symptoms, which can vary depending on the type of pneumonia a person has.

Common symptoms include:

• cough that may produce green, yellow, or even bloody phlegm
• fast breathing and shortness of breath
• chest pain that usually worsens when taking a deep breath
• fast heartbeat
• fever, sweating, and chills
• fatigue
• confusion or delirium, especially in older adults
• loss of appetite
• nausea and vomiting

Pneumonia types differ depending on their cause. The different types and their associated causes include:

• Bacterial pneumonia: Many bacterial strains can cause pneumonia, but the most common is Streptococcus pneumoniae (S. pneumoniae). A doctor may refer to pneumonia resulting from this strain as pneumococcal pneumonia.
• Viral pneumonia: Viral causes of pneumonia include the respiratory syncytial virus and influenza types A and B.
• Fungal pneumonia: This can result from a condition such as valley fever, caused by the Coccidioides fungus.
• Aspiration pneumonia: This type occurs as a result of inhaling food, liquids, or stomach contents into the lungs. Aspiration pneumonia is not contagious.
• Hospital-acquired pneumonia: This can occur in people receiving hospital treatment for other conditions that involve use of a respirator or breathing machine.

Regardless of the cause of pneumonia, the signs and symptoms will be similar.

Walking pneumonia is a non-medical term that describes a mild case of pneumonia with cold-like symptoms. The condition is so-called because people with this type of pneumonia typically do not require bed rest and can continue their usual daily activities.

Despite the name, people with walking pneumonia should rest as much as possible to speed up their recovery. Resting also reduces the risk of spreading the pneumonia-causing pathogens to other people.

Most people with walking pneumonia begin to feel better within 3–5 days. They can take over-the-counter (OTC) medications to ease any symptoms during this time.

In most cases, a child’s immune system will protect them from developing pneumonia. If a child does develop pneumonia, it is usually due to a virus.

Symptoms in children may include:

• difficulty breathing or breathing loudly
• not feeding as they usually do
• coughing
• fever
• irritability
• dehydration

Toddlers may complain of pain in their chest or stomach and vomit after coughing.

Treatment includes plenty of rest and a regular fluid intake. A doctor may suggest OTC medications to help ease symptoms such as abdominal problems or coughing, but these medicines will not help treat pneumonia.

Adults should not smoke around children, especially if the child has pneumonia.

Pneumonia is typically due to infectious pathogens, such as bacteria and viruses. These pathogens can spread via coughing and sneezing or by contaminating surfaces that people touch.

In most cases, a person contracts pneumonia-causing pathogens by breathing them into the small air sacs, or alveoli, within their lungs. The immune system responds by sending white blood cells to attack the infection, which triggers inflammation of the alveoli. The alveoli fill with fluid and pus, causing pneumonia.

People most at risk of developing pneumonia are those who:

• are under 5 years old or over 65 years old
• have recently recovered from a cold or influenza infection
• have underlying conditions, such as:
  • cystic fibrosis
  • chronic obstructive pulmonary disease (COPD)
  • asthma
  • conditions that affect the kidneys, heart, or liver
• have a weakened or impaired immune system, which may occur as a result of several conditions, including:
  • diabetes
  • HIV
  • AIDS
  • cancer
• take medicines for gastroesophageal reflux disease (GERD)
• experience malnutrition
• smoke tobacco, consume large amounts of alcohol, or both
• have been exposed to certain chemicals or pollutants
• have been recently hospitalized in an intensive care unit

Pneumonia can cause complications.

These are more common among the following groups of people:

• young children
• older adults
• people with certain preexisting health conditions

According to the Centers for Disease Control and Prevention (CDC), some potential complications of pneumococcal pneumonia include:

• Empyema: An infection of the space between the membranes that surround the lungs and chest cavity.
• Pericarditis: Inflammation of the sac, or pericardium, surrounding the heart.
• Endobronchial obstruction: A blockage of the airway that allows air into the lungs.
• Atelectasis: A complete or partial collapse of an entire lung or an area within the lung.
• Lung abscess: A collection of pus in the lungs. This is a rare complication that mostly occurs in people with serious underlying medical conditions or a history of alcohol misuse.

Other possible complications of pneumonia include:

• Pleurisy: Inflammation of the thin membranes between the lungs and ribcage that can lead to respiratory failure.
• Septicemia: An infection in the blood that originated elsewhere in the body.
• Sepsis: A life threatening immune reaction to septicemia, which can lead to tissue damage, organ failure, and death.

There are two different vaccines to help prevent pneumococcal disease, the most common bacterial cause of pneumonia.

The vaccines protect against a wide variety of pneumococcal infections. While they may not completely protect older adults from pneumonia, they can significantly reduce the risk of pneumonia and other infections caused by S. pneumoniae, including blood and brain infections.

There are two pneumonia vaccines available. As discussed below, healthcare professionals offer them to different age groups:

Pneumococcal conjugate vaccine

The pneumococcal conjugate vaccine is a pneumococcal vaccine that doctors may refer to as Prevnar or PCV13. Doctors recommend PCV13 for the following groups:

• children under 2 years old, as PCV13 is a typical part of an infant’s routine immunizations
• those ages 2 years or above who have certain underlying medical conditions

Pneumococcal polysaccharide vaccine

The pneumococcal polysaccharide vaccine is a pneumococcal vaccine that doctors may also refer to as Pneumovax or PPSV23. Doctors recommended PPSV23 for the following groups:

• people ages 2–64 years who have certain underlying medical conditions, such as:
  • diabetes
  • chronic heart, lung, or kidney disease
  • lack of a spleen due to surgical removal
• adults ages 19–64 years who smoke cigarettes
• all adults ages 65 years or above

Other preventative measures

Along with vaccinations, doctors recommend the following measures to help prevent pneumonia:

• regular hand washing
• covering the mouth and nose when coughing or sneezing
• refraining from smoking
• eating a balanced, nutritious diet
• exercising regularly
• staying away from people who have pneumonia, or being extra vigilant about hygiene when around people who are unwell

To diagnose pneumonia, a doctor will usually ask about a person’s symptoms and medical history and carry out a physical examination. The physical exam may include listening to the chest through a stethoscope and measuring blood oxygen levels using a pulse oximeter attached to the finger.

A doctor may suspect pneumonia if they hear the following when listening to the chest through a stethoscope:

• coarse breathing
• wheezing
• crackling
• decreased breath sounds

If doctors suspect pneumonia, they may order additional tests, including:

• Chest X-rays: These can confirm a pneumonia diagnosis and show which areas of the lungs are affected.
• A chest CT scan: This scan can provide more detailed images of the lungs.
• White blood cell (WBC) count: A blood test that measures levels of WBCs in the blood. This helps determine how severe the infection is and whether bacteria, virus, or fungus is the likely cause.
• An arterial blood gas test: A blood test that can provide a more accurate reading of the body’s oxygen and carbon dioxide levels and other factors.
• Blood cultures: These may reveal whether the microorganism from the lungs has spread into the bloodstream.
• Sputum analysis: Tests the sputum to determine which pathogens are responsible for the pneumonia.
• Bronchoscopy: A procedure that involves passing a bronchoscope into the lungs while a person is under anesthesia. The bronchoscope is a thin, flexible tube with a light and camera attached, which enables the doctor to directly examine infected parts of the airways and lungs. A doctor may recommend this procedure when further investigation is necessary.

Pneumonia is usually due to an infection (bacterial, viral, or fungal). People can also develop pneumonia after inhaling contaminated food, water, or saliva into their lungs.

This lung condition is more common among young children, older adults, and people with preexisting medical conditions that affect their organs or weaken their immune systems. These groups also have an increased risk of serious complications of pneumonia. As such, they should take extra measures to help prevent pneumonia, which may include receiving a pneumococcal vaccine.

Whatever the cause of pneumonia, treatment includes getting lots of rest and drinking plenty of fluids.

A doctor may recommend additional treatments depending on a person’s pneumonia type, symptoms, and overall health. People should contact their doctor if their symptoms persist or worsen.

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Pneumonia – risk assessment, diagnosis and treatment – the role of a nurse

Printable version

The peak incidence occurs in the middle of winter, and this time is already quite difficult in terms of incidence.

In clinical practice, the prevalence of pneumonia is often underestimated. However, pneumonia sometimes progresses very quickly and the patient may end up in the intensive care unit, and even die from it. Not in all cases, patients with pneumonia require hospitalization, but patients still need to be closely monitored, especially children and the elderly are vulnerable.

Patients requiring hospitalization rarely have to stay in the hospital for more than a week. Of these, approximately 10% require hospitalization in the intensive care unit and resuscitation. If pneumonia is not treated, then the mortality rate will be approximately 30%.

Causes

There are several reasons for the development of pneumonia. Pneumonia is defined as inflammation of the bronchioles and alveoli. The alveoli are filled with mucus and inflammatory effusion, which limits gas exchange, and, depending on the severity of the disease and the extent of the lesion, can lead to hypoxia. Pneumonia is classified according to two main features: localization and area of ​​the lung lesion (lobar or focal) and according to the microorganism that caused the disease (Macfarlane et al, 2000).

Pneumonia can be caused by many microorganisms – viruses, bacteria and fungi. Pneumonia of fungal etiology develops in patients with immunodeficiency. In clinical practice, these are patients with neutropenia and other immunodeficiencies.

Viral pneumonia leads to the development of inflammation that spreads to the alveoli, while bacterial pneumonia destroys the alveolo-capillary membrane. Bacterial pneumonia can occur on its own or as a complication of other chronic diseases.

Community-acquired and hospital-acquired pneumonia

Pneumonia is also classified in these two areas – community-acquired and hospital-acquired. Community-acquired pneumonia is pneumonia in which symptoms are present on admission or within 48 hours after admission. The annual incidence is 1 in 1000, and the mortality rate is about 10% (Royal College of Surgeons, 2004).

There are microorganisms that most often cause the development of community-acquired pneumonia. Most often it is Streptococcus pneumoniae (Royal College of Surgeons, 2004), and chlamydia and mycoplasmas often cause pneumonia.

Nosocomial pneumonia – develops 48 hours after admission to the hospital and up to 10 days after discharge. It often occurs in postoperative patients, and its mortality rate is 25-50%. It is most commonly caused by gram-negative organisms or staphylococci, with a serious prognosis (Royal College of Surgeons, 2004).

Risk factors

Lung infections can develop in many patients. Patients with renal insufficiency and diabetes are a special risk group. These patients are recommended annual influenza vaccination. The risk group also includes patients with bronchial asthma and chronic obstructive pulmonary disease.

Immunocompromised patients (HIV patients, organ transplant recipients, and infants) are also at risk and should be subjected to especially stringent infection control measures (Bellamy, 2006). Patients with chronic alcoholism, drug addiction and malnutrition are at risk of aspiration pneumonia, which occurs in an unconscious state or during convulsions. Aspiration pneumonias are severe and require aggressive treatment.

Intubated patients are also at risk for developing pneumonia if infection control measures are not strictly followed. Physiological breathing prevents bacteria from entering the lungs. Large particles are filtered in the nasal cavity, smaller particles are eliminated by coughing and sneezing. Those very small particles that do get into the lungs, settle on the surface of the mucus and cough up. Mechanical ventilation overrides these defenses and allows bacteria to enter the alveoli directly (Woodrow and Roe, 2003; Zack et al, 2002).

Clinical manifestations

As with any other disease, the clinical manifestations of pneumonia in different patients can vary significantly, this is influenced by underlying diseases, age and health in general. It is important to understand that not only old people and children die from pneumonia. It is also dangerous for other age groups. The severity of pneumonia can be determined using a clinical scale, such as CURB-65, and the presence of underlying diseases must also be taken into account.

When treating patients with pneumonia or any other infection, one should always remain alert for sepsis and the development of general reactive inflammation syndrome (SIRS), especially when the infection is localized in the chest. If sepsis develops, mortality increases significantly (Laterre et al, 2005). Sepsis symptoms:

• Hypotension;
• Tachycardia;
• Fever;
• Oliguria;
• Dizziness;
• Disorders of consciousness;
• Peripheral vasodilation;
• Hypothermia;
• Ischemia;
• Tachypnea;
• Metabolic acidosis;
• Cough;
• Hypoxia;
• Rash;
• Pale skin;
• Abnormal blood glucose levels;
• Sweating;
• Stiff neck;
• Dyspnea;
• Vomiting;
• Diarrhea.

Sepsis is diagnosed when two of the above criteria are met.

Conclusions

Pneumonia is a serious and potentially life-threatening illness. Mortality in pneumonia is quite high, especially in vulnerable groups of patients. In risk groups, the prevention of pneumonia is vaccination. All infection control measures should be carefully observed to avoid illness in vulnerable groups of patients.

It is important that nurses know the signs and symptoms of pneumonia so that they can be diagnosed and treated early. They should also be aware of the signs and symptoms of sepsis and the criteria for general reactive inflammation syndrome.

Signs and symptoms of pneumonia

• Hypoxia;
• Disorders of consciousness;
• Tachycardia;
• Hypotension;
• Cyanosis;
• Fever;
• Pain in the chest;
• Nausea;
• Weakness;
• Myalgia;
• Dyspnea;
• Wheezing in the lungs;
• Pleural friction rub;
• Cough;
• Tachypnea;
• Bradycardia;
• Sweating;
• Redness of the face;
• Vomiting.

Source: Ramrakha and Moore (1999)

Assessment of the severity of the patient’s condition

As we have already said, the clinical picture in patients with pneumonia can vary significantly in severity – from the almost complete absence of symptoms to an extremely serious condition. It is very important to be able to understand the severity of pneumonia and its impact on the patient’s health status.

The CURB-65 score is most commonly used in Europe to identify patients who are critically ill and need to be admitted to an intensive care unit (Kamath et al, 2006). The scale provides points for changes in consciousness, blood urea level, respiratory rate and blood pressure, and points are awarded for age:

C = Changes in consciousness that were not there before
U = Blood urea >7mmol/l
R = Respiratory rate >30
B = Blood pressure (systolic <90mmHg, diastolic <60mmHg) 65 = age >65
(Buising et al, 2006; Espana et al, 2006).

With a score of 2 or less, hospitalization may not be necessary, but this of course depends on the presence of underlying pathology in the patient. If the score is more than two, hospitalization may be required for examination and treatment. The higher the score, the worse the prognosis and the more severe the course of the disease.

This scale can be further enhanced by adding the MEWS (Modified Early Warning Scale) score, which assesses blood pressure, respiratory rate, level of consciousness, urine output, temperature, and pulse.

In addition to a comprehensive assessment of the patient’s condition, the use of such tools makes it possible to identify a potential or already occurring deterioration in the patient’s condition, and provide him with the best assistance and, if necessary, timely admission to the ICU. If these assessment schemes are used in conjunction with hematological or biochemical parameters, then organ or multiple organ failure can be detected in a timely manner, and the patient can be hospitalized in the intensive care unit.

Chest X-ray can detect not only pneumonia, but also underlying pulmonary pathology, which can aggravate the course of pneumonia. Also, radiography is used to assess response to treatment, sometimes it is possible to suggest which pathogen caused the disease, the presence of infiltration, atelectasis, or effusion in the pleural cavity.

However, the diagnosis of nosocomial pneumonia can be very difficult, as many patients will have the same symptoms and chest x-ray changes. These patients require additional diagnostic tests.

Additional tests for pneumonia

Sputum tests may help to make a specific diagnosis, but in some patients it can be difficult to obtain, especially when dehydrated. If the patient cannot drink at all, he is prescribed intravenous fluids and humidified oxygen inhalations – this helps to separate sputum.

Sputum samples are sent for culture and testing for TB – Acid Fast Bacteria (AFB). Before examination under a microscope, sputum is examined for the presence of blood, pus and other inclusions in it.

Also, when examining a patient, a clinical blood test is done, in which attention is paid to the number of lymphocytes – during infection, their number increases. A low number of lymphocytes is also an alarming sign, as it indicates a decrease in immunity. The level of urea is also examined and the CURB-65 indicator is calculated. Sometimes it is possible to get the causative agent of pneumonia in a blood culture.

Urinalysis is sometimes helpful in establishing the correct diagnosis. The presence of glucose, protein and blood in the urine is often noted in pneumonia. A urinalysis should be collected and sent for legionellosis and pneumococcal antigen.

Arterial blood gas analysis can detect acidosis and hypoxia, which require urgent intervention, and examination by a resuscitator or respiratory specialist. This analysis should take into account the concentration of oxygen in the inhaled air.

Treatment

Oxygen therapy is an absolutely essential component of the treatment of pneumonia (Royal College of Surgeons, 2004). The goal of this therapy is to maintain saturation above 93%. The concentration of oxygen in the inhaled air can vary – from low concentrations through cannulas to high concentrations through a special mask. The oxygen must be humidified to facilitate the separation of sputum. Respiratory physiotherapy also facilitates the drainage of the airways.

Although pulse oximetry is a good monitoring method in patients with pneumonia, a blood gas test should be performed to determine adequate oxygenation (Turner, 2003). For patients who persist in persistent hypoxia despite treatment, continuous positive pressure (CPAP) or CPAP respiratory therapy should be considered (BTS, 2004). These patients may need to be hospitalized in an intensive care unit or intensive care unit.

At the slightest sign of dehydration and hypotension, provide venous access and start fluid therapy. Adequate hydration also contributes to the separation of mucus. We must not forget about nutrition – patients with severe pneumonia may experience nausea and have poor appetite. With any infection, the body’s need for calories increases. Sometimes it is necessary to connect a nutritionist to manage the patient.

Antibiotic treatment should be given as soon as possible, consideration should be given to the causative agent and prescribing for suspected drug susceptibility. Treatment is started immediately, and after receiving the culture and isolation of the pathogen, the therapy is adjusted in accordance with the data of drug sensitivity tests. Intravenous antibiotics may be required for patients with severe pneumonia, after the patient’s condition improves, they are transferred to tablet preparations. In case of nosocomial pneumonia, it is extremely important to follow local treatment protocols for the management of patients, taking into account the monitoring of drug susceptibility of the hospital flora.

Pain management is a very important aspect of pneumonia management (Ramrakha and Moore, 1999). Many patients complain of pleuritic chest pain, which makes the patient spare the affected side, which significantly impairs lung expansion and aggravates the course of pneumonia. Patients who develop respiratory failure require respiratory support. Non-invasive ventilation is sometimes enough, but sometimes hospitalization in the intensive care unit is required. Here again, emphasis should be placed on the early involvement of the resuscitator in the management of the patient. It is desirable that the hospital has clear protocols for managing patients with the inclusion of assessment on different scales (Watson, 2006).

Conclusions

Timely and complete examination of the patient, and not only the respiratory function, is extremely important, since pneumonia is a common disease that can affect all organs and systems.

Detailed questioning and history taking can help in early detection of the causative agent, and supportive care—fluid, analgesia, and antibiotics—should be started as early as possible. Severity of illness should be assessed, and pneumonia severity scores such as CURB-65 and MEWS should be reviewed, or other scoring systems should be developed (Buising et al, 2006; BTS, 2006). The scale makes it possible to suspect a severe course of pneumonia early and, accordingly, take timely measures or even hospitalize the patient in the intensive care unit. It is desirable that the patient is managed by a multidisciplinary team that starts physiotherapy early and, if necessary, hospitalizes the patient in the intensive care unit. For those patients who are difficult to diagnose, a consultation with a pulmonologist is required.

Increasing the alertness for pneumonia is vital, especially in the general ward, to help ensure timely and adequate patient care. Close observation of the nurse and good care will allow the nurse to determine the possible causes of pneumonia, and ensure the timely provision of care and improve its quality.

References

British Thoracic Society (2006) Severity assessment criteria recommended by the British Thoracic Society (BTS) for community acquired pneumonia (CAP) and older patients. Should SOAR criteria be used in old people? Age and Aging; 35:3, 286–291.

British Thoracic Society (2004) BTS Guidelines For the Management of Community-Acquired Pneumonia in Adults – 2004 Update. London: BTS.

Buising, K.L. et al (2006) A prospective comparison of severity scores for identifying patients with severe community-acquired pneumonia: reconsidering what is mean by severe pneumonia. Thorax; 61:5, 419–424.

Espana, P.P. et al (2006) Development and validation of a clinical prediction rule for severe community-acquired pneumonia. American Journal of Respiratory Critical Care Medicine; 174:1249–1256.

Watson, D. (2006) The impact of accurate patient assessment on quality care. Nursing Times; 102:6, 34–37.

By David Watson, BA Nursing, PGD Critical Care, SPQ Critical Care, Dip Nursing, Chief Nurse, Intensive Care Unit, Monklands Hospital, Airdrie.

Reference: Watson, D. (2008) Pneumonia 1: recognizing risk, signs and symptoms. Nursing Times; 104:4, 28–29.

Infusion therapy for pneumonia – Clean Clinic

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06/14/2022

Infusion therapy for pneumonia

In many diseases of the bronchopulmonary system, infusion therapy is carried out. It is used for bronchitis, pleurisy, pneumonia, pneumothorax, severe bronchial asthma. Pneumonia is one of the most common and at the same time one of the most dangerous lung diseases. It can be bacterial, viral, less often pneumonia is caused by protozoa or fungi. One of the most important elements of the treatment of any pneumonia is infusion therapy.

Why pneumonia is dangerous

Pneumonia is dangerous, if only because it occupies 4-5th place in the world among all causes of human death.
Previously, people suffered mainly from bacterial pneumonia. They are severe, but usually treated with antibiotics. There are also dangerous bacteria that are resistant to antibiotics. They are much more difficult to destroy.
Severe cases of viral pneumonia occur in immunocompromised older people. Previously, influenza pneumonia was considered the most dangerous. A more dangerous and more contagious virus that causes COVID-19 has emerged today. Effective antiviral drugs have not yet been invented either against the flu or against COVID-19, so the task of doctors is to maintain vitality in the body while the immune system itself tries to expel uninvited guests from the lungs.

What is the infusion therapy for pneumonia

Fluid therapy for pneumonia in both children and adults is aimed at:
Elimination of the causative agent of infection;
Compensation of water-electrolyte exchange;
elimination of intoxication;
Strengthening of immunity;
normalization of blood circulation;
Reducing the severity of the inflammatory response;
prevention of complications, such as the formation of blood clots in the vessels.
Etiotropic treatment is considered the main one, if possible. Antibiotics are added to the composition of the dropper, which destroy bacteria. In fungal inflammatory processes, antimycotics (antifungal drugs) are used.
Infusion therapy for viral pneumonia, including coronavirus, is pathogenetic. So far, there are no drugs that destroy the coronavirus. But usually the body itself successfully gets rid of the virus, if favorable conditions are created for this.
Indications for fluid therapy in pneumonia:
moderate or severe pneumonia;
Intoxication with high fever;
dehydration;
Lack of effect from oral medication.
Infusion therapy means intravenous delivery of drugs along with a large volume of fluid. This is the best method of treatment, as it reduces fever, removes toxins, normalizes water and electrolyte metabolism and blood composition, and reduces the risk of complications. With intravenous administration, 100% bioavailability of drugs is ensured.

Fluid therapy after pneumonia

After pneumonia, people often feel bad: weakness, fatigue, insomnia, blood pressure surges, headaches, reduced work capacity, unstable stools – this is just a small list of the many problems that can torment a person for months.