Here is our monthly article from Jessica over at www.ViveHealth.com. It's a great post about pneumonia and what we, as nurses, should understand in order to give excellent care to our patients.
Pneumonia: Causes, Treatment, and How to Prevent It
As your anatomy class once covered, when a patient breathes, they take in air through the trachea and down the bronchi. As the air continues on its journey to the lungs, it funnels through tiny branches called bronchioles which lead finally to air sacs in the lungs called alveoli. There are about 600 million alveolus hanging out in there, which is where oxygen gets transmitted to the blood. This incredible feat of biological design makes it possible for humans to survive on Earth.
Unfortunately, both bacteria, fungi, and viruses can infect the lungs, leading to fluid and pus buildup in those air sacs as well as inflammation. This type of infection is referred to as pneumonia, and for older adults, young children, and patients with diminished immune systems and chronic disease, can be life-threatening.
Causes of Pneumonia
Most generally, pneumonia is caused by airborne droplets making their way into the lung’s air sacs. Community-acquired pneumonia (CAP) is spread through the air via cough or sneeze and takes up in a patient’s lungs when the germ is inhaled. Common culprits that cause pneumonia include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Having a cold, the influenza virus, or underlying COPD may make a patient more susceptible to developing a pneumococcal infection. Pneumonia may also result when food or drink goes down the wrong pipe (aspiration pneumonia); this is more common in older patients or patients with chronic diseases which limit their mobility.
When a patient acquires pneumonia in the hospital within 48 to 72 hours of staying there, this is known as hospital-acquired, or nosocomial, pneumonia. This type of pneumonia is typically bacterial in origin and is extremely dangerous as hospital patients are already more vulnerable to infection. Pneumonia is associated with the highest rates of mortality from sepsis in ICU patients according to a 2014 report from the National Institute of Health.
Patients with pneumonia will not always exhibit the same symptoms, and pneumonia may present in a variety of ways. Most notably, pneumonia will cause a consistent cough, often with production of phlegm or pus. The infection may also cause:
fever and chills
changes in blood pressure
low oxygen saturation levels
difficulty breathing (shortness of breath)
chest pain when coughing or breathing
Gone untreated, pneumonia can lead to sepsis or fluid and pus buildup in the pleural cavity in the lungs known as empyema and pleural effusion.
Depending on the type and severity of pneumonia which a patient contracts, treatment will vary from antibiotics, to antivirals, to over the counter medicines to aid symptoms. A chest x-ray and blood test will typically be completed to track down a pneumonia diagnosis, and in some cases, further testing will be ordered like a CT scan, bronchoscopy, or pleural fluid culture. Treatment may include:
Antibiotics - to treat bacterial pneumonia, intravenous and oral antibiotics may be prescribed and are typically effective rather quickly. If one antibiotic doesn’t seem to do the trick, a longer regimen or different antibiotic may be prescribed.
Antiviral - to treat the viral-based pneumonia (30% of pneumonia cases are viral). Antivirals track down, eliminate, and prevent the spread of viruses like influenza A and B as well as respiratory syncytial virus.
Pain reliever - over the counter NSAIDS or Tylenol may be prescribed to help with symptoms of fever, chills, pain, and discomfort from pneumonia.
Cough medicine - while coughing up phlegm and maintaining movement in the lungs is important, constant coughing from pneumonia may cause debilitating fatigue and muscle soreness. Cough medicine can help suppress some coughing symptoms to help a patient sleep.
Hospitalization - in extreme cases when a pneumonia infection is leading to irregular blood pressure, heart rate, and respiration, which can affect overall organ and heart function, hospitalization for treatment and monitoring is required.
Supportive care - care to aid other symptoms of pneumonia might include oxygen therapy, fluids, and other breathing treatments.
Multiple vaccines are now FDA-approved for preventing bacterial pneumonia, including the Pneumoccocal Conjugate Vaccine which is recommended by the CDC for babies and children under 2 years of age and all adults over 65 years of age. The Pneumococcal Polysaccharide Vaccine is recommended for those age groups as well, but also for people between the ages of 2 and 64 who are at higher risk for developing pneumonia because of medical conditions, like patients with chronic heart and lung diseases. The yearly Influenza Vaccine can also help prevent the flu virus from developing into pneumonia in patients.
Cold and Flu Etiquette
As pneumonia can be contracted via airborne viruses and bacteria in respiratory secretions like saliva or mucus, which stick to commonly touched surfaces like doorknobs and phones, it’s important for patients to practice good cold and flu etiquette. This includes thoroughly washing hands, using hand sanitizer, disinfecting commonly touched surfaces, coughing into one’s elbow, and sneezing into a tissue and throwing it away.
For the 6 million people in the U.S. diagnosed with dysphagia, aspiration pneumonia is a real and prevalent reality. Dysphagia, or the difficulty and uncomfortability with swallowing, results from weakened mouth and throat muscles, likely from chronic disease (like MS, ALS, etc), stroke, general wear and tear from aging, or injury.
People with diagnosed dysphagia may not be able to get all their food and drink “down the right pipe” and instead, they can aspirate, drawing food or liquid down into the lungs instead where it can lead to infection, pneumonia. Preventing aspiration pneumonia involves a patient’s direct consultation with a speech pathologist as well as a swallowing test. They may recommend a dysphagia diet, where liquids are thickened to a consistency that makes them more swallowable, as well as pureed and smoothied foods.
For patients limited to beds or wheelchairs, or who use an aid like a quad cane to get around, not only is mobility decreased, but general movement which aids the lungs in breaking up built-up fluid or phlegm as well as strengthens respiratory muscles is limited as well. This increases risk of pneumonia, can diminish breathing capacity, and makes it harder to cough. As much movement as possible, including temporary standing, being lifted up and down, and frequently changing positions and promoting good posture can help.
Durable Medical Equipment
Some durable medical equipment assists patients with chronic pneumonia by helping loosen phlegm in their lungs, assist a patient with coughing, and even suck extra liquid and phlegm out of the mouth and throat. Typically a primary care physician will recommend a patient see a pulmonologist for chronic pneumonia, and their office will be the ones to write the order for durable medical equipment like a cough assist, yankeur (suction device), nebulizer, even a hospital bed to assist with sitting upright when eating and drinking.
Naturally healthy habits like not smoking (because cigarettes weaken and damage lung tissue), eating a healthy diet, maintaining a healthy weight, and exercising regularly help any person maintain heart and lung strength as well as keep their immune system strong to fight off potential infections.
Jessica Hegg is the content manager at ViveHealth.com. Avid gym-rat and nutrition enthusiast, she’s interested in all things related to staying active and living healthy lifestyle. Through her writing she works to share valuable information aimed at overcoming obstacles and improving the quality of life for others.