Medical Problem
Pneumonia is an infectious disease that irritates the air sacs in one or both lungs. The affected air sacs are filled with fluid or purulence that causes a cough, difficulty breathing, chills, and fever. Pneumonia can be caused by many organisms, including viruses, fungi, and bacteria (Musher & Thorner, 2014).
Signs and Symptoms
The signs and symptoms of pneumonia are ranging from mild to life-threatening. Main symptoms and signs of pneumonia include:
- Productive cough.
- High temperature, fever, and chills.
- GIT disorders including nausea and diarrhea.
- Shortness of breath.
- Fatigue.
- Chest pain while coughing or breathing (Bonten et al., 2014).
Diagnosis
Pneumonia can be diagnosed with:
- Chest X-ray.
- Physical examination.
- Sputum, blood, and urine testing.
- Bronchoscopy (Musher & Thorner, 2014).
Clinical Course
Generally, pneumonia is associated with a sudden onset of symptoms and fast progression. The incubation period is 1-3 days. On the onset, the symptoms usually include a productive cough, fatigue, chills, and fever. With the delayed response to the disease, the mortality rates can reach 50-80%, depending on the age of a patient, types of pneumonia, type concomitant diseases, and the overall patient’s health. The usual treatment period of the disease is one month (Postma et al., 2015).
Aggravating factors:
- People aged <12 and >65.
- Smoking.
- Chronic diseases.
- Delayed response.
- Weak immune system.
Alleviating factors:
- Timely response.
- Strong immune system.
Concomitant diseases usually associated with pneumonia:
- Asthma.
- Acute cardiac disorder (ACD).
- Hepatic diseases.
- Influenza (Postma et al., 2015).
Pathophysiology
For the development of pneumonia, it is necessary that the bacteria reach the alveoli and that the immune system is overwhelmed by the bacteria virulence. The external sources of bacteria are sinusitis, tracheal or gastric colonization, oropharynx, hematogenous spread, and nasal carriers (Bonten et al., 2014).
Differential Diagnoses
Bronchitis
Similar symptoms:
- Productive cough.
- Chest pain while coughing and breathing.
- Fatigue.
- Shortness of breath.
- Fever.
Differences:
- Subfebrile temperature.
- Discomfort in the chest (Bonten et al., 2014).
Tuberculosis
Similar symptoms:
- Productive cough.
- Fatigue.
- Chest pain while coughing or breathing.
- GIT disorders.
- Shortness of breath.
- Fever.
Differences:
- Coughing up blood.
- Subfebrile temperature.
- Unintentional weight loss (Postma et al., 2015).
Treatment
The goal of treatment for patients with pneumonia is the elimination of the infection and the prevention of complications. The treatment of pneumonia is fulfilled with the help of antibiotics. The choice of antibiotics depends on the person’s specific medical problems and the risk of being infected by drug-resistant bacteria (Musher & Thorner, 2014).
Expected Outcomes
The improvement of patients’ state of health usually begins in three to five days after the antibiotic intervention. All the symptoms usually disappear in one month. However, the residual cough may continue up to two months (Bonten et al., 2014).
Clinical Note
S: Mr. Monroe is a 43-year-old man who complains of productive cough and fever that began two days ago. He complains of chest pain on the left side when he coughs. He denies diarrhea, abdominal pain, and nausea. He smokes one pack of cigarettes a day and does not consume alcohol. The last time he took antibiotics was three years ago. Last year, he had an influenza vaccine, but he has never had a pneumococcal vaccine (Jain et al., 2015).
O: Vital signs: T 37.5°C, BP 132/84, RR 19, HR 102 (regular), pulse oximetry 97%.
- GEN: Appears slightly tachypneic.
- Skin: dry and warm.
- HEENT: No sinus tenderness, EOM intact, TM intact, no congestion, Pharynx without enlargement, exudate, or cobblestoning.
- Resp: Decreased breath sounds, increased tactile fremitus in the left lower lobe, dullness to percussion.
- Abdomen: Nontender, soft, good bowel sounds.
- Extremities: PT and DP pulse +2.
- Labs: CBC (WBC = 14,800, neutrophils = 85%, platelets = 300,000/uL, Hgb = 15, Hct = 49); CXR (Consolidation of left midlobe); BMP (K = 4.2, Na = 135, BUN = 14, BG = 148); (CURB-65 Pneumonia Severity Score = 1 point low risk).
A: Pneumonia: Clinically stable.
Tobacco use: Weak motivation to try to quit smoking.
P: Pneumonia: Azithromycin 500 mg daily for 3 days. Breathe deeply, drink fluids, use a humidifier, rest. Use acetaminophen for pain or fever. Receive a pneumococcal vaccine as soon as possible (Jain et al., 2015).
References
Bonten, M., Bolkenbaas, M., Huijts, S., Webber, C., Gault, S., Gruber, W., … Grobbee, D. (2014). Community acquired pneumonia immunisation trial in adults (CAPITA). Pneumonia, 3(13), 1-38.
Jain, S., Self, W. H., Wunderink, R. G., Fakhran, S., Balk, R., Bramley, A. M.,… Chappell, J. D. (2015). Community-acquired pneumonia requiring hospitalization among US adults. New England Journal of Medicine, 373(5), 415-427.
Musher, D. M., & Thorner, A. R. (2014). Community-acquired pneumonia. New England Journal of Medicine, 371(17), 1619-1628.
Postma, D. F., Van Werkhoven, C. H., Van Elden, L. J., Thijsen, S. F., Hoepelman, A. I., Kluytmans, J. A.,… Oosterheert, J. J. (2015). Antibiotic treatment strategies for community-acquired pneumonia in adults. New England Journal of Medicine, 372(14), 1312-1323.