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[pneumono- + -ia]
ABBR: PNA Inflammation of the lungs, usually due to infection with bacteria, viruses, or other pathogens. Clinically, pneumonia is an infectious disease. Pulmonary inflammation due to other causes is called pneumonitis. In the U.S., about 4,500,000 people contract pneumonia each year, and pneumonia is the sixth most common cause of death in the U.S. and the most common cause of death due to infectious disease. Pneumonia occurs most commonly in weakened people (those with cancer, heart or lung disease, immunosuppressive illnesses, diabetes mellitus, cirrhosis, malnutrition, and renal failure), but virulent pathogens can cause pneumonia in the healthy. Smoking, general anesthesia, and endotracheal intubation increase the risk for developing pneumonia by inhibiting airway defenses and helping pathogens reach the alveoli of the lungs.
SEE: aspiration; SEE: pleural effusion; SEE: empyema; SEE: pleurisy; SEE: pneumonitis; SEE: tuberculosis (and names of lung pathogens)
Pneumonias are categorized by site and cause. Lobar pneumonia affects most of a single lobe; bronchopneumonia involves smaller lung areas in several lobes; interstitial pneumonia affects tissues surrounding the alveoli and bronchi of the lung. Atypical pneumonias diffusely affect lung tissues rather than anatomical lobes or lobules. Community-acquired pneumonia is a lung infection that occurs in noninstitutionalized people, typically involving organisms such as viruses, Streptococcus pneumoniae, Klebsiella pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila, Chlamydia pneumoniae, Moraxella spp. or Pneumocystis carinii. Nosocomial pneumonia develops in patients in the hospital or nursing home; this type is most likely to be caused by gram-negative rods or staphylococcal species. Aspiration pneumonias result from the inhalation of oropharyngeal microorganisms and often involve anaerobic organisms. Pneumonias in immunocompromised patients sometimes are caused by Pneumocystis jiroveci or by fungal species such as Aspergillus or Candida. Some fungal pneumonias occur in specific geographical regions of the U.S. For example, histoplasmosis is common in the Ohio River Valley, and coccidioidomycosis is found in the San Joaquin River Valley of southern California. Viral pneumonias may be caused by influenza, varicella-zoster, herpes, or adenoviruses.
Most patients with pneumonia have cough, shortness of breath, and fever although these symptoms are not universal. Bacterial pneumonias are marked by abrupt onset, with high fevers, shaking chills, pleuritic chest pain, and prostration. Patients with atypical pneumonias usually have lower temperatures and nonproductive coughs and appear less ill.
Pneumococcal vaccine effectively prevents many forms of streptococcal pneumonia. This vaccine is recommended for people over 65; those with chronic respiratory, cardiac, or neuromuscular diseases; and patients with diabetes mellitus or renal failure.
Treatment is based on the clinical presentation (such as community-acquired versus nosocomial), results of the Gram stain of sputum specimens, the radiographical appearance of the pneumonia, the degree of respiratory impairment, and the results of cultures. Many patients hospitalized with pneumonia require supplemental oxygen and analgesics. Initial antibiotic treatments for pneumonia should be given without delay and typically involve powerful, broad-spectrum drugs. The antibiotic used for subsequent therapy is guided by the results of cultured specimens taken on presentation.
A large percentage of patients with pneumonia are not admitted to hospitals but are treated with antibiotics given on an outpatient basis. However, older adults, people with serious chronic diseases, and those with evidence of organ dysfunction, poor oxygenation, or acute decompensation may need hospitalization to reduce the risk of injury or death. Supportive care is provided to the patient to remove secretions and improve gas exchange. Such care includes position changes, deep breathing and coughing exercises, incentive spirometry, active and passive limb exercises, and assistance with self-care. Respiratory status is monitored by listening to the chest for crackles and/or wheezing, performing oximetry on a regular basis, and, when patients are failing, performing arterial blood gas studies. Supplemental oxygen is usually prescribed to maintain an oxygen saturation of above 92%. The patient is assessed for signs and symptoms of respiratory failure, sepsis, and shock. Mechanical ventilation is required in patients with respiratory failure. Analgesics are provided as prescribed to manage pain and discomfort and encourage good pulmonary toilet. A large percentage of patients receive care to remove secretions and to improve gas exchange. Such care includes position changes, deep-breathing, and coughing exercises. The patient is encouraged to verbalize concerns; diagnostic studies and therapeutic measures are explained, and the patient is taught about the importance of follow-up care. Outpatient therapy of community-acquired pneumonia can be recommended for selected patients who are young, otherwise healthy, and not hypoxic, hypotensive, hypothermic, or in renal failure. Activities are scheduled to allow for plenty of rest. The patient is taught hand hygiene and encouraged to wash hands with soap and water or use an alcohol-based hand wipe entirely over both hands after blowing the nose, coughing, using the bathroom, or eating or drinking. Only disposable tissues are used for sneezing and coughing. Used tissues are deposited in a lined bag taped to the bedside and are disposed of frequently according to agency policy. Unless otherwise restricted, the patient should drink eight 12-ounce glasses of water daily to help thin and loosen mucous secretions. Each patient’s meal preferences and restrictions are discussed to plan a diet that ensures adequate high-caloric intake. Emotional support is provided, and all procedures and treatments are explained. The patient who smokes is taught the relationship between smoking and lung diseases (including the increased risk of respiratory infections) and referred for support group assistance with quitting as needed. Pneumonia prevention is aided by encouraging individuals to avoid indiscriminate antibiotic use, receive pneumonia and influenza vaccinations, perform deep-breathing and coughing exercises when confined to bed and after surgery, and ambulate early after surgery. Aspiration pneumonia is prevented in tube-fed patients by correct positioning and slow, low-volume feedings. The chronically ill and debilitated in nursing homes should have swallowing function assessed as necessary; caregivers should be taught correct feeding techniques to prevent aspiration.