Pneumonia Health Article

Diagnosis

Diagnosis is based on the patient's symptoms and physical examination of the chest. When the physician listens with a stethoscope, abnormal sounds are revealed. Tapping on the patient's back, which should produce a resonant sound as a result of air filling the alveoli, may yield a dull thump if the alveoli are filled with fluid and debris.

Diagnosis of some bacterial pneumonias can be made with the results of specific laboratory tests. By staining sputum with special chemicals and examining it under a microscope, the technician can identify specific types of bacteria. Identification may require culturing the sputum, a procedure in which the sputum sample is used to grow greater numbers of itself (the bacteria) in a lab (petri) dish.

Treatment

Prior to the discovery of penicillin and other antibiotics, bacterial pneumonia was almost always fatal. As of 2001, when antibiotics are given early in the course of the disease, they are very effective against bacterial causes of pneumonia. Both erythromycin (E-Mycin, ERYC) and tetracycline (achromycin, sumycin) improve recovery time for symptoms of mycoplasma pneumonia. They do not, however, eradicate the organisms. Amantadine (Symmetrel) and acyclovir (Zovirax) may be helpful against certain viral pneumonias.

Prognosis

Prognosis varies according to the type of organism causing the infection. Recovery following pneumonia with Mycoplasma pneumoniae is nearly 100%. Staphylococcus pneumoniae has a death rate of 30–40%. Similarly, infections with a number of gram-negative bacteria (such as those in the gastrointestinal tract, which can cause infection following aspiration) have a high death rate—25–50%. Streptococcus pneumoniae, the most common organism causing pneumonia, produces a death rate of about 5%. More complications occur in the very young, or in elderly individuals who may have infections in multiple areas of the lung simultaneously. Individuals with other chronic illnesses—such as cirrhosis of the liver, congestive heart failure—or those without a functioning spleen or those who have other diseases that result in a weakened immune system—may experience complications. Patients with immune disorders, various types of cancer, transplanted organ(s) or tissue(s) transplants, or AIDS also may experience complications.

Health care team roles

In most cases, a diagnosis of pneumonia is made in a physician's office, a general medical clinic, or emergency room by a primary care practitioner. Children and adolescents with pneumonia are most likely to be diagnosed by their primary care physician or pediatrician.

KEY TERMS

Alveoli—The little air sacs clustered at the ends of the bronchioles, in which oxygen-carbon dioxide exchange takes place.

Aspiration—A situation in which solids or liquids that should be swallowed into the stomach are instead breathed into the respiratory system.

Cilia—Hair-like projections from certain types of cells.

Cyanosis—A bluish tinge to the skin that can occur when the blood oxygen level drops too low.

Parenchyma—A term used to describe the supportive tissue surrounding a particular structure. An example is the tissue that surrounds and supports the actually functional lung tissue.

Sputum—Material produced within the alveoli in response to an infectious or inflammatory process.

Both registered nurses (RNs) and licensed practical nurses (LPNs) must complete a prescribed course in nursing and pass a state examination. RNs typically have a degree in nursing. Both RNs and LPNs are often the specialists who deal the most with pneumonia patients, both in general hospitals, homes, or other health care facilities. Good nursing care and observation are primary requirements. These include monitoring vital signs, including oxygen saturation (the amount of oxygen circulating in the blood), encouraging the patient to move, breathe deeply, cough, and get out of bed with assistance (if indicated) to facilitate good lung expansion. The nurse should also provide education to the patient about the importance of coughing, breathing deeply, and taking in adequate fluid.

Clinical laboratory scientists have specialized training and must pass a state examination. These are the staff who analyze blood samples or test urine/sputum specimens that reflect the presence of pneumonia at the outset, and as it resolves. These tests are typically ordered by physicians to diagnose and assess the progress of the infection.

Radiologic technologists have specialized training and must pass a state examination. Their responsibility is to take chest x rays to visualize and monitor the course of the pneumonia.

Prevention

Because many bacterial pneumonias occur in patients who are first infected with the influenza virus (the flu), yearly vaccination against influenza can decrease the risk of pneumonia in certain patients. This is particularly true of the elderly and those afflicted with such chronic diseases as asthma, cystic fibrosis, other lung or heart diseases, sickle cell disease, diabetes, kidney disease, and some cancers.

A specific vaccine against Streptococcus pneumoniae and another vaccine developed in the early 2000s against Pneumococcus are very protective, and should also be administered to people over 65 years of age as well as to patients with chronic illnesses.