Question

A patient has been admitted to the hospital with pneumonia.  She seems a little testy and complains of headaches and a stomachache.  She also says she has not been sleeping well. She is waking up in the wee hours of the morning and is not able to go back to sleep.  She says it’s making her very tired and is wearing her out.  

What do the symptoms signal? What are some factors that cause this condition in older adults?  How will you discuss guidelines and community resources with your patient?

Answer 1

Ans

Pneumonia -

Infection that inflames air sacs in one or both lungs, which may fill with fluid.

With pneumonia, the air sacs may fill with fluid or pus. The infection can be life-threatening to anyone, but particularly to infants, children and people over 65.

Symptoms of Pneumonia

Your symptoms can vary depending on what’s causing your pneumonia, your age, and your overall health. They usually develop over several days.

Common pneumonia symptoms include:

• Chest pain when you breathe or cough
• Cough that produces phlegm or mucus
• Fatigue and loss of appetite
• Fever, sweating, and chills
• Nausea, vomiting, and diarrhea
• Shortness of breath

Along with these symptoms, older adults and people with weak immune systems might be confused or have changes in mental awareness, or they might have a lower-than-usual body temperature.

Newborns and infants may not show any signs of infection. Or they might vomit, have a fever and a cough, and seem restless or tired.

If

you have a new cough, fever, or shortness of breath, call your doctor to ask about whether it could be COVID-19. Illness with the new coronavirus can also lead to pneumonia.

Causes of Pneumonia

Bacteria, viruses, or fungi can cause pneumonia.

Common causes include:

• Flu viruses
• Cold viruses
• RSV virus (the top cause of pneumonia in babies age 1 or younger)
• Bacteria called Streptococcus pneumoniae and Mycoplasma pneumoniae

Some people who are in the hospital get “ventilator-associated pneumonia” if they got the infection while using a ventilator, a machine that helps you breathe.

If you get pneumonia while you’re in a hospital and aren’t on a ventilator, that’s called “hospital-acquired” pneumonia. But most people get “community-acquired pneumonia,” which means they didn’t get it in a hospital.

The following guidance is based on the best available evidence. The full
guideline [hyperlink to be added for final publication] gives details of the
methods and the evidence used to develop the guidance.
Terms used in this guideline:
Clinical diagnosis of community-acquired pneumonia Diagnosis based on
symptoms and signs of lower respiratory tract infection in a patient who, in the
opinion of the GP and in the absence of a chest X-ray, is likely to have
community-acquired pneumonia. This might be because of the presence of
focal chest signs, illness severity or other features.
Community-acquired pneumonia Pneumonia that is acquired outside
hospital. Pneumonia that develops in a nursing home resident is included in
this definition.
Dual antibiotic therapy Treatment with 2 different antibiotics at the same
time.
Hospital-acquired pneumonia Pneumonia that develops 48 hours or more
after hospital admission and that was not incubating at hospital admission. For
the purpose of this guideline, pneumonia that develops in hospital after
intubation (ventilator-associated pneumonia) is excluded from this definition.
Lower respiratory tract infection An acute illness (present for 21 days or
less), usually with cough as the main symptom, and with at least 1 other lower
respiratory tract symptom (fever, sputum production, breathlessness, wheeze
or chest discomfort or pain) and no alternative explanation (such as sinusitis
or asthma).
Mortality risk The percentage likelihood of death occurring in a patient in the
next 30 days.

Severity assessment A judgement by the managing clinician as to the
likelihood of adverse outcomes in a patient. This should be based on a
combination of clinical acumen and a mortality risk score.
Severity assessment and mortality risk scores The difference between
these can be important. Typically the mortality risk score will match the
severity assessment. However, no mortality risk score is perfect and there
may be occasional situations where the score does not accurately predict
mortality risk and needs to be overridden by clinical judgement. An example
might be a patient with a low mortality risk score with an unusually low oxygen
level who would be considered to be have a severe illness.