Mini Med School: Pneumonia

Objectives:

At the end of this class, you will be able to:

1. Discuss the causes of pneumonia.
   
2. List things that make a person at high risk for pneumonia.
   
3. Care for people with pneumonia.
   
4. Describe ways that pneumonia can be prevented.
   

What is Pneumonia?

Pneumonia is a very serious infection of the lungs. The lungs give the body oxygen. The lungs take in air from outside of the body and then they fill our blood with oxygen so that it can then be carried to every part of our body. This oxygen is needed to keep all our body parts and us alive.

Pneumonia takes the needed oxygen from our body. The amount of oxygen that our body needs to live cannot be carried when the lungs fill with a liquid, pus and an infection like pneumonia. The human body and all of the body’s cells do not work in the correct way when enough oxygen is not being sent to all the body parts. When this disease is serious enough, it may very greatly lower the amount of oxygen in the body, thus leading to death.

How Serious is It?

In the past, pneumonia used to be the number one cause of death in the United States. This changed when antibiotics were developed. These new medicines very rapidly controlled the disease when they first came on the market. They continue to control the disease and save many lives but it still has not gone away completely. Some people are now getting pneumonia that will not be attacked by medicines. Some pneumonia strains resist medicine.

Pneumonia and the flu are still very serious. They are the 7th leading cause of death in the United States, according to the American Lung Association.

Who is At Greatest Risk for Pneumonia?

A person of any age can get pneumonia, but it is seen most often in older adults. It is a very serious problem for this age group. The elderly are the most seriously harmed age group when pneumonia strikes. It is the number one leading infection among the elderly and it is the 4th leading cause of death in this age group.

It is very often the cause of death for older adults and people who are younger after they have had a serious illness or something like a broken hip that keeps them in bed for a long period of time. This disease often happens when a person is not mobile and out of bed. Nursing assistants can help prevent pneumonia by encouraging a person to get out of bed and to stay as mobile as possible, in addition to other things, like having the person take deep breaths and cough, by providing fluids, a good diet and using proper infection control procedures.

As many as ¼ of our residents in long term care facilities (nursing homes) get pneumonia. That means that about 25 out of 100 get this very serious disease. It is also very common for patients and residents who have had serious surgery, like chest or abdominal surgery, those on a ventilator, or breathing machine, and those who are getting a tube feeding.

Pneumonia can affect only a section of one lung or it can affect areas of both lungs. It is caused by over 30 different causes. Most cases, however, result from a bacteria, a virus, chemicals and other things like a fungus.

People with serious diseases and with many diseases are more prone to pneumonia. Older adults over 65 years of age and those that live in a close living arrangement, like a nursing home, hospital or prison, are also at risk. This disease is also found most often among people who have:

• taken many antibiotics,
  
• a tube in their throat to help them to breathe,
  
• smoked cigarettes,
  
• heart disease,
  
• lung disease,
  
• diabetes,
  
• kidney disorders,
  
• anemia (sickle cell),
  
• not been getting a good diet, and/or
  
• had major surgery.
  

What are the Signs and Symptoms of Pneumonia?

The usual signs of pneumonia are:

• cough,
  
• fever,
  
• the production of mucous and sputum
  
  
• a fast respiratory rate,
  
• a fast pulse,
  
• confusion and delirium, especially with the elderly.
  

The patient’s or resident’s doctor will order a chest x-ray to look at the lungs and to find out if and how much they are affected by this disorder.

The person will also have blood work done and a laboratory sputum culture. When you obtain a sputum culture, you must:

• Have the person breathe deeply and cough up mucus. A sputum culture should not have saliva from the mouth. It should contain mucus from the lungs.
  
• Keep the sputum specimen sterile.
  
• Label the specimen and make sure that it gets to the lab right away and without delay.
  

How is Pneumonia Treated?

Most young people will get better pretty quickly in their own home without having to go to the hospital. A healthy, young person may be able to lead a normal life and go back to work or school in about a week after they begin to get treatment.

For older people and for some kinds of pneumonia, however, it may take weeks until the person feels strong and well enough to lead a normal life. Some of these people, especially if they are older, may need some home care services from a nurse and nursing assistant while they are sick with pneumonia. Other people, like those that have been sick for a long time and older people, may have to go to the hospital. Still others may die from it.

Young, healthy people get better very quickly when they:

• see their doctor and get treatment right away,
  
• have good natural defenses against infection,
  
• are well nourished,
  
• healthy, and
  
• have NO other diseases.
  

The treatment of pneumonia includes:

· medications to kill the germs that are causing the disease when it is caused by a bacteria or some viruses,

• rest,
  
• fluids,
  
  
• a good diet,
  
• lung care (pulmonary hygiene) to clear the lungs and mucus, and
  
• oxygen for some people in the hospital or nursing home.
  

When a person takes medicine for this disease, they must take it according to the doctor’s order. They should not stop taking it even when they are feeling better or when their temperature is normal unless their doctor has told them that it is time to stop taking it. The patient may get a second, worse case of pneumonia if the person stops the medication before the doctor tells them to.

Can Pneumonia Be Prevented?

This disease can be prevented by:

• staying healthy,
  
• getting enough rest,
  
• eating a good diet,
  
• going to the doctor and getting treatment for any respiratory infection or problem,
  
• getting the pneumonia shot when the doctor advises it and
  
• getting the flu shot, especially if one is elderly or has a disease of the lungs, heart, etc.
  

Getting the pneumococcal pneumonia shot can prevent one common type of pneumonia. Not all people get this shot. People who are at risk for getting this disease and those 65 years or over should get this shot. Some people who should get this shot are those with:

• lung disease, such as COPD,
  
• heart disease,
  
• kidney disease,
  
• sickle cell anemia,
  
• diabetes, or
  
• other serious illnesses.
  

Doctors also tell people that are living in a nursing home or another long term care place, such as an assisted living facility, to get the shot. This shot may protect the healthy, older person for the rest of their life. For other people, such as those who have diabetes, kidney disease, heart or lung disease, they may have to get the shot every 6 to 10 years.

Pneumonia often follows a respiratory infection, including a flu. One way that people can prevent pneumonia is to stay healthy and to go to doctor as soon as they have respiratory or breathing problem. Finally, another way that people can avoid getting pneumonia is to get a flu shot every year in the fall of each year. Many people who get the flu then progress to pneumonia. For these people, this shot can help to prevent pneumonia.

End of Life Care

Older people often get pneumonia after a long illness. It is a common cause of death, especially when the person has had years of a disease like diabetes, COPD, heart disease, cancers, dementia, such as Alzheimer’s disease, renal disease and long periods of time when they are on complete bed rest.

Nursing assistants play a very important role in end of life care. They should observe and report all end of life needs to the charge nurse. They also provide end of life care. For example, a nursing assistant must report when a patient tells them that they would like to see a minister so that the minister can visit with the dying patient. They may also be asked to sit and talk to a resident so the resident will not fear being alone.

Nursing assistants also must care for the family. We must allow families to spend a lot of time with the loved one that is dying. Make the family comfortable. Give the family privacy.

Tell the family and other visitors where the telephones are. Show them the rest rooms and the coffee shop. Arrange for visitor meals to the patient's room if they want meals.

Other ways that nursing assistants can meet the needs of the dying patient and family.

Communication

• Spend time with the patient and family.
  
• Listen to what they have to say.
  
• Speak in a kind and respectful way.
  
• Answer their questions if you can. If you can't answer a question, ask the nurse to help them.
  
• Use body language that shows caring and respect. A gentle touch, holding the person’s hand and just spending time shows caring. Do NOT cross your arms, tap you feet or show other signs of being hurried.
  
• Communicate with patients that are in a coma or unconscious. Do NOT treat unconscious patients different from those that are awake and alert. Do NOT ever say anything that you do not want the patient or resident to hear. Hearing is the last sense to die at the end of life.
  

Physical Comfort

Patients during the end of life have physical care needs. Many patients at the end of life choose to NOT have some treatments, such as CPR, tube feedings and other things. This is their right. They can choose to have some nursing care and choose to NOT have other things. All patients, however, have a right to physical comfort.

• Observe and report signs of pain. Tell the nurse if a person tells you that they are in pain or if you see an unconscious person with a look of pain on their face. Pain is now called the 5th vital sign. Patients should be checked for pain often.
  
  
• Provide a quiet room, a backrub and even soothing music to patients that are in pain. Allow the person in pain to speak to you. Spend quiet time with them when that is what they want.
  
• Give the person their bath and provide very good skin care. Keep them clean and dry at all times.
  
  
• Turn and position the patient at least every 2 hours. Many dying patients are at risk for pressure ulcers.
  
  
• Provide very good mouth care. The patient may be dehydrated and have a dry mouth. Use mouth swabs for unconscious patients that have a dry mouth. Give sips of water to patients that are conscious and able to swallow safely.
  
  
• Keep the bed and the room neat.
  
  
• Adjust the temperature in the room if the person is too warm or too cold. Give them lighter clothing to wear if they are hot. Give them a sweater or blankets if they are cold.
  

Mental Comfort

• Listen to the patient, resident or family members. Spend time with them. Allow them to express their fears and concerns.
  
• Keep the nurse call bell in reach of the person so they can call for help if they need it.
  
• Answer the call bell immediately. Do NOT ignore any person or their needs when they need your help, especially at the end of life.
  
• Allow the person to do their end of life tasks, like calling their family and speaking to their attorney or funeral director.
  
• Make the person feel loved and cared for.
  
• Report any signs mental distress, like crying, to the nurse.
  

Spiritual Comfort

• Respect the need for spiritual support.
  
• Do NOT force your own religious or spiritual beliefs on the patient. People have the right to choose their own beliefs. These beliefs must be respected. People also have the right to have no religious or spiritual beliefs at all.
  
• Provide a quiet and private place to pray, read the bible, meditate and speak to their religious chaplain.
  
• If a person wants to see their rabbi, priest, or other religious representative, report this to the nurse.
  

Social Needs

• Welcome visitors. People at the end of life have a desire for closeness. Make visitors comfortable and welcome.
  

Financial Needs

• Tell the nurse if the person is worried about their money or financial needs. Social workers often help them with these and other matters, such as writing a will or advance directives.
  

Post Mortem Care

• Allow the family to cry, grieve and spend some time with the person who has died.
  
• Follow your hospital or nursing home procedure for post mortem care.
  
• Provide post mortem care with dignity and respect for the person that has died.
  

People at the end of life need physical care, mental care, spiritual care and comfort. The family also needs care. To learn more about end of life care, take our course titled “End of Life Care.”

References

American Lung Association. (2010). “Pneumonia”. [online]. http://www.lungusa.org/lung-disease/pneumonia/

Berman, Audrey, Shirlee Snyder, Barbara Kozier and Glenora Erb. (2010). Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice. 8th Edition. Pearson Prentice Hall.

Kee, Joyce LeFever and Evelyn Hayes. (2009). Pharmacology: A Nursing Process Approach 6th Edition. Saunders Elsevier.

Monahan, Frances Donovan and Wilma J. Phipps (2007). Phipps’ Medical-Surgical Nursing: Health and Illness Perspectives. 8th Edition. Elsevier Mosby.

Nettina, Sandra M. (2009). The Lippincott Manual of Nursing Practice. 7th Ed. Lippincott, Williams and Wilkins.

Wold, Gloria Hoffmann. (2008). Basic Geriatric Nursing. Elsevier Mosby.

Copyright © 2010 Alene Burke