Pneumonia causes the infection of one or both lungs.

It is characterized by the
inflammation of lungs. It is mainly caused by the infection due to bacteria, fun
gi, viruses or parasites. Pneumonia generally starts following the infection in
upper respiratory tract. After this infection, symptoms of pneumonia appear afte
r 2-3 days of cold or sore throat. People older than 65 years or younger than 2
years of age and people with impaired immune system or chronic illness are at hi
gher risk of pneumonia. There are more than 50 types of pneumonia that range in
severity from mild to life-threatening. Pneumonia accounts for the death of more
than 60,000 people in the United States every year.
Causes of Pneumonia
Pneumonia is mainly caused by the infections from microorganisms such as bacteri
a, fungi and viruses. Bacterial infection is the most common and most serious ca
use of pneumonia. Streptococcus pneumoniae is the most common bacterium causing
pneumonia in adults. Respiratory viruses are another common cause of pneumonia.
Mycoplasma pneumoniae is the common microorganism causing pneumonia in children
of 2-3 years of age. In some elderly people, pneumonia may be followed by influe
nza or common cold. There are different types of pneumonia depending upon the ca
use of disease such as community-acquired pneumonia (acquired at work or school)
, hospital-acquired pneumonia (gastroesophageal reflux disease is the predisposi
ng factor), aspiration pneumonia (because of inhaling the foreign matter), pneum
onia caused by opportunistic organisms (common in people with compromised immune
system) and emerging pathogens such as outbreaks of H5N1 influenza virus/bird f
lu and severe acute respiratory syndrome (SARS).
Signs and Symptoms of Pneumonia
In most cases, people have the symptoms of cold before developing pneumonia. It
is followed by high fever, cough and shaking chills. Severity of symptoms varies
according to the causes and age of the patient. Chest pain is the most common s
ymptom in most types of pneumonia.
Bacterial pneumonia: Bacterial pneumonia causes symptoms such as high fever, sha
king chills, chest pain, sweating, cough with thick, yellow or greenish sputum a
nd shortness of breath.
Viral pneumonia: Viral pneumonia is characterized by the signs that are similar
to flu-like symptoms. It generally starts as a dry cough, fever, fatigue, headac
he and muscle pain. When the disease progresses, it causes shortness of breath a
nd cough with small quantities of clear or white phlegm. Viral pneumonia invites
the risk of developing a secondary bacterial pneumonia.
Fungal pneumonia: This type of pneumonia is less common. Some people may develop
acute pneumonia after inhaling the fungi, while some may develop chronic pneumo
nia.
Pneumonia due to Mycoplasma: Mycoplasma causes the signs and symptoms of pneumon
ia similar to bacterial and viral pneumonia. These symptoms may be flu-like and
mild. You may not require any medical treatment for this type of pneumonia. That s
why this pneumonia is known as walking pneumonia.
Pneumocystis carinii: It is an opportunistic organism that causes infection in p
eople with AIDS. It can lead to pneumonia. The signs of such type of pneumonia a
re persistent cough, fever and shortness of breath.
Diagnosis and Treatment of Pneumonia
Diagnosis of pneumonia is based on the physical examination, imaging tests such
as X-ray, bronchoscopy and certain laboratory investigations such as sputum exam
ination and blood tests such as white blood cell count.
Treatment option for pneumonia is decided depending upon the cause of pneumonia.
Pneumonia can be treated with antibiotics, antiviral medications, antifungal me
dications, etc. Some over-the-counter medications are also recommended to treat
pain, reduce fever and soothe the cough.
Is pneumonia contagious?
People often ask, is pneumonia contagious? Will we catch the infection if we com
e in contact with an infected person? Pneumonia is a life-threatening infection
of lungs. However, pneumonia itself is not a contagious disease. But bacteria an
d viruses that cause pneumonia can be contagious. People when exposed to infecti
on may catch the symptoms of normal cough and cold symptoms. It is not necessary
that each person, exposed to cold virus or bacteria, develops pneumonia. It dep
ends on the susceptibility and immunity of that individual. Transmission of infe
ction may occur due to direct exposure to infectious secretions.

Pneumonia is primarily an infection of the lungs and is caused due to microorgan

isms like bacteria, fungi or viruses. There are nearly 50 microorganisms that ca
use pneumonia and that's why it is difficult to trace the microorganism responsi
ble for pneumonia infection. According to the recent reports, nearly 3 million p
eople in the United States develop pneumonia every year and pneumonia is the six
th leading cause of deaths in the United States.
Pneumonia Symptoms in Elderly
In many cases of pneumonia, the germ or the microorganism invades the lung tissu
e and causes swelling in it. Swelling in the lungs causes the accumulation of fl
uids in the air sacs of the lungs and this hinders the lungs ability to take oxy
gen and move it to different parts of the body that require oxygen. Pneumonia ca
n be acquired at home, in communities and in nursing homes. Many cases of pneumo
nia appear when the person inhales the air containing the pneumonia causing micr
oorganisms. This usually happens in public places when the person suffering from
pneumonia sneezes or coughs, without putting a handkerchief on the mouth. The g
erms traveling in the air enter through the respiratory passage and eventually a
ffect the lungs. Once the microorganisms infiltrate the nose and enter the lungs
, they settle into the air sacs of the lungs and start growing in numbers. This
area of the lung that fights the infections, gets filled with pus or fluid. Pneu
monia symptoms in the elderly are as follows:
Upper respiratory infections like common cold or influenza.
Production of large amount of mucus or sputum from the lungs. The mucus will app
ear rusty or green or containing some amounts of blood in it.
Fever ranging from mild to high degrees.
Shortness of breath and a feeling of discomfort while breathing.
Extreme pain in the chest while coughing and breathing.
Fast Heartbeat.
Fatigue.
Diarrhea.
Nausea and Vomiting.
Most adults developing pneumonia, initially show symptoms of cold accompanied by
high fever. One of the rare pneumonia symptoms in adults is that some people ma
y show change in skin color, wherein the skin turns dusky or purplish, which in
medical terms is known as 'cyanosis'. Change in the skin color results due to po
or blood circulation in the body. Read more on the signs and symptoms of pneumon
ia.
Diagnosis of Pneumonia Symptoms in Adults
Pneumonia symptoms in adults can vary depending on the past history of the patie
nt and the resistance power of the immune system. For the diagnosis, the doctor
may tap the chest of the patient and listen to the breath sounds with a stethosc
ope. The doctor may also ask the patient for a blood test (to detect concentrati
on of oxygen in the blood) and X-ray so that he can trace the exact problem and
the cause behind the infection. Testing the phlegm is also common while detectin
g the presence of pneumonia. Normally, either you will show viral pneumonia symp
toms or bacterial pneumonia symptoms and so the GP won't advise for some advance
level tests. However, in case the microorganism causing pneumonia has not been
traced, the GP can recommend some tests like the phlegm test. You may also read
up more on walking pneumonia symptoms in adults.
Treatments of Pneumonia in Adults
Generally, pneumonia patients can be treated at home but in case the person is s
eriously ill, the GP may refer the patient to a hospital. In the hospital, the n
urses will assist the patient and treatment in the form of antibiotics will be g
iven to the patient, either in the form of tablets or through a drip. If the mic
roorganism responsible for pneumonia is a virus, then the antibiotics won't work
and your GP would have to give you some other treatments. This is the reason fo
r the doctors trying to detect the exact microorganism causing the infection. Ge
nerally after 4 to 5 days of treatment, the patient is well enough to return hom
e, however, the patient needs to exercise care so that the symptoms don't resurf
ace due to infection relapses.
You may read more on:
Pneumonia Prevention
What is Walking Pneumonia
The onset of pneumonia symptoms in adults is marked by chest pain and coughing a
nd so one should not ignore the initial symptoms of pneumonia. Following a healt
hy lifestyle and quitting unhealthy habits like smoking, can go a long way in ke
eping the immune system healthy, and this would indirectly help the body to figh
t against pneumonia infections.

Pneumonia is an inflammation of the lung parenchyma, associated with alveolar ed

ema and congestion that impair gas exchange. Primary pneumonia is caused by the
patient s inhaling or aspirating a pathogen. Secondary pneumonia ensues from lung
damage caused by the spread of bacteria from an infection elsewhere in the body.
Likely causes include various infectious agents, chemical irritants (including
gastric reflux/aspiration, smoke inhalation), and radiation therapy. This plan o
f care deals with bacterial and viral pneumonias, e.g., pneumococcal pneumonia,
Pneumocystis carinii, Haemophilus influenzae, mycoplasma, and Gram-negative micr
obes.
CARE SETTING
Most patients are treated as outpatients; however, persons at higher risk (e.g.,
with ongoing/chronic health problems) are treated in the hospital, as are those
already hospitalized for other reasons.
RELATED CONCERNS
AIDS
Chronic obstructive pulmonary disease (COPD) and asthma
Psychosocial aspects of care
Sepsis/septicemia
Surgical intervention
Patient Assessment Database
ACTIVITY/REST
May report: Fatigue, weakness
Insomnia
May exhibit: Lethargy
Decreased tolerance to activity
CIRCULATION
May report: History of recent/chronic heart failure (HF)
May exhibit: Tachycardia
Flushed appearance or pallor
EGO INTEGRITY
May report: Multiple stressors, financial concerns
FOOD/FLUID
May report: Loss of appetite, nausea/vomiting
May exhibit: Distended abdomen
Hyperactive bowel sounds
Dry skin with poor turgor
Cachectic appearance (malnutrition)
NEUROSENSORY
May report: Frontal headache (influenza)
May exhibit: Changes in mentation (confusion, somnolence)
PAIN/DISCOMFORT
May report: Headache
Chest pain (pleuritic), aggravated by cough; substernal chest pain (influenza)
Myalgia, arthralgia
May exhibit: Splinting/guarding over affected area (patient commonly lies on aff
ected side to restrict movement)
RESPIRATION
May report: History of recurrent/chronic URIs, tuberculosis or COPD, cigarette s
moking
Progressive dyspnea
Cough: Dry hacking (initially) progressing to productive cough
May exhibit: Tachypnea; shallow grunting respirations, use of accessory muscles,
nasal flaring
Sputum: Scanty or copious; pink, rusty, or purulent (green, yellow, or white)
Percussion: Dull over consolidated areas
Fremitus: Tactile and vocal, gradually increases with consolidation
Pleural friction rub
Breath sounds: Diminished or absent over involved area, or bronchial breath soun
ds over area(s) of consolidation; coarse inspiratory crackles
Color: Pallor or cyanosis of lips/nailbeds
SAFETY
May report: Recurrent chills
History of altered immune system: i.e., systemic lupus erythematosus (SLE), AIDS
, steroid or chemotherapy use, institutionalization, general debilitation
Fever (e.g., 1028F 1048F/398C 408C)
May exhibit: Diaphoresis
Shaking
Rash may be noted in cases of rubeola or varicella
TEACHING/LEARNING
May report: History of recent surgery; chronic alcohol use; intravenous (IV) dru
g therapy or abuse; immunosuppressive therapy
Discharge plan
DRG projected mean length of inpatient stay: 4.3 8.3 days
Assistance with self-care, homemaker tasks.
Oxygen may be needed, especially if recovery is prolonged or other predisposing
condition exists.
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES
Chest x-ray: Identifies structural distribution (e.g., lobar, bronchial); may al
so reveal multiple abscesses/infiltrates, empyema (staphylococcus); scattered or
localized infiltration (bacterial); or diffuse/extensive nodular infiltrates (m
ore often viral). In mycoplasmal pneumonia, chest x-ray may be clear.
Fiberoptic bronchoscopy: May be both diagnostic (qualitative cultures) and thera
peutic (re-expansion of lung segment).
ABGs/pulse oximetry: Abnormalities may be present, depending on extent of lung i
nvolvement and underlying lung disease.
Gram stain/cultures: Sputum collection; needle aspiration of empyema, pleural, a
nd transtracheal or transthoracic fluids; lung biopsies and blood cultures may b
e done to recover causative organism. More than one type of organism may be pres
ent; common bacteria include Diplococcus pneumoniae, Staphylococcus aureus, ahem
olytic streptococcus, Haemophilus influenzae; cytomegalovirus (CMV). Note: Sputu
m cultures may not identify all offending organisms. Blood cultures may show tra
nsient bacteremia.
CBC: Leukocytosis usually present, although a low white blood cell (WBC) count m
ay be present in viral infection, immunosuppressed conditions such as AIDS, and
overwhelming bacterial pneumonia. Erythrocyte sedimentation rate (ESR) is elevat
ed.
Serologic studies, e.g., viral or Legionella titers, cold agglutinins: Assist in
differential diagnosis of specific organism.
Pulmonary function studies: Volumes may be decreased (congestion and alveolar co
llapse); airway pressure may be increased and compliance decreased. Shunting is
present (hypoxemia).
Electrolytes: Sodium and chloride levels may be low.
Bilirubin: May be increased.
Percutaneous aspiration/open biopsy of lung tissues: May reveal typical intranuc
lear and cytoplasmic inclusions
(CMV), characteristic giant cells (rubeola).
NURSING PRIORITIES
1. Maintain/improve respiratory function.
2. Prevent complications.
3. Support recuperative process.
4. Provide information about disease process/prognosis and treatment.
DISCHARGE GOALS
1. Ventilation and oxygenation adequate for individual needs.
2. Complications prevented/minimized.
3. Disease process/prognosis and therapeutic regimen understood.
4. Lifestyle changes identified/initiated to prevent recurrence.
5. Plan in place to meet needs after discharge