The Risk of Pneumonia Infection - Case Study Example

Pneumonia Name Institution Date Pneumonia Introduction Amelia Jones had just returned from abroad where she gone on holiday with her extended family. She reportedly got unwell and was rushed to hospital where she was admitted to the emergency department. She reported having felt unwell for five days, and had a productive cough, fever, night chills and difficulty in breathing. She could not sleep well, and experienced a decreasing appetite. Her past medical report indicates that she has previously been treated for Hypertension, Asthma, Hyperlipidemia and COPD. Before embarking on her journey home, she reported having felt like she was going to have a cold. Based on Amelia’s symptoms and physical examination, it is possible to predict that Amelia had contacted pneumonia during her trip. Pneumonia is an infection or inflammation of the lung that is caused by various organisms that include bacteria, viruses, amoebae, parasites and fungi. Williams (2007) argues that common symptoms of pneumonia infection include a productive cough, difficulty in breathing, chest pain and fever. According to MedicineNet, Inc. (2008), bacteria and viruses are the most common cause of pneumonia. The fact that Amelia had symptoms of flue, and her condition worsened after five days, it is further possible to attribute her condition to bacterial infection referred to as Staphylococcus (S.) aureus. People infected with this type of bacteria develop pneumonia in five days and experience symptoms of a cold before that. It is mostly associated with people with weak immune systems and drug abusers. Amelia is known to be a heavy smoker and drinks an average of 5-6 bottles of wine per week (Hale & Isaacs, 2006). This analysis presents a case study on Amelia’s condition. The objective of the study is to discuss the various causes of pneumonia, symptoms of the disease, and how it can be assessed and diagnosed. The study goes further to provide a description of physiological alterations attributed to pneumonia. Given that Amelia has pneumonia infection, the study provides alternative treatments available for her including both non-pharmacological and pharmacological ones. A brief discussion is provided on the acute and chronic complications associated with pneumonia. In conclusion, the study highlights some of the changes in lifestyle that Amelia can employ in preventing recurrence or development of similar complications in future (Williams, 2007). Pathophysiology of Pneumonia According to Baxamusa (2010), Pneumonia is a type of disease that affects 1 out 100 each year and there are various factors that are responsible for the development of the disease. Some of the related pneumonia disorders include aspirational pneumonia and viral pneumonia. The contributing argents gain entry into the body of a person through respiratory tract and through inspiration of oral secretion. The pulmonary defence system act promptly to protect the body. The cough reflext works towards protecting the body from the impending infection. However, the defense mechanisms in some people are sometimes inhibited by the invading agents leading to the growth of the infection (Singh, 2012). The organism that invades the body begins to multiply and in the process, it releases toxins which eventually that are responsible for the inflammation and edema of lungs parenchyma. This form of action brings about build-up of cellular remains which exudes within the lungs. Eventually, the airless state of the lungs is transformed to a consolidated form due to the fluid as well as exudate filling up. In case of viral pneumonia, ciliated epithelial are usually earnestly damaged (Singh, 2012). Fungal pneumonia presents an uncommon condition. In most cases it is found on people with compromised immune systems such as AIDS. Pathophysiology of fungal pneumonia is basically the same as that of bacterial pneumonia. The predominant agents that are fond of causing pneumonia are Coccidioides, Histoplasma, Pneumocystis jiroveci among others (Baxamusa, B. N 2010). Etiology of Pneumonia Etiology is the analysis of the origin or causes of a condition or disease. According to Cunha (2010), pneumonia is an infection of the lung that can be caused by bacteria, viruses, fungus, or foreign substance inhalation. Etiology of pneumonia mostly involves research on bacterial infection, though it is not always possible to identify specific causes. Common symptoms of Pneumonia and the underlying path physiology Based on signs and symptoms of a patient’s condition, doctors can be able to predict the types of bacteria that may be causing pneumonia and possible treatment for the condition. Common Symptoms of pneumonia include: A productive cough of brown or yellow sputum, Chest pain that worsens when coughing or breathing and Shortness of breath especially in patients with other chronic conditions such as emphysema and asthma. Williams (2007) notes that symptoms of pneumonia result when lungs are invaded by microorganisms and the response of the immune system to infection. Pneumonia is commonly caused by bacteria and viruses, other uncommon causes include parasites and fungi (Williams, 2007). Viruses For viruses to reproduce, they must invade body cells. Viruses reach the lungs through inhalation of airborne droplets through the nose or mouth. The viruses then invade cells that line alveoli and airways. The virus kills the cells directly, or the cells die through a self-destruction process referred to as apoptosis. The damage worsens when the immune system attempts to respond to the infection. Several chemical cytokines are activated by white blood cells thereby allowing leakage of fluid into the alveoli. Destruction of cells and the filling of alveoli with fluid cause interruption in oxygen transportation in the bloodstream. Virus infection also affects other organs causing disruption of various body functions. Besides damaging the lungs, the body becomes more susceptible to other bacterial infections (MFMER, 2008). Bacteria Hale and Isaacs (2006) argue that bacterial infections that cause pneumonia are typically caused through inhalation of airborne droplets. Bacterial lung infections can also occur via the bloodstream in the event of other infections in other parts of the body. Most bacteria reside in the upper respiratory tracts, such as the mouth, nose and sinuses where they can easily get into the alveoli. Once they get into the alveoli, they can easily invade spaces that separate cells and the spaces between alveoli. The immune system is thereby triggered to send to the lungs neutrophils, which are typically defensive white blood cells. The neutrophils destroy the offensive organisms while releasing cytokines which activates the immune system. This is the cause of fever, fatigue and chills commonly experienced in bacterial pneumonia. Oxygen transportation is thereby interrupted when the alveoli is filled with bacteria, neurophils and fluid (Hale & Isaacs, 2006). Bacteria are grouped into two broad categories based on laboratory procedures commonly referred to as Gram staining. Special dyes are used to stain the bacteria, and then washed to observe changes in color. Change in the color of determines the bacteria are Gram-positive or Gram-negative. Knowledge of the category the bacteria belongs to helps in determination of severity of infection, and the appropriate treatment for the disease. Different drugs are used to treat different bacteria. Appearance of blue coloration on the stain after washing is an indication of presence of Gram-positive bacteria, and pneumonia is more often than not caused by these organisms (MedicineNet Inc., 2008). There are several types of Gram positive bacteria. They include Streptococcus (S.) pneumonia which is the kind of bacteria that is the most frequent cause of pneumonia. 20-60% of community acquired pneumonia CAP) is caused by this bacterium. Another type of bacteria is Staphylococcus (S.) aureus. 10-15% of pneumonias acquired in hospital and 2% of Cap are caused by this bacterium. In most cases it develops 5 days after experiencing symptoms of flue. It is mostly prevalent in people with weak immune systems, in-patients, young children and drug abusers. Gram-negative bacteria indicate a pink coloration on the stain. They are the most common cause of infection in patients admitted in hospitals or nursing homes. The common types of these bacteria include Haemophilus (H.) influenza is yet another form of bacteria that causes pneumonia. It accounts for 3-10% of community acquired pneumonia. It is most common in patients infected with chronic lung diseases alcoholics and elderly people. Klebsiella (K.) pneumonia is the most common cause of pneumonia in physically incapacitated people and alcoholics. Recently it has been associated with use of strong antibiotics. The last form of bacteria is Moraxella (M.) catarrhalis. This bacterium is normally found in the mouth or nose. It is a rare cause of pneumonia How Pneumonia is assessed and diagnosed To assess and diagnose pneumonia, doctors analyze the symptoms and physical examination findings of the patient. Information is collected from blood tests, chest X-rays and sputum cultures. X-ray diagnosis is only possible in hospitals and clinics that have appropriate X-ray machines. In community settings however, health care providers rely on physical examination and predictions from symptoms alone. For patients with multiple illnesses, chest CT-scan is used to provide a distinction between other illnesses and pneumonia (MFMER, 2008). Physical Examination Physical examination on a patient may indicate whether the patient has fever, increase in respiratory rate, low body temperature and blood pressure, a faster heart rate or lower oxygen saturation. Oxygen saturation refers to oxygen levels in the blood as is indicated by blood gas analysis or pulse oximetry. Patients that are finding difficulty in breathing, have a blue- tinged skin (cyanosis) or are confused should be given urgent attention. A stethoscope can be used to listen to the lungs and reveal important information. In the event the breathing sounds are abnormal, cracking sounds can be heard, or a loud whispered speech, areas in the lung that refilled with fluid or stiff can be identified (Singh, 2012). Chest X-rays and sputum cultures Chest X- rays can be used effectively to detect pneumonia in situations that are unclear. X-rays do not always show presence of pneumonia, this is because the disease may still be in the initial stages, or the location of the infection cannot be traced by the X-ray. In such cases, chest CT can be used to detect pneumonia that X-rays have failed to detect (Singh, 2012). Alteration in physiology associated with Pneumonia The respiratory system is a complex arrangement of passageways and spaces that supply air into the lungs and blood while releasing waste gasses. Breathing is a mechanical process of the respiratory system. In several cases pneumonia causes respiratory failure as it can easily trigger acute respiratory syndrome (ARDS). This is normally as a result of the infection and subsequent inflammatory response. In such cases the lungs are quickly filled with fluids and become stiff. Severe difficulty in extraction of oxygen as a result of the alveolar fluid and the stiffness of the lungs require the patient to be provided with mechanical ventilation (Health Information Publications, 2005). In consideration of the fact that pneumonia damages the lungs, patients with pneumonia experience a lot of difficulty in breathing. Such patients require support to enable them breathe properly. Healthcare providers in such situations are compelled to use breathing assistance facilities such as the bi-level positive airway pressure machine. It may be necessary in some cases to place an end tracheal tube/breathing tube and a ventilator to assist the patient in breathing (Hale & Isaacs, 2006). Goal of treatment and the pharmacological and non-pharmacological treatment available for Amelia Most pneumonia cases do not require hospitalization, but in consideration of the fact that her condition was severe, and she has a history of other medical complications such as Asthma, hospitalization was essentially necessary (Nawal, et al., 2006). Oral antibiotics, fluids, rest and home care are sufficient remedies for effective recovery. Nonetheless, people like Amelia who have difficulty breathing and have additional medical problems such as asthma and hypertension require advanced treatment which requires hospitalization. The antibiotics that are chosen to treat pneumonia depend on the microorganisms causing the disease, and hence treatment should be in consideration of the causative microorganism and antibiotic sensitivity. People with acute pneumonia should receive immediate medical attention; empiric treatment should therefore be started even when the laboratory report is not yet available. For people with community acquired pneumonia such as Amelia, the most preferable antibiotics for her treatment is amoxicillin and clarithromycin, but patients who are allergic to penicillin, erythromycin is recommended in place of amoxicillin (MedicineNet, Inc., 2008). Though pharmacological treatment is effective, non-pharmacological treatment such as natural remedies is also equally effective. Food that is rich in vitamin C such as fruits and vegetables result in a substantial improvement in this condition. These may include food such as broccoli, citrus fruits and red peppers. Oil from Tulsi is also effective in treatment of pneumonia, and is widely considered as the best natural remedy available, the oil can easily be rubbed on the chest on regular basis, and relief is normally quite immediate. Tulsi leaves can also be effective when mixed with tea and combined with black pepper for a better result. Fenugreek which can be taken in the form of tea can also prove very helpful, as it makes affected persons sweat more and hence reduces body temperature (Health Information Publications, 2005). Short term (acute) and long term (chronic) complications of Pneumonia According to Williams (2007), complications that result from pneumonia include sepsis and septic shock. Sepsis is triggered by entry of microorganisms into the bloodstream, causing the immune system to respond through secretion of cytokines. People with sepsis normally require medications or intravenous fluids to stabilize their blood pressure. Sepsis causes damage to the kidney, liver, heart, and can even cause death. Future occurrences of acute and chronic pneumonia can be prevented by observing good hygienic practices. Additionally, it is important to exercise control of risky habits such as alcohol abuse and cigarette smoking. This is particularly applicable to Amelia’s case, which is a regular smoking and consumes a fair amount of wine on daily basis (Hale & Isaacs, 2006). Lifestyle modifications to prevent complications occurring again or the development of complications in the future Amelia’s lifestyle is a significant factor that complicates her health condition. She is a regular smoker, and probably finds it hard to quit just like other tobacco users. According to Cunha (2010), a significant step in Amelia improving her health condition and preventing future occurrence of the condition is to quit smoking. Amelia has been a widow for 10 years and she probably feels lonely which could lead to stressful situations. The body naturally reacts to stress. Stress weakens the immune system and and renders the body more susceptible to infectious diseases. It is therefore important for Amelia to observe stress management to prevent serious health complications. Having been a heavy smoker for some time, Amelia should consider commencing on a regular fitness program. Physical activity significantly reduces the risk of chronic conditions and diseases. Regular exercise also enhances coordination and balance of the body, besides raising one’s self esteem. It is therefore in Amelia s self-interest to start on a regular fitness program that involves aerobics and strength training (Nawal, Henley, & Chang, 2006). Conclusion The primary objective in managing Amelia’s condition is to first provide the appropriate treatment for her condition. Secondly, Amelia has to adhere to a prescribed medical plan that will ensure prevention of recurrence of the complications. Bacterial pneumonias are known to occur after influenza virus (flu) infection. The risk of pneumonia infection can be substantially reduced through yearly vaccinations. Yearly vaccinations have proved to be very effective with elderly people, and people like Amelia who have other chronic diseases such as asthma, lung and heart disease. References Cunha, B. (2010). Pneumonia Essentials 2010. Burlington: Jones & Bartlett Learning. Nawal, L. M., Henley, E. & Chang, L. F. (2006). Diagnosis and Treatment of Community- Acquired Pneumonia. American Family Physician Journal. 73 (3), 442-450. Health Information Publications (2005). How is Pneumonia Diagnosed? Retrieved March 23, 2008, from the Hale, K. & Isaacs, D. (2006). Antibiotics in childhood pneumonia. Paediatr Respir Rev. 7(2):145-51. Mayo Foundation for Medical Education and Research (MFMER) (2008). Screening and Diagnosis Retrieved March 23, 2008, from the MayoClinic.com MedicineNet, Inc. (2008). How is pneumonia diagnosed? Retrieved March 23, 2008, from the MedicineNet.com Williams, M. (2007). Comprehensive Hospital Medicine: An Evidence-Based and Systems Approach. New York: Elsevier Health Sciences. Singh. Y. D 2012, Pathophysiology of Community Acquired Pneumonia, Supplement To Japi , 2012, VOL. 60. Baxamusa, B. N 2010, Pathophysiology of Pneumonia, Retrieved on May 20, 2013 from < http://www.buzzle.com/articles/pathophysiology-of-pneumonia.html> Read More