Diagnostic tests / Interprofessional Care / Pneumonia

Diagnostic tests

  • History and physical examination
  • Chest x-ray
  • Gram stain of sputum
  • Sputum culture and sensitivity test
  • Pulse oximetry or ABGs (if indicated)
  • Blood cultures
  • Thoracentesis
  • Bronchoscopy  with washings
  • Biologic markers to guide clinical decisions:
    • C-reactive protein (CRP)
    • Procalcitonin

Interprofessional Care

  • Pneumococcal vaccine
    • To prevent Streptococcus pneumoniae
  • Prompt treatment with antibiotics is essential
    • Response generally occurs within 48-72 hr
      • Drop in temperature
      • Improved breathing
      • Decreased chest discomfort
    • Repeat chest x-ray in 6-8 weeks
  • Supportive care
    • Oxygen for hypoxemia
    • Analgesics for chest pain
    • Antipyretics
    • Individualize rest and activity
  • No definitive treatment for majority of viral pneumonias
  • Antivirals for influenza pneumonia

Drug therapy

  • Start with empiric therapy
    • Based on likely infecting organism and risk factors for MDR organisms
    • Varies with local patterns of antibiotic resistance
  • Should see improvement in 3-5 days
  • Start with IV and then switch to oral therapy as soon as patient stable

Nutritional therapy

  • Adequate hydration
    • Prevent dehydration
    • Thin and loosen secretions
    • Adjust for older adults, patients with heart failure, those with preexisting respiratory conditions
  • High calorie, small, frequent meals
    • Monitor for weight loss