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