Question

ND is an 82-year-old female who lives in a skilled nursing facility. She suffers from rheumatoid arthritis, coronary artery disease, chronic bronchitis and hypertension. She is wheel chair bound and tends to spend most of her days in bed. She smoked for 52 years but quit 14 years ago. She has lost 10 pounds in the last month and has a productive cough for about 2 weeks that has copious amounts of white/yellow mucous. Over the last 3 days she has refused to get out of bed and has been refusing to eat or drink. This morning she is confused, has a fever, and is coughing continuously. Her sputum now is rust-colored. Her lungs sounds are coarse rhonchi throughout with crackles and diminished lung sounds in her right middle lobe area. Her vital signs are BP 86/54, HR 98, RR 28, O₂ sat on RA 85% and temperature 102.4 F. She is being admitted to the hospital.

1. Discuss the different classifications of pneumonia and pick which classification of pneumonia best fits NDs situation.
2. What are the most probable contributing factors to NDs contracting pneumonia?
3. What diagnostic tests would you expect to be done to diagnose NDs pneumonia?

Answer 1

1. Three classifications of pneumonia :-

Etiology

Anatomic distribution of the inflammatory process

Predisposing factors that lead to development of pneumonia

The classification of pneumonia that best fits ND's situation is predisposing factors that lead to development of pneumonia .

2. The contributing factors for pneumonia are :-

- bed ridden ,no movement

- productive cough that she never expelled out

- chronic bronchitis

3. Diagnostic test :-

1) Sx and signs of lower respiratory tract infection (mean duration of 6 days at presentation in one study)

2) Radiographic infiltrate (CXR or CT)

(Criteria are not 100% specific for pneumonia, and CXR can be negative, although CTs should not be)