“Pneumonia is an excellent example of an illness in which nursing measures (and not simply drug treatments) are very clearly central to a patient’s rapid and full recovery.”

In these pandemic times, a patient with signs and symptoms of pneumonia is assumed to have COVID-19. But of course other types of pneumonia continue to occur both in the hospital and in the community, and people with COVID-19 can develop secondary bacterial pneumonias as well.

Abandoning old pneumonia categories in determining antibiotic use.

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Until recently, pneumonia was routinely classified as either community-acquired or health care–associated, and the category determined treatment. Health care–associated pneumonias were more often caused by resistant organisms, while someone with no recent exposure to hospitals or nursing homes was thought likely to have a more “benign” infection. But now, a 2019 guideline developed jointly by the American Thoracic Society and the Infectious Diseases Society of America offers new recommendations for the initial treatment of pneumonia.

As described in a CE article “Community-Acquired Pneumonia:  A Review of Current Diagnostic Criteria and Management” in the December issue of AJN, the new guidelines recommend abandoning the use of categories of pneumonia to determine antibiotic coverage.

Instead, treatment decisions should be based on local epidemiology (what is the multidrug-resistant organism profile of your hospital and your community?) along with an assessment of whether the patient has risk factors for antibiotic resistance (i.e., prior infection with a resistant organism, or hospitalization with antibiotic treatment in the previous 90 days).

“…whether patients acquire pneumonia in a health care setting or in the community, they should not be treated for multidrug-resistant pathogens unless they either have the risk factors for these pathogens or meet validated criteria for severity.”

Community-acquired pneumonia: medical and nursing management essentials.

Authors Linda Cook and Janet Wulf use the new guidelines to discuss the medical and nursing management of community-acquired pneumonia. A handy table (suitable for posting) compares the recommendations of the old and new guidelines regarding culturing, pharmacotherapy, radiological follow-up, and more.

Pneumonia is an excellent example of an illness in which nursing measures (and not simply drug treatments) are very clearly central to a patient’s rapid and full recovery, and this article presents the nursing management of the person with pneumonia in detail. The authors discuss patient assessment, respiratory management, infection control, oxygen therapy, mobility, and discharge planning.