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This book is to help you learn. It
should not be used to replace any of your health care professional’s advice or treatment.
lungs
Pneumonia is an infection of the lungs that is often caused by a bacteria or virus. It can affect anyone: babies, teens and adults of all ages. It can be mild or severe—even life threatening. About 4 million Americans get pneumonia each year. Of these, about 15% are admitted to the hospital, and about 60,000 die from it. Most people who get pneumonia recover without serious problems. This book can help you learn more about pneumonia. It explains how you may have gotten it and how it is diagnosed. It gives you a treatment plan to help you recover. And, it also offers tips for preventing pneumonia and other infections that may lead to pneumonia.
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How did I get pneumonia? You can get pneumonia when you have direct contact with someone who has it. You can also get it when a virus or bacteria enters your body through your nose, mouth or eyes, such as when you have a cold or the flu. Although pneumonia can affect anyone, some are more likely to catch it than others. Such risk factors include: Other diseases, such as HIV/AIDS or chronic illnesses with the lungs or heart, and cancer treatments, like chemotherapy. Any of these can leave your immune system weak and less able to defend itself. Smoking or drinking a lot of alcohol. Staying in the intensive care unit (ICU). Breathing tubes can keep your breathing system from using its natural ways of protection, like coughing. Chemicals or pollutants involved in certain types of work, like construction or agriculture (farming). Certain types of fungi grown in some areas of the country. Age. Older people are more likely to get pneumonia than younger people. Abnormal gag reflex. This may lead to foreign matter (such as food) getting into your lungs. 2
As your body fights the infection, your lungs become inflamed, and the tiny air sacs in your lungs fill with thick mucus (phlegm). This thick mucus makes it harder for your lungs to work. Most of the signs and symptoms of pneumonia occur as a result of this mucus.
Signs and symptoms chest pain when you breathe in or cough fever and chills coughing feeling tired and weak rattling sounds in your lungs mucus (bloody, dark yellow or rust-colored) shortness of breath fast breathing bluish tint to your skin, lips or nails 3
Diagnosis Pneumonia is diagnosed by your health care provider. He or she can: take your medical history — including any recent infections, travels and some lifestyle habits (such as, drinking alcohol or using drugs) do a physical exam — listening to your chest to hear how clear your lungs are run lab tests — taking samples of your – urine – blood – mucus take a chest x-ray With these steps, your health care provider can tell if you have pneumonia and what kind. Then, he or she can decide on the best way(s) to treat it.
Why the hospital? Several things are looked at to decide if you need to be in the hospital for treatment: how much of your lungs is infected if you have other medical problems, such as heart or kidney disease if you can drink fluids by mouth if you need intravenous (IV) antibiotics if you have a family care giver if you have home health care available your age 4
Treatment Your doctor may order any of these treatments: medicines (antibiotics, cough medicine, pain and fever reducers) respiratory therapy (inhaled medicines, breathing and coughing exercises) oxygen therapy light activity increased fluids good nutrition Whether you are at home or in the hospital, your recovery will be faster and more complete if you follow your treatment plan closely (see page 16). Keep your follow-up appointments.
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Medicine Antibiotics Many people with pneumonia need medicines (antibiotics) to fight bacteria. Some can be taken as pills, but others are taken through an IV (a small needle in your vein). Antibiotics must be very strong to treat pneumonia. There may be some side effects: upset stomach sore mouth or tongue
If you are allergic to any medicine, tell your doctor or nurse.
diarrhea pain, itching and burning when you go to the bathroom itching, burning and irritation in and around the vagina thick, white vaginal discharge If you have any of these side effects, tell your doctor. He or she may need to change your antibiotics or give you other medicine.
! CAUTION: Take all of your medicine—even if you feel better. This can help prevent a relapse (getting sick again). If you have a relapse, you are often much sicker than you were the first time.
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Cough medicine Coughing helps your lungs get rid of the mucus. Your infection may spread or get worse if you don’t cough this up. When you have a wet cough with a lot of thick mucus, your doctor may prescribe a cough expectorant. This will help loosen the mucus and make it easier to cough up. It will not stop you from coughing. Tell your doctor if long spells of dry coughing are keeping you awake at night. He may give you a cough suppressant to help you cough less. Pain and fever control By controlling the pain in your chest, you will breathe deeper and get more oxygen into your lungs. You will also be able to cough more and get the mucus out of your lungs. Your doctor may order a pain medicine or tell you to take over-the-counter pain relievers such as aspirin, acetaminophen (Tylenol®, etc.) or ibuprofen (Advil®, Motrin®, etc.). These will also help control fever and chills.
!
You should not take over-the-counter cough medicine without asking your doctor.
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Respiratory therapy Inhaled medicines You may need medicine (bronchodilators) to help open your airways and decrease the inflammation in your lungs. These can be given by a nebulizer or an inhaler. These devices create a fine mist of liquid medicine or powder that is inhaled directly into the lungs.
A nebulizer is a small machine that you plug into a wall outlet. You may use a mask or a mouthpiece with it to breathe in the medicine. If you are at home when you begin to use this device, your doctor’s office might arrange for a medical equipment company to bring it to your home and show you how to use it. (Follow the cleaning directions carefully so you don’t get another infection in your lungs.)
nebulizer mouthpiece
medicine port
inhaler medicine can inhaler
spacer mouthpiece
An inhaler is a hand-held device that lets you breathe in a premeasured dose of medicine. Your doctor may want you to use a spacer (holding chamber) with the inhaler. This helps you get the right amount of medicine each time. Your doctor will order the medicine, inhaler and spacer. Ask the pharmacist to show you how to use them. (You could be in the hospital when you get your inhaler. If so, your nurse or therapist will show you how to use it.) 8
incentive spirometer mouthpiece
Incentive spirometer Deep breathing and coughing help your lungs work better. Your doctor may order an incentive spirometer. This small device helps you breathe deeply. Using it as instructed can help clear the fluid buildup in your lungs.
tubing
Controlled coughing Controlled coughing (planned coughing sessions) can help you get the mucus out of your lungs. Plan these short sessions of coughing when you are rested and are not having coughing spells. These sessions are most helpful when your mucus is thin enough to be coughed up. When you cough up mucus, spit it into a tissue, and check the color. Later your doctor or nurse may ask you about the color and thickness. As you heal, your mucus will thin out and return to white or clear.
The mucus you cough out is filled with bacteria. Use tissues to catch and get rid of it. Keep a garbage bag next to your bed so you can throw them away. Wash your hands after you throw away dirty tissues.
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How to do controlled coughing
inhale
cou
gh
1. Sit up, and lean your
head forward slightly.
2. Take a deep, slow
breath through your nose, and hold it for 2 seconds.
inhale
4. Wait a few seconds.
Gently inhale. (A big breath may push mucus back into your lungs and make you cough again.)
5. Relax. 6. Repeat these steps if you still need to cough.
3. Cough once (to loosen
mucus).Cough a second time (to move mucus forward). Try not to inhale between the 1st and 2nd cough. If you must, inhale very slowly and not too deeply, so you don’t breathe the mucus back into your lungs.
Do controlled coughing with small, short coughs. Avoid large blasts of air.
7. Spit coughed up
mucus into a tissue and throw away.
10
Oxygen therapy You may need more oxygen in the air you breathe so your lungs can get more oxygen into your blood. Two of the ways to give you more oxygen are: nasal cannula – a plastic tube with two prongs that fit into your nose oxygen mask – fits over your mouth and nose (this gives more oxygen than the cannula, if needed) The extra oxygen will be decreased slowly as you heal and your body’s oxygen level returns to normal.
Take it easy You most likely won’t have much energy while you are sick. This can frustrate you. But you must take it easy! Your body is fighting an infection and working with less oxygen than normal. Rest in your bed or chair. Try to slowly increase your activity each day, but don’t overdo it. You may not regain your full strength for up to six weeks after your infection is gone.
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Fluid intake When you have pneumonia, your body uses extra fluid to control your fever and make the mucus in your lungs. Unless you take special care, you can become dehydrated (not enough water in your body) and need IV fluids. Drink at least eight - 8 ounce glasses of liquids each day unless your doctor tells you not to. This will help make the mucus thin and easier to cough up. Drinking milk may make mucus feel thicker by coating the back of your throat. Avoid caffeine, too, since it tends to increase shortness of breath.
Nutrition Pneumonia can make you feel too tired to eat. But getting as many calories as you can through food and/or liquids will help you recover. Unless your doctor tells you not to eat certain foods, you may choose whatever you like. Plan a period of rest before you begin to eat. If your throat is sore, warm fluids may be soothing and make eating easier. Eat small, frequent meals (6 or more) that have a lot of calories in them. Large meals may make breathing more uncomfortable.
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No smoking! If you are a smoker, it’s time to quit. Smoking harms the lungs and airways, causing more mucus and less defense against infection. Even second-hand smoke hurts your lungs, so don’t be around others who smoke. There are many options to help you quit. Get help if you need it. Your doctor can refer you to a stop-smoking program, or you may want to use nicotine replacement aids (NRT), such as: patches
nasal sprays
gum
lozenges
inhalers
pills
Talk with your doctor about these.
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For better breathing Comfort measures When you have pneumonia, it’s important to stay as comfortable as you can. This will help you breathe better and get more oxygen. With more oxygen, all the cells of your body work better. Not only will you feel better all over, but you will also heal better, faster. To increase comfort and improve breathing, do these: Control your pain. If your doctor has given you medicine for pain, take it on schedule. Don’t wait until pain is severe to take a dose. If your medicine does not control your pain, tell your doctor or nurse. Sit upright or propped up on pillows. This lets your lungs expand fully and take in more air. When sitting or lying, make sure all parts of your body are supported so you can relax fully. Use pillows to support your head, back and legs. Make sure your room is not too warm. It’s easier to breathe if air is cooler. 14
Do things that help you relax. Take a warm bath (if your doctor allows), listen to soothing music, etc. Think about other things that help you relax. Keep items you use often close at hand. This keeps you from straining to reach them or having to do too much walking.
Getting well Slowly, your strength and appetite will return, and your coughing will go away. But, if you get chills and fever or your mucus gets
thick and dark, tell your doctor right away.
It may take up to six weeks for your body to return to full strength, so take it easy for a while. Talk to your doctor about when you can return to work.
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Your treatment plan Ask your doctor or nurse to help you fill in the form below:
Treatment
What to do
How much?
How often?
Medicine cough medicine antibiotics pain medicine
Oxygen Therapy nasal cannula mask Respiratory Therapy incentive spirometer nebulizer inhaler Diet
Activity
Other
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Stay healthy Once you’ve had pneumonia, you may be more likely to get it again. Having the flu, common cold, bronchitis or other viral infections of the airways increases your chance of getting pneumonia. Here are some tips that may help you prevent pneumonia and other infections that may lead to pneumonia: Get the flu vaccine each fall. Ask your doctor if you should get a pneumonia vaccine. Wash your hands to keep other people’s germs away from you. Stay away from crowds (lots of people with lots of germs). Stay away from sick people. Don’t smoke! And avoid dirty air like car fumes and places where people are smoking. If you must go out in cold weather, wear a scarf or mask over your nose and mouth. This will warm the air before it reaches your lungs. Eat plenty of fruits and vegetables to maintain your body’s defense system. Get treatment if you have reflux (GERD) and lose weight if you need to. Drink plenty of fluids (eight - 8 oz glasses a day), if your doctor allows. Don’t get run down. Know your body, and rest when you need to.
Resources
Consultants
If you want more information about pneumonia call:
Meryl Golden, BS, RRT, RPFT Phelps Memorial Hospital Sleepy Hollow, NY
The American Lung Association 1-800-LUNG-USA lung.org The American Association for Respiratory Care 972-243-2272 aarc.org
Special thanks to consultant and reviewers of previous versions. Barbara Hatfield, RN, MS Robert J. Crawford, BSRT, RRT Jane F. Hess, RRT Marilyn Murphy, RNC, MS Becky Provine, RN, MSN, CS Sue Labuary, RNC Shirley Lee, RN Ann Riggs, BSN
We believe that you have the right to know as much as you can about your health. Our goal is to give you enough facts to get the main points clearly in mind. We do this with medical accuracy, warmth and humor. The result for you: less tension, more healing and a good idea of what to ask your doctor, nurse or others. We have other health information materials on a variety of topics. Call for a free catalog of product descriptions.
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