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art & science clinical practice Pneumonia: classification, diagnosis and nursing management Dunn L (2005) Pneumonia: classification, diagnosis and nursing management. Nursing Standard. 19, 042, 50-54. Date of acceptance: March 29 2005. Summary This article provides an overview of pneumonia as a high-Incidence respiratory disease of varying severity in the 21st century. Many cases are mild to moderate and patients are successfully treated with antibiotics at home and v^'ith no lasting damage to the lungs. Vaccinations for influenza and, more recently, pneumococcal infections are becoming widely available for vulnerable groups of people, which will help to reduce the incidence of these diseases. However, pneumonia causes death in more severe cases with atypical forms such as Legionnaires' disease and severe acute respiratory syndrome (SARS) causing fatal outbreaks. Author Liz Dunn is clinical nurse manager, haemostasis and thrombosis, Guy's and St Thomas' Foundation Trust London. Email: elizabeth,[email protected]< Keywords Infection; Pneumonia; Respiratory system and disorders These keywords are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review. For related articles and author guidelines visit the online archive at www.nursing-standard.co.uk and search using the keywords. THE INCREASING emphasis on reducing admissions to hospital and minimising length of patient stays makes it important to consider the impact of respiratory disease on the NHS. Respiratory illness is the single most common reason for emergency hospital admissions in the UK (BritishThoracic Society (BTS) 2001a). The number of people requiring admission peaks in early January each year and contributes to the well-acknowledged 'winter bed crisis' [Damiani and Dixon 2002). A significant number of these patients have pneumonia. An estimated five million people worldwide die of pneumonia each year - older people and the very young are among the most vulnerable (Farr 1997]. The average length of stay for patients admitted with a community-acquired pneumonia is 11 days, and one in ten patients is admitted to intensive care (McDonald etal 1997). The majority of cases can be treated in the community provided that patients are given good nursing care. Minima! investigation is needed other than taking a clinical history from the patient and chest auscultation. The most common antibiotics used for a bacterial pneumonia are amoxicillin or erythromycin (usually prescribed if a person is sensitive to penicillin). More serious cases warrant further investigation, tests and treatment with intravenous antibiotics, oxygen therapy and chest physiotherapy, and therefore these patients require admission to hospital (BTS 2001 b, Woods and Hathaway 2004). Respiratory tract 50 June 29 :: vol 19 no 42 :: 2005 The respiratory tract (Figure 1) comprises the nose, paranasal sinuses, pharynx, larynx, trachea, bronchi, bronchioles and alveoli. The upper respiratory tract refers to the area above the larynx and the lower respiratory tract to the area below it. In the upper region, inspired air is moistened, warmed and airborne particles are filtered out. The mucous membrane from the nose to the terminal bronchioles consists of a layer of epithelial cells with a brush border of hair-like cilia interspersed with mucus-secreting goblet cells. The mucus traps particles of dust and airborne pollutants and the cilia move in synchronised 'waves' to carry the substances out ofthe lungs. Ty pe s 0 f pneumonia Pneumonia is inflammation and infection in the terminal bronchioles and alveoli, causing consolidation. Consolidation occurs when the alveolar spaces and small airways are filled with fluid (or possibly another substance) instead of air (Hansall and Padley 1999). This is seen as 'shadowing' on a chest X-ray and can be detected on auscultation. There are a number of ways to classify pneumonia (Anon 2003): • According to the part of lung affected, for example, lobar or bronchial pneumonia. • According to the organism causing the condition. NURSING STANDARD