High Blood Pressure Makes Pneumonia Deadlier

Elevated blood sugar levels may help predict death in pneumonia patients, researchers say.

The new study included nearly 6,900 patients, average age 60, with community-acquired pneumonia who were admitted to hospitals and private practices in Austria, Germany and Switzerland between 2003 and 2009.

Community-acquired pneumonia, one of the leading infectious diseases in industrialized nations, is a major cause of illness and death, according to background information in the study published online May 29 in the journal BMJ.


Compared to patients with normal glucose levels at admission, those with elevated levels had a higher risk of death within 28 and 90 days. The higher a patient's glucose levels, the greater the risk of death, the investigators said in a journal news release.

The death rate within 90 days was 3 percent for patients without diabetes and normal glucose levels, 10 percent for those without diabetes but with elevated glucose levels, and 14 percent for patients with diabetes, regardless of their glucose levels on admission, the study revealed.

The findings show the necessity of glucose testing and close glucose monitoring after patients with community-acquired pneumonia are discharged from hospital, in order to diagnose diabetes and to prevent further complications, concluded Dr. Philipp Lepper, of the University Hospital of Saarland in Germany, and colleagues.

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Dose of Zinc Helps Sick Babies Recover

A simple, cheap dose of zinc helps the recovery of newborns suffering from bacterial infections such as pneumonia and meningitis, according to an Indian study reported on Thursday in The Lancet.

Doctors gave 10-milligram daily supplements of zinc to 332 babies who were being given antibiotic treatment at hospitals in New Delhi, and compared the outcome against 323 infants who were given a placebo as well as antibiotics.

The three-year probe, running from 2005 to 2008, focussed on babies aged between one week and four months.

Compared to the non-zinc group, children who were given the supplements were 40-percent less likely to experience treatment failure.

This was defined as needing a second course of antibiotics within a week or intensive care, or culminating in death, the study found.

In the zinc group, 34 treatment failures occurred, compared to 55 in the placebo group.
Use of zinc also reduced the number of deaths, but not by a margin considered statistically significant.

"Zinc is an accessible, low-cost intervention that could add to the effect of antibiotic treatment and lead to substantial reductions in infant mortality," said lead researcher Shinjini Bhatnagar from the All India Institute of Medical Sciences.

The benefit would be highest in developing countries where several million children die from infection each year and where second-line antibiotics and intensive care may be unavailable, he said.

Zinc can be easily administered, either as a syrup or as a soluble tablet, according to the investigation.

Previous research has found that zinc supplements help cure diarrhoea and pneumonia in small children younger than five years old.

Still unclear is why zinc works. One theory is that the mineral has a moderating influence on the immune system, preventing over-inflammation that disrupts drug therapy and leads to tissue injury.

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Nursing Care Plan for Pneumonia

Pneumonia is an infection of the lungs involving alveoli that are in contact with bronchioles or complete lobes. The disease is identified by the causative agents that may be bacterial, viral, fungal, or protozoan and may be termed lobar or bronchopneumonia.

Nursing Diagnosis: Ineffective airway clearance related to decreased energy and fatigue resulting in decreased coughing and accumulation of secretions; tracheobronchial secretions related to inflammation resulting in increased mucus accumulation. Ineffective breathing pattern related to pain caused by positioning and coughing; decreased energy and fatigue caused by inflammatory process; decreased lung expansion caused by pain and fatigue resulting in hypoventilation.

Expected Outcomes: Adequate ventilation evidenced by respiratory rate, depth and ease within baseline limits.

Intervention and Rationale:
I. Assess for:

Respiratory status including rate, depth, ease, shallow or irregular breathing, dyspnea, use of accesory muscles, and diminished breath sounds, rhonchi or crackles on auscultation - provides data baseline.
Changes in mental status, skin color, cyanosis - indicates possible decrease in oxygenation.
Quality of cough and ability to raise secretions including consistency and characteristics od sputum - removal of secretions prevents obstruction of airways and stasis leading to further infection and consolidation of lungs; clearing airways facilitates breathing.

II. Monitor, record, describe:
Respiratory rate, quality and breath sounds q2-q4 - indicates airway resistance, air movement, severity of disease.

ABGs, oximeter reading - decreased oxygen levels result in hypoxemia.

III. Administer:
Oxygen therapy via cannula - maintain optimal oxygen level.

Antitussives/expectorants (terpin hydrate, guaifenesin) - acts on bronchial cells to increase fluid production and promote expectoration; guaifenesin reduces surface tension of secretions; both relieve non-productive cough

Mucolytic (acetylcysteine) - decrease viscosity of mucus for easier removal.
Antibiotic (ampicillin, cephalexin) - acts by binding to cell wall organisms preventing synthesis and destroying pathogens.

IV. Perform or Provide:
Position of comfort in semi or high fowlers and change position q2h - facilitates breathng and allows for full expansion of lungs.

Encourage coughing if sounds is moist; if dry and hacking, increase fluid intake and administer cough suppresant - reduces continual irritation to throat and liquefies secretions.

Coughing and deep breathing exercise q2h; use incintive spirometer 5-10 breaths if tolerated - coughing clears airway by propelling secretions to mouth deep breathing promoes ventilation and prolongs expiratory phase.

Assist with coughing by splinting chest; humidified air with cool mist - loosens seretions and improves ventilation, moistens mucous membranes


Postural drainage and percussion PRN - mobilizes secretion.
Suction secretions if cough ineffective - removal if unable to bring up secretions.

Oral care after expectoration and provide tissues and bag for disposal - promotes comfort and prevents transmission of organisms to others.

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