As a practicing internal medicine physician working in the ICU, I take care of patients with pneumonia on a daily basis. Although pneumonia is recognized as a single disease, its signs and symptoms can vary significantly based on the unique characteristics of the patient. This is the first of a series of articles I will be writing about pneumonia. Each one will be based on a real patient I took care of. I will be changing the names, professions and other details to protect the identities of those patients.
Mrs. B is an 85 year old female who has been living in the nursing home for the last 2 years. She has three sons and a total of nine grandchildren who visit her frequently. She is always excited when the grandchildren visit her and she is always looking forward to hearing their wiggles and giggles. She does have some problems with remembering things and sometimes looses track of what day it is but she always remembers the names of all her grandchildren. She also does not forget about the good old days when she was at home with her husband. He died from a stomach cancer 3 years ago.
On a Friday afternoon, one of the nurses went into her room to give her medications. She noticed that Mrs. B was not quite herself that day. The nurse knew her very well. She always had a very friendly and cheerful manner. But that day, she seemed very sleepy and tired. The nurse asked her if anything was wrong with her but she could not pin point any specific symptom. She just said that she was feeling very tired that day and wanted to sleep early. The nurse checked her temperature and took her blood pressure and pulse. She did not have a fever. Everything seemed to be within normal limits but something did not appear quite right.
Next morning, the nurse went in her room to wake her up but she was very weak and was unable to get out of the bed. She seemed somewhat confused and was asking the nurse where her husband was. She seemed to have forgotten about his death. At that point, the nurse was really concerned and made a few phone calls. Later, they decided to take her to the local hospital.
In the ER, she was still unable to tell what was bothering her. She just seemed confused and lethargic. They ran a series of tests on her. They did some blood work, a head CT and a chest x-ray. When the ER doctor looked at the chest x-ray, he discovered that the patient had pneumonia. He then called me to admit the patient and start the treatment as I was the on-call doctor that day.
The patient did not have the usual text book signs and symptoms of pneumonia but I was not surprised at all. In fact, this is the most common way elderly nursing home patients are diagnosed as having pneumonia. Here is an article published in the Oxford Journals under Clinical Infectious Disease. It is titled Pneumonia in older persons and describes how only a small number of these patients complain of fever and cough.
I talked to the family and explained about the diagnosis of pneumonia in the elderly. They were surprised that she did not have the actual symptoms of pneumonia but were happy that we got the diagnosis right. I admitted her to the ICU and gave her antibiotics and supplemental oxygen. I also gave her some fluids through her veins as she appeared somewhat dehydrated. Dehydration is common in patients with pneumonia in this age group. Next morning, she was more alert and was able to have a more normal conversation. It took four days of treatment to get her back to how she felt before she got sick but everyone was happy at the end.
Pneumonia is a very common disease but there are so many different things you can learn about the disease from actually taking care of the patients with pneumonia. I hope this patient centered approach to educating my readers about pneumonia was helpful. I will talk about several other aspects of pneumonia in my next few articles. Please let me know if you have any questions or comments. I will try my best to answer those. You can read some general information about pneumonia in the links I have provided here.
