TREATMENT—General measures consist of complete bed rest and administering sufficient fluids to maintain a urinary output of at least 1500 ml daily. Penicillin G is the antibiotic of choice with usual does of 600,000 units every 12 hours IM. Tetracycline and erythromycin are alternatives when a patient is hypersensitive to penicillin. Ventilation and oxygenation are of a distinct value. The patient should be fed a liquid diet initially, and when improvement occurs, a normal diet as tolerated.
Other Bacterial Pneumonias
Other primary bacterial pneumonias are caused by single bacterial species other than pneumococcus. To treat the pneumonia properly, the specific etiologic agent must be identified. Treatment is generally the same as for pneumococcal pneumonia except that a broad-spectrum antibiotic is used.
Aspiration Pneumonia
This is an especially severe pneumonia with a 60 percent mortality rate. It is caused by aspiration of the gastric contents and inhalation of hydrocarbons. Treatment is the same as for other pneumonias. Vigorous antibiotic therapy is essential.
Primary Atypical Pneumonia
This type of pneumonia is caused by a variety of viral and mycoplasmal agents. The symptoms include a gradually increasing fever with a history of URI; a nonproductive cough; hoarseness; headache and malaise; and extreme fatigue. The treatment is similar to other pneumonias.
Acute Bronchitis
Acute bronchitis is an inflammation of the bronchial tree caused by infections and physical and chemical agents. Bronchitis may appear as a primary disorder or as a prominent finding in many pulmonary diseases. The symptoms include dry, scratchy throat; hoarse, husky voice; fever; cough that produces mucopurulent sputum; and musical rhonchi and wheezing.
TREATMENT—General measures consist of bed rest, forcing fluids to prevent dehydration, and discontinuing smoking. Using steam or mist inhalators is frequently beneficial in helping to relieve coughing. Severe coughing may be controlled with antitussives. Antihistamines should be administered to help relieve inflammation. Headaches, sore throats, and fever may be treated with aspirin. In patients with impaired respiratory or cardiac function, or in patients debilitated by other diseases, antibiotic therapy should be used to prevent secondary infections. One of the complications is pneumonia.
Chronic Bronchitis
Chronic bronchitis is marked by a normally nonproductive cough of long duration. If the cough is productive, the sputum is usually very thick. There are usually no other symptoms of URI.
TREATMENT—As in the treatment for acute bronchitis, the patient with chronic bronchitis should be advised to discontinue smoking and to avoid other sources of lung irritation such as fumes. If the patient’s cough is nonproductive, suppress it with antitussives. If it is productive, liquify it by adequate fluid intake, inhalation, and expectorants. Other treatment is as indicated for acute bronchitis.
Asthma
Asthma is a bronchial hypersensitivity disorder characterized by reversible airway obstruction. It is produced by the combination of mucosal edema, hypertrophy of the bronchial musculature, and excessive secretion of mucus, which causes mucosal plugs.
SYMPTOMS—The patient experiences repeated attacks of wheezing, dyspnea, and coughing with mucoid sputum produced. Nocturnal coughing and wheezing on exertion is common. The patient usually has a history of frequent colds and displays nasal symptoms, such as itching and congestion.
TREATMENT—The first step is to eliminate the source of any known allergies. Maintain adequate rest and reassure the patient to relieve his or her apprehensions. Treat respiratory infections with antibiotics. Force fluids to prevent dehydration and help break up or liquify secretions. Epinephrine is the drug of choice, but may be replaced by aminophylline if not effective. Epinephrine should be administered cautiously in patients with angina or hypertension. Oxygen therapy is indicated in all cases of moderate to severe symptoms. Status asthmatics is a continued, severe wheezing to a life-threatening point. The patient with this condition should be
