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The most common cause of pneumonia is from microorganisms, which include bacteria, viruses, and fungi. Pneumonias are often distinguished as either community acquired or hospital acquired (nosocomial) depending on where the disease was contracted (Braun & Anderson, 2020). Nosocomial pneumonias, particularly in the immunosuppressed individual, tend to be more severe and lead to a less favorable prognosis than community-acquired pneumonias (Braun & Anderson, 2020). Typical community-acquired pneumonia is most commonly caused by Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus species (Braun & Anderson, 2020). Atypical forms of community-acquired pneumonia are caused by Mycoplasma pneumoniae, Legionella, and Chlamydia species (Braun & Anderson, 2020). The clinical manifestations relevant to pneumonia include a sudden onset of fever, chills, cough, sputum production, fatigue, loss of appetite, dyspnea, tachypnea, tachycardia, pleuritic pain, adventitious breath sounds caused by fluid accumulation in the lungs (crackles), and in adults (particularly in the elderly), headache and even confusion can occur. Why would a headache develop in adults only? Diagnosis is based on a thorough patient history and physical examination, noting the characteristic clinical manifestations (Braun & Anderson, 2020). A complete blood count is performed to determine an elevation in the WBC count, which suggests bacterial infection (Braun & Anderson, 2020). A chest radiograph or possibly a thoracic CT scan is also needed to identify areas of consolidation and to rule out other diseases or complications that may present with similar symptoms, such as bronchiectasis (irreversible dilation and destruction of the bronchial tree most often caused by chronic obstruction or infection), lung tumors, or heart failure (Braun & Anderson, 2020). The goal of treatment for pneumonia is to restore optimal ventilation and diffusion (Braun & Anderson, 2020). The plan of care, particularly the location of treatment (hospital or home) and the appropriate antibiotic, depends on the type of pneumonia (community or hospital acquired), the severity of disease, the presence of comorbid conditions, and the type of pathogen (Braun & Anderson, 2020).
Heart failure reflects an inadequacy of heart pumping so that the heart fails to maintain the circulation of blood (Braun & Anderson, 2020). Because forward movement of blood is restricted, heart failure results in congestion and edema in pulmonary or peripheral tissues (Braun & Anderson, 2020). In those with heart failure, cardiac reserve (the ability to increase output during increased activity) is expended during rest (Braun & Anderson, 2020). Traditionally, heart failure is discussed based on the location of origin, either the left or right side of the heart (Braun & Anderson, 2020). In left heart failure, the left ventricle is unable to effectively meet cardiovascular demands, forward movement of blood through the circulation is inhibited, and fluid accumulates in the lung tissues (Braun & Anderson, 2020). Congestive heart failure is another term used to describe left heart failure (Braun & Anderson, 2020). Right heart failure begins on the right side of the heart (Braun & Anderson, 2020). This impairs the heart’s ability to move deoxygenated blood forward to the pulmonary circulation (Braun & Anderson, 2020). In right heart failure, the clinical manifestations are related to congestion in peripheral tissues from the ineffective right ventricle (Braun & Anderson, 2020). Early clinical manifestations in left heart failure can be absent (Braun & Anderson, 2020). When present, clinical manifestations specific to left heart failure are related to decrease cardiac output and pulmonary congestion from a failing left ventricle, which leads to poor tissue and organ perfusion (Braun & Anderson, 2020). In order to diagnose heart failure a thorough patient history and physical examination is done. Chest radiography can detect pulmonary congestion, whereas two-dimensional echocardiography detects the heart’s pumping ability, chamber size and thickness, the presence of valvar abnormalities, and measurements of various heart pressures (Braun & Anderson, 2020). ECG supplies information on conduction impairments (Braun & Anderson, 2020). Cardiac catheterization may be needed to visualize structural defects or to determine pressure levels in the heart chambers (Braun & Anderson, 2020). Severity is based on the level of activity restriction imposed by the heart failure (Braun & Anderson, 2020). Treatment of heart failure is focused on correcting the cause if possible, some options are surgically replacing defective valves, treating an underlying respiratory infection, or treating anemia. In many cases, the cause cannot be reversed (Braun & Anderson, 2020). What would cause it to not be reversible? Lifestyle modifications are important in the management of heart failure and include smoking cessation, limitation or cessation of alcohol intake, salt and fluid restriction as well as weight management (Braun & Anderson, 2020).
