Pneumonia is a lung infection, and in a person with COPD it often triggers a flare with more breathlessness and sputum. These patients have little lung reserve, so they can tire out and retain carbon dioxide quickly.
Key symptoms
- Fever, chills and feeling very unwell
- More cough with yellow or green sputum
- More shortness of breath than usual
- Chest pain when breathing in
- Confusion or sleepiness in older adults
What you find on exam
- Fast breathing, use of neck muscles, pursed lips
- Crackles or bronchial breath sounds over one area, plus wheeze
- Oxygen saturation, temperature, heart rate and blood pressure
- Drowsiness or flapping hands suggest high carbon dioxide
- Severity score such as CURB-65
Tests
- Chest X-ray: new infiltrate or consolidation
- Blood gas: carbon dioxide and pH
- Blood count, electrolytes, kidney function
- Sputum culture and blood cultures if admitted; viral swab
Treatment basics
- Controlled oxygen to 88 to 92 percent
- Antibiotics for community-acquired pneumonia, such as ceftriaxone with azithromycin in the hospital
- Inhaled albuterol with ipratropium and a short course of oral prednisone
- Noninvasive ventilation (BiPAP) for acidosis from high carbon dioxide
- Fluids, early mobility, and vaccines and smoking cessation at discharge
Red flags
- pH under 7.35 or rising carbon dioxide
- Low blood pressure, confusion or signs of sepsis
- Tiring out, slowing breathing or saturation low despite oxygen
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Sources: NCCPA PANCE Content Blueprint; AAMC Core Entrustable Professional Activities (Core EPAs); Open RN, Nursing Fundamentals 2e. Written by Making Synapses. Making Synapses is not affiliated with these organizations.