Therapeutic regimen and nutrition for pneumonia

Treatment regimen

Treatment of a patient with acute pneumonia is usually carried out in a hospital. Patients with lobar pneumonia, complicated forms of acute pneumonia, severe clinical course with severe intoxication, severe concomitant diseases, as well as the impossibility of receiving high-quality outpatient treatment (lack of constant medical supervision, living in a dormitory, etc.) are subject to mandatory hospitalization. Only mild pneumonia can be treated on an outpatient basis with proper patient care.

The American Thoracic Association lists the following indications for hospitalization of patients with community-acquired pneumonia, based on the risk of high mortality and complications:

• age over 65 years;
• the presence of concomitant diseases - chronic bronchial obstruction, bronchiectasis, pneumofibrosis, diabetes mellitus, chronic renal failure, congestive heart failure, chronic liver diseases of various etiologies, suspected aspiration of gastric contents, mental status disorders;
• chronic alcoholism;
• post-splenectomy condition;
• severe pneumonia (the number of breaths per minute is more than 30; severe respiratory failure; the need for mechanical ventilation; radiographic data on bilateral damage to several lobes; systolic blood pressure below 90 mm Hg, diastolic blood pressure below 60 mm Hg; body temperature above 38.3 C; urine volume less than 20 ml/h, indicating renal failure or transient oliguria, as in patients with shock);
• signs of septicemia;
• Laboratory data - white blood cell count <4x10 ⁹ /l or >30x10 ⁹ /l or absolute neutrophil count below 1x10 ⁹ /l: PaO2 <60 mm Hg or Pa CO2>50 mm Hg; blood creatinine >1.2 mg/dl; hematocrit <30%, hemoglobin <90 g/l; presence of metabolic acidosis; increased thromboembolism and thromboplasty times.

Bed rest is observed during the entire febrile period and intoxication, as well as until the complications are eliminated. Three days after the body temperature has normalized and the intoxication has disappeared, a semi-bed rest and then a ward regime are prescribed.

The approximate periods of temporary disability for acute pneumonia depend on its severity, the presence of complications and are:

• for mild forms of acute pneumonia 20-21 days;
• in moderate cases 28-29 days;
• in severe cases, as well as in cases of complications (abscess, exudative pleurisy, pleural empyema) - 65-70 days.

Proper patient care is of great importance in the treatment of acute pneumonia: spacious room; good lighting; ventilation; fresh air in the ward, which improves sleep, stimulates the mucociliary function of the bronchial tree; careful oral care. It is advisable to install negative ion aeroionization devices in the ward. Inhalation of such air contributes to a significant improvement in the drainage function of the bronchi, reduces bronchospastic phenomena, and accelerates the resorption of the inflammatory focus.

Therapeutic nutrition

In the acute febrile period of the disease, in the absence of symptoms of heart failure, the patient should be advised to drink about 2.5-3 liters of liquid: slightly acidified mineral water or boiled water with lemon juice, cranberry juice, fruit juices, vitamin infusions (rosehip infusion, etc.). In the first days, the diet consists of a variety of easily digestible foods, compotes, and fruits.

In the future, a diet is prescribed that provides a sufficient amount of proteins, fats, carbohydrates, vitamins, i.e. tables No. 10 or No. 15. Chicken broths are useful. Smoking and alcohol are prohibited.