The World Health Organization (WHO, 2021) defines pneumonia as “a form of acute respiratory infection that affects the lungs.” The causal agents for pneumonia are viruses, bacteria, and fungi. Despite various causal agents, Streptococcus pneumoniae remains the most common cause of bacterial pneumonia, especially in children (WHO, 2021).
In terms of the global burden of the disease, Ferreira-Coimbra et al. (2020) contend that community-acquired pneumonia is the leading cause of premature deaths among infectious diseases since it accounts for about 3 million deaths annually. Further, the disease leads to poor outcomes, a high risk of comorbidities, and increased care costs. In the United States, pneumonia kills more children younger than five years than other infectious diseases, including HIV/AIDS, tuberculosis, and malaria (Centers for Disease Control and Prevention, 2021).
Like other contagious diseases, CAP’s prevalence and effects are disproportionate to people struggling with poor social determinants of health, including poverty, limited access to quality care, susceptibility to air pollution, and low education attainment. Therefore, this paper elaborates on the disease’s determinants of health, epidemiological triad, and the role of nurse practitioners (NPs) in preventing, treating, and managing CAP.
Causes and Symptoms of Community-acquired Pneumonia
Various causative agents are responsible for community-acquired pneumonia (CAP). According to the World Health Organization (WHO, 2021), viruses, bacteria, and fungi are the major causes of the disease. Streptococcus pneumoniae is the most profound cause of bacterial pneumonia, alongside Haemophilus influenzae.
On the other hand, the respiratory syncytial virus is responsible for most incidences of viral pneumonia. Finally, Pneumocystis jiroveci accounts for the most cases of pneumonia among infants infected with HIV (WHO, 2021). The disease manifests through various symptoms, including cough, fever, breathing difficulties, heavy sputum, fever, and chills.
Risk Factors for CAP
Multiple intrinsic and extrinsic factors contribute to individual susceptibility to community-acquired pneumonia. According to Almirall et al. (2017), age, smoking, exposure to air pollutants, malnutrition, immunosuppressive therapy, alcoholism, and other respiratory conditions such as chronic obstructive pulmonary disease (COPD) are the primary risk factors for CAP. In terms of demographic aspects, age is a significant risk factor for CAP prevalence and incidences.
Ferreira-Coimbra et al. (2020) contend that older adults have a higher incidence of community-acquired pneumonia, representing 63.0/10000 in the age group 65-79 years and 164/10000 among people above 80 years. Adults are more susceptible to CAP-associated mortalities due to their exposure to intrinsic and extrinsic risk factors. According to Almirall et al. (2017), the mortality rate for community-acquired pneumonia varies between 0.1 and 0.7 per 1000 persons annually in the adult population, rendering them more vulnerable to premature deaths.
Mode of Transmission
Community-acquired pneumonia (CAP) spreads primarily through airborne droplets released when infected people sneeze or cough. Also, the World Health Organization (WHO, 2021) contends that pneumonia may transmit through exposure to infected blood, especially during and shortly after birth. Undoubtedly, the presence of different transmission pathways renders the disease highly infectious.
Complications and Treatment
Apart from premature deaths and increased care costs, community-acquired pneumonia can lead to multiple complications, including convulsions, hypothermia, acute respiratory failure, lung abscess, and cavitation (WHO, 2021). As a result, it is essential to incorporate appropriate pharmacological and non-pharmacologic treatment options.
In terms of pharmacological interventions, it is possible to treat pneumonia through antibiotic therapies and medication options such as macrolide (azithromycin, clarithromycin, and erythromycin) and respiratory fluoroquinolones (Metlay et al., 2019).
On the other hand, the Centers for Disease Control and Prevention (CDC, 2021) recommends children immunization, regular hand hygiene, personal protective strategies such as using a tissue to cover the mouth when sneezing, smoking cessation, and management of conditions like diabetes, asthma, or heart disease as preventative and control interventions for CAP. These approaches form the basis for non-pharmacologic treatment options for community-acquired pneumonia.
Determinants of Health and Community-acquired Pneumonia
Undoubtedly, everyone is susceptible to the interplay between social, economic, cultural, and environmental issues that influence health and well-being. Healthy People 2020 (n.d.) defines determinants of health as “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and the quality-of-life-outcomes and risks.”
In this sense, issues like economic stability, education attainment, access to quality care, neighborhood and built environment, and social support systems play a significant role in determining people’s susceptibility to diseases.
In community-acquired pneumonia, people grappling with poverty, limited access to timely and quality care, low education attainment, and underdeveloped neighborhood and built environment bear a massive health burden of the disease (Mèndez-Brich et al., 2019). In children, malnutrition, overcrowded learning institutions, and parental lifestyle choices such as cigarette smoking increase their susceptibility to community-acquired pneumonia.
The epidemiological triad for pneumonia contains three profound aspects: the causal agents, the host, and environmental factors that contribute to a high prevalence rate of the disease. According to the World Health Organization (WHO, 2021), the significant causes of CAQ are viruses, bacteria, and fungi such as Streptococcus pneumoniae, Haemophilus influenzae, and respiratory syncytial virus.
These infectious agents enter through the host’s respiratory tract in the form of inhaled air-borne droplets. Various host factors increase the likelihood of the disease’s clinical manifestation. According to Ticona et al. (2020), age, cigarette smoking, alcoholism, and the presence of underlying respiratory conditions such as chronic obstructive pulmonary disease (COPD) and asthma are intrinsic factors that exacerbate the magnitude of CAP prevalence and effects.
Finally, environmental factors that increase the individual susceptibility to community-acquired pneumonia include exposure to occupational pollutants, air pollution, overcrowded institutions, and zoonotic infections (Smith, 2022). Notably, understanding the interplay between causative agents of pneumonia, host factors, and environmental issues can inform preventive, management, and control interventions for the disease.
The Role of Nurse Practitioner
The role of nurse practitioners is ever-expanding due to the prevailing demands in the current healthcare systems. According to the American Association of Nurse Practitioners (AANP, 2019), nurse practitioners (NPs) provide a wide range of health services, including disease diagnosis and management, health promotion, and counseling individuals, families, and communities.
These services are consistent with the significant components of nursing practice, including assessment, ordering, supervising and interpreting diagnostics, making diagnoses, coordinating care, and counseling (AANP, 2019). In preventing, managing, and controlling community-acquired pneumonia, NPs are responsible for implementing evidence-based interventions to reduce people’s susceptibility to CAP and other infectious diseases.
According to Cupp Curley (2020), nurses can integrate evidence-based practice (EBP) into the management of public health problems by asking clinical questions, reviewing the literature, assessing the evidence, and translating evidence to practice.
Finally, NPs can collaborate with patients and other stakeholders to establish the thresholds for community health needs assessments, disease surveillance, educating the public, follow-up activities, and implementing quality improvement initiatives. Undoubtedly, these roles position nurse practitioners at the forefront of preventing, managing, and controlling community-acquired pneumonia.
Like other infectious diseases, community-acquired pneumonia (CAP) leads to premature deaths, increased care costs, lengthy hospitalization, and compromised quality of life. The at-risk populations for this disease are children, older adults, cigarette smokers, people with underlying respiratory conditions, and individuals grappling with unfavorable social determinants of health, including poverty.
While the disease is associated with multiple health complications, nurse practitioners are responsible for implementing evidence-based practice (EBP) and actualizing policies that entail infection tracing, surveillance, and alleviation. Also, they can educate the public about the disease, conduct community health needs assessments, understand patterns of causation, and collaborate with patients to develop a plan for care, including follow-up activities.
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