Community acquired pneumonia (CAP) is among the most pressing challenges that healthcare professionals grapple with today. Essentially, CAP is a lung disease that occurs in individuals who have had minimal interactions with the healthcare system (Ramirez, File & Bond, 2019). What makes CAP particularly worrying is the symptoms and complications that are exhibited by patients ailing from the condition. Heavy sputum, difficulty breathing, fever, chest pain, nausea, vomiting and coughing are some of the common symptoms that accompany CAP (Wang et al., 2012). Bacteria, fungi and viruses are among the organisms implicated in the development of CAP (Brown, 2012). This condition is especially difficult to prevent and treat since it occurs in individuals and communities which are not closely engaged with healthcare professionals. Person-to-person is the primary mode through which CAP is transmitted. For example, when an infected person sneezes, those around them may contract CAP as they breathe in (Steel et al., 2013). If the patient is not provided with treatment in good time, complications can occur. Among these complications include hypotension, acute respiratory failure, lung abscess, sepsis, and lung cavitation, among others (Mbata et al., 2013). Since some of these complications are life-threatening, efforts should be committed to delivering care and support to individuals with CAP.
While it threatens hundreds of thousands across the globe, CAP is indeed treatable. Among the treatments available for this illness include antibiotic therapy which has proven to be highly effective (Correa et al., 2018). To be successful in the prevention, treatment and management of CAP, practitioners need to understand the demographic issues and risk factors that relate to this illness. Some of the known risk factors for CAP include advanced age, smoking, ailing from such conditions as asthma and chronic bronchitis, and the use of such items as steroids (Almirall et al., 2017). Race is another risk factor. It is understood that the prevalence and incidence of CAP is higher among African Americans than whites (Burton et al., 2010). Data indicates that the incidence rate of CAP among African Americans is 663 for every 100,000 adults while that of whites stands at 667/100,000 (Ramirez et al., 2017). It is worth noting that race-specific data on such issues as mortality, morbidity and prevalence is scant, suggesting that more research on CAP should be conducted. However, ample data is available for older adults, among the groups that have borne the brunt of CAP. For example, research estimates that the incident rate of CAP among older adults aged at least 65 years stands between 25 and 44 per 1000 (Stupka et al., 2009). The mortality rate for this demographic group is also high. Stupka et al. (2009) noted that the rate is 10-30%. Raw figures on the morbidity of CAP among older adults appear to be absent. However, research has consistently shown that in addition to CAP, many older adults also grapple with a host of other health challenges (Stupka et al., 2009). There is no question that CAP remains one of the greatest threats to older adult health and that this population should be prioritized in CAP prevention, treatment and management.
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Determinants of Health
Various determinants of health appear to influence the development of CAP. Educational attainment and one’s marital status have been identified as among the determinants that shape one’s risk of contracting CAP. Generally, being single, widowed, living in overcrowded spaces and having received little education expose individuals to higher risk of CAP (Mendez-Brich et al., 2018). These risk factors are not surprising. For example, single individuals may lack the support structures needed to prevent and manage CAP. On the other hand, living in overcrowded spaces increases the chances of contact with infected individuals. Lifestyle factors are other determinants of health that have been implicated in the development of CAP. Smoking and alcohol consumption are among these factors. Moreover, individuals who have regular interactions with children and those who have not adopted proper dental hygiene practices face a greater risk of developing CAP (Torres et al., 2013). Socioeconomic factors have also been linked to CAP. This condition is significantly more prevalent among poor communities which also account for a bulk of the hospital admissions and deaths resulting from CAP (Azab et al., 2014). For the poor, access to preventive and treatment services is usually limited. It is therefore not surprising that CAP imposes a heavier burden on this population.
Epidemiological Triad
The epidemiological triad helps to shed further light on CAP. As already noted, CAP is primarily transmitted from person-to-person. The infected individual (agent) can spread CAP through various behaviors. For example, coughing and sneezing facilitate the transmission of this illness. Failure to wash their hands and handling shared utensils are other behaviors through which the agent may infect others. On the other hand, the individual who contracts CAP (host) may also engage in behaviors that increase their risk. Improper dental hygiene, malnutrition, smoking and taking oral steroids are some of these behaviors (Almirral et al., 2017). The environment where the host and the agent meet also plays a vital role. Overcrowded spaces are some of the environments which fuel the disease’s transmission (Torres et al., 2013). While the three elements of the epidemiological triad apply to all demographic groups, they are particularly more impactful among older adults. These adults are usually ailing from various other health conditions, tend to grapple with poverty that forces them to stay in environments that increase their risk of CAP and are more likely to adopt the behavioral practices which could cause them to develop CAP. For example, older adults held in nursing homes often come into contact with ill fellow seniors. These contacts could result in the transmission of CAP.
Role of the NP
Nursing practitioners (NP) have important roles to play in the prevention, management and treatment of CAP. According to the American Association of Nurse Practitioners (AANP), some of the functions that NPs are expected to perform include care management, performing diagnoses, administering pharmacological treatment , educating patients, and creating spaces for communities and families to participate in the healthcare delivery process (“Scope of Practice”, n.d.). Furthermore, this organization charges NPs to participate in disease prevention, health promotion and the counseling patients and their families. While all these roles are crucial, it is especially important for NPs to be involved in the management of infectious diseases. Some of the roles that accompany this function include monitoring disease progression within communities, designing and implementing interventions, collecting and analyzing data and working with such other stakeholders as community health workers to determine the impact of administered interventions (Rebmann & Carrico, 2017). All these roles could hold the key to the successful management of CAP. For instance, NPs could launch public sensitization campaigns through which they educate at-risk groups about such practices as proper hygiene and the need for infected individuals to isolate themselves. Furthermore, the NPs need to collect data when a CAP outbreak occurs. The data will facilitate surveillance and the design of effective interventions. These practitioners should also be involved in follow up to ensure that preventive and treatment solutions have had the intended impact. In summary, by performing their duties as stipulated by such organizations as the AANP, nurses can help to curb the spread of CAP.
In conclusion, CAP continues to plague many communities in the US and other parts of the globe. This disease is responsible for a significant portion of the costs that the US incurs in delivering care to its people. Furthermore, CAP costs thousands of lives every year and is to blame for unimaginable suffering that many grapple with. It is encouraging that such treatments as antibiotic therapy have shown promise in relieving the pain and anguish that CAP causes. For greater progress in the fight against CAP to be made, NPs need to revamp their efforts. They should be aggressive in educating the public and administering treatment.
References
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Azab, S. F. A. H., Sherief, L. M., Saleh, S. H., Elsaeed, W. F., Elshafie, M. A., & Abdelsalam, S. M. (2014). Impact of the socioeconomic status on the severity and outcome of community-acquired pneumonia among Egyptian children: a cohort study. Infectious Diseases of Poverty. https://doi.org/10.1186/2049-9957-3-14
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Burton, D. C., Flannery, B., Bennett, N. M. et al. (2010). Socioeconomic and racial/ethnic disparities in the incidence of bacteremic pneumonia among US adults. American Journal of Public Health, 100 (10), 1904-11.
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