Assessment of Severity of Symptoms among Patients with Pneumonia in Medical Ward


  • Aphisit Tamsat Police Nursing College


pneumonia, severity of symptoms


This study aimed to explore the severity of symptoms among patients with pneumonia in the medical ward. The participants were 100 patients who have been diagnosed with pneumonia by the doctor and recruited by using purposive selection technique regarding inclusion criteria. The instrument used for data collection was the pneumonia symptom severity (Marrie et al. 2004). Its content validity was tested by five experts and reported as 1.00. Four registered nurses were assigned to implement this instrument with four patients who had similar characteristics with the study’s participants. Using the intra-class correlation methods, the inter-rater reliability between the evaluators was found as .93. Data were analyzed using descriptive statistics and Pearson product-moment correlation coefficient.

The results of the research revealed that patients with pneumonia had low average score of severity of symptoms (M = 9.66, SD = 4.81). The most severe symptom among patients with pneumonia was fatigue (M = 3.19, SD = 1.32), following by dyspnea (M = 2.73, SD = 1.70), sputum (M = 1.59, SD = 1.44) and cough (M = 1.36, SD = 1.17). The lowest average score of severity of symptoms was pleuritic chest pain (M = .49, SD = .75). Five symptoms that had positively significant correlated to severity of symptoms among patients with pneumonia including dyspnea, fatigue, sputum, cough, and pleuritic chest pain (r = .509 - .865, p < .00), respectively.


Download data is not yet available.


Jaikran T, Wongcharoen N. Incidence rates and impact of pneumonia in Pong hospital. Journal of The Royal Thai Army Nurses. 2021; 22(1):351-60. (in Thai)

Chebib N, Cuvelier C, Malézieux-Picard A, Parent T, Roux X, Fassier T, et al. Pneumonia prevention in the elderly patients: The other sides. Aging Clin Exp Res. 2021;33(4): 1091-100.

National Center for Immunization and Respiratory Diseases. Pneumonia. 2020.

Srireaungrut W. The development and evaluation of clinical nursing practice guideline for preventing ventilator-associated pneumonia in intensive care unit, Hatyai hospital (A thesis, the degree of Master of Nursing Science, adult nursing). Prince of Songkla University, Songkla. 2013. (in Thai)

Nakrod S, Oucharoen N, Nakarit K. Development of patients with ventilator care model to prevent ventilator associated pneumonia in Ranong hospital. Journal of The Royal Thai Army Nurses. 2020;21(2): 295-304. (in Thai)

Noguchi S, Yatera K, Kawanami T, Fujino Y, Moro H, Aoki N, et al. Pneumonia severity assessment tools for predicting mortality in patients with healthcare-associated pneumonia: A systematic review and meta-analysis. Respiration. 2017;93(6):441-50.

Spagnolello O, Ceccarelli G, Borrazzo C, Macrì A, Suppa M, Baldini E, et al. qSOFA as a new community-acquired pneumonia severity score in the emergency setting. Emerg Med J. 2021;38(12):906-12.

Yamagata A, Ito A, Nakanishi Y, Ishida T. Prognostic factors in nursing and healthcareassociated pneumonia. J Infect Chemother. 2020; 26(6):563-9.

Grief S, Loza J. Guidelines for the evaluation and treatment of pneumonia. Prim Care: Clin Off Pract. 2018;45(3):485-503.

Goyal D, Inada-Kim M, Mansab F, Iqbal A, McKinstry B, Naasan A, et al. Improving the early identification of COVID-19 pneumonia: A narrative review. BMJ Open Respir Res. 2021;8(1):e000911.

Jeon K, Yoo H, Jeong BH, Park H, Koh WJ, Suh G, et al. Functional status and mortality prediction in community-acquired pneumonia. Respirology. 2017;22(7):1400-6.

Marcos P, Restrepo M, González-Barcala F, Soni N, Vidal I, Sanjuàn P, et al. Discordance of physician clinical judgment vs. pneumonia severity index (PSI) score to admit patients with low risk community-acquired pneumonia: A prospective multicenter study. J Thorac Dis. 2017;9(6):1538-46.

Zhang Z, Yong Y, Tan W, Shen L, Ng H, Fong K. Prognostic factors for mortality due to pneumonia among adults from different age groups in Singapore and mortality predictions based on PSI and CURB-65. Singapore Med J. 2018;59(4):190-8.

Cao B, Huang Y, She DY, Cheng QJ, Fan H, Tian XL, et al. Diagnosis and treatment of community-acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association. CRJ. 2018;12(4):1320-60.

Boltey E, Yakusheva O, Costa D. 5 Nursing strategies to prevent ventilator-associated pneumonia. Am Nurse Today. 2017;12(6): 42-3.

Hase T, Miura Y, Nakagami G, Okamoto S, Sanada H, Sugama J. Food bolus-forming ability predicts incidence of aspiration pneumonia in nursing home older adults: A prospective observational study. J Oral Rehabil. 2020; 47(1):53-60.

Manabe T, Kotani K, Teraura H, Minami K, Kohro T, Matsumura M. Characteristic factors of aspiration pneumonia to distinguish from community-acquired pneumonia among oldest-old patients in primary-care settings of Japan. Geriatrics. 2020;5(3):42.

Zand F, Zahed L, Mansouri P, Dehghanrad F, Bahrani M, Ghorbani M. The effects of oral rinse with 0.2% and 2% chlorhexidine on oropharyngeal colonization and ventilator associated pneumonia in adults’ intensive care units. J Crit Care. 2017;40:318-22.

Marrie T, Beecroft M, Herman-Gnjidic Z, Poulin-Costello M. Symptom resolution in patients with mycoplasma pneumoniae pneumonia. Can Respir J. 2004;11(8):573-7.

Gayam V, Konala V, Naramala S, Garlapati P, Merghani M, Regmi N, et al. Presenting characteristics, comorbidities, and outcomes of patients coinfected with COVID-19 and Mycoplasma pneumoniae in the USA. J Med Virol. 2020;92(10):2181-7.

Htun T, Sun Y, Chua H, Pang J. Clinical features for diagnosis of pneumonia among adults in primary care setting: A systematic and meta-review. Sci Rep. 2019;9(1):7600.

Özger H, Aysert-Yıldız P, Gaygısız Ü, Uğraş Dikmen A, Demirbaş-Gülmez Z, Yıldız M, et al. The factors predicting pneumonia in COVID-19 patients: Preliminary results from a university hospital in Turkey. Turk J Med Sci. 2020; 50(8):1810-6.

Martins M, Boavida JM, Raposo JF, Froes F, Nunes B, Ribeiro RT, et al. Diabetes hinders community-acquired pneumonia outcomes in hospitalized patients. BMJ Open Diabetes Res Care. 2016;4(1):e000181.

Contou D, Claudinon A, Pajot O, Micaëlo M, Longuet Flandre P, Dubert M, et al. Bacterial and viral co-infections in patients with severe SARS-CoV-2 pneumonia admitted to a French ICU. Ann Intensive Care. 2020; 10(1):119.

Besen B, Park M, Ranzani O. Noninvasive ventilation in critically ill very old patients with pneumonia: A multicenter retrospective cohort study. PLoS One. 2021;16(1):e0246072.

Gonçalves-Pereira J, Mergulhão P, Nunes B, Froes F. Incidence and impact of hospitalacquired pneumonia: A Portuguese nationwide four-year study. J Hosp Infect. 2021;112:1-5.

Suter I, Christ-Crain M, Zimmerli W, Albrich W, Müller B, Schuetz P. Predictors for length of hospital stay in patients with community-acquired pneumonia: Results from a Swiss Multicenter study. BMC Pulm Med. 2012; 12:21.

Marques C, Menezes J, Belas A, Aboim C, Cavaco-Silva P, Trigueiro G, et al. Klebsiella pneumoniae causing urinary tract infections in companion animals and humans: Population structure, antimicrobial resistance and virulence genes. J Antimicrob Chemother. 2018;74(3): 594-602.

Jung Y, Yoon J, Kim H, Lee A, Kim M, Cho J. Atypical clinical presentation of geriatric syndrome in elderly patients with pneumonia or coronary artery disease. Ann Geriatr Med Res. 2017;21(4):158-63.

Shellenberger R, Balakrishnan B, Avula S, Ebel A, Shaik S. Diagnostic value of the physical examination in patients with dyspnea. Cleve Clin J Med. 2017;84(12):943-50.

Nie S, Han S, Ouyang H, Zhang Z. Coronavirus disease 2019-related dyspnea cases difficult to interpret using chest computed tomography. Respir Med. 2020; 167:105951.

Kushima H, Kinoshita Y, Fujita M, Ishii H. A retrospective study on the efficacy of Ninjin’yoeito on fatigue in patients with interstitial pneumonia. Neuropeptides. 2021; 89:102178.

Bjarnason A, Westin J, Lindh M, Andersson L-M, Kristinsson K, Löve A, et al. Incidence, etiology, and outcomes of communityacquired pneumonia: A population-based study. Open Forum Infectious Diseases. 2018; 5(2):1-9.



How to Cite

Tamsat อ. Assessment of Severity of Symptoms among Patients with Pneumonia in Medical Ward. J Royal Thai Army Nurses [Internet]. 2022 May 4 [cited 2022 Jun. 29];23(1):483-9. Available from:



Research Articles

Most read articles by the same author(s)