Pneumonia
Presented by :- AvdBJHM
Introduction
• Pneumonia is defined as the infection and
inflammation of the lung parenchyma tissue
(bronchioles, alveolar ducts and alveoli) that impairs
gas exchange.
• It can occur as a primary disease, or a secondary
disease as a complication of other infection.
• It is one the leading causes of under 5 mortality in
developing countries.
Classification and Causes
• 1 on the basis of ontatomical involvement
a) Bronchopneumonia:-
-Inflammation begins in the terminal bronchide become clogged with
mucopurulent exudate and form consolidated patches in nearby lobules
b) Lobar pneumonia
-Inflammation is involved in all or large Segment of one or more
pulmonary lobes.
C) Interstitial pneumonia:-
-Alveoli or interstitial tissue are involved
• 2 on the basis of etiology
a) viral pneumonia
b) Bacterfal pneumonia
c) Fungal pneumonia
d) other pneumonia
• 3) on the basis of pathology
a) consolidation of alveoli
b) Inflammation and infiltration of the tissue/cells
• 4) On the baste of Severity of infections
(WHO recommendations)
a) No pneumonia
b) pneumonia
c) Severe pneumonia
d) Very pneumonea severe pneumonia /Very
Severe disease.
Data of Pneumonia in children
• Pneumonia remains a leading cause of
morbidity and mortality among children under
five in developing countries
• According to UNICEF, children in this Over 700,000 age group dee
from pneumonia annually.
• Equating to a death every every 43 sec.
• The highest incidence rates are Observed in south Asia and west
and central Africa.
• While global under - fire deaths due to pneumonia have declined
by 54% since 2000.
• This reduction is slower compared to other infectious disease like
diarrhea, which has seen a 63 %. decrease in the some period.
Prodreporing factors of preumonia.
1) Malnutrition:-
• poor nutrition weakens the immunity System. Increasing vulnerability to infections
like pneumonia.
2) vitamin difficiencies:-
(vitamin A or zinc) further Compromise Immune responses.
3) Age: children up to 2 years 2 years of age at greater risk.
4) Season-
→TOO Cold environment Increase the risk of respiratory infections-
• 5) Socioeconomic factors:-
Limited access to health care
Delay diagnosis & treatment, exacerbate disease
severity Severity.
• 6) Low Vaccination Coverage:
→Increases susceptibility to vaccine Preventable
cause like Hib в pneumococcus
7) Poverty:-
-contributes to malnutrition, poor Iiving conditions, Lack of
preventive measures
• Lack of preventive measures:-
-Inadequate breast feeding which deprives Children of maternal
antibodies
-Poor handwashing practices Increase the spread of pathogens.
8) smoking:-
Active and passive Smoking
9) History of Repeated respiratory tract infection
Causes:-
i. Bacteria:-
• In first 2 months:-
-Common bacteria are klebsiella. E. coli, stre
staphylococcus, pneumococci.
• 3 months to 3 years:-
-Common bacteria are preumococci, H. influenza
staphylococcos
• More than 3 years:-
-Common Bacteria are preanmococcus and
staphylococcus
ⅱ)Virus:-
→Respiratory syncytial virus (RSV)
• A major viral cause in young children.
• influenza viruses, adenoviruses and human
metapneumovirus.
(iii)Fungi:-
-Candidiasis
-Coccidomycoses
-Histoplasmosis
(iv)protozoal Cause :-
Rare but possible, such as Malaria - associated pneumonia
-pneumocystic Carinii
-Toxoplasma gondii
-Entameobahistolytica
4) Atypical organisms :-
Mycoplasma and chlamydia are Common cause of community acquired pneumonia & Common
among under five children.
v) Others:-
Aspiration et foods, oils, Iiquid paraffin, Kerosene poisoning, hypersensitivity pneumonta Etc.
Pathophysiology:
Invasion or entry of organisms to lower respiratory tract
↓
Inflammatory response in the alveoli, characterized by exudation WBC and neutrophils migrate Into
the alveoli and fill the air space and mucosal edema
↓
Narrowing and occlusion of the bronchi and alveoli, decrease alveolar oxygen tension
↓
Interference in the diffusion of oxygen and carbon dioxide
↓
Ventilation perfusion mismatch in affected areas of lungs.
↓
Inadequate oxygenation of blood entering left ventricle
↓
Arterial hypoxemia.
Clinical Features
• High grade Fever
• Respiratory symptoms:-
Cough (unproductive to productive with white sputum), tachypnea, Wheezing,
dyspnea, breath sounds (Crackles present), decreased breath Sound (If
Consolidation exists), Chest pain, nasal flaring, cyanosis (depending on severity.
• Behavior:
-Irritability,
-Restlessness
-Malarse
-Lethargy
• Gastrointestinal symptoms:-
-Anorexia
-Vomiting
-Diarrhea
-Abdominal pain
Complication:-
- pleural effusion, Bacteremia, Septicemia, Meningitis.
Septic arthritis Endocarditis, pericarditis.
Management
• The child should be hospitalized and maintain isolation to prevent the
spread of resistance Staphylococci or until causative agent is Identified.
• The Course of treatment is based on the etiology of the disease.
• Bacterial pneumonia are treated with organism sensitive antibiotics
• Mycoplasma pneumonia may also be treated with antibiotics to prevent
Secondary bacterial infection.
• viral pneumonia is managed only with Supportive care to relieve
symptoms.
• Oxygen therapy and chest physiotherapy
Supportive general measure:
• Antipyretic to control fever
• Anti-inflammatory medication
• Bed rest and rest promotion, propped up
position or side lying position, warmth
• Suctioning to remove tracheobronchial tree.
• Adequate fluid and dietary intake, humid
environment and maintain warmth.
Prevention
• Proper Suctioning the mouth and throat of infants with
meconium-stained amniotic fluid decreases the rate of
aspiration pneumonia
• vaccination is important for preventing pneumonia in
both children and adults
• Vaccination against Haemophilus influenza (Hib) at
6,10and 14 week's of age and pneumococcal (pcv) at
6,10 weeks and 9 months.
Nursing Managements
(Interventions)
promoting effective Airway clearance.
o provide a humidified environment enriched with oxygen to
combat hypoxia and to liquefy Secretfons.
o Advise and encourage parents to provide oral fluids
frequently as tolerated.
o Keep nasal passages free of secretions.
Use a bulb syringe to clear nares and Oropharynx
Improving Breathing pattern:-
• Monitor oxygen Saturation as indicated. Use head box to administer 0 2
• Provide semi-fawler's position or elevate the head of bed to promote easier
Ventilation.
• provide measures to improve ventilation of the affected portion of the lung.
change position frequently
provide postural drainage if prescribed.
Relieve nasal blockage by instilling normal saline solution-.
Avoid prolonged Crying which can irritate the airway.
Relieve coughing by allowing the child to to take a sip of water; use extreme
caution to prevent aspiration.
Insert NG tube as ordered to relieve abdominal distension if present.
promoting adequate, nutrition and. hydration.
• Encourage breastfeeding if the infants or or child can drink
• Offer small and frequent meal to the children if the oral fluid is tolerable
• Administer IV fluids at the prescribed rate.
• To prevent aspiration, withhold oral food and fluids if the child in Severe respiratory
distress.
• Offer the child small sips of clear fluid when respiratory I status improves .
• Record the child's intake and Output, and monitor urine specific gravity.
Promoting adequate rest:
• cluster the nursing interventions to provide Interrupted periods.
• Encourage the parents to stay with the child as much as possible to provide comfort
and security.
• provide opportunities for quiet play as the child's condition improves.
