Pneumonia in children

PNEUMONIA IN CHILDRENBYSWAROOPA

MSc Nursing

1. It is a inflammatory process involving lung parenchyma

“Indian Academy of Pediatrics”

2. It is a inflammation with consolidation (it is a state of being solid with exudate) of parenchymal cells of the lung.

“Marlow – Redding”

DEFINITION

INCIDENCE Occurs most commonly in infants and young children30% children are admitted because of pneumonia 90% of deaths in respiratory illnesses are due to pneumonia

The condition kills an estimated 1.8 million children every year, according to World Health Organization. In India, the casualty is as high as 3 to 4 lakh children.

Classification 1. According to anatomical distribution---Lobar pneumonia.---Broncho pneumonia or lobular pneumonia---Interstitial pneumonia

2. ACCORDING TO ETIOLOGICAL DISTRIBUTION---VIRAL---BACTERIAL---MICOPLASMA PNEUMONIA (PRIMARY ATYPICAL PNEUMONIA)

3.ACCORDING TO DURATION ---PERSISTENT---RECURRENT PNEUMONIA.

4. ASPIRATION PNEUMONIA.

ETIOLOGY

BACTERIAL INFECTION: PNEUMOCOCCUS, STREPTOCOCCUS, STEPHYLOCOCCUS, HEMOPHILUSINFLUENZA (TYPE B GRAME –VE ORAGNISM.

VIRALRESPIRATORY SYNCYTIAL VIRUS (RSV) MOST COMMON VIRUS, INFLUENZA, CHICKEN POX, MEASLES VIRUSES.

FUNGAL INFECTION OR MYCOTIC : MONILIASIS ORAL THRUSH, HISTOPLASMOSIS.

OTHER CAUSES :ASPIRATION OF AMNIOTIC FLUID, FOOD, FOREIGN BODY, VOMITERS, CHEMICALS.

RISK FACTORSLOW BIRTH WEIGHTVITAMIN DEFICIENCY LACK OF BREAST FEEDINGPASSIVE SMOKINGPOOR SOCIOECONOMIC STATUSLARGE FAMILY SIZEOVER CROWDINGFAMILY HISTORY OF BRONCHITISOUT DOOR AND INDOOR AIR POLLUTIONS.

THE ORGANISM REACH THE PHERIPARY OF THE LUNG AND CAUSE REACTIVE OEDEMA WHICH ENCOURAGES PROLIFERATION OF THE ORGANISMS.

THE INVOLVED LOBE UNDERGOES CONSOLIDATION WITH POLYMORPHONUCLEAR LEUKOCYTES, FIBRIN, RBC, OEDEMA, FLUID AND PNEUMOCOCCI FILLING ALVEOLI

.

PATHOPHYSIOLOGY

THERE ARE 4 STAGES OF ILLNESS

1.REACTIVE EDEMA

2. RED HEPATISATION

3. GREY HEPATSATION

4. RESOLUTION

☺THERE IS ABRUPT ON SET OF HIGH FEVER WITH RESPIRATORY DISTRESS. RESTLESSNESS AND AIR HUNGER.

☺CYANOSIS ☺GRUNTING , FLARING (NAZAL)☺RETRACTION OF THE SUPRACLAVICULAR,

INTERCOSTAL AND SUBCOSTAL AREAS.☺TACHYPNEA (50 BREATHS/ MINUTE) , TACHY CARDIA.☺COUGH APPEARS LATER.☺DYSPNEA, ANOXIA.☺VOMITINGS( REFUSAL OF FEEDS).

CLINICAL MANIFESTATONS

DIAGNOSTIC EVALUATION:---THE DIAGNOSIS IS MADE BY 4 METHODS OF PHYSICAL EXAMINATION

---INSPECTION OF RAPID RESPIRATION, DYSPNEA, CYANOSIS

---ON PERCUSSION THERE MAY BE LOCALIZED DULL NESS

• ---AUSCULTATION REVEALS RONCHIAL BREATHING CRACKLING RAYS.

• ---SEROLOGICAL EXAMINATION FOR CULTURAL SENSITIVITY (BACTERIAL, VIRAL, IgG/IGM INSERUM.

• ---WBC COUNT IS ELIVATED UPTO MORE THAN 15000 CELLS.

• ---CBP FOR EVIDENCE OF SEPSIS.

NASOPHARYNGEAL FOR VIRAL ANTIGEN (CMV, ADENOVIRUS)

TUBERCULIN SKIN TEST TO RULE OUT TB ORGANISM

CHEST X-RAY

INVASIVE PROCEDURES - BRONCHOSCOPY - BRONCHOALVEORLAR LAVAGE - LUNG ASPIRATION - LUNG BIOPSY

OUT PATIENT MANAGEMENT- SUPPORTIVE CARE- FOLLOWUP OF CHILD- ORAL COTRIMAXAZOLE OR

AMOXICILLINE/CEPHALEXIL FOR 5-7 DAYS- ASSESS FOR CLINICAL STATUS AND

DETERIORATION OF CHILD.

MEDICAL MANAGEMENT

INPATIENT MANAGEMENT- SPECIFIC: - AMPLICINE, SEPHALOSPORINS FOR INFANTS

BELOW 2 MONTHS.- AMOXICILLINE, CEFITOXIME (CHILDREN MORE

THAN 2 MONTHS FOR 10-14 DAYS.- ERYTHROMYCIN, CLARIPHROMYCIN FOR 10

DAYS.

SUPPORTIVE CARE :---ANTIPYRATICS (PARACETAMOL

10-15MG/KG/DOSE EVERY 4-6HRS.---OXYGEN ADMINISTRATION (OXYGEN HOOD,

MASK, NASAL PRONGS)---HYDRATION ---CHEST PHYSIOTHERAPY---NUTRITION

ASSESSEMENT OF A CHILD AND DETERMINE THE CAUSATIVE ORGANISM.

CONTROL OF FEVER MAINTAINE PATENT AIRWAY PROVISION OF HIGH HUMIDIFIED OXYGEN. POSITIONING MONITOR RESPIRATORY STATUS AND VITAL SIGNS. ADMINISTRATION OF ANTIBIOTICS PROMOTION OF REST PROVISION OF APPROPRIATE AND ADEQUATE FLUIDS AND

NUTRITION SUPPORT AND EDUCATION TO PARENTS PREVENTION OF COMPLICATIONS

NURSING CARE

EMPYEMA LUNG ABSCESS PNEUMOTHORAX PYOTHORAX SEPSIS PERICARDIAL EFFUSION

COMPLICATIONS

INCREASED ORAL IN TAKE ADEQUATE BED REST FREQUENTLY CHECK TEMPERATURE PLACE THE CHILD IN SEMI FOWLER POSITION GIVE ANTIPYRETICS REGURAL FOLLOW-UPS.

HOME CARE MANAGEMENT

PROGNOSIS• DEPENDS ON NUTRITIONAL STATUS, AGE, TYPE OF

PNEUMONIA, ADEQUACY OF TREATMENT• STREPTOCOCCUS – GOOD WITH TREATMENT• STAPHYLOCOCCAL – REQUIRED HOSPITALIZATION,

MOTALITY RATE 10-30%.• H.INFLUENZA OR VERY HIGH BECAUSE OF SEVEOUR

COMPLICATIONS.• RECOVERY FROM MYCOPLASMA PNEUMONIA MAY BE

SLOW.

CONCLUSION