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Pediatric pneumonia.pptx
- 1.
- 2. At the endof this lecture students will be able to 1) Define Pneumonia 2) Identify the epidemiology of pneumonia 3) Explain risk Factors for Pneumonia 4) Differentiate between the deferent classifications of Pneumonia 5) Describe the diagnosis of Pneumonia 6) Identify the deferential diagnosis of pneumonia 7) Illustrate the prevention of pneumonia 8) Explain the nursing care for children having pneumonia 9) Analyze the complications of pneumonia 10) Identify the medical management of pneumonia
- 3. Definition of Pneumonia Inflammationof lung parenchyma leads to consolidation of affected part and filling of alveolar air spaces with exudates & inflammatory cells
- 4. Epidemiology Pneumonia and otherlower respiratory tract infections are the leading cause of death worldwide Highest in infancy, high in childhood, low in adult, increase in old age
- 5. Risk Factors forPneumonia âą Younger age (2-6 months) âą Low parental education & who smoking at home âą Prematurity, âą Weaning from breast milk at < 6 months, âą Anemia and malnutrition âą Chronic lung disease âą Congenital heart disease
- 6. Causative Agents According torecent (8) studies (conducted in Africa and South America) the most common agents are: 1. Streptococcus pneumoniae 2. Haemophilus influenzae 3. Mycoplasma pneumoniae âą 20-60% of cases, a pathogen is not identified âą The most often isolated bacteria is Streptococcus pneumonia followed by Haemophilus influenzae âą 8-40% represent a mixed infection
- 7. Classifications of pneumonia I.Classification by pathogen II. Classification by anatomy III. Classification by acquired environment
- 8. A. Bacterial pneumonia 1.Aerobic Gram-positive bacteria, such as streptococcus pneumoniae, staphy-lococcus aureus 2. Aerobic Gram-negative bacteria, such as klebsiella pneumoniae, Hemophilus influenzae, E. coli 3. Anaerobic bacteria â .Classification by pathogen Pathogen classification is the most useful to treat the child by choosing effective antimicrobial agents
- 9. C. Viral pneumonia Viralpneumonia may be caused by adenoviruses, respiratory syncytial virus, influenza, cytomegalovirus, herpes simplex Fungal pneumonia is commonly caused by candida B. Fungal pneumonia ï§ parasites ï§ protozoa D. Pneumonia caused by other pathogen
- 10. â Ą. Classification byanatomy 1. Lobar: Involvement of an entire lobe 2. Lobular: Involvement of parts of the lobe only, segmental or of alveoli contiguous to bronchi (bronchopneumonia) Lobar pneumonia Lobular pneumonia
- 11. III. Classification byacquired environment ï” Community Acquired Pneumonia (CAP) ï” Hospital Acquired Pneumonia (HAP)
- 12. Diagnosis Clinical evaluation ofpneumonia âą Cough, Grunting, Chest pain, âą Tachypnea. âą Crackles wheezing , âą Cyanosis, âą Abdominal pain
- 13. Symptoms and Signsin Pneumonia 0 10 20 30 40 50 60 70 80 90 100 Cough Indrawing Convulsion Cyanosis Abdominal pain crepitations Fast breathing Wheeze
- 14. Signs of pneumonia-Indrawing out---breathing---in Lower chest wall indrawing: with inspiration, the lower chest wall moves in
- 15. Signs of pneumonia-NasalFlare Nasal flaring: with inspiration, the side of the nostrils flares outwards
- 16. Clinical features âą Rarelycough âą poor feeding, irritability, tachypnea, retractions, grunting and hypoxemia Newborn âą Cough (persistent) most common âą Upper respiratory symptoms âą Congestion, fever, irritability, wheezing (noisy breathing) and decreased feeding Infants âą Fever, cough , tachypnea, congestion âą posttussive emesis Toddlers and preschoolers âą Fever, cough (productive or nonproductive), congestion, chest pain, dehydration and lethargy Older children and adolescents âą Headache, pleuritic chest pain, abdominal pain, pharyngitis Constitutional symptoms
- 17. âą Degree ofrespiratory effort and accessory muscle use, during feeding âą Grunting, flaring and retractions âą Central cyanosis (trunk) concentration âą High temp + pleural effusion associated with bacterial pneumonia Inspection âą Identify an area of consolidation (dullness) Percussion âą Pericardial effusion (H influenzae) causing friction rub Auscultation Physical examination
- 18. Diagnosis of pneumonia Laboratoryinvestigation: âą WBC count âą Blood cultures âą Chest radiograph. âą Nasopharyngeal cultures
- 19. Differential diagnosis âą Pulmonarytuberculosis âą Lung cancer âą Acute lung abscess
- 20.
- 21. Assessment: ï§ Assess respiratorystatus including rate, depth, ease, shallow or irregular breathing, dyspnea, and diminished breath sounds, rhonchi or crackles on auscultation - provides data baseline. ï§ Changes skin color, cyanosis - indicates possible decrease in oxygenation. Nursing management
- 22. Monitor, record, describe: ï§Respiratory rate, quality and breath sounds - indicates airway resistance, severity of disease. ï§ ABGs, oximeter reading - decreased oxygen levels result in hypoxemia. ï§ Quality of cough - removal of secretions prevents obstruction of airways and stasis leading to further infection and consolidation of lungs.
- 23. Nursing Diagnosis: 1. Ineffectiveairway clearance related to decreased energy and fatigue resulting in decreased coughing and accumulation of secretions. 2. Tracheobronchial secretions related to inflammation resulting in increased mucus accumulation. 3. Ineffective breathing pattern related to pain caused by positioning and coughing; decreased energy and fatigue caused by inflammatory process; decreased lung expansion caused by pain and fatigue resulting in hypoventilation
- 24. Intervention and Rationale Administer: ïOxygen therapy - maintain optimal oxygen level. ï Antitussives/expectorants - acts on bronchial cells to increase fluid production and promote expectoration. ï Mucolytic (acetylcysteine) - decrease viscosity of mucus for easier removal. ï Antibiotic (ampicillin, cephalexin)
- 25. ï Position: semior high fowlers position - facilitates breathing and allows for full expansion of lungs. ï Encourage coughing if sounds is moist; if dry increase fluid intake and administer cough suppressant - reduces continual irritation to throat ïPostural drainage and percussion - mobilizes secretion
- 26. ï Assist withcoughing humidified air with cool moist - loosens secretions and improves ventilation, moistens mucous membranes. ï Suction secretions if cough ineffective ï Oral care after expectoration and promotes comfort ï prevents transmission of organisms to others
- 27. Medical Management Admission indications O2saturation (<93%) Severe tachypnea Dyspnea Grunting Apnea Family unable to take good care General supportive care Analgesia for pain O2 for hypoxia Fluid given Antibiotic Determined by: age, severity, chest x ray Newborn: broad-spectrum IV Older infants: oral amoxicillin > 5 yrs: amoxicillin
- 28. Complications of pneumonia âąPleural effusion âą Empyema âą Lung abscess âą RDS Pulmonary âą Dehydration âą Septicaemia âą Meningitis Extra pulmonary âą persistent Asthma Anatomic and functional anomalies
- 29. Key terms relatedto complications of Pneumonia ïš Pleural effusion â collection of fluid in the pleural space as the result of inflammation. ïš Empyema â Collection of pus due to bacterial infection in the pleural space. ïš Lung Abscess â A collection of inflammatory cells leading to tissue destruction resulting in one or more cavities in the lungs. A rare complication.
Editor's Notes
- #15Â Reference: Integrated Management of Childhood Illness. Chapter Three: Cough or difficulty breathing. World Health Organization. 2000âhttps://apps.who.int/chd/publications/referral_care/chap3/chap31.htm. Accessed February 2, 2012
- #16Â Reference: Integrated Management of Childhood Illness. Chapter Three: Cough or difficulty breathing. World Health Organization. 2000âhttps://apps.who.int/chd/publications/referral_care/chap3/chap31.htm. Accessed February 2, 2012
- #30Â Reference: British Thoracic Society (BTS) of Standards of Care Committee. BTS Guidelines for the Management of Community Acquired Pneumonia in Childhood. Thorax. 2002;57: i1-i24.