Pediatric pneumonia

1. Pediatric pneumonia

2. At the end of 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
Inflammation of
lung parenchyma
leads to
consolidation of
affected part and
filling of alveolar
air spaces with
exudates &
inflammatory cells

4. Epidemiology
Pneumonia and other lower 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 for Pneumonia
• Younger age (2-6 months)
• Low parental education & who smoking at home
• Prematurity,
• Weaning from breast milk at < 6 months,
• Anemia and malnutrition
• Chronic lung disease
• Congenital heart disease

6. Causative Agents
According to recent (8) studies (conducted in Africa and South
America) the most common agents are:
1. Streptococcus pneumoniae
2. Haemophilus influenzae
3. Mycoplasma pneumoniae
• 20-60% of cases, a pathogen is not identified
• The most often isolated bacteria is Streptococcus pneumonia
followed by Haemophilus influenzae
• 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
Ⅰ.Classification by pathogen
Pathogen classification is the most useful to treat the child by
choosing effective antimicrobial agents

9. C. Viral pneumonia
Viral pneumonia may be caused by adenoviruses, respiratory
syncytial virus, influenza, cytomegalovirus,
herpes simplex
Fungal pneumonia is commonly caused by candida
B. Fungal pneumonia
 parasites
 protozoa
D. Pneumonia caused by other pathogen

10. Ⅱ. Classification by anatomy
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 by acquired environment
 Community Acquired Pneumonia (CAP)
 Hospital Acquired Pneumonia (HAP)

12. Diagnosis
Clinical evaluation of pneumonia
• Cough, Grunting, Chest pain,
• Tachypnea.
• Crackles wheezing ,
• Cyanosis,
• Abdominal pain

13. Symptoms and Signs in 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-Nasal Flare
Nasal flaring: with inspiration, the side of the
nostrils flares outwards

16. Clinical features
• Rarely cough
• poor feeding, irritability, tachypnea, retractions, grunting and hypoxemia
Newborn
• Cough (persistent) most common
• Upper respiratory symptoms
• Congestion, fever, irritability, wheezing (noisy breathing) and decreased
feeding
Infants
• Fever, cough , tachypnea, congestion
• posttussive emesis
Toddlers and preschoolers
• Fever, cough (productive or nonproductive), congestion, chest
pain, dehydration and lethargy
Older children and adolescents
• Headache, pleuritic chest pain, abdominal pain, pharyngitis
Constitutional symptoms

17. • Degree of respiratory effort and accessory muscle use, during feeding
• Grunting, flaring and retractions
• Central cyanosis (trunk) concentration
• High temp + pleural effusion associated with bacterial pneumonia
Inspection
• Identify an area of consolidation (dullness)
Percussion
• Pericardial effusion (H influenzae) causing friction rub
Auscultation
Physical examination

18. Diagnosis of pneumonia
Laboratory investigation:
• WBC count
• Blood cultures
• Chest radiograph.
• Nasopharyngeal cultures

19. Differential diagnosis
• Pulmonary tuberculosis
• Lung cancer
• Acute lung abscess

20. Prevention of pneumonia

21. Assessment:
 Assess respiratory status including rate, depth, ease,
shallow or irregular breathing, dyspnea, and diminished
breath sounds, rhonchi or crackles on auscultation -
provides data baseline.
 Changes skin color, cyanosis - indicates possible
decrease in oxygenation.
Nursing management

22. Monitor, record, describe:
 Respiratory rate, quality and breath sounds - indicates
airway resistance, severity of disease.
 ABGs, oximeter reading - decreased oxygen levels
result in hypoxemia.
 Quality of cough - removal of secretions prevents
obstruction of airways and stasis leading to further
infection and consolidation of lungs.

23. Nursing Diagnosis:
1. Ineffective airway 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:
 Oxygen therapy - maintain optimal oxygen level.
 Antitussives/expectorants - acts on bronchial cells to increase
fluid production and promote expectoration.
 Mucolytic (acetylcysteine) - decrease viscosity of mucus for
easier removal.
 Antibiotic (ampicillin, cephalexin)

25.  Position: semi or high fowlers position - facilitates breathing
and allows for full expansion of lungs.
 Encourage coughing if sounds is moist; if dry increase fluid
intake and administer cough suppressant - reduces continual
irritation to throat
Postural drainage and percussion - mobilizes secretion

26.  Assist with coughing humidified air with cool moist - loosens
secretions and improves ventilation, moistens mucous
membranes.
 Suction secretions if cough ineffective
 Oral care after expectoration and promotes comfort
 prevents transmission of organisms to others

27. Medical Management
Admission indications
O2 saturation (<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
• Pleural effusion
• Empyema
• Lung abscess
• RDS
Pulmonary
• Dehydration
• Septicaemia
• Meningitis
Extra pulmonary
• persistent Asthma
Anatomic and
functional
anomalies

29. Key terms related to complications of Pneumonia
 Pleural effusion – collection of fluid in the pleural space as the result of
inflammation.
 Empyema – Collection of pus due to bacterial infection in the pleural
space.
 Lung Abscess – A collection of inflammatory cells leading to tissue
destruction resulting in one or more cavities in the lungs. A rare
complication.