child health nursing pneumonia

1. GOOD MORNING

3. pneumonia
PRESENTED BY : AVNEET KAUR
BSC {N} 3RD YR

4. 0BJECTIVES
 DEFINE PNEUMONIA
 INCIDENCE RATE
 RISK FACTOR
 CLASSIFICATION OF PNEUMONIA
 ETIOLOGY OF PNEUMONIA
 PATHOPHYSIOLOGY OF PNEUMONIA
 CLINICAL MENIFESTATION OF PNEUMONIA
 DIAFNOSTIC MANAGEMENT OF PNEUMONIA
 MANAGEMENT OF PNEUMONIA
 PREVENTION OF PNEUMONIA

5. INTR0DUCTION
Pneumonia is the leading cause of mortality and
a common cause of morbidity in children below
5 years of age.
“PNEUMONITIS” is a general term that describes
an inflammatory process in the lung tissue that
may predispose a patient to or place a patient at
risk for microbial invasion.

6. definition
 Pneumonia is an infection that inflames the air sacs in one or
both lungs. The air sacs may fill with fluid or pus.
 “ It is a inflammatory process involving lung parenchyma”
Indian Academy of Paediatrics
 “It is a inflammation with consolidation (it is a state of being solid
with exudate) of parenchymal cells of the lung.” –
Marlow Redding

7. ANATOMY OF LUNGS

9. incidence
 Occurs most commonly in infants and young children.
 30%Child are admitted because of pneumonia..
 90% of deaths in respiratory illnesses are due to pneumonia.
 The condition kills an estimated 3million children every year.
 According to World Health Organization… In India, the
casualty is as high as 3 to 4 lakh children.

10. RISK FACTORS
Breathing second hand smoke
Asthma or certain genetic disorders, such
as sickle-cell anaemia.
Heart defects, such as ventricular septal
defect (VSD), atrial septal defect (ASD), or
patent ductus arteriosus (PDA)
PREMATURE BIRTH

11. CONT..
 LOW BIRTH WEIGHT
 VITAMIN DEFICIENCY
 LACK OF BREAST FEEDING
 POOR SOCIOECONOMIC STATUS
 FAMILY HISTORY OF BRONCHITIS
 OUT DOOR AND INDOOR AIR POLLUTIONS

12. CLASSIFICATION
1
• According to Anatomical Distribution
2
• According to etiological distribution
3
• According to Duration

13. 1.According to Anatomical position
Lobular pneumonia
Bronchopneumonia
 Interstitial Pneumonia

14. 2. ACCORDING TO ETIOLOGICAL
DISTRIBUTION
 VIRAL
 BACTERIAL
 FUNGAL PNEUMONIA
3. ON THE BASIS OF AQUIRED
 COMMUNITY BASED
 HOSPITAL BASED

15. 4. MISCELLANEOUS TYPES
 ASPIRATION
PNEUMONIA
 LOFFLERS
SYNDROME
 HYPERSENSTIVITY

16. LOBULAR PNEUMONIA
• A lobar pneumonia is an infection that only
involves a single lobe, or section, of a lung.
• Lobar pneumonia is often due to bacteria
Streptococcus pneumoniae
• Multilobe pneumonia involves more than
one lobe, and it often causes a more severe
illness.

17. Bronchial and interstitial
• Bronchial pneumonia affects the lungs in
patches around the tubes (bronchi or
bronchioles).
• Interstitial pneumonia involves the areas in
between the alveoli, and it may be called
"interstitial pneumonitis." It is more likely to
be caused by viruses or by atypical
bacteria.

18. Anatomical distribution

19. Viral pneumonia
 Viral pneumonia is a complication of the viruses that cause colds
and the flu. It accounts for about one third of pneumonia cases.
 Virus causing pneumonia include ;
 ADENOVIRUS , RESPIRATORY SYNCYTIAL VIRUS
 INFLUENZA VIRUS , VARICELLA ZOOSTER VIRUS
 The virus invades your lungs and causes them to swell, blocking
your flow of oxygen.
.

20. Cont.…
 RSV is the most important cause in
infants under 2 years of age
At other ages, Influenza ,Parainfluenza
and Adenoviruses are common.

21. bacterial PNEUMONIA
A] Pneumococcal pneumonia
It is a type of bacterial pneumonia that is caused
by Streptococcus pneumoniae (which is also
called pneumococcus).
 It is the most common bacterial
pneumonia found in adults, the most common
type of community-acquired pneumonia, and one
of the common types of pneumococcal infection.

22. B] STAPHYLOCOCCAL PNEUMONIA
STAPHYLOCOCCAL PNEUMONIA IS
CAUSED BY STAPHYLOCOCCUS
AUREUS
This bacteria is an opportunistic
pathogen that infects the respiratory
system after the immune system
weakens.

23. IN CHILDREN
A.Bacteremia without known site of
infection most common clinical
presentation
B. S. pneumoniae leading cause of
bacterial meningitis among children OF
5 years of child
C.Major cause of OTITIS MEDIA

24. FUNGAL PNEUMONIA
Fungal pneumonia is an infection of the
lungs by fungi.
It can caused by either endemic or
opportunistic fungi or a combination of
both.
Mortality case in fungal pneumonia is 90%.
 It occurs in immunocompromised children

25. NORMAL V/S ABNORMAL ALVEOLI

26. COMMUNITY ACQUIRED
 Community-acquired pneumonia is an infection that is
acquired outside of the healthcare system, including
hospitals, nursing homes, outpatient clinics, or any
other health care facility.
 STREPTOCCOUS PNEUMONIA , the leading cause of
community-acquired pneumonia which is responsible
for 20% to 60% of all cases.
 Other: Haemophiles influenza, Staphylococcus
aureus,

27. HOSPITAL ACQUIRED
It is an infection that is acquired during the stay
in the hospital.
This form of pneumonia can be serious because
often times the patient, by nature of being in the
hospital in the first place, is in an immune-
weakened state due to illness or traumatic injury
and thus is more susceptible to infection.

28. MISCELLENOUS TYPE
A. ASPIRATION PNEUMONIA
• It occurs due to aspiration of the following:
FOOD
AMNIOTIC FLUID
WATER BY DROWNING
CHEMICALS LIKE KEROSCENE, FUMES

29. CONT.
B. LOFFLERS SYNDROME
 It is a disease in which eosinophils
accumulate in lungs in response to
parasitic infection.
 Caused by parasite
[ ASCARIS LUMBRICOIDES]

30. Cont.
C.HYPERSENSITIVITY PNEUMONIA
It is an inflammation of alveoli within the
lungs caused by hypersensitivity to inhaled
dust and mold.
 it is a rare immune system disorder.

31. ETIOLOGY
1. VIRUS RESPIRATORY SYNCYTIAL VIRUs, PARAINFLUENZA OR
ADENOVIRUS
2. BACTERIA GRAM NEGATIVE BACTERIA
GRAM POSITTIVE BACTERIA
3. ATYPICAL
0RGANISM
CHLAMYDIA
MYCOPLASMA
4. FUNGI HISTOPLASMOSIS
COCCIDIOMYCOSIS
5. METAZOA ASCARIS as in Loeffler's syndrome
6. ASPIRATION FOOD ,OILY NOSE DROPS, LIQUID PAAFFIN
7. KEROSENE CHEMICAL POISIONING CAUSES CHEMICAL POISIONNING
8. IMMUNO-
COMPROMISED
Congenital anomalies such as cleft palate and tracheoesophageal
fistula predispose to aspiration pneumonia by organisms present in

32. ETIOLOGY

34. pathophysiology

35. STAGES
 STAGE OF CONSOLIDATION
STAGE OF RED HEPATIZATION
STAGE OF GREY HEPATIZATION
STAGE OF RESOLUTION

36.  CONSOLIDATION
 This stage occurs within the first 24 hours of
contracting pneumonia.
 During congestion, the body will experience vascular
engorgement, intra-alveolar fluid .
 The lungs will be very heavy and red.
 Capillaries in the alveolar walls become congested and
the infection will spread to the hilum and pleura.
 During this stage, a person will experience coughing
and deep breathing.

37.  Red Hepatization
• Occurs in the 2-3 days after consolidation
• At this point, the consistency of the lungs
resembles that of the liver
• The lungs become hyperemic
• Alveolar capillaries are engorged with blood
• Fibrinous exudates fill the alveoli
• This stage is "characterized by the presence
of many erythrocytes, neutrophils,
desquamated epithelial cells, and fibrin within
the alveoli

38. Grey Hepatization
• Occurs in the 2-3 days after Red Hepatization
• This is an avascular stage
• The lung appears "grey-brown to yellow
because of fibrinopurulent exudates,
disintegration of red cells, and hemosiderin"
• The pressure of the exudates in the alveoli
causes compression of the capillaries
• "Leukocytes migrate into the congested
alveoli"

39. Resolution
• This stage is characterized by the "resorption
and restoration of the pulmonary
architecture"
• A large number of macrophages enter the
alveolar spaces
• Phagocytosis of the bacteria-laden leucocytes
occurs
• "Consolidation tissue re-aerates and the fluid
infiltrate causes sputum"
• "Fibrinous inflammation may extend to and
across the pleural space, causing a rub heard
by auscultation, and it may lead to resolution
or to organization and pleural adhesions

42. FREQUENT PATHOGENS WITH REFERENCE
TO AGE
AGE GROUP FREQUENT PATHOGENS
NEONATE[<3 week] Group B Streptococcus, E.COLI, Gram negative Bacilli,
Streptococcus pneumoniae, Hemophilus influenza typeB
3week – 3 month Respiratory syncytial virus , para influenza virus, adeno
virus, S. pneumonia, Chlamydia trachomatous
4 month- 4 year Respiratory syncytial virus, other respiratory viruses
(parainfluenza viruses, influenza viruses, adenovirus), S.
pneumoniae, H. influenzae (type b), Mycoplasma
pneumoniae, group A streptococcus
less then 5 year M. pneumoniae, S. pneumoniae, Chlamydophila pneumoniae,
H. influenzae (type b} influenza viruses, adenovirus, other
respiratory viruses, Legionella pneumophila

43. Clinical manifestation
SIGN SYMPTOMS
1. Fever with chills 1. NASAL FLARRING
2.Fast and difficult breathing 2. Chest retraction
3.Cough 3. Grunting and Stridor
4. Chest pain 4. Cyanosis
5. Abdominal pain 5. Tachypnea and Diminished
breath sound , wheeze, and
crackles sound
6. Excessive sleepiness 6. Hiccups

48. Diagnostic evaluation
1. Chest radiography- PA and lateral view
2 . Blood tests; Total and differential blood count, HB
3. Tests to identify organisms
 Microscopic examination
 Serological tests for bacteria and viruses
 Rapid antigen detection tests such as direct
fluorescent antibody test
 Polymerase chain reaction for mycobacterium
 Sputum Culture studies

49.  BRONCHOSCOPY
 PULSE OXIMETERY
 PLEURAL FLUID CULTURE
 ARTERIAL BLOOD GAS

51. LEOFFLERS SYNDROME CHEST XRAY

52. MANAGEMENT

53. PNEUMONIA SEVERITY ASSESSMENT
MILD SEVERE
INFANTS Temperature < 50 breaths/min Mild
recession
Taking full feeds
Temperature >38.5 C
RR > 70 breaths/min
Moderate to severe recession
Nasal Flaring, Cyanosis Intermittent
Apnea
Grunting Respirations
Not feeding
OLDER CHILDREN Temperature < 50 breaths/min Mild
breathlessness
No vomiting
Temperature >38.5 C
RR > 50 breaths/min
Severe difficulty in breathing Nasal
Flaring Cyanosis
Grunting Respirations
Signs of dehydration

55. INDICATION FOR ADMISSSION
1. Severe malnutrition
2. Immunodeficiency
3. Severe anaemia
4. disseminated infection, septicaemia and
shock
5. Decreased O2 saturation
8. Culture and sensitivity tests- result growth

56. NURSING MANGEMENT
OUTPATIENT DEPARTMENT
FOLLOWUP OF CHILD
ORAL COTRIMAXAZOLE OR AMOXICILLINE/CEPHALEXIL
FOR 5-7 DAYS
ASSESS FOR CLINICAL STATUS AND DETERIORATION OF
CHILD

57. INPATIENT DEPARTMENT
SPECIFIC
 - AZITHROMYCIN, CEPHALOSPORINS FOR
INFANTS BELOW 2 MONTHS *10 mg kgday
FOR 7 to 10 days.
- AMOXICILLINE, CEFITOXIME (CHILDREN MORE
THAN 2 MONTHS *40 mgkg FOR 10-14 DAYS.
- ERYTHROMYCIN, CLARIPHROMYCIN FOR 10
DAYS* 40mgkgday

58. SUPPORITIVE CARE
ANTIPYRATICS (PARACETAMOL 10-
15MG/KG/DOSE EVERY 4-6HRS.
 OXYGEN ADMINISTRATION (OXYGEN HOOD,
MASK, NASAL PRONGS)
 HYDRATION
 CHEST PHYSIOTHERAPY
 NUTRITION

59. NURSING CARE
 ASSESSEMENT OF A CHILD AND DETERMINE THE
CAUSATIVE ORGANISM.
 CONTROL OF FEVER
 MAINTAIN PATIENT AIRWAY
 PROVISION OF HIGH HUMIDIFIED OXYGEN.
 POSITIONING
 MONITOR RESPIRATORY STATUS AND VITAL SIGNS.

60.  PROMOTION OF REST
 PROVISION OF APPROPRIATE AND ADEQUATE
FLUID AND NUTRITION.
 SUPPORT AND EDUCATION TO PARENTS
 PREVENTION OF COMPLICATION
 EMPYEMA
 LUNG ABSCES

61. COMPLICATION
 Pleural effusion
 Empyema
 Parapneumonic effusions
 Lung abscess
 Pneumothorax
 Pneumatocele
 Respiratory Failure
 Activation of latent TB

62. PREVENTION

63. INCIDENCE RATE

66. NURSING Diagnosis
 INEFFECTIVE AIRWAY CLEARANCE RELATED TO ASPIRATION ,
INCREASED SPUTUM PRODUCTION AS EVIDENCE BY TACHYPNEA,
COUGH ,DECREASED BREATH SOUND,PURULENT SPUTUM.
 IMPAIRED GAS EXCHANGE RELATED TO FLUID FILLED ALVEOLI
EVIDENCE BY DYSPNEA TACHYCARDIA, HYPOTENSION
 INEFFECTIVE BREATHING PATTERN RELATED TO ALTERATION IN
OXYGEN AND CARBONDIOXIDE RATION ,DECREASED LUNG
EXPANSION EVIDENCE BY CYNOSIS.
 RISK FOR INFECTION RELATED TO INADEQUATE DEFENSE
MECHANISM.
 ACUTE PAIN RELATED TO INFLAMMATION OF LUNG PARENCHYMA AS
EVIDENCE BY DISTRACTION BEHAVIOUR AND CRY.

67. SUMMARIZATION
 DEFINE PNEUMONIA
 INCIDENCE OF PNEUMONIA
 CLASSIFICATION OF PPNEUMONIA
 ETIOLOGY OF PNEUMONIA
 CLINICAL MENIFESTATION OF PNEUMONIA
 DIAGNOSTIC EVALUATION
 MANAGEMENT OF PNEUMONIA
 PREVENTION OF PNEUMONIA