Pneumonia

Pneumonia is the infection of lung parenchyma. Its one of the common respiratory disease in children

1. PNEUMONIA BY: Mr.Ganesh V. Naik II year MSc (N) Pediatric Dept SDM Institute of Nursing Science’s Dharawad

2. INTRODUCTION Pneumonia is a form of acute respiratory infection that affects the lungs. Pneumonia accounts for 15% of all death of under five year age of children

3. DEFINITION Pneumonia is defined as acute inflammation and consolidation of lung parenchyma (i.e. alveoli rather than the bronchi)

4. Incidence 1/3 rd of all hospital out patients include respiratory tract infection of which nearly 30% have pneumonia It is second leading cause of death in children under five years of age

5. Classification Classification on anatomical basis Lobar or lobular pneumonia: One or more lobes of lungs are involved Interstial pneumonia: Interstial tissues of lungs are involved Bronchopneumonia : Patchy consolidation of lungs is known as bronchopneumonia

6. Cont… Classification on etiological basis Bacterial pneumonia : It may be caused by Pneumococcus , Streptococcus, Staphylococcus, Hemophilus influenzae and H.pertusis Viral pneumonia :It is caused by viruses like influenza, Measles, Adenovirus and Respiratory Syncytial Virus. Fungal pneumonia: It may be caused by histoplasmosis and Coccidiomycosis . Protozoal pneumonia:It is caused by Pneumocystitis carini , Entamoeba histolytica .

7. Cont… Miscellaneous types 1. Aspiration Pneumonia: It is caused by aspiration of food, nasal drops, amniotic fluid by newborn, water(drowning) and chemicals like kerosene oil etc. 2. Loffler’s pneumonia: In which eosinophils accumulate in the lungs in response to parasitic infection It may be caused by parasites like Ascaris lumbricoides .

8. Cont… 3. Hypersensitivity pnemonitis : It is an inflammation of alveoli within the lungs caused by hypersensitivity to inhaled dust 4. Hypostatic pneumonia: It results from collection of fluid in dorsal region of lungs and occurs especially in those confined to bed for long time( bedridden)

9. ETIOLOGY VIRUSES: Includes Adenovirus Rhinovirus Influenza virus Respiratory Syncytial Virus(RSV) Parainfluenza virus Bacterias : Includes Group B Streptococci Streptococcus pneumoniae Staphylococcus Upper respiratory tract infection

10. Cont…. People with weak immune system including people undergoing chemotherapy are more susceptible to pneumonia Self infection : Vomiting occurs and the person breathes in harmful bacteria contents from his own stomach developing pneumonia

11. PATHOPHYSIOLOGY Alteration in net bacterial lung resistance caused by either: Decreased bactericidal ability of the alveolar macrophages Extreme virulence of the bacteria Increased susceptibility of host to infection Acute inflammation occurs that caused excess water and plasma proteins go to the development areas of the lower lobes

12. CONT……. RBC’s fibrin and polymorphonuclear leukocytes infiltrate the alveoli Containment of the bacteria within the segments of pulmonary lobes by cellular recruitment Consolidation of leukocytes and fibrin within the affected area Stage of congestion Engorgement of alveolar spaces with fluid and

13. CONT….. The disease in number of RBC in the exudates is replaced by neutrophils which infiltrate the alveoli making the lung tissue to be solid and grayish in color Pneumonia

14. Cont… It includes 4 stages congestion red hepatization gray hepatization resolution

15. Congestion After the pneumococcus organism reaches the alveoli, there is an outpouring of fluids into alveoli. The organism multiplies in the serous fluid and infection spreads

16. Red hepatization The massive dilation of the capillaries and alveoli that are filled with this organism, neutrophils, RBC, and fibrin. The lung appears red and granular, similar to that of liver which is why the process is called hepatization .

17. Grey hepatization Blood flow decreases and leukocytes and fibrin consolidate in the affected part of lung.

18. Resolution Complete resolution and healing occurs if there is no complications. The exudates become lysed and is processed by macrophages. The normal lung tissue is restored and the persons gas exchange ability returns to normal.

19. Clinical features Early signs and symptoms Sudden onset of High fever with chills Cough with thick sputum Increased respiration rate Grunting respiration Nasal flaring Running nose Irritability Malaise Sore throat Anorexia

20. Cont….. Late signs and symptoms include: Drowsiness Inability to drink from mouth Chest indrawing Wheezing Hoarseness of voice Cyanosis Pleural pain which may be increased by deep breathing

21. DIAGNOSTIC EVALUATION History collection Physical examination Complete blood count: to check white blood cell count Arterial Blood Gas Pulse oximetry Sputum culture Bronchoscopic examination Chest X-ray- shows patchy consolidation Computed Tomography Scan of chest

22. Lobar pneumonia Lobarpneumonia

23. MANAGEMENT Therapeutic Management Antimicrobial therapy effective treatment Oral amoxicillin is used for infants and children younger than 5years Erythromycin is the drug of choice for older children Administration of antipyretics for fever Hospitalization is indicated when the pleural effusion or empyema accompanies disease and also for staphylococcal pneumoniae Oxygen may be required if the child is respiratory distress

24. PREVENTION Exclusive breastfeeding for first 6months of life. Weaning to solid foods after 6 months of age preferably with homemade foods. Avoidance of risk factors like overcrowded environment exposure to pollution and bottle feeding. Protection from malnutrition and supplementation of vitamin A and D. Optimum immunization with Diptheria , Pertusis -Tetanus(DPT), measles, Haemophilus influenzae ( Hib ), Pneumococcal vaccines at appropriate age.

25. Cont…. Two vaccines are available to prevent pneumococcal disease Pneumococcal Conjugate Vaccine(PCV) Pneumococcal Polysaccharide Vaccine( Pneumovax ) Pneumococcal Conjugate Vaccine(PCV) is recommended for all children <2years of age. This vaccine should be repeated every 5-7years of age.

26. COMPLICATIONS Pleural effusion Emphysema Bronchiectasis

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