Pneumonia BNS Nursing .pptx

It's an teaching learning practicum slideshare of pneumonia. Prepared by samikshya banjara from CMC BNS 14th batch.

1. PNEUMONIA Presented By: Student Teacher Samikshya Banjara BNS 14 th Batch

2. General Objective At the end of the session, the students will be able to explain about “ Pneumonia ”

3. Specific Objective At the end of the session students will be able to i ntroduce pneumonia d efinition of pneumonia list the incidence of pneumonia state the types of pneumonia l ist the risk factors of pneumonia l ist the causes of pneumonia

4. Contd.. - explain the pathophysiology of pneumonia - list the clinical features of pneumonia - list the diagnostic procedure - explain the management of pneumonia -Medical -Nursing -CB-IMNCI - list the complications of pneumonia

5. Introduction Pneumonia is the inflammation of the lung parenchyma that is most often caused by infection with bacteria, viruses, or other organisms. Occasionally, inhaled chemicals that irritate the lungs can cause pneumonia.

6. Definition Pneumonia is an infection of the lower respiratory tract that involves the airways and parenchyma with consolidation of the alveolar space.

7. Incidence Incidence of pneumonia at the National Level was 45 per 1000 in under five children. DOHS, Annual Report 2077/78

8. Types According to anatomical distribution -Lobar Pneumonia -Broncho Pneumonia or lobular pneumonia -Interstitial Pneumonia

9. Bronchopneumonia Lobar pneumonia

10. Contd.. 2 . According to etiological distribution -Viral -Bacterial -Mycoplasma Pneumonia/ Atypical -Protozoal -Fungal

11. Contd.. 3 . According to type and course: - Community Acquired Pneumonia (CAP) - Hospital Acquired Pneumonia (HAP) - Ventilator Associated Pneumonia (VAP) - Aspiration Pneumonia

12. Ventilator Associated Pneumonia

13. Contd.. 4. According to duration: - Persistent - Recurrent Pneumonia

14. Contd.. 5. According to severity of infection (WHO): - No Pneumonia - Pneumonia - Severe Pneumonia - Very Severe Pneumonia

15. Risk factors Low birth weight Vitamin Deficiency Lack of breast feeding Passive smoking Poor socioeconomic status Large family size

16. Contd.. Gastroesophageal reflux Immunocompromised status Anatomical abnormalities of respiratory tract

17. Gastro Esophageal Reflux Disease

18. Causes Bacterial Causes : Streptococcus penumoniae , Hemophilus influenzae , streptococcus, staphylococcus, E.coli. Viral Cause : Respiratory syncytial virus(RSV) Mycoplasma : Mycoplasma pneumoniae

19. Contd.. Fungal: Candidiasis, histoplasmosis, coccidiomycosis . Protozoal : Pneumocystis carinii , Toxoplasmosis gondi , Entamoeba Histolytica . Others : Aspiration Pneumoniae

20. PATHOPHYSIOLOGY

21. Pathophysiology Invasion of organism to lower respiratory tract via inhalation, aspiration or hematogenous spread. Inflammatory response initiated in the alveoli characterized by exudation of WBC and neutrophils migrate into the alveoli.

22. Contd.. Alveolar edema with filling of serous exudate (Consolidation ) Interfere with the diffusion of oxygen and co2 and occulsion of alveoli resulting in decrease alveolar oxygen tension.

23. Contd.. Hypoxia occurs, with retention of Co2 Shortness of breath, fatigue, crackles in lungs, chest pain or decrease breath sounds.

24. CLINICAL FEATURES Chest retraction Chest in-drawing Nasal flaring Crackles sound over affected area d ifficulty in breathing. Cyanosis / Pallor may be present Cough : Unproductive to productive Dullness on percussion over affected area.

25. Chest Retraction Chest In-drawing

26. Nasal Flaring

27. Cyanosis

28. Contd.. Unequal chest expansion Pleuritic Chest Pain Hypoxemia Tachypnea Difficulty in breathing Irritability, restlessness, fatigue. Fever (>101°F)/, chills and sweating Nausea, Vomiting

29. Diagnostic Procedure History Taking Physical Examination INVESTIGATIONS Chest X-ray Complete Blood Count Sputum culture Arterial Blood Gas(ABG) analysis Positive Anti- Streptolycin O titer.

30. Chest X-ray of pneumonia

31. Medical Management Medical Management : Give antimicrobial therapy as prescribed. Provide humidified oxygen as needed. Provide antipyretic and analgesic if indicated. Provide bronchodilator as prescribed. Provide chest physiotherapy .

32. Contd.. Suction as needed Keep the patient in semi- fowler’s position Nothing given per oral during acute phase of dyspnea. Maintain intake and output. Encourage to drink plenty of fluids . Provide frequent small amount of foods.

33. B. Nursing Assessment History of present complaints Previous illness and associated symptoms General condition of the child Vital signs and oxygen saturation Physical Examination Other diagnostic investigations

34. C. Nursing Diagnosis Ineffective airway clearance related to increased mucus production. Ineffective breathing pattern related to decreased lung expansion Activity intolerance related to compromised pulmonary function resulting in shortness of breath.

35. Contd.. Hyperthermia related to invasion of microorganism. Risk for imbalance nutrition : less than body requirement related to decrease appetite.

36. D. Nursing Intervention To maintain patent airway and minimize respiratory difficulties : -Administer oxygen as needed -Change the position frequently -Keep the child warm and comfortable - Suction as needed -Provide chest physiotherapy -Nothing per oral during acute phase of dyspnea

37. Contd.. 2. To promote rest and comfort -Provide oxygen as per needed -Keep the child in semi-fowler’s position -Encourage the presence of parents. -Avoid unnecessary procedure. -Provide planned nursing care.

38. Contd.. 3. To control fever : -Provide open ventilate room -Monitor vital signs -Remove extra clothing -Provide tepid sponge bath as necessary -Encourage to take more fluids . -Give antibiotics and analgesics . -Reassess the condition.

39. Contd.. 4. Provide nutritional care: -Obtain the weight daily -Encourage to have breastfeeding and fluids -Administer intravenous infusion as needed -Maintain intake and output chart strictly -Maintain oral hygiene -Provide a high calorie, high protein diet consisting of soft, easy to eat.

40. Management of Pneumonia according to CB-IMNCI CBIMNCI is an integration of CBIMCI and CBNCP. It is an integrated approach to child that focuses on the wellbeing of under-five children.

41. Contd .. According to CB-IMNCI guideline, pneumonia is classified based on severity with specific treatment for each of them.

42. CB-IMNCI steps of case management Assessment Classification of illness Identify the treatment Treatment of the child or refer Counsel the mother Provide follow up care

43. The integrated case management process Assess and classify the sick child age 2 month up-to 5 years old. Ask the mother what the child’s problems are. Determine if this is initial or follow up visit. If initial visit, assess the child as follow:

44. Check for the general danger sign Ask: Is the child able to drink or breastfeed? Does the child vomit everything? Has the child had convulsion? Look: Is the child is lethargic or unconscious?

45. Contd.. Then ask about the major symptoms. Does the child have cough or difficulty breathing? If yes, Ask: For how long? Look, listen and feel on calm child: Count the breath in one minute. Look for chest in-drawing. Look and listen for stridor. Look and listen for wheezing .

46. CB-IMNCI classification of pneumonia S IGNS CLASSIFY Any general danger sign Very severe pneumonia Stridor in calm child Severe Pneumonia Chest in- drawing Pneumonia Fast Breathing Age Rates <2 months >60 breaths/ minute 2-12 months > 50 breaths/ minute 12-59 months >40 breaths/ minute No sign of pneumonia or very severe disease No pneumonia: Cough or cold

47. TREATMENT A. No pneumonia Treat the child at home , give advice mother for home care. If wheezing present, give the salbutamol 3 times per day for 5 days. If Coughing is present for more than 14 days, refer to check-up.

48. Contd.. Relieve the throat pain and coughing by following : Continue breastfeeding Provide honey, holy basil leaves, ginger and lemon with lukewarm water Avoid harmful medicines such as codeine, atropine, antihistamine syrup.

49. Contd.. Give advice for when to return immediately Follow up in 5 days if not improving Return Immediately if the child is having any following sign If the child has: Signs No pneumonia: Cough or cold Fast Breathing Difficulty in breathing

50. Contd.. B . Pneumonia First line- Give amoxicillin BD for 5 days Second line- Ciprofloxacillin PO BD for 3 days - If wheezing is present, provide bronchodilator inhalation if available in clinic. Give salbutamol TDS for 5 days.

51. Contd.. Soothe the throat pain and treat cough. If coughing more than 14 days and frequent wheezing is present, can suspect TB or asthma. Refer to higher center for check-up. Give advice when to return immediately. Follow up in 3 days .

52. Contd.. C. Severe pneumonia -Give first dose of an appropriate antibiotic -Prevent hypoglycemia : -If the baby is able to breastfeed: Tell the mother to feed breast-milk. -If the baby is unable to breastfeed but able to drink: -Give expressed breast-milk upto 6 months baby

53. Contd.. Provide expressed breast-milk or cow or buffalo milk for more than 6 months baby. If not possible, give sugar water Give 30 - 50 ml milk or sugar water before referral to the child.  Preparation : 20 g or 4 teaspoon sugar dissolve in 200 ml clean water.

54. Contd.. If the child is unable to drink, If you are trained, provide 50 ml milk or sugar water via nasogastric tube. ( for neonate give 5 ml/kg ) Keep the baby warm Refer urgently to higher center .

55. Contd.. D. Very Severe Disease - Give diazepam if the convulsion is present . - If convulsion is not present, complete the assessment . - Prevent hypoglycemia. - Keep the baby warm. - Refer immediately to higher center.

56. COMPLICATIONS Acute Respiratory Distress Syndrome Lung abscess Septicemia Pleural effusion Empyema Respiratory failure

57. Assignment Write down the preventive measures of pneumonia.

58. References Department of Health Services, (2078). Annual Report Fiscal Year 2077/78, Government of Nepal, Ministry of Health and Population, Kathmandu. Department of Health Services, (2078). CB-IMNCI Treatment Chart Booklet, Government of Nepal, Ministry of Health and Population, Teku , Kathmandu. Dutta, P. (2010). Paeditric Nursing, 2nd edition: Jaypee brother's medical publishers (P).Ltd, New Delhi, India. Page no. 273-277 James, S.R. (2013). Nursing care of children, 4th edition: By Saunders an imprint of Elsevier. Page no. 503-504 Shrestha,T . (2012). Essential Child Health Nursing, 1st edition: Medhavi publication, Kathmandu, Nepal. Page no. 340-344 Upreti , K. (2071). Child Health Nursing, 4th editiom : Published by Ms. Hima Uprety , Chhetrapati , Kathmandu. Page no. 318-323