Pneumonia in children

Swaroopa Beulah Perumalla

1. PNEUMONIA IN CHILDREN BY SWAROOPA MSc Nursing

2. 1. It is a inflammatory process involving lung parenchyma “Indian Academy of Pediatrics” 2. It is a inflammation with consolidation (it is a state of being solid with exudate) of parenchymal cells of the lung. “Marlow – Redding” DEFINITION

3. INCIDENCE Occurs most commonly in infants and young children 30% children are admitted because of pneumonia 90% of deaths in respiratory illnesses are due to pneumonia The condition kills an estimated 1.8 million children every year, according to World Health Organization . In India, the casualty is as high as 3 to 4 lakh children.

4. Classification 1. According to anatomical distribution ---Lobar pneumonia. --- Broncho pneumonia or lobular pneumonia ---Interstitial pneumonia

5. 2. ACCORDING TO ETIOLOGICAL DISTRIBUTION ---VIRAL ---BACTERIAL ---MICOPLASMA PNEUMONIA (PRIMARY ATYPICAL PNEUMONIA) 3.ACCORDING TO DURATION --- PERSISTENT ---RECURRENT PNEUMONIA. 4. ASPIRATION PNEUMONIA.

6. ETIOLOGY BACTERIAL INFECTION : PNEUMOCOCCUS, STREPTOCOCCUS, STEPHYLOCOCCUS, HEMOPHILUSINFLUENZA (TYPE B GRAME –VE ORAGNISM. VIRAL RESPIRATORY SYNCYTIAL VIRUS (RSV) MOST COMMON VIRUS, INFLUENZA, CHICKEN POX, MEASLES VIRUSES.

7. FUNGAL INFECTION OR MYCOTIC : MONILIASIS ORAL THRUSH, HISTOPLASMOSIS. OTHER CAUSES : ASPIRATION OF AMNIOTIC FLUID, FOOD, FOREIGN BODY, VOMITERS, CHEMICALS.

8. RISK FACTORS LOW BIRTH WEIGHT VITAMIN DEFICIENCY LACK OF BREAST FEEDING PASSIVE SMOKING POOR SOCIOECONOMIC STATUS LARGE FAMILY SIZE OVER CROWDING FAMILY HISTORY OF BRONCHITIS OUT DOOR AND INDOOR AIR POLLUTIONS.

9. THE ORGANISM REACH THE PHERIPARY OF THE LUNG AND CAUSE REACTIVE OEDEMA WHICH ENCOURAGES PROLIFERATION OF THE ORGANISMS. THE INVOLVED LOBE UNDERGOES CONSOLIDATION WITH POLYMORPHONUCLEAR LEUKOCYTES, FIBRIN, RBC, OEDEMA, FLUID AND PNEUMOCOCCI FILLING ALVEOLI . PATHOPHYSIOLOGY

10. THERE ARE 4 STAGES OF ILLNESS 1.REACTIVE EDEMA 2. RED HEPATISATION 3. GREY HEPATSATION 4. RESOLUTION

11. ☺ THERE IS ABRUPT ON SET OF HIGH FEVER WITH RESPIRATORY DISTRESS. RESTLESSNESS AND AIR HUNGER. ☺ CYANOSIS ☺ GRUNTING , FLARING (NAZAL) ☺ RETRACTION OF THE SUPRACLAVICULAR, INTERCOSTAL AND SUBCOSTAL AREAS. ☺ TACHYPNEA (50 BREATHS/ MINUTE) , TACHY CARDIA. ☺ COUGH APPEARS LATER. ☺ DYSPNEA, ANOXIA. ☺ VOMITINGS( REFUSAL OF FEEDS). CLINICAL MANIFESTATONS

12. DIAGNOSTIC EVALUATION: ---THE DIAGNOSIS IS MADE BY 4 METHODS OF PHYSICAL EXAMINATION ---INSPECTION OF RAPID RESPIRATION, DYSPNEA, CYANOSIS ---ON PERCUSSION THERE MAY BE LOCALIZED DULL NESS

13. ---AUSCULTATION REVEALS RONCHIAL BREATHING CRACKLING RAYS . ---SEROLOGICAL EXAMINATION FOR CULTURAL SENSITIVITY (BACTERIAL, VIRAL, IgG /IGM INSERUM. ---WBC COUNT IS ELIVATED UPTO MORE THAN 15000 CELLS . ---CBP FOR EVIDENCE OF SEPSIS.

14. NASOPHARYNGEAL FOR VIRAL ANTIGEN (CMV, ADENOVIRUS ) TUBERCULIN SKIN TEST TO RULE OUT TB ORGANISM CHEST X-RAY INVASIVE PROCEDURES - BRONCHOSCOPY - BRONCHOALVEORLAR LAVAGE - LUNG ASPIRATION - LUNG BIOPSY

15. OUT PATIENT MANAGEMENT - SUPPORTIVE CARE - FOLLOWUP OF CHILD - ORAL COTRIMAXAZOLE OR AMOXICILLINE/CEPHALEXIL FOR 5-7 DAYS - ASSESS FOR CLINICAL STATUS AND DETERIORATION OF CHILD. MEDICAL MANAGEMENT

16. INPATIENT MANAGEMENT SPECIFIC: AMPLICINE, SEPHALOSPORINS FOR INFANTS BELOW 2 MONTHS. AMOXICILLINE, CEFITOXIME (CHILDREN MORE THAN 2 MONTHS FOR 10-14 DAYS. ERYTHROMYCIN, CLARIPHROMYCIN FOR 10 DAYS.

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

18. ASSESSEMENT OF A CHILD AND DETERMINE THE CAUSATIVE ORGANISM. CONTROL OF FEVER MAINTAINE PATENT AIRWAY PROVISION OF HIGH HUMIDIFIED OXYGEN. POSITIONING MONITOR RESPIRATORY STATUS AND VITAL SIGNS. ADMINISTRATION OF ANTIBIOTICS PROMOTION OF REST PROVISION OF APPROPRIATE AND ADEQUATE FLUIDS AND NUTRITION SUPPORT AND EDUCATION TO PARENTS PREVENTION OF COMPLICATIONS NURSING CARE

19. EMPYEMA LUNG ABSCESS PNEUMOTHORAX PYOTHORAX SEPSIS PERICARDIAL EFFUSION COMPLICATIONS

20. INCREASED ORAL IN TAKE ADEQUATE BED REST FREQUENTLY CHECK TEMPERATURE PLACE THE CHILD IN SEMI FOWLER POSITION GIVE ANTIPYRETICS REGURAL FOLLOW-UPS. HOME CARE MANAGEMENT

21. PROGNOSIS DEPENDS ON NUTRITIONAL STATUS, AGE, TYPE OF PNEUMONIA, ADEQUACY OF TREATMENT STREPTOCOCCUS – GOOD WITH TREATMENT STAPHYLOCOCCAL – REQUIRED HOSPITALIZATION, MOTALITY RATE 10-30%. H.INFLUENZA OR VERY HIGH BECAUSE OF SEVEOUR COMPLICATIONS. RECOVERY FROM MYCOPLASMA PNEUMONIA MAY BE SLOW.

22. CONCLUSION