Pneumonia pathophysiology details ppt free

Pneumonia pathophysiology

1. College OF MEDICINE AND HEALTH SCIENCE DEPARTEMENT OF COMPREHSIVE NURSING SEMINAR ON PNEUMONIA IN CHILDREN Prepared by: C. Nursing Students(2016 E.C) 6/12/2016 E.C 1

2. PNEUMONIA IN CHILDREN OUTLINES Definition Epidemiology Etiology Risk factors Pathophysiology Classification Clinical Manifestation Diagnosis and Differential Diagnosis Treatment Prevention Complication Prepared by: C. Nursing Students(2016 E.C) 6/12/2016 E.C 2

3. D efinition Pneumonia is an acute inflammation of lung parenchyma (bronchioles, alveolar ducts and sacs and alveoli) that impairs gas exchange. Clinically, pneumonia may occur either as a primary disease or as a complication of another illness. 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 3

4. EPIDEMIOLOGY 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 . The incidence of pneumonia is more than 10-fold higher and the number of childhood-related deaths due to pneumonia 2000-fold higher, in developing than in developed countries. 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 4

5. E tiology Infectious Causes include: B acterial infection : pneumococcus, streptococcus, staphylococcus, hemophilusinfluenza V iral : respiratory syncytial virus (rsv) most common virus, influenza, chicken pox, measles viruses. F ungal infection or mycotic : moniliasis oral thrush, histoplasmosis. P arasitic : Non-infectious causes include: A spiration of food or gastric acid, F oreign bodies, H ydrocarbons , and lipoid substances, H ypersensitivity reactions, and D rug- or radiation-induced pneumonitis 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 5

6. Risk factors L ow birth weight M alnutrition L ack of breast feeding P assive smoking P oor socioeconomic status L arge family size O ver crowding F amily history of bronchitis O ut door and indoor air pollutions. 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 6

7. Pathophysiology Pneumonia occurs through invasion of the lower respiratory tract by pathogens. Infectious agents may be inhaled or aspirated directly into the lungs, invade respiratory epithelium and spread contiguously, or, less commonly, reach the lungs hematogenously. Viral inoculation is typically by droplet or fomite (e.g., influenza, respiratory syncytial virus), whereas bacterial pneumonia often follows colonization of the nasopharynx. 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 7

8. Pathophysiology (CONT..) Infection can result in injury or death of the respiratory epithelium, interstitial inflammation, or alveolar injury. The air space fills with exudate and WBCs, which disrupt oxygenation and cause air space collapse, with eventual ventilation-perfusion mismatch. 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 8

9. classification A. Morphological Classification 1. Lobar Pneumonia: - all or a large segment of one or more pulmonary lobes are involved. 2. Bronchopneumonia: - This begins in the terminal bronchioles , which become clogged with mucopurulent exudate to form consolidated patches in nearby lobules; also called lobular pneumonia. 3. Interstitial Pneumonia: - the inflammatory process is more or less confined with in the alveolar walls (interstitial) and the peribronchial and interlobular tissues 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 9

10. Classification (cont..) B. Based on Etiologic agent I. Typical pneumonia: usually is caused by any bacteria such as streptococcus II. Atypical pneumonia : usually is caused by virus, fungus, parasites or other unidentified microorganism C. Based on infectious causes Infections causes (like bacterial, virus, fungus and parasite) Non-infections causes (irritant gas, aspiration, forebode, etc) 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 10

11. Classification (cont..) D . Based on acquired site of infections I . Community-acquired pneumonia ( CAP )- pneumonia acquired outside of healthcare facilities or before 48 hours of hospital admission. II. Hospital-acquired ( nosocomial ) pneumonia ( HAP )-Pneumonia that develops after 48 hours of hospital admission, an individuals who are already hospitalized for other medical condition. 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 11

12. Classification (cont..) III. Ventilator-associated pneumonia ( VAP ): Pneumonia occurring in individuals who are on mechanical ventilation in intensive care units. IV. Aspiration pneumonia: is a type of lung infection that results from aspirations of stomach contents or saliva into your lungs 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 12

13. Classification (cont..) 8/12/2024 By Dawit T. 13 E. Classification based on severity Mild pneumonia Moderate pneumonia Severe pneumonia pneumonia with mild symptoms and minimal impact on daily activities. Mild cough, Low-grade fever Slight increase in respiratory rate Mild chest discomfort Normal or slightly decreased appetite Normal oxygen saturation levels(95-100 %) pneumonia that causes more significant symptoms and may require medical treatment. Persistent cough, may be moist and productive Moderate fever Increased respiratory rate ( fast breathing ) Chest pain and discomfort while breathing Decreased appetite Mild to moderate oxygen desaturation pneumonia with severe symptoms, requiring hospitalization and intensive medical care. Severe, persistent cough with thick sputum High grade fever Rapid and shallow breathing (severe tachypnea) Sever chest pain Severe loss of appetite Severe oxygen desaturation and cyanosis

14. CLINICAL MANIFASTATION H igh fever R espiratory distress R estlessness and air hunger. C yanosis G runting, flaring(nasal) R etraction of the supraclavicular(intercostal and subcostal areas) T achypnea (50 breaths/ minute), tachycardia. C ough D yspnea, anoxia. Vomiting(refusal of feeds). 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 15

15. Diagnosis History: cough, fever, sob, PE- I nspection : chest indwelling, nasal flaring, cyanosis P ercussion there may be localized dull ness A uscultation : crackles or wheezing. C hest x-ray- it is often performed to visualize the lungs and assess for areas of consolidation or inflammation B lood test- CBC, WBC, ESR, HCT S erological examination(blood culture) for cultural sensitivity (bacterial, viral.) 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 16

16. Differential diagnosis Tuberculosis Asthma Atelectasis Bronchiolitis Heart failure Sepsis Radiographically , pneumonia must be differentiated from lung trauma and contusion, hemorrhage, foreign body obstruction, and irritation from subdiaphragmatic inflammation . 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 17

17. MANAGEMENT Goals of management To treat/relief sign & symptoms To cure To prevent complications Supportive care Oxygen therapy If the child has fever (≥38.5 °C) give paracetamol . If wheeze is present, give a rapid-acting bronchodilator . Remove by gentle suction any thick secretions in the throat which the child cannot clear it . Rehydration 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 18

18. MANAGEMENT (CONT..) Outpatient Treatment Typical pneumonia Amoxicillin , oral (90 mg/kg/day in 2 doses) Alternative : oral amoxicillin with clavulanate (Augmentin 60mg/kg/day in 3 doses) Atypical pneumonia Azithromycin oral (10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2–5); Alternatives : oral clarithromycin (15 mg/kg/day in 2 doses for 7-14 days) or oral erythromycin (40 mg/kg/day in 4 doses) 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 19

19. MANAGEMENT (CONT…) In patient admission criteria Age < 6mo Respiratory distress Requires supplemental oxygen Dehydration Vomiting(can’t tolerate PO fluids and meds) Multiple lobar involvement Toxic appearance Immunocompromised No response to PO ABX tx Social/care issue 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 20

20. MANAGEMENT (CONT….) In patient treatment For Typical pneumonia Ampicillin or penicillin G ; ---first line drugs Alternatives: ceftriaxone or cefotaxime ; Addition of vancomycin or clindamycin for suspected MRSA For Atypical pneumonia Azithromycin Alternatives : clarithromycin or erythromycin ; doxycycline for children >7 years old; levofloxacin for children who cannot tolerate Azithromycin. 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 21

21. NURSING CARE Assessment of a child and determine the causative organism. Control of fever Maintain 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 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 22

22. Complications Pleural effusion Empyema Parapneumonic effusions Lung abscess Pneumothorax Pneumatocele Delayed Resolution Respiratory Failure Metastatic Septic lesions Activation of latent TB 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 23

23. Prevention Immunizations : for vaccine-preventable causes of pneumonia. Reducing the length of mechanical ventilation and using antibiotic treatment only when necessary can reduce ventilator-associated pneumonias. Hand washing before and after every patient contact and use of gloves for invasive procedures are important measures to prevent nosocomial transmission of infections. Hospital staff with respiratory illnesses or who are carriers of certain organisms, such as methicillin-resistant S. aureus, should use masks or be reassigned to non-patient care duties. 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 24

24. References Nelson Textbook of Pediatrics, 21th edition 2020 Pocket book of hospital care for children Second edition Standard treatment guidelines for general hospitals 2021 edition 6/12/2016 E.C Prepared by: C. Nursing Students(2016 E.C) 25

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