bronchophneumonia

1. BRONCHOPNEUMONIA

2. INTRODUCTION
Pneumonia is the leading infectious cause of death in children worldwide, accounting for
for 15% of all deaths of children under five years old.
DEFINITION
 It is a inflammatory process involving lung parenchyma “Indian Academy of Pediatrics”
 It is a inflammation with consolidation (it is a state of being solid with exudate) of
parenchymal cells of the lung. “Marlow – Redding”

3. INCIDENCE
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
World Health
Organization.
In India, the
casualty is as
high as 3 to 4
lakh children.

4. CLASSIFICATION
• Lobar pneumonia
• Interstitial pneumonia
• Bronchopneumonia
Based on
anatomy
• Infective: Bacterial, atypical, and viral pneumonia
• No infective: Chemical, aspiration pneumonia
Based on etiology

5. • Community acquired pneumonia (CAP)
• Hospital acquired pneumonia (HAP)
• Opportunistic pneumonia
Based on source
of infection:
Classification according to WHO:
• No pneumonia: Cough or cold, no fast breathing, chest indrawing or indicators of
severe illness.
• Pneumonia: Increased respiratory rate - <2 mo. old: > 60 per minute, 2-12 mo. old >
50, per minute 12-60 months old> 40 per minute
• Severe pneumonia: Chest in drawing
• Very severe pneumonia: cyanosis, severe chest indrawing, inability to feed

6. ETIOLOGY
Bacterial
Viral
Atypical
Others: Aspiration of food, oily
nasal drops, kerosene poisoning

7. PATHOPHYSIOLOGY
Pneumonia is characterized by inflammation of the alveoli and terminal airspaces in response to invasion by
an infectious agent introduced into the lungs through hematogenous spread or inhalation.
The inflammatory cascade triggers the leakage of plasma and the loss of surfactant, resulting in air loss and
consolidation. The breach in pulmonary defence mechanism leads to reactive edema with more
proliferation of organism
In bronchopneumonia, a patchy consolidation involving one or more lobes occurs and the neutrophilic
exudate it centered in bronchi and bronchioles, with centrifugal spread to the adjacent alveoli
Viral pneumonias are characterized by the accumulation of mononuclear cells in the submucosa and
perivascular space, resulting in partial obstruction of the airway. In staphylococcal pneumonia, abscess
erodes the walls of the bronchi and cavities of the abscess are filled with trapped air and thus
pneumatoceles are formed,

8. CLINICAL
FEATURES
Cough
Fever
Signs of respiratory distress:
Chest pain
Abdominal pain.
Headache
Signs of severe pneumonia differ with age
comprise of temperature 38.5°C
On auscultation, crackles, bronchial breath
sounds and diminished breath sounds.
INVESTIGATIONS
Chest X-ray - Lobar consolidation
Total and differential blood counts and
hemoglobin
Sputum gram staining and culture
Blood culture
Serological tests for bacteria and
viruses
Urinary antigen tests
Polymerase chain reaction

9. • Give appropriate antibiotic for 5
days.
• Non-severe pneumonia is treated
with a 5-day course of either oral
cotrimoxazole or amoxicillin
• In severe pneumonia give first
dose of IV or intramuscular
chloramphenicol (40 mg/kg).
• Intramuscular antibiotic for pre-
referral use include ampicillin plus
gentamicin combination, or
TREATMENT
Treatment according to
specific organism
Pneumococcal pneumonia:
Streptococcal pneumonia:
Staphylococcal pneumonia:
Hemophilus pneumonia:.
Viral pneumonia: Ribavirin is

10. Supportive measures
Hospitalized hypoxemic children should be given oxygen to maintain
oxygen saturation >92%.
Dehydrated children should be provided adequate amount of oral fluids
and if unable administer IV fluids,
Electrolytes and creatinine serum levels should be measured on daily basis.
Fever management with paracetamol.
Empyema is managed with closed drainage with indwelling intercostals
tube.
Good nutrition is ensured.

11. COMPLICATIONS
• Empyema
• Pleural effusion
• Lung abscess
• Necrotising
pneumonia
NURSING MANAGEMENT
Assessmen
t
Respiratory status: Tachypnea, retractions,
labored breathing, nasal flaring, crackles, chest
indrawing, diminished brenth sounds
Cough with or without sputum
Vital signs
Pulse oximetry and ABG
Signs of dehydration

12. NURSING
DIAGNOSIS
Ineffective airway clearance related to increased mucous production
Impaired gas exchange related to ventilation perfusion mismatch
Ineffective breathing pattern related to pulmonary congestion
Imbalanced body temperature related to pulmonary infection
Risk for fluid volume deficit related to effect of pulmonary inflammation,
Acute pain related to coughing, secondary disease condition
Deficient knowledge related to disease process and home care
Anxiety (parental) related to child's problem and hospitalization

13. Goal
• Child will exhibit no signs of abnormal respiration.
• Child will have clear airways as evidenced by absence of abnormal
breath sounds and thick secretions.
• Child will maintain adequate gas exchange as evidenced by
adequate oxygen saturation and improved nail bed color.
• Child will maintain normal body temperature.
• Child will exhibit no signs of dehydration
• Child will have decreased pain as evidenced by less irritability and
verbalization of increased comfort.
• The parents will express confidence in home care of the child
• The parents will verbalize relief of anxiety.

14. Interventions
Facilitation of Respiration
• Assess respiratory rate, breathing pattern frequently
• Monitor oxygen saturation by pulse oximetry.
• Clear the airway by suctioning if indicated.
• Administer cough expectorant or mucolytics as prescribed
• Provide nebulisation with or without bronchodilator to clear the
airway
• Provide propped up position or position of comfort to the child and
change the position every 2 hourly to promote pulmonary drainage.
• Encourage coughing and deep breathing if child is cooperative
• Administer humidified oxygen if needed.
• Infants can be avoided oral feeding to prevent aspiration.

15. Maintenance of body temperature and
pam relief
Administer antipyretics,
analgesics as prescribed
Promote adequate rest
periods
Use diversional therapies
Provide comfortable position
with extra pillows
Maintain quiet and cool
environment
Restrict visitors to provide
rest and prevent cross
infection

16. Maintenance of fluid volume
Provide oral or IV fluids as ordered
Monitor intake output daily
Observe for signs of dehydration and poor tissue perfusion
Monitor weight daily
Parental education and relief of anxiety:
Provide all necessary information regarding disease process,
treatment, and outcome to parents.
Encourage questions regarding child care.
Involve in child care and encourage staying with the child.
Inform about home management of the child.

17. Expected Outcome
• The child maintains normal respiration and adequate gas
exchange
• The child exhibits no signs of fever
• The child maintains normal fluid volume and no dehydration
• The child verbalizes less pain.
• The parents exhibit confidence in child care and less anxiety.