DESCRIPTION OF PNEUMONIA SIGN AND SYMPTOMS CAUSE DIAGNOSIS AND MAGMENT

1. PNEUMONIA
Moderator
Ms.Remiya Mohan
Lecture CON
AIIMS, jodhpur Presenter
Maneesh
Msc (N) 1st
year

2. ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM
Nose Pharynx Larynx Trachea
Primary bronchi/Main bronchi(left and right)
Secondary bronchi/lobar bronchi
Tertiary bronchi/segmental bronchi
Sub segmental bronchioles
Terminal bronchioles
Respiratory bronchioles
Respiratory unit

3. PHYSIOLOGY
 Video

4. INTRODUCTION
 According to WHO (2015), Pneumonia in children is a
major concern in developing countries, because 1/3rd of
all hospital out patients comprise of acute respiratory
infection of which nearly 16% have pneumonia.
 It is the second leading cause of death in children less
than five years of age.
 While 99 percent of pneumonia-related deaths occur in
low- and middle-income countries.

5. DEFINITION:-
 Pneumonia is defined as acute inflammation and consolidation of
lungs parenchyma
CLASSIFICATION:-
 Classification on anatomical basis
 Lobar or lobular pneumonia:- one or more lobe of lungs are
involved
 Interstitial pneumonia:- interstitial tissue of lungs are affected
 Bronchopneumonia: - Patchy consolidation of lungs is known as
bronchopneumonia.

6. CONT...
 Classification on etiological basis
 Bacterial pneumonia:- it may cause by pneumococcus,
streptococcus, staphylococcus, hemophilus influenza etc.
 Viral pneumonia:- it is caused by viruses like influenza, measles,
adenovirus,
 Fungal pneumonia: - it may be caused by histoplasmosis and
cocci diomycosis.
 Protozoal pneumonia:- it is caused by pneumocystis carnii,
toxoplasma gondii and entamoeba histolytica

7. PATHOPHYSIOLOGY
Due to etiological factors (bacteria, virus, fungus, protozoa etc.)
Bacteria/virus enter into the lungs
Within the alveoli bacteria/virus multiply and disturbed the defense
mechanism of lung
Gross alteration in properties of normal lungs and neutrophils are
active and cause inflammation and infiltration occur(stage of
filtration)
Lungs became dark bluish red and heavy

8. CONT....
The affected lobe becomes solid with red cells and fibrin and air
displaced (red hepatization)
The pleural surface becomes dull in color and alveoli are filled with
leukocyte and fibrin(grey hepatization)
Consolidation
(due to invading organism produce inflammation in mucosa with
exudation in alveoli)

9. CLINICAL MANIFESTATION
 High grade fever
 Cough – unproductive to productive with white sputum
 Tachypnea – increase respiratory rate
 Breath sounds – crackle/ rales , Ronchi ,wheezing
 Rhinorrhea
 Sore throat
 Retraction- image video
 Nasal flaring- video
 Pallor to cyanosis ( depend upon severity )
 Behavior – irritability, restlessness, malaise, lethargy
 Gastrointestinal – anorexia, vomiting, diarrhoea, abdominal pain

10. DIAGNOSIS
 Physical examination
 History of the child reveals presence of cough with increased
respiration
 Chest X-ray-image
 Diagnosis is confirmed by isolating the organism in blood or from
pleural fluid or bronchoalveolar levage fluid.
 Isolation of organism from nasopharynx or throat by culture PCR in
viral pneumonia
 Blood test :- increase TLC count and DLC(Neutrophil, lymphocyte,
monocyte, eosinophill and basophill)
 ESR increase

11. MANAGEMENT
 PHARMACOLOGICAL MANAGEMENT
 Antibiotics
 Penicillin(DOC)
 Amoxicillin and clavulanic acid-100mg/kg, IV/PO, OD/TDS
 Vancomycine – 50mg/kg/day , IV divided-BD/TDS/QID doses
 Cefriaxon - 80mg/kg/day, OD/BD, IV
 Linezoid -30mg/kg/day, PO/IV,BD/TDS
 Mycoplasma - Microlides including-
 Azithromycin – 10mg/kg/OD - PO
 Erythromycin – 50mg/kg/day – PO/IV
 For viruses - Oseltamavir
 For pyrexia – Paracetamole
 Neubulization with asthaline and budisonide
 Symptomatic treatment

12. NURSING MANAGEMENT
 Make continuing assessment.
 Monitor the respiratory rate and pattern.
 Monitor breath sounds to note presence of rales, Ronchi and
wheezing
 Observe for sign of respiratory distress.
 facilitate respiratory effort
 Maintain patent airway and provide high humidity atmosphere
 Administer oxygen to maintain the oxygen saturation in blood
 Place the child in semi-fowler position to help in breathing
 In case of unilateral pneumonia, make the child lie on affected
side, to splint the chest wall and prevent painful pleural rubbing

13. CONT...
 Keep the child warm and comfortable
 Administer cough suppressants and bronchodilators, as
prescribed
 Provide steam inhalation and chest physiotherapy to help in
drainage of secretions
 If the child is old enough, teach him effective coughing and deep
breathing.
 Give increased amount of fluids as this will help in liquefying
the thick tenacious secretions

14. CONT...
 Control fever
 Provide bed rest to child.
 Administer the prescribed antibiotics and antipyretics.
 Tepid sponging is done to reduce fever.
 Increase the fluid intake to prevent dehydration.
 Maintain fluid and electrolyte balance along with nutritional status
of the child
 Provide adquant fluids.
 If the child’s having breathing difficulty, do not give anything
orally.
 When oral feeding are started, after the child’s condition permits,
feed the child slowly and carefully to prevent aspiration.
 Give high calorie liquid diet to the child.

15. CONT...
 Promote rest and sleep
 Provide diversion therapy to child to avoid boredom.
 Administer mild sedatives (if prescribed) when the child is restless or
irritable.
 Make the baby lie on affected side, to splint the chest wall and reduce
pleural pain.
 Administer cough suppressants.

16. COMPLICATION
 Pleural effusion
 Emphysema
 Bronchiectasis
PREVENTION
In February 2010, a 13-valent pneumococcal conjugate vaccine
(PCV13) was approved for use in children ages 6 weeks to 71
months to protect against 13 pneumococcal serotypes.

17. NURSING DIAGNOSIS
 Ineffective Airway Clearance related to Tracheal bronchial
inflammation, edema formation, increased sputum production,
evidence by Changes in rate, depth of respirations and cough.
 Intervention
 Assess the rate and depth of respiration and chest movement
 Elevate head of bed, change position frequently
 Encourage patient for deep breathing
 Provide IV fluid
 Neubulization
 Sectioning

18. CONT...
 Impaired Gas Exchange related to Alveolar-capillary membrane
changes (inflammatory effects) evidence by dyspnea, cyanosis
tachycardia
 Intervention
 Observe color of skin, mucous membranes, and nail beds, noting
presence of peripheral cyanosis (nail beds) or central cyanosis
(circumoral).
 Assess vital sign
 Administer oxygen therapy
 Maintain bed rest.
 Encourage use of relaxation techniques and diversional
activities.
 Elevate head, frequent position change, and encourage for deep
breathing, and effective coughing.

19.  Risk for Deficient Fluid Volume related to Excessive fluid loss
(fever, profuse diaphoresis, hyperventilation, vomiting), evidence
by decreased oral intake
 Intervention
 Assess vital sing changes :increasing temperature, prolonged
fever ,tachycardia
 Assess skin turgor, moisture of mucous membranes.
 Assess I/O Chart
 Administer IV fluid
 Administer medication (antiemetic ,antipyretic)

20. CONT...
 Ineffective breathing pattern related to presence of tracheo-
bronchial secretions and nasal secretions evidence by dyspnea,
Tachypnea
 Intervention
 Assess vital sing changes
 Instruct patient to increase oral fluid intake.
 Instruct patient to do deep breathing exercise.
 Keep environment allergen free (dust, feather pillows, smoke,
pollen).
 Suctioning.
 Position the patient in semi fowler’s position.
 Encourage patient to eat nutritious foods such as green leafy
vegetables and lean meat.

21.  Hyperthermia related to presence of microorganism in the body
evidence by increase body temperature more than normal.
 Intervention
 Assess vital sing
 Loose the cloths
 Provide tepid sponge bath
 Increase fluid intake orally or IV as ordered
 Measure intake output
 Administer medication (antipyretic, antibiotics)

22. CONCLUSION
 Pneumonia is the inflammation of the pulmonary parenchyma, is
common in childhood but occurs more frequently in early
childhood. The causative agent is either inhaled into the lungs
directly or comes from the bloodstream and second common cause
of under five mortality. It is preventable disease.

23. RECENT UPDATES
1.Effectiveness of β-Latam Monotherapy vs Macrolide
Combination Therapy for Children Hospitalized With
Pneumonia
(November 1, 2017)
 A combination of two antibiotics is often prescribed to treat
community-acquired pneumonia in children but a study is now
showing that using just one of the two has the same benefit to
patients in most cases.

24. CONT.....
2. Bacterial pneumonia far more dangerous to the heart than viral
pneumonia (November 12, 2018)
 Heart complications in patients diagnosed with bacterial pneumonia
are more serious than in patients diagnosed with viral pneumonia,
according to new research from the Intermountain Heart Institute at
Intermountain Medical Center in Salt Lake City.
 Intermountain Medical Center. "Bacterial pneumonia far more
dangerous to the heart than viral pneumonia." ScienceDaily.
ScienceDaily, 12 November 2018.
<www.sciencedaily.com/releases/2018/11/181112082436.htm>.