SORIANO, Perceline Aizle V.

BSN 2-D

SELF DIRECTED LEARNING

1. Pneumonia
What is Pneumonia?

Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are
made up of small sacs called alveoli, which fill with air when a healthy person breathes. When
an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing
painful and limits oxygen intake.

Causative Agents

 Streptococcus pneumoniae – the most common cause of bacterial pneumonia in children;

 Haemophilus influenzae type b (Hib) – the second most common cause of bacterial
pneumonia;
 respiratory syncytial virus is the most common viral cause of pneumonia;
 in infants infected with HIV, Pneumocystis jiroveci is one of the most common causes of
pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected infants.

Signs & Symptoms

In children under 5 years of age, who have cough and/or difficult breathing, with or without
fever, pneumonia is diagnosed by the presence of either fast breathing or lower chest wall
indrawing where their chest moves in or retracts during inhalation (in a healthy person, the chest
expands during inhalation). Wheezing is more common in viral infections. Very severely ill
infants may be unable to feed or drink and may also experience unconsciousness, hypothermia
and convulsions.

Cough, which may produce greenish, yellow or even bloody mucus. Fever, sweating and
shaking chills, Shortness of breath, Rapid, shallow breathing, Sharp or stabbing chest pain that
gets worse when you breathe deeply or cough, Loss of appetite, low energy, and fatigue, Nausea
and vomiting, especially in small children, Confusion, especially in older people

Management

 Children with fast breathing pneumonia with no chest indrawing or general danger sign
should be treated with oral amoxicillin: at least 40mg/kg/dose twice daily (80mg/kg/day)
for five days. In areas with low HIV prevalence, give amoxicillin for three days.
 Children with fast-breathing pneumonia who fail on first-line treatment with amoxicillin
should have the option of referral to a facility where there is appropriate second-line
treatment.
  Children age 2–59 months with chest indrawing pneumonia should be treated with oral
amoxicil- lin: at least 40mg/kg/dose twice daily for five days.

Treatment may include antibiotics for bacterial pneumonia. No good treatment is available
for most viral pneumonias. They often get better on their own. Flu-related pneumonia may
be treated with an antiviral medicine.

Other treatments can ease symptoms. They may include:

 Plenty of rest 

 Getting more fluids

 Cool mist humidifier in your child’s room

 Acetaminophen for fever and discomfort

 Medicine for cough

Some children may be treated in the hospital if they are having severe breathing problems.
While in the hospital, treatment may include:

 Antibiotics by IV (intravenous) or by mouth (oral) for bacterial infection

 IV fluids if your child is unable to drink well

 Oxygen therapy

 Frequent suctioning of your child’s nose and mouth to help get rid of thick mucus

 Breathing treatments, as ordered by your child’s health care provider

Nursing Interventions

 Assess the rate, rhythm, and depth of respiration, chest movement, and use of accessory
muscles.
 Assess cough effectiveness and productivity
 Auscultate lung fields, noting areas of decreased or absent airflow and adventitious
breath sounds: crackles, wheezes.
 Auscultate lung fields, noting areas of decreased or absent airflow and adventitious
breath sounds: crackles, wheezes.
Assess the patient’s hydration status.
Suction as indicated: frequent coughing, adventitious breath sounds, desaturation related
to airway secretions.
  Assist and monitor effects of nebulizer treatment and other respiratory physiotherapy:
incentive spirometer, IPPB, percussion, postural drainage.
Perform treatments between meals and limit fluids when appropriate.


 Assess respiratory symptoms. Symptoms of fever, chills, or night sweats in a patient

should be reported immediately to the nurse as these can be signs of bacterial pneumonia.
 Assess clinical manifestations. Respiratory assessment should further identify clinical
manifestations such as pleuritic pain, bradycardia, tachypnea, and fatigue, use of
accessory muscles for breathing, coughing, and purulent sputum.
 Physical assessment. Assess the changes in temperature and pulse; amount, odor, and
color of secretions; frequency and severity of cough; degree of tachypnea or shortness of
breath; and changes in the chest x-ray findings.
 Assessment in elderly patients. Assess elderly patients for altered mental
status, dehydration, unusual behavior, excessive fatigue, and concomitant heart failure.

How can you be a carrier of Pneumonia?

The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs
if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In
addition, pneumonia may spread through blood, especially during and shortly after birth. 

2. Malaria

What is Malaria?
Malaria is caused by Plasmodium parasites. The parasites are spread to people through the bites
of infected female Anopheles mosquitoes, called "malaria vectors." There are 5 parasite species
that cause malaria in humans, and 2 of these species – P. falciparum and P. vivax – pose the
greatest threat. It is an intermittent and remittent fever caused by a protozoan parasite that
invades the red blood cells. The parasite is transmitted by mosquitoes in many tropical and
subtropical regions.

Causative Agents
 Malaria is caused by single-celled protozoan parasites of the genus Plasmodium. Four species
infect humans by entering the bloodstream: Plasmodium falciparum, which is the main cause of
severe clinical malaria and death; Plasmodium vivax; Plasmodium ovale; and Plasmodium
malariae. 

Signs & Symptoms

Malaria symptoms usually appear six to 30 days after infection. Symptoms may take up to 12
months to show. The symptoms are similar to a terrible flu: 

 fever
 chills
 headache
  nausea
 vomiting
 diarrhea
 extreme weakness
 muscle aches
 pain in the abdomen, back and joints
 coughing
 confusion

Management

Oral paracetamol (acetaminophen) is safe and effective for fever and should be used in doses of
10 mg/kg. This dose can be repeated 3-6 times a day, as required. If the child has hyperpyrexia,
tepid sponging can rapidly bring the temperature down.
Many children with malaria develop anemia. Because the onset is gradual, children withstand a
low level of hemoglobin quite well and blood transfusions are rarely needed. Standard hematinic
therapy is effective.
Vomiting is common in malaria. An antiemetic such as domperidone can be used, and
antimalarials should be continued. Vomiting stops when the malaria is cured. If repeated
vomiting has led to dehydration, the child needs appropriate parenteral fluids to correct it.
Glucose-containing fluids help to counter the hypoglycemia that sometimes accompanies severe
malaria.

Nursing Interventions

• Ensure meticulous nursing care. This can be life- saving, especially for unconscious
patients. Maintain a clear airway. Nurse the patient in the lateral or semi-prone position to
avoid aspiration of fluid. If the patient is unconscious, insert a nasogastric tube and aspirate
the stomach contents to minimize the risk for aspiration pneumonia, which is a potentially
fatal complication that must be dealt with immediately.

 Turn the patient every 2h. Do not allow the patient to lie in a wet bed. Pay particular
attention to pressure points.

 Suspect raised intracranial pressure in patients with irregular respiration, abnormal

posturing, worsening coma, unequal or dilated pupils, elevated blood pressure and falling
heart rate, or papilloedema.

In all such cases, nurse the patient in a supine posture with the head of the bed raised.

 Keep a careful record of fluid intake and output. If this is not possible, weigh the patient
daily to calculate the approximate fluid balance. All patients who are unable to take oral
fluids should receive dextrose- containing maintenance fluids, unless contraindicated
(fluid overload), until they are able to drink and retain fluids. Check the speed of infusion
of fluids frequently: too fast or too slow an infusion can be dangerous.
  Monitor the temperature, pulse, respiration, blood pressure and level of consciousness
(use a paediatric scale for children and the Glasgow coma scale for adults; see Annex 5).
These observations should be made
at least every 4h until the patient is out of danger.

 Report deterioration of the level of consciousness, occurrence of convulsions or changes

in behaviour of the patient immediately. All such changes suggest developments that
require additional treatment.

 If the rectal temperature rises above 39°C, remove the patient’s clothes, give oral or rectal
paracetamol and make the child comfortable with tepid sponging and fanning.
 Note any appearance of red or black urine (haemoglobinuria). For all such patients,
determine the blood group, cross-match blood ready for transfusion if necessary and
increase the frequency of haematocrit assessment, as severe anaemia may develop
rapidly. In this situation, the haematocrit is a better measure than the haemoglobin
concentration, because the latter quantifies not only haemoglobin in red cells but also free
plasma haemoglobin.

3. Measles
What are Measles?
Measles is a highly contagious illness caused by a virus that replicates in the nose and throat of
an infected child or adult. Then, when someone with measles coughs, sneezes or talks, infected
droplets spray into the air, where other people can inhale them. It is an infectious viral disease
causing fever and a red rash on the skin, typically occurring in childhood.

The infected droplets may also land on a surface, where they remain active and contagious for
several hours. You can contract the virus by putting your fingers in your mouth or nose or
rubbing your eyes after touching the infected surface.

Causative Agent: Rubella virus

Signs & Symptoms

Measles signs and symptoms appear around 10 to 14 days after exposure to the virus. Signs and
symptoms of measles typically include:

 Fever

 Dry cough

 Runny nose

 Sore throat
  Inflamed eyes (conjunctivitis)

 Tiny white spots with bluish-white centers on a red background found inside the mouth
on the inner lining of the cheek — also called Koplik's spots

 A skin rash made up of large, flat blotches that often flow into one another

Management
The measles vaccine isn’t given to children until they’re at least 12 months old. Before receiving
their first dose of the vaccine is the time they’re most vulnerable to being infected with the
measles virus.

 Babies receive some protection from measles through passive immunity, which is
provided from mother to child through the placenta and during breastfeeding.

 acetaminophen (Tylenol) or ibuprofen (Advil) to reduce fever

 rest to help boost your immune system

 plenty of fluids

 a humidifier to ease a cough and sore throat

 vitamin A supplements

Nursing Interventions

Interventions for a child with measles are:

 If the child's temperature is high, they should be kept cool, but not too cold. Tylenol or
ibuprofen can help control fever, aches, and pains. Children under 16 years should not
take aspirin. A doctor will advise about acetaminophen dosage, as too much can harm the
child, especially the liver. There is an excellent selection online if you want to
buy Tylenolor ibuprofen.

 People should avoid smoking near the child.

 Sunglasses, keeping the lights dim or the room darkened may enhance comfort levels, as
measles increases sensitivity to light.
  If there is crustiness around the eyes, gently clean with a warm, damp cloth.

 Cough medicines will not relieve a measles cough. Humidifiers or placing a bowl of
water in the room may help. If the child is over 12 months, a glass of warm water with a
teaspoon of lemon juice and two teaspoons of honey may help. Do not give honey to
infants.

 A fever can lead to dehydration, so the child should drink plenty of fluids.

 A child who is in the contagious stage should stay away from school and avoid close
contact with others, especially those who are not immunized or have never had measles.

 Those with a vitamin A deficiency and children under 2 years who have measles may
benefit from vitamin A supplements. These can help prevent complications, but they
should only be taken with a doctor's agreement.

4. Diarrhea

What is Diarrhea?
Diarrhea is an increase in the frequency of bowel movements, as well as the water content and
volume of the waste. It may arise from a variety of factors, including malabsorption disorders,
increased secretion of fluid by the intestinal mucosa, and hypermotility of the intestine. It may
also due to infection, inflammatory bowel diseases, side effects of drugs, increased osmotic
loads, radiation, or increased intestinal motility.

Diarrhea can be an acute or a severe problem. Mild cases can be recovered in a few days.
However, severe diarrhea can lead to dehydration or severe nutritional problems. 

Causative Agents
Viruses
Viral gastroenteritis (often called the "stomach flu") is a common illness in children. It causes
diarrhea and, often, nausea and vomiting. The symptoms usually last a few days, but kids
(especially babies) who can't take enough liquids may become dehydrated.
Rotavirus affects babies and young kids and can bring on watery diarrhea. Outbreaks are more
common in the winter and early spring months, especially in childcare centers. The rotavirus
vaccine can protect children from this illness.
Enteroviruses, like coxsackievirus, also can cause diarrhea in kids, especially during the summer
months.
Bacteria
Many different types of bacteria can cause diarrhea, including E.
coli, Salmonella, Campylobacter, and Shigella. These bacteria are often responsible for cases of
"food poisoning," which can cause diarrhea and vomiting within a few hours after someone is
infected.

Parasites
Parasitic infections that can cause diarrhea in children include giardiasis and cryptosporidiosis.

Signs & Symptoms

 Abdominal cramps

 Loose watery stools

 Abdominal pain

 Fever

 Blood in the stool

 Mucus in the stool

 Bloating

 Nausea

 Urgent need to have a bowel movement

Management

Viral diarrhea goes away on its own. Most kids with bacterial diarrhea need treatment with an
antibiotic. Parasites always need treatment with anti-parasitic medicines.

Kids who aren't vomiting or becoming dehydrated can continue eating and drinking or
breastfeeding as usual. Continuing a regular diet may even shorten the diarrhea episode. You
may want to serve smaller portions of food until the diarrhea ends.

Don't give your child an over-the-counter anti-diarrhea medicine unless your doctor tells you to
do so.

Nursing Interventions
 Dehydration in children and toddlers can be a great concern. Loose stools are more common in
breastfed newborns than in formula-fed babies, so check with your doctor about to expect for
your child.

 Infants and toddlers pose special problems because of their increased risk of dehydration.

They should be offered a bottle frequently. Solutions such as Pedialyte may be more

appealing than water. These fluids also contain necessary electrolytes lost with diarrhea.

Never use salt tablets as they may worsen diarrhea.

 Children with frequent stools, fever, or vomiting should stay at home and avoid school

and day-care until these symptoms go away. This allows the child to rest and recover and

prevents other children from being exposed to possible infection.

 As mentioned previously, infants, toddlers, and children should be encouraged to follow

the BRAT diet (bananas, rice, applesauce, and toast). The BRAT diet (diarrhea diet) is a

combination of foods used for decades to treat diarrhea.

5. Dengue
What is Dengue?

Dengue is a mosquito-borne viral infection causing a severe flu-like illness and severe pain in the
joints and, sometimes causing a potentially lethal complication called severe dengue. 

Causative Agent

The Aedes aegypti mosquito is the main vector that transmits the viruses that cause dengue.
The viruses are passed on to humans through the bites of an infective female Aedes mosquito,
which mainly acquires the virus while feeding on the blood of an infected person.

Signs & Symptoms

 high fever, possibly as high as 105°F (40°C)

 pain behind the eyes and in the joints, muscles and/or bones
 severe headache
 rash over most of the body
 mild bleeding from the nose or gums
 bruising easily
Management
No specific treatment is available for dengue fever. Mild cases are managed with lots of fluids to
prevent dehydration and getting plenty of rest. Pain relievers with acetaminophen can ease the
headaches and pain associated with dengue fever. Pain relievers with aspirin or ibuprofen
should be avoided, as they can make bleeding more likely.

Most cases of dengue fever go away within a week or two and won't cause any lasting problems.
If someone has severe symptoms of the disease, or if symptoms get worse in the first day or two
after the fever goes away, seek immediate medical care. This could be an indication of DHF,
which is a medical emergency.

To treat severe cases of dengue fever at a hospital, doctors will give intravenous (IV) fluids and
electrolytes (salts) to replace those lost through vomiting or diarrhea. When started early, this is
usually enough to effectively treat the disease. In more advanced cases, doctors may have to do
a blood transfusion.

In all cases of dengue infection, efforts should be made to keep the infected person from being
bitten by mosquitoes. This will help prevent the illness from spreading to others.

Nursing Interventions
 Administration of antipyretic/ analgesics as indicated by the physician
 Close observation and intensive monitoring of vital signs especially blood pressure
 Early detection for signs of bleeding and immediate referral
 Use of Tourniquet test (Rumpel Leade test) to detect petechial hemorrhage 
 Rapid replacement of fluids: clients are encouraged to increase their fluid intakes as
much as possible if tolerated; In the community, ORS is given to halt moderate
dehydration at 75ml/ kg in 4 -6 hours or up  to 2- 3 liters in adults.
 Monitoring pain. Note client report of pain in specific areas, whether pain is increasing,
diffused, or localized.
 Vascular access. Maintain patency of vascular access for fluid administration or blood
replacement as indicated.
 Managing nose bleeds. Elevate position of the patient and apply ice bag to the bridge of
the nose and to the forehead.
 Trendelenburg position. Place the patient in Trendelenburg position to restore blood
volume to the head.

References:
 American Lung Association. (2020). Lungs & Diseaseshttps://www.lung.org/lung-health-
and-diseases/lung-disease-lookup/pneumonia/symptoms-and-diagnosis.html
Belleza, M. (2018). Measles Rubeola. Retrieved from https://nurseslabs.com/measles/
 Belleza, M. (2016). Dengue Hemorrhagic Feverhttps://nurseslabs.com/dengue-
hemorrhagic-fever/
 Toure, Y. (2020). Disease Watch Focus: Malaria. Retrieved from https://www.who.int
/tdr/publications/diseasewatch/malaria/en/
Valencia H. (2019). Everything you need to know about Measles. Retrieved from
https://www.healthline.com/health/measles#in-babies
Vera, M. (2017). 11 Pneumonia Nursing Care Plans. Retrieved from
https://nurseslabs.com/8-pneumonia-nursing-care-plans/
World Health Organization. (2014). WHO Revised Classification & Treatment of
childhood pneumonia at health facilities. Retrieved from
https://apps.who.int/iris/bitstream/handle/106
65/137319/9789241507813_eng.pdf;jsessionid=95C6150CE4667D91361117E5D6576A
8E?sequence=1
World Health Organization. (2019). Pneumonia. Retrieved from
https://www.who.int/news-room/fact-sheets/detail/pneumonia
 World Health Organization. (2012). Management of severe malaria: A Practical
Handbook 3rd Ed. Retrieved from
https://apps.who.int/medicinedocs/documents/s20170en/s20170en.pdf