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Invalid login INTRODUCTION Pneumonia is an inflammation of the lungs caused by an infection. It is also called Pneumonitis or Bronchopneumonia. Pneumonia can be a serious threat to our health. Although pneumonia is a special concern for older adults and those with chronic illnesses, it can also strike young, healthy people as well. It is a common illness that affects thousands of people each year in the Philippines, thus, it remains an important cause of morbidity and mortality in the country. There are many kinds of pneumonia that range in seriousness from mild to life-threatening. In infectious pneumonia, bacteria, viruses, fungi or other organisms attack your lungs, leading to inflammation that makes it hard to breathe. Pneumonia can affect one or both lungs. In the young and healthy, early treatment with antibiotics can cure bacterial pneumonia. The drugs used to fight pneumonia are determined by the germ causing the pneumonia and the judgment of the doctor. Its best to do everything we can to prevent pneumonia, but if one do get sick, recognizing and treating the disease early offers the best chance for a full recovery. A case with a diagnosis of Pneumonia may catch ones attention, though the disease is just like an ordinary cough and fever, it can lead to death especially when no intervention or care is done. Since the case is a toddler, an appropriate care has to be done to make the patients recovery faster. Treating patients with pneumonia is necessary to prevent its spread to others and make them as another victim of this illness. ANATOMY AND PHYSIOLOGY The lungs constitute the largest organ in the respiratory system. They play an important role in respiration, or the process of providing the body with oxygen and releasing carbon dioxide. The lungs expand and contract up to 20 times per minute taking in and disposing of those gases. Air that is breathed in is filled with oxygen and goes to the trachea, which branches off into one of two bronchi. Each bronchus enters a lung. There are two lungs, one on each side of the

breastbone and protected by the ribs. Each lung is made up of lobes, or sections. There are three lobes in the right lung and two lobes in the left one. The lungs are cone shaped and made of elastic, spongy tissue. Within the lungs, the bronchi branch out into minute pathways that go through the lung tissue. The pathways are called bronchioles, and they end at microscopic air sacs called alveoli. The alveoli are surrounded by capillaries and provide oxygen for the blood in these vessels. The oxygenated blood is then pumped by the heart throughout the body. The alveoli also take in carbon dioxide, which is then exhaled from the body. Inhaling is due to contractions of the diaphragm and of muscles between the ribs. Exhaling results from relaxation of those muscles. Each lung is surrounded by a two-layered membrane, or the pleura, that under normal circumstances has a very, very small amount of fluid between the layers. The fluid allows the membranes to easily slide over each other during breathing. PATHOPHYSIOLOGY

Pneumonia is a serious infection or inflammation of your lungs. The air sacs in the lungs fill with pus and other liquid. Oxygen has trouble reaching your blood. If there is too little oxygen in your blood, y

our body cells cant work properly. Because of this and spreading infection through the body pneumonia can cause death. Pneumonia affects your lungs in two ways. Lobar pneumonia affects a section (lobe) of a lung. Bronchial pneumonia (or bronchopneumonia) affects patches throughout both lungs.

Bacteria are the most common cause of pneumonia. Of these, Streptococcus pneumoniae is the most common. Other pathogens include anaerobic bacteria, Staphylococcus aureus, Haemophilus influenzae, Chlamydia pneumoniae, C. psittaci, C. trachomatis, Moraxella (Branhamella) catarrhalis, Legionella pneumophila, Klebsiella pneumoniae, and other gram-negative bacilli. Major pulmonary pathogens in infants and children are viruses: respiratory syncytial virus, parainfluenza virus, and influenza A and B viruses. Among other agents are higher bacteria including Nocardia and Actinomyces sp; mycobacteria, including Mycobacterium tuberculosis and atypical strains; fungi, including Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, Cryptococcus neoformans, Aspergillus fumigatus, and Pneumocystis carinii; and rickettsiae, primarily Coxiella burnetii (Q fever). The usual mechanisms of spread are inhaling droplets small enough to reach the alveoli and aspirating secretions from the upper airways. Other means include hematogenous or lymphatic dissemination and direct spread from contiguous infections. Predisposing factors include upper respiratory viral infections, alcoholism, institutionalization, cigarette smoking, heart failure, chronic obstructive airway disease, age extremes, debility, immunocompromise (as in diabetes mellitus and chronic renal failure), compromised consciousness, dysphagia, and exposure to transmissible agents. Typical symptoms include cough, fever, and sputum production, usually developing over days and sometimes accompanied by pleurisy. Physical examination may detect tachypnea and signs of consolidation, such as crackles with bronchial breath sounds. This syndrome is commonly caused by bacteria, such as S. pneumoniae and H. influenzae. NURSING PROFILE a. Patients Profile Name: R.C.S.B. Age: 1 yr,1 mo. Weight:10 kgs Religion: Roman Catholic Mother: C.B. Address: Valenzuela City b. Chief Complaint: Fever Date of Admission: 1st admission Hospital Number: 060000086199

c. History of Present Illness 2 days PTA (+) cough (+) nasal congestion, watery to greenish (+) nasal discharge Tx: Disudrin OD Loviscol OD Few hrs PTA - (+) fever, Tmax= 39.3 C (+) difficulty of breathing (+) vomiting, 1 episode Tx: Paracetamol Sought consultation at ER: Rx=BPN, Salbutamol neb. IE: T = 38.3C, CR= 122s, RR= 30s (+) TPC SCE, (-) retractions, clear BS, (-) cyanosis, (-) edema d. Past Illness (-) asthma (-) allergies e. Family History PMHx: (+) asthma (mother) f. Activities of Daily Living Sleeping mostly at night and during afternoon Usually wakes up early in the morning (5AM) to be milkfed. Eats a lot (hotdogs, chicken, crackers, any food given to her)

Active, responsive BM (1-2 times a day) Urinates in her diaper (more than 4 times a day) Likes to play with those around her g. Review of Systems Neuromuscular: weakness of muscles Integumentary: (-) cyanosis Respiratory: tavhypnea; (+) DOB; (+) coarse crackles, (+) wheezes, Digestive: food aversion, vomits ingested milk

DRUG STUDY View NCP NURSING ACTIONS INDEPENDENT

positioning of the patient with head on mid line, with slight flexion rationale: to provide patent, unobstructed airway , maximum lung excursion auscultating patients chest rationale: to monitor for the presence of abnormal breath sounds provide chest and back clapping with vibration rationale: chest physiotheraphy facilitates the loosening of secretions

considering that the patient is an infant, and has developed a strong stranger anxiety as manifested by white coat syndrome , it is a nursing action to play with the patient. rationale: to establish rapport, and gain the patients trust

DEPENDENT

administer due medications as ordered by the physician, bronchodilators, anti pyretics and anti biotics rationale: bronchodilators decrease airway resistance, secondary to bronchoconstriction, anti pyretics alleviate fever, antibiotics fight infection placing patient on TPN prn rationale: to compensate for fluid and nutritional losses during vomiting

COLLABORATIVE

assist respiratory therapist in performing nebulization of the patient rationale: nebulization is a favourable route of administering bronchodilators and aid in expectorating secretions, hence patients breathing

PHYSICIANS ORDER SHEET 11/19/06 Admit patient to ROC under the service of Dr. Vitan secure consent for admission and management, TPR every shift then record. May have diet for age with strict aspiration precaution, IVF D5 0.3NaCl 500cc to run at 62-63mgtts/min.May give paracetamol 125mg 1supp/rectum if oral paracetamol is not tolerated. 11/20/06 For urinalysis, IVF to follow D5 0.3 NaCl 500 at SR (62-63mgtt/m Use zinacef brand of cefuroxine 750mg- given vial 375mg every 8hours, nebulize (Ventolin 1 nebule) every 6 hours, paracetamol drugs prn every 4hours (Temp 37.8). 11/21/06 Continue cefuroxine and nebulizer every 6 hours. May not reinsert IVF, revise Cefuroxine IV to Cefuroxine 500mg via deep Intramuscular BID,continue management. 11/22/06 Continue management and refer. DISCHARGE PLANNING

Take the entire course of any prescribed medications. After a patients temperature returns to normal, medication must be continued according to the doctors instructions, otherwise the pneumonia may recur. Relapses can be far more serious than the first attack. Get plenty of rest. Adequate rest is important to maintain progress toward full recovery and to avoid relapse. Drink lots of fluids, especially water. Liquids will keep patient from becoming dehydrated and help loosen mucus in the lungs. Keep all of follow-up appointments. Even though the patient feels better, his lungs may still be infected. Its important to have the doctor monitor his progress. Encourage the guardians to wash patients hands. The hands come in daily contact with germs that can cause pneumonia. These germs enter ones body when he touch his eyes or rub his nose. Washing hands thoroughly and often can help reduce the risk. Tell guardians to avoid exposing the patient to an environment with too much pollution (e.g. smoke). Smoking damages ones lungs natural defenses against respiratory infections. Give supportive treatment. Proper diet and oxygen to increase oxygen in the blood when needed. Protect others from infection. Try to stay away from anyone with a compromised immune system. When that isnt possible, a person can help protect others by wearing a face mask and always coughing into a tissue.

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Pneumonia Symptoms After having symptoms of a mild upper respiratory tract infection, such as a runny nose and mild cough, children who develop pneumonia may have a sudden worsening and develop other symptoms, including:

worsening cough fever increased respiratory rate (tachypnea) retractions (labored breathing) wheezing (usually a sign of viral pneumonia) cyanosis decreased breath sounds crackles chest pain abdominal pain vomiting nasal flaring

Diagnosis of Pneumonia Most cases of pneumonia are diagnosed clinically, meaning that your Pediatrician makes the diagnosis after examining your child based on your child's symptoms and after a physical exam. When necessary, a chest xray and blood culture are also done. Other testing might including a complete blood count (CBC) and C-reactive protein (CRP). A pulse ox test to check your child's oxygen level is also sometimes done if your Pediatrician thinks that he has pneumonia, especially if he is having a lot of trouble breathing.

Testing for RSV, flu, and other viral causes of pneumonia can also be helpful when the tests are available. Sputum cultures are not as helpful in children as they are in adults, because they are hard to obtain. Pneumonia Treatments Antibiotics are the usual treatment when a child is suspected of having bacterial pneumonia. Treatments for other types of pneumonia will depend on the cause, although there is usually no specific treatment for most viral causes of pneumonia.

Abstract
Worldwide paediatricians advocate that children should be managed differently from adults. In this article, similarities and differences between children and adults related to cough are presented. Physiologically, the cough pathway is closely linked to the control of breathing (the central respiratory pattern generator). As respiratory control and associated reflexes undergo a maturation process, it is expected that the cough would likewise undergo developmental stages as well. Clinically, the 'big three' causes of chronic cough in adults (asthma, post-nasal drip and gastroesophageal reflux) are far less common causes of chronic cough in children. This has been repeatedly shown by different groups in both clinical and epidemiological studies. Therapeutically, some medications used empirically for cough in adults have little role in paediatrics. For example, anti-histamines (in particular H1 antagonists) recommended as a front-line empirical treatment of chronic cough in adults have no effect in paediatric cough. Instead it is associated with adverse reactions and toxicity. Similarly, codeine and its derivatives used widely for cough in adults are not efficacious in children and are contraindicated in young children. Corticosteroids, the other front-line empirical therapy recommended for adults, are also minimally (if at all) efficacious for treating non-specific cough in children. In summary, current data support that management guidelines for paediatric cough should be different to those in adults as the aetiological factors and treatment in children significantly differ to those in adults.

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Your name: Your email: Send Mail Bottom of Form Close Window Pneumonia in children Respiratory tract infections are very common in children. Occasionally these infections will develop into pneumonia (inflammation of the lungs). If your child has pneumonia, the signs of the disease and the symptoms they experience will depend on their age, the organism (i.e. type of bacteria or virus) that is causing the pneumonia, and the severity of the infection. Common signs of pneumonia include cough and rapid breathing. Your child may also show signs that they are having trouble breathing, including: flaring of the nostrils; grunting when breathing out; and using their abdominal and neck muscles when breathing. Other signs and symptoms of pneumonia may include a general feeling of being unwell, restlessness, irritability, fever and headache. Sometimes a child with pneumonia will develop abdominal pain, nausea and vomiting (especially after coughing). Chest pain may occur, but it is probably less common than in adults with pneumonia. Your doctor can make the diagnosis of pneumonia based on your childs symptoms, physical examination, and chest X-ray results. Bacterial pneumonia Pneumonia that is caused by a bacterial infection commonly affects one lobe (or section) of the lung. Bacterial pneumonia can affect children of any age, and can develop very quickly. It is most likely to be

associated with a very high fever and a cough that is productive of sputum (phlegm), although children tend to swallow sputum rather than cough it up. The most common type of bacteria responsible for bacterial pneumonia in children is Streptococcus pneumoniae (or pneumococcus), with toddlers being the most at risk. However, with the introduction of Prevenar a vaccine that protects against pneumococcus into the childhood immunisation schedule, the number of cases of pneumococcal pneumonia has dropped. A penicillin-based antibiotic is the standard treatment that doctors use for bacterial pneumonia. Viral pneumonia Pneumonia that is caused by a virus is probably the most common type of pneumonia affecting children of any age, although it tends to affect infants and preschool-aged children most frequently. Viruses tend not to confine themselves to a single lobe of the lungs, but have a more widespread, patchy effect. Symptoms can be more variable than with bacterial pneumonia, in terms of whether the illness comes on quickly or gradually, and whether or not there is an associated fever. Antibiotics will not help viral pneumonia. Usually children with viral pneumonia will get better by themselves over a period of time that can range from days to weeks. Most children will have a cough that lasts for some weeks after the infection. Mycoplasma pneumonia The organism known as Mycoplasma pneumoniae is one of the most common causes of pneumonia in school-aged children and young adults. It is rarely seen in infants and young children. It usually occurs in epidemics among confined groups, such as families and boarding schools. Classically, Mycoplasma pneumonia develops gradually, with symptoms such as a sore throat, cold, lowgrade fever and a general feeling of being unwell. Over the course of the infection, the cough tends to become worse and your child may develop shortness of breath. Your doctor can confirm the diagnosis with a chest X-ray and a blood test. Treatment usually involves antibiotics such as clarithromycin or roxithromycin.