It's an teaching learning practicum slideshare of pneumonia. Prepared by samikshya banjara from CMC BNS 14th batch.

2. PNEUMONIA
Presented By:
Student Teacher
Samikshya Banjara
BNS 14th Batch

3. General Objective
• At the end of the session, the students will be
able to explain about “Pneumonia”

4. Specific Objective
At the end of the session students will be able to
- introduce pneumonia
- definition of pneumonia
- list the incidence of pneumonia
- state the types of pneumonia
- list the risk factors of pneumonia
- list the causes of pneumonia

5. Contd..
- explain the pathophysiology of pneumonia
- list the clinical features of pneumonia
- list the diagnostic procedure
- explain the management of pneumonia
-Medical
-Nursing
-CB-IMNCI
- list the complications of pneumonia

7. Introduction
Pneumonia is the inflammation of the lung
parenchyma that is most often caused by
infection with bacteria, viruses, or other
organisms.
Occasionally, inhaled chemicals that irritate the
lungs can cause pneumonia.

9. Definition
Pneumonia is an infection of the lower
respiratory tract that involves the airways and
parenchyma with consolidation of the alveolar
space.

10. Incidence
Incidence of pneumonia at the National Level
was 45 per 1000 in under five children.
DOHS, Annual Report 2077/78

11. Types
1. According to anatomical distribution
-Lobar Pneumonia
-Broncho Pneumonia or lobular pneumonia
-Interstitial Pneumonia

12. Bronchopneumonia Lobar pneumonia

13. Contd..
2. According to etiological distribution
-Viral
-Bacterial
-Mycoplasma Pneumonia/ Atypical
-Protozoal
-Fungal

14. Contd..
3. According to type and course:
- Community Acquired Pneumonia (CAP)
- Hospital Acquired Pneumonia (HAP)
- Ventilator Associated Pneumonia (VAP)
- Aspiration Pneumonia

15. Ventilator Associated Pneumonia

16. Contd..
4. According to duration:
- Persistent
- Recurrent Pneumonia

17. Contd..
5. According to severity of infection (WHO):
- No Pneumonia
- Pneumonia
- Severe Pneumonia
- Very Severe Pneumonia

18. Risk factors
 Low birth weight
 Vitamin Deficiency
 Lack of breast feeding
 Passive smoking
 Poor socioeconomic status
 Large family size

19. Contd..
 Gastroesophageal reflux
 Immunocompromised status
 Anatomical abnormalities of respiratory tract

20. Gastro Esophageal Reflux Disease

21. Causes
• Bacterial Causes: Streptococcus penumoniae,
Hemophilus influenzae, streptococcus,
staphylococcus, E.coli.
• Viral Cause: Respiratory syncytial
virus(RSV)
• Mycoplasma : Mycoplasma pneumoniae

22. Contd..
• Fungal: Candidiasis, histoplasmosis,
coccidiomycosis.
• Protozoal : Pneumocystis carinii,
Toxoplasmosis gondi, Entamoeba Histolytica.
• Others: Aspiration Pneumoniae

23. PATHOPHYSIOLOGY

26. Pathophysiology
Invasion of organism to lower respiratory tract via
inhalation, aspiration or hematogenous spread.
Inflammatory response initiated in the alveoli
characterized by exudation of WBC and neutrophils
migrate into the alveoli.

27. Contd..
Alveolar edema with filling of serous exudate
(Consolidation)
Interfere with the diffusion of oxygen and co2 and
occulsion of alveoli resulting in decrease alveolar
oxygen tension.

28. Contd..
Hypoxia occurs, with retention of Co2
Shortness of breath, fatigue, crackles in lungs, chest
pain or decrease breath sounds.

29. CLINICAL FEATURES
• Chest retraction
• Chest in-drawing
• Nasal flaring
• Crackles sound over affected area difficulty in
breathing.
• Cyanosis/ Pallor may be present
• Cough : Unproductive to productive
• Dullness on percussion over affected area.

30. Chest Retraction Chest In-drawing

31. Nasal Flaring

32. Cyanosis

33. Contd..
• Unequal chest expansion
• Pleuritic Chest Pain
• Hypoxemia
• Tachypnea
• Difficulty in breathing
• Irritability, restlessness, fatigue.
• Fever(>101°F)/, chills and sweating
• Nausea, Vomiting

35. Diagnostic Procedure
 History Taking
 Physical Examination
INVESTIGATIONS
Chest X-ray
 Complete Blood Count
 Sputum culture
Arterial Blood Gas(ABG) analysis
 Positive Anti- Streptolycin O titer.

36. Chest X-ray of pneumonia

37. Medical Management
A. Medical Management:
 Give antimicrobial therapy as prescribed.
 Provide humidified oxygen as needed.
 Provide antipyretic and analgesic if indicated.
 Provide bronchodilator as prescribed.
 Provide chest physiotherapy.

38. Contd..
 Suction as needed
 Keep the patient in semi- fowler’s position
 Nothing given per oral during acute phase of
dyspnea.
 Maintain intake and output.
 Encourage to drink plenty of fluids.
 Provide frequent small amount of foods.

39. B. Nursing Assessment
 History of present complaints
 Previous illness and associated symptoms
 General condition of the child
 Vital signs and oxygen saturation
 Physical Examination
 Other diagnostic investigations

40. C. Nursing Diagnosis
 Ineffective airway clearance related to increased
mucus production.
 Ineffective breathing pattern related to
decreased lung expansion
 Activity intolerance related to compromised
pulmonary function resulting in shortness of
breath.

41. Contd..
 Hyperthermia related to invasion of
microorganism.
 Risk for imbalance nutrition: less than body
requirement related to decrease appetite.

42. D. Nursing Intervention
1. To maintain patent airway and minimize
respiratory difficulties:
-Administer oxygen as needed
-Change the position frequently
-Keep the child warm and comfortable
-Suction as needed
-Provide chest physiotherapy
-Nothing per oral during acute phase of
dyspnea

43. Contd..
2. To promote rest and comfort
-Provide oxygen as per needed
-Keep the child in semi-fowler’s position
-Encourage the presence of parents.
-Avoid unnecessary procedure.
-Provide planned nursing care.

44. Contd..
3. To control fever:
-Provide open ventilate room
-Monitor vital signs
-Remove extra clothing
-Provide tepid sponge bath as necessary
-Encourage to take more fluids.
-Give antibiotics and analgesics.
-Reassess the condition.

45. Contd..
4. Provide nutritional care:
-Obtain the weight daily
-Encourage to have breastfeeding and fluids
-Administer intravenous infusion as needed
-Maintain intake and output chart strictly
-Maintain oral hygiene
-Provide a high calorie, high protein diet
consisting of soft, easy to eat.

46. Management of Pneumonia
according to CB-IMNCI
• CBIMNCI is an integration of CBIMCI and
CBNCP.
• It is an integrated approach to child that
focuses on the wellbeing of under-five
children.

47. Contd..
• According to CB-IMNCI guideline,
pneumonia is classified based on severity
with specific treatment for each of them.

48. CB-IMNCI steps of case
management
1. Assessment
2. Classification of illness
3. Identify the treatment
4. Treatment of the child or refer
5. Counsel the mother
6. Provide follow up care

49. The integrated case management
process
• Assess and classify the sick child age 2 month
up-to 5 years old.
• Ask the mother what the child’s problems are.
• Determine if this is initial or follow up visit.
• If initial visit, assess the child as follow:

50. Check for the general danger sign
Ask:
• Is the child able to drink or breastfeed?
• Does the child vomit everything?
• Has the child had convulsion?
Look:
• Is the child is lethargic or unconscious?

51. Contd..
Then ask about the major symptoms.
• Does the child have cough or difficulty breathing?
If yes, Ask:
• For how long?
Look, listen and feel on calm child:
• Count the breath in one minute.
• Look for chest in-drawing.
• Look and listen for stridor.
• Look and listen for wheezing.

52. CB-IMNCI classification of pneumonia
SIGNS CLASSIFY
Any general danger sign Very severe pneumonia
Stridor in calm child Severe Pneumonia
Chest in- drawing Pneumonia
Fast Breathing
Age Rates
<2 months >60 breaths/ minute
2-12 months > 50 breaths/ minute
12-59 months >40 breaths/ minute
No sign of pneumonia or very severe
disease
No pneumonia: Cough or cold

53. TREATMENT
A. No pneumonia
• Treat the child at home, give advice mother
for home care.
• If wheezing present, give the salbutamol 3
times per day for 5 days.
• If Coughing is present for more than 14 days,
refer to check-up.

54. Contd..
Relieve the throat pain and coughing by
following:
• Continue breastfeeding
• Provide honey, holy basil leaves, ginger and
lemon with lukewarm water
• Avoid harmful medicines such as codeine,
atropine, antihistamine syrup.

55. Contd..
• Give advice for when to return immediately
• Follow up in 5 days if not improving
Return Immediately if the child is having any following sign
If the child has: Signs
No pneumonia: Cough or cold a. Fast Breathing
b. Difficulty in breathing

56. Contd..
B. Pneumonia
First line- Give amoxicillin BD for 5 days
Second line- Ciprofloxacillin PO BD for 3
days
- If wheezing is present, provide bronchodilator
inhalation if available in clinic. Give salbutamol
TDS for 5 days.

57. Contd..
• Soothe the throat pain and treat cough.
• If coughing more than 14 days and frequent
wheezing is present, can suspect TB or asthma.
Refer to higher center for check-up.
• Give advice when to return immediately.
• Follow up in 3 days.

58. Contd..
C. Severe pneumonia
-Give first dose of an appropriate antibiotic
-Prevent hypoglycemia:
-If the baby is able to breastfeed: Tell the mother
to feed breast-milk.
-If the baby is unable to breastfeed but able to
drink:
-Give expressed breast-milk upto 6 months baby

59. Contd..
• Provide expressed breast-milk or cow or
buffalo milk for more than 6 months baby.
• If not possible, give sugar water
• Give 30 - 50 ml milk or sugar water before
referral to the child.
• Preparation: 20 g or 4 teaspoon sugar dissolve
in 200 ml clean water.

60. Contd..
• If the child is unable to drink,
• If you are trained, provide 50 ml milk or sugar
water via nasogastric tube. ( for neonate give 5
ml/kg )
• Keep the baby warm
• Refer urgently to higher center.

61. Contd..
D. Very Severe Disease
- Give diazepam if the convulsion is present.
- If convulsion is not present, complete the
assessment.
- Prevent hypoglycemia.
- Keep the baby warm.
- Refer immediately to higher center.

62. COMPLICATIONS
• Acute Respiratory Distress Syndrome
• Lung abscess
• Septicemia
• Pleural effusion
• Empyema
• Respiratory failure

63. Assignment
• Write down the preventive measures of
pneumonia.

64. References
• Department of Health Services, (2078). Annual Report Fiscal Year
2077/78, Government of Nepal, Ministry of Health and Population,
Kathmandu.
• Department of Health Services, (2078). CB-IMNCI Treatment
Chart Booklet, Government of Nepal, Ministry of Health and
Population, Teku, Kathmandu.
• Dutta, P. (2010). Paeditric Nursing, 2nd edition: Jaypee brother's
medical publishers (P).Ltd, New Delhi, India. Page no. 273-277
• James, S.R. (2013). Nursing care of children, 4th edition: By
Saunders an imprint of Elsevier. Page no. 503-504
• Shrestha,T. (2012). Essential Child Health Nursing, 1st edition:
Medhavi publication, Kathmandu, Nepal. Page no. 340-344
• Upreti, K. (2071). Child Health Nursing, 4th editiom: Published by
Ms. Hima Uprety, Chhetrapati, Kathmandu. Page no. 318-323