Pneumonia : Acute inflammation of the lung parenchyma ( the
respiratory bronchioles , alveolar ducts and sacs , and alveoli)
the impairs gas exchange .
2. pneumonia is classified according to etiologic agent
3. pneumonia also may be classified according to location and
extent of involvement as :
a. Lobar pneumonia, involving a large segment of one or more
lung lobes.
b. Bronchopneumonia , beginning in the terminal bronchioles
and involving nearby lobules
c. Interstitial pneumonia , confined to the alveolar walls and per
bronchial and interlobular tissues.
Etiology and incidence :
1. Pneumonia most commonly results from infection with
viruses , bacteria , or mycoplasmas , from aspiration of
foreign substances this entry deals primarily with viral and
bacterial pneumonia.
2. Viral pneumonia is the most common type with
respiratory syncytial viral the most common causative
organism. Other include influenza and par influenza
viruses and adenovirus.
3. Major causative organisms in bacterial pneumonia include
pneumococcal , streptococci and staphylococci
a. Pneumococcal : the most common cause of lobar
pneumonia most often affects children age 1 to 4 , with
highest incidence in late winter or early spring .
b. Streptococci : infection usually results in lobular
pneumonia commonly occurs as complication of
influenza or measles
c. Staphylococci : the most common cause of
bronchopneumonia ; most often affects children
d. n under age 2 years , with highest incidence in winter
4. Pneumonia occurs in about 4% children under age 4
incidence decreases with advancing age
Path physiology :
1. Pneumonia typically begins as a mild upper respiratory
infection .
2. As the disorder progresses , parenchyma inflammation
occurs .
3. Bacterial pneumonia most often causes lobular
involvement and sometimes consolidation , viral
pneumonia , inflammation of interstitial tissue
Assessment findings :
1. Common clinical manifestations of viral pneumonia
include ;
a. Signs and symptoms varying from mild fever , slight
cough, and malaise to high fever , sever cough and
prostration .
b. Cough nonproductive or productive of whitish
sputum
c. Rhonchi or fine crackles.
In pneumococcal pneumonia , clinical
manifestations vary with age and commonly
include :
a. Infants; vomiting , seizures , poor feeding , fever
, stiff neck , bulging anterior fontanel ,
respiratory distress , diminished breath sounds
and rales.
b. Older children : headache , abdominal or chest
pain , high fever with chills , intermittent
drowsiness and restlessness , tachycardia
tachypnea , hacking nonproductive cough ,
expiratory grunting , tubular breath sounds and
disappearance of crackles ( indicating
consolidation ) moist crackles and cough
productive of copious blood- tinged mucus ( as
the disease resolves).
2. Clinical findings in streptococcal pneumonia are
similar to those of pneumococcal pneumonia with
sudden onsets of :
a. Fever and chills
b. Signs of respiratory distress
c. Listlessness or extreme prostration
d. Rales.
3. Clinical findings in staphylococcal pneumonia may
include:
a. High fever
b. Cough
c. Tachypnea
d. Cyanosis
e. Anorexia
f. Dyspnea
g. Sub costal and stermal retractions
h. Grunting respirations
i. Nasal discharge
j. Lethargy
k. Abdominal distention
l. Diminished breath sounds , crackles and rhonchi
m. AS the child’s condition deteriorate signs of
emphysema ( purulent fluid in he pleural cavity )
Laboratory study results commonly include :
a. Elevated white blood cell count
b. Identification of the causative organism through
blood cultures
c. In streptococcal pneumonia , positive
antistreptolysin- o titer.
Diagnostic thoracentesis may be performed if
fluid in the pleural cavity is suspected.
Nursing diagnoses
1. Activity intolerance
2. Ineffective airway clearance
3. High risk for altered temperature
4. Ineffective breathing pattern
5. Potential fluid volume deficit
6. Knowledge deficit
7. Altered nutrition : less than body requirement
8. Pain
Planning and implementation
1. Assess for respiratory distress by
monitoring vital signs and respiratory status
2. Ease respiratory efforts by :
3. A. administering oxygen therapy as ordered
4. Performing chest physiotherapy and
postural drainage
5. Suctioning as needed
6. Changing position frequently and elevating
the head of the bed.
7. Help prevent dehydration by ensuring
adequate oral IV fluid intake evaluate fluid
status by monitoring intake and output and
weighing the child daily
8. Promote rest by maintaining bed rest and
organizing nursing care to minimize
disturbances .
9. Ensure a adequate nutrition by providing
desirable high- calorie foods
10.
Support the child’s family by answering
and explaining all treatment and
procedures
11.
Encourage parents to participate in
their child’s care as appropriate
12.
Administer prescribed medications as
ordered , which may include :
a. Penicillin G to treat staphylococcal
pneumonia .
b. Synthetic penicillin to treat
staphylococcal pneumonia
c. Antipyretics to reduce fever
13.
Provide patient and family teaching