PCAP

Pediatric Community-Acquired Pneumonia is a lung infection that occurs in

children who have not been recently hospitalized. “Community-acquired” means the
child got the infection outside the hospital, usually from the environment, school, or
home.

Major Organ Affected: The Lungs

 The lungs are the main part of the body affected in pneumonia.

 Inside the lungs are tiny air sacs called alveoli. These sacs are where oxygen
goes into the blood.

 In pneumonia, these air sacs fill with fluid or pus.

 When that happens, it’s hard for the child to breathe and get enough oxygen
into the body.

Etiology (Causes): Why Children Get Pneumonia

1. Viruses – the most common cause, especially in young children:

o RSV (Respiratory Syncytial Virus) – a virus that causes lung infections,

especially in babies.

o Influenza virus – causes the flu and can lead to pneumonia.

o Adenovirus – can cause coughs, colds, and sometimes pneumonia.

o Parainfluenza – another virus that can lead to coughing and pneumonia.

2. Bacteria – more common in older children:

o Streptococcus pneumoniae – the most common bacterial cause.

o Haemophilus influenzae – a bacteria that can infect the lungs.

o Mycoplasma pneumoniae – often causes “walking pneumonia” (milder

symptoms but still pneumonia).
 3. Fungi – rare, and usually only in kids with weak immune systems (like those
with serious illnesses).

o Fungi live in the environment and can cause infections if the immune
system is weak.

Simplified Pathophysiology: How Pneumonia Affects the Body

1. Exposure to germs:

o The child breathes in a virus or bacteria from the air, or it enters the body
some other way.

2. Germ travels to the lungs:

o The germ travels through the airways and reaches the lungs, especially
the tiny air sacs (called alveoli) where oxygen is absorbed.

3. Body's defense reaction:

o The body’s immune system tries to fight off the germ, which causes
inflammation (swelling) in the lungs.

4. Fluid buildup:

o The inflammation causes fluid or pus to fill the alveoli, which makes it
harder for the lungs to bring in enough oxygen.

5. Symptoms:

o The buildup of fluid leads to problems like coughing, fever, difficulty

breathing, and less oxygen in the blood.

Medical Management of Pediatric Pneumonia

1. Kill the infection:

o Antibiotics (for bacterial pneumonia) or antivirals (for viral pneumonia)

are used to fight the infection causing the pneumonia.

2. Support breathing:
 o The child may be given oxygen if their breathing is difficult or they are not
getting enough oxygen in the blood.

3. Keep the child hydrated and comfortable:

o Fluids are given to keep the child hydrated and help loosen mucus.

o Pain relievers or fever reducers (like acetaminophen or ibuprofen) can

be used to ease discomfort.

Treatment Based on Severity:

 Mild pneumonia:

o This can be treated at home with rest, fluids, and medications.

 Moderate to severe pneumonia:

o More serious cases may require hospitalization, especially for infants or

very young children, to provide stronger treatments and closer monitoring.

Laboratories and Diagnostics

1. Chest X-ray:

o A picture of the lungs to see where and how much of the lung is infected.

2. Complete Blood Count (CBC):

o A blood test that looks for signs of infection, like high white blood cells
(which fight infection).

3. Pulse oximetry:

o A small clip placed on the finger or toe to measure how much oxygen is in
the blood.

4. Blood culture or sputum culture:

o Tests done on a sample of blood or mucus (sputum) to find out which

germ (bacteria or virus) is causing the infection.
 5. Nasopharyngeal swab:

o A swab from the nose or throat to test for viruses that can cause
pneumonia, like RSV or influenza.

Medications

1. Antibiotics (for bacterial pneumonia):

o Amoxicillin: A common antibiotic used to treat bacterial pneumonia.

o Azithromycin: Used for special types of bacteria that cause pneumonia,

like Mycoplasma.

2. Antiviral drugs:

o These are used only if a virus (like the flu) is the cause. They're not used
for most pneumonia cases.

3. Antipyretics (for fever):

o Paracetamol (Tylenol) or Ibuprofen (Advil): Medications to help reduce

fever and make the child more comfortable.

4. Bronchodilators:

o Inhalers or nebulizers that help the child breathe easier by opening up

the airways, especially if they are wheezing or having trouble breathing.

5. Oxygen therapy:

o If the child's oxygen levels are low, they may need extra oxygen to help
them breathe better.

Treatment (Surgery, if applicable)

1. Surgery is NOT usually needed for pneumonia:

o Most children with pneumonia can be treated with medications and rest
without needing surgery.
 2. Complications (rare):

o Lung abscess: A pocket of pus forms in the lung.

o Empyema: Pus collects in the space between the lung and the chest wall.

3. Surgical treatment (only if complications occur):

o If these complications happen, the child may need a drainage procedure

(a way to remove the pus) or very rarely, surgery to remove the infected
part of the lung.

Nursing Management:

1. Monitor vital signs:

o Temperature: Keep track of fever.

o Respiratory rate: Watch how fast the child is breathing.

o Oxygen saturation: Check if the child is getting enough oxygen.

2. Administer prescribed medications:

o Antibiotics: Give the child medicine to treat bacterial infections.

o Fever reducers: Help reduce the child’s fever using medicines like
paracetamol or ibuprofen.

3. Provide oxygen therapy:

o If the child has trouble breathing or low oxygen levels, give extra oxygen
to help them breathe easier.

4. Encourage fluid intake:

o Make sure the child drinks plenty of fluids to stay hydrated and help thin
mucus, making it easier to clear out.

5. Promote rest and comfort:

 o Keep the child in a calm, comfortable environment with fresh air to help
them rest.

6. Suctioning or chest physiotherapy:

o If the child has a lot of mucus, use gentle suction or special techniques
(like chest clapping) to help clear the airways, as advised by the doctor.

7. Educate parents:

o Complete the full course of antibiotics: It's important to finish all the
prescribed medicine even if the child feels better.

o Watch for warning signs: Tell parents to look out for signs like fast
breathing, bluish lips, or a very high fever, and seek medical help if they
occur.

o Importance of vaccines: Make sure the child gets vaccines like the
pneumococcal and flu vaccine to prevent future pneumonia.

Possible Nursing Diagnoses:

1. Ineffective airway clearance related to mucus and inflammation:

o The child has trouble clearing their airways because of mucus and
swelling in the lungs, which can make breathing harder.

2. Impaired gas exchange related to fluid in the alveoli:

o The fluid in the tiny air sacs (alveoli) of the lungs makes it harder for the
oxygen to pass into the blood, leading to difficulty breathing.

3. Hyperthermia related to infection:

o The child has a high fever due to the infection in their body, which is the
body's natural response to fight germs.

4. Risk for fluid volume deficit related to fever and decreased intake:
 o The child may become dehydrated because they have a fever (causing
fluid loss) and might not be drinking enough fluids.

5. Anxiety (child or caregiver) related to illness and hospitalization:

o The child or their caregivers may feel worried, scared, or stressed

because of the illness and the hospital setting.

Prognosis (Outcome):

1. With early diagnosis and proper treatment, most children recover fully
within 1–2 weeks:

o If pneumonia is found early and treated correctly, most children get better
in 1 to 2 weeks.

2. Complications are rare but can happen, especially in very young children
or those with weak immune systems:

o Although most children recover without problems, some may face serious
issues if they are very young or have a weak immune system.

3. Vaccination, good hygiene, and avoiding smoke exposure can help prevent
pneumonia:

o Getting vaccines, washing hands well, and staying away from cigarette
smoke can reduce the chance of getting pneumonia.