PNEUMONIA

PEADIATRIC NURSING

LECTURE BY
C.J SIMUYEMBA
E/N, R/N, BSc Student UNZA
INTRODUCTION

Pneumonia is "a severe form of acute lower

respiratory infection that specifically affects the
lungs".
INTRODUCTION

During a Pneumonia infection, the alveoli of one or both

lungs fill up with pus or fluid.
This increases the labor of breathing, and thus gaseous
exchange cannot occur as it normally would
(unicef/WHO, 2006).
OBJECTIVES

General Objective
At the end of this lecture/discussion, students should be
able to demonstrate their basic knowledge of
pneumonias and be able to provide nursing care to
patients with pneumonia.
OBJECTIVES

Specific Objectives
At the end of the lecture/discussion students should be able to:
1. Define pneumonia
2. Outline the types of pneumonia
OBJECTIVES CONT………..

3. Explain the stages of pneumonia.

4. Describe the medical management of a patient with
pneumonia.
5. Describe the nursing management of a patient with
pneumonia.
6. Sate the complications of pneumonia.
 DEFINITIONS
Pneumonia is defined as "inflammation of the lung caused
by bacteria, in which the air sacs (alveoli) become filled
with inflammatory cells and the lungs become solid"
(Oxford Concise Medical Dictionary, 6th Edition, 2003).
DEFINITIONS

Pneumonia is an inflammation of the airspaces in the lung

most commonly caused by infections (Stöppler M.C,
2017).
CLASSIFICATIONS
ACCORDING TO PLACE:
Community-acquired pneumonia (CAP), as the name
implies, develops outside of the hospital or health-care
environment.
CLASSIFICATIONS

 Hospital-acquired pneumonia (HAP) is acquired when an

individual is already hospitalized for another condition. HAP
is generally more serious because it develops in ill patients
already hospitalized or under medical care for another
condition.
- Ventilator acquired pneumonia (example of HAP)
CLASSIFICATIONS CONT……

ACCORDING TO ANATOMY:
Bronchopneumonia is “a descending infection starting
around the bronchi and bronchioles” (Nurse’s dictionary,
Twenty-third edition, 2000). The terminal bronchioles
become blocked with exudates and form consolidated
patches.
CLASSIFICATIONS CONT……
 Lobar pneumonia- causes an inflammation of one lobe of a
lung and typically involves all the airspaces in a single lobe.
 Multi lobar pneumonia- this is where more than one lobe of
the lung is involved. This occurs in more severe illnesses.
CLASSIFICATIONS CONT……
 Interstitial Pneumonia is the term used for inflammation
and accumulation of fluid in the tissue between two
alveoli.
 Lipoid pneumonia is characterized by the accumulation
of fats within the airspaces.
CLASSIFICATIONS CONT……
ACCORDING TO THE CAUSE:
Bacterial Pneumonia due to bacteria. Common causes:
streptococcus pneumonia, hemophilus influenza,
legionella pneumophilia and staphylococcus aureus.
CLASSIFICATIONS CONT……
 Viral Pneumonia is believed to be the cause of half of all
pneumonias. The viruses invade the lungs and then multiply-
causing inflammation (healthscout.com).
 Mycoplasmal Pneumonia It is similar to bacterial pneumonia,
whereby the mycoplasmas proliferate and spread - causing
infection.
CLASSIFICATIONS CONT……
 Pneumocystis carinii Pneumonia result from a fungal
infection in the lungs caused by the Pneumocystis carinii
fungus. This fungus does not cause illness in healthy
individuals, but rather in those with a weakened immune
system. (Health-cares.net, 2005).
CLASSIFICATIONS CONT……
o Aspiration Pneumonia caused by inhalation of, food,
drink, vomit, secretions or other foreign material.
 RISK FACTORS
The elderly, infants and young children are more at risk of
contracting community-acquired pneumonia than young
and middle-aged adults. Underlying health problems such
as:
Flu
Cancer
Age >65years
Smoking
RISK FACTORS CONT.…..
Chronic obstructive pulmonary disease
Bronchiectasis

Immunosuppressive disorders and therapy

Coma

Problems with swallowing

Alcoholism
RISK FACTORS CONT.……
Asthma

Chronic bronchitis
 CAUSES OF PNEUMONIA

Bacterial causes include:

Haemophilus influenza. (Common in children)
Streptococcus pneumoniae, is the most common cause of
pneumonia.
Mycoplasma pneumoniae
CAUSES OF PNEUMONIA CONT………..
Viral causes
Influenza virus, the most common cause of viral
pneumonia in adults.
Respiratory syncytial virus (RSV).
Measles virus
SARS (severe acute respiratory syndrome).
CAUSES OF PNEUMONIA CONT………..

FUNGAL CAUSES
Cryptococcus

Histoplasma

 Pneumocystis jiroveci pneumonae (PJP) , formerly

known as Pneumocystis carinii pneumonae (PCP).
 PATHOPHYSIOLOGY
 The microorganism typically enters the lung through inhalation or
the bloodstream if other parts of the body are infected.
 The bacteria usually live in parts of the upper respiratory tract and
are continually being inhaled into the alveoli
 Following the successful invasion of microorganisms, the small
blood vessels in the lungs (capillaries) become leaky, and a protein-
rich fluid seeps into the alveoli causing congestion within the
alveoli.
 PATHOPHYSIOLOGY CONT……
 The patient becomes relatively oxygen deprived, while retaining
potentially damaging carbon dioxide.
 The patient’s breathing rate increases in an effort to bring in more
oxygen and blow off more carbon dioxide.
 Mucus production is also increased, and the leaky capillaries may
tinge the mucus with blood.
 Mucus plugs actually further decrease the efficiency of gaseous
exchange in the lungs.
 PATHOPHYSIOLOGY CONT……
 The invading microorganisms also trigger the immune system to
respond by sending white blood cells responsible for attacking
microorganisms (neutrophils) to the lungs.
 The neutrophils engulf and kill the offending organisms but also
release cytokines which result in a general activation of the
immune system.
 This results in the fever, chills, and fatigue common in bacterial
and fungal pneumonia.
 PATHOPHYSIOLOGY CONT……
 The bacteria that survive the body’s defence mechanism often
travel from the lung into the blood stream and can result in serious
illness such as septic shock, in which there is low blood pressure
leading to damage in multiple parts of the body including the brain,
kidney, and heart.
 The alveoli is further filled with fluid leaked from the surrounding
blood vessels, debris from the bacteria and the large number of
white blood cells being produced to fight the infection.
 PATHOPHYSIOLOGY CONT……
 Consolidation, a feature of bacterial pneumonias, occurs when
the alveoli, which are normally hollow air spaces within the
lung, instead become solid, due to quantities of fluid and debris.
 Viral pneumonias, and mycoplasma pneumonias, do not result in
consolidation, because these types of pneumonia primarily infect
the walls of the alveoli and the parenchyma of the lung .
SINGS AND SYMPTOMS

Initially symptoms are similar to that of a cold followed by:

A high fever (pyrexia)- this is due to the presence of infection in which
there is antigen antibody reaction with an increase in the basal metabolic
rate as well as prostaglandins resulting in heat production with a subsequent
increase in temperature.
 Chills- this is due to antigen antibody reaction
A productive cough- due to irritations in the throat with increased mucus
production. Sputum may be discoloured and may become blood-stained as
the pneumonia progresses.
SINGS AND SYMPTOMS
 Dyspnoea- due to inflammation and exudation in the alveoli
impairing gaseous exchange.
 Sharp chest pain- due to inflammatory processes in the alveoli
occurring in an attempt to breath in air.
 Tachycardia- this occurs in attempt for the heart to compensate
the deficit of oxygen in circulation.
 pleuritic chest pain- this occurs in an attempt for the lungs to
SINGS AND SYMPTOMS
Cyanosis due to poorly oxygenated blood
Rapid breathing
Wheezing or grunting during breathing
Chest in drawing
Nasal flaring

vomiting
STAGES OF PNEUMONIA

Pneumonia has four stages, namely:

Congestion

Red hepatization
Grey hepatization
Resolution
STAGES OF PNEUMONIA
CONGESTION
Occurs in the first 24 hours
Cellular exudates containing neutrophils, lymphocytes and
fibrin replaces the alveolar air
Capillaries in the surrounding alveolar walls become
congested
Marked by coughing and deep breathing (Atkuri & King,
2006; Steyl, 2007).
STAGES OF PNEUMONIA
RED HEPATIZATION
Occurs in the 2-3 days after consolidation
At this point the consistency of the lungs resembles that of
the liver.
The lungs become hyperemic due to alveolar capillary
engorgement with blood.
This stage is "characterized by the presence of many
erythrocytes, neutrophils, desquamated epithelial cells, and
fibrin within the alveoli" (Atkuri & King, 2006; Steyl, 2007).
STAGES OF PNEUMONIA
GREY HEPATIZATION
Occurs in the 3-5 days after Red Hepatization
This is an avascular stage

The lung appears "gray-brown to yellow because of

fibrinopurulent exudates, disintegration of red cells.
The pressure of the exudates in the alveoli causes compression
of the capillaries.
STAGES OF PNEUMONIA
 RESOLUTION

This stage is characterized by the "resorption and restoration

of the pulmonary architecture"
Phagocytosis of the bacteria-laden leucocytes occurs
"Consolidation tissue re-aerates and the fluid infiltrate causes
sputum"(Atkuri & King, 2006; Steyl, 2007).
MEDICAL MANAGEMENT
DIAGNOSIS
1. Physical examination: Auscultation- Bronchial breath sounds or
fine cracks over the affected area
2. Chest X-ray- The X-ray will show decreased lung
expansion and patchy opacity on the affected side
with ill-defined margins (Hough, 1991; Klein, 2008).
3. Sputum samples- Sputum test is done to determine whether it is a
fungal or bacterial infection.
MEDICAL MANAGEMENT CONT.
……….
Full Blood Count (FBC)- is done to examine the White
Blood Cell count of the involved patient- this can be used
to indicate the severity of the pneumonia, as well as to
determine whether it is a viral or bacterial infection.
-Bacterial infection- increased amount of neutrophils.
-Viral infection- increased amount of lymphocytes.
TREATMENT
SUPPORTIVE/ SYMPTOMATIC TREATMENT:
Bed rest
Analgesic administration (i.e.: calpol 10mg 8 hourly)
Cough suppressant medication
Fever-reducing medication (i.e.: calpol 10mg 8 hourly)
Oxygen therapy 0.5 – 2 liters
TREATMENT
Modified postural drainage - this allows gravity to drain
secretions from specific segments of the lungs.
Administer humidification - to mobilize secretions
Mobilization of the patient - done to increase air entry,
increase chest expansion, and to loosen secretions
(Madjoe & Marais, 2007).
TREATMENT CONT.………
Drug therapy
The treatment involves administration of appropriate as

determined by the results of gram stain. Drugs include;

 TREATMENT CONT.………

Antibiotics - depending on the organisms isolated the following

drugs can be given:
Benzyl penicillin
 Premature infants and neonates 50mg/kg body weight in 2
divided doses
 Infants 1-4 weeks 75mg/kg body weight in 3 divided doses
 TREATMENT CONT.………
Amoxicillin can be given in mild cases of pneumonia.
 Dosage 125 mg/ 5mls TDS for 5 days.
 Child of 1 month to 12 years 100/kg body weight in 4 divided
doses
Side effects- Anaphylactic shock, urticaria, fever and joint pains
Nursing implication - give a test dose
 Ask for any hypersensitivity reactions
 TREATMENT CONT.…….
Erythromycin QID (four times a day)
 Child up to two years 125mg every 6 hours for 5 days
 Children 2- 8 years 250mg 6 hourly for 5 days
Side effects- Nausea, vomiting, abdominal discomfort, urticaria,
diarrhea reversible loss of hearing.
 TREATMENT CONT.………
Nursing implication- To be given with caution to patients with
renal or hepatic impairment, pregnant and breast feeding mothers.
 Bronchodilators therapy- salbutamol 2- 4mg TDS
 Increased fluid intake
 Antipyretics such as calpol 125mg TDS for 3 days
 Humidified Oxygen therapy
TREATMENT CONT.………..
Ceftriaxone- Children 50-75mg/Kg/day in 1-2 divided
doses.
SPECIFIC NURSING CARE
Objectives
To establish a normal breathing pattern
To improve the nutrition status
To control infection
To prevent complications
NURSING CARE CONT.………

Environment
The baby should be nursed in well-ventilated area.
Clean environment to prevent secondary infections.
Nurse the baby in a noise free environment.
NURSING CARE CONT.……..

Position
Nurse the patient in a semi prone position to promote
lung expansion and this will relieve dyspnoea.
Encourage frequent change of position to promote
drainage of secretions.
NURSING CARE CONT.……..
Observations
4 hourly observations of vital signs that is respiration for depth,
rate and rhythm so as to rule out dyspnoea. Temperature, pulse
and blood pressure are checked 4 hourly so as to know if the
patient is improving or not. Patient also needs to be observed for
side effects of drugs if severe drugs can be discontinued.
NURSING CARE CONT.……….
Medication
Give oxygen via a correct mask or nasal cannulae so as
to prevent dyspnoea and improve the respirations.
Administer prescribed antibiotics as well as prescribed
bronchodilators.
NURSING CARE CONT.……
Nutrition
Encourage hourly drinks of fluids according to patient’s
preference this will help keep secretions/ sputum less
viscous thereby aiding their expectoration. Give protein
and calorie to promote healing. Encourage soft fruit and
vegetables in diet adds fibre to prevent constipation.
 NURSING CARE CONT.……..
Hygiene
 Hygiene is important to promote comfort of the patient. You can
do a bed bath if the patient is very sick and a big bath if the patient
is stable. Oral toilet is encouraged to prevent bad odour and
halitosis.
Exercise
 Exercises are encouraged if the condition of the patient allows to

promote blood circulation and recovery.

NURSING CARE CONT.………
Information, Education and Communication
Patient should be encouraged to adhere to treatment so as to
promote recovery.
Patient should be given information of the disease so as to
gain cooperation.
Patient should avoid overcrowding places to avoid cross
infection as well as reinfection.
COMPLICATIONS

 Pleural effusion- this occurs due to infiltration of fluids in the

pleural cavity as a result of inflammatory processes.
 Empyema- due to spread and unresponsiveness of the infection
to treatment, it results in pus formation and accumulation in the
pleural cavity.
 Bacteremia- this is generalized spread of bacteria in the blood
stream.
 COMPLICATIONS CONT.…..
 Septicemia- this is generalized spread of infection and toxins
into the blood stream.
 Meningitis- this is inflammation of the meninges occurring due
to infection spreading to the meninges.
 Septic arthritis- this is inflammation and infection of the joints
due to spread of infection.
COMPLICATIONS CONT.…..
 Endocarditis or pericarditis- it is inflammation of either the
pericardium or endocardium of the heart due to spread of
infection to the heart.
 Lung abscess- due to spread and unresponsiveness of the
infection to treatment, it results in pus formation and
accumulation in the lung tissue/ spaces.
 SUMMARY

 In our lecture today we have talked about pneumonia and we said

it is an acute inflammation of the lung parenchyma caused by
various microorganisms, including bacteria, mycobacteria, fungi
and viruses.
SUMMARY CONT.…..

 We also said pneumonias can be classified as community-

acquired pneumonia (CAP), hospital-acquired pneumonia
(nosocomial), pneumonia in the immmunocompromised host
and aspiration pneumonia.
 It can also be classified according to the part that is affected for
example bronchopneumonia and lobar pneumonia.
ASSIGNMENT

Identify five (5) problems a patient with pneumonia will

develop and using the problems identified, write the
nursing care plan.
To be checked during the next lecture.
REFERENCES

 Koenig, S., & Truwit, J. (2006). Ventilator-associated pneumonia: Diagnosis,

treatment and prevention. Clin Microbiol Rev. 2006 October; 19(4): 637–657.
Retrieved April 12, 2009 from
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1592694
 Nicholas A. B, Nicki R. C, Brian R. W and John A. A. H (2007),Davidson’s principles
& practice of medicine, 20th edition, Churchill Livingstone Elsevier. London. UK.
 Suzanne C. S, Janice.L. H, Brenda G. B and Kerry H. C (2010), Brunner &
Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition, Wolters Kluwer
Health, Hong Kong, China
 REFERENCES
 Madjoe, L., & Marais, M. (2007). Applied Physiotherapy 203 notes:
Physiotherapy in Respiratory Care. University of the Western Cape.
 Martin, E.A. (Ed.). (2003). Oxford Concise Medical Dictionary, 6th
Edition. Oxford, United Kingdom. Oxford University Press
 Haesh Mohan (2002), Textbook of Pathology, 4th edition, Jaypee Brothers
medical publishers, New Delhi, India