Pneumonia

 Pneumonia

Infection that inflames sir sac in lung. Acute inflammation and consolidation of lung parenchyma.

Air sac may fill with fluid or pus (purulent material).

Classification of Pneumonia

1. Anatomic Basis (in children)

a. Lobar or lobular pneumonia (one or more lobes of lung)

b. Interstitial pneumoniae (interstitial tissue effected)

c. Bronchopneumonia

(Patchy consolidation of lung.

2. Etiologic Basis

a. Bacterial pneumonia

Pneumococcus

Streptococcus

Staphylococcus

b. Viral pneumonia

Haemophilus influenza

Measles

Adenovirus

Pertussis 

Respiratory syncytial viruses

c. Fungal 

Histoplasmosis

coccidioidomycosis; Valley fever

d. Protozoal

Pneumocystis Carnii

Toxoplasmosis gondii

Entamoeba histolytica

3. Miscellaneous type (in adult)

1. Aspiration pneumonia

Caused by aspiration of food, nasal drops, amniotic fluid by Neonates.

Water (drowning)

Ingestion of chemical, kerosene oil

2. Loffler's pneumonia

Eosinophilus accumulates in lungs in response of parasitic infection.

Parasities;

Ascaris lumbricoides

Strongyloides stercoralis

ancylostoma duodenale

3. Hypersensitivity pneumonia

Inflammation of alveoli within lungs, caused by hypersensitivity to inhale dust.

4. Hyperstatic pneumonia

Result from collection of fluids in dorsal region of lungs. (Bedridden or elderly person).

5. Community acquired Pneumonia

6. Mycoplasma pneumonia

7. Walking pneumonia (atypical pneumonia)

8. Ventilator associated pneumonia (VAP)

 Clinical features

1. Sudden onset; high fever with chills

2. Cough with thick sputum

3. Increase Respiratory rate

4. Grunting Respiration; forced exhaled sound (short, deep sound)

Indicates baby has low lung volume or functional residual capacity (FRC) ; volume remaining in lung after normal passive exhalation.

5. Nasal flaring

6. Running nose

7. Irritability

8. Sore throat

9. Anorexia

Late symptoms

1. Convulsion

2. Drowsiness

3. Cyanosis

4. Wheezing

5. Inability to drink from mouth

6. Chest in drowning

7. Hoarseness of mouth

8. Pleural pain; increase deep breathing; referred to shoulder or abdomen.

Pathophysiology

Bacteria/ virus reaches lung through Respiratory tract

Multiply in alveoli

Disturb defence mechanism of lung

Alteration in properties in normal lung secretion.

First stage of attack called "Engorgement" 

Lung become dark bluish red and heavy.

Next stage; Red Hepatization

Affected lobe become soiled with red cells 

Last stage in grey Hepatization

Pleural surface become dull in color and alveoli filled with leucocytes and fibrin.

Invading organism produce inflammation in mucosa with exudation in alveoli become consolidate.

Diagnostic Evaluation

1. Child history taking/ physical examination

2. Chest X ray;

Bronchopneumonia, patchy consolidation in lungs (opacity occupying anatomic area of lobe).

3. Pleural fluid or bronchoalveolar levage fluid test

4. Blood test

Increase blood count with polymorphonuclear leucocytes

5. Throat culture

Isolation of organism from nasopharynx or throat pneumonia culture.

6. PCR in viral pneumonia

Management

Depend upon causative agent.

Antimicrobial therapy is started on basis of sensitivity tests.

1. Antibiotics for bacterial pneumonia

Penicillin

Amoxicillin

Clavulanic acid

Macrolides, Erythromycin, clarithromycin, Azithromycin

2. Pneumonia caused by Klebsiella pneumonia, Hemophilus influenza

Antibiotics 2nd and 3rd generation, cephalosporin, clavulanic acid, Amoxicillin, Fluoroquinolones ( levofloxacin).

Sulfamethoxazol/ Trimethoprim

3. For mycoplasma pneumonia

(Atypical pneumonia)

Macrolides

(Erythromycin, clarithromycin, Azithromycin).

4. For viral pneumonia; Antiviral therapy 

Viral pneumonia caused by; 

Adenovirus

Rhinovirus

Influenza viruses (flu)

Respiratory syncytial virus( RSV)

Parainfluenza virus

5. Fungal pneumonia; Antifungal drugs 

Amphotericin B

Fluconazole

Sulphonamide

Penicillin 

Fungal pneumonia caused by;

Histoplasmosis

Coccidiomycosis

Blastomycosis

Aspergillosis

Cryptococcosis

Nursing Management

1. Make continuing assessment

2. Facilitate Respiratory effort

3. Control fever

4. Maintain fluid and electrolyte balance/ nutritional status 

5. Promote rest and sleep

Diversion therapy

Administer mild sedative (if prescribed)

Reduce plural pain

Cough supressant before baby sleeps

Complication

Pleural effusion

Pneumatocele; air filled cyst (single or multiple)

Emphysema; alveoli damage

Bronchiectasis; permanently damaged, widened, and thickened