Pneumonia OF LOWER RESPIRATORY TRACT -an inflammation with consolidation of the parenchyma of the lung. It effect more commonly in new born babies and young children .it may occur as primary disease or as a complication of another illness or may due to aspiration of foreign substance.
Pneumonia may classified on these two basis anatomic and etiological basis.
Anatomic: lobar pneumonia, lobular pneumonia, interstitial pneumonia, Broncho pneumonia.
Etiologic: It may be caused by virus; influenze, parainfluenza, adenovirus, mixovirus etc. Bacteria; pneumococci staphylococci, Streptococci, klebseilla, E.coli, pseudomonas etc. Fungi; protozoa, metazoa, chemicals, etc.
Pathology
Bacteria reach the lungs through respiratory passages and multiply in the alveoli. The engorgement is known as first stage of attack, in this period the lungs become bluish red, dark and heavy. During the second stage i.e. red hepatization the affected lobes become solid with red cells ,fibrin and the air is displaced. In last stage of this grey hepatization the pleural surface lacks lustre and is dull in colour. The alveoli are filled with leukocytes and fibrin. Invading organism produces inflammation in mucosa with exudation in alveoli so that it becomes solid relatively .
Clinical Features
- cough
- High fever
- Chills
- chest indrawing
- Wheezing
- Chest Pain
- Cynosis
Medical Management
This includes administration of
– specific antibiotic
– bronchodilators
– oxygen inhalation
– chest physiotherapy
Nursing Assessment
The onset is abrupt and )he child may manifest with general malaise, fever, cough, repid and shallow respaation and chest pain, tachypnoea and grunting, pain is increased by deep breathing. and may be referred to abdomen. The younger child may have convulsions and older child may have chills with fever. Other symptoms may include flaring of alae nasi, retraction of ribs and lower intercostal spaces and signs of consolidation like bronchial breathing may be present. There may be widespread rales and fine crepitations and rhonchi which indicate disseminated bronchopneumonia. Diagnostic evaluation includes X-ray chest which shows a dense opacity of segmental or lobular distribution or dissemmated shadows of lesser size. In bacterial Pneumonia, blood count will be raised with polymerphonuclear leukocytosis which differentiates it from viral pneumonia.
Planning of Nursing Care Pneumonia OF LOWER RESPIRATORY TRACT
- Make Continuing assessement
- Facilitate respiratory effort
- Control fever
- Administer accurate and appropriate antibiotics
- Maintain fluid and electrolyte balance and nutrition
- Promote rest
- Support and educate parents.
Implementation of Nursing Care Pneumonia OF LOWER RESPIRATORY TRACT
Make Continuing Assessment
Continuing assessment includes monitoring the child’s respiratory rate and pattern, monitoring breath sounds to note the presence of raks, rhonchi and wheezing etc. and , observation of signs of respiratory distress.
Facilitate Respiratory Efforts
Keep the airways patent i.e. provide high humidity atmosphere and administer oxygen. Child may be placed in semifowler position or any position of comfort. If there is unilateral pneumonia child may like to be on affected side to splint chest wall and prevent painful pleural rubbing. Position should be changed frequently 2-3 hours to increase drainage of secretions and encourage respiratory effort. If necessary child is prepared for thoracentasis and/or closed chest drainage.
Control Fever
Appropriate antibiotics in acurate dosage are administered depending upon the culture and sensitivity. In the absence of identification of causative organism a combination of antibiotics is provided. This combination could be pencillin in the dose of 50,000 to one lakh per kg and gentamicin in the dose of 5 mg to 10 mg per kg andlor pencillin and chloromycetin. Cloxacillin may also be substituted for pencillin where there is some history of sensitivity to pencillin.
Maintain Fluid and Efectrolyte Balance and Nsdrition
Provide adequate fluids and diet to supply the body’s increased demand for fluid due to infection. In severe distress W fluids are given in sufficient quantity to maintain normal specific gravity. Nurse has to monitor the IN infusion, regulate the flow rate carefully and observe the child for dehydration and volume overload. Maintain intake output chart and specific gravity of urine and daily weight record. When oral feeding is begun these should be given carefully and slowly to prevent aspiration.
Promote Rest and Sleep
Handle the child as little as possible during procedures to provide rest, relieve child’s psychological and physical stress to conserve energy, provide toys or quiet diversions depending upon age. Mild sedatives may be given if the child is restless or uncomfortable.
Complications – Pleural effusion
– Collapse of lung
– Emphysema
– Pneumatocele
– Abscess – Bronchiectasis
Evaluation
The outcome for children who have pneumonia depends on the age, type of pneumonia, promptness and adequacy of supportive care and antibiotic therepy. With prompt treatment the recovery is comulete.
