Acute respiratory infections in children

Factors affecting type of illness and the response to illness Nature of infectious agent Nature of infectious agent Size and frequency of dose Size and frequency of dose Age of the child Age of the child Size of the child Size of the child Ability to resist invading organisms Ability to resist invading organisms Disease conditions Disease conditions Disorders affecting respiratory tract Disorders affecting respiratory tract season season

Etiology Viruses Viruses Bacteria Bacteria -beta hemolytic streptococcus -beta hemolytic streptococcus -staphylococcus -staphylococcus -Hemophilus influenza -Hemophilus influenza -Pneumococci -Pneumococci Fungus Fungus Aspiration of foreign substance Aspiration of foreign substance

Pnemonia Localised acute inflammation of the lung tissue. Localised acute inflammation of the lung tissue. May occur as aprimary disease,a complication of another illness or aspiration of foreign substance May occur as aprimary disease,a complication of another illness or aspiration of foreign substance

Pathologic changes in tissues Pnemococci cause consolidation of all or part of lobe in lobar pneumonia or cause consolidation of scattered lobules in bronchopneumonia Pnemococci cause consolidation of all or part of lobe in lobar pneumonia or cause consolidation of scattered lobules in bronchopneumonia Staphylococci tend to destroy tissue producing small abscesses Staphylococci tend to destroy tissue producing small abscesses H.infleunza cause excessive destruction of the epithelia of small airway,interstitial inflammation and hemorrhagic edema H.infleunza cause excessive destruction of the epithelia of small airway,interstitial inflammation and hemorrhagic edema Virus/ S.viridans destroy mucosa and cause interstitial lesions Virus/ S.viridans destroy mucosa and cause interstitial lesions M.pnemonia attach to cell surface and cause ulcers and sloughing of mucosa M.pnemonia attach to cell surface and cause ulcers and sloughing of mucosa

Forms of infectious pneumonia 1. anatomic distribution lobar pneumonia :all or a large segment of one or more of lobe is affected. lobar pneumonia :all or a large segment of one or more of lobe is affected. bronchopneumonia: begins in the terminal bronchioles, which become clogged with mucopurulent exudates to form consolidated in nearby lobules. also called lobular pneumonia bronchopneumonia: begins in the terminal bronchioles, which become clogged with mucopurulent exudates to form consolidated in nearby lobules. also called lobular pneumonia Interstitial pneumonia:the inflammatory process is more or less confined within alveolar walls and the peribronchial and inter lobular tissues. Interstitial pneumonia:the inflammatory process is more or less confined within alveolar walls and the peribronchial and inter lobular tissues.

Forms of infectious pneumonia 2.Causative organism Bacterial Bacterial Viral Viral Other infections Other infections

bacterial pneumonia

Clinical manifestations of pneumonia Fever Fever Cough: unproductive to productive Cough: unproductive to productive Tachypnea Tachypnea Breath sounds: ronchi or fine crackles Breath sounds: ronchi or fine crackles Dullness with percussion Dullness with percussion Chest pain Chest pain Retractions Retractions Nasal flaring Nasal flaring Pallor to cyanosis Pallor to cyanosis X-ray shows diffuse or patchy infiltration with peribronchial distribution X-ray shows diffuse or patchy infiltration with peribronchial distribution Behavior: irritable, lethargic or restless Behavior: irritable, lethargic or restless Gastro intestinal: anorexia, vomiting, diarrhea and abdominal pain Gastro intestinal: anorexia, vomiting, diarrhea and abdominal pain

Medical management of pneumonia Most of children can be treated at home Most of children can be treated at home  bed rest  antibiotic therapy  oral fluid intake  antipyretics  antitussives  oxygen therapy

Nursing assessment Assess for : fever,malaise,cough,chills Assess for : fever,malaise,cough,chills Rapid,shallow respiration: Rapid,shallow respiration: -60 / minute for a baby less than 2 months -60 / minute for a baby less than 2 months - 50/mt for a baby up to 12 months - 50/mt for a baby up to 12 months - 40 /mt for a baby upto 5 years - 40 /mt for a baby upto 5 years

Severe pneumonia Retractions Retractions Very severe pneumonia Grunting Grunting Not able to drink Not able to drink Sleep problems Sleep problems Stridor in a calm child Stridor in a calm child Severe malnutrition Severe malnutrition

Nursing care plan

Ineffective breathing pattern related to inflammatory process,pain Goal:child will exhibit normal respiratoy function Intervention: Allow position of comfort Allow position of comfort Promote rest Promote rest Maintain patent airway Maintain patent airway Provide high humidity environment Provide high humidity environment Reduce anxiety and apprehension Reduce anxiety and apprehension Organize activities to reduce energy expenditure Organize activities to reduce energy expenditure

Ineffective airway clearance r/t mechanical obstruction, increased secretion Goal 1. The child will maintain patent airway Goal 1. The child will maintain patent airway Intervention: Intervention:  Suction secretion as and when needed  Position to drain secretion  Assist in expectorating sputum  Nebulise as prescribed  Keep NPO until stable Expected outcome: Airway remains clear Breathes easily,respiration within normal limits

Fear /anxiety r/t hospitalisation,dyspnea Goal:child will be relieved of anxiety Explain unfamiliar procedure and equipments Explain unfamiliar procedure and equipments Remain with the child Remain with the child Hold and cuddle the child Hold and cuddle the child Be aware of rest and sleep pattern Be aware of rest and sleep pattern Provide security objects Provide security objects Try to avoid intrusive procedure Try to avoid intrusive procedure Encourage the parents to be with the child Encourage the parents to be with the child Expected outcome: -child responds positively to comforting measures -parents relate positively Child is calm and cooperate

Risk for infection/actual infection r/t presence of infective organism and inflammation Goal 1.:child exhibit no sign of infection Goal 1.:child exhibit no sign of infectionInterventions Administer antibiotics and antiinflammatory drugs Administer antibiotics and antiinflammatory drugs Provide adequate nutrition a/c to childs preferences and limitations Provide adequate nutrition a/c to childs preferences and limitations Expected outcome: Expected outcome: The child exhibit no signs of infection

Goal 2. Goal 2. The child will not spread infection to others Interventions Employ appropriate infection control measures Employ appropriate infection control measures Instruct others in precautionary measures Instruct others in precautionary measures Assess home situation administer antimicrobial medication Assess home situation administer antimicrobial medication Administer pneumococcal vaccine to susceptible children Administer pneumococcal vaccine to susceptible children Support body,s natural defence mechanism Support body,s natural defence mechanism

Ineffective airway clearance… Goal 2:the child will expectorate secretion adequately Ensure adequate fluid intake Ensure adequate fluid intake Provide humidified atmosphere Provide humidified atmosphere Assist in deep breathing and coughing Assist in deep breathing and coughing Suction as necessary Suction as necessary Expected outcome: Expected outcome: Expectorate secretion without stress or fatigue