08.04 Pneumonia

Hey everyone, in this lesson we are going to talk about pneumonia in pediatric patients. Pneumonia is pretty common in early childhood so it’s good to be familiar with it.

Pneumonia occurs when an infectious organism or irritant enters the lungs causing an inflammation in the alveoli. The lungs become consolidated which just means there’s fluid where there should be air. So, the alveoli are full of pus and liquid. You can see in the bottom x-ray, the white areas are consolidated.

Pneumonia is classified according to its cause. So you can have viral, bacterial, fungal, irritant or aspiration pneumonia. The most common in kids are viral, bacterial and aspiration.

The most common clinical manifestation of pneumonia is a cough. This can be non-productive or productive. One thing to know about kids, especially very young children and babies, is that even if they have a very wet sounding cough, they aren’t likely to cough up any phlegm. What they are more likely to do is vomit from the coughing and gagging on the mucus.

They will also likely have a fever and increased work of breathing.

Always remember, and I know I say this all the time, that a child’s work of breathing is our best indicator of how they are doing. Don’t rely on your pulse-ox to tell you there is a problem. This means you’ve got to be fully exposing the child’s chest to look for these these signs they are working hard. Be patient with your respiratory assessment and really take time to watch them breath.

Just to recap the things you are looking for: Tachypnea is the easiest way for a baby to compensate for poor oxygenation- make sure to count respirations for a full minute in your babies! Retractions indicate that the child is using extra muscles to move air. Nasal flaring in that baby trying to increase the amount of air coming through those passages.

These three assessment findings have all come up a lot in other lessons, but one we haven’t talked about as much is grunting. Grunting is a red flag and indicates serious illness. It’s primarily seen in babies and it happens as an effort to create positive pressure in the lungs and try to keep those alveoli (that are filling up with fluids) from collapsing. If you haven’t seen this in clinical or are unsure what it might sound like, check out the video in the resources. It shows a baby who’s working really hard to breath and is grunting.

When listening to the lungs you’ll probably hear crackles. On percussion the chest will sound dull due to the consolidation that we talked about earlier.

Chest pain can also happen with pneumonia. This is true for adults too, but one thing that commonly happens with kids is that they describe the pain as being abdominal pain. So sometimes when kids complain of pain in the right upper quadrant of the abdomen it could be caused by pneumonia.

Hypoxia can occur with more severe cases so you may notice pallor and cyanosis.

Dehydration is a common problem associated with pneumonia and can really complicate the illness so make sure to assess for signs of dehydration.

Our top priority with pneumonia is to support the patient's respiratory effort. This means providing suction, giving chest physiotherapy, providing oxygen if needed and doing other things like elevating the HOB to support respiratory effort.

Remember kids can easily become dehydrated when they are sick so we’ve got to encourage fluids and possibly even give IV fluids if needed.

Medications commonly used with pneumonia are antipyretics, cough suppressants and if it’s caused by bacteria, antibiotics.

Most of the time therapeutic management will be supportive and can be done at home. This is because most cases of pneumonia are viral. But sometimes in cases like severe bacterial pneumonia, or in children who have another chronic illness hospitalization is required.

Your priority nursing concepts for a pediatric patient with pneumonia are oxygenation, gas exchange, and infection control.
Okay, lets go over the key points for this lesson on pneumonia! So pneumonia is lower respiratory tract infection where the alveoli become inflamed and full of pus and fluid. This causes the lungs to become consolidated, which shows up as white patches on an x-ray and also causes the chest to sound dull on percussion.

The most common causes of pneumonia in kids are viral, bacterial and aspiration.

Primary symptoms to be on the lookout for are, cough, fever, crackles on auscultation and dullness on percussion.

Treatment is usually supportive and involves supporting respiratory effort with oxygen and chest physiotherapy. Dehydration occurs pretty often with pneumonia so fluids are often given as well.

Medications commonly used are antipyretics, cough suppressants and antibiotics if the cause is bacterial.

That's it for our lesson on pneumonia. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!