Pneumonia Disease in Children - Research Paper Example

Pneumonia in Children Introduction: Pneumonia is a contagious disease that spreads easily and it affects children the most. In underdeveloped countries there are child deaths of high percent due to this disease. This death toll is usually caused by community acquired pneumonia and it usually affects children below five years. As Thomas J. Marrie points out “the overall incidence is likely between 5 and 20 per 1000 per year, with a higher incidence in young children” (2001, p 16). Pneumonia is caused by either bacteria or virus and it is difficult to diagnose the cause. Usually death is caused due to wrong diagnosis or because more time is taken for detecting the issue. Children will suffer from respiratory difficulties as well as high fever and muscle aches and all these make the situation worse. It is easy to cure the disease caused by bacteria when compared to that caused by virus. Proper nursing assistance and medication along with rest is very essential for the alleviation of the disease.   Over View Description: Generally the healthy human lung is always defending from diseases caused by foreign substances such as fungi, virus, or bacteria. The human body has resistance power to keep away from all the microorganism substances. Part of respiratory system called epiglottis prevent the food and other substance from entering into the lungs. The thick fluid called mucus detains all microorganism and other dust particles. Celia and the extraordinary white blood cell; macrophages also capture all the foreign substances and protect the function of respiratory system effectively. Sometimes the immune system does not function properly that can cause infection into the lungs. For instance, for a person who consumed excessive alcohol, there is a possibility of disrupting the immune system of our body by alcohol particle. This can also cause infection to the lungs and may turn out to be pneumonia. Pathosphysiology: pathophtysiology is the twig of medical science which observes and analyses the changes of normal biochemical, mechanical and physical functions of human body. Pneumonia is an inflammatory disease which occurs in respiratory organs of human body with the infection of fungi, viruses, bacteria or parasites. It is also termed as lung parenchyma or alveolar inflammation. Pneumonia is identified as a common phenomenon and it affects all age groups. Sometimes it will lead to death in case the patient is constantly and terminally sick. In addition, pneumonia is the prime cause of raising the ratio of death in children less than five years. The symptoms of pneumonia mainly consist of chest pain, fever, cough and complexity in inhalation. The main reason is the tiny blood vessel called capillaries tubes become leak and protein-rich fluid passes through the air sacs in the lungs called alveoli. This process obstructs the function of oxygen-carbon dioxide exchange. The result is that the patient put maximum effort to inhale oxygen and exhale more of carbon dioxide.  The pathophysiology points out that the increment of mucus production and the leakage of capillary tubes may reason the mucous to get a rusty colored of blood. Mucous again tries to reduce the oxygen-carbon dioxide exchange within the respiratory system. Fluid keeps on filling in to the alveoli and the debris also is deposited in the alveoli. Alveoli are tending to become rigid because of the collection of fluid and debris. This process is known as consolidation. The main diagnosis devices of pneumonia are examination of sputum, and taking x-rays. Treatment of pneumonia mainly depends on the cause of disease. For instance, pneumonia is treated with antibiotics if it is caused by bacteria. There are some vaccines available in the market to prevent certain types of pneumonia. The prognosis of this illness is totally relied on the type of disease, the proper treatment, any risk factors, and under lying heath of the patients. Causes of pneumonia: medical scientists have discovered almost 30 different causes for pneumonia and they all come under the infective and aspiration pneumonia categories (LIFE Magazine, p. 55). Infective pneumonia is due to the bacteria or viral infection and inflammation of respiratory system like lungs and bronchial tubes. Aspiration pneumonia is also a swelling of respiratory system caused by inhaling vomit, mucous or other bodily fluid. Inhaling some type foreign substances also cause aspiration pneumonia. The main cause of bacterial pneumonia is streptococcus pneumoniae or pneumococcus. Pneumococcal pneumonia is occurring in the lobar part of lungs. Virus is the fundamental cause of many of the infective pneumonia but it cures very rapidly without any medicine or other treatment. It means our body produces antibody to fight against antigen like virus and bacteria. Pneumococcus is serious bacterial infection that occurs in the lungs, meningitis, blood stream and parts of human body. The main causes of aspiration pneumonia are inhaling vomit, annoying odors, or chemical substances. Petroleum substances such as petrol, diesel, kerosene, waxes, gasoline, are the primary cause of aspiration pneumonia. Risk factor: There are many risk factors involved in the development of pneumonia. The main risk factors are those who involved in smoking, consuming alcohol, any other pulmonary diseases such as emphysema, asthma, HIV or AIDS; these people are facing the high risk of inhaling mucus of saliva from the nose or mouth.  The children below one year or older persons, the person who are malnourished and the person who are native Alaskan or Native American ethnicity undergo high risk factor of pneumonia. Other main risk factor is the weakened or impaired immune system, recently recovered from cold or influenza infection, recently hospitalized in intensive care unit, and exposed to certain chemicals or pollutants. Incidence: Studies by Feigin (2004) shows that the invasive infection occur children at their very early ages of 5to 6 in Western Europe but it was very lesser compared to nations like United states, and Africa. In Western Europe, Out of 100,000 populations 25 cases reported the incidence of pneumonia. But in nations like chili, Australia and New Zealand it was 25 to 60 cases per 100,000 populations. The study shows that invasive infection of children was almost 65 to 70 cases per 100,000 in United States. But the incidence pneumococcal meningitis in United States   is almost similar in Western Europe. The ratio is 3.6 per 100,000 in the United States and 4.6 per 100,000 populations in Europe. The ethnic group called Navajo and Apache in the United States is the main victim of higher incidence of invasive pneumococcal disease. Alaskan native children are the other main prey of pneumococcal bacteremia and meningitis. The studies prove that out of 100,000 population  598 cases they belong to 6 t0 11 months old children and 56 cases are belong to 36 to 47 months. Comparatively African American children in the United States are suffering from the disease of invasive infection three times higher than of white children in the same age (Feigin, 2004, P. 1224-25). Characteristics of pneumonia: Based on clinical characteristics the physicians classify pneumonia into acute and chronic. Chronic pneumonias generally are caused by airway obstacles and it may have either non-infectious or mixed bacterial infections.  Pneumonia is caused by particular etiologic agent. The classifications of pneumonia are community acquired or hospital acquired. The symptoms and signs of community acquired pneumonia is fever, cough with or without sputum, sweats, dyspnea, hypothermia or rigors. There are no specific sign reported of pneumonia in children but usually it seems fever or irritability. If the new born children find difficulty in breathing that can be cause of pneumonia disease. Complication of pneumonia: Higher amount of fluid deposit in the area between respiratory system and chest wall, Collection of pus in the area between the respiratory organ and empyema, bacterial lung infection after viral infection or secondary infection, bacteria in the blood stream or entire body swelling of meningitis, infection of joint (septic arthritis) and infection of the heart muscle surrounding the heart are the complication of pneumonia disease. Assessment History: In the initial clinical evaluation the doctor aims to find that whether the history of child and findings of physical examination are likely to confirm community acquired pneumonia (CAP). Initial history takes account of the age of the child, month in which disease came, if there are any infectious diseases spreading at the time, immunization capability of the patient like medicines for Streptococcus pneumoniae and influenza virus especially if the patient has issues like those diseases etc. Doctor also needs to take into account the situation in which the disease is diagnosed like if the patient was having a long travel or travel to areas where some diseases are prevalent. A physical examination will be performed for checking respiratory illnesses, cold and flue etc. This is very necessary because children will be having a frequently changing respiratory pattern according to behavioral and physiologic patterns. A combination of clinical findings is usually used to determine pneumonia as the chances of missing or wrong diagnosis are more. More over if you are using a combination of diagnosis reports findings can be more predictive. Physical examination of children usually includes nasal flaring, checking of oxygen saturation, checking if oxygen saturation is less than 94%, identifying retractions and tachypnea (Green-Hernandez, Singleton and Aronzon, 2001, p. 420). If it is found that there is an absence of tachypnea alone or any signs of other respiratory illnesses it is possible to obtain best negative predictive value. Physical findings: Severity of the disease is assessed on the basis of overall clinical appearance and behavior, child’s eating pattern, alertness level, breathing efficiency, sub costal retractions etc. Those affected severely with pneumonia will be finding it more difficult to breathe. Sometimes children below five years may be found without any breathing difficulty also. If the disease has become acute they might develop abdominal pain, high and continuing fever without any cause etc. faster heart rate is an important factor to be considered along with high temperature. Breathing efficiency includes fast or shallow breathing or shortness r difficulty to breath. Chest pain and oxygen levels are also necessary to be analyzed for confirming pneumonia. Some children may develop rashes. Some others might have fatigue, cough, nausea etc. Some of them might have dehydration, vomiting tendency or body pain especially muscle aches. Swollen joints and stiff neck are other symptoms found in people having pneumonia attack. Doctor tries to examine rales or bubbling noises during breathing which is caused by fluid movement or by tiny air sacs in lungs. Your doctor might tap the chest to test dull thuds caused by fluid in lungs or partial lung collapse.  Swollen lung tissues are likely to make sound which doctor can easily find out. Lack of breathing sound is yet another symptom. Egophony is yet another method. In this the doctor will be saying ‘E’ as he listens to chest as this letter will sound like ‘A’ through a stethoscope in those patients having pneumonia. Wheezing is also considered as a symptom for physical examination as this is caused by inflammation in bronchial tubes. Chest radiographs are taken to confirm the disease through physical examination. But this is not enough to predict the disease or to know its severity. Test Results: If doctor feels that the child is likely to be affected with pneumonia it is better to take an x-ray of chest for confirming the disease. This is also better in cases of complication of pleural effusion or a suspicion of pleural effusion and in cases where the disease is prolonged. It is advisable to take chest x-ray when the patient is not responding to antimicrobials. In most of the cases it is the positive chest x-ray that helps to diagnose the disease. But it is to be kept in mind that the chest x-rays can not be helpful in determining whether the infection or viral or etiological. An x-ray will be helpful in diagnosis for an experienced clinician. If a child is diagnosed to have high fever and high white blood cell it is always advisable to take an x-ray. Count of white blood cells are best in cases where doctor need to prescribe anti biotic. This is because when white blood cells count is high particularly above 20,000/mm3 and when fever is there about 102.2 degrees F the disease may be diagnosed as bacterial (National Guideline Clearinghouse). Routine blood culture is not of much use in diagnosing pneumonia. This is because chances are only less than 2.7% (National Guideline Clearinghouse). Blood cultures are found effective in those with acute and unusual types of pneumonia. But usually antibiotics are prescribed even from initial stage of notion of pneumonia. Then the culture will not prove effective in detecting the disease. Diagnosis methods like C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are also of no use. It is better to make an analysis of purified protein derivative (PPD) in those children with a history of tuberculosis or those who have traveled recently in an area where there this disease is prevalent. Skin testing is also good under such conditions. If a child is having severe pneumonia sputum Gram stain or methods like culture can be done using high quality specimens. If the specimen contains less than 10 squamous epithelial cells and is having more than 25 white blood cells per low power field it can be considered as a high quality specimen (Geiger-Bronsky & Wilson, 2008, 264). If a child is found to have effusion then pleural cultures need to be analyzed. Certain conditions like immunodeficiency or foreign body aspiration is to be considered when all other findings are found to be insistent. Treatment General: Community acquired pneumonia caused by bacteria is mostly affecting children of developing countries. Mostly children below age of five are affected by this disease and mortality rate due to pneumonia is also high. Several other antibiotics are prescribed by doctors for reducing the severity or to control the disease even though it antiseptic alone can not cure the disease. But if the case is of bacterial infection these antibiotics will bring the situation under control. As classic antibiotics are not effective in viral cause some doctors prescribe antiviral medication. As it is difficult to distinct between these two causes it is common to give antibiotics in initial stage. Outpatients are usually treated with antibiotics. But it is better to get hospitalized if one is suffering from chronic diseases or low oxygen level. At this stage one might require oxygen therapy or intravenous antibiotics. If one is taking treatment from home it is necessary to intake plenty of water, take rest completely and to take medications for fever. But children must not be given medications like aspirin or acetaminophen.  If one is admitted to hospital one might receive treatments to remove secretions and at times steroid medications are also given to reduce wheezing in case of lung disease. Medication: Eddelston et al (2005) elaborately deal with the various medications commonly employed in the case of pneumonia patients. The authors state that doctors usually prescribe amoxycillin or procaine penicillin for those coming with pneumonia. At times co-trimoxazole is also prescribed which is less effective than the other two. At times, a permutation of penicillin and gentamycin is also given to inpatients. Chloramphenicol is also given but is found less effective. Oral and injectable amoxicillin are equal in effect. For ambulatory patients CAP it is better to prescribe amoxicillin than co-trimoxazole. But both azithromycin and erythromycin are found effective in same depth. Same is the case with cefpodoxime and co-amoxyclavulanic acid. For inpatients it is better to give penicillin or a combination of penicillin and gentamycin and not co-trimoxazole or chloramphenicol alone. Injectable penicillin is also a failure like oral amoxicillin. Those with mild pneumonia are given oral macrolide antibiotics. For instance azithromycin, clarithromycin, or erythromycin. If the patient suffers from any chronic disorders or kidney failure, diabetes or heart diseases they are given Fluoroquinolone like levofloxacin or Levaquin, sparfloxacin or Zagam,  gemifloxacin or Factive and moxifloxacin or Avelox. At times amoxicillin or amoxicillin-clavulanate, along with macrolide antibiotic like azithromycin, clarithromycin, or erythromycin are given in high dose. If the patient is suffering from any kind of lung disease Pneumococcal vaccination is given to prevent lung infections caused by Pneumococcus bacterium. Vaccine is injected to body as this will help to stimulate normal immune system of the patient by producing necessary antibodies (Eddelston et al, 2005, p. 205). Surgery: Those patients suffering from abscess and empyema may require invasive therapy. Thoracotomy is the name of surgery for patients suffering from pneumonia. It necessitates general anesthesia and a slit for opening the chest and for viewing lungs. By this the surgeon will be able to do away with dead or dented tissues of lungs. If the case is more severe whole lobe of lungs is removes through surgery. This surgery is called alobectomy. If this is done left over hale and hearty lung tissue expands and make up for those tissues removed through surgery. Yet another method is using of Chest tubes for draining away infected pleural fluid. After giving local anesthesia to patient the tube is inserted to lungs and it remains there for two to four days. But some of the patients experience distress. There are some complications like infection, accidental injury etc for this method. Removing of this tube is likely to cause lung collapse and this condition might require re insertion of chest tube for blowing up the lung. Nursing considerations Key outcomes: Nursing assistance is very important in identifying pneumonia. Patient might experience fever, night sweats etc and the condition is very important for those affected with bacterial pneumonia. Respiratory symptoms are very important as it might lead to fatigue, tachypnea, coughing etc. When a child is identified with pneumonia there are chances of respiratory difficulties also. He/she may experience flaring, cute tachypnea or grunting which needs immediate oxygen for respiration. For this it is necessary to have proper nursing assistance. On diagnosis of community-acquired pneumonia the disease may be treated with high dose amoxicillin or antibiotics like azithromycin and this is to be done under proper nursing assistance. The child might be experiencing severe body pain, dehydration, fatigue etc which needs special nursing assistance. As pneumonia is a dangerous disease that causes death of children in developing countries the children with any such symptoms must be given proper nursing assistance in all ways possible. It is better to admit the child for this will increase scope of nursing attention. Nursing Interventions: A nurse may intervene in three stages. The first is in assessment of disease where by a proper intervention plan is prepared and the child suspecting pneumonia will be administered with common antibiotics and some other medicine to reduce fever etc. If in need of respiratory support it will be provided and a dose of tetanus will also be provided. If the patient has already consulted doctor and is having medical orders from doctor nursing assistant will follow that along with a nursing plan. Child’s vitals, fluid output etc will be checked and the parents and patient will be educated with the situation. Counseling for patients and bystanders, proper administration of medicine, doing minor medical procedures in general etc are all his duties. Nursing assistant has to keep the patient constant enough to accept treatment and to provide with the child’s needs necessary for the situation. They can easily avail medical support from professionals in case of any need. They assist the child in every way possible so that the disease cures faster. Monitoring: A child admitted with pneumonia is in need of proper assistance for he/she might experience different difficulties especially with breathing. It is necessary to monitor the patient for knowing the reaction to medicine and to provide respiratory support when ever needed. Proper medicines must be given on time and the child must be helped to gain happiness and must be prepared for treatment. Lung sounds, oxygen level, breathing difficulties etc must be monitored and must be reported or provided as per necessity. In some cases chest physiotherapy might become necessary. If found necessary, the child and parents must be given proper guidance regarding incentive spirometry and flutter valve. In case the patient is immobile he/she must be helped to turn position every two hours and must be encouraged to cough and to take deep breathe. In cases of tracheostomy after hyperoxygenating necessary trach care and suctioning must be performed. Patient Teaching: When a child is affected with pneumonia it is necessary to give more care than adults as the parents will be more tensed and will lose confidence easily. It is the duty of medical professionals to educate the child as well as parents about the condition and necessities to be taken care of. As the disease is not easy to diagnose on initial days of admission child might experience more difficulties. This is because he/she might be given antibiotics only and in cases of viral cause this will not be effective. It is very necessary to educate the patient and bystanders at this stage. Later they must be properly guided regarding medicines, proper timings, necessity to follow every instructions etc. Children are difficult to be managed in case of diseases as they will find it more difficult than adults to manage the situation. Much patience is necessary for taking care of children. He /she must be kept happy and as they are not aware of any thing medicines and such other needs have to be taken care of with due concentration. Conclusion: Pneumonia in children is more complicated than in adult and hence it needs proper care and medical attention on time. If one feels that child is having any symptoms of pneumonia it is advisable to approach the doctor as soon as possible. As the condition is very critical it is better to get admitted in a hospital. This will help to get more attention and nursing assistance. A child suffering from pneumonia is likely to have difficulty in breathing and hence will be in need of respiratory devices. This is also possible in a hospital. At times it might be difficult to find out proper cause and in such cases also it is better to remain in hospital till the diagnosis is complete and the doctor advises a discharge.  References Eddelston, Michael et al (2005). Oxford handbook of tropical medicine. Oxford University Press. Feigin, Ralph D. (2004). Text Book of Pediatric Infectious Diseases. Fifth edition: Gulf Professional Publishing. Geiger-Bronsky, M & Wilson, D. (2008). Respiratory nursing: a core curriculum. Springer Publishing Company. Green-Hernandez, C., Singleton, J.K., and Aronzon, D.Z. (2001). Primary care pediatrics. Illustrated Edition: Lippincott Williams & Wilkins. LIFE Magazine. (13 Feb 1950). Retrieved September 06, 2009, from Time Inc: http://books.google.co.in/books?id=FlMEAAAAMBAJ&pg=PA53&dq=Causes+of+pneumonia:+there+are+almost+discovered+30+different+causes+of+pneumonia&ei=0UnLSr7FJJqEkATN0Iy0Aw#v=onepage&q=30&f=false Marrie, Thomas J. (2001). Community-Acquired Pneumonia, Springer. National Guideline Clearinghouse. Evidence-based care guideline for community acquired pneumonia in children 60 days through 17 years of age. Retrieved September 06, 2009, from: http://www.guideline.gov/summary/summary.aspx?doc_id=9690 Read More