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that her baby is not feeding well, have fast breathing and is
coughing since 4 days. What might be the diagnosis for
baby?
• Respiratory examination in pediatrics.mp4
Inspection of chest
• Nearly circular or cylindrical in infants
• The shape may be normal, barrel shaped(asthma )
or pigeon shaped.(rickets)
• Barrel shaped chest is seen when lungs are
chronically overinflated with air, so the rib cage stays
partially expanded all the time this makes breathing
difficult as well
• Symmetry
• Movement of chest: breathing is mostly abdominal in
infants
Palpation
• Look for any tender areas, crepitus and assess any
differences of movements on two sides of chest
• Feel any abnormal vibrations e.g ronchi, friction rub,
crackles.
• Vocal or tactile fermitus is looked for by comparing
tactile transmission of spoken words or cry in infants
• Assess the expansion of chest on two sides.
Lung sounds
• Pleural rubs are discontinuous or continuous, creaking or
grating sounds. The sound has been described as similar to
walking on fresh snow type of sound.
• Coughing will not alter the sound. They are produced because
two inflamed surfaces are sliding by one another, such as in
pleurisy.
• Crackles, crepitations, or rales are the clicking, rattling, or
crackling noises that may be made by one or both lungs of a
human with a respiratory disease during inhalation.
• Rhonchi are coarse rattling respiratory sounds, usually
caused by secretions in bronchial airways.
percussion
• Tympanitic, drum-like sounds heard over air filled structures
during the abdominal examination.
• Hyperresonant (pneumothorax) said to sound similar to
percussion of puffed up cheeks.
• Normal resonance/ Resonant the sound produced by
percussing a normal chest.
• Impaired resonance (mass, consolidation) lower than normal
percussion sounds.
• Dull (consolidation) similar to percussion of a mass such as
a liver.
ARI/Pneumonia
Acute Respiratory Tract Infection
• Acute respiratory infection is an acute infection of any
part of respiratory tract and related structures
including paranasal sinuses, middle ear and pleural
cavity.
• It may cause inflammation of respiratory tract
anywhere from nose to alveoli with a wide range of
combinations of symptoms and signs.
ARI
• It includes all infections of less than 30 days
duration, except the infection of ear lasting less than
14 days.
• The incidence of ARI is highest in young children,
especially below 5 years of age and decreases with
the increasing age.
ARI includes
• Pneumonia
• Diptheria
• Pertussis (Whooping cough)
Pneumonia
Definition
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Classification
• on severity basis
• on etiologic basis.
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Classification on Anatomic Basis
a. Bronchonpeumonia
bronchopneumonia.
c. Interstitial Pneumonia
• No Pneumonia
• Pneumonia
• Severe Pneumonia
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Classification on Severity Basis
• No Pneumonia
• Severe Pneumonia
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Classification on Etiologic Basis
a. Bacterial Pneumonia
b. Loffler’s Pneumonia
It is a disease in which eosinophils accumulate
in lungs in response to parasitic infection.
It may be caused by parasites like Ascaris,
lumbricoides, Strongyloides, stercoralis and
Ancylostoma duodenale.
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Miscellaneous Types
c. Chemical Pneumonia
It results from aspiration of Kerosene oil
poisoning.
d. Hypostatic Pneumonia
It results from collection of fluid in dorsal region
of lungs and occurs especially in those confined
to bed for long time (like bed ridden patients.)
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Other classification
• Community acquired pneumonia: occurs with in first
48hrs of hospitalization. Common organism are
Pneumonia are streptococci, hemophilus influenza,
mycoplasma, viral, pneumococcal
• Hospital acquired: pneumonia occurred greater than
48 hrs after hospital admission. About 0.5 to 1% of
all hospitalization
• Pneumonia in immune compromised host: child
using immuno-suppressive agent, chemotherapy,
nutritional depleted, broad spectrum antibiotics,
genetic acquired pneumonia
Causative Organisms
Bacterial: Pneumococcus, Staphylococcus,
36
Risk Factors
• Malnutrition
• Vitamin A deficiency
• LBW
• Lack of breast feeding
• History of previous respiratory tract infection
• Passive smoking
• Young age, advanced birth order
• Indoor and outdoor pollution
• Family history
• Overcrowding damp residence
• immobility
Vit A deficiency and pneumonia
• Vitamin A/retinol is involved in the production,
growth and differentiation of red cells, lymph cells
and antibodies , and epithelial integrity.
• Because of its proven effectiveness in protecting
against measles-associated pneumonia , vitamin A
supplementation has been investigated as a
possible intervention to speed recovery, reduce the
severity and prevent against subsequent episodes
of acute lower respiratory tract infections
Pathogenesis
Bacteria or virus reach the lungs through
respiratory passage and multiply in the alveoli.
During this period, the lungs become dark bluish red and
heavy.
45
Diagnostic Evaluation
47
Signs Classification Treatment
49
Additional signs of severe pneumonia
hospitalization.
child.
59
Nursing Management
Nursing management is focused on
3. Control fever
3. Control fever
62
Nursing Management:
Facilitate respiratory efforts
• Maintain patent airway and provide high
humidity atmosphere.
• Administer oxygen to maintain the oxygen
saturation in blood.
• Place the child in semi-fowlers position to
help in breathing.
63
Nursing Management:
Facilitate respiratory efforts
Position of the child should be changed frequently
64
Nursing Management:
Facilitate respiratory efforts
65
Nursing Management: Facilitate respiratory
efforts
• If the child is old enough, teach them effective
coughing and deep breathing.
66
Nursing Management:
Control fever
• Provide bed rest to the child.
67
Nursing Management
Maintain fluid & electrolyte balance
• Provide adequate fluid to meet increased fluid
demand of the child.
68
Nursing Management
Maintain fluid & electrolyte balance
• When oral feedings are started, after the child’s
condition permits, feed the child slowly and
carefully to prevent aspiration and aggravation of
cough.
69
Nursing Management:
Promote rest and sleep
• Handle the child as little as possible to provide
rest.
• Provide diversion therapy to the child to avoid
boredom.
• Administer mild sedatives (if prescribed) when
the child is restless or irritable.
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Complications
• Pleural effusion
• Emphysema: is a long-term, progressive disease of
the lungs that primarily causes shortness of breath
due to over-inflation of the alveoli (air sacs in the
lung).
• Pneumatocele: is a cavity in the lung parenchyma
filled with air that may result from pulmonary trauma
during mechanical ventilation.
• Bronchiectasis: is a disease in which there is
permanent enlargement of parts of the airways of the
lung.
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Prevention
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Research Article