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Patient Jhennyl Ogalesco, female, who is one year of age was admitted

to Valenzuela Medical Center (VMC). The mother of the child panicked when
the child exhibited signs of irritability, having difficulty of breathing and
slight fever after having series of cold. Those signs urged her to rush her
child to the nearest hospital. The principal diagnosis of the attending
physician was severe pneumonia. After running several tests, the diagnosis
was then confirmed.
Age: 1 year old
Gender: Female
Major Complaint: Difficulty of breathing
Principal Diagnosis: Severe Pneumonia

Vital Signs
Heart rate: 166 beats /min
Respiratory rate: 31 beats /min
Temperature: 38.3C

The said patient was diagnosed of having severe pneumonia.
But what do we really know about pneumonia?
Few abstract key facts of pneumonia are as follows:
O Pneumonia is the leading cause of death in children worldwide.
O Pneumonia kills an estimated 1.6 million children every year -
more than AIDS, malaria and tuberculosis combined.
O Pneumonia can be caused by viruses, bacteria or fungi.
O Pneumonia can be prevented by immunization, adequate
nutrition and by addressing environmental factors.
O Pneumonia can be treated with antibiotics, but less than 20% of
children with pneumonia receive the antibiotics they need
O Research suggests that men with a history of pneumonia and
other respiratory illnesses in childhood are more than twice as
likely to die of COPD as those without a history of childhood
respiratory disease.

What is pneumonia?

In a medical view, pneumonia is commonly defined as the presence of
fever or acute respiratory symptoms and evidence of parenchymal infiltrates
on a chest radiograph. Pneumonia is a form of acute respiratory infection
that affects the lungs.
In laymans understanding, pneumonia is the accumulation of phlegm
in the lungs that is usually caused by unattended and undried back portion
of the body as well as from the different types of germs, including bacteria,
viruses, fungi, and parasites.
When an individual has pneumonia, the alveoli are filled with pus and
fluid, which makes breathing painful and limits oxygen intake, rendering
difficulty of breathing to those affected by this. (Patients with complicated
pneumonia are more likely to present with respiratory distress). Often
pneumonia begins after an upper respiratory tract infection (an infection of
the nose and throat). When this happens, symptoms of pneumonia begin
after 2 or 3 days of a cold or sore throat with associated with a greater fall in
hemoglobin level from the time of admission, longer time to defer escence
(9.2 days vs 2.3 days), and a longer duration of hospitalization (13.2 days
vs 5.3 days).

How many are affected by the disease?
Pneumonia is the single largest cause of death in children worldwide.
Every year, it kills an estimated 1.6 million children under the age of five
years, accounting for 18% of all deaths of children under five years old
worldwide. Pneumonia affects children and families everywhere. It has been
the most prevalent disease in the third world countries; verifying the disease
as the "no. 1 killer for children under the age of 5 in the Philippines with more
than 5,000 or so Filipino children dying from every year.
What are the causes?
Pneumonia is caused by a number of infectious agents such as viruses,
bacteria and fungi, including:

O Streptococcus pneumoniae - the most common cause of bacterial
pneumonia in children;
O aemophilus influenzae type b (Hib) - the second most common cause of
bacterial pneumonia;
O #espiratory Syncytial Virus is the most common viral cause of pneumonia;
O Infants infected with HIV, !neumocystis jiroveci is one of the most common
causes of pneumonia, responsible for at least one quarter of all pneumonia
deaths in HIV-infected infants.

What are the common signs and symptoms of pneumonia?
(Symptoms of pneumonia vary, depending on the age of the child and the
cause of the pneumonia)
Common symptoms include:
O fever
O chills
O cough
O unusually rapid breathing
O breathing with grunting or wheezing sounds
O labored breathing that makes a child's rib muscles retract (when muscles
under the rib cage or between ribs draw inward with each breath)
O vomiting
O chest pain
O abdominal pain
O decreased activity
O loss of appetite (in older kids) or poor feeding (in infants)
O in extreme cases, bluish or gray color of the lips and fingernails

What are the most effective treatments?
Pneumonia can be treated with antibiotics.
(These are usually prescribed at a health centre or hospital, but the vast
majority of cases of childhood pneumonia can be administered effectively
within the home).
Hospitalization is recommended in infants aged two months and
younger, and also in very severe cases.
Surgery:
Although most patients with pneumonia do not need invasive therapy,
it may be necessary in patients with abscesses, emphysema and other
complications.
Thoracotomy
Thoracotomy is the standard surgery for pneumonia, requiring general
anesthesia and an incision to open the chest and view the lungs. This
procedure allows the surgeon to remove dead or damaged lung tissue. In
severe cases, the entire lobe of the lung is removed, known as alobectomy.
The remaining healthy lung tissue re-expands after surgery to make up for
tissue that has been removed.
hest Tubes
Chest tubes are used to drain infected pleural fluid but are not
typically required for pneumonia or abscesses. The tubes are inserted after
the patient is given a local anesthetic, and remain in place for 2 - 4 days.
(This can be very distressing, although some patients experience no
discomfort). However, complications of chest tubes include:
O Accidental injury to the lung
O Fluid build-up within the lung if the pleural fluid is removed too rapidly
O Infection
O Perforation of the diaphragm
The chest tubes removal may cause the lung to collapse and may be
needed to inflate the lung.

How is pneumonia transmitted?
The viruses and bacteria that cause pneumonia are contagious and are
usually found in fluid from the mouth or nose of an infected person. Illness
can spread when an infected person coughs or sneezes on a person, by
sharing drinking glasses and eating utensils, and when a person touches the
used tissues or handkerchiefs of an infected person.
Nursing Management
The management of complicated pneumonias is more challenging. It
should be anticipated that radiographic and clinical progression may not
occur for the first 24 to 48 hours after initiation of therapy. Persistent fevers,
particularly in complicated pneumonia, are frequently seen. In most children
with complicated pneumonias, chest radiographic findings at 1 year of
follow- up will appear near-normal or normal.
Case management of ARI in children 2 month to 5 years
O Assessment, classification and treatment of ARI are summarized on the
attached charts. All children presenting with cough or difficult breathing
should be assessed according to these charts.
O All children should also be assessed for signs of severe malnutrition - visible
severe wasting and oedema of both feet. Children with any of these signs
must be referred to a hospital as they are at a very high risk of death from
pneumonia.
O Children with danger signs should be referred to a hospital after a single
dose of IM chloramphenicol. In situations where referral is not possible,
twice daily injections of IM chloramphenicol should be continued for 5 days,
followed by oral antibiotic therapy for another 5 days.
O Children with severe pneumonia should be referred to a hospital for
treatment with IM ampicillin/penicillin. In situations where referral is not
possible, these children can be treated with oral amoxicillin given thrice daily
for 7 days. Oral amoxicillin has recently been shown to be effective in
treatment of severe pneumonia.
O Children with non-severe pneumonia should be given antibiotics for 5 days.
The new Emergency Health kits contain co-trimoxazole, which is a low-cost
broad spectrum antimicrobial. An alternative is oral amoxicillin.
O Supportive measures include increased oral fluids to prevent dehydration,
continued feeding to avoid malnutrition and anti-pyretics to reduce high
fever.