LOWER RESPIRATORY DISORDERS (CONTINUATION

MAAM THAI)
CONTINUATION OF PNEUMONIA
ADDITIONAL INFO ON: SIGNS CLASSIFY AS: TREATMENT
 Tachypnea Severe Pneumonia  Refer urgently
BRONCHIECTASIS  Lower chest to hospital for
wall indrawing injectable
Clinical Feautures:  Stridor in a antibiotics and
 Cough – chronic productive cough usually worse in the calm child oxygen if
morning and often brought on by change in posture. needed
Cough occurs due to accumulation of pus in (dik naka  Give first dose
of appropriate
klaro ha pic basta may word ini before bronchi HAHAHA)
antibiotic
bronchi
 Tachypnea Non-severe  Prescribe
 Sputum – copious and purulent Pneumonia appropriate
 Fever antibiotics
 Hemoptysis  Advise
 Anorexia and poor weight gain may occur as time passes caregiver of
 Crackles localized to the affected area other
 Wheezing, stridor supportive
measure and
 Chronic lung disease symptoms (digital clubbing, easy
when to return
fatigability)
for a follow-up
visit
Diagnosis:  Normal Other Repsiratory  Advise
 Thin-section HRCT scanning – is the gold standard Respiratory Illness caregiver on
because it has excellent sensitivity and specificity Rate other
 CT – provided further information on disease location, supportive
presence of mediastinal lesions and the extent of measures and
segmental involvement when to return
 Chest X-ray – increase in size and loss of definition of if symptoms
bronchovascular markings, crowding of bronchi, and loss persist or
of lung volume. Severe case: Honeycombing worsen
 Sputum Culture
RECOGNITION OF SIGNS OF PNEUMONIA
 TACHYPNEA is the most sensitive and specific sign of
TX:
pneumonia
 Aims at decreasing airway obstruction and controlling
infection
WHO DEFINITION OF TACHYPNEA
 Postpartal drainage and control infection
 <2 months = >60
 2-4 week of parenteral antibiotics is often necessary to
 2 to 12month = > 50
manage acute exacerbations adequately
 12 months to 5 years = > 40
 Amoxicillin/Clavulanic acid (22.5mg/kg/dose twice daily)
 Greater the 5 years = > 20
has been successful at treating the exacerbations
 Long-term prophylactic oral (macrolide) or nebulized
OTHER SIGNS OF PNEUMONIA
antibiotics (e.g. tobramycin, colistin, aztreonam) may be
 Lower chest wall indrawing during inspiration
beneficial
 Airway hydration (inhaled hypertonic saline or mannitol)  Nasal Flaring
also improves quality of life in adults with bronchiectasis
INDICATIONS FOR ADMISSION – IMCI
 Any underlying disorder (immunodeficiency, aspiration)
 All children with VERY SEVERE PNEUMONIA need
that may be contributing must be addressed
admission
 It includes any of:
PNEUMONIA  Cough or difficult breathing plus at least one of the
following: central cyanosis, inability to breastfeed or
Basic Pathophysiology: drink, vomiting everything, convulsions, lethargy or
 Most cases ofpneumonia are cause by the aspiration of unconsciousness, severe respiratory distress (e.g.
infective particles into the lower respiratory tract head nodding), some or all of the other signs of
pneumonia (tachypnea, grunting, nasal flare,
 Organisms that colonize child’s upper airways can cause
indrawing, changes)
pneumonia
 Pneumonia can be cause by person to person
IN-PATIENT CONSIDERATIONS
transmission via airborne droplets
 Due to the risk of transmission, a child suspected of
having pneumonia should be cared for in an area that is
 isolated from others to who are at risk of becoming
infected
 Contact precautions by health care workers such as hand
washing, gloves, gowns and masks to prevent
transmission between patients are often appropriate.
EPIDEMIOLOGY
 Antibiotics serve an essential role in reducing child deaths
from pneumonia
 Limited date suggests that in the early 1990’sless than
one in five children with pneumonia received antibiotics
 Children in urban areas and those with well-educated
mothers were more likely to receive antibiotics
TREATMENT-ORAL ANTIBIOTICS
Common medications for treating pneumonia:
 Penicillins: Amoxicillin, Amoxicillin-Clavulanate
 Sulfonamides: Co-trimoxazole
 Macrolides: Azithromycin, Clarithromycin, Erythromycin
 2nd generation cephalosphorins: Cefaclor
 Dose according to child’s weight
 A diagnosis of pneumonia should be considered in all
children with tachypnea and difficulty in breathing
 Common first-line antibiotics include: amoxicillin and
co-trimoxazole
ATELECTASIS
 Collapse or airless condition of the lungs with incomplete
expansion
 Primary: preterm, infants have mucus or meconium plugs
in the trachea
 Respiratory grunt
 Secondary: children with respiratory tract obstruction,
compression from diphramatic hernia, scoliosis, enlarged
lymph node
 “whiteout” in x-ray, asymmetry of the chest
 Prone to secondary infection since mucus becomes
stagnant
THERAPEUTIC MANAGEMENT
 Early recognition of atelectasis
 Removal of object through BRONCHOSCOPY
 SEMI_FOWLER’S positioning should be maintained
 Oxygen therapy
 Suction and postural drainage may be used to reduce the
amount of mucus in the respiratory tract
 Increased humidity in the environment can prevent the
drying of secretions and the formations of bronchial plugs
 Ensure chest is kept from pressure
 Prevent secondary infection and respiratory distress
PNEUMOTHORAX
 Presence of atmospheric air in the pleural space causing
the alveoli to collapse
 Air seeps from the ruptured alveoli, external puncture
 1% in newborns
 Chest hyperresonant, shift of apical pulse (mediatinal
shift)
 Darkened area of the air-filled pleural space
THERAPEUTIC MANAGEMENT
 Oxygen therapy
 THORACOSTOMY CATHETER or needle
 Low-pressure suction with water seal drainage –
symptoms are relieved within 24 hours
 PUNCTURE WOUND – cover with petrolatum gauze or
your gloved hand
BRONCHOPULMONARY DYSPLASIA (BPD)
 Preterm infants who received mechanical ventilation for
respiratory distress syndrome at birth
 Combination of surfactant deficiency, barotrauma, oxygen
toxicity and continuing inflammation
 X-ray show overinflation, inflammation and atelectasis
 Infant left with FIBROTIC SCARRING
THERPEUTIC MANAGEMENT
 Chronic tracheostomy
 Mechanical ventilation for as long as the first2 years of life
 Corticosteroids
 Bronchodilator by nebulizer
 Monitor nutrition and intake
 Support parents
Prophylactic
 Administration of caffeine
 Oxygen administration at the lowest level possible
TUBERCULOSIS
 It is estimated that 1/3rd of the world’s population is
infected with Mycobacterium Tuberculosis
 WHO has estimated that around 10% of global
tuberculosis case load occurs in children (0-14 years old)
 Of these childhood cases, 75% occur annually in 22 high-
burden countries that together account for 80% of the
world’s estimated incident cases
Key Risk Factors:
 Household contact with a newly diagnosed smear-positive
case
 Age less than 5 years
 HIV infection
 Severe malnutrition
 When the agent invades the child’s lungs, a primary
inflammation occurs (slight cough, anorexia, night sweats,
low-grade fever)
 Leukocytes and lymphocytes then invade the lung area to
attack the organisms, calcifying and confining it
permanently
 If in poor health and low in calcium intake, may spread to
other parts of the body (military TB)
ASSESSMENT
 Tuberculin test at 9-12 months of age and yearly
thereafter if high-risk
 Should not be done immediately after MMR vaccination
= false negative & primary to military TB
 MANTOUX TEST: 0.1ml with 5 units of PPD intradermally
at the volar aspect of the forearm (or 2 TU of PPD RT 23)
 A weal of 5mm should be raised – readafter 48-72 hours
(+) induration and erythema
 Not given to children who had hx of TB – site may slough
 X-ray early course = not evident
 (+) local inflammation = cloudiness in the area

 Sputum: expectorate from the lungs not throat

 Younger than 5 years old: gastric lavage early in the
morning before meals
 3 consecutive days

 Use therapeutic play

 Children who have primary TB are not infectious

Therapeutic Management
 Isoniazid (INH) is the drug of choice
 Peripheral neurologic symptoms if Vitamin B6 is not given
 Rifampicin )2nd choice) combined with INH
 Para-amniosalicylic acid (PAS) = GI disturbances (given
after meals)
 Ethambutol for older children = optic neutritis
 Diethigh in protein, Ca, B6
 !8 months of therapy
 Periodic X-ray for the rest of their life
 Verify regular immunization = pertussis can reactivate TB