TEXTBOOK & DISCUSSION

Definition:
Pneumonia is an acute infectious disease caused by a pneumococcus, associated by general toxemia and
a consolidation of one or more lobes of either one or both lungs.

It is an inflammation of the lungs caused by infectious agent in which the air are filled with pus or
exudates so that the air is excluded and the lungs become solid.

Cause:
Many germs can cause pneumonia. The most common are bacteria and viruses in the air we breathe.
Your body usually prevents these germs from infecting your lungs. But sometimes these germs can
overpower your immune system, even if your health is generally good.

Pneumonia is classified according to the types of germs that cause it and where you got the infection.

Predictors of CAP in a Patient with cough:

 1. Ages 3-5 y.o – Tachypnea and/or chest in-drawing
 2. Ages 5-12 y.o – Fever, tachypnea & crackles
 3. >12 y.o – Fever, tachypnea, tachycardia, at least 1 abnormal chest findings, rhonchi, crackles,
wheezes and Breath sounds.
 Reliable indicators- either tachypnea and/ or chest in-drawing among infants and preschool
children
 Tachypnea is still the best predictor
 Age specific criteria for tachypnea:
2-12 months – 50 breaths/min
1-5 years– 40 breaths/min

>5 years – 30 breaths/min

 Patients with CAP are 2-3 times more likely to have the following S/Sx:
Nasal flaring, grunting, tachypnea, rales and pallor
 Diagnosis of an adolescent suspected to have CAP:
Cough
Tachypnea (RR. 20 breaths/min)
Tachycardia (HR. 100bpm)
Fever (temp >37.8 °C)
At least 1 abnormal chest findings CXR with infiltrates
 PCAP CLASSIFICATION
Variables PCAP A PCAP B PCAP C PCAP D
Minimal Risk Low Risk Moderate Risk High Risk

Co-morbid None Present Present Present

illness
Compliant Yes Yes No No
Care giver
Presence of None Mild Moderate Severe
Dehydration
Ability to feed Able Able Unable Unable

Age >11 months >11 months <11 months <11 months

Resp. rate
2-12 months >50/min >50/min >60/min >70/min
1-5 years >40/min >40/min >50/min >50/min
>5 years >30/min >30/min >35/min >35/min
Signs of resp.
failure
A. Retraction Intercostal/subcosta Supraclavicular/
B. Head l Inter/subcostal
bobbing None None Present
C. Cyanosis
D. Grunting Present
Present
Nona
Signs of resp.
failure
E. Apnea None None None Present
F. Sensoriu Awake Awake Irritable Lethargic,
m stuporous/
comatose
Complications None None Present Present

Action plan OPD OPD Admit to regular Admit to I.C.U

ward
Clinical Manifestation:
 There is sudden onset of chills with rising fever.
 There is tabbing chest pain aggravated by respiration and coughing.
 There is paroxysmal or choking cough.
 The sputum is rusty or prune juice color. This is considered pathognomonic pneumonia.
 There is pain on the abdomen mistaken as appendicitis.
 Herpes may appear on the lips.
 Body malaise.
 There is respiratory grunting with marked tachypnea and flaring of the nares.
 There is labored respiration.

From the textbook Manifested by the patient Rationale

Cough Present Caused by an infection in the
respiratory.

Ear pain and infection None Cause by an ear injury,

inflammation, or infection.

Nausea or Vomiting Present Appearing shortly after meal

caused by food.

Aching muscles None A condition that causes

tenderness in your muscles and
surrounding soft tissues, sleep
difficulties, fatigue and
headaches.

Fever and Chills Present Occurrence of the inflammation

process which stimulates the
hypothalamus, causing
temperature to rise above
normal range.

Weight loss Present Loss of appetite and lack of

nutrition.

Sharp chest pains None Caused by inflammation of the

membrane that lines the lungs.
Diagnostic procedures:
1. Physical findings for patient with lobar pneumonia
a. The patient has malar paleness, flushed face and dilated pupils, with high fever, fast respiration,
and relatively low pulse.
b. The chest movement on affected side is diminished, with dull percussion.
c. The chest movement on affected side diminished, with dull percussion.
2. Chest X-ray is necessary to confirm the diagnostic examination.
3. Sputum analysis, sputum smear and culture is important.
4. The patient may be subjected to blood/ serologic exam.

Treatment:
 Antimicrobial therapy with the causative agent.
 Humidified oxygen therapy is administered for hypoxia.
 Mechanical ventilation may be necessary for the patient with respiratory failure.
 High-calorie diet, adequate fluid intake, and bed rest are additional supportive measures.
 An analgesic may be prescribed to relieve pleuritic chest pain.
 Patients with severe pneumonia on mechanical ventilation may require end-expiratory to
facilitate adequate oxygenation.

Medical and surgical Procedures:

Laboratory and diagnostic study findings:

a. Chest X-ray may reveal diffuse or patchy infiltrates, consolidation or disseminated infiltration or
patchy clouding, depending on the type of pneumonia.
b. Complete blood count may reveal an elevated white blood cell count.
c. Blood culture, Gram stain and sputum culture may reveal the causative organisms.
d. Positive anti-streptolysin-O titer is a diagnostic of streptococcal pneumonia.
Treatment:

Treatment for pneumonia involves curing the infection and preventing complications. People who have
community-acquired pneumonia usually can be treated at home with medication. Although most
symptoms ease in a few days or weeks, the feeling of tiredness can persist for a month or more.

Specific treatments depend on the type and severity of your pneumonia, your age and your overall
health. The options include:

 Antibiotics. These medicines are used to treat bacterial pneumonia. It may take time to identify
the type of bacteria causing your pneumonia and to choose the best antibiotic to treat it. If your
symptoms don't improve, your doctor may recommend a different antibiotic.

 Cough medicine. This medicine may be used to calm your cough so that you can rest. Because
coughing helps loosen and move fluid from your lungs, it's a good idea not to eliminate your cough
completely. In addition, you should know that very few studies have looked at whether over-the-
counter cough medicines lessen coughing caused by pneumonia. If you want to try a cough
suppressant, use the lowest dose that helps you rest.

 Fever reducers/pain relievers. You may take these as needed for fever and discomfort. These
include drugs such as aspirin, ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol,
others).