useful slide

1. A CASE PRESENTATION ON
PNEUMONIA
PRESENTED BY
PM
PRESENTED BY
Princy Varghese, PICU

2. Presentation
A 2 years 4 months old female child
brought with the history of fever since 1
week, low grade, wet type Cough associated
with rapid breathing .
She got hospitalized and was evaluated for
fever in PMICU

3. ON ADMISSION
Initial symptoms
Temperature
was normal
98.6 F
CVS;
S1 S2
normal, no
murmur
CNS;
Conscious
, coherent ,
active and
alert
Respiratory
system;
decreased
breath sounds-
mild tachypnea,
subcostal
retractions
On physical
examination
Per Abdomen;
soft, no
tenderness

4. Nothing
significan
t
Past
history
Family
history Birth
history
Immunization history;
Upto date
Developmental
history:
Appropriate for age

5. PROVISIONAL DIAGNOSIS
WAS THOUGHTTO BE:
PNEUMONIA

6. DEFINITION
PNEUMONIA IS AN
INFLAMMATION OF THE
LUNGS AFFECTING MAINLY
THE AIR SACS OF ALVEOLI

9. DUE TO RISK FACTORS
LIKE AGE , ILLNESS,
FATIGUE, AUTO IMMUNE
DISORDERS
THERE IS IMPAIRMENT
IN THE DEFENCE
MECHANISM OF THE
LUNGS [MAINLY
ANTIBODIES AND CILIA]
OUR BODY LOSES ITS
FIGHT AGAINST THESE
MICROBES
MICROBES MULTIPLY
RAPIDLY & PASS FROM THE
TUBES INTO THE ALVEOLI
[WHERE GAS EXCHANGE TAKES
PLACE]
THIS TRIGGERS AN
INFLAMMATORY REACTIONS
WHICH GENERATES A LOT OF
INFECTIOUS FLUID COMPOSED
OF DEAD MICROBES, DEAD
ANTIBODIES AND FLUID FROM
THE ADJACENT BLOOD
VESSELS
PATHOPHYSIOLOGY

10. THIS FLUID NOW BLOCKS THE
MOVEMENT OF O2 AND CO2,
MAKING IT DIFFICULT TO
BREATHE
SO FINALLY AFTER THE
LONG WAR THE NAME OF
THE DEFEAT IS CALLED
“PNEUMONIA”
PATHOPHYSIOLOGY

11. Symptoms in my patient
Fever
Rapid or difficult breathing
Non-productive cough
Loss of appetite
Headache
Myalgia
Fatigue
Sharp or stabbing
chest pain
Excessive sweating or
clammy skin

12. DIAGNOSTIC TESTS
INITIAL
DIAGNOSTIC
TESTS
BLOOD TEST
INITIAL
CBC -13,000
CRP-225
CHEST X RAY
WHICH SHOWED
LEFT MIDLE LOBE
CONSOLIDATIONCLINICAL
SYMPTOMS
BLOOD
CULTURE

13. INITIAL TREATMENT
INITIAL
TREATMENT
DIETARY
MANAGE
MENT
FLUID
MANAGEMENT
ANTIBIOTICS
STARTED ON
INJ.
CEFTRIAXONE
OTHER SUPPORTIVE
TREATMENT LIKE
ANTI-PYRETICS,
NEBULIZATION
OXYGEN
THERAPY

14. Symptoms
On day 2
SYMPTOMS
Persistent
fever
spikes Rapid or
difficult
breathing
Productiv
e cough
chills
Loss of
appetite
malaise
fatigue
Excessiv
e
sweating

15. DIAGNOSTIC TESTS
FURTHER
DIAGNOSIS
REPAETED
BLOOD TESTS
WHICH SHOWED
CBC- 21,000(T.C)
CRP-141
(decreased)
CHEST
X-RAY SHOWED LEFT
SIDED
CONSOLIDATION
COLLAPSE WITH
PLEURAL EFFUSION
FURTHER USG CHEST & CT THORAX
DONE WHICH SHOWED LOCULATED
EMPHYEMA

16. TREATMENT
FURTHER TREATMENT
TREATMENT
CHILD WAS
CONNECTED
ON HFNC
SURGICAL TREATMENT
REFERRED TO
PEDIATRIC SURGEON
DR. SHREEDHAR
MURTHY
ANTIBIOTICS
UPGRADED TO
CLINDAMYCIN
AND VANCOMYCIN
CHEST
PHYSIOTHERAPY SPIROMETRY

17. VATS (VIDEO ASSISTED
THORACOSOPIC SURGERY)
BASED ON INVESTIGATIONS,
VATS AND DECORTICATION OF PLEURA UNDER GA
WAS DONE ON DAY 3 OF HOSPITALIZATION
PICTURE

19. DURING THIS PROCEDURE, 300 ML OF
PUS WAS DRAINED AND ICD
(INTERCOSTAL DRAINAGE) WAS KEPT
INTACT FOR TWO DAYS

20. NURSING
MANAGEMENT

21. NURSING MANAGEMENT
IMPAIRED GAS
EXCHANGE R/T POOR
LUNG COMPLIANCE
RISK OF INFECTION
R/T DISEASE
CONDITION
NURSING CARE
• PROPPED UP POSITION
• OXYGEN THERAPY
• NEBULIZATION THERAPY
• HAEMODYNAMIC
MONITORING
• AUSCULTATION
• SUCTIONING
• ABG ANALYSIS
• CHEST PHYSIO &
SPIROMETRY
• STRICT I/O CHART
• ANTIBIOTICS & DIURETICS
NURSING CARE
• PROPER HAND WASHING
• MAINTAINING ASEPTIC
TECNIQUE
• MONITORING TEMPERATURE
• ANTIBIOTICS & STEROIDS
• BLOOD FOR TC ,DC, CRP DONE
• BLOOD, URINE & SPUTUM C/S
DONE
• HIGH PROTEIN DIET GIVEN
• HYGIENE MAINTAINED

22. NURSING MANAGEMENT
ACIVITY
INTOLERANCE AND
SELF CARE DEFICIT
R/T DISEASE
CONDITION
NURSING CARE
• COMFORTABLE POSITION
PROVIDED
• ASSISTED IN FEEDING, BATHING &
TOILETTING
• SPONGE BATH, BACK CARE
PROVIDED
• POSITION CHANGED
• ENCOURAGED ACTIVITY AS PER
SYMPTOMS TOLERANCE
ANXIETY R/T
FEAR OF
UNKNOWN
OUTCOME
NURSING CARE
• REASSURANCE
• COUNSELLING
• GOOD IPR
• PROPER
EXPLANATION
• PARTICIPATION IN
CARE

23. SIGNS OF IMPROVEMENT
Improvement
Child became
symptomatically
better
Serial chest
x ray showed
clearing
Minimal
drains, ICD
removed
Afebrile
period
Air entry improved
on left side
Removed
from HFNC

24. After the course of 10 days of IV
Antibiotics
Child was
Haemodynamically
stable
Taking
orally well
Afebrile
Hence planned
for Discharge
with 7 more
days of oral
antibiotics &
Nebulization

25. conclusion
child got admitted in PMICU ON 31.07.18
with the hope that
“she will be able to take breathe without any
effort in her day to day activity and
ultimately, with the efforts of PMICU team
her hope became a real one”
She got discharged on 11.08.18 without any
evident of complication…..

26. thank you