Clinical Reference Systems: Pediatric Advisor 10.0

Description

• labored breathing (respiratory distress)
• rapid breathing
• occasionally painful breathing
• coughing
• fever, sometimes with chills
• abnormal patch (infiltrate) on chest x-ray.

Note: Most rattly breathing is not pneumonia.

Causes

Pneumonia is an infection of the lung(s) that causes fluid to collect in the air sacs (alveoli). About 80% of pneumonia cases are caused by viruses and 20% by bacteria. Viral pneumonia is usually milder than bacterial pneumonia. Bacterial pneumonia tends to occur more suddenly and cause higher fevers (often over 104ƒF, or 40ƒC). Because pneumonia is usually a complication of a cold, it is not considered contagious.

Reasons for Admission to the Hospital

Main complication:___________________________________________.

___ Needs IV fluids.

___ Needs antibiotic or other medicine.

___ Needs oxygen.

___ Other reason: ____________________________________________.

Expected Course

Only bacterial pneumonia is helped by antibiotics. Because it's difficult to distinguish bacterial from viral pneumonia in all cases, sometimes antibiotics are prescribed for children who have viral pneumonia.

Before antibiotics were available, bacterial pneumonia was dangerous. With antibiotics it improves within 24 to 48 hours. On the other hand, viral pneumonia can continue for 2 to 4 weeks. Recovery from viral pneumonia is gradual but complete.

Most children with pneumonia can be cared for at home. Children admitted to the hospital are usually young infants or children, those who have large areas of pneumonia (as determined by an x-ray), or those who are vomiting.

Recurrences of pneumonia are rare.

Requirements for Discharge

• ________________________________________________________
• _______________________________________________________
• _______________________________________________________

Discharge Instructions for Home Treatment

1. Antibiotics

   Children with bacterial pneumonia need an antibiotic. Your child's antibiotic is ___________________________. Give ______________ every ______ hours. Continue the antibiotic for a full ______ days.

2. Medicines for fever

   Use acetaminophen or ibuprofen for fever over 102ƒF (38.9ƒC). This can be repeated every 4 to 6 hours. These medicines can also help chest pain.

3. Warm fluids for coughing spasms

   Coughing spasms are often caused by sticky secretions in the back of the throat. Warm liquids usually relax the airway and loosen the secretions. Offer your child warm lemonade, apple juice, or herbal tea. Children over 1 year old can sip warm chicken broth.

   In addition, breathing warm moist air helps to loosen the sticky mucus that may be choking your child. You can provide warm mist by placing a warm wet washcloth loosely over your child's nose and mouth. Or you can fill a humidifier with warm water and have your child breathe in the warm mist it produces. Avoid steam vaporizers because they can cause burns.

   Don't give cough-suppressant medicines (such as those containing dextromethorphan) to children with pneumonia. The infectious secretions need to be coughed up.

4. Humidity

   Dry air tends to make coughs worse. Use a humidifier in your child's bedroom. Buy one that removes molds and bacteria that might be in the water.

5. No smoking

   Tobacco smoke aggravates coughing and makes coughs last longer. Don't let anyone smoke around your child. In fact, try not to let anybody smoke inside your home. Remind a teenager with pneumonia that if he or she smokes, the cough will last weeks longer.

6. Other medicines
   • _____________________________________________________
   • _____________________________________________________
   • _____________________________________________________

7. Additional instructions
   • _____________________________________________________
   • _____________________________________________________

Follow-Up Appointment after Discharge

___ Your child needs to be rechecked and has an appointment on _____________ at _______ with _________________________.

___ Your child needs to be rechecked in ________ days. Call your child's doctor to make an appointment.

___ A follow-up appointment is not necessary. Call the doctor if you have any concerns.

Call Your Child's Physician Immediately If:

• Breathing becomes more labored or difficult.
• The fever returns.
• Your child starts acting very sick.

Call Your Child's Physician During Office Hours If:

• You have other questions or concerns.