Management of Pneumonia According to IMCI Guidelines

Subject: Child Health Nursing

Overview

Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.Give the first dose of injection chloramphenicol if not possible give oral amoxicillin and refer urgently to hospital. Keep the baby warm on the way. For mild pneumonia administer antibiotics such as chloramphenicol 25mg/kg, IM/IV 8 hourly until the child has improved then switch to oral form and continue for 10 days, or give benzylpenicillin 50,000 units/kg/IM/IV 6 hourly and gentamicin 7.5/kg/IM once a day for 10 days and for severe pneumonia Give the first dose of injection chloramphenicol, if not possible, give oral amoxicillin and refer urgently to a hospital, keep baby warm while referring to a higher center.

 

Guidelines for the management of acute lower respiratory tract infection (pneumonia) children aged between 2 months to 5 years.

Very severe pneumonia/very severe disease

Clinical signs include: 

  1. Cough or difficulty breathing plus
  2. Central cyanosis or not being able to drink
  3. Severe chest in-drawing
  4. Convulsion, lethargy or unconsciousness, severe respiratory distress

Treatment of Pneumonia 

  1. Give the first dose of injection chloramphenicol if not possible give oral amoxicillin and refer urgently to hospital. Keep the baby warm on the way.
  2. Admit the child in a hospital.
  3. Give oxygen therapy
  4. Administer antibiotics such as chloramphenicol 25mg/kg, IM/IV 8 hourly until the child has improved then switch to oral form and continue for 10 days, or give benzylpenicillin 50,000 units/kg/IM/IV 6 hourly and gentamicin 7.5/kg/IM once a day for 10 days
  5. Reassessing the child with very severe pneumonia: if the child is getting worse after 48 hours on chloramphenicol then examine for complications and switch to cloxacillin 150mg/kg IM/IV 6 hourly when improves continue 3 weeks and add gentamicin if staphylococcal pneumonia is suspected.
  6. Treat fever with antipyretic if present.
  7. Treat wheezing of a present with a rapid-acting bronchodilator.
  8. Give supportive care.
  9. Monitor the baby's condition at least 3 hourly by nurses and 2 times by doctors for improvement and further management.

Clinical signs of Pneumonia

  1. Difficulty breathing
  2. Chest in drawing
  3. No central cyanosis
  4. Able to drink

Treatment Process

  1. Give the first dose of injection chloramphenicol, if not possible, give oral amoxicillin and refer urgently to a hospital, keep baby warm while referring to a higher center.
  2. Admit to hospital
  3. Give oxygen therapy
  4. Administration of antibiotic therapy e.g benzylpenicillin(50,000 units/kg IM every 6 hourly for at least 3 days and if the condition is improved, switch to oral antibiotic (amoxicillin) 15 mg/kg 3 times a day. Treatment should be continued for 3 days after a child is well.
  5. Switch to chloramphenicol if the child not improving after 48 hours on benzylpenicillin or getting worse on benzylpenicillin and shows signs of pneumonia after 10 days of antibiotic, then examine for complications and switch to chloramphenicol.
  6. Supportive care
  7. Assess the child every 2 hours by a nurse and at least once a day by a doctor.

Clinical signs of Pneumonia

  1. Signs of a cough and cold
  2. Fast breathing but no chest indrawing

The treatment process for Pneumonia

  1. Advice to mother to give home care.
  2. Give antibiotics at home: clotrimazole 5days, amoxicillin 3times a day for 5 days.
  3. Treat fever
  4. Treat wheezing with rapid-acting bronchodilators if present.
  5. Reassess the child.

No pneumonia

Clinical signs:

  1. A cough and cold
  2. No fast breathing
  3. No chest in drawing

Treatment:

  1. Treat at home
  2. Treat fever
  3. Treat wheezing, if present
  4. If a cough is more than 30 days, refer for further assessment for causes of a chronic cough.
  5. Assess and treat ear problems if present
  6. Advise the mother to return quickly if breathing becomes difficult, fast, a child is not able to drink and becomes sick.

Management of pneumonia in the young infant age less than 2 months.

Severe pneumonia/ very severe disease

Clinical signs:

  1. Stop feeding well
  2. Convulsions
  3. Abnormal sleeping or difficulty to wake
  4. Stridor in claim child
  5. Wheezing
  6. Fever, temperature more than 38-degree c, low body temperature less than 35-degree c
  7. Fast breathing
  8. Severe cheating in drawing
  9. Central cyanosis
  10. Grunting
  11. Apnoeic episodes
  12. Distended tense abdomen

Treatment:

  1. Admit the child in a hospital.
  2. Give oxygen
  3. Give antibiotics
  4. Fluid management
  5. Maintain a good thermal environment
  6. Do specific management of wheezing or stridor.

No pneumonia

Clinical signs:

No fast breathing no signs of pneumonia

Treatment:

  1. Keep young infants warm
  2. Breastfeed frequently.
  3. Clear nose if interference with feeding is present.
  4. Return quickly if difficulty in breathing, or feeding problems, the infant becomes

Nursing care:

  1. Promote rest
  2. Maintain patent airway
  3. Assist in easy respiration
  4. Control fever
  5. Prevent dehydration
  6. Nutritional care
  7. Minimize respiratory difficulties
  8. Reduce anxiety
  9. Prevention of complications.

 
Things to remember
  • Pneumonia is a form of acute respiratory infection that affects the lungs.
  • The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.
  • Give the first dose of injection chloramphenicol if not possible give oral amoxicillin and refer urgently to hospital. Keep the baby warm on the way.
  • For severe pneumonia, give the first dose of injection chloramphenicol, if not possible, give oral amoxicillin and refer urgently to a hospital, keep baby warm while referring to a higher center.
Questions and Answers

Management of pneumonia according to IMCI guidelines

Guidelines for treating acute lower respiratory infections (pneumonia) in kids between the ages of 2 months and 5 years.

Very serious diseases/very severe pneumonia

Clinical indicators comprise:

  • A cough or breathing issues additionally
  • Inability to drink or central cyanosis
  • Significant chest in-drawing
  • Severe respiratory distress, lethargy or unconsciousness, and convulsions

Treatment:

  • In case an injection is not possible, administer the first dose of chloramphenicol orally and immediately refer the patient to the hospital. On the trip, keep the infant warm.
  • Place the kid in a medical facility.
  • Provide oxygen treatment
  • Give antibiotics such benzylpenicillin 50,000 units/kg/IM/IV 6 hourly and gentamicin 7.5/kg/IM once a day for 10 days, or give chloramphenicol 25mg/kg, IM/IV 8 hourly until the child has improved, then switch to oral form, and continue for 10 days.
  • The kid with very severe pneumonia should be reassessed. If the child is becoming worse after 48 hours on chloramphenicol, check for complications, move to cloxacillin 150mg/kg IM/IV 6 hourly, continue for another three weeks, and add gentamicin if staphylococcal pneumonia is suspected.
  • If a fever exists, treat it with an antipyretic.
  • Provide comforting care.
  • Nurses and doctors should check on the condition of the baby at least three times per hour for any changes or future management.

Severe pneumonia

Clinical signs include:

  • Having trouble breathing
  • Drawing of a chest
  • No cyanosis in the center
  • Drinking capacity

Treatment:

  • Administer the infant the first injection of chloramphenicol; if this is not possible, give oral amoxicillin and refer them immediately to a hospital. Keep the infant warm while doing this.
  • Enter a hospital
  • Provide oxygen treatment
  • Administration of antibiotic therapy, such as benzylpenicillin (50,000 units/kg IM every 6 hours for at least 3 days; switch to oral antibiotic (amoxicillin) 15 mg/kg 3 times per day if the situation has better. After the youngster is healthy, the treatment should be continued for three days.
  • If the child is not getting better after 48 hours on benzylpenicillin, is getting worse on benzylpenicillin, and is showing signs of pneumonia after 10 days of antibiotic treatment, switch to chloramphenicol, check for complications, and repeat the process.
  • Support services
  • A nurse should evaluate the child every two hours, and at least once a day by a doctor.

Pneumonia

Clinical signs include

  • Indications of a cold and cough
  • Rapid breathing without chest tightening

Treatment:

  • Mother is advised to provide care at home.
  • At-home antibiotics should be administered for 5 days with clotrimazole and 3 times daily with amoxicillin.
  • Cure for fever
  • If wheezing is present, treat it with quick-acting bronchodilators.
  • Reevaluate the kid.

No pneumonia

Clinical signs:

  • A cold and cough
  • Not breathing quickly
  • Drawing with no chest

Treatment:

  • Give at home
  • Cure for fever
  • If wheezing occurs, treat it.
  • Refer for additional evaluation to determine the causes of a chronic cough if a cough lasts longer than 30 days.
  • Evaluation and treatment of any ear issues
  • If a child's breathing becomes difficult or if they start to have trouble drinking or feel sick, tell the mother to come back right away.

Management of pneumonia in the young infant age less than 2 months.

Very serious illness, such as severe pneumonia

Medical symptoms:

  • Give up eating well
  • Convulsions
  • Abnormal sleeping patterns or trouble waking up
  • Stridor in child claim
  • Wheezing
  • Fever, high body temperature over 38 degrees Celsius, and low body temperature below 35 degrees Celsius
  • Rapid respiration
  • Severe drawing fraud
  • Cyanosis central
  • Grunting
  • Episodes of apnoea
  • Stretched-out, tense abdomen

Treatment:

  • Place the kid in a medical facility.
  • Supply oxygen
  • Dose with antibiotics
  • Fluid control
  • Maintain a healthy thermal environment and manage wheezing and stridor specifically.
  • No pneumonia

Clinical signs:

  • No rapid breathing, no pneumonia symptoms

Treatment:

  • Keep a tiny child warm.
  • Frequently breastfeed.
  • If there is any interference with feeding, blow your nose.
  • Immediately return if the infant has breathing or feeding issues.

Nursing care:

  • Encourage rest
  • Ensure a clear airway
  • Assist with simple breathing
  • Manage fever
  • Stop dehydration
  • Nutritional support
  • Reduce breathing difficulties
  • Lessen anxiety
  • Avoiding complications

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