Cardinal Signs and Symptoms of Pneumonia

• Fever
• Shaking chills
• Productive cough
• Sputum production
  • Rusty colored – Streptococcus pneumoniae
  • Creamy Yellow – Staphylococcus pneumoniae
  • Currant Jelly – Klebsiella
  • Greenish – Pseudomonas
  • Clear – No infection
• Pleuritic chest pain due to the friction between the pleural layer.

Infants and Children with Pneumonia have:

With the findings above plus chest in drawing or stridor is observed, the client has Severe Pneumonia.

Diagnostic Exam for Pneumonia

• Chest X-Ray. Most confirmatory diagnostic exam for pneumonia. Lung consolidation or patchy infiltrates are observed.
• Sputum exam. This is taken in the morning, upon rising, because of copious amounts of sputum in the morning. Teach the client deep breathing and coughing.
• Bronchoalveolar lavage.

Management for Pneumonia

Antibiotic therapy like Co-trimoxazole is administered, Oxygen administration as needed, and Pulmonary toilet (suctioning, chest physiotherapy, blow bottles, and nasotracheal suctioning).

Nursing Care Management for Pneumonia

• Splint the chest or apply chest binder
• Turn the patient towards affected side
• Maintain patent airway
• Provide adequate rest
• Provide comfort measures. Keep patient warm and dry

Prevention of Pneumonia

• Pneumococcal and influenza vaccines
• Proper disposal of nasopharyngeal secretions
• Covering of the nose and mouth when sneezing and coughing
• Never kiss the patient

The critical care environment has high noise levels, with natural and artificial light 24 hours a day, movement of people and environment is constant, and there is a lack of privacy. This can bring about stress, anxiety, and poor adaptation or coping. Clients may feel that they are losing control, helpless, and isolated. This may lead them to feel dependent, angry, and depressed.

The Critically Ill Pediatric Patient

Vital Signs

• Vital signs differ with age
• Blood pressure is the last vital sign to change in a child with shock
• Bradycardia is not well tolerated in young children and can be precipitated by hypoxia
• Tachycardia can be a non-specific response to many conditions
• Tachypnea might indicate respiratory distress
• Bradypnea may indicate respiratory arrest

Neurological

• Needs to be age appropriate
• Check reflexes
• Check the fontanels
• Assess mental status
  • Interaction with the environment
  • For children should know parents
  • Is awake and is looking around

Cardiovascular

• Skin Color
  • Peripheral cyanosis is normal for newborn only
  • Central cyanosis is always abnormal
  • Mottling should be taken into consideration if in room temperature
• Capillary refill time is less than 2 seconds

Respiratory

• Infants under 6 months are obligatory nose breathers
• Smaller airway diameter and length is easier to occlude
• Watch for retractions (Abdominal breathing, Seesaw breathing)
• Listen for sounds (Grunting, Stridor, Wheezing)

Renal

• Normal urine output for infants is 2 mL/kg/hour. Take note that infants has a decreased ability to concentrate urine.
• Normal urine output for children is 1 mL/kg/hour
• Children have increased risk for dehydration. Observe for dry mucous membranes, poor skin turgor, and sunken fontanels.

The Critically Ill Pregnant Woman

• Severe pre eclampsia
• Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP)
• Disseminated Intravascular Coagulation (DIC)
• Amniotic Fluid Embolus
• Acute Respiratory Distress Syndrome (ARDS)

The Critically Ill Older Patient

• Many changes occur in every system
• Most troublesome changes are: loss of sight, loss of hearing, decrease in quality of sleep, and cognitive changes

Medications in the Older Adult

Be guided with “Start low and go slow” which means that you should start administering medications in a low dose and observe for any reactions.

Bear in mind that geriatric clients also have altered drug absorption, distribution, metabolism and excretion.

The Post Anesthesia Patient

• Airway
• Hypoxemia
• Hypertension
• Cardiac dysrhytmias
• Hypothermia

Basic Life Support

Basic Life Support can be rapidly performed by trained laypersons and health care providers to ensure recognition of common emergencies, access to Advanced Cardiac Life Support, adequate airway, breathing, and oxygenation, and adequate circulation.

Skills included are Cardio-Pulmonary Resuscitation (CPR), the use of automated electrical defibrillation, and relief of foreign body airway obstruction.

Advanced Cardiac Life Support

Advanced Cardiac Life Support includes Basic Life Support plus the use of adjunct equipment to support ventilation.

Skills included are establishment of an Intravenous access, administration of drugs, use of cardiac monitoring, defibrillation or other control of arrhythmias, and care after resuscitation.

Chain of Survival

1. Early Access
2. Early Cardio-Pulmonary Resuscitation
3. Early Defibrillation
4. Early Advanced care

First Link: Early Access

Problem: Long emergency call-to-defibrillation intervals are common.

Key to effectiveness of this link: Recognition of early warning signs.

Second Link: Early Cardio-Pulmonary Resuscitation

Cardio-Pulmonary Resuscitation (CPR) is most effective when started immediately after collapse.

Bystander CPR has been consistently shown to have a significant positive effect on survival. Is considered to be the best treatment that a cardiac arrest patient can receive until the arrival of defibrillation and ACLS care.

Third Link: Early Defibrillation

The link that will most likely improve the survival rate of the patient. The time to defibrillate is the crucial variable for successful conversion from Ventricular Fibrillation to a normal rhythm. Every minute that passes can reduce the chance for successful conversion by 7-10%.

Fourth Link: Early Advanced Care

Is designed to prevent cardiac arrest through the use of advanced airway management, administration of medicine, and other interventions. This includes therapies that help resuscitate victims of cardiac arrest who are not responding to defibrillation. It can provide defibrillation if ventricular tachycardia develops and helps stabilize the patient after resuscitation.

Triage is a way to sort patients by hierarchy based on the severity of health problems and the immediacy with which these problems should be treated. Protocol may be initiated in the triage area.

A triage nurse is responsible for collecting data and classifying the illness or injuries to ensure that the patients most in need of care do not have to wait.

Emergency department triage differs from disaster triage wherein the Emergency department triage the patients who are the most critically ill receive the most resources regardless of potential outcome.