PNEUMONIA IN IMCI

 1. SEVERE PNEUMONIA OR VERY SEVERE DISEEASE

Any general danger sign or chest indrawing or stridor in a calm child classifies this as severe pneumonia or very severe disease.

NURSING INTERVENTIONS FOR SEVERE PNEUMONIA

Manage the airway

Clear a blocked nose. Use a plastic syringe (without a needle) to gently suck any secretions from the nose.

Keep the infant warm

Infants lose heat rapidly when wet, so keep them dry and warm. If child is wheezing and you have a bronchodilator, give it.

Treat fever

If the child has an auxiliary temperature of 38.5*c or above, give Paracetamol every 6 hours.

Antibiotics are very important for children with pneumonia, fever increases consumption of oxygen

Manage fluids carefully

Children with pneumonia or very severe disease can become overloaded with fluids. So give fluids cautiously. Children with pneumonia or very severe disease often lose water, especially if there is fever. If they can drink, give fluids by mouth. Encourage the caretaker to continue with breastfeeding if the child is not in respiratory distress. If the child is too ill to breastfeed but can swallow, have the caretaker express milk into the cup and slowly feed the child the breast milk with a spoon. Encourage the child to drink. If the child is not able to drink, either use a dropper to give the child fluid very slowly or drip fluid from a cup or a syringe without a needle. Avoid using an NGT if the child is in a respiratory distress.

How to calculate amount of fluid to be given

Ø  For less than 12 months old give 5ml/ kg/hour milk or formula.

Ø  For children 12 months up to 5 years give 3-4 ml/kg/hour milk or formula.

Ø  The total amount in 24 hours should be 72 to 96 ml/kg.

Give antibiotic treatment

Children with severe pneumonia or very severe disease should receive antibiotic treatment.

If the child has mild chest indrawing and does not appear to be in respiratory distress, give oral cotrimoxazole. Observe the child each day. If the child does not get better, give IM Chloramphenicol instead of oral cotrimoxazole.

 

If child has general danger sign or severe chest indrawing but doesn’t have the classification “very severe febrile disease", give IM Chloramphenicol. If IM Chloramphenicol is not available, give IM Benzyl penicillin. If the child vomits oral drug, repeat the dose. Cephalosporins are useful alternatives to penicillin or Chloramphenicol in serious infections.

 

2. PNEUMONIA

The sick child is classified to have pneumonia if he/she has fast breathing. Give the child who has pneumonia cotrimoxazole or amoxicillin for 5 days and then review him/her 2 days later to see if there is any improvement.

 

3.  NO PNEUMONIA: COUGH OR COLD

The sick child is classified under cough or cold when there is no sign of severe disease or pneumonia.

 

NURSING INTERVENTIONS FOR COUGH OR COLD

If the child has a cough for more than 3 weeks re-assess the child or refer for assessment.

Advise the caretaker on safe remedy for cough and sore throat. You can then review the child after 5 days.