CASE Pneumonia English

8/18/2019 CASE Pneumonia English

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PNEUMONIA

Case

Presentation

Elia Megasari1408465699

Supervisor :dr !edi Sa"ri#a Pu"ra$ SpA %&'

&EPANI(E)AAN &*INI& SENIO) +A,IAN ANA& -A&U*(AS &E!O&(E)AN UNI.E)SI(AS )IAU

)SU! A)I-IN A/MA! PE&AN+A)U016



INTRODUCTION

+a23groud Peuoia is a a2u"e ie2"io lug

pare27#a i2ludes alveolar ad i"ers"i"ial"issue

Peuoia os" 2oo i 27ildre aged5 #ears "7e ai 2ause o dea"7 o ore"7a illio 27ildre ea27 #ear "7a" o22ur i

developig 2ou"ries 155 illio ei2ide2e o peuoia i 27ildre$ ;1<=severe peuoia 2a >e lie;"7rea"eig

Peuoia se2od 2ause o dea"7 a"erdiarr7ea



LITERATURE REVIEW

•.irus• )S. %<#ears'

•+a2"eria

• S. pneumoniae (<3month)

• Haemophylus infuenzae

• Streptococcus haemolyticus

•

Mycoplasma pneumoniae• Chlamydia pneumoniae

• Staphylococcus aureus



MI/)OO),ANISMS (A( /AUSE PNEUMONIAA//O)!IN, (O A,E

+or;0da#s

< ee3s ? <o"7s

4 o"7s? 5 #ears

5 #ears ;adoles2e"



@O /*ASSI-I/A(ION

• Ia" o"7:• Severe Peuoia : "a27#pea severe

re"ra2"io

• .er# Severe Peuoia : ua>le "o eed or

dri3$ 2ovulsios$ le"7arg#$ever7#po"7eria$ >radipea irregular >rea"7

• /7ild o"7s ; 5 #ears

•

Mild Peuoia : "a27#pea• Severe Peuoia : re"ra2"io

• .er# Severe Peuoia : ua>le "o dri3 orea"$ 2ovulsios$ le"7arg#$ alu"ri"io



EPIDEMIOLOGY

)is3esdas$ i2reased i 00 >#1= "o = i 01<

!eograp7i2 ad eal"7 Surve#$6= i 00 "o 11= i 00

@O$ developig 2ou"ries 1518illio peuoia 2ases #ear$8= %1<$ 1 illio' o 7o are

severe peuoia ad eed7ospi"aliBa"io



)IS& -A/(O)

I"risi2

• Age• ,eder• Nu"ri"ioal s"a"us• *o >ir"7 eig7"• IuiBa"io s"a"us

EC"risi2

• !esi"# 7a>i"a"io• Air pollu"io• (#pe o 7ouse• .e"ila"io• uidi"#

• /igare""e so3e• -ail# i2oe• Ma"eral a2"ors



/*INI/A* MANI-ES(A(IONS

No spesiD2 ever$ aCie"#$gas"roi"es"ial

disorders su27 as

voi"ig$ >loa"ig$diarr7ea or

a>doial pai

Puloar#s#p"os 2oug7

ad 2olds$ os"ril>rea"7$ "a27#pea

d#spea ad apea$re"ra2"io

Pleural

%Streptococcus pneumoniae ad

Staphylococcusaureus' 27es"

pai

EC"rapuloar#

%Streptococcus pneumoniae or

Haemophillusinfuenza' O"i"is

edia$

2ou2"ivi"is$siusi"is



!iagosis

• -ever$ 2oug7$i2reasedrespira"or# ra"ead a i2reasei respira"or#

eFor"

Aaesi

s

• )espira"or#os"ril

• I"er2os"alre"ra2"ios$su>s"eral$epigas"ri2

• @e" r7o27iaus2ul"a"io

P7#si2aleCaia"i

o • *a>ora"or#

%leu3o2#"osis'• )adiologi2al

/7es" G;)a#%iDl"ra"es'Suppor"i

g

eCaia"io



Hospitalization Criteria

ChilIn!ant O sa"ura"io H

9=$ 2#aosis )espira"or#

ra"e 60C

iu"e )espira"or#

dis"ress$ apeai"eri""e"

!o o" a" "odri3 >reas"eed

(7e ail#2ould o" 2are

O sa"ura"io9=$ 2#aosis

-reJue2# o>rea"7 50C iu"e

,ru"ig )espira"or#

dis"ress (7ere are sigs

o de7#dra"io (7e ail# 2ould

o" 2are or a"



MANAGEMENT

MilPne"#onia

• Ou"pa"ie" 2are

• A"i>io"i2

"7erap#

%e&erePne"#onia

• ospi"aliBed

• A"i>io"i2

"7erap#• OC#ge "7erap#



/ASE I**US()A(ION

Patient ientit'

Nae Medi2al )e2ord +#S 916<8

Age 4 o"7s

,eder eale

-a"7erMo"7er S!

!a"e o adissio -e>ruar# 4"7 $ 016

Address Mias



ANAMNESIS

Alloaaesis %Pa"ie"Ks pare"s'

/7ie 2oplai" : S7or"ess o >rea"7 "7a">e2oe 7eav# si2e oe da# >eore "7e7ospi"aliBa"io



1 da#s >eore adi""ed "o 7ospi"al

S7or"ess o i2reasigl# >e2oe 7eav#$ el" s7or"ess a" a# "ie$o" redu2ed durig sleep$ ose seeed "o eCpad ad deLa"ed$

pa"ie" is o"e sile"

da#s >eore adi""ed "o 7ospi"alPa"ie" appears s7or"ess o >rea"7$ s7or"ess el" ever# 2oug7$voi"ig %'$ 1 "ie a da#$ u2us %' !ee2a"io 1 "ies a da#$

liJuid 2osis"e2#$ #ello 2olor$ aJua;2up aou" Uria"io oral

< da#s >eore adi""ed "o 7ospi"al-ever$ 2oug7 ad 2olds$ 2oug7 i"7 spu"u$ persis"e" 2oug7 adredu2ed a" res" Pa"ie"s go or "rea"e" "o "7e Pus3esas ad

ere give ever edi2ie ad 2oug7 edi2ie$ ever re2overed >u""7e 2oug7 7as o" diiis7ed



PI

• Never el"sae2oplai"• (ravelrela"ed7is"or# %;'

-I

• Pa"ie"Ks,rada"7er>eig"rea"ed or"u>er2ulosis$i"7 a7is"or# o

27roi22oug7• No ail#el" sae2oplai"

Pare"al

• -a"7er :arer• Mo"7er :ouseie

Prega2#

• Eoug7o"7sprega2#• )egular AN/"o idie$/oplai"durig

prega2# ordeliver# %;'• Noral la>or• Assis"ed >#do2"or• ++@ 00gr$ orge"

>ir"7 eig7"• rd 27ild o 27ildre

-eed

• ,ross o"ors3ills: a2edo si2e"7e age o <o"7s

• -ie o"or

s3ills:7oldig "o#s• /oui2a"io: laug7igads2reaig$"ured "osoud i2alled si2eage o 4o"7s



.a22ia"io

• /ople"e>asi2va22ia"io

• +ased o age

,ro"7

• ,ro"7 ageappropria"e

!evelope"al

• Appropria"e

ouse ad*ivigs

S"a#ig i oilpalpla"a"ios+oards 7ouse$su2ie"lig7"ig

Sour2es odri3ig a"er: gallo a"erSour2e o M/&: dug ells



•

ead : Noro2ep7ali$ >la23 7air$ ueas#"o gra>

• E#es : /ou2"iva aeis %;'$ s2lerai2"eri2 %;'

roud pupil iso3or$

lig7" reLeCes %'

• Ears : @i"7i oral lii"

• Nose : Nos"ril >rea"7 %'

• Mou"7 : !r# lips u2osal$ >lood# gu %;'$"osil ad p7ar#C o 7#pereia

,A : odera"e illess/os2ie2e: respo "o ver>al) : 140 Ci %regular$ ea3 palpa"ed')) : 65 Ci

( : <$5/

P7#si2al ECaia"io



Thora(

• Inspe)tion *

S#e"ri2al 27es" all ovee"$ su>2os"alre"ra2"io %'$ i"er2os"al re"ra2"ios %'

• Palpation *

.o2al -rei"us oral %7e "7e 27ild 2r#'$ I/palpa>le

• Per)"ssion *

soor "7e 7ole lug Delds

• A"s)"ltation *

@e" r7o27i "7e 7ole lug Delds %'$7eeBig%;;'

)egular 7ear" souds$ urur %;'$ gallop %;'



• A+o#en :

I : La" s7ape$ vee2"a"io %;'$ s2ar %;'

• P : >oel souds oral$ reJue2# 8Ciu"e

P : (#pai %'

A : Noral peris"al"i2 soud



E(tre#it' :@ar a2ral$ capillary rell time se2$ edea%;'$ 2lu>>ig Dger %;'$ 2#aosis %;'



Ro"tine +loo ,-e+r"ar' ./th

0.1234@+/ : 0$C10<ul M/. : 6$5H+ * 506 78l M/ : 6$4

( : $5 = M// : <4$4P*( : 5 C 10< ul

*a>ora"or# -idigs



Ele)trol'te ,-e+r"ar' ./th

0.1234Na : 1<1$9 ol*& : <$59 ol*

/l : 10<$9 ol*



9loo )he#istr' ,-e+r"ar'./th0 .1234

,lu : 10 gd*Ure : 4 g*Cre * 1:./ #78L

%GOT* 35 U8LS,P( : <1 U*Al> : 4<6 gd*



/ES( G;)AQ %-E+)UA)Q 4 ( $ 016'

/or: oral siBe ads7ape

Pulo: 2ora3a>ro3ovas3uleri2reased*oo3s salliDl"ra"es i alos"all lug Delds

Ipressio:+ro27opeuoia



Dia7nosis

@or3ig diagosis :

Severe PeuoiaAeia

Nu"ri"ioal

diagosis :• Noral

Treat#ent

Phar#a)olo7'• O 1; *

• I.-! !5 R NS &/l 5 eJ 8dropsiu"e

i2ro• &alpi2ili I. 150

g67our• &ei2e"i I. 15

g67our

Pro7nosis

;"o a &ita# * du>ia

;"o a

!"n)tiona# * du>ia

DAY8DATE %U9<ECTIVE O9<ECTIVE A%%E%MENT THERAPY



5016PI/U

Pa"ie"Ks o2oplai os7or"essredu2ed$ ever%;'$ 2oug7 i"7

spu"u %'$diarr7ea %;'

/os2iousess: apa"7e"i2,eeral appeara2e: severeilless+P: 944 g ) : 1<0Ciu"e )) : 5<Ciu"e

( : <6$5

0

2eig7" : 500grE#e : /A %;;'$ SI %;;'Nose : os"ril >rea"7 %'Ne23 : oral

(7ora3s : su>2os"aere"ra2"io %'$ e" r7o27i"7e 7ole lug Delds %'

A>doe : La"EC"rei"ies : ar a2ral$/)( I##"noserolo7'*/)P: )ea2"ive 18 gd*9loo 7as anal'sis*P7 : 40$ p/O : <8 g$

pO : 9 g$/O<:<5g$

(/O: 4g$ +E :;11$SO2 : 98=Ele)trol'te*Na:1<5ol*&: <$ ol*

Severepeuoia aeia

- I.-! )* 10dp

- /e"riaCoC50g

- )ai"idie

C5g- !eCae"aso

<C1g- Ne>uliBer

ve"oli 167our



6016PI/U

Pa"ie"Ks o2oplai os7or"essredu2ed$ ever

%;'$ 2oug7 i"7spu"u %'$diarr7ea %;'

/os2iousess: aler",eeral appeara2e:odera"e illess+P: 10168 g

) : 91 Ciu"e)) : Ciu"e

( : <6$502eig7" : 500grE#e : /A %;;'$ SI %;;'Nose : os"ril >rea"7 %'Ne23 : oral

(7ora3s : su>2os"ae

re"ra2"io %'$ e"r7o27i "7e 7ole lugDelds %'A>doe : La"EC"rei"ies : ar a2ral$/)(

Severepeuoia aeia

- I.-! )* 10 dp- /e"riaCo

C50g- )ai"idie C5g

-!eCae"aso<C1g

- Ne>uliBerve"oli 16 7our




016PI/U

Pa"ie"Ks o2oplai os7or"essredu2ed$ ever%;'$ 2oug7 i"7spu"u %'$diarr7ea %;'

/os2iousess: aler",eeral appeara2e:odera"e illess+P: 10069 g) : 10 Ciu"e)) : <0 Ciu"e

( : <60/SPO : 100=

E#e : /A %;;'$ SI %;;'Nose : os"ril >rea"7 %'Ne23 : oral

(7ora3s : su>2os"ae

re"ra2"io %'$ e"r7o27i "7e 7ole lugDelds %'A>doe : La"EC"rei"ies : ar a2ral$/)(

+lood /ul"ure :

S"rep2o2us + eoli"i2us

Peuoia - I.-! )* 10 dp- /e"riaCo

C50g- )ai"idie C5g- !eCae"aso

<C1g- Ne>uliBer

ve"oli 16 7our




8016PI/U

S7or"ess o>rea"7 %'ever %;'$ 2oug7%'$ diarr7ea%;'

/os2iousess: aler",eeral appeara2e:odera"e illess+P: 916 g) : 1< Ciu"e)) : Ciu"e

( : <6$50/SPO : 100=

E#e : /A %;;'$ SI %;;'

Nose : os"ril >rea"7 %'Ne23 : oral

(7ora3s : su>2os"aere"ra2"io %'$ r7o27i%;;'A>doe : La"EC"rei"ies : ar a2ral$/)(



<C1g- Ne>uliBer

ve"oli 16 7our




9016PI/U

S7or"ess o>rea"7 %'ever %;'$ 2oug7%'$ diarr7ea%;'

/os2iousess: aler",eeral appeara2e:odera"e illess+P: 1008< g) : 101 Ciu"e)) : 6 Ciu"e

( : <6$80/SPO : 95=

E#e : /A %;;'$ SI %;;'

Nose : os"ril >rea"7 %;'Ne23 : oral

(7ora3s : su>2os"aere"ra2"io %'$ r7o27i%;;'A>doe : La"EC"rei"ies : ar a2ral$/)(



<C1g- Ne>uliBer

ve"oli 16 7our- +reas"il3 dire2"l#

ad oved i"o aregular roo




1<016-la>o#a

S7or"ess o>rea"7 %;' ever%;'$ 2oug7 %;'$diarr7ea %;'$ausea %;'$voi"ig %;'$s"rog su23le

/os2iousess: aler",eeral appeara2e:ild illess) : 16 Ciu"e)) : 6 Ciu"e

( : <6$50/E#e : /A %;;'$ SI %;;'Nose : os"ril >rea"7 %;'Ne23 : oral

(7ora3s: su>2os"aere"ra2"io %;'$ r7o27i%;;'A>doe : La"EC"rei"ies : ar a2ral$/)(



<C1g- Ne>uliBer

ve"oli 16 7our- +reas"il3




<016-la>o#a

S7or"ess o>rea"7 %;' ever%;'$ 2oug7 %;'$diarr7ea %;'$ausea %;'$voi"ig %;'$s"rog su23le

/os2iousess: aler",eeral appeara2e:ild illess) : 16 Ciu"e)) : 6 Ciu"e

( : <6$50/E#e : /A %;;'$ SI %;;'Nose : os"ril >rea"7 %;'Ne23 : oral

(7ora3s: su>2os"aere"ra2"io %;'$ r7o27i%;;'A>doe : La"EC"rei"ies : ar a2ral$/)(



<C1g- Ne>uliBer

ve"oli 16 7our- +reas"il3-

Pla re"urig7oe

Medi2a"io :Mul"ivi"ai/eDCie 150g


!is2ussio



!is2ussio



(7erap#

• /e"riaCo• )ai"idie• !eCae"a

so• Ne>uliBer

Progosis

• Tuo advi"a :du>ia

• Tuo adugsioa: du>ia



(AN& QOU

Documents

CASE Pneumonia English