NCLEX Review Guide: Pediatric Pneumonia

Definition & Types

• Pneumonia is an inflammatory infection of the lung parenchyma that can be bacterial, viral, or atypical in children.
• Bacterial pneumonia (Streptococcus pneumoniae most common) presents with sudden onset, high fever, and productive cough.
• Viral pneumonia has gradual onset, lower-grade fever, and dry cough with more systemic symptoms.

Clinical Manifestations

• Respiratory distress signs: tachypnea, retractions, nasal flaring, grunting, and use of accessory muscles.
• Fever patterns vary: bacterial causes high fever >102°F, viral causes moderate fever.
• Auscultation reveals decreased breath sounds, crackles, or bronchial breath sounds over affected areas.
• Infants may present with poor feeding, irritability, and lethargy rather than classic respiratory symptoms.

Priority Nursing Actions

1. Assess respiratory status: monitor oxygen saturation, respiratory rate, and work of breathing every 2-4 hours.
2. Position child in semi-Fowler's or high-Fowler's position to maximize lung expansion.
3. Administer oxygen therapy as prescribed to maintain SpO2 >92% in children.
4. Encourage fluid intake to thin secretions and prevent dehydration from fever and tachypnea.

Medication Administration

• Antibiotics for bacterial pneumonia: amoxicillin first-line for outpatient, IV antibiotics for hospitalized children.
• Antipyretics (acetaminophen/ibuprofen) to reduce fever and improve comfort, but avoid aspirin in children due to Reye's syndrome risk.
• Bronchodilators may be prescribed if wheezing is present to improve airflow.

Common Pitfalls

• Don't give cough suppressants to children with pneumonia as they need to clear secretions.
• Remember that chest percussion and postural drainage are contraindicated in acute pneumonia.
• Infants may not present with typical symptoms - watch for feeding difficulties and behavioral changes.