Pneumonia: Diagnosis (Pediatric Nursing)

00:01 Community-acquired pneumonia is a common disease in infancy and childhood, and it's diagnosed in otherwise healthy children who have been outpatient.

00:08 These kids have not been in the hospital.

00:11 However, determining a cause of their pneumonia is still a challenge due to the relative inaccessibility of their infected tissue, right, because it's inside their lungs, and the difficulty in obtaining a non-contaminated sample of the airway.

00:24 So, there is a way to send a sputum sample to the lab and determine if a patient has a viral or a bacterial pneumonia.

00:30 However, the technique for actually expectorating that sputum and getting it from deep down in the lungs is actually quite difficult.

00:37 Most children and adults cannot get a good sample.

00:41 So, if the child just spits into the cup, you're going to be sending their oral flora to the lab, and that's not helpful.

00:49 The diagnosis of community- acquired pneumonia can also be made based on their symptoms, right? Does the child have a new fever or respiratory symptoms? When you do a chest X-ray, is there a presence of pulmonary infiltration? And also, consolidation.

01:05 A child can be diagnosed with hospital-acquired pneumonia, or HAP, if they happen to develop a pneumonia about 48 hours after they've been inpatient in the hospital.

01:15 These are treated differently.

01:17 Often, pneumonia is a clinical diagnosis without the use of diagnostic testing.

01:23 Patients with severe symptoms, those who are in the hospital, and those who are having a complicated clinical course should undergo diagnostic testing.

01:32 You can do a chest X-ray on your patient, but remember, this causes radiation to the patient and there's a financial cost.

01:39 Unfortunately, also, chest X-rays don't tell you the causative agent of the pneumonia as well as previously thought.

01:46 Previously, it was thought that a lobar consolidation was associated with pneumococcal infections like Strep pneumoniae, and interstitial infiltrations were associated with viral infections.

01:56 However, that has been debunked and both findings are identified in both types of pneumonia, either viral alone, bacterial alone, or some patients that actually have a viral and bacterial co-infective pneumonia.

02:11 In most children with community- acquired pneumonia, the identification of the causative organism is not critical.

02:17 And chest X-rays should not be done in an outpatient setting in children with a mild course.

02:23 You might do a chest radiograph on patients with ambiguous clinical findings, a prolonged pneumonia that's just not resolving as it should, and meeting the possibility of complications such as pleural effusions.

02:35 It's reasonable to treat your patient for pneumonia based on their clinical findings.

02:41 Now, another way to diagnose pneumonia is bronchoalveolar lavage, or BAL, and this yields an adequate sample, but it's reserved only for very severe cases at risk for a poor outcome.

02:54 During this procedure, a bronchoscope is advanced through the mouth or nose and all the way to the lungs.

02:59 A fluid is squirted into part of the lung and then it's collected and sent to the lab for analysis.

03:04 This can tell the clinician what type of infection is present.

03:08 Blood cultures should be obtained in only very ill children in whom bacterial pneumonia is suspected, or a neonates suspected of having pneumonia.

03:18 Another diagnostic tool is a nasopharyngeal PCR test that can identify airway pathogens.

03:25 Now, just classic standard blood work is not particularly helpful in identifying a viral from a bacterial pneumonia infection.

03:32 It's not recommended.