Community-Acquired Pneumonia in children
+ Fever, cough, tachypnea
CBC, CMP, CXR ordered and reviewed.
Admit to peds floor.
Condition: Stable; Routine vitals; Activity as tolerated; Diet as tolerated.
f/u BCx and Sputum Cx. The patient got a dose of ceftriaxone in the ED before blood culture and sputum culture was ordered.
f/u Influenza A & B viral RNA from a nasopharyngeal swap, routine collect by a nurse. Re: This is done b/c this patient also has headaches, n/v/d, abdominal pain–diffuse symptoms that give a viral picture.
Cont Ceftriaxone 50-100mg/kg/day IM/IV divided q12-24hr x10days for severe bacterial infection. Ampicillin is the drug of choice in fully immunized patients. However, 2/2 to unknown immunization status, we will do ceftriaxone.
Breathing treatments as needed.
Oxygen to keep sats >92
Zofran for nausea, Acetaminophen for fever, D5 NS + 20 KCL @65ml/hr in this 23kg pt with hyponatremia. Maint fluids in children are usually D5 1/2 NS + 20 KCL we are using NS because of pt’s hyponatremia. Calculate maint fluids using 4, 2, 1 Rule.
f/u UA, Lipase, and Abd. CT because of the abd pain, n/v/d picture in this patient.
Sample Case
6 yo F with 3-week hx of recurrent fevers, coughing, SOB, with two-day hx of n/v/d, abdominal pain as well as diarrhea and headaches.
Source: Infectious Disease Society of America
Criteria for Hospitalization for Children with Community-Acquired Pneumonia