NURSING CARE FOR CHILDREN WITH PNEUMONIA WITH INEFFECTIVE AIRWAY CLEARANCE THROUGH THE APPLICATION OF THE PAPER PROPELLER BLOWING TECHNIQUE PAPER PROPELLERS AS BREATH STIMULATION IN THE ANGGREK ROOM AT ARIFIN AHMAD HOSPITAL, RIAU PROVINCE

Abstract

Pneumonia is a major cause of morbidity and mortality in children, particularly toddlers, and is often complicated by ineffective airway clearance due to increased secretion production and impaired gas exchange. This condition can be exacerbated by comorbidities such as rheumatic heart disease, pleural effusion, malnutrition, and pulmonary infiltrates. This case study aims to describe comprehensive nursing care for a child with pneumonia accompanied by cardiovascular disorders and poor nutritional status, with interventions focused on improving airway clearance. The study subject was a preschool-aged child with tachypnea up to 52 breaths/minute, bilateral moist rales, ineffective cough, use of accessory muscles, decreased oxygen saturation, and pleural effusion. The patient also had a history of severe rheumatic heart disease (RHD), hypotension, generalized edema, and poor nutritional status (BMI 10.9).

The nursing intervention was carried out for three days, including airway management (semi-Fowler's position, nebulization, chest physiotherapy, and effective coughing techniques), oxygen therapy, family education, pharmacological collaboration, and breathing exercises using the propeller blowing technique as a modification of pursed lips breathing. This technique was applied 15 times per session for three minutes each time signs of respiratory distress appeared. The evaluation results showed a decrease in respiratory rate from 42x/minute to 30x/minute, a decrease in rhonchi, increased cough effectiveness, and an improved breathing pattern. In addition, there was an improvement in cardiac output and a gradual improvement in nutritional status. This study proves that the blowing technique as a play-based approach is effective in children with pneumonia with complex clinical conditions as part of a comprehensive nursing intervention.