新生儿科：一例宫内感染性肺炎患儿护理查房课件

1、（一例宫内感染性肺炎患儿的护理查房）speaker：何绮晴Physicalexamination：姚莲萍PPTproduction：石彩兰Advisor：陈松珠老师、陈丽英老师、何兆梅老师Onecaseofintrauterineinfectionpneumoniaofthenewborninnursingroundsspeaker：何绮晴OnecaseofintrauteriOperation purpose1.Discussing and using 14 items about clinical nursing service quality in nursing rounds(探讨运用

2、“14条”进行护理查房)2. Master(掌握) the nursing of intrauterine infection pneumonia with newborn 3. Improve the nurses understanding of intrauterine infection pneumoniaOperation purpose1.Discussing General information（一般资料）：Name: Son of Geng yinghua （庾颖华之子）Age: 11 days Weight：3.55kg Sex: male Data of Birth：:

3、14:57 ,July 26th, 2016 Race: Han Nationality: ChinaParents Name: father Chen haiyan，Mother Geng yinghuaDate of admission: July 27th, 2016Chief complaint（主诉）: short of breath for 2 hoursGeneral information（一般资料）：Present illness（现病史）:GW: 38+weeks, G3P2, LMP: 2016-08-05; EDC: 2016-7-26 .Babys mother is

4、 a elderly pregnant woman with scarred uterus(疤痕子宫) .he birthed in 14:57 ,July 26th, 2016 with cesarean(剖腹产) .The afflicted(受苦的) baby was delivered in 14:57 ,July 26th, 2016.His Birth weight was 3.55 kg and head circumference was 32 cm . There was no history of asphyxia rescue（无窒息抢救史） at birth with

5、clear amniotic fluid（羊水清）. Present illness（现病史）:It was nine points with Apgar scoring in 1 minute , and 10 points with Apgar scoring in five minutes (1分钟阿氏评分为9分，五分钟阿氏评分为10分)，and had shortness of breath after 24 hours along with obtuse（迟钝的） response and Oral cyanosis (口唇发绀)and moaning（呻吟）.No restless

6、ness（烦躁不安）or vomit or fever or pale complexion（面色苍白） or seizure（癫痫发作） or scream（尖叫） were observed. Breast feed not very well and his crying is a bit poor .His stool(大便) and urine is normal .It was nine points with Apgar Family history（家族史）：The patients mother had an operation with laparoscopic myome

7、ctomy（子宫肌瘤剔除术） in 2005，and delivered a girl with cesarean(剖腹产) in 2009.The patients father suffered from hypertension（高血压） and gout(痛风)Diagnosis(诊断)：intrauterine infection pneumonia of the newborn （宫内感染性肺炎）新生儿科：一例宫内感染性肺炎患儿护理查房课件What s it ？Intrauterine infection pneumonia of the newborn（新生儿宫内感染性肺炎）:C

8、aused by viruses（病毒）, bacteria（细菌）, protozoa（原虫）, or chlamydia（衣原体）Had infection before birth (出生前就感染)Always attacked（发病） within 24 hours after birth with asphyxia（窒息史）Had shortness of breath（气促），moans（呻吟）, difficulty breathing（呼吸困难）, and had not stable temperature（体温不稳定）, and the response is poor（反

9、应差)after recovery（复苏）.What s it ？Intrauterine clinical manifestation（临床表现）Serum （血清） IgM and IgA is higher than normal newborns, and Ig M 200 mg/L in umbilical cord blood(脐带血) or the specificity Ig M is higher for prenatal diagnosis（产前诊断）.X-ray chest radiography is often shown as interstitial pneumo

10、nia（间质性肺炎), and the bacterial pneumonia(细菌性肺炎)is bronchopneumonia(支气管肺炎).Checked the gastric juice(胃液) 1 2 hours after birth, which could see pus cells脓细胞, and find bacteria sometimes. Concha pharyngeal swab bacteria culture(外耳道咽拭子细菌培养)can be positive(阳性). clinical manifestation（临床表现）SeProgress note

11、（病程记录）2016-07-27SPO2 80-85%，呼吸急促，约80次/分，伴呻吟样呼吸，口周发绀，吸气三凹征阳性，给予CPAP辅助通气（PEEP 5cmH2O，FiO2 30-35%），患儿气促较前好转，SPO2上升至93-95%，禁食，停留胃管无潴留，予告病重，给予抗感染、营养心肌及补液等治疗，续观07-28CPAP辅助通气（PEEP 5cmH2O，FiO2 30-35%），禁食,停留胃管无潴留，呼吸稍促，三凹征阳性，双肺呼吸音粗，闻及双肺低湿性啰音，全身皮肤黏膜无黄染，辅助检查：血气分析：PH 7.279,PC O2 47.1mmol/L,HCO3 -21.6mmol/L,BE -6

12、.1mmol,血常规：WBC 19.63x109/L , HGB 142g/L, 血型“B”，电解质：Na142.5mmol/L，CA 1.94 mmol/L,K 4.40mmol/L , CL108.1mmol/L，CK-MB,床边胸片X片显示斑片状阴影，目前诊断明确：宫内感染性肺炎，继续、监护、CPAP辅助通气、抗感染、营养心肌等治疗07-28PO2氧分压37.2 mmHg，继续给予CPAP辅助通气，持续血氧饱和度维持在90-95%07-29CPAP辅助通气（PEEP 5cmH2O，FiO2 30-35%），呼吸稍促，反应稍差，哭声稍弱，试喂5ml/次，停留胃管通畅，无潴留，轻度吸气三凹征

13、阳性，双肺呼吸音粗，可闻及双肺低湿性啰音，伴呻吟样呼吸，查CPR升高，胸片提示可见斑片状阴影，查HGB 137 g/L，全身皮肤黏膜轻度黄染，SB 5mg/dl07-30CPAP辅助通气，间中呼吸稍促，反应稍差，哭声稍弱，轻度吸气性三凹征，全身皮肤黏膜轻度黄染，SB 5mg/dl，双肺呼吸音粗，可闻及双肺低湿性啰音，伴呻吟样呼吸，开塞露塞肛后排出16g胎便，血钾较低，已静脉补钾，低钾血症Progress note（病程记录）2016-07-27S07-31 CPAP辅助通气间中呼吸稍促，停留胃管通畅，无潴留，持续心电监护显示：RR 35-45次/分，P 130-144次/分，BP 75/43

14、mmHg，SPO2 93-98%，反应稍差，哭声稍弱，轻度吸气三凹征阳性，双肺呼吸音粗，可闻及双肺低湿性啰音，伴呻吟样呼吸，全身皮肤黏膜轻度黄染,，SB 7mg/dl，辅助检查：血培养至今：未见细菌、真菌生长，电解质：Na 142.3mmol/L，CA 2.08 mmol/L,K 3.28mmol/L ,CPR 2.1mg/L,目前继续监护、CPAP辅助通气、抗感染、营养心肌等治疗08-01试停CPAP辅助通气，呼吸尚顺，血氧饱和度可维持在90-98%之间，反应稍可，哭声响，停留胃管通畅，无潴留，持续心电监护显示：RR 40-48次/分，P 125-146次/分，BP 79/43 mmHg，S

15、PO2 92-98%，全身皮肤轻度黄染，SB 7mg/dl，双肺呼吸音粗，未闻及双肺干湿啰音，目前继续监护、抗感染、营养心肌等治疗08-02患儿呼吸顺，无发绀，血氧饱和度可维持在93-98%之间，持续心电监护显示：RR 40-45次/分，P125-148次/分，BP72/41mmHg，全身皮肤轻度黄染，SB 8mg/dl，双肺呼吸音粗，未闻及干湿啰音，G6PD 4.9U/L08-03患儿呼吸顺，无发绀，无三凹征，持续心电监护显示：RR 40-46次/分，P127-144次/分，BP 87/42 mmHg，SPO2 92-94%，全身皮肤轻度黄染，SB 7mg/dl，双肺呼吸音粗，辅助检查：血常

16、规：WBC 11.68x109/L , HGB 117g/L,电解质：CA 2.14 mmol/L,K 4.35 mmol/L ,CPR 0.2mg/L,患儿复查血红蛋白较前降低，必要时输注浓缩红细胞，目前继续监护、抗感染、营养心肌等治疗08-04患儿呼吸顺，无发绀，无三凹征，全身皮肤轻度黄染，SB 7mg/dl，双肺呼吸音稍粗，未闻及干湿啰音，血氧饱和度可维持在92-97%之间，持续心电监护显示：RR 40-48次/分，P120-142次/分，BP69/35mmHg，SPO2 92-97%，辅助检查：血培养：未见细菌、真菌生长，患儿呼吸顺，吃奶好，病情治愈，予出院07-31 CPAP辅助通气

17、间中呼吸稍促，停留胃管通畅，无潴Physical examination（体格检查）Physical examination（体格检查）Nursing problem1、Ineffective Airway Clearance（清理呼吸道无效)：Associated with the respiratory secretions （呼吸道分泌物），and baby was unable to row of phlegm（痰液）weakly.2、Impaired gas exchange（气体交换受损）：Associated with lung inflammation（炎症）3、Malnutr

18、ition（营养失调）：Associated with inadequate（不足的）intake and the increase consumption(消耗)Nursing problem1、Ineffective 4、Ineffective Thermoregulation（体温调节无效）：associated with the lung infection5、Potential Complication（潜在并发症)：(1) heart failure（心力衰竭）：Associated with pulmonary hypertension（肺动脉高压）and the toxic m

19、yocarditis（中毒性心肌炎）. (2) toxic encephalopathy（中毒性脑病）：Related to the lack of oxygen and carbon dioxide retention.（二氧化碳储留）(3) toxic enteroparalysis（中毒性肠麻痹）：Related to toxemia毒血症and the severe cyanosis（严重缺氧）. 4、Ineffective ThermoregulatioNursing measures Keep from obstruction（保持呼吸道通畅）：（1）slapping back t

20、o excretory sputum（拍背排痰）（2）ultrasonic aerosol inhalation（超声雾化吸入）If necessary：（3）expectorant（祛痰药）（4）Mouth sputum suction with negative pressure（口腔吸痰负压）：Premature（早产儿）：0.01 0.013mpaTerm infant（足月儿）：0.013 0.015mpaNursing measures Keep from oRational(合理) usage of oxygenControl the time and oxygen concen

21、tration （浓度）吸氧指征：PaO250-60mmHg(1)nasal catheter oxygen inhalation(鼻导管给氧)：0.5-1 L/min(2)mask oxygen inhalation(面罩给氧) :2-4 L/min(3)Hood oxygen inhalation(头罩吸氧):5-8 L/min(4)CPAP：continuous positive airway pressure (持续气道正压通气）Rational(合理) usage of oxygenCoMaintain（保持）normal body temperatureMaintain norma

22、l body temperature： 36 to 37 Hypothermia（体温过低）：keeping warmHyperthermia（体温过高）： coolingIf necessary：Use the antipyretic （退热药）in accordance with the doctors adviceMaintain（保持）normal body tempantibiotic therapy(抗生素治疗)According to the illness needs to choose the appropriate（合适的）antibiotics（抗生素）Observed the effect of drugs closely（密切观察药物的作用）antibiotic therapy(抗生素治疗)AccorSupply enough energy and moisture(水分)Eat smaller, more frequent meals（少量多餐）Prevent asphyxia duri