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儿童呼吸系统疾病英文第1页/共41页
AnatomyandPhysiologyoftheChildhoodRespiratorySystemUpperrespiratorytractNosePharynxLarynxEpiglottisLowerrespiratorytractTracheaBronchiBronchiolesandalveoli第2页/共41页
TheUpperAirwaydifferences:shorterandnarrow4mm<20mmnosebreatherairwayresistancelooselymucousmembranesandsofttissueTheLowerAirwaydifferences:rightbronchusismorewider,shorter,verticallessalveolarsurfacearea
AnatomyandPhysiologyoftheChildhoodRespiratorySystem第3页/共41页Pneumonia第4页/共41页Definition
AninflammationorinfectionofthebronchiolesandalveolarspacesofthelungsPneumonia第5页/共41页Introduction
occur:ininfantsandyoungchildrenrecovery:childrensoonerthanadultsexisttype:diseaseorcomplication
season:latewinterandearlyspring
Pneumonia第6页/共41页
LobarpneumoniaBronchopneumonia(lobularpneumonia)InterstitialpneumoniaPneumoniaclassificationMorphologicalclassification第7页/共41页EtiologicAgent
InfectiousvirusbacterialMycoplasma(支原体肺炎)
chlamydial（衣原体肺炎）fungipneumocystis(肺囊虫)
Noninfectious
foreignbodyaspirationPneumoniaclassification第8页/共41页CourseAgent
Acute<1monthProgressive1-3monthsChronic>3months
Pneumoniaclassification第9页/共41页StateofIllness
MildSevere
Pneumoniaclassification第10页/共41页theclinicalmanifestationsofbronchopneumoniaMildbronchopneumoniafever:irregularfevercough:dry,hacking,non-productivetoproductivecoughtachypnea:RR40~80ts/mnasalflaring,sighingrespiration,threedepressionsignsandcyanosis
fixedfinemoistralesPneumonia第11页/共41页theclinicalmanifestationsofbronchopneumoniaSeverebronchopneumoniacirculationsystemmanifestationsofmyocarditissignsofheartfailurenervoussystem
gastrointestinal
Chest:X-rayfilmPneumonia第12页/共41页Severebronchopneumonia
Circulationsystem
myocarditis,congestiveheartfailure
pathogens
invadingthemyocardiumandproducetoxintoxicmyocarditishypoxia
pulmonaryarteryhypertensionCHFPneumoniamanifestation第13页/共41页Severebronchopneumonia
manifestationsofmyocarditis
paletachycardiadiminishedcardiacsoundandarrhythmia
STslowingdownTwaveupdown
Pneumoniamanifestation第14页/共41页SeverebronchopneumoniaSignsofheartfailure
RestlessobviouscyanosisgreyfacesTachypnea:RR>60ts/mTachycardia:HR>160-180bpmSweatingdyspneacervicalveindistentionoliguriaoranuriaface/lowerlimbsedemaHepatomegalyprogressively
Pneumoniamanifestation第15页/共41页Severebronchopneumonia
Nervoussystem:
dysphoria(烦躁)irritable
alert/stuporous
convulsion
somnolence(嗜睡)
intracranialhypertension
Pneumoniamanifestation第16页/共41页Severebronchopneumonia
Gastrointestinal
anorexiavomitingabdominal
distention
toxicenteritishemorrhageofGIabsentintestinalsoundbloodystoolPneumoniamanifestation第17页/共41页Severebronchopneumonia
Chest:X-rayfilm
diffuseorpatchyinfiltration
smallspottedshadowoftherightmiddlePneumoniamanifestation第18页/共41页TherapeuticManagement
principle
antimicrobialtherapy
supportivemeasuresPneumoniatherapy第19页/共41页principle
controlinfection
promoteoxygenationandcomfort
preventcomplication
fevermanagement
fluidintake
familysupport
Pneumoniatherapy第20页/共41页Antimicrobialtherapy
PGgivenbyIMorIV
PG-allergic:erythromycinclindamycin
PG-resistent:cephalosporin
PGandcephalosporin-resistent:vancomycin
Pneumoniatherapy第21页/共41页SupportiveMeasures
controlcoughanddyspneakeepairwaycleargiveoxygenposition:semi-reclining
Pneumoniatherapy第22页/共41页NursingDiagnosis
Impairedgasexchange
collectionmucousinairway
Ineffectiveairwayclearance
mechanicalobstruction,inflammation
andincreasedsecretions
Pneumonia第23页/共41页AnticipatedgoalsThechildwillshownormalrespiratoryfunctionwillreceiveoptimumoxygensupplyThechildwillmaintainpatentairwaywillexpectoratesecretionsadequatelyPneumonia第24页/共41页NursingIntervention第25页/共41页
RestoreOptimalRespiratoryFunction
MaintainAirwayCleaning
ProvideAdequateRestandNutrition
Observation
PreventInfectionNursingIntervention第26页/共41页
RestoreOptimalRespiratoryFunction
Keepcomfortableenvironment
Positionchildformaximumventilation—semi-recliningposition
ProvideOxygen:masknasalcannulaintubationmechanicalventilation第27页/共41页MaintainAirwayCleaning
Institutesuctioningofairway,cougheffectivelyandposturaldrainageProvidenebulizationChestPhysiotherapyAdministermedications第28页/共41页ProvideAdequateRestandNutrition
Provide
quietenvironmentdarkenroom,schedulevisitingtime
Bedrest
Appropriatediethigh-proteinandcarbohydratedigestive,nutritionalliquidandsemi-liquiddietsmallfrequentfeedingenteralorparenteralnutrition
第29页/共41页observationTemperature:preventhyperthermiaseizureSignsofheartfailureSignsofintracranialhypertentionSignsoftoxicenteroplegiaandGIblood第30页/共41页Signsofheartfailure
usecardiacmonitorvitalsignsoxygensaturationbreathsounds,colorofskin,intakeandoutput,electrolytelevelssideeffectofmedicationheartfailuresigns
observation第31页/共41页SignsofintracranialhypertensionAlertorstuporousSeizurecomairregularrespirationobservation第32页/共41页SignsoftoxicenteroplegiaandGIbloodabdominaldistentiontreatment:supplypotassium,dietaryrestriction,placingnasogastrictube,injectneostigmine.BowlsoundVomitingBloodstoolobservation第33页/共41页PreventInfection
Assesssignsofinfection
vitalsigns,temperaturefluctuationsputumculture,sensitivityreportsandWBC
MaintainasepticenvironmentLimitvisitorsandisolatethepatientsAdministerantibiotics第34页/共41页BeforetreatmentAftertreatment第35页/共41页
severalspecialtypesofpneumonia
Viralpneumonia
mostcommoncause:RSVpeakattackrate:<2ageonset:acuteorinsidioussymptom:fever,cough,tachypnea,nasalflaringcyanosis,respiratoryfatigue
IntercostalSubcostalSuprasternal
Pneumonia第36页/共41页severalspecialtypesofpneumonia
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