新生儿科一例宫内感染性肺炎患儿的护理查房PPT课件

（一例宫内感染性肺炎患儿的护理查房）,speaker：何绮晴Physical examination：姚莲萍PPT production：石彩兰Advisor：陈松珠老师、陈丽英老师、何兆梅老师,One case of intrauterine infection pneumonia of the newborn in nursing rounds,1,Operation purpose,1.Discussing and using 14 items about clinical nursing service quality in nursing rounds(探讨运用“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 pneumonia,2,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：: 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 hours,3,Present illness（现病史）:GW: 38+weeks, G3P2, LMP: 2016-08-05; EDC: 2016-7-26 .Babys mother is 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 clear amniotic fluid（羊水清）.,4,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 restlessness（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 .,5,Family history（家族史）：The patients mother had an operation with laparoscopic myomectomy（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）,6,What s it ？,Intrauterine infection pneumonia of the newborn（新生儿宫内感染性肺炎）:Caused 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（反应差)after recovery（复苏）.,7,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 pneumonia（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).,8,Progress note（病程记录）,9,10,Physical examination（体格检查）,11,Nursing problem,1、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、Malnutrition（营养失调）：Associated with inadequate（不足的）intake and the increase consumption(消耗),12,4、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 myocarditis（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）.,13,Nursing measures,Keep from obstruction（保持呼吸道通畅）：（1）slapping back to 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 0.015mpa,14,Rational(合理) usage of oxygen,Control the time and oxygen concentration （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）,15,Maintain（保持）normal body temperature,Maintain normal 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 advice,16,antibiotic 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）,17,Supply enough energy and moisture(水分),Eat smaller, more frequent meals（少量多餐）Prevent asphyxia during feeding（喂奶时防止窒息） severe patients（病重者）：Nasal feeding（鼻饲） &Intravenous supplement with nutriention and liquid由静脉补充营养物质及液体,18,Closely observe the illness,（1）Heart rate：120-140 times/min on average（2）breathing：40 times/min on average（3）Blood pressure monitoring: 70/50 mmHg on average（4）conscious responses:,19,discharge(出院)guidance,Explain the relevant knowledge of the disease to parentsGive the living gu