儿童呼吸系统疾病英.ppt

RespiratoryDysfunction AnatomyandPhysiologyoftheChildhoodRespiratorySystem UpperrespiratorytractNosePharynxLarynxEpiglottisLowerrespiratorytractTracheaBronchiBronchiolesandalveoli TheUpperAirwaydifferences shorterandnarrow4mm 20mmnosebreatherairwayresistancelooselymucousmembranesandsofttissueTheLowerAirwaydifferences rightbronchusismorewider shorter verticallessalveolarsurfacearea AnatomyandPhysiologyoftheChildhoodRespiratorySystem Pneumonia Definition Aninflammationorinfectionofthebronchiolesandalveolarspacesofthelungs Pneumonia Introduction occur ininfantsandyoungchildrenrecovery childrensoonerthanadultsexisttype diseaseorcomplicationseason latewinterandearlyspring Pneumonia LobarpneumoniaBronchopneumonia lobularpneumonia Interstitialpneumonia Pneumonia classification Morphologicalclassification EtiologicAgent InfectiousvirusbacterialMycoplasma 支原体肺炎 chlamydial 衣原体肺炎 fungipneumocystis 肺囊虫 Noninfectiousforeignbodyaspiration Pneumonia classification CourseAgent Acute3months Pneumonia classification StateofIllness MildSevere Pneumonia classification theclinicalmanifestationsofbronchopneumonia Mildbronchopneumoniafever irregularfevercough dry hacking non productivetoproductivecoughtachypnea RR40 80ts mnasalflaring sighingrespiration threedepressionsignsandcyanosisfixedfinemoistrales Pneumonia theclinicalmanifestationsofbronchopneumonia SeverebronchopneumoniacirculationsystemmanifestationsofmyocarditissignsofheartfailurenervoussystemgastrointestinalChest X rayfilm Pneumonia Severebronchopneumonia Circulationsystemmyocarditis congestiveheartfailure pathogens invadingthemyocardiumandproducetoxin toxicmyocarditis hypoxia pulmonaryarteryhypertension CHF Pneumonia manifestation Severebronchopneumonia manifestationsofmyocarditispaletachycardiadiminishedcardiacsoundandarrhythmiaSTslowingdownTwaveupdown Pneumonia manifestation Severebronchopneumonia SignsofheartfailureRestlessobviouscyanosisgreyfacesTachypnea RR 60ts mTachycardia HR 160 180bpmSweatingdyspneacervicalveindistentionoliguriaoranuriaface lowerlimbsedemaHepatomegalyprogressively Pneumonia manifestation Severebronchopneumonia Nervoussystem dysphoria 烦躁 irritablealert stuporousconvulsionsomnolence 嗜睡 intracranialhypertension Pneumonia manifestation Severebronchopneumonia Gastrointestinal anorexiavomitingabdominaldistentiontoxicenteritishemorrhageofGIabsentintestinalsoundbloodystool Pneumonia manifestation Severebronchopneumonia Chest X rayfilmdiffuseorpatchyinfiltration smallspottedshadowoftherightmiddle Pneumonia manifestation TherapeuticManagement principleantimicrobialtherapysupportivemeasures Pneumonia therapy principle controlinfectionpromoteoxygenationandcomfortpreventcomplicationfevermanagementfluidintakefamilysupport Pneumonia therapy Antimicrobialtherapy PGgivenbyIMorIVPG allergic erythromycinclindamycinPG resistent cephalosporinPGandcephalosporin resistent vancomycin Pneumonia therapy SupportiveMeasures controlcoughanddyspneakeepairwaycleargiveoxygenposition semi reclining Pneumonia therapy NursingDiagnosis ImpairedgasexchangecollectionmucousinairwayIneffectiveairwayclearancemechanicalobstruction inflammationandincreasedsecretions Pneumonia Anticipatedgoals ThechildwillshownormalrespiratoryfunctionwillreceiveoptimumoxygensupplyThechildwillmaintainpatentairwaywillexpectoratesecretionsadequately Pneumonia NursingIntervention RestoreOptimalRespiratoryFunctionMaintainAirwayCleaningProvideAdequateRestandNutritionObservationPreventInfection NursingIntervention RestoreOptimalRespiratoryFunction KeepcomfortableenvironmentPositionchildformaximumventilation semi recliningpositionProvideOxygen masknasalcannulaintubationmechanicalventilation MaintainAirwayCleaning Institutesuctioningofairway cougheffectivelyandposturaldrainageProvidenebulizationChestPhysiotherapyAdministermedications ProvideAdequateRestandNutrition Providequietenvironmentdarkenroom schedulevisitingtimeBedrestAppropriatediethigh proteinandcarbohydratedigestive nutritionalliquidandsemi liquiddietsmallfrequentfeedingenteralorparenteralnutrition observation Temperature preventhyperthermiaseizureSignsofheartfailureSignsofintracranialhypertentionSignsoftoxicenteroplegiaandGIblood Signsofheartfailure usecardiacmonitorvitalsignsoxygensaturationbreathsounds colorofskin intakeandoutput electrolytelevelssideeffectofmedicationheartfailuresigns observation Signsofintracranialhypertension AlertorstuporousSeizurecomairregularrespiration observation SignsoftoxicenteroplegiaandGIblood abdominaldistentiontreatment supplypotassium dietaryrestriction placingnasogastrictube injectneostigmine BowlsoundVomitingBloodstool observation PreventInfection Assesssignsofinfectionvitalsigns temperaturefluctuationsputumculture sensitivityreportsandWBCMaintainasepticenvironmentLimitvisitorsandisolatethepatientsAdministerantibiotics Beforetreatment Aftertreatment severalspecialtypesofpneumonia Viralpneumoniamostcommoncause RSVpeakattackrate 2ageonset acuteorinsidioussymptom fever cough tachypnea nasalflaringcyanosis respiratoryfatigue IntercostalSubcostalSuprasternal Pneumonia severalspecialtypesofpneumonia Staphylococcalpneumonia 葡萄球菌肺炎 season OctoberandMayfollowing viralupperrespiratorytractage girlssymptom tachypnea cyanosisandanxietysignsininfants lethargic irritable toxicgastrointestinaldisturbances Pneumonia severalspecialtypesofpneumonia Mycoplas