内科护理学英语考试资料

内科护理学英语考试资料第1页/共22页Bronchiectasis

支气管扩张第2页/共22页Pathophysiology

Bronchiectasis支气管扩张

isadisordercharacterizedbypermanent,abnormaldilatation扩张ofoneormoremedium-sizedanddiametergreaterthan2mmproximalbronchi近端支气管.Pathophysiologicchangethatresultindilatationisdestructionoftheelastictissue弹性组织andmuscularstructuresofthebronchialwall支气管壁.第3页/共22页Etiology病因Thediseaseprocessisoftenbelievedtostartinchildhoodasanacquireddisorder,beginningwithrespiratorycomplicationssecondarytoinfluenza流行性感冒,measles麻疹,orwhoopingcough百日咳.Infantbronchial-lunginfection婴幼儿期支气管-肺组织感染isthemostcommoncauseofbronchiectasis.Recurringlowerrespiratorytractinfectionsareanotherpatternofdiseaseinchildhoodthatmaypredisposeanindividualtobronchiectasis.Thispatternistypicallyseenintheindividualwhohascysticfibrosis囊肿性纤维化,asthma哮喘,a-1aitirypsindeficiency抗胰蛋白酶不足,orimmunodeficiencydiseases免疫缺陷疾病.第4页/共22页Pathologictypes病理类型

Saccularbronchiectasis囊状支气管扩张:occursmainlyinlargebronchiandischaracterizedbycavity-likedilatations.Theaffectedbronchiendinlargesacs.Cylindricalbronchiectasis圆柱支气管扩张:involveinmedium-sizedbronchithataremildlytomoderatelydilated.第5页/共22页Pathophysiology病理生理Almostallformsofbronchiectasisareassociatedwithbacterialinfection细菌感染.Infectionscausethebronchialwallstobeweaken,andpocketsofinfectionbegintoform.Whenthewallsofthebronchialsystemareinjured,themucocilliarymechanism粘膜-纤毛防御机制

isdamaged,allowingbacteriaandmucustoaccumulatewithinthepockets.Theinfectionbecomesworseandresultsinbronchiectasis.第6页/共22页Classification分类

Localizedbronchiectasis局部支气管扩张:resultsfromfocalairwayobstruction,orfromnecrotizing坏死性orlobarpneumonia大叶性肺炎whosebronchiectaticsequelae后遗症arelimitedtooneareaofthelung.Obstructiveprocessesofanykindcanpredisposeanindividualtobronchiectasis.Theobstructioncausesthebronchi支气管andbronchioles细支气管todistendandballoonoutbelowthelevelofobstruction.第7页/共22页Classification分类

2. Generalizedbronchiectasis广泛性支气管扩张:ismultifocalnecrotizing

多灶性坏死性bacterialinfection,butotherconditioncanpredisposepersonstothedevelopmentofbronchiectasis,suchas:Congenital先天性factors:alteredbronchialstructuressuchascysts支气管囊肿andcul-de-sacs盲囊,whichleadtopoolingofsecretion.Avarietyofimmunodeficiencydiseases免疫缺陷疾病areassociatedwithrecurrentbacterialpneumonia.Someinhalationexposures,particularlytoirritantgasessuchasoxidesofsulfur硫氧化物andnitrogen氮,havebeennoticedascausesofbronchiectasis.第8页/共22页Clinicalmanifestation临床表现

Theprimarymanifestationsofbronchiectasisvaryconsiderably,dependingontheextentandlocationofthediseaseprocess:Chroniccoughwithproductionofmucopurulentsputum黏液性脓性痰;thecoughisparoxysmal阵发性andisoftenstimulatedwithpositionchanges.*Hemoptysis咯血Recurrentpneumonia肺炎Exertionaldyspnea运动性呼吸困难Fatigue

疲劳WeightlossAnorexia厌食症Fetidbreath恶臭呼吸第9页/共22页Diagnosticstudies辅助检查Anindividualwithachronicproductivecoughwithcopioussputum(whichmaybebloodstreaked血丝shouldbesuspectedofhavingbronchiectasis.Characteristicfindingsinthehealthhistorysuchaschildhooddiseasescomplicatedbyrespiratoryinfectionsorchronicbronchitisaresignificant.ChestX-raymayshowstreakyinfiltrates.Bronchoscope支气管镜maybeusefulinidentifyingthesourceofsecretionsorsitesofhemoptysisintheindividualwithchronicproductivecough.Sputumcollection痰液收集mayprovidewithadditionalinformationregardingtheseverityofimpairmentandthepresenceofactiveinfection.Pulmonaryfunction肺功能测试testmaybeabnormalinadvancedbronchiectasis.Acompletebloodcount血细胞计数maybenormalorshowevidenceofanemiaandleukocytosis.第10页/共22页Therapeuticmanagement治疗方案Antibiotics抗生素arethemajorformoftreatmentandshouldbegivenonthebasisofsputumculture痰培养result.Maintaininggoodhydrationisimportanttoliquefysecretions.Encouragedailydrinkingwaterofnotlessthan1500~2000ml.Posturaldrainage体位引流isvitaltofacilitateexpectorationofsputum咳痰.Theindividualshouldreduceexposuretoexcessiveairpollutantsandirritants,avoidcigarettesmokingandobtainpneumococcal肺炎球菌andinfluenzavaccinations流感疫苗接种.Surgicalresectionofpartsofthelungsmaybedoneifconservativetreatmentisnoteffective;surgicalinnotavailablewhenthereisdiffuseorwidespreadinvolvement.第11页/共22页第12页/共22页第13页/共22页NursingmanagementAcuteandchronicinterventionAnimportantnursinggoalistopromotedrainage引流andremovalofbronchialmucus支气管黏液.Someindividualsrequireelevationofthefootofthebedby4to6itchestofacilitatedrainage.Posturaldrainage体位引流shouldbedoneontheaffectedpartsofthelungs患侧肺部.Thepatientsshouldbetaughteffectivedeep-breathingexercises深呼吸练习andeffectivewaystocough.Administrationoftheprescribedantibiotics抗生素,bronchodilators支气管扩张剂orexpectorantsisimportant祛痰剂.第14页/共22页Nursingmanagement护理措施AcuteandchronicinterventionBedrestmaybeindicatedduringtheacutephaseoftheillness,chillingandexcessfatigueshouldbeavoided.Goodnutritionisimportantbutmaybedifficulttomaintainbecausethepatientisoftenanorexic.Oralhygienetocleansethemonthandremovedriedsputumcrustsmayimprovethepatient’sappetite.Adequatehydrationtohelpliquefysecretion,thusthepatientshouldbeinstructedtodrinkatleast3Loffluiddaily.However,generallythepatientshouldbecounseledtouselow-sodiumfluidstoavoidsystemicfluidretention.第15页/共22页Nursingmanagement护理措施AcuteandchronicinterventionThepatientwithbronchiectasisshouldavoidultrasoundnebulizers超声雾化吸入becausetheyofteninducebronchospasm支气管痉挛.Itisimportantthatthepatientmedicatewithaninhaledbronchodilator10to15minutesbeforetopreventbronchoconstriction.Thepatientandfamilyshouldbetaughttorecognizesignificantmanifestationtobereportedtothehealthcareproviders,thesemanifestationincludeincreasedsputumproduction,grosslybloody血腥痰sputum,increasingdypsnea呼吸困难,fever,chills发烧,andchestpain.第16页/共22页HemoptysisHemoptysisistheexpectoration(coughingup)ofbloodorofblood-stainedsputumfromthebronchi,larynx,trachea,orlungs.<100ml：smallvolume；=100~500ml:moderatevolume；>500mlor>100~500ml/time:massivevolume。第17页/共22页Nursingmanagement护理措施Hemoptysiscare咯血的护理Promotepersonalandspecialenvironmenttodecreaseanxietyfromdisease.Keepingthepatientatrest,positionformaximalaerationoflungfields,thebleedinglungshouldbeplacedinthedependentposition,sothatbloodisnotaspiratedintotheunaffectedlung.Whenhelpingpatientcough,usewhateverpositionbestensurescooperationandminimizesenergyexpenditure.Usingsuctionasordered,whenit’sneeded.withmassivebleeding,endotrachealintubation气管内插管andmechanicalventilation机械通气maybeneededtocontrolairwayandmaintainadequategasexchange.Ifthereismassivebleedingwhichispronetobesuffocated,preparingforendotrachealintubation气管内插管,asorder.Monitoranddocumentvitalsigh,bleedingcharacteristictogaugetherapy’seffectivenessanddetectpossibleprogression.第18页/共22页咯血的护理促进个人和特殊的环境，减少焦虑。保证病人休息和正确体位，能够最大限度促使肺野的通气。小量咯血应静卧休息，大量咯血者需绝对卧床休息。肺出血时应协助患者在患侧卧位，从而使血液不能被吸入健侧。当帮助病人咳嗽时，选择任何合适的位置，最好确保病人能够配合的同时最大限度地减少能量和体力的消耗。及时为病人漱口，擦净血迹，保持口腔清洁，舒适，防止口腔异味刺激，再度引起咯血。如果需要，遵医嘱使用吸引。当患者出现大出血，可能需要气管内插管和机械通气，以控制呼吸道和保持足够的气体交换。如果有大量出血，患者很容易被窒息，因此，必须遵医嘱准备气管插管。监测并记录生命体征，出血的情况，用于衡量治疗的效果和发现疾病可能的进展。遵医嘱用止血药，抗生素，祛痰剂，支气管舒张药。大咯血可使用垂体后叶素。剧烈咳嗽者给予小剂量镇静剂。烦躁不安者适当选用镇静剂如地西拌，禁用吗啡，派替啶以免抑制呼吸。第19页/共22页asphyxia窒息Ifthepatientpresentstressed精神紧张,restless坐卧不安anddullcomplexion面色晦暗,poorinhemoptysis,itisoftenchokingsign窒息先兆.Ifthepatientsuddenlybecomedread表情恐怖,chesttightness胸闷,shortnessofbreath气促,cyanosis发绀ofmouthandlip

.sweating,orlossofconsciousness意识丧失,etc.,indicatingthatasphyxia窒息hasoccurred,itshouldbeurgentlyaddressed.第20页/共22页NursingcareforasphyxiaFirstaiditemsareready,closelymonitorpatientswithaurasuffocation.Whensignsofa