儿童呼吸系统疾病英.ppt

Respiratory Dysfunction,Anatomy and Physiology of the Childhood Respiratory System,Upper respiratory tract NosePharynxLarynxEpiglottisLower respiratory tractTracheaBronchiBronchioles and alveoli,The Upper Airway differences:shorter and narrow 4 mm 20 mm nose breather airway resistance loosely mucous membranes and soft tissue The Lower Airway differences:right bronchus is more wider,shorter,vertical less alveolar surface area,Anatomy and Physiology of the Childhood Respiratory System,Pneumonia,Definition,An inflammation or infection of the bronchioles and alveolar spaces of the lungs,Pneumonia,Introduction,occur:in infants and young children recovery:children sooner than adults exist type:disease or plication season:late winter and early spring,Pneumonia,Lobar pneumonia Bronchopneumonia(lobular pneumonia)Interstitial pneumonia,Pneumonia,classification,Morphological classification,Etiologic Agent,Infectiousvirus bacterial Mycoplasma(支原体肺炎)chlamydial（衣原体肺炎）fungi pneumocystis(肺囊虫),Noninfectious foreign body aspiration,Pneumonia,classification,Course Agent,Acute 3 months,Pneumonia,classification,State of Illness,Mild Severe,Pneumonia,classification,the clinical manifestations of bronchopneumonia,Mild bronchopneumonia fever:irregular fever cough:dry,hacking,non-productive to productive cough tachypnea:RR4080ts/m nasal flaring,sighing respiration,three depression signs and cyanosis fixed fine moist rales,Pneumonia,the clinical manifestations of bronchopneumonia,Severe bronchopneumoniacirculation systemmanifestations of myocarditissigns of heart failurenervous system gastrointestinal Chest:X-ray film,Pneumonia,Severe bronchopneumonia,Circulation system myocarditis,congestive heart failure,pathogens,invading the myocardium and produce toxin,toxic myocarditis,hypoxia,pulmonary artery hypertension,CHF,Pneumonia,manifestation,Severe bronchopneumonia,manifestations of myocarditis pale tachycardia diminished cardiac sound and arrhythmia ST slowing down T wave updown,Pneumonia,manifestation,Severe bronchopneumonia,Signs of heart failure Restless obvious cyanosis grey facesTachypnea:RR 60ts/mTachycardia:HR 160-180bpmSweating dyspnea cervical vein distentionoliguria or anuria face/lower limbs edemaHepatomegaly progressively,Pneumonia,manifestation,Severe bronchopneumonia,Nervous system:dysphoria(烦躁)irritable alert/stuporous convulsion somnolence(嗜睡)intracranial hypertension,Pneumonia,manifestation,Severe bronchopneumonia,Gastrointestinal,anorexia vomiting abdominal distention toxic enteritis hemorrhage of GI absent intestinal sound bloody stool,Pneumonia,manifestation,Severe bronchopneumonia,Chest:X-ray film diffuse or patchy infiltration,small spotted shadow of the right middle,Pneumonia,manifestation,Therapeutic Management,principle antimicrobial therapy supportive measures,Pneumonia,therapy,principle,control infection promote oxygenation and fort prevent plication fever management fluid intake family support,Pneumonia,therapy,Antimicrobial therapy,PG given by IM or IV PG-allergic:erythromycin clindamycin PG-resistent:cephalosporin PG and cephalosporin-resistent:vanycin,Pneumonia,therapy,Supportive Measures,control cough and dyspnea keep airway clear give oxygen position:semi-reclining,Pneumonia,therapy,Nursing Diagnosis,Impaired gas exchange collection mucous in airway Ineffective airway clearance mechanical obstruction,inflammation and increased secretions,Pneumonia,Anticipated goals,The child will show normal respiratory function will receive optimum oxygen supplyThe child will maintain patent airway will expectorate secretions adequately,Pneumonia,Nursing Intervention,Restore Optimal Respiratory Function Maintain Airway Cleaning Provide Adequate Rest and Nutrition Observation Prevent Infection,Nursing Intervention,Restore Optimal Respiratory Function,Keep fortable environment Position child for maximum ventilation semi-reclining position Provide Oxygen:mask nasal cannula intubation mechanical ventilation,Maintain Airway Cleaning,Institute suctioning of airway,cough effectively and postural drainage Provide nebulization Chest Physiotherapy Administer medications,Provide Adequate Rest and Nutrition,Provide quiet environment darken room,schedule visiting time Bed rest Appropriate diet high-protein and carbohydrate digestive,nutritional liquid and semi-liquid diet small frequent feeding enteral or parenteral nutrition,observation,Temperature:prevent hyperthermia seizureSigns of heart failureSigns of intracranial hypertentionSigns of toxic enteroplegia and GI blood,Signs of heart failure,use cardiac monitor vital signs oxygen saturation breath sounds,color of skin,intake and output,electrolyte levels side effect of medication heart failure signs,observation,Signs of intracranial hypertension,Alert or stuporousSeizurea irregular respiration,observation,Signs of toxic enteroplegia and GI blood,abdominal distention treatment:supply potassium,dietary restriction,placing nasogastric tube,inject neostigmine.Bowl soundVomitingBlood stool,observation,Prevent Infection,Assess signs of infection vital signs,temperature fluctuation sputum culture,sensitivity reports and WBC Maintain aseptic environment Limit visitors and isolate the patients Administer antibiotics,Before treatment,After treatment,several special types of pneumonia,Viral pneumonia most mon cause:RSV peak attack rate:2 age onset:acute or insidious symptom:fever,cough,tachypnea,nasal flaring cyanosis,respiratory fatigue,IntercostalSubcostalSuprasternal,Pneumonia,several special types of pneumonia,Staphylococcal pneumonia（葡萄球菌肺炎）season:October and May following:viral upper respiratory tract age:girls symptom:tachypnea，cyanosis and anxiety signs in infants:lethargic,irritable,toxic gastrointestinal disturbances,Pneumonia,several special types of pneumonia,Mycoplasmal pneumonia(支原体肺炎)age:5-12 years season:fall and winter symptom:dry,hacking cough,fever extrapulmonary plications:blood,heart,CNS,Pneumonia,several special types of pneumonia,Chlamydial pneumonia（衣原体肺炎）age:6 months symptom:cough scattered inspiration rales wheeze rarely no fever,Pneumonia,Thank You,