儿童呼吸系统疾病英

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1、 Respiratory Dysfunction Anatomy and Physiology of the Childhood Respiratory SystemUpper respiratory tract NosePharynxLarynxEpiglottisLower respiratory tractTracheaBronchi Bronchioles and alveoli The Upper Airway differences: shorter and narrow 4 mm 20 mm nose breather airway resistance loosely muco

2、us membranes and soft tissue The Lower Airway differences: right bronchus is more wider, shorter, vertical less alveolar surface areaAnatomy and Physiology of the Childhood Respiratory System Pneumonia Definition An inflammation or infection of the bronchioles and alveolar spaces of the lungsPneumon

3、ia Introduction occur: in infants and young children recovery: children sooner than adults exist type: disease or complication season: late winter and early spring Pneumonia Lobar pneumonia Bronchopneumonia (lobular pneumonia) Interstitial pneumoniaPneumonia classificationMorphological classificatio

4、n Etiologic Agent Infectiousvirus bacterial Mycoplasma(支 原 体 肺 炎 ) chlamydial （ 衣 原 体 肺 炎 ）fungi pneumocystis(肺 囊虫 ) Noninfectious foreign body aspirationPneumonia classification Course Agent Acute 3 months Pneumonia classification State of Illness Mild Severe Pneumonia classification the clinical m

5、anifestations of bronchopneumoniau 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 bronchopne

6、umoniauSevere bronchopneumonial circulation system manifestations of myocarditis signs of heart failurel nervous systeml gastrointestinall Chest:X-ray filmPneumonia Severe bronchopneumonia Circulation system myocarditis, congestive heart failure pathogens invading the myocardium and produce toxin to

7、xic myocarditishypoxia pulmonary artery hypertension CHFPneumonia manifestation Severe bronchopneumonia manifestations of myocarditis pale tachycardia diminished cardiac sound and arrhythmia ST slowing down T wave updown Pneumonia manifestation Severe bronchopneumoniaSigns of heart failure Restless

8、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 som

9、nolence(嗜 睡 ) intracranial hypertension Pneumonia manifestation Severe bronchopneumonia Gastrointestinal anorexia vomiting abdominal distention toxic enteritis hemorrhage of GI absent intestinal sound bloody stoolPneumonia manifestation Severe bronchopneumonia Chest:X-ray film diffuse or patchy infi

10、ltration small spotted shadow of the right middlePneumonia manifestation Therapeutic Management principle antimicrobial therapy supportive measuresPneumonia therapy principle control infection promote oxygenation and comfort prevent complication fever management fluid intake family support Pneumonia

11、 therapy Antimicrobial therapy PG given by IM or IV PG-allergic: erythromycin clindamycin PG-resistent: cephalosporin PG and cephalosporin-resistent: vancomycin Pneumonia therapy Supportive Measures control cough and dyspnea keep airway clear give oxygen position: semi-reclining Pneumonia therapy Nu

12、rsing Diagnosis Impaired gas exchange collection mucous in airway Ineffective airway clearance mechanical obstruction, inflammation and increased secretions Pneumonia Anticipated goalsu The child will show normal respiratory function will receive optimum oxygen supplyu The child will maintain patent

13、 airway will expectorate secretions adequatelyPneumonia Nursing Intervention Restore Optimal Respiratory Function Maintain Airway Cleaning Provide Adequate Rest and Nutrition Observation Prevent InfectionNursing Intervention Restore Optimal Respiratory Function Keep comfortable environment Position

14、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

15、 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 observationu Temperature:prevent hyperthermia seizureu

16、Signs of heart failureu Signs of intracranial hypertentionu Signs 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

17、Signs of intracranial hypertensionu Alert or stuporousu Seizureu coma u irregular respiration observation Signs of toxic enteroplegia and GI bloodu abdominal distention treatment: supply potassium, dietary restriction, placing nasogastric tube, inject neostigmine.u Bowl soundu Vomitingu Blood stool

18、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 Vir

19、al pneumonia most common 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 an

20、d 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 pneumoniaMycoplasmal pneumonia(支 原 体 肺 炎 ) age: 5-12 years season: fall and winter symptom: dry, hacking cough, fever extrapulmonary complications: blood, heart, CNSPneumonia several special types of pneumoniaChlamydial pneumonia（ 衣 原 体 肺 炎 ） age: 6 months symptom: cough scattered inspiration rales wheeze rarely no feverPneumonia Thank You