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1、 Respiratory DysfunctionAnatomy and Physiology of the Childhood Respiratory SystemUpper respiratory tract NosePharynxLarynxEpiglottisLower respiratory tractTracheaBronchiBronchioles and alveoli The Upper Airway differences:shorter and narrow 4 mm 20 mm nose breather airway resistance loosely mucous
2、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 SystemPneumoniaDefinition An inflammation or infection of the bronchioles and alveolar spaces of the lungsPneumonia Intro
3、duction 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 classificationEtiologic Age
4、nt Infectiousvirus bacterial Mycoplasma(支原体肺炎支原体肺炎)chlamydial（衣原体肺炎）（衣原体肺炎）fungi pneumocystis(肺囊肺囊虫虫)Noninfectious foreign body aspirationPneumonia classificationCourse Agent Acute 3 months Pneumonia classificationState of Illness Mild Severe Pneumonia classificationthe clinical manifestations of br
5、onchopneumoniauMild 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 ralesPneumonia the clinical manifestations of bronchopneumoniauSevere bronchopne
6、umonialcirculation systemmanifestations of myocarditissigns of heart failurelnervous systeml gastrointestinall Chest:X-ray filmPneumonia Severe bronchopneumonia Circulation system myocarditis,congestive heart failure pathogens invading the myocardium and produce toxintoxic myocarditishypoxia pulmona
7、ry artery hypertensionCHFPneumonia manifestationSevere 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 obvious cyanosis grey facesTachy
8、pnea:RR 60ts/mTachycardia:HR 160-180bpmSweating dyspnea cervical vein distentionoliguria or anuria face/lower limbs edemaHepatomegaly progressively Pneumonia manifestationSevere bronchopneumonia Nervous system:dysphoria(烦躁烦躁)irritable alert/stuporous convulsion somnolence(嗜睡嗜睡)intracranial hypertens
9、ion Pneumonia manifestationSevere bronchopneumonia Gastrointestinal anorexia vomiting abdominal distention toxic enteritis hemorrhage of GI absent intestinal sound bloody stoolPneumonia manifestationSevere bronchopneumonia Chest:X-ray film diffuse or patchy infiltration small spotted shadow of the r
10、ight middlePneumonia manifestationTherapeutic Management principle antimicrobial therapy supportive measuresPneumonia therapyprinciple control infection promote oxygenation and comfort prevent complication fever management fluid intake family support Pneumonia therapyAntimicrobial therapy PG given b
11、y IM or IV PG-allergic:erythromycin clindamycin PG-resistent:cephalosporin PG and cephalosporin-resistent:vancomycin Pneumonia therapySupportive Measures control cough and dyspnea keep airway clear give oxygen position:semi-reclining Pneumonia therapyNursing Diagnosis Impaired gas exchange collectio
12、n mucous in airway Ineffective airway clearance mechanical obstruction,inflammation and increased secretions Pneumonia Anticipated goalsuThe child will show normal respiratory function will receive optimum oxygen supplyuThe child will maintain patent airway will expectorate secretions adequatelyPneu
13、monia 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 child for maximum ventilation semi-reclining posit
14、ion Provide Oxygen:mask nasal cannula intubation mechanical ventilationMaintain Airway Cleaning Institute suctioning of airway,cough effectively and postural drainage Provide nebulization Chest Physiotherapy Administer medicationsProvide Adequate Rest and Nutrition Provide quiet environment darken r
15、oom,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 observationuTemperature:prevent hyperthermia seizureuSigns of heart failureuSigns of intracranial hypertentionuS
16、igns of toxic enteroplegia and GI bloodSigns 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 observationSigns of intracranial hypertensionuAlert or stuporousuSeizureucoma
17、 uirregular respiration observationSigns of toxic enteroplegia and GI blooduabdominal distention treatment:supply potassium,dietary restriction,placing nasogastric tube,inject neostigmine.uBowl sounduVomitinguBlood stoolobservationPrevent Infection Assess signs of infection vital signs,temperature f
18、luctuation sputum culture,sensitivity reports and WBC Maintain aseptic environment Limit visitors and isolate the patients Administer antibioticsBefore treatmentAfter treatment several special types of pneumonia Viral pneumonia most common cause:RSV peak attack rate:2 age onset:acute or insidious sy
19、mptom:fever,cough,tachypnea,nasal flaring cyanosis,respiratory fatigue IntercostalIntercostalSubcostalSubcostalSuprasternalSuprasternal Pneumonia several special types of pneumonia Staphylococcal pneumonia（葡萄球菌肺炎）（葡萄球菌肺炎）season:October and May following:viral upper respiratory tract age:girls sympto
20、m:tachypnea，cyanosis and anxiety signs in infants:lethargic,irritable,toxic gastrointestinal disturbances Pneumonia several special types of pneumoniaMycoplasmal pneumonia(支原体肺炎支原体肺炎)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）（衣原体肺炎）age:6 months symptom:cough scattered inspiration rales wheeze rarely no feverPneumonia Thank YouThank You