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 I
3、ntroduction 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 classificationEti
4、ologic Agent 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 man
5、ifestations of bronchopneumoniauMild 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 bronchopneumon
6、iauSevere bronchopneumonialcirculation 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 myoca
7、rditishypoxia pulmonary 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 cya
8、nosis grey facesTachypnea: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
9、) intracranial hypertension 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
10、 spotted shadow of the right middlePneumonia manifestationTherapeutic Management principle antimicrobial therapy supportive measuresPneumonia therapyprinciple control infection promote oxygenation and comfort prevent complication fever management fluid intake family support Pneumonia therapyAntimicr
11、obial therapy PG given by 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 Imp
12、aired gas exchange collection 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 expector
13、ate 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 child for maximum ven
14、tilation semi-reclining position 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 Pro
15、vide 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 observationuTemperature:prevent hyperthermia seizureuSigns of heart failureuSi
16、gns of intracranial hypertentionuSigns 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 hyperte
17、nsionuAlert or stuporousuSeizureucoma 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 sig
18、ns of infection vital signs, temperature fluctuation 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 a
19、ttack rate: 2 age onset: acute or insidious symptom: 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 fol
20、lowing: 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
