1、（一例宫内感染性肺炎患儿的护理查房）speaker：何绮晴：何绮晴Physicalexamination：姚莲萍：姚莲萍PPTproduction：石彩兰：石彩兰Advisor：陈松珠老师、陈丽英老：陈松珠老师、陈丽英老师、何兆梅老师师、何兆梅老师OnecaseofintrauterineinfectionpneumoniaofthenewborninnursingroundsOperation purpose1.Discussing and using 1.Discussing and using 14 14 items about items about clinical clinical
2、 nursing service quality nursing service quality in nursing in nursing rounds(rounds(探探讨运用讨运用“1414条条”进行护理查进行护理查房房)2.2.Master(Master(掌握掌握)the the nursing of intrauterine nursing of intrauterine infection pneumonia infection pneumonia with newborn with newborn 3 3.Improve Improve the nurses the nurses
3、 understanding of understanding of intrauterine infection pneumoniaintrauterine infection pneumoniaGeneral informationGeneral information（一般资料）：（一般资料）：Name:Son of Geng yinghua Name:Son of Geng yinghua（庾颖华之子）（庾颖华之子）Age:11 days WeightAge:11 days Weight：3.55kg 3.55kg Sex:male Sex:male Data of BirthData
4、 of Birth：:14:57,July 26th,2016:14:57,July 26th,2016 Race:Han Nationality:ChinaRace:Han Nationality:ChinaParents Name:father Chen haiyanParents Name:father Chen haiyan，Mother Geng yinghuaMother Geng yinghuaDate of admission:July 27th,2016Date of admission:July 27th,2016Chief Chief complaintcomplaint
5、（主诉）（主诉）:short short of breath for 2 hoursof breath for 2 hoursPresent illnessPresent illness（现病史）（现病史）:GWGW:38+weeks38+weeks,G3P2,G3P2,LMP:LMP:2016-08-05;2016-08-05;EDC:EDC:2016-7-26.2016-7-26.BabyBaby s mother is a elderly pregnant woman with s mother is a elderly pregnant woman with scarred uteru
6、s(scarred uterus(疤痕子宫疤痕子宫).he birthed in 14:57,July).he birthed in 14:57,July 26th,2016 with cesarean(26th,2016 with cesarean(剖腹产剖腹产).).The The afflicted(afflicted(受苦的受苦的)baby was delivered in)baby was delivered in 14:57,July 26th,2016.His Birth weight was 3.55 kg 14:57,July 26th,2016.His Birth weig
7、ht was 3.55 kg and head circumference was 32 cm.and head circumference was 32 cm.There There was was no history of asphyxia rescueno history of asphyxia rescue（无窒息抢救史）（无窒息抢救史）at birth with at birth with clear amniotic fluidclear amniotic fluid（羊水清）（羊水清）.It It was nine points with Apgar scoring in 1
8、minute,and 10 was nine points with Apgar scoring in 1 minute,and 10 points with Apgar scoring in five minutes(1points with Apgar scoring in five minutes(1分钟阿氏评分为分钟阿氏评分为9 9分，分，五分钟阿氏评分为五分钟阿氏评分为1010分分)，and had and had shortness of breath after 24 shortness of breath after 24 hours hours along with obtu
9、sealong with obtuse（迟钝的）（迟钝的）response response and Oral cyanosis and Oral cyanosis(口唇发绀口唇发绀)and and moaningmoaning（呻吟）（呻吟）.No restlessness（烦躁不安）（烦躁不安）or vomit or fever or pale complexion（面色苍白）（面色苍白）or seizure（癫痫发作）（癫痫发作）or scream（尖叫）（尖叫）were observed.Breast feed not very well and his crying is a bit
10、 poor.His stool(大便大便)and urine is normal.Family historyFamily history（家族史）：（家族史）：The patients mother had an operation with The patients mother had an operation with laparoscopic myomectomylaparoscopic myomectomy（子宫肌瘤剔除术）（子宫肌瘤剔除术）in 2005 in 2005，and delivered a girl with cesarean(and delivered a girl
11、 with cesarean(剖腹产剖腹产)in)in 2009.2009.The The patients father suffered from hypertensionpatients father suffered from hypertension（高血压）（高血压）and gout(and gout(痛风痛风)Diagnosis(Diagnosis(诊断诊断)：intrauterine infection pneumonia of the newborn intrauterine infection pneumonia of the newborn（宫内感染性肺炎）（宫内感染性肺
12、炎）What s it？Intrauterine Intrauterine infection pneumonia of the infection pneumonia of the newbornnewborn（新生儿宫内新生儿宫内感染性肺感染性肺炎炎）:Caused by virusesCaused by viruses（病毒）（病毒）,bacteria,bacteria（细菌）（细菌）,protozoa,protozoa（原（原虫）虫）,or chlamydia,or chlamydia（衣原体）（衣原体）Had infection before Had infection before
13、 birth birth(出生前就感染出生前就感染)Always attackedAlways attacked（发病）（发病）within within 24 hours after 24 hours after birth with birth with asphyxiaasphyxia（窒（窒息息史）史）Had shortness Had shortness of of breathbreath（气促），（气促），moansmoans（呻吟）（呻吟）,difficulty difficulty breathingbreathing（呼吸困难呼吸困难）,and had,and had no
14、t not stable temperaturestable temperature（体（体温温不稳不稳定）定）,and the,and the response is response is poorpoor（反（反应应差差)after recoveryafter recovery（复复苏）苏）.clinical manifestation（临床表现）Serum（血清）（血清）IgM and IgA is higher than normal newborns,and Ig M 200 mg/L in umbilical cord blood(脐带血脐带血)or the specificit
15、y Ig M is higher for prenatal diagnosis（产前诊断）（产前诊断）.X-ray chest radiography is often shown as interstitial pneumonia（间（间质性肺质性肺炎炎),and the bacterial pneumonia(细细菌性肺菌性肺炎炎)is bronchopneumonia(支支气管肺气管肺炎炎).Checked the gastric juice(胃液胃液)1 2 hours after birth,which could see pus cells脓细胞脓细胞,and find bacte
16、ria sometimes.Concha pharyngeal swab bacteria culture(外外耳道咽拭子细菌培耳道咽拭子细菌培养养)can be positive(阳性阳性).Progress note（病程记录）2016-2016-07-2707-27SPO2 80-85%SPO2 80-85%，呼吸急促呼吸急促，约，约8080次次/分，分，伴呻吟样呼吸伴呻吟样呼吸，口周发绀口周发绀，吸气三凹征阳性吸气三凹征阳性，给予，给予CPAPCPAP辅助通辅助通气气（PEEP 5cmH2OPEEP 5cmH2O，FiO2 30-35%FiO2 30-35%），患儿气促较前好转，），患
17、儿气促较前好转，SPO2SPO2上升至上升至93-95%93-95%，禁禁食食，停留胃管无潴留，予告病重，给，停留胃管无潴留，予告病重，给予抗感染、营养心肌及补予抗感染、营养心肌及补液等治疗，续观液等治疗，续观07-2807-28CPAPCPAP辅助通辅助通气气（PEEP 5cmH2OPEEP 5cmH2O，FiO2 30-35%FiO2 30-35%），），禁禁食食,停留胃管无潴留，停留胃管无潴留，呼呼吸稍促吸稍促，三，三凹征凹征阳性，双肺呼吸音粗，阳性，双肺呼吸音粗，闻及双肺低湿性啰闻及双肺低湿性啰音音，全身皮肤黏膜无黄染全身皮肤黏膜无黄染，辅助检查：血气分析：，辅助检查：血气分析：PH
18、7.279,PC O2 47.1mmol/L,HCO3-21.6mmol/L,BE-6.1mmol,PH 7.279,PC O2 47.1mmol/L,HCO3-21.6mmol/L,BE-6.1mmol,血常规：血常规：WBC 19.63x109/L,WBC 19.63x109/L,HGB 142g/L,HGB 142g/L,血型血型“B B”，电解质：，电解质：Na142.5mmol/LNa142.5mmol/L，CA 1.94 CA 1.94 mmolmmol/L,K 4.40mmol/L,/L,K 4.40mmol/L,CL108.1mmol/LCL108.1mmol/L，CK-MB,
19、CK-MB,床边床边胸片胸片X X片显示斑片状阴影片显示斑片状阴影，目前诊断明确：，目前诊断明确：宫内感染性肺炎宫内感染性肺炎，继，继续、监护、续、监护、CPAPCPAP辅助通气、抗感染、营养心肌等治疗辅助通气、抗感染、营养心肌等治疗07-2807-28PO2PO2氧分压氧分压37.2 mmHg37.2 mmHg，继续给予，继续给予CPAPCPAP辅助通气，持续血氧饱和度维持在辅助通气，持续血氧饱和度维持在90-95%90-95%07-2907-29CPAPCPAP辅助通辅助通气（气（PEEP 5cmH2OPEEP 5cmH2O，FiO2 30-35%FiO2 30-35%），），呼吸稍促呼吸
20、稍促，反应稍差，哭声稍弱，反应稍差，哭声稍弱，试喂试喂5ml/5ml/次，停留胃管通畅次，停留胃管通畅，无潴留，无潴留，轻轻度吸气三凹征阳性度吸气三凹征阳性，双肺呼吸音粗双肺呼吸音粗，可闻及，可闻及双肺低湿性双肺低湿性啰音，伴呻吟样呼吸啰音，伴呻吟样呼吸，查，查CPRCPR升高，升高，胸片提示可见斑片状阴影胸片提示可见斑片状阴影，查，查HGB 137 HGB 137 g/Lg/L，全身皮肤黏，全身皮肤黏膜轻度黄染，膜轻度黄染，SB 5mg/dlSB 5mg/dl07-3007-30CPAPCPAP辅助通气，辅助通气，间中呼吸稍促，间中呼吸稍促，反应稍差，哭声稍弱，反应稍差，哭声稍弱，轻度吸气性
21、三凹征轻度吸气性三凹征，全身皮肤黏膜轻，全身皮肤黏膜轻度黄染，度黄染，SB 5mg/dlSB 5mg/dl，双，双肺呼吸音粗，可闻及双肺低湿性啰音，伴呻吟样呼吸肺呼吸音粗，可闻及双肺低湿性啰音，伴呻吟样呼吸，开塞露塞肛，开塞露塞肛后排出后排出16g16g胎便，血钾较低，已静脉补钾，低钾血症胎便，血钾较低，已静脉补钾，低钾血症07-31 07-31 CPAPCPAP辅助通气间中呼吸稍促辅助通气间中呼吸稍促，停留胃管通畅，无潴留，持续心电监护显示：，停留胃管通畅，无潴留，持续心电监护显示：RR 35-45RR 35-45次次/分，分，P 130-144P 130-144次次/分，分，BP 75/4
22、3 mmHgBP 75/43 mmHg，SPO2 93-98%SPO2 93-98%，反应稍差，哭声稍弱，反应稍差，哭声稍弱，轻度吸气三凹征轻度吸气三凹征阳性，双肺呼吸音粗，可闻及双肺低湿性啰音，伴呻吟样呼吸阳性，双肺呼吸音粗，可闻及双肺低湿性啰音，伴呻吟样呼吸，全身皮肤黏膜轻度黄染，全身皮肤黏膜轻度黄染,，SB 7mg/dlSB 7mg/dl，辅助检查：血培养至今：未见细菌、真菌生长，电解质：，辅助检查：血培养至今：未见细菌、真菌生长，电解质：Na 142.Na 142.3 3mmol/Lmmol/L，CA CA 2.08 mmol/L,K 3.28mmol/L,CPR 2.1mg/L,2.
23、08 mmol/L,K 3.28mmol/L,CPR 2.1mg/L,目前继续监护、目前继续监护、CPAPCPAP辅助通气、抗感染、营养辅助通气、抗感染、营养心肌等治疗心肌等治疗08-0108-01试停试停CPAPCPAP辅助通气辅助通气，呼吸尚顺呼吸尚顺，血氧饱和度可维持在，血氧饱和度可维持在90-98%90-98%之间，反应稍可，哭声响，停之间，反应稍可，哭声响，停留胃管通畅，无潴留，持续心电监护显示：留胃管通畅，无潴留，持续心电监护显示：RR 40-48RR 40-48次次/分，分，P 125-146P 125-146次次/分，分，BP 79/43 BP 79/43 mmHgmmHg，S
24、PO2 92-98%SPO2 92-98%，全身皮肤轻度黄染，全身皮肤轻度黄染，SB 7mg/dlSB 7mg/dl，双肺呼吸音粗，未闻及双肺干湿啰双肺呼吸音粗，未闻及双肺干湿啰音音，目前继续监护、抗感染、营养心肌等治疗，目前继续监护、抗感染、营养心肌等治疗08-0208-02患儿患儿呼吸顺，无发绀呼吸顺，无发绀，血氧饱和度可维持在，血氧饱和度可维持在93-98%93-98%之间，持续心电监护显示：之间，持续心电监护显示：RR 40-45RR 40-45次次/分，分，P125-148P125-148次次/分，分，BP72/41mmHgBP72/41mmHg，全身皮肤轻度黄染，全身皮肤轻度黄染，
25、SB 8mg/dlSB 8mg/dl，双肺呼吸音粗，未闻双肺呼吸音粗，未闻及干湿啰音及干湿啰音，G6PD 4.9U/LG6PD 4.9U/L08-0308-03患儿患儿呼吸顺，无发绀，无三凹征，呼吸顺，无发绀，无三凹征，持续心电监护显示：持续心电监护显示：RR 40-46RR 40-46次次/分，分，P127-144P127-144次次/分，分，BP 87/42 mmHgBP 87/42 mmHg，SPO2 92-94%SPO2 92-94%，全身皮肤轻度黄染，全身皮肤轻度黄染，SB 7mg/dlSB 7mg/dl，双肺呼吸音粗双肺呼吸音粗，辅助检查：，辅助检查：血常规：血常规：WBC 11.
26、68x10WBC 11.68x109 9/L,HGB 117g/L,/L,HGB 117g/L,电解质：电解质：CA 2.14 mmol/L,K 4.35 mmol/L,CPR CA 2.14 mmol/L,K 4.35 mmol/L,CPR 0.2mg/L,0.2mg/L,患儿复查血红蛋白较前降低，必要时输注浓缩红细胞，目前继续监护、抗感染、患儿复查血红蛋白较前降低，必要时输注浓缩红细胞，目前继续监护、抗感染、营养心肌等治疗营养心肌等治疗08-0408-04患儿患儿呼吸顺，无发绀，无三凹征呼吸顺，无发绀，无三凹征，全身皮肤轻度黄染，全身皮肤轻度黄染，SB 7mg/dlSB 7mg/dl，双肺
27、呼吸音稍粗，未闻双肺呼吸音稍粗，未闻及干湿啰音及干湿啰音，血氧饱和度可维持在，血氧饱和度可维持在92-97%92-97%之间，持续心电监护显示：之间，持续心电监护显示：RR 40-48RR 40-48次次/分，分，P120-142P120-142次次/分，分，BP69/35mmHgBP69/35mmHg，SPO2 92-97%SPO2 92-97%，辅助检查：血培养：未见细菌、真菌生长，辅助检查：血培养：未见细菌、真菌生长，患儿呼吸顺，吃奶好，病情治愈，患儿呼吸顺，吃奶好，病情治愈，予出院予出院Physical examination（体格检查）Nursing problem1 1、Ineff
28、ective Ineffective Airway ClearanceAirway Clearance（清理呼吸道无（清理呼吸道无效效)：A Associated ssociated with with the respiratory the respiratory secretions secretions（呼吸道分泌呼吸道分泌物物），），and baby and baby was unable was unable to row of to row of phlegmphlegm（痰液）（痰液）weakly.weakly.2 2、Impaired Impaired gas exchange
29、gas exchange（气体交换受损（气体交换受损）：）：Associated Associated with lung with lung inflammationinflammation（炎症炎症）3 3、MalnutritionMalnutrition（营养失调（营养失调）：）：Associated with Associated with inadequateinadequate（不不足的）足的）intake and the intake and the increase increase consumption(consumption(消消耗耗)4、Ineffective Ther
30、moregulation（体温调节无效）：（体温调节无效）：associated with the lung infection5、Potential Complication（潜在并发症（潜在并发症)：(1)heart failure（心力衰竭（心力衰竭）：）：Associated with pulmonary hypertension（肺动脉高压肺动脉高压）and the toxic myocarditis（中毒性心肌中毒性心肌炎）炎）.(2)toxic encephalopathy（中毒性脑病中毒性脑病）：）：Related to the lack of oxygen and carbo
31、n dioxide retention.（二氧化碳储二氧化碳储留）留）(3)toxic enteroparalysis（中毒性肠麻痹中毒性肠麻痹）：）：Related to toxemia毒毒血血症症and the severe cyanosis（严重缺氧严重缺氧）.Nursing measures Keep from obstructionKeep from obstruction（保持呼吸道通畅）：（保持呼吸道通畅）：（1 1）slapping back to excretory slapping back to excretory sputumsputum（拍背排痰）（拍背排痰）（2 2
32、）ultrasonic aerosol inhalationultrasonic aerosol inhalation（超声雾化吸入）（超声雾化吸入）If If necessarynecessary：（3 3）expectorantexpectorant（祛痰祛痰药）药）（4 4）Mouth Mouth sputum suction with negative pressuresputum suction with negative pressure（口（口腔吸痰负压）：腔吸痰负压）：PrematurePremature（早产儿）：（早产儿）：0.01 0.013mpa0.01 0.013mp
33、aTerm infantTerm infant（足月儿）：（足月儿）：0.013 0.015mpa0.013 0.015mpaRational(合理)usage of oxygenControl the time and oxygen concentration Control the time and oxygen concentration（浓度）（浓度）吸氧指征：吸氧指征：PaO2PaO250-60mmHg50-60mmHg(1)nasal(1)nasal catheter oxygen inhalation(catheter oxygen inhalation(鼻鼻导导管给氧管给氧)：
34、0.5-1 0.5-1 L/minL/min(2)mask(2)mask oxygen oxygen inhalation(inhalation(面罩给氧面罩给氧):2-4 L/min:2-4 L/min(3)Hood(3)Hood oxygen oxygen inhalation(inhalation(头头罩吸罩吸氧氧):5-8 L/min):5-8 L/min(4)CPAP(4)CPAP：continuous continuous positive airway positive airway pressure(pressure(持续气道正持续气道正压通压通气）气）Maintain（保持）
35、normal body temperatureMaintain normal body Maintain normal body temperaturetemperature：36 36 to 37 to 37 HypothermiaHypothermia（体温过低）：（体温过低）：keeping warmkeeping warmHyperthermiaHyperthermia（体温过高）：（体温过高）：cooling coolingIf If necessarynecessary：Use the antipyretic Use the antipyretic（退热退热药）药）in in ac
36、cordance with the doctors accordance with the doctors adviceadviceantibiotic therapy(抗生素治疗)According to the illness needs to choose the appropriate（合（合适适的）的）antibiotics（抗（抗生生素）素）Observed the effect of drugs closely（密（密切观察药物的切观察药物的作用作用）Supply enough energy and moisture(水分)Eat smaller,more frequent me
37、als（少量多餐）（少量多餐）Prevent asphyxia during feeding（喂奶时防止窒息）（喂奶时防止窒息）severe patients（病重者）：（病重者）：Nasal feeding（鼻（鼻饲饲）&Intravenous supplement with nutriention and liquid由静脉补充营养物质及液体由静脉补充营养物质及液体Closely observe the illness（1 1）Heart Heart raterate：120-140 times/min on average120-140 times/min on average（2 2）
38、breathingbreathing：40 40 times/min on times/min on averageaverage（3 3）Blood pressure monitoring:70/50 mmHg on Blood pressure monitoring:70/50 mmHg on averageaverage（4 4）conscious conscious responses:responses:discharge(出院)guidanceExplain the relevant knowledge of the disease to parentsGive the living guidance of feeding and growing.Pay attention to prevent infectionInform parents to attend the clinic（复诊）（复诊）when baby is feeling unwellMedical staff should have follow-up survey(随访随访)for neonates in times，and know the recovery situation of neonates.Thank you！
