1、 Respiratory Dysfunction儿童呼吸系统疾病英1Anatomy and Physiology of the Childhood Respiratory SystemUpper respiratory tract NosePharynxLarynxEpiglottisLower respiratory tractTracheaBronchiBronchioles and alveoli儿童呼吸系统疾病英2 The Upper Airway differences:shorter and narrow 4 mm 20 mm nose breather airway resist
2、ance loosely mucous 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儿童呼吸系统疾病英3Pneumonia儿童呼吸系统疾病英4Definition An inflammation or infection of the bronchioles and alv
3、eolar spaces of the lungsPneumonia 儿童呼吸系统疾病英5Introduction occur:in infants and young children recovery:children sooner than adults exist type:disease or complication season:late winter and early spring Pneumonia 儿童呼吸系统疾病英6 Lobar pneumonia Bronchopneumonia(lobular pneumonia)Interstitial pneumoniaPneu
4、monia classificationMorphological classification儿童呼吸系统疾病英7Etiologic 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 classification儿童呼吸系统疾病英8Course Agent Acute 3 months Pneumonia classification儿童呼吸系
5、统疾病英9State of Illness Mild Severe Pneumonia classification儿童呼吸系统疾病英10the clinical manifestations 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 cyan
6、osis fixed fine moist ralesPneumonia 儿童呼吸系统疾病英11the clinical manifestations of bronchopneumoniauSevere bronchopneumonialcirculation systemmanifestations of myocarditissigns of heart failurelnervous systeml gastrointestinall Chest:X-ray filmPneumonia 儿童呼吸系统疾病英12Severe bronchopneumonia Circulation sys
7、tem myocarditis,congestive heart failure pathogens invading the myocardium and produce toxintoxic myocarditishypoxia pulmonary artery hypertensionCHFPneumonia manifestation儿童呼吸系统疾病英13Severe bronchopneumonia manifestations of myocarditis pale tachycardia diminished cardiac sound and arrhythmia ST slo
8、wing down T wave updown Pneumonia manifestation儿童呼吸系统疾病英14 Severe bronchopneumoniaSigns 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 Pneumo
9、nia manifestation儿童呼吸系统疾病英15Severe bronchopneumonia Nervous system:dysphoria(烦躁烦躁)irritable alert/stuporous convulsion somnolence(嗜睡嗜睡)intracranial hypertension Pneumonia manifestation儿童呼吸系统疾病英16Severe bronchopneumonia Gastrointestinal anorexia vomiting abdominal distention toxic enteritis hemorrhag
10、e of GI absent intestinal sound bloody stoolPneumonia manifestation儿童呼吸系统疾病英17Severe bronchopneumonia Chest:X-ray film diffuse or patchy infiltration small spotted shadow of the right middlePneumonia manifestation儿童呼吸系统疾病英18Therapeutic Management principle antimicrobial therapy supportive measuresPn
11、eumonia therapy儿童呼吸系统疾病英19principle control infection promote oxygenation and comfort prevent complication fever management fluid intake family support Pneumonia therapy儿童呼吸系统疾病英20Antimicrobial therapy PG given by IM or IV PG-allergic:erythromycin clindamycin PG-resistent:cephalosporin PG and cephal
12、osporin-resistent:vancomycin Pneumonia therapy儿童呼吸系统疾病英21Supportive Measures control cough and dyspnea keep airway clear give oxygen position:semi-reclining Pneumonia therapy儿童呼吸系统疾病英22Nursing Diagnosis Impaired gas exchange collection mucous in airway Ineffective airway clearance mechanical obstruc
13、tion,inflammation and increased secretions Pneumonia 儿童呼吸系统疾病英23Anticipated goalsuThe child will show normal respiratory function will receive optimum oxygen supplyuThe child will maintain patent airway will expectorate secretions adequatelyPneumonia 儿童呼吸系统疾病英24Nursing Intervention儿童呼吸系统疾病英25 Restor
14、e Optimal Respiratory Function Maintain Airway Cleaning Provide Adequate Rest and Nutrition Observation Prevent InfectionNursing Intervention儿童呼吸系统疾病英26 Restore Optimal Respiratory Function Keep comfortable environment Position child for maximum ventilation semi-reclining position Provide Oxygen:mas
15、k nasal cannula intubation mechanical ventilation儿童呼吸系统疾病英27Maintain Airway Cleaning Institute suctioning of airway,cough effectively and postural drainage Provide nebulization Chest Physiotherapy Administer medications儿童呼吸系统疾病英28Provide Adequate Rest and Nutrition Provide quiet environment darken r
16、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 儿童呼吸系统疾病英29observationuTemperature:prevent hyperthermia seizureuSigns of heart failureuSigns of intracranial hyp
17、ertentionuSigns of toxic enteroplegia and GI blood儿童呼吸系统疾病英30Signs 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儿童呼吸系统疾病英31Signs of intracranial hypertensio
18、nuAlert or stuporousuSeizureucoma uirregular respiration observation儿童呼吸系统疾病英32Signs of toxic enteroplegia and GI blooduabdominal distention treatment:supply potassium,dietary restriction,placing nasogastric tube,inject neostigmine.nBowl soundnVomitingnBlood stoolobservation儿童呼吸系统疾病英33Prevent Infect
19、ion 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儿童呼吸系统疾病英34Before treatmentAfter treatment儿童呼吸系统疾病英35 several special types of pneumonia Viral pneum
20、onia most common cause:RSV peak attack rate:2 age onset:acute or insidious symptom:fever,cough,tachypnea,nasal flaring cyanosis,respiratory fatigue IntercostalIntercostalSubcostalSubcostalSuprasternalSuprasternal Pneumonia 儿童呼吸系统疾病英36 several special types of pneumonia Staphylococcal pneumonia（葡萄球菌肺
21、炎）（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 儿童呼吸系统疾病英37 several special types of pneumoniaMycoplasmal pneumonia(支原体肺炎支原体肺炎)age:5-12 years s
22、eason:fall and winter symptom:dry,hacking cough,fever extrapulmonary complications:blood,heart,CNSPneumonia 儿童呼吸系统疾病英38 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 儿童呼吸系统疾病英39Thank YouThank You儿童呼吸系统疾病英40
