兒科筆記整理(共30頁)

1、 36/36袁同慧 兒科護理學Chapter 1 Overview of pediatric nursing （加粗和下劃線表示(biosh)課件中的紅字，只有(zhyu)下劃線表示課件上只有下劃線）1. Focuses on the pattern of child growth and development, child health promotion and disease prevention, and direct care of illness children2.The nursing care of children from birth to the end of ado

2、lescence: Adolescence from 11 to 21; In China pediatric department only offer services for child 14 years; International common practice 18 years3.Stages of growth and development: 名解（兒童(r tng)年齡分期是重點）. Fetal period conceptionbirth 胎兒期. Neonatal period umbilical ligation 28 days 新生兒期. Infant period

3、birth1 year 嬰兒期. Toddlers age 13 years 幼兒期. Preschool age 36 years 學齡前期. School age begin with entry into a school system and end with the beginning of teenage. (Girls: 711 or 12 years / boys 712 or 13 yrs) 學齡期. Adolescence begins with the gradual appearance of secondary sex characteristics and end

4、with cessation of body growth.Features of fetal periodFrom the conception to approximately 12 weeks is crucial period； Many causes could result in abortion流產(chǎn) and congenital malformation.Features of Neonatal PeriodMorbidity發(fā)病率 and mortality死亡率 of neonatal is the highest ；Perinatal period圍生期: commence

5、s at 28 completed weeks of gestation and ends 7 days after birth.Features of infant periodGrows and changes dramatically than any other time ；Diarrhea and malnutrition is the potential health concern；The transplacental經(jīng)胎盤的 immunity is effective only for about 36 months； Infants are vulnerable to inf

6、ectious diseases.Features of toddlers ageMore activities and more curiosity; At risk for accidental injuryFeatures of preschool ageCoordination and muscle strength increase rapidly. Develop self-control, mastery and independent. Acquire wider social relationships and learn role standards. Discipline

7、 training is necessary.Features of school ageLife center is changed from the family group to the wider world. Children experience stress from societal change, school, competition and media.A critical period in the development of mental, social, moral.Features of adolescencePhysical growth during ado

8、lescence is second only to infancy；Adolescence may be emotionally labile情緒不穩(wěn), with extreme highs and extreme lows.；Adolescence question the values of family and society4.The characteristics of pediatric nursingPhysical characteristics：Immunology: IgG, IgM, SIgA，The newborn receive IgG from the mothe

9、r, gradually disappear in 6 month.Category of disease：More congenital disease and inherited diseaseClinical manifestation: Intensive monitoring and active interventionPrognosis and prevention: Recover rapidly and less sequela后遺癥Chapter 2: growth and developmentPart 1 Overview of growth and developme

10、nt1.Growth: An increase in measurable physical and physiologic changes. Development: A gradual change in function and the individuals capacities.2.Principles of Growth & Development 簡答題Continuity and stage like Two dramatic stages: Infant period; adolescenceUbalanced growth of each system Nervous sy

11、stem develop earlier Genital system matures later Lymphoid system develops rapidly in earlier childhood but decline at later stageDirection of growth & development From head to toe (cephalocaudal)從頭至尾(cng tu zh wi); From the midline to the periphery (proximodistal)靠近(kojn)遠端的; from general to specif

12、ic; From simple to complex Individual differences3. Factors influencing growth & developmentGenetic factor: genderEnvironmental factors: Nutrition; Prenatal factors; Environmental conditions; Diseases: catch up growthcatch up growth 追趕(zhugn)生長(名解)：is an accelerated growth of an organism following a

13、 period of slowed growth, particularly as a result of nutrient deprivation.Part 2 Physical growth and development1.Weight (W) 體重 數(shù)據(jù)記The purpose of measure W（目的記?。篒ndication of general nutrition and health status of child；A crucial indicator of fluid status(Dehydration and edema)；the base of calcula

14、ting dosageBirth weight: y (3.30.4) kg; girl (3.20.4)kg3 months: W doubles (6 kg); 1year: W triples (9kg); 2 years: W quadruples (12kg)1-6 months: W (kg) birth weight (kg) months0.77-12 months：W (kg) 6(kg) months0.252-12 years: W(kg)= age of years2+7/8 加7或者8Physiological weight loss生理性體重下降（名解，選擇）：Du

15、ring the first week after birth, infant may loss 3%9% of their weight due to the insufficient milk supply, water loss and meconium excretion. The weight loss reaches the peak at 3 to 4 days after birth and return to the level of birth weight at 7 to 10 days after birth.2.Height or length身高 數(shù)據(jù)記Newbor

16、n: length 50cm; 1year: length 75cm; 2years: length 85cm; 2-12years: H (cm)= age of years7+75Body proportion changes: 1/41/83.HeadCircumference (HC) 頭圍 指標記住HC is the length around above the supraorbital ridges and over the most prominent part of the occiput.2歲前更有價值 newborn:33-34cm; 1year: 46cm; 2 yea

17、rs: 48cm；5 years 50 cm； 15 years 54-58 cm4.Chest Circumference (CC)胸圍The length around the chest at the nipple line.Newborn: 32cm; 1 year: CC=HC; 1 year: CCHC5.UpperArmCircumference (UAC)上臂圍: The length around mid-point between the tip of the shoulder and the tip of the elbow (olecranon鷹嘴 and the ac

18、romion肩峰)6.Growth of skull顱骨發(fā)育（閉合時間考）Anterior fontanel 前囟Closed by age 12-18 months;Newborn normally range in size from 1.5 to 2.0 cm.Posterior fontanel 后囟Closed by age 6-8 weeks; cranial suture顱骨縫: Closed by age 3-4 months7.Growth of Spine脊柱發(fā)育(fy)（記?。? physiological arcuations3個生理(shngl)彎曲: 3 month

19、s appear cervical lordosis頸椎(jngzhu)前凸; 6 months appear thoracic kyphosis胸椎后凸; 1 year appear lumbar lordosis腰椎前凸8. Growth of Long bonesthe numbers of ossific centers骨化中心=age(year)+1，10歲出全，共10個9.Growth of TeethThe eruption of deciduous/ primary teeth 乳牙begins around 4-10 months. All 20 deciduous teet

20、h are present by 2.5 years of age. Permanent teeth恒牙 usually erupt around 6 years. The exchange of teeth begin by age 6 years and end by 12 years. All 32 permanent teeth are present by age 20-30 years.10.Genital System Developmentprecocious puberty性早熟 In girls, the appearance of the secondary sexual

21、 characteristics before 8 years of age. In boys, before 9 years of age. delayed puberty 性發(fā)育延遲 In girls, the lack of development of the secondary sexual characteristics by 14 years of age. In boys, by 16 years of age.Part 3 Psychosocial development神經(jīng)心理發(fā)育1.Neurologic developmentNewborn: the cord ends

22、at level of the inferior margin of the second lumbar vertebrae脊髓下端在胎兒時位于第2腰椎下緣. 4 years old, the cord at the level of the first lumbar vertebrae. Some primitive reflexes disappear gradually. Rooting reflex覓食反射; Suck reflex吮吸反射; Grasping reflex握持反射; Moro reflex擁抱反射; The Babinski reflex is present in

23、children46 y).；Rectal temperatures (measured in infants and children 33w, consistent sucking and swallowing)Gavage-feeding (choose breast milk or formula milk; offer pacifier to strengthen sucking reflex and prepare for bottle feeding; feeding by gravity)Before a feeding, a stomach content should be

24、 less than 02ml/kgBefore oral feeding or during a feeding transition period, IV could be given to prevent dehydration and hypoglycemia.Intravenous nutrition (peripheral, total)Check the blood glucose level closely. Development careTouching and talking to infant can help infant develop a sense of tru

25、st.Help parents overcome their feelings of guilt and encourage them participating in nursing.Using appropriate toy to improve development of infant.Regular home visiting.Jaundice (hyperbilirubinemia)新生兒黃疸(hungdn)定義(dngy)：An increase in serum bilirubin levels. It makes skin and eye yellowed.Unconjuga

26、ted bilirubin (lipid-soluble); Conjugated bilirubin (water-soluble)1.Physiologic jaundice時間(shjin)記住: appears in 23 days after birth, peaks on 45 days, and normally disappear within 2 weeks of birth. To preterm baby jaundice disappear until 34 w. No other clinical symptoms.2.Nonphysiologic jaundice:

27、 occurs less than 24h after birth, hyperbilirubinemia persists beyond 2w in full-term infant or 4 weeks in a preterm infant. 時間，黃疸出現(xiàn)順序記住3.ManifestationFirst becomes visible in the face and forehead. Then gradually becomes visible on the trunk and extremities. Jaundice disappears in the opposite dire

28、ction. Drowsiness and feeding intolerance. Overt neurologic findings, such as changes in muscle tone, seizures, or altered crying characteristics, are danger signs and require immediate attention to avoid bilirubin encephalopathy (kernicterus).4.Treatment and care Treat the underlying disorder Close

29、 monitor the consciousness level to detect signs of bilirubin encephalopathy.Ensure stooling Phototherapy 藍光療法 Exchange transfusion5.Care for the phototherapy (考簡答題) The infant should be naked except for diapers (cut them to minimum workable size) the eyes should be covered to reduce risk of retinal

30、 damage. (Ensure the eye sheild does not slip down)Monitor the temperature to reduce the risk of overheating. Ensure fluid supplementation. Monitor the progress of illness.Retinopathy of prematurity, ROPRisk factorsPrematurity 32w; Low birth weight; High levels of supplemental oxygen; Disease: newbo

31、rn and mother; Susceptibility to ROP varies but correlates with the proportion of retina that remains avascular at birth.Intervention and care1. Monitoring oxygen level (pulse oximeter); 2. Oxygen concentration 40%, time 30s or until stable for subsequent dosing. After replacement do not suction as

32、long as possible to avoid suctioning the drug away.Chapter 7 The child with nutritional deficient diseaseRickets重點1.Rickets is likely to develop in children from 3 months to 2 yearsof age. Mainly caused by a lack of vitamin DTwo sources to get VitD: Formation in the skin (ultraviolet ray); Diet2Etio

33、logy （考） eq oac(,1)Inadequate direct exposure to ultraviolet ray in sunlight (main cause) eq oac(,2)Diet (inadequate intake of VitD or/and calcium) eq oac(,3)Rapid growth eq oac(,4)Influence of diseases (hepatic, renal) eq oac(,5)Influence of medicine 3.Key words about clinical manifestations ：Squar

34、e head方顱, caput quadratum方頭(fn tu) ；Funnel breast漏斗(ludu)胸, chicken breast雞胸(jxing) ；Rachitic rosary佝僂病串珠；Harrison grooves 赫氏溝；Pot belly腹膨??；O-leg(bowlegs ） , X-leg ；Rickets bracelet佝僂病手鐲4.Intervention 案例分析PreventionTreatment (natural light, oral or intramuscular administration of VitD, osteotomies m

35、ay be planed for severe deformities)Nursing (altered nutrition; potential for complications: related to skeleton deformity; high risk for infection; knowledge deficient of rickets)5.Nursing managementRegular outdoor activities for adequate sunlight Supplement vitamin D, monitor side-effect of medica

36、tionTender daily care, prevent infectionPrevent skeleton deformity Parents health educaionInfantile Tetany手足抽搐 重點Etiology ：Earlier therapeutic stage of rickets (sudden exposure to sunlight and earlier stage of supplementing VitD) ；Phosphorus increase (fever, infection) Clinical manifestation Carpope

37、dal spasm全身性驚厥, spasm of the larynx喉痙攣, convulsions, etc; Carpal spasm關(guān)節(jié)腕痙攣 Trousseau s Sign陶瑟征Treatment and nursing Keep the airway clear ；Protect the child from trauma. ；Control the tetany (calcium gluconate IV push at least 10min)Protein-energy malnutrition（PEM）Definition: Caused by the various l

38、evels of inadequate protein and/or energy intake or may result from inadequate absorption of food.Classification Dry (thin, marasmus消瘦, athrepsia消瘦) characterized in caloric deficiency ；Wet (edematous, kwashiorkor惡性營養(yǎng)不良) characterized in protein deficiency ；Marasmic kwashiorkor消瘦型惡性營養(yǎng)不良Marasmus：Fail

39、ure to gain weight, followed by weight loss and growth retardation.The order of loss fat: Abdomen trunk buttock extremities faceKwashiorko：From a localized edema (primarily eyelids and feet) to a generalized edema ；Dermatosis is common.Complications：Iron Deficiency Anemia ；Infection；Disorder of wate

40、r and electrolyte ；HypoglycemiaTreating and nursingFirstly correct fluid and electrolyte abnormalities. Adjustment of diet graduallyDelayed 24 to 48h to supply macronutrients by dietary therapy. The amount of diets is gradually increased during the first week (monitor the tolerance). Observe disease

41、Provide education about normal growth and feeding.Chapter 8 Digestive Disorders1.Whats the composition of the digestive system?Mouth，Esophagus，Stomach，Intestine，liver，pancreaEsophagus（長度(chngd)記?。?：length is about 10cms at birth, 12cms at 1y ，16cms at 5ys ， 20 25cms for older children2. What is the

42、physiological salivate.Saliva increases greatly at age of 56 monthes, due to the shallow mouth floor and limited swallowing, physiological salivate developed.3. whats the physiological causes of gastrointestinal allergic problems in young children?Lower lactase levels ，large digestive surface and th

43、in intestinal wall4. Why infants apt to get gastroesophageal reflux?Cardiac sphincter is not fully developed but pyloric sphincter is good5. The younger the child, the relative larger the liver.6. The typical manifestation of Herpetic Gingivostomatitis is Vesicle, singly or in groups.致病菌Thrush鵝口瘡- C

44、andida albican白色(bis)念珠菌，Herpetic gingivostomatitis皰疹(po zhn)性口炎- HSV1 (herpers simplex virus單純帶狀皰疹病毒)，Ulcerative stomatitis潰瘍性口炎streptococcus鏈球菌, staphylococcus aureus金葡菌7.whats the correct application method for the children with stomatitis?rinse the mouth keep the oral cavity dry(sponge swab ) ap

45、ply in a rolling typeclose the mouth for 10 minutes8. Most pathogens that cause diarrhea are spread by the fecal-oral route route. Route of transmission腹瀉傳播方式（記住） ：fecal-oral route，person contact9. Rotavirus輪狀病毒 is the most important cause of autumn diarrhea.（記住）10. Dietary diarrhea is the most comm

46、on type of noinfectious diarrhea.11.Maintaining balance of fluid, electrolyte and acid-baseORS口服補液鹽: Mild-moderate dehydrationMild dehydration: 50-80ml/kg; Moderate dehydration: 80-100ml/kgIntravenous therapy one fluid therapy in the first day靜脈補液量 Mild dehydration: 90-120ml/kg； Moderate dehydration

47、: 120-150ml/kg； Severe dehydration: 150-180ml/kg12.How to prevent diarrhea from spreading to others? Controlling infection13. Whats the dietary of adjustment to diarrhea?（ Can you state the principle of adjustment of dietary？）Early restrictions of diet would lead to malnutrition、acidosis、prolonged d

48、uration impact of growth and development so feeding should be continued but adjusted to the condition of diseaseMild and moderate diarrhea: continue feeding; Serious vomiting: NPO 4-6h (continue drinking); Breast-feeding: stop supplemental food; Artificial feeding: cows milk; diluted milk/formula; r

49、ice soup; Virus enteritis: lactose-free soybean formulas; Toddlers: continuing soft/pureed foods; Older child: easily digestible diet; Oral feedings intolerance: introducing parenteral nutrition14.how to define deferred diarrhea遷延性腹瀉?2w2m，malnutrition，bottle feeding，unstable stool，infection and mult

50、iple organs disfunction15.whats dehydration?脫水是指水分攝入不足或丟失過多所引起的體液總量尤其是細胞外液量的減少。除失水外，尚有鈉，鉀等電解質(zhì)的丟失。16.How to keep the skin integrally? 期中考過Cotton diaper and diaper changing Buttock cleaning Ointment applicationExposing red buttock Avoid plastic diaper and rectal temperature17. diarrhea腹瀉分類 期中考過 Accord

51、ing to disease course:Acute diarrhea : 2w；deferred diarrhea：2w2m； Chronic diarrhea：2mAccording to etiology factors: Infectious；NoninfectiousAccording to clinical manifestation： Mild diarrhea； Severe diarrhea18. Composition of fluid: types of dehydration 期中考過hypotonic: hyperosmolar(2/3 isotonic)isoto

52、nic: isotosmolar(1/2 isotonic) ; unclear typehypertonic : hyposmolar(1/3 isotonic)Chapter9 Respiratory Dysfunction1. Inhaled foreign bodies more often lodge in the right bronchus after 2 years of age. why? more shorter 、wider、vertical2.The younger the child, the quicker the respiration rate.3. The V

53、ital capacity is about 5070ml/kg in childhood，tidal volume:6-10 ml/kg（記住(j zh)） 期中考過4. The breathing type for infants and toddlers is diaphragmatic breathing.5.what are the four focuses of childhood diseases prevention in China?rickets of vitamin D deficiency維生素D缺乏性佝僂病;Nutritional iron deficiency an

54、emia 營養(yǎng)性缺鐵性貧血(pnxu)Infantile diarrhea嬰幼兒腹瀉(fxi); pneumonia小兒肺炎6. What are the common manifestations of pneumonia in childhood? Fever, cough, tachypnea, fine moist rales7. What are the signs of heart failure with pneumonia? (重要)肺炎合并心衰 期中考過Tachypnea: RR 60ts/m dyspnea; Tachycardia: HR 160-180bpm; Muff

55、led heart sounds gallop rhythm; Restless, obvious cyanosis grey faces; Hepatomegaly progressively; oliguria or anuria; others: Sweating cervical vein distention face/lower limbs edema8.The most common type of pneumonia in childhood is Bronchopneumonia.9. With viral pneumonia, the most common cause i

56、s: RSV (respiratory syncytial virus)10. The symptom of Mycoplasmal pneumonia include: dry, hacking cough, fever.11. The etiological factors of bronchial asthma include allergic constitution, inheritable disease, and environment12. the essence of asthma is inflammation13. The common precipitating fac

57、tors誘因 include infection, foods, contestants and other environmental factors 14.the route of medicine administration for asthma include oral , inhalation(aerosol噴霧) , iv 15. State the advantages of inhalation route.Directly to the lungs Small dosage Rapid onset of action Few side effects Reduce long

58、term use of oral medication16. What is status asthmaticus? （記?。㏑espiratory distress continues without response to treatment for 24hs or longer. Life threatening asthma is caused by severebronchospasm, excessive mucous secretion,inflammation, and edema of the airways,even die of respiratory failure.1

59、7. What is the first choice in anti-inflammatory drugs to control asthma exacerbation? Glucocorticosteroidwhat is the drug of choice in the treatment of asthma? Glucocorticosteroid18. What is the first choice of route of medicatin for asthma? Inhalation16.Breathing exercises and physical training fo

60、r children with asthma include diaphragmatic breathing腹部呼吸運動法, bend forward movement向前彎曲運動法, chest expansion movement胸部擴張運動(improve mobility of the chest wall)Chapter10 Cardiovascular Dysfunction1.小兒(xio r)血壓（記住）SP is 60-70mmHg in neonate, 70-80 in infancy; SP=age2+80,between2-12ys, DP is 2/3 of SP2