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RespiratoryDysfunction

AnatomyandPhysiologyoftheChildhoodRespiratorySystemUpperrespiratorytractNosePharynxLarynxEpiglottisLowerrespiratorytractTracheaBronchiBronchiolesandalveoli

TheUpperAirwaydifferences:shorterandnarrow4mm<20mmnosebreatherairwayresistancelooselymucousmembranesandsofttissueTheLowerAirwaydifferences:rightbronchusismorewider,shorter,verticallessalveolarsurfacearea

AnatomyandPhysiologyoftheChildhoodRespiratorySystemDefinition

AninflammationorinfectionofthebronchiolesandalveolarspacesofthelungsPneumoniaIntroduction

occur:ininfantsandyoungchildrenrecovery:childrensoonerthanadultsexisttype:diseaseorcomplication

season:latewinterandearlyspring

Pneumonia

LobarpneumoniaBronchopneumonia(lobularpneumonia)InterstitialpneumoniaPneumoniaclassificationMorphologicalclassificationCourseAgent

Acute<1monthProgressive1-3monthsChronic>3months

PneumoniaclassificationStateofIllness

MildSevere

PneumoniaclassificationtheclinicalmanifestationsofbronchopneumoniaMildbronchopneumoniafever:irregularfevercough:dry,hacking,non-productivetoproductivecoughtachypnea:RR40~80ts/mnasalflaring,sighingrespiration,threedepressionsignsandcyanosis

fixedfinemoistralesPneumoniaSeverebronchopneumonia

Circulationsystem

myocarditis,congestiveheartfailure

pathogens

invadingthemyocardiumandproducetoxintoxicmyocarditishypoxia

pulmonaryarteryhypertensionCHFPneumoniamanifestationSeverebronchopneumonia

manifestationsofmyocarditis

paletachycardiadiminishedcardiacsoundandarrhythmia

STslowingdownTwaveupdown

PneumoniamanifestationSeverebronchopneumoniaSignsofheartfailure

RestlessobviouscyanosisgreyfacesTachypnea:RR>60ts/mTachycardia:HR>160-180bpmSweatingdyspneacervicalveindistentionoliguriaoranuriaface/lowerlimbsedemaHepatomegalyprogressively

PneumoniamanifestationSeverebronchopneumonia

Gastrointestinal

anorexiavomitingabdominal

distention

toxicenteritishemorrhageofGIabsentintestinalsoundbloodystoolPneumoniamanifestationSeverebronchopneumonia

Chest:X-rayfilm

diffuseorpatchyinfiltration

smallspottedshadowoftherightmiddlePneumoniamanifestationTherapeuticManagement

principle

antimicrobialtherapy

supportivemeasuresPneumoniatherapyAntimicrobialtherapy

PGgivenbyIMorIV

PG-allergic:erythromycinclindamycin

PG-resistent:cephalosporin

PGandcephalosporin-resistent:vancomycin

PneumoniatherapySupportiveMeasures

controlcoughanddyspneakeepairwaycleargiveoxygenposition:semi-reclining

PneumoniatherapyNursingDiagnosis

Impairedgasexchange

collectionmucousinairway

Ineffectiveairwayclearance

mechanicalobstruction,inflammation

andincreasedsecretions

PneumoniaNursingIntervention

RestoreOptimalRespiratoryFunction

MaintainAirwayCleaning

ProvideAdequateRestandNutrition

Observation

PreventInfectionNursingInterventionProvideAdequateRestandNutrition

Provide

quietenvironmentdarkenroom,schedulevisitingtime

Bedrest

Appropriatediethigh-proteinandcarbohydratedigestive,nutritionalliquidandsemi-liquiddietsmallfrequentfeedingenteralorparenteralnutrition

observationTemperature:preventhyperthermiaseizureSignsofheartfailureSignsofintracranialhypertentionSignsoftoxicenteroplegiaandGIbloodSignsofheartfailure

usecardiacmonitorvitalsignsoxygensaturationbreathsounds,colorofskin,intakeandoutput,electrolytelevelssideeffectofmedicationheartfailuresigns

observationSignsofintracranialhypertensionAlertorstuporousSeizurecomairregularrespirationobservationSignsoftoxicenteroplegiaandGIbloodabdominaldistentiontreatment:supplypotassium,dietaryrestriction,placingnasogastrictube,injectneostigmine.BowlsoundVomitingBloodstoolobservationPreventInfection

Assesssignsofinfection

vitalsigns,temperaturefluctuationsputumculture,sensitivityreportsandWBC

MaintainasepticenvironmentLimitvisitorsandisolatethepatientsAdministerantibioticsBeforetreatmentAftertreatment

severalspecialtypesofpneumonia

Viralpneumonia

mostcommoncause:RSVpeakattackrate:<2ageonset:acuteorinsidioussymptom:fever,cough,tachypnea,nasalflaringcyanosis,respiratoryfatigue

IntercostalSubcostalSuprasternal

Pneumoniaseveralspecialtypesofpneumonia

Staphylococcalpneumonia（葡萄球菌肺炎）

season:OctoberandMayfollowing:viralupperrespiratorytractag

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