新生兒科一例宮內(nèi)感染性肺炎患兒的護(hù)理查房

1、（一例宮內(nèi)感染性肺炎患兒的護(hù)理查房）,speaker：何綺晴Physical examination：姚蓮萍PPT production：石彩蘭Advisor：陳松珠老師、陳麗英老師、何兆梅老師,One case of intrauterine infection pneumonia of the newborn in nursing rounds,Operation purpose,1.Discussing and using

2、"14 items about clinical nursing service quality" in nursing rounds(探討運(yùn)用“14條”進(jìn)行護(hù)理查房)2. Master(掌握) the nursing of intrauterine infection pneumonia with newborn 3. Improve the nurse’s understanding of intr

3、auterine infection pneumonia,General information,（一般資料）：Name: Son of Geng yinghua （庾穎華之子）Age: 11 days Weight：3.55kg Sex: male Data of Birth：: 14:57 ,July 26th, 2016 Race: Han Nationality:

4、ChinaParents Name: father Chen haiyan，Mother Geng yinghuaDate of admission: July 27th, 2016Chief complaint（主訴）: short of breath for 2 hours,Present illness（現(xiàn)病史）:GW: 38+weeks, G3P2, LMP: 2016-08-05; EDC: 2016-7-26 .

5、Baby´s mother is a elderly pregnant woman with scarred uterus(疤痕子宮) .he birthed in 14:57 ,July 26th, 2016 with cesarean(剖腹產(chǎn)) .The afflicted(受苦的) baby was delivered in 14:57 ,July 26th, 2016.His Birth weight was

6、 3.55 kg and head circumference was 32 cm . There was no history of asphyxia rescue（無(wú)窒息搶救史） at birth with clear amniotic fluid（羊水清）.,It was nine points with Apgar scoring in 1 minute , and 10 points with Apgar scoring

7、 in five minutes (1分鐘阿氏評(píng)分為9分，五分鐘阿氏評(píng)分為10分)，and had shortness of breath after 24 hours along with obtuse（遲鈍的） response and Oral cyanosis (口唇發(fā)紺)and moaning（呻吟）.No restlessness（煩躁不安）or vomit or fever or pale complexion（面

8、色蒼白） or seizure（癲癇發(fā)作） or scream（尖叫） were observed. Breast feed not very well and his crying is a bit poor .His stool(大便) and urine is normal .,Family history（家族史）：The patient’s mother had an operation with laparoscopi

9、c myomectomy（子宮肌瘤剔除術(shù)） in 2005，and delivered a girl with cesarean(剖腹產(chǎn)) in 2009.The patient’s father suffered from hypertension（高血壓） and gout(痛風(fēng))Diagnosis(診斷)：intrauterine infection pneumonia of the newborn （宮內(nèi)感染性肺炎）

10、,What ´s it ？？？,Intrauterine infection pneumonia of the newborn（新生兒宮內(nèi)感染性肺炎）:Caused by viruses（病毒）, bacteria（細(xì)菌）, protozoa（原蟲(chóng)）, or chlamydia（衣原體）Had infection before birth (出生前就感染)Always attacked（發(fā)?。?within

11、 24 hours after birth with asphyxia（窒息史）Had shortness of breath（氣促），moans（呻吟）, difficulty breathing（呼吸困難）, and had not stable temperature（體溫不穩(wěn)定）, and the response is poor（反應(yīng)差)after recovery（復(fù)蘇）.,clinical manifestatio

12、n（臨床表現(xiàn)）,Serum （血清） IgM and IgA is higher than normal newborns, and Ig M > 200 mg/L in umbilical cord blood(臍帶血) or the specificity Ig M is higher for prenatal diagnosis（產(chǎn)前診斷）.X-ray chest radiography is often show

13、n as interstitial pneumonia（間質(zhì)性肺炎), and the bacterial pneumonia(細(xì)菌性肺炎)is bronchopneumonia(支氣管肺炎).Checked the gastric juice(胃液) 1 ~ 2 hours after birth, which could see pus cells膿細(xì)胞, and find bacteria sometimes. Conc

14、ha pharyngeal swab bacteria culture(外耳道咽拭子細(xì)菌培養(yǎng))can be positive(陽(yáng)性).,Progress note（病程記錄）,Physical examination（體格檢查）,Nursing problem,1、Ineffective Airway Clearance（清理呼吸道無(wú)效)：Associated with the respiratory secretions （呼吸道

15、分泌物），and baby was unable to row of phlegm（痰液）weakly.2、Impaired gas exchange（氣體交換受損）：Associated with lung inflammation（炎癥）3、Malnutrition（營(yíng)養(yǎng)失調(diào)）：Associated with inadequate（不足的）intake and the increase consumption(消耗),4、I

16、neffective Thermoregulation（體溫調(diào)節(jié)無(wú)效）：associated with the lung infection5、Potential Complication（潛在并發(fā)癥)：(1) heart failure（心力衰竭）：Associated with pulmonary hypertension（肺動(dòng)脈高壓）and the toxic myocarditis（中毒性心肌炎）. (2) toxi

17、c encephalopathy（中毒性腦病）：Related to the lack of oxygen and carbon dioxide retention.（二氧化碳儲(chǔ)留）(3) toxic enteroparalysis（中毒性腸麻痹）：Related to toxemia毒血癥and the severe cyanosis（嚴(yán)重缺氧）.,Nursing measures,Keep from obstruction

18、（保持呼吸道通暢）：（1）slapping back to excretory sputum（拍背排痰）（2）ultrasonic aerosol inhalation（超聲霧化吸入）If necessary：（3）expectorant（祛痰藥）（4）Mouth sputum suction with negative pressure（口腔吸痰負(fù)壓）：Premature（早產(chǎn)兒）：0.01~ 0.013mpaTerm

19、 infant（足月兒）：0.013~ 0.015mpa,Rational(合理) usage of oxygen,Control the time and oxygen concentration （濃度）吸氧指征：PaO2＜50-60mmHg(1)nasal catheter oxygen inhalation(鼻導(dǎo)管給氧)：0.5-1 L/min(2)mask oxygen inhalation(面罩給氧) :2-4 L/

20、min(3)Hood oxygen inhalation(頭罩吸氧):5-8 L/min(4)CPAP：continuous positive airway pressure (持續(xù)氣道正壓通氣）,Maintain（保持）normal body temperature,Maintain normal body temperature： 36 to 37 ℃Hypothermia（體溫過(guò)低）：keeping warmH

21、yperthermia（體溫過(guò)高）： coolingIf necessary：Use the antipyretic （退熱藥）in accordance with the doctor's advice,antibiotic therapy(抗生素治療),According to the illness needs to choose the appropriate（合適的）antibiotics（抗生素）Observe

22、d the effect of drugs closely（密切觀察藥物的作用）,Supply enough energy and moisture(水分),Eat smaller, more frequent meals（少量多餐）Prevent asphyxia during feeding（喂奶時(shí)防止窒息） severe patients（病重者）：Nasal feeding（鼻飼） &Intr

23、avenous supplement with nutriention and liquid由靜脈補(bǔ)充營(yíng)養(yǎng)物質(zhì)及液體,Closely observe the illness,（1）Heart rate：120-140 times/min on average（2）breathing：40 times/min on average（3）Blood pressure monitoring: 70/50 mmHg on average

24、（4）conscious responses:,discharge(出院)guidance,Explain the relevant knowledge of the disease to parentsGive the living guidance of feeding and growing.Pay attention to prevent infectionInform parents to attend the cl