RespiratoryDysfunction

AnatomyandPhysiologyoftheChildhoodRespiratorySystemUpperrespiratorytractNosePharynxLarynxEpiglottisLowerrespiratorytractTracheaBronchiBronchiolesandalveoli

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

AnatomyandPhysiologyoftheChildhoodRespiratorySystemDefinition

AninflammationorinfectionofthebronchiolesandalveolarspacesofthelungsPneumoniaIntroduction

occur:ininfantsandyoungchildrenrecovery:childrensoonerthanadultsexisttype:diseaseorcomplication

season:latewinterandearlyspring

Pneumonia

LobarpneumoniaBronchopneumonia(lobularpneumonia)InterstitialpneumoniaPneumoniaclassificationMorphologicalclassificationEtiologicAgent

InfectiousvirusbacterialMycoplasma(支原體肺炎)

chlamydial（衣原體肺炎）fungipneumocystis(肺囊蟲)

Noninfectious

foreignbodyaspirationPneumoniaclassificationStateofIllness

MildSevere

PneumoniaclassificationtheclinicalmanifestationsofbronchopneumoniaSeverebronchopneumoniacirculationsystemmanifestationsofmyocarditissignsofheartfailurenervoussystem

gastrointestinal

Chest:X-rayfilmPneumoniaSeverebronchopneumonia

manifestationsofmyocarditis

paletachycardiadiminishedcardiacsoundandarrhythmia

STslowingdownTwaveupdown

PneumoniamanifestationSeverebronchopneumoniaSignsofheartfailure

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

PneumoniamanifestationSeverebronchopneumonia

Nervoussystem:

dysphoria(煩躁)irritable

alert/stuporous

convulsion

somnolence(嗜睡)

intracranialhypertension

PneumoniamanifestationSeverebronchopneumonia

Gastrointestinal

anorexiavomitingabdominal

distention

toxicenteritishemorrhageofGIabsentintestinalsoundbloodystoolPneumoniamanifestationSeverebronchopneumonia

Chest:X-rayfilm

diffuseorpatchyinfiltration

smallspottedshadowoftherightmiddlePneumoniamanifestationprinciple

controlinfection

promoteoxygenationandcomfort

preventcomplication

fevermanagement

fluidintake

familysupport

PneumoniatherapyAntimicrobialtherapy

PGgivenbyIMorIV

PG-allergic:erythromycinclindamycin

PG-resistent:cephalosporin

PGandcephalosporin-resistent:vancomycin

PneumoniatherapyNursingDiagnosis

Impairedgasexchange

collectionmucousinairway

Ineffectiveairwayclearance

mechanicalobstruction,inflammation

andincreasedsecretions

PneumoniaAnticipatedgoalsThechildwillshownormalrespiratoryfunctionwillreceiveoptimumoxygensupplyThechildwillmaintainpatentairwaywillexpectoratesecretionsadequatelyPneumonia

RestoreOptimalRespiratoryFunction

MaintainAirwayCleaning

ProvideAdequateRestandNutrition

Observation

PreventInfectionNursingIntervention

RestoreOptimalRespiratoryFunction

Keepcomfortableenvironment

Positionchildformaximumventilation—semi-recliningposition

ProvideOxygen:masknasalcannulaintubationmechanicalventilationMaintainAirwayCleaning

Institutesuctioningofairway,cougheffectivelyandposturaldrainageProvidenebulizationChestPhysiotherapyAdministermedicationsobservationTemperature: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:viralupperrespiratorytract