1、I. Assessment of respiratory function II. 兒童常見呼吸系統疾病,Nursing care of children with respiratory dysfunction,Assessment of respiratory function,Health history Physical assessment p418 Table 13-1 Quality of respirations Quality of pulse Color Cough Behavior change Signs of dehydration Diagnostic assess
2、ment 胸部X光檢查 痰液檢查 血液氣體分析 支氣管鏡檢查 肺功能檢查(Pulmonary function test),兒童常見呼吸系統疾病,Urgent respiratory threats Sudden infant death syndrome P423 Upper respiratory tract infection Otitis Media P703 Tonsilitis P718 Common cold Epidemic Influenza Acute pharyngitis,Reactive airway disorders Croup P427 Asthma Lower
3、 respiratory tract infection Bronchitis Bronchiolitis P447 Pneumonia P451 Long-term respiratory dysfunction Cystic fibrosis,Otitis medial P703,Inflammation of the middle ear. At least one episode by 6 years of age , with peak incidence at 2 years Boys Winter months.,Etiology and pathophysiology (1),
4、Eustachian tube equalizes air pressure between the middle ear and the outside environment and allows for drainage of secretions from middle ear mucosa. P691圖19-1 Anatomical differences in the Eustachian tube between adult and small children（short, wider, more horizontal）. P691圖19-1 Cause：unknown, bu
5、t it appears to be related to Eustachian tube dysfunction P703倒數第3行 Often an upper respiratory infection precedes the development of otitis medial. P703倒數第2行,Etiology and pathophysiology (2),Infection the mucous membranes of the Eustachian tube to become edematousEustachian tube blocked air in the m
6、iddle ear is reabsorbed into the bloodstreamfluid is pulled from the mucosal lining into the former air spaceinfected. P703最後1行 . Causative organisms：streptococcus pneumoniae, Haemophilus influenzae . P704第1段第4行 Allergic rhinitis, cleft palate, Down syndrome. P704第2段 Higher risk：crowded conditions,
7、exposed to cigarette smoke, attend child care with multiple children. Breastfeeding provides protection.,Clinical manifestations,Pulling at the ear 第2行 Diarrhea, vomiting, and fever Irritability and “acting out” may be signs of a related hearing impairment Asymptomatic（some）p705第1行,Otoscopic examina
8、tion.第1段第1行 Otitis medial : red, bulging, nonmobile tympanic membrane圖19-7 Otitis medial with effusion : fluid line or air bubbles圖19-8 Pneumatic otoscopy (氣式耳鏡) 第3行 Special gradient acoustic reflectometry（SGAR） (聽覺反射傾斜度) Tympanogram (鼓室壓力圖)第2段,Diagnostic tests,Medical management,Acute and recurrent
9、 otitis media 第3段 Antibiotic therapywide spectrum antibiotics Amoxicllin Amoxicllin with clavulanate or cefuroxime axetil ceftriaxome Chronic otitis media with effusion 第5段result in sensorineural or conductive hearing loss and cochlear damage Audiology If infection recurs Myringotomy and tympanostom
10、y tube 最後1段第2行 Neither decongestants nor antihistamines最後1段第1行,Nursing assessment p706,Assess tympanic membranecolor, transparency, mobility, presence of landmarks, and light reflex. Ask the parents if the child has had a fever, been fussy, or been pulling at the ears. Observe for signs of impaired
11、hearing.,Nursing management P707 care plan,Pain Infection Risk for caregiver role strain Knowledge deficit about infection Altered growth and development,Etiology and pathophysiology An infection or inflammation（hypertrophy）of the palatine tonsils. P718 Most children with pharyngitis may have infect
12、ed tonsils. May be caused by virus or bacterium. P719,Tonsillitis,Clinical manifestations,Frequent throat infections with breathing and swallowing difficulties. Persistent redness of the anterior pillars Enlargement of the cervical lymph nodes Mucous membranes may become dry and irritated,Visual ins
13、pection Clinical manifestations Throat culture,Diagnostic tests,Medical management,Symptomatic treatment Penicilline for 10 days（or erythromycin） Tonsillectomy 3 per year for 3 years Chronic tonsillitis Obstructive sleep apnea Malformations causing nasal speech or a facial growth abnormality If the
14、pharyngeal tonsils are enlarged Mouth breathing, cough, impaired taste and smell, a muffled quality to the voice, and chronic otitis media.,Nursing assessment,Assess the throat Observe for tonsils Pain or difficulty swallowing History,Nursing management P720,Supportive care（symptomatic relief） Compl
15、etion of the full course of treatment.（10-day） Acetaminophen reduces throat pain and generalized fever. P718 Cool, nonacidic fluids and soft foods, ice chips or frozen juice pops given frequently in small amounts facilitate swallowing and prevent dehydration. Humidification, chewing gum, and garglin
16、g with warm salt water soothe an irritated throat. Encourage the child to rest.,Nursing management,Before surgery P720第2段 Free of sore throat, fever, or URI for at least 1 week before surgery. Not be given aspirin or ibuprofen for 2 weeks before surgery. Check if any herbal medications are taken Aft
17、er surgery 局部用冷 觀察嘔吐次數，可能早期出血的徵象 避免不必要的擤鼻涕、咳嗽或清喉嚨 術後採側臥或俯臥 避免酸性飲料或辛辣食物，且避免使用吸管 術後12週可恢復正常活動 合併症bleeding, infection, pain P720,Croup syndrom,Swelling of the epiglottis and larynx. p427第1段第2行 Viral syndromes and bacterial syndromes p429 Table13-5 Viral syndromes Acute Spasmodic Laryngitis Laryngotrach
18、eitis Laryngotracheobronchitis (LTB) Bacterial syndromes Epiglottitis Bacterial Tracheitis Big threeLTB, epiglottis, and bacterial tracheitis p428第2段 Stridor, seal-like barking cough, and hoarseness,Etiology and pathophysiology Viral invasion Throughout the larynx, trachea, and bronchi Age：3 months
19、to 4 years of age Boys than girls Cause：Parainfluenze virus（75%）、RS virus、Influenze virus Airway tissues produce copious, tenacious secretions and swelling. P429第1段圖13-5,Laryngotracheobronchitis（LTB）p428,Clinical manifestationsTachypnea, inspiratory stridor, seal-like barking cough, and hoarseness F
20、ever may or may be not present.Diagnostic tests Clinical signs Pulse oximetry Anteroposterior and lateral x-rayssteeple sign,Humidification Medications P430 上表 Beta-agonists and beta-adrenergics Aerosolized through face mask Improvement in 30 & lasts about 2 hours Tachycardia & hypertension Dizzines
21、s, headache, and nausea stop medication Corticosteroids IM, PO, Nebulized budesonide CV symptoms Stridor resolves faster Oxygen,Medical management,Nursing management P431,Maintain airway patency Meet fluid and nutritional needs,Epiglottitis（Supraglottitis） P431,Etiology and pathophysiology 第1段 An in
22、flammation of the epiglottis. Edema can rapidly obstruct the airway by occluding the trachea. Potentially life-threatening Cause：bacterial invasion of the soft tissue of the larynx 第2段 Streptococcus Staphylococcus Haemophilus influenzae type B Inflammation and edema airway obstruction,Clinical manif
23、estations 第3段,Suddenly becomes very ill High fever（39oC） Sore throat 4D（Dysphonia、Dysphagia、Drooling、Distressed respiratory effort） Stridor Sits up and leans forward,Diagnostic tests P432 第4段,Lateral neck x-ray Blood culture,圖13-6,PS： Laryngospasm and airway obstruction visual inspection of the mout
24、h and throat is contraindicated,Medical management,On endotracheal tube Antibiotics Antipyretics Hydration Humidifies oxygen,Nursing management,Airway management 第2段 Sit upright or assume a position of comfort to maintain the airway Humidifies oxygen Provide a quiet environment Treat the infection a
25、nd provide fluid to provide hydration 第3段 Provide emotional support 第4段,Bacterial Tracheitis P433,Etiology and pathophysiology 第1段 Senondary infection of the upper trachea after viral laryngotracheitis. Most caused by group A streptococcus or Haemophilus influenzaeClinical manifestations Starts with
26、 croupy cough and stridor High fever greater than 390C，persists for several days. Prefer lying flat to sitting up,Diagnostic tests,Blood culture,Medical management Antibiotics are given for a full 10-day course Artificial airway and ventilatory support.,Nursing management,Airway assessment and suppo
27、rt Airway maintenance Suctioning as needed Humidified oxygen Antibiotics Preparation for resuscitation,Bronchiolitis P447,An infecting agent（virus or bacterium）causes inflammation and obstruction of the small airway, the bronchioles. Infection occurs most frequently in toddlers and preschooers.,Etio
28、logy and pathophysiology,RSV is the most common cause. Direct or close contact with respiratory secretions of infected individuals. Viruses invade the mucosal cellcell debris clogs and obstruct the bronchioles and irritates the airway. Partial airway obstruction and bronchospasms. Wheezing & Crackle
29、srespiration failure（O2 , CO2 ）Apnea and pulmonary edema The noisier the lungs, the better.第3段,Clinical manifestations,URI symptomsNasal stuffiness, cough, and fever for a few days（39oC） LRI symptomswheezing; a deeper, more frequent cough; more labored breathing Respirations are rapid, shallow, and
30、accompanied by nasal flaring and retraction. Acting more illappearing sicker, less playful, and less interested in eating,Diagnostic tests,History PE X-ray Nasal swab or nasopharyngeal wash 第2段第2行,Nursing assessment,Physiologic assessment Psychosocial assessment 參考P439 Table13-10 Developmental asses
31、sment,Nursing implementation P449, 450-451 care plan,Maintain respiratory function Support physiologic function Reduce anxiety Discharge planning Use of the bulb syringe to suction the nares Fluid intake Rest P452 Families want to know,Pneumonia p451,Etiology and pathophysiology An inflammation or i
32、nfection of the bronchioles and alveolar spaces. Most often in infants and young children Viral, mycoplasmal, or bacterial in origin 第2段,Clinical manifestations,Fever, rhonchi, crackles, wheezes, cough, dyspnea, tachypnea, restlessness, and decreased breath sound Bacteria：one or more lobes of a sing
33、le lung; unilateral lobar pneumonia Viruses：infiltrating the alveoli nearest the bronchi of one or both lungs.,Diagnostic tests P452第4段,PE X-ray Sputum culture（blood culturelung puncture）,Symptomatic therapy Supportive care（airway management, fluids, and rest） Organism-sensitive antibiotics Oxygen a
34、nd anti-inflammatory medications,Pulmonary care Antibiotics Hydration Pain management 持續性密閉式胸腔引流 Discharge planning Administration of drugs and any side effects F/U chest X-ray,Medical management,Nursing management,Nursing care plan for the children with respiratory dysfunction,Ineffective breathing
35、 pattern related to increased work of breathing and decreased energy（fatigue）. Altered tissue perfusion（cardiopulmonary）related to partially obstructed airway. Risk for fluid volume deficit related to inability to meet body requirements and increased metabolic demand Fear/Anxiety（child and parent）related to acute illness, hospitalization, and uncertain course of illness and treatment . Knowledge deficit（child and parent）related to diagnosis, treatment, prognosis, and home care needs . High risk infection Pain 活動無耐力 營養狀況少於身體需求 睡眠型態混亂,
