新生儿科一例宫内感染性肺炎患儿护理查房.ppt

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1、新生儿科一例宫内感染性肺炎患儿护理查房Operation purpose1.Discussing and using 14 items about clinical nursing service quality in nursing rounds(探探讨讨运用运用“14条条进进展展护护理理查查房房)2.Master(掌握掌握)the nursing of intrauterine infection pneumonia with newborn 3.Improve the nurses understanding of intrauterine infection pneumoniaGene

2、ral informationGeneral information一般一般资料：料：Name:SonofGengyinghua庾庾颖华之子之子Age:11daysWeight：3.55kgSex:maleDataofBirth：:14:57,July26th,2021Race:HanNationality:ChinaParentsName:fatherChenhaiyan，MotherGengyinghuaDateofadmission:July27th,2021Chiefcomplaint主主诉:shortofbreathfor2hoursPresent illnessPresent il

3、lness 现现病史病史:GW:38+weeks,G3P2,LMP:2021-08-05;EDC:2021-7-26.GW:38+weeks,G3P2,LMP:2021-08-05;EDC:2021-7-26.Babys mother is a elderly pregnant woman with scarred Babys mother is a elderly pregnant woman with scarred uterus(uterus(疤痕子疤痕子宫宫).he birthed in 14:57,July 26th,2021).he birthed in 14:57,July 26

4、th,2021 with cesarean(with cesarean(剖腹剖腹产产).).The afflicted(The afflicted(受苦的受苦的)baby was delivered in 14:57,July)baby was delivered in 14:57,July 26th,2021.His Birth weight was 3.55 kg and head 26th,2021.His Birth weight was 3.55 kg and head circumference was 32 cm.circumference was 32 cm.There was

5、 no history of asphyxia rescueThere was no history of asphyxia rescue 无窒息无窒息抢抢救史救史 at at birth with clear amniotic fluidbirth with clear amniotic fluid 羊水清羊水清.It was nine points with Apgar scoring in 1 minute,and 10 points with Apgar scoring in five minutes(1分分钟钟阿氏阿氏评评分分为为9分，五分分，五分钟钟阿阿氏氏评评分分为为10分分)，

6、and had shortness of breath after 24 hours along with obtuse 迟钝迟钝的的 response and Oral cyanosis(口唇口唇发绀发绀)and moaning 呻吟呻吟.No restlessness 烦烦躁不安躁不安 or vomit or fever or pale complexion 面面色色苍苍白白 or seizure 癫痫发癫痫发作作 or scream 尖叫尖叫 were observed.Breast feed not very well and his crying is a bit poor.His

7、stool(大大便便)and urine is normal.Family history 家族史家族史：The patients mother had an operation with laparoscopic myomectomy 子子宫宫肌瘤剔除肌瘤剔除术术 in 2005，and delivered a girl with cesarean(剖腹剖腹产产)in 2021.The patients father suffered from hypertension 高血高血压压 and gout(痛痛风风)Diagnosis(诊诊断断)：intrauterine infection p

8、neumonia of the newborn 宫宫内感染性肺炎内感染性肺炎 What s it？Intrauterine infection pneumonia of the newborn 新生儿新生儿宫宫内感染内感染性肺炎性肺炎:Caused by viruses 病毒病毒,bacteria 细细菌菌,protozoa 原虫原虫,or chlamydia 衣原体衣原体 Had infection before birth(出生前就感染出生前就感染)Always attacked 发发病病 within 24 hours after birth with asphyxia 窒息史窒息史 H

9、ad shortness of breath 气促气促，moans 呻吟呻吟,difficulty breathing 呼吸困呼吸困难难,and had not stable temperature 体温不体温不稳稳定定,and the response is poor 反响差反响差)after recovery 复复苏苏.clinical manifestation临床表现Serum 血清血清 IgM and IgA is higher than normal newborns,and Ig M 200 mg/L in umbilical cord blood(脐带脐带血血)or the s

10、pecificity Ig M is higher for prenatal diagnosis 产产前前诊诊断断.X-ray chest radiography is often shown as interstitial pneumonia 间质间质性肺炎性肺炎),and the bacterial pneumonia(细细菌性肺炎菌性肺炎)is bronchopneumonia(支气管肺炎支气管肺炎).Checked the gastric juice(胃液胃液)1 2 hours after birth,which could see pus cells脓细脓细胞胞,and find

11、bacteria sometimes.Concha pharyngeal swab bacteria culture(外耳道咽拭子外耳道咽拭子细细菌培养菌培养)can be positive(阳性阳性).Progress note病程记录2016-2016-07-2707-27SPO2 80-85%SPO2 80-85%，呼吸急促呼吸急促，约，约8080次次/分，分，伴呻吟样呼吸伴呻吟样呼吸，口周发绀口周发绀，吸气三凹征阳性吸气三凹征阳性，给予，给予CPAPCPAP辅助通气辅助通气（PEEP 5cmH2OPEEP 5cmH2O，FiO2 30-35%FiO2 30-35%），患儿气促较前好转，

12、），患儿气促较前好转，SPO2SPO2上升至上升至93-95%93-95%，禁食禁食，停留胃管无潴留，予告病重，给予抗感染、营养心肌及补液等治疗，续观，停留胃管无潴留，予告病重，给予抗感染、营养心肌及补液等治疗，续观07-2807-28CPAPCPAP辅助通气辅助通气（PEEP 5cmH2OPEEP 5cmH2O，FiO2 30-35%FiO2 30-35%），），禁食禁食,停留胃管无潴留，停留胃管无潴留，呼吸稍促呼吸稍促，三凹征，三凹征阳性，双肺呼吸音粗，阳性，双肺呼吸音粗，闻及双肺低湿性啰音闻及双肺低湿性啰音，全身皮肤黏膜无黄染全身皮肤黏膜无黄染，辅助检查：血气分析：，辅助检查：血气分析：

13、PH 7.279,PC O2 47.1mmol/L,HCO3-21.6mmol/L,BE-6.1mmol,PH 7.279,PC O2 47.1mmol/L,HCO3-21.6mmol/L,BE-6.1mmol,血常规：血常规：WBC 19.63x109/L,WBC 19.63x109/L,HGB 142g/L,HGB 142g/L,血型血型“B B”，电解质：，电解质：Na142.5mmol/LNa142.5mmol/L，CA 1.94 mmol/L,K 4.40mmol/L,CA 1.94 mmol/L,K 4.40mmol/L,CL108.1mmol/LCL108.1mmol/L，CK-

14、MB,CK-MB,床边床边胸片胸片X X片显示斑片状阴影片显示斑片状阴影，目前诊断明确：，目前诊断明确：宫内感染性肺炎宫内感染性肺炎，继，继续、监护、续、监护、CPAPCPAP辅助通气、抗感染、营养心肌等治疗辅助通气、抗感染、营养心肌等治疗07-2807-28PO2PO2氧分压氧分压37.2 mmHg37.2 mmHg，继续给予，继续给予CPAPCPAP辅助通气，持续血氧饱和度维持在辅助通气，持续血氧饱和度维持在90-95%90-95%07-2907-29CPAPCPAP辅助通气（辅助通气（PEEP 5cmH2OPEEP 5cmH2O，FiO2 30-35%FiO2 30-35%），），呼吸稍

15、促呼吸稍促，反应稍差，哭声稍弱，反应稍差，哭声稍弱，试喂试喂5ml/5ml/次，停留胃管通畅次，停留胃管通畅，无潴留，无潴留，轻度吸气三凹征阳性轻度吸气三凹征阳性，双肺呼吸音粗双肺呼吸音粗，可闻及，可闻及双肺低湿性双肺低湿性啰音，伴呻吟样呼吸啰音，伴呻吟样呼吸，查，查CPRCPR升高，升高，胸片提示可见斑片状阴影胸片提示可见斑片状阴影，查，查HGB 137 g/LHGB 137 g/L，全身皮肤黏，全身皮肤黏膜轻度黄染，膜轻度黄染，SB 5mg/dlSB 5mg/dl07-3007-30CPAPCPAP辅助通气，辅助通气，间中呼吸稍促，间中呼吸稍促，反应稍差，哭声稍弱，反应稍差，哭声稍弱，轻度

16、吸气性三凹征轻度吸气性三凹征，全身皮肤黏膜轻，全身皮肤黏膜轻度黄染，度黄染，SB 5mg/dlSB 5mg/dl，双，双肺呼吸音粗，可闻及双肺低湿性啰音，伴呻吟样呼吸肺呼吸音粗，可闻及双肺低湿性啰音，伴呻吟样呼吸，开塞露塞肛，开塞露塞肛后排出后排出16g16g胎便，血钾较低，已静脉补钾，低钾血症胎便，血钾较低，已静脉补钾，低钾血症07-31 CPAP辅助通气间中呼吸稍促辅助通气间中呼吸稍促，停留胃管通畅，无潴留，持续心电监护显示：，停留胃管通畅，无潴留，持续心电监护显示：RR 35-45次次/分，分，P 130-144次次/分，分，BP 75/43 mmHg，SPO2 93-98%，反应稍差，

17、哭声稍弱，反应稍差，哭声稍弱，轻度吸气轻度吸气三凹征阳性，双肺呼吸音粗，可闻及双肺低湿性啰音，伴呻吟样呼吸三凹征阳性，双肺呼吸音粗，可闻及双肺低湿性啰音，伴呻吟样呼吸，全身皮肤黏膜轻度，全身皮肤黏膜轻度黄染黄染,，SB 7mg/dl，辅助检查：血培养至今：未见细菌、真菌生长，电解质：，辅助检查：血培养至今：未见细菌、真菌生长，电解质：Na 142.3mmol/L，CA 2.08 mmol/L,K 3.28mmol/L,CPR 2.1mg/L,目前继续监护、目前继续监护、CPAP辅辅助通气、抗感染、营养心肌等治疗助通气、抗感染、营养心肌等治疗08-01试停试停CPAP辅助通气辅助通气，呼吸尚顺呼

18、吸尚顺，血氧饱和度可维持在，血氧饱和度可维持在90-98%之间，反应稍可，哭声响，之间，反应稍可，哭声响，停留胃管通畅，无潴留，持续心电监护显示：停留胃管通畅，无潴留，持续心电监护显示：RR 40-48次次/分，分，P 125-146次次/分，分，BP 79/43 mmHg，SPO2 92-98%，全身皮肤轻度黄染，全身皮肤轻度黄染，SB 7mg/dl，双肺呼吸音粗，未闻及双肺干双肺呼吸音粗，未闻及双肺干湿啰音湿啰音，目前继续监护、抗感染、营养心肌等治疗，目前继续监护、抗感染、营养心肌等治疗08-02患儿患儿呼吸顺，无发绀呼吸顺，无发绀，血氧饱和度可维持在，血氧饱和度可维持在93-98%之间，

19、持续心电监护显示：之间，持续心电监护显示：RR 40-45次次/分，分，P125-148次次/分，分，BP72/41mmHg，全身皮肤轻度黄染，全身皮肤轻度黄染，SB 8mg/dl，双肺呼吸音粗，双肺呼吸音粗，未闻及干湿啰音未闻及干湿啰音，G6PD 4.9U/L08-03患儿患儿呼吸顺，无发绀，无三凹征，呼吸顺，无发绀，无三凹征，持续心电监护显示：持续心电监护显示：RR 40-46次次/分，分，P127-144次次/分，分，BP 87/42 mmHg，SPO2 92-94%，全身皮肤轻度黄染，全身皮肤轻度黄染，SB 7mg/dl，双肺呼吸音粗双肺呼吸音粗，辅助，辅助检查：血常规：检查：血常规：

20、WBC 11.68x109/L,HGB 117g/L,电解质：电解质：CA 2.14 mmol/L,K 4.35 mmol/L,CPR 0.2mg/L,患儿复查血红蛋白较前降低，必要时输注浓缩红细胞，目前继续监患儿复查血红蛋白较前降低，必要时输注浓缩红细胞，目前继续监护、抗感染、营养心肌等治疗护、抗感染、营养心肌等治疗08-04患儿患儿呼吸顺，无发绀，无三凹征呼吸顺，无发绀，无三凹征，全身皮肤轻度黄染，全身皮肤轻度黄染，SB 7mg/dl，双肺呼吸音稍粗，未双肺呼吸音稍粗，未闻及干湿啰音闻及干湿啰音，血氧饱和度可维持在，血氧饱和度可维持在92-97%之间，持续心电监护显示：之间，持续心电监护显

21、示：RR 40-48次次/分，分，P120-142次次/分，分，BP69/35mmHg，SPO2 92-97%，辅助检查：血培养：未见细菌、真菌，辅助检查：血培养：未见细菌、真菌生长，患儿呼吸顺，吃奶好，病情治愈，生长，患儿呼吸顺，吃奶好，病情治愈，予出院予出院Physical examination体格检查Nursing problem1 1、Ineffective Airway ClearanceIneffective Airway Clearance 清理呼吸道无效清理呼吸道无效)：Associated with the respiratory secretions Associated

22、 with the respiratory secretions 呼吸呼吸道分泌物道分泌物，and baby was unable to row of phlegmand baby was unable to row of phlegm 痰痰液液 weakly.weakly.2 2、Impaired gas exchangeImpaired gas exchange 气体交气体交换换受受损损：Associated with lung inflammationAssociated with lung inflammation 炎症炎症 3 3、MalnutritionMalnutrition 营

23、营养失养失调调：Associated with Associated with inadequateinadequate 缺乏的缺乏的 intake and the increase intake and the increase consumption(consumption(消耗消耗)4、Ineffective Thermoregulation 体温体温调节调节无效无效：associated with the lung infection5、Potential Complication 潜在并潜在并发发症症)：(1)heart failure 心力衰竭心力衰竭：Associated wit

24、h pulmonary hypertension 肺肺动动脉高脉高压压 and the toxic myocarditis 中毒中毒性心肌炎性心肌炎.(2)toxic encephalopathy 中毒性中毒性脑脑病病：Related to the lack of oxygen and carbon dioxide retention.二氧化碳二氧化碳储储留留(3)toxic enteroparalysis 中毒性中毒性肠肠麻痹麻痹：Related to toxemia毒血症毒血症and the severe cyanosis 严严重缺氧重缺氧.Nursing measures Keep fr

25、om obstructionKeep from obstruction 保持呼吸道通保持呼吸道通畅畅：1 1 slapping back to excretory sputumslapping back to excretory sputum 拍背排痰拍背排痰 2 2 ultrasonic aerosol inhalationultrasonic aerosol inhalation 超声超声雾雾化吸入化吸入 If necessaryIf necessary：3 3 expectorantexpectorant 祛痰祛痰药药 4 4 Mouth sputum suction with nega

26、tive pressureMouth sputum suction with negative pressure 口腔口腔吸痰吸痰负压负压：Rational(合理)usage of oxygenControl the time and oxygen concentration Control the time and oxygen concentration 浓浓度度 吸氧指征：吸氧指征：PaO2PaO250-60mmHg50-60mmHg(1)nasal catheter oxygen inhalation(1)nasal catheter oxygen inhalation(鼻鼻导导管管给

27、给氧氧)：0.5-0.5-1 L/min1 L/min(2)mask oxygen inhalation(2)mask oxygen inhalation(面罩面罩给给氧氧):2-4 L/min):2-4 L/min(3)Hood oxygen inhalation(3)Hood oxygen inhalation(头头罩吸氧罩吸氧):5-8 L/min):5-8 L/min(4)CPAP(4)CPAP：continuous positive airway pressure(continuous positive airway pressure(持持续续气气道正道正压压通气通气 Maintai

28、n保持normal body temperatureMaintain normal body temperatureMaintain normal body temperature：36 to 37 36 to 37 HypothermiaHypothermia 体温体温过过低低：keeping warmkeeping warmHyperthermiaHyperthermia 体温体温过过高高：cooling coolingIf necessaryIf necessary：Use the antipyretic Use the antipyretic 退退热药热药 in in accordan

29、ce with the doctors adviceaccordance with the doctors adviceantibiotic therapy(抗生素治疗)According to the illness needs to choose the appropriate 适宜的适宜的 antibiotics 抗生素抗生素 Observed the effect of drugs closely 密切密切观观察察药药物的作物的作用用 Supply enough energy and moisture(水分)Eat smaller,more frequent meals 少量多餐少量多

30、餐 Prevent asphyxia during feeding 喂奶喂奶时时防止窒息防止窒息 severe patients 病重者病重者：Nasal feeding 鼻鼻饲饲&Intravenous supplement with nutriention and liquid由静脉由静脉补补充充营营养物养物质质及液体及液体Closely observe the illness1 1Heart rateHeart rate：120-140 times/min on average120-140 times/min on average2 2breathingbreathing：40 tim

31、es/min on average40 times/min on average3 3Blood pressure monitoring:70/50 mmHg on Blood pressure monitoring:70/50 mmHg on averageaverage4 4conscious responses:conscious responses:discharge(出院)guidanceExplain the relevant knowledge of the disease to parentsGive the living guidance of feeding and growing.Pay attention to prevent infectionInform parents to attend the clinic 复复诊诊 when baby is feeling unwellMedical staff should have follow-up survey(随随访访)for neonates in times，and know the recovery situation of neonates.Thank you！