新生儿科一例宫内感染性肺炎患儿的护理查房.ppt

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1、新生儿科一例新生儿科一例宫内感染性肺炎患内感染性肺炎患儿的儿的护理理查房房Operation purpose1.Discussing and using 14 items about clinical nursing service quality in nursing rounds(探探讨运用运用“14条条”进行行护理理查房房)2.Master(掌握掌握)the nursing of intrauterine infection pneumonia with newborn 3.Improve the nurses understanding of intrauterine infectio

2、n pneumoniaGeneral informationGeneral information（一般（一般资料）：料）：Name:Son of Geng yinghua Name:Son of Geng yinghua（庾（庾颖华之子）之子）Age:11 days WeightAge:11 days Weight：3.55kg 3.55kg Sex:male Sex:male Data of BirthData of Birth：:14:57,July 26th,2016:14:57,July 26th,2016 Race:Han Nationality:ChinaRace:Han Nat

3、ionality:ChinaParents Name:father Chen haiyanParents Name:father Chen haiyan，Mother Geng yinghuaMother Geng yinghuaDate of admission:July 27th,2016Date of admission:July 27th,2016Chief complaint（主（主诉）:short of breath for 2 hoursPresent illnessPresent illness（现病史）病史）:GW:38+weeks,G3P2,LMP:2016-08-05;E

4、DC:2016-7-26.GW:38+weeks,G3P2,LMP:2016-08-05;EDC:2016-7-26.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).he birthed in 14:57,July 26th,2016).he birthed in 14:57,July 26th,2016 with cesarean(with cesarean(剖腹剖腹产).).Th

5、e afflicted(The afflicted(受苦的受苦的)baby was delivered in 14:57)baby was delivered in 14:57,July 26th,2016.His Birth weight was 3.55 kg and head,July 26th,2016.His Birth weight was 3.55 kg and head circumference was 32 cm.circumference was 32 cm.There was There was no history of asphyxia rescueno histo

6、ry of asphyxia rescue（无窒息（无窒息抢救史）救史）at birth with at birth with clear amniotic fluidclear 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分分钟阿氏阿氏评分分为9分，五分分，五分钟阿阿氏氏评分分为10分分)，and had shortness of breath after 24 hours along w

7、ith obtuse（迟钝的）的）response and Oral cyanosis(口唇口唇发绀)and moaning（呻吟）（呻吟）.No restlessness（烦躁不安）躁不安）or vomit or fever or pale complexion（面色（面色苍白）白）or seizure（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 stool(大便大便)and urine is normal.Family historyFami

8、ly history（家族史）：（家族史）：The patients mother had an operation with The patients mother had an operation with laparoscopic myomectomylaparoscopic myomectomy（子（子宫肌瘤剔除肌瘤剔除术）in 2005 in 2005，and delivered a girl with cesarean(and delivered a girl with cesarean(剖腹剖腹产)in)in 2009.2009.The patients father suffe

9、red from hypertensionThe patients father suffered from hypertension（高血（高血压）and gout(and gout(痛痛风)Diagnosis(Diagnosis(诊断断)：intrauterine infection pneumonia of the newborn intrauterine infection pneumonia of the newborn（宫内感染性肺炎）内感染性肺炎）What s it？Intrauterine infection pneumonia of the newborn（新生儿新生儿宫内感

10、内感染性肺染性肺炎炎）:Caused by viruses（病毒）（病毒）,bacteria（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（发病）病）within 24 hours after birth with asphyxia（窒（窒息息史）史）Had shortness of breath（气促），（气促），moans（呻吟）（呻吟）,difficulty breathing（呼吸困呼吸困难）,and had not stable

11、temperature（体（体温不温不稳定）定）,and the response is poor（反（反应差差)after recovery（复复苏）.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(脐带血血)or the specificity Ig M is higher for prenatal diagnosis（产前前诊断）断）.X-ray chest radiography is

12、 often shown as interstitial pneumonia（间质性肺炎性肺炎),and the bacterial pneumonia(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脓细胞胞,and find bacteria sometimes.Concha pharyngeal swab bacteria culture(外耳道咽拭子外耳道咽拭子细菌培养菌培养)can be pos

13、itive(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，），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

14、，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：PH 7.279,PC O2 47.1mmol/L,HCO3-21.6mmol/L,BE-6.1mmol,PH 7.279,PC O2 47.1mmol/L,HCO3-21.6

15、mmol/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-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

16、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

17、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

18、，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，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

19、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

20、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，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/

21、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：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

22、，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

23、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)：A Associated with the respiratory secretions ssociated with the respiratory secretions（呼吸道分（呼吸道分泌物），泌物），and baby was unable to row of phle

24、gmand baby was unable to row of phlegm（痰液）（痰液）weakly.weakly.2 2、Impaired gas exchangeImpaired gas exchange（气体交（气体交换受受损）：）：Associated with lung inflammationAssociated with lung inflammation（炎症）（炎症）3 3、MalnutritionMalnutrition（营养失养失调）：）：Associated with Associated with inadequateinadequate（不足的）（不足的）int

25、ake and the increase consumption(intake and the increase consumption(消消耗耗)4、Ineffective Thermoregulation（体温（体温调节无效）：无效）：associated with the lung infection5、Potential Complication（潜在并（潜在并发症症)：(1)heart failure（心力衰竭）：（心力衰竭）：Associated with pulmonary hypertension（肺（肺动脉高脉高压）and the toxic myocarditis（中毒性心

26、肌（中毒性心肌炎）炎）.(2)toxic encephalopathy（中毒性（中毒性脑病）：病）：Related to the lack of oxygen and carbon dioxide retention.（二氧化碳（二氧化碳储留）留）(3)toxic enteroparalysis（中毒性（中毒性肠麻痹）：麻痹）：Related to toxemia毒血毒血症症and the severe cyanosis（严重缺氧）重缺氧）.Nursing measures Keep from obstructionKeep from obstruction（保持呼吸道通（保持呼吸道通畅）：）

27、：（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（超声雾化吸入）化吸入）If necessaryIf necessary：（3 3）expectorantexpectorant（祛痰（祛痰药）（4 4）Mouth sputum suction with negative pressureMouth sputum suction with nega

28、tive pressure（口（口腔吸痰腔吸痰负压）：）：PrematurePremature（早（早产儿）：儿）：0.01 0.013mpa0.01 0.013mpaTerm infantTerm infant（足月儿）：（足月儿）：0.013 0.015mpa0.013 0.015mpaRational(合理)usage of oxygenControl the time and oxygen concentration Control the time and oxygen concentration（浓度）度）吸氧指征：吸氧指征：PaO2PaO250-60mmHg50-60mmHg(1

29、)nasal catheter oxygen inhalation(1)nasal catheter oxygen inhalation(鼻鼻导管管给氧氧)：0.5-1 0.5-1 L/minL/min(2)mask oxygen inhalation(2)mask oxygen inhalation(面罩面罩给氧氧):2-4 L/min:2-4 L/min(3)Hood oxygen inhalation(3)Hood oxygen inhalation(头罩吸氧罩吸氧):5-8 L/min):5-8 L/min(4)CPAP(4)CPAP：continuous positive airwa

30、y pressure(continuous positive airway pressure(持持续气道正气道正压通气）通气）Maintain（保持）normal body temperatureMaintain normal body temperatureMaintain normal body temperature：36 to 37 36 to 37 HypothermiaHypothermia（体温（体温过低）：低）：keeping warmkeeping warmHyperthermiaHyperthermia（体温（体温过高）：高）：cooling coolingIf neces

31、saryIf necessary：Use the antipyretic Use the antipyretic（退（退热药）in in accordance with the doctors adviceaccordance with the doctors adviceantibiotic therapy(抗生素治疗)According to the illness needs to choose the appropriate（合适的）（合适的）antibiotics（抗生素）（抗生素）Observed the effect of drugs closely（密切（密切观察察药物的物的作

32、用作用）Supply enough energy and moisture(水分)Eat smaller,more frequent meals（少量多餐）（少量多餐）Prevent asphyxia during feeding（喂奶（喂奶时防止窒息）防止窒息）severe patients（病重者）：（病重者）：Nasal feeding（鼻（鼻饲）&Intravenous supplement with nutriention and liquid由静脉由静脉补充充营养物养物质及液体及液体Closely observe the illness（1 1）Heart rateHeart ra

33、te：120-140 times/min on average120-140 times/min on average（2 2）breathingbreathing：40 times/min on average40 times/min on average（3 3）Blood pressure monitoring:70/50 mmHg on Blood pressure monitoring:70/50 mmHg on averageaverage（4 4）conscious responses:conscious responses:discharge(出院)guidanceExplai

34、n 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）when baby is feeling unwellMedical staff should have follow-up survey(随随访)for neonates in times，and know the recovery situation of neonates.Thank you！谢谢！