新生儿科：一例宫内感染性肺炎患儿的护理查房.pptx

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1、（一例宫内感染性肺炎患儿的护理查房）（一例宫内感染性肺炎患儿的护理查房）speaker：何绮晴何绮晴Physical examination：姚莲萍姚莲萍PPT production：石彩兰石彩兰Advisor：陈陈松松珠珠老老师师、陈陈丽丽英英老老师、何兆梅老师师、何兆梅老师One case of intrauterine infection pneumonia of the newborn in nursing roundsOperation purpose1.Discussing and using 14 items about clinical nursing service qual

2、ity in nursing rounds(探探讨讨运用运用“14条条”进行护理查进行护理查房房)2.Master(掌握掌握)the nursing of intrauterine infection pneumonia with newborn 3.Improve the nurses understanding of intrauterine infection pneumoniaGeneral informationGeneral information（一般资料）：（一般资料）：Name:Son of Geng yinghua Name:Son of Geng yinghua（庾颖华之

3、子）（庾颖华之子）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 Nationality:ChinaParents Name:father Chen haiyanParents Name:father Chen haiyan，Mother Geng yinghuaMother Geng yinghu

4、aDate of admission:July 27th,2016Date of admission:July 27th,2016Chief complaint（主诉）（主诉）:short of breath for 2 hoursPresent illnessPresent illness（现病史）（现病史）:GWGW:38+weeks38+weeks,G3P2,G3P2,LMP:LMP:2016-08-05;2016-08-05;EDC:EDC:2016-7-26.2016-7-26.Babys mother is a elderly pregnant woman with Babys m

5、other is a elderly pregnant woman with scarred uterus(scarred uterus(疤痕子宫疤痕子宫).he birthed in 14:57,July).he birthed in 14:57,July 26th,2016 with cesarean(26th,2016 with cesarean(剖腹产剖腹产).).The The afflicted(afflicted(受苦的受苦的)baby was delivered in 14:57)baby was delivered in 14:57,July 26th,2016.His Bi

6、rth weight was 3.55 kg and,July 26th,2016.His Birth weight was 3.55 kg and head circumference was 32 cm.head circumference was 32 cm.There There was was no history of asphyxia rescueno history of asphyxia rescue（无窒息抢救史）（无窒息抢救史）at birth with at birth with clear amniotic fluidclear amniotic fluid（羊水清）

7、（羊水清）.It was nine points with Apgar scoring in 1 minute,and 10 points with Apgar scoring in five minutes(1分钟阿氏评分为分钟阿氏评分为9分，五分钟阿分，五分钟阿氏评分为氏评分为10分分)，and had shortness of breath after 24 hours along with obtuse（迟钝的）（迟钝的）response and Oral cyanosis(口唇发绀口唇发绀)and moaning（呻吟）（呻吟）.No restlessness（烦躁不安）（烦躁不安）

8、or vomit or fever or pale complexion（面色苍白）（面色苍白）or seizure（癫痫发作）（癫痫发作）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 historyFamily history（家族史）：（家族史）：The patients mother had an operation with The patients mother had an

9、operation with laparoscopic myomectomylaparoscopic myomectomy（子宫肌瘤剔除术）（子宫肌瘤剔除术）in 2005 in 2005，and delivered a girl with cesarean(and delivered a girl with cesarean(剖腹产剖腹产)in)in 2009.2009.The The patients father suffered from patients father suffered from hypertensionhypertension（高血压）（高血压）and gout(a

10、nd gout(痛风痛风)Diagnosis(Diagnosis(诊断诊断)：intrauterine infection pneumonia of the newborn intrauterine infection pneumonia of the newborn（宫内感染性肺炎）（宫内感染性肺炎）What s it？Intrauterine infection pneumonia of the newborn（新生儿宫内感新生儿宫内感染性肺染性肺炎炎）:Caused by viruses（病毒）（病毒）,bacteria（细菌）（细菌）,protozoa（原虫）（原虫）,or chlam

11、ydia（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）（发病）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（呼吸困难呼吸困难）,and had not stable temperature（体（体温不温不稳稳定）定）,and the response is poor（反（反应应差差)after recovery（复

12、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(脐带血脐带血)or the specificity Ig M is higher for prenatal diagnosis（产前诊断）（产前诊断）.X-ray chest radiography is often shown as interstitial pneumonia（间（间质性肺质性肺炎炎),and the bacter

13、ial pneumonia(细细菌性肺菌性肺炎炎)is bronchopneumonia(支支气管肺气管肺炎炎).Checked the gastric juice(胃液胃液)1 2 hours after birth,which could see pus cells脓细胞脓细胞,and find bacteria sometimes.Concha pharyngeal swab bacteria culture(外外耳道咽拭子细菌培耳道咽拭子细菌培养养)can be positive(阳性阳性).Progress note（病程记录）2016-2016-07-2707-27SPO2 80-

14、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，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 5cmH2OP

15、EEP 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,HCO3-21.6mmol/L,BE-6.1mmol,血常规：血常规：WBC 19.63x109/L,WBC 19.63x109/L,H

16、GB 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

17、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

18、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，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

19、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

20、：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，持续心电监护显示：RR 40-48次次/分，分，P 125-146次次/分，分，BP 79/43 mmHg，SPO2 92-9

21、8%，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/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

22、，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，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

23、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 examina

24、tion（体格检查）Nursing problem1 1、Ineffective Ineffective Airway ClearanceAirway Clearance（清理呼吸道无（清理呼吸道无效效)：A Associated ssociated with with the respiratory the respiratory secretions secretions（呼吸道分呼吸道分泌物泌物），），and baby and baby was unable was unable to row of to row of phlegmphlegm（痰液）（痰液）weakly.weakly.

25、2 2、Impaired Impaired gas exchangegas exchange（气体交换受损（气体交换受损）：）：Associated Associated with lung with lung inflammationinflammation（炎症炎症）3 3、MalnutritionMalnutrition（营养失调（营养失调）：）：Associated with Associated with inadequateinadequate（不不足的）足的）intake and the intake and the increase increase consumptionco

26、nsumption(消消耗耗)4、Ineffective Thermoregulation（体温调节无效）：（体温调节无效）：associated with the lung infection5、Potential Complication（潜在并发症（潜在并发症)：(1)heart failure（心力衰竭（心力衰竭）：）：Associated with pulmonary hypertension（肺动脉高压肺动脉高压）and the toxic myocarditis（中毒性心肌中毒性心肌炎）炎）.(2)toxic encephalopathy（中毒性脑病中毒性脑病）：）：Relate

27、d to the lack of oxygen and carbon dioxide retention.（二氧化碳储二氧化碳储留）留）(3)toxic enteroparalysis（中毒性肠麻痹中毒性肠麻痹）：）：Related to toxemia毒毒血血症症and the severe cyanosis（严重缺氧严重缺氧）.Nursing measures Keep from obstructionKeep from obstruction（保持呼吸道通畅）：（保持呼吸道通畅）：（1 1）slapping back to excretory slapping back to excre

28、tory sputumsputum（拍背排痰）（拍背排痰）（2 2）ultrasonic aerosol inhalationultrasonic aerosol inhalation（超声雾化吸入）（超声雾化吸入）If If necessarynecessary：（3 3）expectorantexpectorant（祛痰祛痰药）药）（4 4）Mouth Mouth sputum suction with negative pressuresputum suction with negative pressure（口（口腔吸痰负压）：腔吸痰负压）：PrematurePremature（早产儿

29、）：（早产儿）：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）（浓度）吸氧指征：吸氧指征：PaO2PaO250-60mmHg50-60mmHg(1)nasal(1)nasal catheter oxygen inhalation(cathet

30、er oxygen inhalation(鼻鼻导导管给氧管给氧)：0.5-1 0.5-1 L/minL/min(2)mask(2)mask oxygen oxygen inhalation(inhalation(面罩给氧面罩给氧):2-4 L/min:2-4 L/min(3)Hood(3)Hood oxygen oxygen inhalation(inhalation(头头罩吸罩吸氧氧):5-8 L/min):5-8 L/min(4)CPAP(4)CPAP：continuous continuous positive airway positive airway pressure(pressu

31、re(持续气道正压持续气道正压通通气）气）Maintain（保持）normal body temperatureMaintain normal body Maintain normal body temperaturetemperature：36 36 to 37 to 37 HypothermiaHypothermia（体温过低）：（体温过低）：keeping warmkeeping warmHyperthermiaHyperthermia（体温过高）：（体温过高）：cooling coolingIf If necessarynecessary：Use the antipyretic Use

32、 the antipyretic（退热退热药）药）in in accordance with the doctors accordance with the doctors adviceadviceantibiotic therapy(抗生素治疗)According to the illness needs to choose the appropriate（合（合适适的）的）antibiotics（抗（抗生生素）素）Observed the effect of drugs closely（密（密切观察药物的切观察药物的作用作用）Supply enough energy and moistur

33、e(水分)Eat smaller,more frequent meals（少量多餐）（少量多餐）Prevent asphyxia during feeding（喂奶时防止窒息）（喂奶时防止窒息）severe patients（病重者）：（病重者）：Nasal feeding（鼻（鼻饲饲）&Intravenous supplement with nutriention and liquid由静脉补充营养物质及液体由静脉补充营养物质及液体Closely observe the illness（1 1）Heart Heart raterate：120-140 times/min on average

34、120-140 times/min on average（2 2）breathingbreathing：40 40 times/min on times/min on averageaverage（3 3）Blood pressure monitoring:70/50 mmHg on Blood pressure monitoring:70/50 mmHg on averageaverage（4 4）conscious conscious responses: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（复诊）（复诊）when baby is feeling unwellMedical staff should have follow-up survey(随访随访)for neonates in times，and know the recovery situation of neonates.Thank you！