小兒腹瀉雙語課件

1、Chapter 8-1nursing care of children with digestive disordersHuiQin-Yu2020/10/131Chapter 8-1nursing care of chDialogueVomitingParent: my child has been vomiting frequently.Doctor: when did it start? How frequently?Parent: it started about ten days ago. He vomits about five times a day.Doctor: when do

2、es he usually vomit?Parent: usually after taking food.Doctor: does he vomit a large or small amount each time?Parent: not too much.Doctor: is his stool normal?Parent: yes.Doctor: how about his appetite?Parent: its good.Doctor: is he losing weight?Parent: no. everything else seems to be all right.202

3、0/10/132DialogueVomitingParent: my chDoctor: most likely this is due to improper feeding. After feeding, the baby should be held erect over your shoulder and patted gently on the back, so that any swallowed air can come out. After burping him, put him in his cradle on his right side with his head sl

4、ightly raised. If he vomits, you should turn him on to his side with his face down, so he cant inhale his vomit.2020/10/133Doctor: most likely this is duDialog -diarrheaDoctor: has he got diarrhea?Parent: yes, for two days.Doctor: how many times a day? Is stool watery (very loose, large in amount)?

5、Is there pus, blood or mucus in it ?Parent: about five times a day. They are quite loose with milk curd and undigested food in them.Doctor: hes probably got indigestion. Please stop all food except milk. Try to give him a little less milk than usual. Now, Ill prescribe some medicine for him.2020/10/

6、134Dialog -diarrheaDoctor: has hKey wordsFluid, electrolyte and acid-alkali imbalances 水、電解質(zhì)、酸堿平衡紊亂Dehydration 脫水Hypokalemia 低鉀血癥Disturbances of acid-base balance 酸堿平衡紊亂Fluid therapy 液體療法Deficit replacement 累積損失量Supplemental replacement of ongoing losses 繼續(xù)損失量Maintenance 生理需要量Diarrhea 小兒腹瀉Stomatitis

7、 口炎Esophagus and stomach 食管和胃Intestine 腸Liver 肝臟Pancreas 胰腺Stool 糞便10% dextrose 10%葡萄糖Fluid therapy液體療法2020/10/135Key wordsFluid, electrolyte ancase 患兒，男性，1歲。因嘔吐、腹瀉2天伴發(fā)熱1天，于1998年6月20日入院。患兒2天前突起腹瀉，每天10余次，稀水便，無粘液。入院當(dāng)天感覺發(fā)熱伴咳嗽，咳后即吐，一上午嘔吐3次，吐出為胃內(nèi)容物，量少；哭時(shí)淚少，尿量顯著減少。護(hù)理體檢：T388，體重85kg，精神萎，眼窩及前囪凹陷，皮膚彈性差；口唇呈櫻桃紅

8、，呼吸深快，心率120次分，律齊，兩肺呼吸音稍粗，腹軟，肝肋下1 cm，脾肋下未觸及，腸鳴音亢進(jìn)。大便為黃水樣，未見膿細(xì)胞。血生化：血鈉135mmolL，血鉀4mmolL.2020/10/136case 患兒，男性，1歲。因嘔吐、腹Anatomy and physiology of the childhood digestive systemMouthEsophagus and stomachIntestine LiverPancreasStool patterns of infant2020/10/137Anatomy and physiology of the Mouth The newb

9、orn is capable of sucking, swallowing, and holding food in the mouth. By the end of the five months the salivary glands have gradually increased in size to reach their function.Esophagus and stomachAt birth the capacity of the stomach is only about 3060ml. Stomach lies horizontally after birth and t

10、hen gradually elongates assume the shape and anatomic position of the adult until at about 7 years of age.The acidity of gastric juice is low during infancy and enzymes are usually not present in sufficient quantities. Thus, the function of digestion is immature and abdominal distention from gas is

11、common.2020/10/138Mouth The newborn is capable oIntestine The length of the intestine in infants is 57 times longer than his/her height.The infantile digestive tract is characterized by relative large digestive surface and thin intestinal wall, which may result in greater absorption of immunoglobuli

12、n in breast milk, however quick absorption of intestinal toxin and undigested food also happen, which may cause toxicosis or allergic reaction. This perhaps explains the young childs susceptibility to gastrointestinal allergic problems.Liver Liver function is also immature. The newborn and infant pr

13、oduces only small amounts of bile and insufficiently digest and absorb fat.Pancreas Because the activity of amylase is low within 6 months and it gradually presents in sufficient quantities after 1 year old, the digestion of starch is immature within 3 to 4 months.2020/10/139Intestine The length of

14、the inStool patterns of infantMeconium Breast-Fed infantsFormula-Fed infantsA dark-green, viscous material without special odorYellow to golden, pasty in consistency, an odor similar to that of sour milk.Pale yellow to light brown, firmer in consistency, more yellow in color.2020/10/1310Stool patter

15、ns of infantMeconiFluid and electrolyte balance and fluid therapyCharacteristics of fluid and electrolyte balance in childrenImbalances of fluid, electrolyte and acid-alkaliFluid therapy2020/10/1311Fluid and electrolyte balance Age intracellularextracellularTotal body fluidInterstitialPlasma newborn

16、35405801Yrs4025570214Yrs4020565Adult 4045101555560Body fluid distribution in different age (%)2020/10/1312Age intracellularextracellularNon-Electrolytical SolutionElectrolytical SolutionCombined SolutionConfecting Common Solution5%and 10% dextrose0.9%NaCl; 1.4%NaHCO3;10%KCl;Composed of dextrose(5%or

17、10%);10%NaCl;5%NaHCO3;2020/10/1313Non-Electrolytical SolutionEleMild dehydrationModerate dehydrationSevere dehydrationWeight loss=10%General appearanceAlert, restlessLethargic, irritableComatose Skin elasticityDecreased Moderately decreasedMarked decreasedAnterior fontanellesLevel or flatSlight sunk

18、enSunken TearsPresent Decrease Absent Thirst Slight Moderate Severe Mucous membranesDry Very dry Parched Urine outputDecreased Oliguria Marked oliguria Blood pressureNormal Normal or loweredLowered pulseNormal or increasedIncreased Rapid, threadyDegrees of dehydration and clinical manifestation2020/10/1314Mild dehydrationModerate dehyd5%or 10% dextrose (ml)10%NaCl(ml)5%NaCO3(ml)Osmolality 2:1 solution5003047Isotonic1:1 solution500201/2isotonic2:3:1 solution50015241/2isotonic4:3:2 solution50020332/3isotonic1:2 solut