【精品】II儿童常见呼吸系统疾病.pptVIP

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 assessment 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 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) 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, but 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 edematous→Eustachian tube blocked →air in the middle ear is reabsorbed into the bloodstream→fluid is pulled from the mucosal lining into the former air space→infected. 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, 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 examination.第1段第1行 Otitis medial : red, bulging, nonmobile tympanic membrane圖19-7 Otitis medial with effusion : fluid line or air bubble