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【医学ppt课件】一位學齡前兒童泌尿道感染之護理經驗

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Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 一位學齡前兒童泌尿道感染之 護理經驗 四年愛班 劉芮圻 實習單位:若瑟PED病房 指導老師:任沛淳 1 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 前言前言 ‧泌尿道感染在小兒科是一種常見的疾病 ,迅速確立診斷,及早積極治療與追蹤 這些病童,避免腎臟受到不可挽回的傷 害,防止慢性腎衰竭與末期腎病變的發 生是相當重要的(吳,無日期)。 2 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 文獻查證 • 新生兒的泌尿感染通常發生在男孩,是因細 菌經由尿路逆行上去、免疫系統發育未成熟 、男嬰包皮過長合併有尿路結構異常、排尿 或排便習慣不良(陳,1995)。 • 致病菌:最常見的是大腸桿菌。 • 危險因素有水分攝取不足、內褲或尿布穿著 不當、憋尿、尿液滯留會增加泌尿道感染的 危險性,其原因有解剖結構異常、功能不正 常(如神經性膀胱),最常見的結構異常是膀 胱輸尿管逆流(蔣、蔡、吳,2009)。 3 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 臨床情形 ‧個案性別為女生 ‧年齡為六個月 ‧尿液培養未找出感染菌種,續觀察。 4 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 臨床表徵 • 嬰幼兒的症狀通常較模糊,可能有無法解釋 的發燒、哭鬧不停、食慾減低、餵食困難、 體重減輕、昏睡急尿臭味。 • 較大的兒童的症狀有: – 上泌尿道感染:發燒、腹瀉及腰窩疼痛。 – 下泌尿道感染:頻尿、解尿困難、急尿、遺尿 ,不會出現明顯的發燒症狀。 • 合併症菌血症及敗血症,若發燒超過38℃通 常已引起腎臟發炎(蔣、蔡、吳,2009)。 5 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 臨床情形 • 04/05發燒至39.8℃,嘔吐兩次。 6 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 相關檢查 • 尿液分析:可能出現乳白色尿、綠色尿、混濁尿或膿 尿,尿液中會出現圓柱體及多量的白血球。 • 尿液培養:於恥骨上抽取尿液培養單一菌種或取中 段尿以集尿袋,導尿方式取得培養的株種每毫升大 於105即可確定診斷。 • 排尿性膀胱尿液攝影:為了進一步了解是否有尿液 系統如阻塞或畸型存在,則膀胱排空檢查(VCUG )及腎臟脈攝影(IVU)都是不可或缺的診斷工具, VCUG除了可以生動的顯示出膀胱輸尿管逆流的情 形,並可描繪出膀胱及尿道外形(蔡、黃、李、林 1987)。 • 血液常規檢查:上泌尿道感染時血中白血球時常升 高。 7 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 臨床情形 • 4/5 U/A – Appearance:Turbid – Leucocyte esteras: 3+ • 4/5 CBC – WBC 14.89K/uL – Hb 10.6g/dL – HCT 31.3% – MCV 76.2fL – HCH 25.8Pg • 4/9 U/A – Sp.gr 1.005 – Leucoyte esteras:1+ 8 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 醫療措施 • 泌尿道最主要是給抗生素治療,抗生素使用若認為 是一急性腎盂炎,則應考慮靜脈注射兩種抗生素使 用,若僅是膀胱炎、尿道炎只給予口服抗生素一種 ,用藥時間為10~14天為多,療程不能中斷,不過 應以臨床症狀、尿液培養結果作為是否繼續給藥的 指標,在療程結束後需再收集一次尿液檢查作尿液 培養,已確定沒有菌落存在,痊癒後應至少每1~3 個月追蹤一次(陳,1995)。 • 對於2個月~2歲的病童若出現脫水症狀,有嘔吐且 無法餵食且無法配合藥物治療出現敗血症菌血症, 通常會建議住院接受靜脈注射抗生素的治療。 • 若有尿路結構異常時應以外科方式矯治,或長期投 與預防性藥物,並密切追蹤腎功能之變化。 9 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 臨床情形 • 4/6~4/11依醫囑給予 – Cefa 2c.c./IVD/Q6H – Gentamicin 0.4c.c./ IVD/Q8H – Taita(No.2)/Keep10ml/IVD/hr 10 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 護理措施 ‧每六小時監測生命徵象 ‧衛教病童家屬預防泌尿感染的方法: –勤換尿布。 –上廁所前後應洗手,女病童宜注意會陰部清潔, 清潔方向由尿道口向後到肛門擦拭,減少感染機 會。 –鼓勵喝蔓越莓汁可以酸化尿液以減少細菌滋生( 可以每日喝一杯,持續一週) –避免泡澡與使用有香味的肥皂,以減少刺激尿道 (蔣、蔡、吳,2009)。 11 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 臨床情形 • Q6H測量生命徵象 • 4/7衛教勿等尿布全濕才更換,約2~3小時更換一 次。 • 洗澡時避免泡澡及使刺激性沐浴乳,以免尿道過 於刺激。 • 擦拭時要由尿道口往肛門口,不來回擦拭。 • 鼓勵飲用可酸化尿液之飲品,如:蔓越莓汁。 – 由於個案6個月,消化系統不如成人,所以要觀 察3~5天飲用後有無腹瀉、嘔吐、出疹或皮膚 泛紅的症狀即可持續飲用。 12 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 個案基本資料 • 姓名:林○忻 • 床號:0425 • 性別:女 • 生日:98年9月17日 • 診斷:泌尿道感染 (UTI) • 住院日期/出院日期: 99/04/05;99/04/11 • 護理期間: 99/04/06~99/04/09 • 宗教信仰:無 • 家中排行:老二 • 語言:國語 13 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ‧過去病史:無過去病史及過敏症。 4/3發燒到耳溫39.8℃,鼻塞曾至診所求診,因反覆 發燒故自急診後。 4/5入院觀察。 4/6每3~4個小時更換一次尿布,依醫囑給予Cefa 2CC/IVD/Q6H、Gentamicin 0.4㏄/ IVD/Q8H、 Taita(No.2)/Keep10ml/IVD/hr。 4/6~4/9測量耳溫維持在36.4~37.1℃,護理期間未 有發燒情形,續觀察。 14 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 家庭評估-家庭樹 15 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 身高、體重之生長發展曲線 (百分位點)狀況 ‧體重之生長發展曲線:體重7.3公斤,位於 25~50之百分位之間。 ‧身高之生長發展曲線:身高68公分,位於 75~90之百分位之間。 16 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. DDST測驗結果 ‧個人-社會性方面:除了不會說話表示其於 都可達成。 ‧精細動作-適應能力方面:除了不會將積木 換隻手之外剩下的精細動作都可完成。 ‧語言方面:除了不會具體說話表達,剩下 皆可達成。 ‧粗動作方面:還不會站立,一般坐著(需協 助)及翻身都可達成。 17 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 利用Freud、Erikson及Piaget的理 論分析其發展情形 18 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 氣質量表 19 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 氣質量表-續 20 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 護理評估-身體評估 ‧GCS:E 4 M 6 V 5;個案意識清楚、行為 正常、精神狀況良好 。 • 生命徵象: 21 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 身體評估(二) ‧胸部:胸腔大小適中、有對稱性。 ‧肺:無咳嗽、呼吸平順、無呼吸困難。 ‧心臟:無肥大、無異常之心雜音。 ‧乳房:無淋巴結腫大、無壓痛、無甲狀腺腫。 ‧腹部:外觀無疤痕。 ‧消化道:食慾佳、有脹氣、無吞嚥困難、無便秘、腹瀉、無疝 氣、無排尿習慣改變、無噁心、嘔吐、左上腸音蠕 動,一分鐘約12次/分。 ‧生殖泌尿道:大小陰唇無粘合,尿道周圍皮膚微紅,有些許白 色分泌物。 ※健康問題:1.與不知預防泌尿道感染的方法有關2. 與藥物使用不瞭解有關 22 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 身體評估 ‧肌肉骨骼系統:四肢活動情形佳、無關節腫脹、 肌肉張力佳、無脊柱側彎、無雙腿長度不等、無 膝內翻、運動感覺功能良好。 ‧神經系統:(kernig`s sign)、(brodzinski`s sign)-皆能做到,沒有疼痛及不適之動作及行為 ‧(babinski`s sign)-自腳跟到小趾,通過腳掌到 大拇指,一開始收縮後展開。 23 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 日常生活習慣(二) 24 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 日常生活習慣(三) 25 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 日常生活習慣(四) 26 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 血清檢驗4/5 27 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 細菌檢驗4/5 28 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 尿液檢驗4/5 29 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 尿液檢驗(續) 4/5 30 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 尿液沉渣(續)4/5 31 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 血液檢查4/5 32 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 血液檢查(續)4/5 33 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 血液檢查(續)4/5 34 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 尿液檢驗(續) 4/9 35 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 尿液檢驗(續) 4/9 36 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 尿液檢驗(續) 4/9 37 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 藥物 38 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. (八) 護理計劃 護理計劃(一):潛在危險性損傷/ 與感染造成腎臟功能異常有關 護理計畫(二):知識缺失/ 與1.不知預防泌尿道感染的方法有關 與2.與藥物使用不瞭解有關 39 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 肆、結論與討論 40 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 陸、參考資料 李宏昌、林金龍、黃富源、蔡淳娟(1987)‧兒童期泌尿道感染之探討放 射線超音波檢查‧中兒醫治,28(1),17-20。 柯惠玲、金幼婷、陳瓊瑤、黃雅雯、楊惠娟、張文軫、梁香、祁安美、 胡月娟、陳麗津、陳玉娟(2008) ‧幼兒期‧楊惠娟編著‧新編人類 發展學(初版,5-9頁)‧台中:華格那。 吳佩玲、蔡綠蓉、蔣立琪(2009)‧兒童泌尿生殖系統疾病與護理‧張 淑敏編著‧實用兒科護理(三版,12~-16頁)‧台北:永大。 吳佩玲、蔡綠蓉、蔣立琪(2009)‧緒論‧吳佩伶、蔣立琦編著‧實用 兒科護理(三版,22~-27頁)‧台北:永大。 周正修、張景勳、劉澤宗、羅慶微(2006)‧非複雜性泌尿道感染的診斷 與治療‧基層醫學,21(10),283-289。 周幸生、歐嘉美、蔡素華、康百淑、葉明珍等(2008)‧新臨床護理診
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