아동간호학 ( 각론 ) Child Health Nursing (Particular) 교과목명아동간호학 ( 각론 ) 간호학과 / 오원옥
12 차시 : 학습주제및학습목표 학습주제 :Ⅳ. 호흡기문제아동간호 1) 상기도감염아동간호 : 비인두염, 인두염, 편도선염 학습목표 : 1. 상기도감염아동과가족을위한간호방법을설명할수있다. 2
➍ 호흡기감염 1. Upper Respiratory Tract (URI) Infection ( 상기도감염 ) 1) Nasopharyngitis ( 비인두염 ) (1) 임상적징후 1 fever 2 점막자극증상 : rinorrhea( 콧물 ), 코막힘, 전반적인비인두울혈 3 불안정, 기면, anorexia 4 sneezing, increased lacrimation, rapsy sensation in the back of the throat 5 점막의과분비 : coughing( esp. at night) 6 바이러스성장염 7 증상의지속時 : bacterial superinfections of the tonsils, ears, sinuses, lower resp. tract 3
(2) 치료적관리 1 일반적인안위제공 : 2 국소부위의자극증세감소 : 3 antipyretics의사용 : 4 합병증의예방 : dehydration, otitis media, and secondary bacterial infection (3) 간호 1 maintaining effective airway : 2 조직의통합성유지 : 3 reducing fever and promoting comfort : 4 합병증을빨리 identify 할수있도록가족의교육 : 4
2) Pharyngitis( 인두염 ) * 합병증 : acute rheumatic fever(arf, 급성류마티스열 ) acute glomerulonephritis ( 급성사구체신염 ) (1) 임상적징후 1 갑작스러운발병 2Headache 3 Fever 4 Abd. pain 5 Exudate tonsil & pharynx(50~80% cares) 6 Complication: 인두후부종양, 부비동염 (2) 진단 1 인두배양 : to rule out GABHS(Grouping A β-hemolytic streptococcus) 2 Antistreptolysion (ASO) : 뒤늦게반응보임 retrospective diagnosis에유용 5
(3) 치료적관리 1 Viral infection: 대증치료 2 GABHS infection: penicillin treatment(for 10 days) 3 Throath pain: ibuprofen or AMP 투여 (4) 간호 1 Throat swab 2 약물투여방법에대한 guide 3 Cold or warm compress 4 Warm saline gargles 5 Cool liquid or ice chips: 인후통시식사도와줌 6 예방 : 항생제사용 24hrs 후까지유치원, 학교에등교시키지않는다. 6
nasopharyngitis (common cold, acuterhinitis,coryza) pharyngitis 부위 nose, pharynx pharynx etiology virus(rhinovirus) virus Group A Beta-hemolytic streptococcus epidemiology 가장일반적호흡기감염 1 세이하는드물고 4-7 세호발 7
3) tonsillitis and adenoids( 편도선염 ) (1) structure & Function of Tonsil : masses of lymphoid tissue encircling pharyngeal cavity ( 인두강을싸고있는림프조직의덩어리 ) 1위치 2기능 a. 병리적원인에대한상기도감염의예방을위해걸러냄 b. 항체의형성 3 크기 : children > adolescents, adults 8
(3) 병태생리 / 임상적증후 1 부종으로인한 palatine tonsil의비대 -> obstruction the pathway of air or food -> swallowing & breathing difficulty 2 adenoids 의비대 -> blocking the space behind the posterior nares -> 구강호흡 -> mucous membranes of the oropharynx become dry and irritated -> 구취 (mouth odor) 3 voice : nasal and muffled quality 4 persistent harassing cough 5 잦은 otitis media의발생 6복통 9
(4) 치료적관리 1 대증치료 2 편도선절제술 (tonsillectomy) : over 3-4 yrs 적응증 ; 지속적만성인후통 retropharyngeal obstruction으로인한호흡곤란 diphtheria 보균자 3 adenoidectomy : indications ; 반복적중이염 adenoids의비후 (5) 간호 1 수술에대한정보결핍으로인한불안감완화 2 수술비적응증에대한사정과수술후합병증예방 3 흡인의예방 4 인후통증으로인한연하곤란예방 5가정간호촉진 10
4) Otitis Media (OM, 중이염 ) - 삼출물이동반 or 비동반된중이의염증상태 - 초기아동기의가장일반적발병잘환중하나 - 삼출물의형태 : serous(thin watery) mucoid(thick and mucus like) purulent(pus-like) - acute O.M. : rapid onset lasting approximately 3 weeks subacute O.M. : 3-week to 3 month period during which an acute phase resolves chronic : persists longer than 3 months (1) 원인 / 빈도 ; 6개월에서 2세사이에호발후감소하다가 5-6세에약간상승, winter 11
(2) 임상적징후 1 급성 OM : upper respiratory infection (persistent fever, otalgia 동반 ) - infant or very young child -- crying, restless, irritable, tendency to rub hold or pull affected ear, rolling head side to side, discomfort - older child -- crying and/or verbalizes feelings of discomfort, irritability, 2만성OM : hearing loss, difficulty communicating, feelings of fullness, tinnitus, vertigo 12
3) 치료적관리 1 antibiotics 2 ear irrigation 3 myringotomy 4 tympanoplasty 13
(5) 간호 1 recognize overt and covert signs and symptoms 2 감염의요인제거 3 편안함촉진 4 fever 감소 5 facilitate drainage when appropriate 6피부손상예방 7재발예방 8부모교육 14
감사합니다.