北港溪水系上游支流理原則說明.ppt

Inflammatory disorders Caring for children with gastrointestinal dysfunction —Chap 17 壹、評估 貳、小兒常見腸胃道疾病 壹、評估（補） 健康史 ?進食狀況 ?營養狀況 ?家庭狀況 ?主要照顧者的衛生習慣 ?排便情形 常見腸胃道疾病 Intussusception P602 Etiology and pathophysiology 第1段 One portion of the intestine prolapses and then invaginates(陷入) or telescopes (使嵌入) into another.第1行 One of the most frequent causes of intestinal obstruction during infant Between the age of 3 months and 6 years Site：ileocecal valve 第2段 Telescoping of the Intestine obstructs the passage of stool. The walls of intestine rub together ? inflammation、edema、decreased blood flow ? necrosis、perforation、hemorrhage、 peritonitis In infant, intussusception is commonly associated with measles, viral disease, and gastroenteritis syndromes. P603 Fig17-7 Clinical manifestations P603第2段 Onset is abrupt Acute abdominal pain（periods of comfort between acute episodes of pain） Vomiting Passage of brown stool→become red and resemble currant jelly A palpable mass may be present in the upper right quadrant or mid-upper abdomen 腹部呈柔軟、膨脹 疲倦、虛脫 發燒及腹膜炎之其他徵象 右下腹區排空（Dance徵象） Diagnosis P603第2段 History Radiographs and ultrasound of the abdomen Barium enema Treatment P603第3段 Hydrostatic pressure靜水壓—Barium enema Oxygen（air）、saline、aqueous contrast material Surgery Supportive care 液體補充 鼻胃管減壓 抗生素 Nursing management Appendicitis P609 Etiology and pathophysiology Result from an obstruction in the appendiceal lumen Caused by a fecalith，parasitic infestations，stenosis，hyperplasia of lymphoid tissue，or a tumor Obstruction?continued secretion of mucus→pressure↑ →ischemia，cellular death，and ulceration Complication：perforation or rupture → peritonitis → small bowel obstruction，electrolyte imbalances，septicemia，and hypovolemic shock Clinical manifestations Pain Fever, vomiting, diarrhea, constipation P610第2段 Motionless, side-lying position with knees flexed Pain Periumbilical cramps，abdominal tenderness第1行 → pain in the right lower