儿科笔记整理.docx
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儿科笔记整理.docx
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儿科笔记整理
Chapter1Overviewofpediatricnursing
(加粗和下划线表示课件中的红字,只有下划线表示课件上只有下划线)
1.Focusesonthepatternofchildgrowthanddevelopment,childhealthpromotionanddiseaseprevention,anddirectcareofillnesschildren
2.Thenursingcareofchildrenfrombirthtotheendofadolescence:
Adolescencefrom11to21;InChinapediatricdepartmentonlyofferservicesforchild<14years;Internationalcommonpractice<18years
3.Stagesofgrowthanddevelopment:
名解(儿童年龄分期是重点)
⑴.Fetalperiodconception~birth胎儿期
⑵.Neonatalperiodumbilicalligation~28days新生儿期
⑶.Infantperiodbirth~1year婴儿期
⑷.Toddler’sage1~3years幼儿期
⑸.Preschoolage3~6years学龄前期
⑹.Schoolagebeginwithentryintoaschoolsystemandendwiththebeginningofteenage.(Girls:
7~11or12years/boys7~12or13yrs)学龄期
⑺.Adolescencebeginswiththegradualappearanceofsecondarysexcharacteristicsandendwithcessationofbodygrowth.
⑴Featuresoffetalperiod
Fromtheconceptiontoapproximately12weeksiscrucialperiod;Manycausescouldresultinabortion流产andcongenitalmalformation.
⑵FeaturesofNeonatalPeriod
Morbidity发病率andmortality死亡率ofneonatalisthehighest;
Perinatalperiod围生期:
commencesat28completedweeksofgestationandends7daysafterbirth.
⑶Featuresofinfantperiod
Growsandchangesdramaticallythananyothertime;Diarrheaandmalnutritionisthepotentialhealthconcern;Thetransplacental经胎盘的immunityiseffectiveonlyforabout3~6months;Infantsarevulnerabletoinfectiousdiseases.
⑷Featuresoftoddler’sage
Moreactivitiesandmorecuriosity;Atriskforaccidentalinjury
⑸Featuresofpreschoolage
Coordinationandmusclestrengthincreaserapidly.Developself-control,masteryandindependent.Acquirewidersocialrelationshipsandlearnrolestandards.Disciplinetrainingisnecessary.
⑹Featuresofschoolage
Lifecenterischangedfromthefamilygrouptothewiderworld.Childrenexperiencestressfromsocietalchange,school,competitionandmedia.Acriticalperiodinthedevelopmentofmental,social,moral.
⑺Featuresofadolescence
Physicalgrowthduringadolescenceissecondonlytoinfancy;Adolescencemaybeemotionallylabile情绪不稳,withextremehighsandextremelows.;Adolescencequestionthevaluesoffamilyandsociety
4.Thecharacteristicsofpediatricnursing
Physicalcharacteristics:
Immunology:
IgG,IgM,SIgA,ThenewbornreceiveIgGfromthemother,graduallydisappearin6month.
Categoryofdisease:
Morecongenitaldiseaseandinheriteddisease
Clinicalmanifestation:
Intensivemonitoringandactiveintervention
Prognosisandprevention:
Recoverrapidlyandlesssequela后遗症
Chapter2:
growthanddevelopment
㈠Part1Overviewofgrowthanddevelopment
1.Growth:
Anincreaseinmeasurablephysicalandphysiologicchanges.
Development:
Agradualchangeinfunctionandtheindividual’scapacities.
2.PrinciplesofGrowth&Development简答题
①Continuityandstagelike---Twodramaticstages:
Infantperiod;adolescence
②Ubalancedgrowthofeachsystem---NervoussystemdevelopearlierGenitalsystemmatureslaterLymphoidsystemdevelopsrapidlyinearlierchildhoodbutdeclineatlaterstage
③Directionofgrowth&development---Fromheadtotoe(cephalocaudal)从头至尾;Fromthemidlinetotheperiphery(proximodistal)靠近远端的;fromgeneraltospecific;Fromsimpletocomplex
④Individualdifferences
3.Factorsinfluencinggrowth&development
⑴Geneticfactor:
gender
⑵Environmentalfactors:
Nutrition;Prenatalfactors ;Environmentalconditions ;Diseases:
catchupgrowth
catchupgrowth追赶生长(名解):
isanacceleratedgrowthofanorganismfollowingaperiodofslowedgrowth,particularlyasaresultofnutrientdeprivation.
㈡Part2Physicalgrowthanddevelopment
1.Weight(W)体重数据记
ThepurposeofmeasureW(目的记住):
Indicationofgeneralnutritionandhealthstatusofchild;Acrucialindicatoroffluidstatus(Dehydrationandedema);thebaseofcalculatingdosage
Birthweight:
y(3.3±0.4)kg;girl(3.2±0.4)kg
3months:
Wdoubles(6kg);1year:
Wtriples(9kg);2years:
Wquadruples(12kg)
1-6months:
W(kg)=birthweight(kg)+months×0.7
7-12months:
W(kg)=6(kg)+months×0.25
2-12years:
W(kg)=ageofyears×2+7/8加7或者8
Physiologicalweightloss生理性体重下降(名解,选择):
Duringthefirstweekafterbirth,infantmayloss3%~9%oftheirweightduetotheinsufficientmilksupply,waterlossandmeconiumexcretion.Theweightlossreachesthepeakat3to4daysafterbirthandreturntothelevelofbirthweightat7to10daysafterbirth.
2.Heightorlength身高数据记
Newborn:
length50cm;1year:
length75cm;2years:
length85cm;2-12years:
H(cm)=ageofyears×7+75
Bodyproportionchanges:
1/4---1/8
3.HeadCircumference(HC)头围指标记住
HCisthelengtharoundabovethesupraorbitalridgesandoverthemostprominentpartoftheocciput.
2岁前更有价值newborn:
33-34cm;1year:
46cm;2years:
48cm;5years50cm;15years54-58cm
4.ChestCircumference(CC)胸围
Thelengtharoundthechestatthenippleline.
Newborn:
32cm;1year:
CC=HC;>1year:
CC>HC
5.UpperArmCircumference(UAC)上臂围:
Thelengtharoundmid-pointbetweenthetipoftheshoulderandthetipoftheelbow(olecranon鹰嘴andtheacromion肩峰)
6.Growthofskull颅骨发育(闭合时间考)
Anteriorfontanel前囟Closedbyage12-18months;
Newbornnormallyrangeinsizefrom1.5to2.0cm.
Posteriorfontanel后囟Closedbyage6-8weeks;cranialsuture颅骨缝:
Closedbyage3-4months
7.GrowthofSpine脊柱发育(记住)
3physiologicalarcuations3个生理弯曲:
3monthsappearcervicallordosis颈椎前凸;6monthsappearthoracickyphosis胸椎后凸;1yearappearlumbarlordosis腰椎前凸
8.GrowthofLongbones
thenumbersofossificcenters骨化中心=age(year)+1,10岁出全,共10个
9.GrowthofTeeth
Theeruptionofdeciduous/primaryteeth乳牙beginsaround4-10months.All20deciduousteetharepresentby2.5yearsofage.Permanentteeth恒牙usuallyeruptaround6years.Theexchangeofteethbeginbyage6yearsandendby12years.All32permanentteetharepresentbyage20-30years.
10.GenitalSystemDevelopment
precociouspuberty性早熟-Ingirls,theappearanceofthesecondarysexualcharacteristicsbefore8yearsofage.-Inboys,before9yearsofage.
delayedpuberty性发育延迟-Ingirls,thelackofdevelopmentofthesecondarysexualcharacteristicsby14yearsofage.-Inboys,by16yearsofage.
㈢Part3Psychosocialdevelopment神经心理发育
1.Neurologicdevelopment
Newborn:
thecordendsatleveloftheinferiormarginofthesecondlumbarvertebrae脊髓下端在胎儿时位于第2腰椎下缘.4yearsold,thecordatthelevelofthefirstlumbarvertebrae.Someprimitivereflexesdisappeargradually.Rootingreflex觅食反射;Suckreflex吮吸反射;Graspingreflex握持反射;Mororeflex拥抱反射;TheBabinskireflexispresentinchildren<2y.
2.Motordevelopment
Newbornandtheinfant3个月抬头,5个月翻身,6个月坐,9-12个月拉着站起来,15个月走路
By3months,theinfantcanliftheadfromapronepositionandcanholditsteadilyerectinasittingposition.
The4-month-oldinfantcaneasilyliftherheadfromapronepositionandholditsteadilyerect.
Theabilitytowillfullyturnfromthebacktotheabdomenoccursat5months.(Rolling)
6-month-oldinfantscansitalone,leaningforwardontheirhands.Cangraspobjects,evensmallones
At6to9months,theinfantbeginstoexploretheworldbycrawling爬.
By6to7months,theinfantcantransferobjectsfromonehandtoanother.
At9to12months,theinfantscanpulltoastandingposition.
By15months,mostchildrencanwalkalone.
Thetoddler-Mosttoddlerscanfeedthemselveswithaspoonby2-year-old.
Thepreschoolchild-Byage4or5,thechildcandressherself,eat,andgotothebathroomwithouthelp.
3.Cognitiveandsensorydevelopment
⑴Newborn:
Abletofixateonmovingobjectwhenheld15~20cmaway.
Doll’seyereflex,Respondstoloudnoisebystartlereflex精跳反射.
Theneonatesprefersweettastesandwillturntowardhermother’smilk
⑵Theinfant
At3to4monthsbinocularvisionandconvergenceonobjectsarewelldeveloped.
The5to7montholdinfantcanadjustsposturetoseeanobjectanddevelophand-eyecoordination.
Atage3-4months,theinfantshouldturnhereyesandheadtowardasoundcomingfrombehind.
By10months,theinfantsshouldrespondtothesoundsoftheirnames.
⑶Thetoddler
-Duringthisperiod,thechild’sconceptoftimeisstillimmature.
-Whentalkingwiththetoddler,thenurseshouldusetimeorientationinrelationtofamiliaractivities.
1.Yourmotherwillbehereafteryournap午睡.(Better)
2.Yourmotherwillbehereat2:
00pm.
⑷Thepreschoolchild
-Thechildendow赋予inanimateobjects无生命的物体withlifelikequalitiesduringplay.(animism泛灵论)
-Itistherapeutictoallowachildtoplaywithmedicalequipmentafteraninjection.Thechildcanfindworkingoutherfeelingsbygivingherdoll“abigshot”
4.Languagedevelopment
⑴Theinfant
-By3to5weeksofage,theinfantswoulddisplayasocialsmile.
-Iftheinfantdoesnotdisplayasocialsmilebytheageof8to12weeksneedsfurtherevaluationbecauseofthepossibilityofdevelopmentaldelay.
⑵Thetoddler
-Mostchildrencancommunicateverballyby2-year-old.
-It’sanimportantperiodtolanguagedevelopmentfrombirthto6years,especiallyfrom2-4years.
-Don’tusechildren’wordstocommunicatewiththechildrenafterage2years.
⑶Thepreschoolchild
-Byage4,childrenmayusespeechaggressivelyandmayuseprofanitytogainattention.
-“Bad”languageshouldbeignored,deprivingthechildofreinforcementofthebehavior.
5.AssessmentoftheDevelopment
Screeningtest-
Thedenverdevelopmentscreeningtest(DDST);PPVT;goodenoughdraw-a-persontest;
Diagnostictest-BSID;Gesellscalesofdevelopment;Standford-Binet;WPPSI;WISC-R;
Part4Commonbehaviorproblemindevelopment
Tempertantrums
-Toddlersmayscream,kickandthrowthings
-Themosteffectivemethodforhandlingistoisolate
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