北港溪水系上游支流治理原則說明怎樣思想，就有怎樣的生活北港溪水系上游支流治理原則說明北港溪水系上游支流治理原則說明怎樣思想，就有怎樣的生活Caringforchildrenwithgastrointestinaldysfunction

—Chap17壹、評估貳、小兒常見腸胃道疾病壹、評估（補(bǔ)）健康史進(jìn)食狀況營養(yǎng)狀況家庭狀況主要照顧者的衛(wèi)生習(xí)慣排便情形診斷性檢查血液檢查、糞便檢查、特殊技術(shù)（LGI、UGI、、）身體檢查身體外觀口腔感染腹部評估Clinicalmanifestations

P603第2段

OnsetisabruptAcuteabdominalpain（periodsofcomfortbetweenacuteepisodesofpain）VomitingPassageofbrownstool→becomeredandresemblecurrantjellyApalpablemassmaybepresentintheupperrightquadrantormid-upperabdomen腹部呈柔軟、膨脹疲倦、虛脫發(fā)燒及腹膜炎之其他徵象

右下腹區(qū)排空（Dance徵象）DiagnosisP603第2段

HistoryRadiographsandultrasoundoftheabdomenBariumenemaTreatmentP603第3段

Hydrostaticpressure靜水壓—BariumenemaOxygen（air）、saline、aqueouscontrastmaterialSurgerySupportivecare液體補(bǔ)充鼻胃管減壓抗生素NursingmanagementPostOPMonitoringforearlysignsofinfectionPainmanagementMaintainNGtubepatency

Assessvitalsigns、Abdominaldistention、

Listenforbowelsoundsevery4hoursAfternormalbowelfunction

Clearliquidfeedinghalf-strengthmilkandotherfoods

MaintainfluidandelectrolytebalanceAppendicitis

P609

EtiologyandpathophysiologyResultfromanobstructionintheappendiceallumen

Causedbyafecalith，parasiticinfestations，stenosis，hyperplasiaoflymphoidtissue，oratumorObstructioncontinuedsecretionofmucus→pressure↑→ischemia，cellulardeath，andulcerationComplication：perforationorrupture→peritonitis→smallbowelobstruction，electrolyteimbalances，septicemia，andhypovolemicshockIsaninflammationofthevermiformappendix.Mostofteninadolescentboys（10-19y/o）；rarelyseenbefore2yearsofageInflammatorydisordersClinicalmanifestationsPainFever,vomiting,diarrhea,constipationP610第2段

Motionless,side-lyingpositionwithkneesflexedSomechildrenAppendixisinadifferentlocation

P609最後1行

DifferentiationP609此段第2行

OvulationRupturedectopicpregnancyPelvicinflammatoryCaution：

Pain

Periumbilicalcramps，abdominaltenderness第1行→painintherightlowerabdomenbecomeconstant第4行

Mostintensehalfwaybetweentheanteriorsuperioriliaccrestandumbilicus→rigidityandreboundtenderness

P610第2行→ifsuddenreliefofpain（ruptured）Signsandsymptomsofarupturedappendixinclude

P609右上

FeverSuddenrelieffromabdominalpainGuardingAbdominaldistentionRapidshallowbreathingPallorChillsIrritabilityorrestlessness

Diagnosis

—evaluationoverseveralhoursP610

WBC↑（teenagers）第2段

AbdominalpainX-rayAbdominalultrasoundFocusedappendicealcomputerizedtomography（FACT）Treatment

第3段Preoperatively

NPO&NGdecompression

IVfluids&electrolytesAntibioticsAppendectomyPostoperatively

AntibioticsIfrupturedPenrosedrainWoundirrigations

Nursingmanagement

PromotecomfortMaintainhydrationProvideemotionalsupportRecognizesymptomsofinfectionSupportrespiratoryfunctionDischargeplanningandhomecareteaching

Disordersofmotility

Diarrhea因消化、吸收及分泌不正常所導(dǎo)致的癥狀特徵：（1）明顯或突然的增加排便次數(shù)（2）含水量增加、性狀的改變（3）糞便傾向綠色並含有黏液或血液?？赡苁羌毙曰蚵浴l(fā)炎或沒發(fā)炎，一般和發(fā)炎有關(guān)的腹瀉通常被敘述成腸胃炎。

Disordersofmotility急性腹瀉：糞便在次數(shù)及性狀上的突然改變，通常是因?yàn)閭魅拘圆≡此斐傻难装Y反應(yīng)所致。慢性腹瀉：持續(xù)兩週以上的腹瀉情形，如吸收不良癥候群。

DisordersofmotilityGastroenteritis（Acutediarrhea）P617

Isaninflammationofthestomachandintestines第1段

VomitinganddiarrheaInfantsandsmallchildrenwithgastroenteritisordiarrheacanquicklybecomedehydratedandareatriskforhypovolemicshock.DisordersofmotilityEtiologyandpathophysiology（P617第2行）

Decreaseintheabsorptivecapacity、decreaseinsurfaceareaforabsorption、alterationofparasympatheticinnervationHighrisk－day-carecenters、impropersanitation（第5～6行）

Causes（Table17-2）

DisordersofmotilityClinicalmanifestations

P617Mild－SlightlyincreasedinnumberandmoreliquidModerate－Severallooseorwaterystools－Irritability、anorexia、nausea、vomiting－Self-limitingSevere－Continuouswaterystools－Fluidandelectrolyteimbalance－Cramp、extremelyirritable、difficulttoconsoleDiagnosis

clinicaltherapy之第1段

HistoryPhysicalexaminationLaboratoryfinding－S/R、S/C、urinesp.gr

Presenceofova,parasite,infectiousorganisms,viruses,fat,andundigestedsugars.

Treatment

P618第2段Dependsontheseverityofthediarrheaandfluidandelectrolyteimbalances.Goal：correctthefluidandelectrolyteMildtomoderate－Oralrehydrationtherapy(Containwater,carbohydrate,sodium,potassium,chlorideandlactateP315

)－CarbonatedbeveragesandthosecontaininghighamountsofsugarshouldNOTbegivenSevere－IV（N/Swithglucose【onehalforonequarternormalsaline】orL/R）第3段

－NPO－Antiemeticsandantidiarrhealsshouldgenerallynotbeusedininfantsandyoungchildren.P618左下Lactose-freemilk,breastmilk,half-strengthmilk.P315倒數(shù)第4行

Nursingassessment

P618

Frequency,color,amountandconsistencyofstools第4行

TheamountandtypeofvomitusObservingdehydrationUrineoutputandspecificgravityWeightVitalsigns(Febrile)SkinintegrityNursingdiagnosis&managementP619AnxietyProvideEmotionalsupportSleeppatterndisturbance活動無耐力PromoterestandcomfortAlterednutritionEnsureadequatenutritionCRAM(Complexcarbohydrates,RiceandMilk)P619綠框DiarrhearelatedtoinfectiousprocessP620careplanFluidvolumedeficitP620

RiskforimpairedskinintegrityP621Dehydration

Chap10--P313Thereisnotenoughfluidintheextracellularcompartment.

Thestateofbodywaterdeficitiscalleddehydration.Sodiumisgenerallylostalongwithwater→hyponatremia

Etiologyandpathophysiology

CausesP313第1段第2行

Lossoffluidcontainingsodiumarevomiting、diarrhea、nasogastricsuction、hemorrhageandburnsRadiantwarmers第2段第2行AdrenalinsufficiencyandoveruseofdiureticsBulimicadolescentsBloodureanitrogen＞25mg/dL

clinicaltherapy第1段第3行

Serumbicarbonate＞17mEq/L

Medicalmanagement

P315Oralrehydrationtherapy－mildandmoderatedehydrationContainwater,carbohydrate,sodium,potassium,chlorideandlactateLactose-freemilk,breastmilk,half-strengthmilk

倒數(shù)第4行

IV－severely

P316第1段

L/R,onehalforonequarternormalsaline同腸胃炎之治療Nursingassessment

WeightI/OUrinespecificgravityConsciousnessPulserateandqualitySkinturgorandmucousmembranemoistureRespirationBloodpressureNursingmanagement

Provideoralrehydrationtherapyguidelines

Teachparentsoralrehydrationmethods

Monitorintravenousfluidadministration

DischargeplanningandhomecareteachingDisordersofmalabsorption

P627

包括各種不同程度的消化或吸收不良疾病。消化不良是指消化霉減少或缺乏的狀況，如囊性纖維、LactoseIntolerance。吸收不良是指腸道運(yùn)輸系統(tǒng)缺乏的狀況，可能是原發(fā)性缺損（如CeliacDisease）或續(xù)發(fā)性腸道發(fā)炎；解剖上之缺損，如shortbowelsyndrome，因物質(zhì)運(yùn)輸時(shí)間及吸收表面減少，而影響吸收。LactoseIntolerance

P628

EtiologyandpathophysiologyInabilitytodigestlactose（adisaccharide）第1行

AcongenitaloracquireddeficiencyoftheenzymelactaseCongenitalRare第3行

AcquiredHighest（約100％）amongAsianandNativeAmerican第5行

Clinicalmanifestations第4行

AbdominalpainFlatulenceDiarrhea

Diagnosis

第2段

HistoryHydrogenbreathtestLactose-freedietforconfirmingthediagnosis

Treatment

第2段

第4行

DietInfant－soy-basedformulaOlderchildren－eliminatinglactose-containingfoodsEnzymetablets

Nursingmanagement

SupportExplaindietarymodificationsanddiscussalternatesourcesofcalciumP337右下DiscusstheneedforsupplementationofcalciumandvitaminDReadfoodlabels

Shortbowelsyndrome（SBS）P628

Etiologyandpathophysiology

第1段

Itisadecreasedabilitytodigestandabsorbaregulardietbecauseofashortenedintestine.Causes：necrotizingenterocolitis（NEC）、inflammatorydisorders、congenitalbowelanomalyTheextentandlocationoftheinvolvedbowelde