Observation on the effect of nebulizer inhalation therapy combined with nurse's hole-course nursing intervention mode for children pneumonia

ZHANG,Lingyi,JI,Yiping

【Abstract】Objective:To observe the effect of using nebulizer inhalation therapy combined with nurse's whole-course nursing intervention mode in children pneumonia.Methods:86 children with pneumonia in pediatrics from September 2020 to August 2021 were selected and all of them were included in the study.According to the random number table method,it was pided into the whole course group(43 cases)and the control group(43 cases).All the children were treated with nebulizer inhalation,the whole course group was combined with nurse's whole course nursing intervention mode,and the control group was combined with routine nursing.Blood gas analysis,lung function and clinical symptoms were observed in the two groups.Results:PaO2,FVC,FEV1,PEF in group B were higher than those in control group,while PaCO2,disappearance of lung rales,antipyretic time,disappearance of cough and expectoration,and recovery of X-ray chest film were lower than those in control group(P<0.05).Conclusion:For children with pneumonia,when using nebulizer inhalation therapy combined with nurse's whole-course nursing intervention mode,the blood gas index and lung function index of children can be significantly improved,and the clinical symptoms can quickly subside,and the intervention effect is remarkable.

【Key words】Infantile pneumonia;Atomizer;Inhalation therapy;Whole-course nursing intervention model of nurses

The main cause of pneumonia is that bacteria,viruses,mycoplasma and other pathogens enter the lungs,causing inflammatory lesions in the lungs[1].Sick children will have respiratory symptoms such as fever,cough,expectoration,etc.In addition,some children will also suffer from anorexia,diarrhea,vomiting and other systemic symptoms due to the disease,which will greatly affect the healthy growth and quality of life of children.The disease is common in infants and young children and can occur in all seasons,but the probability of occurrence is higher in winter and spring.In clinical treatment of this disease,atomization inhalation is usually used.This method can make the drug mist enter the respiratory tract and reach the focus directly.It has fast effect,low drug dose,high local drug concentration,and few adverse reactions[2].However,due to their cognitive characteristics and poor treatment compliance,children need nurses to provide nursing services to guide children to cooperate with treatment.This study has a good effect on children with pneumonia in our hospital when the atomizer inhalation treatment is combined with the whole nursing intervention mode of nurses.The report is as follows.

1 Data and methods

1.1 Clinical data

Eighty-six children with pneumonia were selected from the pediatric department from September 2020 to August 2021,all of whom were included in the study.According to the method of random number table,they were pided into the whole process group(43 cases)and the control group(43 cases).There were 25 boys and 18 girls in the whole course group.The average age was(2.34±0.56)years.There were 26 boys and 17 girls in the control group.The average age was(2.34±0.56)years.Compare the clinical data of the two groups of children,the difference is not significant(P>0.05),and it is feasible to compare.The operation of this study is in accordance with the regulations of the Ethics Committee,and the family members have informed consent to the study.

Inclusion criteria:①children's pneumonia was confirmed by physical sign observation,imaging examination and pathological diagnosis;②No other medication was received before enrollment.

Exclusion criteria:①combined with other lung or important organ diseases;②Do not tolerate nebulizer inhalation treatment;③Transfer to hospital halfway and give up treatment.

1.2 Methods

All children were treated with nebulizer inhalation,while the control group was combined with routine nursing.Observe the condition of the child closely to ensure that the child can complete the atomization inhalation treatment in cooperation.Provide comfortable treatment environment for children,with fresh air,temperature of 18~22℃and humidity of 50%~60%.Atomization is used to carry out health education for family members and improve treatment and nursing compliance.Fasting 30 minutes before inhalation to avoid irritation of the trachea and esophagus caused by aerosol inhalation and vomiting.Children should not be exposed to allergens,and their diet should be light and easy to digest.

The whole process group combined with the whole process nursing intervention mode of nurses.(1)Before treatment.Nurses and family members actively communicate,so that parents can know the treatment process and efficacy in detail,so that parents can trust medical staff.Communicate with the child in a kind tone and attitude,tell the child that the treatment will not be painful,so that the child can cooperate with the treatment,and reduce the tension,resistance and behavior of the child.Clean the mouth and nose of the child in advance,remove the secretion,ensure that the respiratory tract of the child is unblocked,and make the drug work.Instruct the children on the method of atomization inhalation,slowly and deeply inhale,pause for a while at the end of inhalation,and let the mist penetrate into the lower respiratory tract.Tell the parents to erect and fix the atomizer to avoid the outflow of the liquid medicine,so that the liquid medicine can be fully inhaled.Prepare cartoons for children to help them cooperate with treatment.(2)In treatment.Instruct the children to inhale correctly and take deep breath to relax their body and mind.Check whether the installation and operation of relevant equipment are normal and whether there is air leakage to ensure the smooth and safe use of the instrument.The amount of inhalation should be from small to large with time,and the standard is children's tolerance.During the treatment,the face color and breath of the child shall be closely observed to ensure the smooth breathing of the child.If the child is crying,hindering treatment and other behaviors,it is necessary to appease the child in time,pert the attention of the child or wait for the emotional stability before treatment.Oxygen inhalation is also required from time to time during treatment.In cold seasons,it is also necessary to heat the liquid medicine first and then atomize it to prevent the cold air from causing respiratory tract contraction and aggravating cough or dyspnea.In case of frequent cough,shortness of breath,nausea and vomiting during treatment,children need to suspend inhalation and apply intermittent inhalation treatment.(3)After treatment.Rinse the mouth of the child immediately,wipe the mouth,nose and surrounding area with a sterile towel,and clean,disinfect and store the treatment equipment.After treatment,help the child turn over and buckle his back to expel sputum.If it is difficult to expel sputum,timely sputum suction intervention is required.

1.3 Observation indicators

The blood gas analysis,lung function and clinical symptoms of the two groups were observed.

1.4 Statistical analysis

The statistical software SPSS21.0 is used for statistical analysis of data.The measurement data is expressed in(±s)and t-test is performed.Inspection levelα=0.05。

2 Results

2.1 Blood gas analysis and lung function comparison between the two groups of children

PaO2,FVC,FEV1 and PEF in the whole process group were higher than those in the control group,and PaCO2 was lower than that in the control group,with a significant difference(P<0.05).See Table 1 for details.

Table 1 Blood gas analysis and lung function comparison of two groups of children（±s）

group	n	Blood gas analysis(mmHg)		Pulmonary function
		PaO2	PaCO2	FVC（L）	FEV1（L）	PEF（L/s）
Whole process group	43	69.75±5.85	43.56±6.63	1.39±0.14	1.29±0.14	2.95±0.24
control group	43	60.41±5.54	54.57±4.35	1.30±0.15	1.20±0.16	2.84±0.23
t	-	7.602	9.105	2.876	2.776	2.170
P	-	0.000	0.000	0.005	0.007	0.033

2.2 Comparison of clinical symptoms between two groups of children

The disappearance of lung rale,time of fever abatement,cough and expectoration,and recovery of chest X-ray in the whole course group were significantly lower than those in the control group(P<0.05).See Table 2 for details.

Table 2 Comparison of clinical symptoms between two groups of children（±s，d）

group	n	Lung rale disappeared	Antipyretic time	Cough and expectoration disappear	X chest radiograph returned to normal
Whole process group	43	5.24±1.75	3.65±0.52	4.56±1.68	5.65±1.86
control group	43	8.26±2.42	5.75±1.35	6.84±2.75	7.57±2.87
t	-	6.631	9.519	4.639	3.681
P	-	0.000	0.000	0.000	0.000

3 Discussion

Because the trachea and bronchi of infants are very narrow,the ciliary movement and clearance function are poor,the secretion of mucus is less,the development of lung elasticity is not perfect,blood vessel congestion is easy to occur,and the development of alveoli is not perfect,and the resistance of respiratory system is poor,so the younger the infants are,the higher the incidence of pneumonia is[3].The principle of clinical treatment is to control inflammatory reaction,improve ventilation and prevent complications.Generally,antipyretic,anti-inflammatory,antitussive,expectorant and antiasthmatic drugs are selected,but the treatment effect is not ideal.

The principle of using atomizer for inhalation treatment is to use gas jet to make water droplets collide with tiny droplets and suspend them in the gas to form aerosols,which enter the respiratory tract through inhalation[4].Due to the small size and uniform distribution of atomized droplets,the focus can fully contact with the drug,which can produce high local drug concentration,thus greatly improving the treatment effect[5].Budesonide is a commonly used aerosol therapy drug,which can directly act on mucosal cells,thus controlling respiratory inflammatory reaction,reducing inflammatory cells,and reducing mucus secretion[6].Terbutaline is an adrenergic agonist that can be selectively excitedβ2 receptors,so as to relax bronchial smooth muscle,relieve tracheal edema,and improve the movement clearance ability of cilia[7].The combination of the two drugs can produce excellent therapeutic effects.

The whole nursing intervention mode of nurses is a new and scientific nursing mode.Nurses actively communicate with children at work to make them understand that treatment will not cause pain,and treatment can improve the disease,so as to guide children to actively cooperate with treatment and greatly improve the treatment cooperation.During the atomization inhalation treatment,the nurse will adjust the amount of inhaled fog at any time according to the patient's affordability to avoid discomfort.When the child cries or feels unwell during treatment,the nurse will also timely appease the child and pert his attention,relieve the child's bad mood and discomfort through intermittent inhalation therapy,so that the child can successfully complete the treatment[8].

The results showed that after the whole process of nursing,the partial pressure of oxygen increased,the partial pressure of carbon dioxide decreased,the forced vital capacity,the forced expiratory volume and the peak expiratory flow rate increased,and the recovery time of lung rale,fever,cough,expectoration and X-ray chest film shortened.Embodiment of this nursing model can enhance the treatment effect and have a positive effect on the recovery of children's lung function.

To sum up,in the process of using atomizer inhalation therapy for children with pneumonia,combined with the nurse's whole-process nursing intervention mode,the blood gas index and lung function index of children were improved,and the time for symptoms to subside was shortened.

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