Nursing Care in Pediatric Respiratory Disease E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 614

Veröffentlichungsjahr: 2011

Beschreibung

Pediatric respiratory disorders are responsible for a number of acute and chronic health conditions and are a leading cause of pediatric emergency room visits and hospitalizations. More than ever, nurses and nurse practitioners must have an understanding of the anatomy, pathophysiology, diagnosis and state of the art treatments in pediatric respiratory disease as they are often the first to come in contact with and recognize respiratory problems in children. Nursing Care in Pediatric Respiratory Disease seeks to provide both nurses and nurse practitioners with this information in order to aid them in the diagnosis and treatment of children suffering from acute and chronic respiratory disorders. Nursing Care in Pediatric Respiratory Disease opens with an overview of the anatomy and physiology of the respiratory system, best practices for assessing respiratory symptoms in children, and common respiratory therapies and treatment methods. It then proceeds through an examination of varying acute and chronic upper and lower respiratory diseases spanning from asthma and cystic fibrosis to vocal cord paralysis and sinusitis in both hospital and ambulatory settings. Nursing Care in Pediatric Respiratory Disease provides nurses and other health care providers with a comprehensive and practical resource which allows them to collaborate and advocate more effectively, as well as educate both the family and child in management of respiratory disorders.

Leseprobe

Table of Contents

Cover

Title page

Copyright page

Dedication

Contributors

Preface

Acknowledgments

Reviewers

1 Pediatric pulmonary anatomy and physiology

INTRODUCTION

ANATOMY OF THE RESPIRATORY SYSTEM

RESPIRATORY AND NONRESPIRATORY FUNCTIONS OF THE LUNG

TRANSPORT OF GAS IN THE RED BLOOD CELL

ACID–BASE BALANCE

RESPIRATORY MECHANICS

CONTROL OF VENTILATION

2 Pediatric respiratory health history and physical assessment

RESPIRATORY HEALTH HISTORY AND PHYSICAL EXAMINATION

3 Principles of lung therapeutics

PRINCIPLES OF LUNG THERAPEUTICS

BRONCHODILATORS

INHALED CORTICOSTEROIDS

LEUKOTRIENE MODIFIERS

OTHER ANTI-INFLAMMATORY DRUGS AND IMMUNE MODULATORS

COUGH SUPPRESSANTS

EXPECTORANTS

DECONGESTANTS

INHALED ANTIBIOTICS

DELIVERY DEVICES

INHALER TEACHING DEVICE

PEAK FLOW METERS/FORCED EXPIRATORY VOLUME IN THE FIRST SECOND METERS

4 Neonatal lung disease: Apnea of prematurity and bronchopulmonary dysplasia

NEONATAL LUNG DISEASE

5 Lower airway disease

LOWER AIRWAY DISEASE

CONCLUSION

6 Upper airway disorders

ANATOMICAL AND PHYSIOLOGICAL CONSIDERATIONS OF THE PEDIATRIC AIRWAY

ASSESSMENT OF THE CHILD WITH AIRWAY DIFFICULTIES

ANOMALIES OF THE LARYNX AND TRACHEA

UPPER AIRWAY INFECTIONS

SINUSITIS AND RHINITIS

7 Asthma

ASTHMA

EPIDEMIOLOGY

PATHOPHYSIOLOGY

SIGNS AND SYMPTOMS

DIAGNOSIS

COMPLICATIONS

MANAGEMENT

NURSING CARE OF THE CHILD AND FAMILY

8 Cystic fibrosis

EPIDEMIOLOGY

PATHOPHYSIOLOGY

SIGNS AND SYMPTOMS

DIAGNOSIS

COMPLICATIONS

MANAGEMENT

NURSING CARE OF THE CHILD AND FAMILY

9 Obstructive sleep apnea

INTRODUCTION

EPIDEMIOLOGY

PATHOPHYSIOLOGY

SIGNS AND SYMPTOMS

DIAGNOSIS

COMPLICATIONS

MANAGEMENT

NURSING CARE OF THE CHILD AND FAMILY

10 Primary ciliary dyskinesia and bronchiectasis

PRIMARY CILIARY DYSKINESIA

BRONCHIECTASIS

11 Acute respiratory problems

INTRODUCTION

FBA

PNEUMOTHORAX

RESPIRATORY FAILURE

ACKNOWLEDGMENTS

Index

This edition first published 2012 © 2012 by John Wiley & Sons, Inc.

Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing.

Registered office: John Wiley & Sons Inc., The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

Editorial offices: 2121 State Avenue, Ames, Iowa 50014-8300, USA

The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

9600 Garsington Road, Oxford, OX4 2DQ, UK

For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell.

Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Blackwell Publishing, provided that the base fee is paid directly to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payments has been arranged. The fee codes for users of the Transactional Reporting Service are ISBN-13: 978-0-8138-1768-2/2012.

Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

Library of Congress Cataloging-in-Publication Data

Nursing care in pediatric respiratory disease / edited by Concettina Tolomeo. – 1st ed.

p. ; cm.

 Includes bibliographical references and index.

 ISBN-13: 978-0-8138-1768-2 (pbk. : alk. paper)

 ISBN-10: 0-8138-1768-4 (pbk. : alk. paper)

 1. Pediatric respiratory diseases–Nursing. I. Tolomeo, Concettina.

 [DNLM: 1. Respiratory Tract Diseases–nursing. 2. Child. 3. Pediatric Nursing– methods. WY 163]

 RJ431.N87 2012

 618.92'2–dc23

2011021938

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF 9780470962947; ePub 9780470962978; Mobi 9780470963005

Disclaimer

The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation warranties of fitness for a particular purpose. No warranty may be created or extended by sales or promotional materials. The advice and strategies contained herein may not be suitable for every situation. This work is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional services. If professional assistance is required, the services of a competent professional person should be sought. Neither the publisher nor the author shall be liable for damages arising herefrom. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read.

On the cover: The Vest® Airway Clearance System is a registered trademark of Hill-Rom Services, Inc. REPRINTED WITH PERMISSION-ALL RIGHTS RESERVED.

This textbook is dedicated to my parents,

Nicolantonio and Caterina Tolomeo

Contributors

Dawn Baker, MSN, CPNP, CCRC

Nurse Practitioner

University of Florida

Gainesville, FL

Anita Bhandari, MD

Assistant Professor of Pediatrics

University of Connecticut School of Medicine

Farmington, CT;

Division of Pediatric Pulmonology

Connecticut Children’s Medical Center

Hartford, CT

Kathryn Blake, PharmD, BCPS, FCCP

Senior Research Scientist

Center for Pharmacogenomics and Translational Research

Nemours Children’s Clinic

Jacksonville, FL

Rosalynn Bravo, BS, MS, APRN, CPNP, AE-C

Division of Pediatric Pulmonology

Connecticut Children’s Medical Center

Hartford, CT;

Adjunct Nursing Faculty

Capital Community College

Hartford, CT;

Clinical Instructor

Yale University School of Nursing

New Haven, CT

Michael Bye, MD, FAAP

Professor of Clinical Pediatrics

Attending Physician

Pediatric Pulmonary Medicine

Columbia University Medical Center

New York, NY

Melissa M. Dziedzic, MSN, CPNP, CORLN

Pediatric Nurse Practitioner

Connecticut Pediatric Otolaryngology

Madison, CT;

Lecturer in Surgery

Yale University School of Medicine;

Clinical Instructor in Pediatrics

Yale University School of Nursing

New Haven, CT

Lisa M. Gagnon, MSN, CPNP

Pediatric Nurse Practitioner

Connecticut Pediatric Otolaryngology

Madison, CT;

Lecturer in Surgery

Yale University School of Medicine;

Clinical Instructor in Pediatrics

Yale University School of Nursing

New Haven, CT

Antoinette Gardner, RN, MEd, CCRC, AE-C

Clinical and Research Nurse Coordinator

LSU Health Sciences Center

Pediatric Pulmonary

Shreveport, LA

Julie Honey, MSN, CPNP

Pediatric Nurse Practitioner

Summit Pediatric Pulmonology

Summit, NJ

Kimberly Jones, MD

Associate Professor

Chief, Pediatric Pulmonary

LSU Health Sciences Center

Shreveport, LA

Lewis J. Kass, MD

Founder

Westchester Pediatric Pulmonology and Sleep Medicine

Mount Kisco, NY;

Director

Pediatric Sleep Medicine

Pediatric Sleep Disorders Center at Norwalk Hospital

Norwalk, CT

Catherine Kier, MD

Associate Professor of Pediatrics

Stony Brook University School of Medicine;

Division Chief

Pediatric Pulmonary

Allergy and Immunology

Stony Brook Long Island Children’s Hospital

Stony Brook, NY

Wendy S.L. Mackey, MSN, APRN-BC, CORLN

Pediatric Nurse Practitioner

Connecticut Pediatric Otolaryngology

Madison, CT;

Lecturer in Surgery

Yale University School of Medicine;

Clinical Instructor in Pediatrics

Yale University School of Nursing

New Haven, CT;

Adjunct Faculty

Quinnipiac University School of Nursing

Hamden, CT

Neal Nakra, MD, FAAP

Pediatric Pulmonologist

Codirector

Cystic Fibrosis Center

St. Joseph’s Children’s Hospital

Paterson, NJ

Linda Niemiec, MSN, RN, CPNP

Clinical Instructor of Nursing

New York University

New York, NY

Concettina Tolomeo, DNP, APRN, FNP-BC, AE-C

Nurse Practitioner

Program Development

Director

Yale University School of Medicine

Department of Pediatrics

Section of Respiratory Medicine

New Haven, CT

Pnina Weiss, MD

Assistant Professor of Pediatrics

Section of Respiratory Medicine

Director of Subspecialty Resident Education

Yale University School of Medicine

Section of Respiratory Medicine

New Haven, CT

Marcia Winston, MSN, CPNP, AE-C

Certified Pediatric Nurse Practitioner

Certified Asthma Educator

The Children’s Hospital of Philadelphia

Division of Pulmonary Medicine

Philadelphia, PA

Preface

Pediatric respiratory disorders are responsible for a number of acute and chronic health conditions in the United States and worldwide. Nurses and nurse practitioners are often the first to come in contact with and recognize respiratory problems in children in either the school or a primary care setting. Therefore, the nursing profession as a whole must be knowledgeable in this area of care. The purpose of this book is to provide both nurses and nurse practitioners with the information required to safely and confidently care for children with common respiratory disorders and their families. The first three chapters of the book are intended to provide readers with a foundation for the specific conditions discussed later in the book. Chapter 1 presents an overview of the anatomy and physiology of the respiratory system; Chapter 2 provides a systematic approach to the assessment of a child with respiratory symptoms; and Chapter 3 provides information regarding common respiratory treatments and their methods of delivery. The remainder of the book details specific childhood respiratory conditions and their management in both hospital and ambulatory settings. The selection of which conditions to include was not an easy task as all conditions are important. However, the final conditions selected include a combination of common disorders encountered in both hospital and ambulatory settings and throughout the childhood years, from infancy to adolescence. Specific topic areas include apnea of prematurity, bronchopulmonary dysplasia, pneumonia, bronchiolitis, obstructive sleep apnea, foreign body aspiration, pneumothorax, respiratory failure, asthma, cystic fibrosis, ciliary dyskinesia, and bronchiectasis. Additionally, because the upper airway is so closely related to the lower airways, a chapter devoted to an overview of upper airway conditions has been included. Topics presented in this chapter include laryngotracheobronchitis, epiglottitis, vocal cord dysfuntion, vocal cord paralysis, laryngomalacia, rhinitis, and sinusitis. To make the book user friendly, each chapter follows the same outline, which includes epidemiology, pathophysiology, signs and symptoms, diagnosis, complications, management, and nursing care of the child and family. Furthermore, the book is written such that the roles of both the nurse and the nurse practitioner are addressed.

Respiratory illnesses and nursing are two areas that are near and dear to my heart. As an infant, I was diagnosed and hospitalized with laryngotracheobronchitis. In addition, as a child, when everyone else wanted to be a teacher or an actress and played school or dress up, I wanted to be a nurse. Therefore, I am both honored and privileged to have played a role in making this book a reality for all nurses and nurse practitioners interested in respiratory conditions. I hope that you enjoy the practical nature of this book and find it to be a useful reference during both your educational preparation as well as your career as a nursing professional.

Concettina (Tina) Tolomeo

Acknowledgments

I would like to thank the following people for helping make this book possible:

Dr. Kathleen Conboy-Ellis for making the initial proposal.

Shelby Allen and Melissa Wahl at Wiley-Blackwell for always being there.

The nursing schools at Southern Connecticut State University and Case Western Reserve University for providing excellent educational experiences.

My colleagues for their support and willingness to contribute to this worthwhile endeavor.

My patients and their families for teaching me the practical side of pediatric respiratory medicine and what it’s like to live with respiratory problems.

My family, mamma, papá, Elvira, Marisa, Giacomo, Greg, Kyle, Louie, Adriana, Antonia, Giana, and Nico, for their never-ending love and support and for being the best family a person could ask for. I love you!

C.T.

Reviewers

Alia Bazzy-Asaad, MD

Associate Professor of Pediatrics

Chief, Section of Pediatric Respiratory Medicine

Yale University School of Medicine

New Haven, CT

Aaron Chidekel, MD

Associate Professor of Pediatrics

Jefferson Medical College of Thomas Jefferson University

Philadelphia, PA

Chief, Division of Pulmonology

Nemours/duPont Hospital for Children

Wilmington DE

Melinda DeSell, MS, CRNP

Pediatric Nurse Practitioner

Division of Pediatric Otolaryngology

Johns Hopkins Hospital

Baltimore, MD

Marie E Egan, MD

Associate Professor of Pediatrics and Cellular and Molecular Physiology

Yale University School of Medicine

Section of Respiratory Medicine

New Haven, CT

Richard A. Ehrenkranz, MD

Professor of Pediatrics and of Obstetrics, Gynecology, and Reproductive Sciences

Division of Perinatal Medicine

Yale University School of Medicine

New Haven, CT

Antonina G. Evans, BPharm, RPh, AE-C

Clinical Consultant

Catalyst Rx

Las Vegas, NV

Edward Vincent S. Faustino, MD

Assistant Professor of Pediatrics

Yale University School of Medicine

Section of Pediatric Critical Care Medicine

New Haven, CT

Maureen George, PhD, RN, AE-C, FAAN

Assistant Professor

University of Pennsylvania School of Nursing

Family and Community Health Division

Center for Health Equity Research

Philadelphia, PA

Stephen Jones, MS, RN, CPNP, ET

Pediatric Clinical Nurse Specialist/Nurse Practitioner and Enterostomal Therapist

Children’s Hospital at Albany Medical Center

Albany, NY

Founder and Principal, Pediatric Concepts

Averill Park, NY

Holger Link, MD, MRCP (UK)

Clinical Associate Professor

Doernbecher Pediatric Sleep Disorders Program

Oregon Health & Science University

Portland, OR

Barbara Sabo, MSN, APRN, NNP-BC

APRN, Coordinator ECMO Program

Yale New Haven Children’s Hospital

Newborn Special Care Unit

New Haven, CT

Pnina Weiss, MD

Assistant Professor of Pediatrics

Section of Respiratory Medicine

Director of Subspecialty Resident Education

Yale University School of Medicine

Section of Respiratory Medicine

New Haven, CT

1

Pediatric pulmonary anatomy and physiology

Neal Nakra, MD, FAAP

INTRODUCTION

In ancient Greece, Erasistratus (304–250 BC), an anatomist and royal physician, was among the first to distinguish between veins and arteries. He described the function of the lungs was to bring air into the body to be transferred to the arteries and then into the heart (Mason, 1962). Our understanding of the anatomy and physiology of the human respiratory system has progressed significantly over the past 2,000-plus years. This chapter will explore the structure of the lung and describe the physiological properties that support ventilation and gas exchange through different stages of development of the respiratory system, from fetus to maturity.

ANATOMY OF THE RESPIRATORY SYSTEM

Embryology

To appreciate the complex physiology of breathing, one must understand the events that occur before the first breath is taken at birth. In utero, the lung does not participate in gas exchange. The responsibility of fetal oxygenation and elimination of carbon dioxide lies with the placenta until the lung takes over the process immediately upon transition from prenatal to postnatal life.

Lung growth in utero can be divided into five overlapping stages: (1) the embryonic period during the first 5 weeks, (2) the pseudoglandular period from 6 to 16 weeks of gestation, (3) the canalicular period from 16 to 24 weeks of gestation, (4) the saccular period from 24 to 36 weeks, and (5) the alveolar phase from 36 weeks to term and continuing for at least 3 years postnatally (Jeffery, 1998). The alveoli continue to multiply and grow during the first few years of life, following the growth in height of each child.

During the embryonic period, the primitive foregut, seen in the third week of embryogenesis, forms and is the origin of the lung. Over the course of the next 3–4 weeks, branches of the right and left lung form through budding and dividing (see Figure 1.1).

Figure 1.1 Development of the bronchial tubes and lungs.

Reprinted from Tortora and Derrickson (2009), with permission from John Wiley & Sons, Inc.

During the pseudoglandular period, there is a differentiation of the primitive airway epithelium (Post & Copland, 2002). At the time of branching, the bronchi are enveloped in the mesenchyme that develops into connective tissue, smooth muscle, and cartilaginous rings, among other things. By the end of the 16th week, the bronchial tree is developed without further formation of airways.

During the canalicular stage, further branching of the bronchioles leads to respiratory bronchioles. The lobules of the lungs start to form, and there is a decrease in interstitial tissue. The differentiation of cuboidal epithelium into types I and II pneumocytes begins at this time (DiFiore & Wilson, 1994). Cartilage starts centrally and proceeds peripherally, ending around the 25th week. It is at this point that the number of bronchial generations with cartilage is the same as the adult lung.

The saccular phase is the period when there is growth of the pulmonary parenchyma, continued development of the surfactant system, and a reduction in the connective tissue between the airspaces. During the alveolar period, branching becomes more extensive. There is an exponential increase in the surface area as saccules, which will eventually form alveoli, develop (Burri, 1984). It is during this time that surface epithelium and blood vessels come into even closer contact, allowing for the future exchange of gases. This process continues for at least 3 years after birth.

The fetal lung is the main source of amniotic fluid in the uterus. Abnormal lungs secondary to poor intrauterine growth are among the many abnormalities associated with a low amount of amniotic fluid. Type II pneumocytes appear in the alveolar epithelium and begin to function around the 24th week of life. These cells go on to produce a surfactant, which is a mixture of phospholipids and proteins. The surfactant decreases the surface tension of the lung, allowing for maturation and, upon delivery, expansion of the lung with the newborn’s first breaths. When expectant mothers begin premature labor, administration of glucocorticoids to the mother accelerates the maturation of type II pneumocytes and therefore the production of surfactants (Liggins & Howie, 1972). The molecular properties of surfactants and the physiological role they play is discussed in the section “Surface Tension Properties of the Lung.”