SpontaneousPneumothorax

IntheNewborn

By:AngelaOliver-Piquette,CarlyJoAmen,KatieKappel,&MarjerieMalabanan堯仍隊控馭豬繼問賭彤闌給據(jù)鰓淄承贈性偉茍騙掛舉災(zāi)蔣賀鄒兆嗅堆隕僑SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax

Inth1OverviewDuringourclinicalexperienceatSt.Anthony’sNorth,wehadtheopportunitytoseemanybirths.Oneofthemostexcitingwasacesareandeliverythatpresentedwithaninfantwhodevelopedaspontaneouspneumothorax.Thoughitisrareininfants,aspontaneouspneumothoraxvariesfrom0.07%-37.5%ofalllivebirths.Wewouldliketotakethisopportunitytosharewithyouwhatwelearnedduringthisclinicalexperienceofthenewbornwithspontaneouspneumothorax.質(zhì)閱識省敵腔側(cè)崎亭瑞瓜牡岸通走棘彭器嗽元霉廖崔漠燈象戌肺葬臼呢笆SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)OverviewDuringourclinic2

Pathophysiology/Physiology

Apneumothoraxisalungdisorderinwhichairinthelungsleaksoutthroughaholeorholesinthelungtissueintothespacebetweenthechestwallandtheoutertissueofthelungs.Airleaksoccurwhenthealveolibecomeover-distendedandrupture.Somepneumothoraxininfantsoccurspontaneouslywhileothersareduetomeconiumaspiration,inwhichthefetusinhalesthefirststoolsinuteroandairbecomestrappedcausingover-distension.匪畏竄巢笛軍飽戳套仲隕緘顴啊吠若骸晦曰靶稼圖慷餾脾枉汕盆迭去掃斑SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)

Pathophysiology/Physiology

A3

PredisposingFactors:

PrematurityDifficultdeliveryNucalcordVigorousresuscitationMechanicalventilationRespiratorydistress醞胎翁寥撲喚刷科澀憐歪吼亂鎳墅曳權(quán)虧哪傳瓶講刀抄嵌佬紳斬格嵌盅鎢SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)

PredisposingFactors:

Prema4

Impact

Thistopichasthepotentialtohaveahugeimpactonneonatalnursing,thoughitdoesnotoccurveryfrequently.Knowingthepredisposingfactorsandlookingforthosenewbornsatriskwillensuretheyreceivethebest,appropriatecarefortheircondition.Newbornssufferingfromsomerespiratorydistressmustbewatchedcarefullyandincorporatefrequentchestradiographsiftheinfant’sconditiondeclines.皮藤賞庸翱喬濺譚履舊頗氰彈宿絮鼎歧醛磐錨蔣每閡影道沃獨背六攣隙陋SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)

Impact

Thistopichasthepot5Impact,conti.Additionally,knowingthesignsandsymptomsofnewbornrespiratorydistress,auscultationoflungsounds,andassessingchestexpansionisimperativetotheneonatalnurseswhomaybefacedwithapneumothorax.Ifnursesareeducatedaboutthistopicitwillensurethebestpossibleoutcomeforallneonateswithrespiratorydistress.兌沿鱗聽癰城液蜜河奶醋遠倘首阿漿似舵私萄入縮狠槳嘛父烴自熔櫻汁煮SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)Impact,conti.Additionally,kn6SignsandSymptomsRespiratorydistress:RapidbreathingGruntingNostrilflaringChestwallretractions

扎濤磋整玄芽印爪誠擋熄棱雷處棱葡秧諄震扁庸齡掇粟深脹伴仇啤燦嬸努SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)SignsandSymptomsRespiratory7SignsandSymptoms,conti.Sudden,unexplaineddeteriorationinthenewborn’sconditionDecreasedbreathsoundsApneaBradycardiaCyanosisIncreasedoxygenrequirements亮貓貶搗遼家梳畦有鐳唯忙銅枉閑猖探混囤曲蒜爸略夫陸尸滿久疑緊盞蠻SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)SignsandSymptoms,conti.Sudd8LateSignsandSymptomsMottled,asymmetricchestexpansionDecreasedarterialbloodpressureShock-likeappearanceShiftintheapicalcardiacimpulsetothesideoppositethepneumothorax,oftenwithmuffledheartsounds.HigherPCO?anddecreasedpH揪辛犁嗆醞馭讒潛陣巒養(yǎng)砰征斟衡巴龔礬宛裸棠羹簿賤尋乍錫呈膝老序岸SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)LateSignsandSymptoms揪辛犁嗆醞馭9DiagnosisX-rayexaminationisthemajormethodfordefinitivediagnosisofpneumothorax.Transillumination

ofthechestcanbeperformedforquickevaluationofthepneumothorax,butcanbeunreliable.氯旋淌倆犁甕陀疼三螢硒凸卒鋸嚨羽君能目蠱宛省港談疥宇主略嗽作茬適SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)Diagnosis氯旋淌倆犁甕陀疼三螢硒凸卒鋸嚨羽君能目蠱宛10TreatmentsThoracentesis

Hollowneedleorcannulaisinsertedintothepleuralspacetoreleaseair,allowingthelungtoreinflate.

Becausepneumothoraxispotentiallylife-threateningforanewborn,immediateremovalofaccumulatedairbythoracentesismaybewarranted.Thisprocedurecarriesariskofdamagingthelungpleurawithneedletracksasthelungreinflates.*Onlycanbeperformedbyspecificallytrainedpersonnel*銀寸癌椿蝸覺哄猜杯具廠沂獰整焦?fàn)a返禱檸阜守餐浦稽密爭魁疥廁攻棟窒SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)TreatmentsThoracentesis銀寸癌椿蝸覺哄11ThoracentesisProcedure賭胎情穴袁跋酌御他騾狡卻衣蛤癱承芍急葉垮橡備嘴相謂境斯墮舷返劈懼SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)ThoracentesisProcedure賭胎情穴袁跋酌12Treatments,conti.ChestTubeAchesttubecanbeinsertedintothepleuralspaceforcompleteresolutionofthepneumothorax.

*Thisprocedurecanonlybeperformedbyspecificallytrainedpersonnel.*畢胰層程棋韻玖耿圃慈恤信澇棵脖奉媒肝琢鉛鉻甥具郎函繩淫轅送耙箋瑯SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)Treatments,conti.ChestTube畢胰13AdditionalTreatmentsHoodorvent100%Oxygen膿唉墊貝芝扶猴辨迭歹懦鐘喀涎澗托梅闌柿灰凳鱉廷擇梁苛刃伊刺栓中音SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)AdditionalTreatmentsHoodorv14ImplicationsforNursingThemostimportantnursingfunctionincaringforinfantssusceptibletopneumothoraxisclosevigilance.Bealertforpneumothoraxin:

1.InfantswithRDSwithorwithoutpositivepressureventilation.

2.Infantswithmeconium-stainedamnioticfluid.

3.Infantswithradiographicevidenceofinterstitialorlobularemphysema.4.Infantswhorequiredresuscitationatbirth.5.Infantsreceivingcontinuouspositiveairwaypressureorpositivepressureventilation.

堅饋犁疇俗惟懂下兒敞似軋卡凍蝕欺錢摩若菱焚剩完伏士寓陵鉻先閃啟低SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)ImplicationsforNursing堅饋犁疇俗惟15ImplicationsforNursing,conti.Nursesworkinginareaswherepotentialforthiscomplicationishigh,suchasnewbornnurseries&NICUs,shouldbeabletoimmediatelyrecognizes/sofrespiratorydistressininfants.Initialmeasuressuchasassessmentofrespiratorystatus,administrationofO?,andimmediatelyalertingpractitionersofnewborn’sstatus.Additionally,nursesmusthaveneedleaspirationequipment(30-mlsyringe,3-waystopcock,and23to35gaugeneedles)atthebedsideforemergencyuse.愛蘑孺喂哪瑩腕官映睦徽馮折徊憨到虜百喊均妻摩迎鄂釘履倦匪咒場掄扒SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)ImplicationsforNursing,cont16CaseStudyBB,38wksgestation,lessthanonedayold.LGA,9lbs10oz.Cesareansection.MultiparaGestationaldiabetes.S/Snasalflaring,grunting,intercostalrespirations,centralcyanosis.O?saturationconsistentlybelow90%bySaO?monitor.賀日肄藉沿誣杯噪履岸社鍺罷稍沉芒濕薪刨毖隋年痹理屑農(nóng)砰蝸慎憑半上SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)CaseStudyBB,38wksgestation17Treatment:X-rayconfirmationofspontaneouspneumothorax.Humidified100%Oxygen@10litersviahood.Createdagradientinhislungssothatairtrappedinthepleuralspacewasabsorbedmoreeffectively.Within5to6hrs,BBwasweaneddownfromO?withSaO?ofabove92%.Atapproximately8hours,hoodremovedandBBabletomaintainabove95%SaO?w/nosupplementaloxygen.寸佐劫候叫坯拱商殿碗信麥澆授卞嚙常駛莆么編亭柜何華恫柴雖華牽洲洶SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)Treatment:X-rayconfirmationo18ReferencesDavidson,M.R.,London,M.L.,&WielandLadewig,P.A.(2008).Maternal-newbornnursing&women’shealthacrossthelifespan(8thed.).NewJersey:PearsonPrenticeHall.Hockenberry,M.J.(2006).Wong’snursingcareofinfantsandchildren.(8thed.).

St.Louis:Mosby.Logan,M.D.,Crispin,M.D.,&Pausa,M.D.(2010).Spontaneouspneumothoraxofthenewborn.AmericanCollegeofChestPhysicians,42,611-614.Singh,S.A.,&Amin,H.(2005).Familialspontaneouspneumothoraxinneonates.IndianJournalofPediatrics,72,445-447.SchneiderChildren’sHospital.(n.d.).HighRiskNeonate.Retrievedfromhttp://www./peds_html_fixed/peds/hrnewborn/pnethorx.htm.棕汛妹輿窖維繕晌卑靳憑訓(xùn)晉資猶耗噎臂哀遵感矣持綢蘆詛儉側(cè)餡矣舊向SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)ReferencesDavidson,M.R.,Lond19SpontaneousPneumothorax

IntheNewborn

By:AngelaOliver-Piquette,CarlyJoAmen,KatieKappel,&MarjerieMalabanan堯仍隊控馭豬繼問賭彤闌給據(jù)鰓淄承贈性偉茍騙掛舉災(zāi)蔣賀鄒兆嗅堆隕僑SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax

Inth20OverviewDuringourclinicalexperienceatSt.Anthony’sNorth,wehadtheopportunitytoseemanybirths.Oneofthemostexcitingwasacesareandeliverythatpresentedwithaninfantwhodevelopedaspontaneouspneumothorax.Thoughitisrareininfants,aspontaneouspneumothoraxvariesfrom0.07%-37.5%ofalllivebirths.Wewouldliketotakethisopportunitytosharewithyouwhatwelearnedduringthisclinicalexperienceofthenewbornwithspontaneouspneumothorax.質(zhì)閱識省敵腔側(cè)崎亭瑞瓜牡岸通走棘彭器嗽元霉廖崔漠燈象戌肺葬臼呢笆SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)OverviewDuringourclinic21

Pathophysiology/Physiology

Apneumothoraxisalungdisorderinwhichairinthelungsleaksoutthroughaholeorholesinthelungtissueintothespacebetweenthechestwallandtheoutertissueofthelungs.Airleaksoccurwhenthealveolibecomeover-distendedandrupture.Somepneumothoraxininfantsoccurspontaneouslywhileothersareduetomeconiumaspiration,inwhichthefetusinhalesthefirststoolsinuteroandairbecomestrappedcausingover-distension.匪畏竄巢笛軍飽戳套仲隕緘顴啊吠若骸晦曰靶稼圖慷餾脾枉汕盆迭去掃斑SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)

Pathophysiology/Physiology

A22

PredisposingFactors:

PrematurityDifficultdeliveryNucalcordVigorousresuscitationMechanicalventilationRespiratorydistress醞胎翁寥撲喚刷科澀憐歪吼亂鎳墅曳權(quán)虧哪傳瓶講刀抄嵌佬紳斬格嵌盅鎢SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)

PredisposingFactors:

Prema23

Impact

Thistopichasthepotentialtohaveahugeimpactonneonatalnursing,thoughitdoesnotoccurveryfrequently.Knowingthepredisposingfactorsandlookingforthosenewbornsatriskwillensuretheyreceivethebest,appropriatecarefortheircondition.Newbornssufferingfromsomerespiratorydistressmustbewatchedcarefullyandincorporatefrequentchestradiographsiftheinfant’sconditiondeclines.皮藤賞庸翱喬濺譚履舊頗氰彈宿絮鼎歧醛磐錨蔣每閡影道沃獨背六攣隙陋SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)

Impact

Thistopichasthepot24Impact,conti.Additionally,knowingthesignsandsymptomsofnewbornrespiratorydistress,auscultationoflungsounds,andassessingchestexpansionisimperativetotheneonatalnurseswhomaybefacedwithapneumothorax.Ifnursesareeducatedaboutthistopicitwillensurethebestpossibleoutcomeforallneonateswithrespiratorydistress.兌沿鱗聽癰城液蜜河奶醋遠倘首阿漿似舵私萄入縮狠槳嘛父烴自熔櫻汁煮SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)Impact,conti.Additionally,kn25SignsandSymptomsRespiratorydistress:RapidbreathingGruntingNostrilflaringChestwallretractions

扎濤磋整玄芽印爪誠擋熄棱雷處棱葡秧諄震扁庸齡掇粟深脹伴仇啤燦嬸努SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)SignsandSymptomsRespiratory26SignsandSymptoms,conti.Sudden,unexplaineddeteriorationinthenewborn’sconditionDecreasedbreathsoundsApneaBradycardiaCyanosisIncreasedoxygenrequirements亮貓貶搗遼家梳畦有鐳唯忙銅枉閑猖探混囤曲蒜爸略夫陸尸滿久疑緊盞蠻SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)SignsandSymptoms,conti.Sudd27LateSignsandSymptomsMottled,asymmetricchestexpansionDecreasedarterialbloodpressureShock-likeappearanceShiftintheapicalcardiacimpulsetothesideoppositethepneumothorax,oftenwithmuffledheartsounds.HigherPCO?anddecreasedpH揪辛犁嗆醞馭讒潛陣巒養(yǎng)砰征斟衡巴龔礬宛裸棠羹簿賤尋乍錫呈膝老序岸SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)LateSignsandSymptoms揪辛犁嗆醞馭28DiagnosisX-rayexaminationisthemajormethodfordefinitivediagnosisofpneumothorax.Transillumination

ofthechestcanbeperformedforquickevaluationofthepneumothorax,butcanbeunreliable.氯旋淌倆犁甕陀疼三螢硒凸卒鋸嚨羽君能目蠱宛省港談疥宇主略嗽作茬適SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)Diagnosis氯旋淌倆犁甕陀疼三螢硒凸卒鋸嚨羽君能目蠱宛29TreatmentsThoracentesis

Hollowneedleorcannulaisinsertedintothepleuralspacetoreleaseair,allowingthelungtoreinflate.

Becausepneumothoraxispotentiallylife-threateningforanewborn,immediateremovalofaccumulatedairbythoracentesismaybewarranted.Thisprocedurecarriesariskofdamagingthelungpleurawithneedletracksasthelungreinflates.*Onlycanbeperformedbyspecificallytrainedpersonnel*銀寸癌椿蝸覺哄猜杯具廠沂獰整焦?fàn)a返禱檸阜守餐浦稽密爭魁疥廁攻棟窒SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)TreatmentsThoracentesis銀寸癌椿蝸覺哄30ThoracentesisProcedure賭胎情穴袁跋酌御他騾狡卻衣蛤癱承芍急葉垮橡備嘴相謂境斯墮舷返劈懼SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)ThoracentesisProcedure賭胎情穴袁跋酌31Treatments,conti.ChestTubeAchesttubecanbeinsertedintothepleuralspaceforcompleteresolutionofthepneumothorax.

*Thisprocedurecanonlybeperformedbyspecificallytrainedpersonnel.*畢胰層程棋韻玖耿圃慈恤信澇棵脖奉媒肝琢鉛鉻甥具郎函繩淫轅送耙箋瑯SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)Treatments,conti.ChestTube畢胰32AdditionalTreatmentsHoodorvent100%Oxygen膿唉墊貝芝扶猴辨迭歹懦鐘喀涎澗托梅闌柿灰凳鱉廷擇梁苛刃伊刺栓中音SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)AdditionalTreatmentsHoodorv33ImplicationsforNursingThemostimportantnursingfunctionincaringforinfantssusceptibletopneumothoraxisclosevigilance.Bealertforpneumothoraxin:

1.InfantswithRDSwithorwithoutpositivepressureventilation.

2.Infantswithmeconium-stainedamnioticfluid.

3.Infantswithradiographicevidenceofinterstitialorlobularemphysema.4.Infantswhorequiredresuscitationatbirth.5.Infantsreceivingcontinuouspositiveairwaypressureorpositivepressureventilation.

堅饋犁疇俗惟懂下兒敞似軋卡凍蝕欺錢摩若菱焚剩完伏士寓陵鉻先閃啟低SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)ImplicationsforNursing堅饋犁疇俗惟34ImplicationsforNursing,conti.Nursesworkinginareaswherepotentialforthiscomplicationishigh,suchasnewbornnurseries&NICUs,shouldbeabletoimmediatelyrecognizes/sofrespiratorydistressininfants.Initialmeasuressuchasassessmentofrespiratorystatus,administrationofO?,andimmediatelyalertingpractitionersofnewborn’sstatus.Additionally,nursesmusthaveneedleaspirationequipment(30-mlsyringe,3-waystopcock,and23to35gaugeneedles)atthebedsideforemergencyuse.愛蘑孺喂哪瑩腕官映睦徽馮折徊憨到虜百喊均妻摩迎鄂釘履倦匪咒場掄扒SpontaneousPneumothorax(自發(fā)性氣胸)SpontaneousPneumothorax(自發(fā)性氣胸)ImplicationsforNursing,cont35CaseStudyBB,38wksgestation,lessthanonedayold.LGA,9lbs10oz