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1、SSpontaneous PneumothoraxIn the NewbornBy:Angela Oliver-Piquette,Carly Jo Amen,Katie Kappel,&Marjerie Malabanan尧 仍 队 控 驭 猪 继 问 赌 彤 阑 给 据 鳃 淄 承 赠 性 伟 苟 骗 挂 举 灾 蒋 贺 邹 兆 嗅 堆 陨 侨 S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)Overview Duri
2、ng our clinical experience at St.Anthonys North,we had the opportunity to see many births.One of the most exciting was a cesarean delivery that presented with an infant who developed a spontaneous pneumothorax.Though it is rare in infants,a spontaneous pneumothorax varies from 0.07%-37.5%of all live
3、 births.We would like to take this opportunity to share with you what we learned during this clinical experience of the newborn with spontaneous pneumothorax.质 阅 识 省 敌 腔 侧 崎 亭 瑞 瓜 牡 岸 通 走 棘 彭 器 嗽 元 霉 廖 崔 漠 灯 象 戌 肺 葬 臼 呢 笆 S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)S p o n t a n e o u s
4、P n e u m o t h o r a x(自 发 性 气 胸)Pathophysiology/PhysiologyS A pneumothorax is a lung disorder in which air in the lungs leaks out through a hole or holes in the lung tissue into the space between the chest wall and the outer tissue of the lungs.S Air leaks occur when the alveoli become over-disten
5、ded and rupture.Some pneumothorax in infants occur spontaneously while others are due to meconium aspiration,in which the fetus inhales the first stools in utero and air becomes trapped causing over-distension.匪 畏 窜 巢 笛 军 饱 戳 套 仲 陨 缄 颧 啊 吠 若 骸 晦 曰 靶 稼 图 慷 馏 脾 枉 汕 盆 迭 去 扫 斑 S p o n t a n e o u s P n
6、e u m o t h o r a x(自 发 性 气 胸)S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)Predisposing Factors:S PrematurityS Difficult deliveryS Nucal cordS Vigorous resuscitationS Mechanical ventilationS Respiratory distress酝 胎 翁 寥 扑 唤 刷 科 涩 怜 歪 吼 乱 镍 墅 曳 权 亏 哪 传 瓶 讲 刀 抄 嵌 佬 绅 斩 格 嵌 盅 钨 S p o n t a n
7、e o u s P n e u m o t h o r a x(自 发 性 气 胸)S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)ImpactS This topic has the potential to have a huge impact on neonatal nursing,though it does not occur very frequently.S Knowing the predisposing factors and looking for those newborns at risk will ens
8、ure they receive the best,appropriate care for their condition.S Newborns suffering from some respiratory distress must be watched carefully and incorporate frequent chest radiographs if the infants condition declines.皮 藤 赏 庸 翱 乔 溅 谭 履 旧 颇 氰 弹 宿 絮 鼎 歧 醛 磐 锚 蒋 每 阂 影 道 沃 独 背 六 挛 隙 陋 S p o n t a n e o
9、u s P n e u m o t h o r a x(自 发 性 气 胸)S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)Impact,conti.S Additionally,knowing the signs and symptoms of newborn respiratory distress,auscultation of lung sounds,and assessing chest expansion is imperative to the neonatal nurses who may be faced wit
10、h a pneumothorax.S If nurses are educated about this topic it will ensure the best possible outcome for all neonates with respiratory distress.兑 沿 鳞 听 痈 城 液 蜜 河 奶 醋 远 倘 首 阿 浆 似 舵 私 萄 入 缩 狠 桨 嘛 父 烃 自 熔 樱 汁 煮 S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)S p o n t a n e o u s P n e u m o t h
11、 o r a x(自 发 性 气 胸)Signs and SymptomsS Respiratory distress:Rapid breathing Grunting Nostril flaring Chest wall retractions扎 涛 磋 整 玄 芽 印 爪 诚 挡 熄 棱 雷 处 棱 葡 秧 谆 震 扁 庸 龄 掇 粟 深 胀 伴 仇 啤 灿 婶 努 S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)S
12、igns and Symptoms,conti.S Sudden,unexplained deterioration in the newborns conditionS Decreased breath soundsS ApneaS BradycardiaS CyanosisS Increased oxygen requirements亮 猫 贬 捣 辽 家 梳 畦 有 镭 唯 忙 铜 枉 闲 猖 探 混 囤 曲 蒜 爸 略 夫 陆 尸 满 久 疑 紧 盏 蛮 S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)S p o n t
13、a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)Late Signs and Symptoms S Mottled,asymmetric chest expansionS Decreased arterial blood pressureS Shock-like appearanceS Shift in the apical cardiac impulse to the side opposite the pneumothorax,often with muffled heart sounds.S Higher PCO and decreased p
14、H揪 辛 犁 呛 酝 驭 谗 潜 阵 峦 养 砰 征 斟 衡 巴 龚 矾 宛 裸 棠 羹 簿 贱 寻 乍 锡 呈 膝 老 序 岸 S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)DiagnosisS X-ray examination is the major method for definitive diagnosis of pneumothorax.S Transillumination of the chest
15、can be performed for quick evaluation of the pneumothorax,but can be unreliable.氯 旋 淌 俩 犁 瓮 陀 疼 三 萤 硒 凸 卒 锯 咙 羽 君 能 目 蛊 宛 省 港 谈 疥 宇 主 略 嗽 作 茬 适 S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)TreatmentsS Thoracentesis Hollow needle or c
16、annula is inserted into the pleural space to release air,allowing the lung to reinflate.Because pneumothorax is potentially life-threatening for a newborn,immediate removal of accumulated air by thoracentesis may be warranted.This procedure carries a risk of damaging the lung pleura with needle trac
17、ks as the lung reinflates.*Only can be performed by specifically trained personnel*银 寸 癌 椿 蜗 觉 哄 猜 杯 具 厂 沂 狞 整 焦 烬 返 祷 柠 阜 守 餐 浦 稽 密 争 魁 疥 厕 攻 栋 窒 S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)Thoracentesis Procedure赌 胎 情 穴 袁 跋 酌 御 他
18、骡 狡 却 衣 蛤 瘫 承 芍 急 叶 垮 橡 备 嘴 相 谓 境 斯 堕 舷 返 劈 惧 S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)Treatments,conti.S Chest Tube A chest tube can be inserted into the pleural space for complete resolution of the pneumothorax.*This procedure
19、can only be performed by specifically trained personnel.*毕 胰 层 程 棋 韵 玖 耿 圃 慈 恤 信 涝 棵 脖 奉 媒 肝 琢 铅 铬 甥 具 郎 函 绳 淫 辕 送 耙 笺 琅 S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)Additional TreatmentsS Hood or ventS 100%Oxygen脓 唉 垫 贝 芝 扶 猴 辨 迭 歹
20、懦 钟 喀 涎 涧 托 梅 阑 柿 灰 凳 鳖 廷 择 梁 苛 刃 伊 刺 栓 中 音 S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)Implications for NursingS The most important nursing function in caring for infants susceptible to pneumothorax is close vigilance.Be alert for
21、pneumothorax in:1.Infants with RDS with or without positive pressure ventilation.2.Infants with meconium-stained amniotic fluid.3.Infants with radiographic evidence of interstitial or lobular emphysema.4.Infants who required resuscitation at birth.5.Infants receiving continuous positive airway press
22、ure or positive pressure ventilation.坚 馈 犁 畴 俗 惟 懂 下 儿 敞 似 轧 卡 冻 蚀 欺 钱 摩 若 菱 焚 剩 完 伏 士 寓 陵 铬 先 闪 启 低 S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)Implications for Nursing,conti.S Nurses working in areas where potential for this compl
23、ication is high,such as newborn nurseries&NICUs,should be able to immediately recognize s/s of respiratory distress in infants.S Initial measures such as assessment of respiratory status,administration of O,and immediately alerting practitioners of newborns status.S Additionally,nurses must have nee
24、dle aspiration equipment(30-ml syringe,3-way stopcock,and 23 to 35 gauge needles)at the bedside for emergency use.爱 蘑 孺 喂 哪 莹 腕 官 映 睦 徽 冯 折 徊 憨 到 虏 百 喊 均 妻 摩 迎 鄂 钉 履 倦 匪 咒 场 抡 扒 S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)Case Study
25、S BB,38 wks gestation,less than one day old.S LGA,9lbs 10oz.S Cesarean section.S MultiparaS Gestational diabetes.S S/S nasal flaring,grunting,intercostal respirations,central cyanosis.S O saturation consistently below 90%by SaO monitor.贺 日 肄 藉 沿 诬 杯 噪 履 岸 社 锗 罢 稍 沉 芒 湿 薪 刨 毖 隋 年 痹 理 屑 农 砰 蜗 慎 凭 半 上
26、S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)Treatment:S X-ray confirmation of spontaneous pneumothorax.S Humidified 100%Oxygen 10 liters via hood.S Created a gradient in his lungs so that air trapped in the pleural space was absorbe
27、d more effectively.S Within 5 to 6 hrs,BB was weaned down from O with SaO of above 92%.At approximately 8 hours,hood removed and BB able to maintain above 95%SaO w/no supplemental oxygen.寸 佐 劫 候 叫 坯 拱 商 殿 碗 信 麦 浇 授 卞 啮 常 驶 莆 么 编 亭 柜 何 华 恫 柴 虽 华 牵 洲 汹 S p o n t a n e o u s P n e u m o t h o r a x(自 发
28、 性 气 胸)S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)ReferencesDavidson,M.R.,London,M.L.,&Wieland Ladewig,P.A.(2008).Maternal-newborn nursing&womens health across the lifespan(8th ed.).New Jersey:Pearson Prentice Hall.Hockenberry,M.J.(2006).Wongs nursing care of infants and children.(8th e
29、d.).St.Louis:Mosby.Logan,M.D.,Crispin,M.D.,&Pausa,M.D.(2010).Spontaneous pneumothorax of the newborn.American College of Chest Physicians,42,611-614.Singh,S.A.,&Amin,H.(2005).Familial spontaneous pneumothorax in neonates.Indian Journal of Pediatrics,72,445-447.Schneider Childrens Hospital.(n.d.).High Risk Neonate.Retrieved from http:/www.schneiderchildrenshospital.org/peds_html_fixed/peds/hrnewborn/pnethorx.htm.棕 汛 妹 舆 窖 维 缮 晌 卑 靳 凭 训 晋 资 犹 耗 噎 臂 哀 遵 感 矣 持 绸 芦 诅 俭 侧 馅 矣 旧 向 S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)S p o n t a n e o u s P n e u m o t h o r a x(自 发 性 气 胸)