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Back to Journal »International Journal of General Medicine» Volume 14
Perioperative nursing care of BAL/FB children with acute exogenous lipoid pneumonia
Author Lin WC, Qin Y, Chun X, Huang RL, Chen RS, Zhang D
Published on November 18, 2021, the 2021 volume: 14 pages 8383-8388
DOI https://doi.org/10.2147/IJGM.S339118
Single anonymous peer review
Editor approved for publication: Dr. Scott Fraser
Wen-Chun Lin,1,* Yi Qin,1,* Xiao Chun,2 Ru-Lin Huang,1 Rong-Shan Chen,1 Dongwei Zhang1 1 Department of Respiratory Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, Chinese People Republic; 2 The Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, China *These authors contributed equally to this work. Corresponding author: Zhang Dongwei, Department of Respiratory Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, Tel + 86 20 38076135 Fax +86 20 38076626 Email [email protected] Purpose: This study evaluates children's acute psychological care and bronchoalveolar lavage (BAL)/fiberbronchoscopy (FB) procedure exogenous lipoid pneumonia (ELP) And a summary of nursing points. Methods: Collect the psychosocial factors and clinical data of patients. Participants included 41 children under the age of three. Results: All children cooperated with BAL/FB surgery. The child’s pain score was 4-6 points, and the child and the caregiver's psychological condition was tense/anxious at the time of admission. After the psychological care and health education of the medical staff, the postoperative pain score of the child dropped to 0 to 3 points, and the caregiver's mental state was good. Conclusion: Psychological nursing can reduce the unhealthy mood of family members and promote the treatment cooperation and recovery of acute ELP. Keywords: children, acute exogenous lipoid pneumonia, psychological care, bronchoscopy, bronchoalveolar lavage
Acute exogenous lipoid pneumonia (ELP) puts children and their parents under extreme stress. 1-4 It is caused by inhalation of fats and oils, such as paraffin oil, cod liver oil, gasoline, etc., which cause lung inflammation and local tissue fibrosis. 1-4 Bronchoalveolar lavage (BAL) and pediatric flexible fiber bronchoscopy (FB) are used for acute ELP in children. 5,6 The pathogens of ELP may vary depending on the cultural and lifestyle differences of the affected countries. 7 Some customs and habits, such as the use of lamp oil/sesame oil, are risk factors in China. 2
Traditional treatment methods ignore the importance of psychological care for patients. Mental health is an important predictor of coping with difficult events and adapting to the psychological and social needs of children diagnosed with ELP. Parental pressure is affected by children's behavior. 8-14 Pediatric nurses play an important role in psychological care. First of all, in the case we introduced, the effect of psychological care on acute ELP is obvious. Although most primary caregivers and children have bad emotions such as fear and anxiety at the beginning of admission, they can be relieved by good psychological care. Therefore, we need to assess the level of pain in children, especially young children who cannot express themselves. Therefore, the current focus on acute ELP treatment should not be limited to disease control, but should be extended to psychological care. During BAL/FB surgery, careful nursing and psychosocial care can improve the clinical symptoms and signs of children with acute ELP and improve the prognosis. This study aims to evaluate the psychosocial care and BAL/FB procedures of children with pediatric acute ELP, and summarize the main points of care.
This study evaluated the psychosocial care and BAL/FB procedures of children with acute exogenous lipoid pneumonia (ELP), and summarized the key points of care. It is assumed that psychological care can alleviate the unhealthy emotions of family members and promote the treatment cooperation and recovery of acute ELP.
The study group consisted of 41 pediatric patients. If there are no contraindications, perform diagnostic bronchoscopy and BAL treatment immediately after admission. In the first three years, the author performed BAL weekly. Perform BAL twice in the first week and once a week if necessary. As a result, the interval between BALs is shorter than before, and the number of BALs has increased by 50% in the past two years. Inhaled corticosteroids are given before and after BAL/FB surgery to reduce complications such as throat edema. We evaluated the safety and effectiveness of the BAL/FB procedure and psychosocial care for children with acute ELP. This study complies with the Declaration of Helsinki and was approved by the ethics committee of our hospital. The guardians of all participants signed an informed consent form.
Collected demographic data, categories of BAL findings of oil intake, social and psychological conditions of children and families, and results. Regularly assess social and psychological problems, initiate targeted psychological care for each child and family, and record family emotions and treatment compliance during this period.
Preoperative examinations such as routine examination of cardiopulmonary function, blood routine, clotting time, etc. of the case were evaluated. The nurse also assessed the parents’ previous experience and current expectations of the bronchoscopy. Encourage parents to honestly express their doubts and actively explain and convey information. Before bronchoscopy surgery, the nurse explained to the parents the methods, effects and possible complications of bronchoscopy in a detailed and easy-to-understand manner, emphasizing the development and prognosis of the disease, the necessity of performing BAL/FB surgery, and active cooperation Medical staff, promote the improvement of the condition.
Before the operation, a video of the operation was played to let parents and/or children understand the operation process and deepen their understanding of BAL. Provide children's cartoon surgery simulation video. Toys, video games, painting, play, and music are used to relieve pre- and post-operative anxiety and fear in children of all ages. 7 In addition, we should use the FLACC scale to closely assess the degree of pain in children during the perioperative period. 8
Understanding the children's family background, including the education level of the main caregivers, family environment, economic status, etc., will affect the way nurses educate them about their health as well as their understanding and decision-making about surgery, which in turn affects their emotional response. Nurses should also observe family relationships during admission assessment and comprehensively assess their mental state, especially before BAL/FB surgery. According to the characteristics of the child and his family, taking into account the psychological, physical, family and social adaptability, personalized nursing care is provided. For primary care workers who speak different dialects (such as Cantonese), it is necessary for medical staff who understand these dialects to better understand the content of health education. We should also consider their different educational levels and choose the appropriate language to educate the main caregivers. Nurses encourage family members to make medical decisions together and carry out prevention and health activities. Psychological care is based on sympathetic and supportive communication so that parents can communicate with other family members or parents of children with the same illness. Psychological care will not happen only once, but throughout the entire hospitalization process.
The nurse should create an environment similar to the family atmosphere for the child, regularly adjust the humidity and ventilation in the ward, establish a good relationship with the child, and pay attention to understanding and satisfying their psychological needs when communicating with the child. Treatment and medical procedures should be concentrated to reduce adverse irritation to children.
BAL/FB surgery requires sedation of the case, but there is a certain risk of aspiration in children's sedation. Preoperative evaluation is necessary to ensure safety. For patients who have received multiple BALs, inhaled corticosteroids are given before and after BAL/FB surgery to reduce throat edema.
The anti-corrosion principle must be followed in the entire BAL/FB operation. BAL is usually performed in the most severely affected areas with sterile saline (radiation and/or endoscopy) heated to body temperature (37°C). In the first three years, the ratio of BAL volume to body weight was 3-5 mL/kg, and each leaf was divided into 3-5 equal parts. With the accumulation of experience in the past two years, the author increased the ratio of ball volume to body weight to 5-8mL/kg. Use a pressure of 6.65–13.3kPa (50–100 mm Hg) to recover the liquid by pumping it into the suction trap. Generally speaking, if> restore to 40%, BAL is acceptable. During BAL/FB surgery, the respiratory tract should be kept unobstructed, and oral and nasal secretions should be cleared in time. The nurse closely monitors the child's vital signs and facial expressions. If the oxygen saturation is found to be less than 80%, immediately stop the operation and increase the oxygen flow to improve hypoxia. The operation is continued after the oxygen saturation exceeds 95% to ensure safety. Patient monitoring includes continuous assessment of heart rate, respiratory function, non-invasive blood pressure, color, and airway position. During this process, supplemental oxygen is used until the oxygenation of the room air is recorded. The frequency of BAL depends on radiology, endoscopy, and clinical conditions, and children who receive long-term sedation should be under long-term observation.
Post-operative rehabilitation takes place in a post-anaesthesia care room equipped with emergency intervention measures. During the recovery period, the patient's blood oxygen saturation and transcutaneous blood oxygen saturation were monitored by electrocardiogram. All patients were fasted and dehydrated for about 2 hours after operation to avoid reflux and aspiration. After BAL/FB surgery, coughing, hoarseness, throat discomfort, low-grade fever and transient exacerbation of blood sputum are normal conditions and do not require symptomatic treatment, and usually subside after 1-2 days. If the symptoms are severe, prompt symptomatic treatment is needed. Nurses need to dynamically observe the children's consciousness, blood circulation, breathing and other conditions during the examination, surgery and rehabilitation, and timely discover complications during postoperative care.
Although the overall prognosis of acute ELP is good, in some cases, the condition may still get worse during treatment, such as increased body temperature, shortness of breath, oxygen inhalation that fails to improve hypoxia, and pulmonary hemorrhage. Nursing staff should cooperate with doctors to communicate with parents in a timely manner, patiently explain the results again, so that parents are fully psychologically prepared for changes in the condition of this situation.
Every parent will receive an out-of-hospital instruction manual after leaving the hospital. Nursing staff and family members jointly formulate daily nursing plans, answer any questions raised by family members, solve problems encountered by family members in the nursing process, and modify the nursing plan based on the child's recovery. Since the absorption of lung exudate in acute ELP cases is relatively slow, parents must be informed that they must accompany their children to regular outpatient follow-ups and follow the doctor’s recommendations.
Most children have a history of misuse of mineral oil, because mineral oil was in a bottle and was drunk by an unattended child. Therefore, it is very important to educate parents about health and avoid putting unsafe substances in bottles and storing them in a safe place.
There were 41 cases from 4 to 53 months, and the median age of onset was 20 months. 85.4% were within 3 years old (35/41), and 51.2% were between 1 and 2 years old (21/41). All patients underwent BAL bronchoscopy; 17 cases were performed once and 24 cases were performed more than twice (some were performed in the day care room after discharge). The hospital stay in the past two years was shorter than the previous three years, the interval between BALs was shorter, and the amount of BAL increased. Due to the use of inhaled corticosteroids before and after BAL/FB surgery, no complications such as throat edema have been observed in children who have received multiple BAL in the past two years. All children were discharged after treatment. Nine patients were lost to follow-up, and the symptoms of the remaining children improved within 1 week to 1 month (Table 1). Table 1 Demographic data and clinical characteristics of children
Table 1 Demographic data and clinical characteristics of children
Although most families have negative emotions such as tension, anxiety and fear during the initial period of hospitalization, these negative emotions have been alleviated through careful psychological counseling. All the children and their families cooperated with the BAL/FB procedure and actively received other treatments without any negative effects. The pain scores of children are mainly between 4 and 6, and the psychological conditions of the children and their caregivers are tense/anxious when they are admitted to the hospital. After the medical staff received psychological care and health education, the postoperative pain score decreased to 0 to 3 points. In this study, only one child came from a welfare agency, and the rest were parents as the main caregivers. The psychosocial status of children and families is shown in Table 2. Table 2 The psychosocial status of children and families
Table 2 The psychosocial status of children and families
We believe this is the first study to present a wide range of pediatric acute ELP cases in nursing. Our patients have no risk factors such as swallowing dysfunction or neurological diseases. 9,10 All subjects were cured after promptly discontinuing the problematic drugs, treating any complications, bronchoscopy, multiple BALs, and supportive treatment, and without any complications such as pulmonary fibrosis. In the first three years, BAL was performed in a volume of 3-5 mL/kg body weight, and each lung lobe was divided into 3-5 portions, which was similar to Selma's experience. 5 However, in our cases in the first two years, the hospital stay was shorter than in the previous three years, the BAL interval was shorter, and the amount of BAL increased. In addition, in children who received multiple BAL, complications such as throat edema and complications such as stomatitis and secondary infections caused by the use of inhaled corticosteroids before and after BAL/FB surgery were not observed. Therefore, through careful preoperative preparation and intraoperative and postoperative care, BAL/FB surgery is safe and effective.
In this study, most children are between 1-2 years old, have limited cognitive abilities and are full of curiosity. Many households usually use beverage bottles to store oil and store them in the open air. This is the most typical reason why children misuse oil in our research, indicating that family prevention cannot be ignored. Medical staff should vigorously promote health education. Therefore, health education for families to prevent similar incidents from happening again is an integral part of our nursing work.
In our study, most children were nervous, anxious or crying when they were admitted to the hospital, and their pain scores were usually 4-6. The mental development of these children is still immature, and their tolerance to pain and the degree of cooperation in treatment are low. For parents, due to lack of medical knowledge of the disease and understanding of BAL/FB procedures, the sudden onset and rapid progress of acute ELP may lead to emotions such as fear, anxiety, and despair. In our research, most of the main caregivers knew nothing about diseases and surgery, while a few had partial knowledge.
It is essential to strengthen psychological counseling and health education. Psychological counseling for children and their parents is essential. In addition, ELP often requires multiple BALs, as an invasive surgery, which makes it difficult for some family members to receive treatment. 15 In our study, 24 (58.53%) patients received more than two BAL bronchoscopy. Improving parents' awareness of diseases and treatment confidence can improve treatment compliance.
Through the psychological care shown in detail above, all the nursing staff cooperated actively and smoothly without any depressive symptoms or negative emotions. All cases achieved a good prognosis without postoperative complications. The child's postoperative pain score is relatively low, ranging from 0-3. In our observations, children with acute ELP who receive support from families and healthcare providers have better psychological adjustments, which is consistent with earlier studies. 15
In this study, nursing staff applied their practice, psychological care of patients and their families, pre-operative preparation, surgical care procedures, and post-operative care. The nurse concluded that good nursing care is of great significance for improving the therapeutic effect of BAL/FB surgery. Psychological care can alleviate the unhealthy emotions of family members and promote the treatment cooperation and recovery of acute ELP.
Good care is of great significance for improving the therapeutic effect of BAL/FB surgery. Nursing staff carry out nursing work with a high sense of responsibility, keen observation, and quick response, which helps to detect changes in the condition in time and prevent complications, while meticulous, high-quality and enthusiastic nurses can alleviate the condition. The negative emotions of children and family members encourage them to actively cooperate with treatment. Strengthening psychological care helps family members take better care of their children, follow the doctor's advice, and the children actively cooperate with the treatment, thereby improving the treatment effect. The care before, during and after BAL/FB operation should be strengthened. Every step should have appropriate care measures to prevent accidents, ensure the smooth progress of the BAL/FB procedure, and promote the recovery of children.
This study complies with the Declaration of Helsinki and was approved by the Ethics Committee of Guangzhou Women's and Children's Medical Center. The parents of all participants signed a written informed consent form.
The author has not received financial support for the research, authorship, and/or publication of this article.
The author declares that there is no potential conflict of interest.
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