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Fundamentals of Children’s Applied Pathophysiology

An Essential Guide for Nursing and Healthcare Students

EDITED BY

LIZ GORMLEY‐FLEMING

Associate Director
Academic Quality Assurance at University of Hertfordshire
Hatfield, UK

IAN PEATE OBE FRCN

Visiting Professor of Nursing
St George’s University of London Kingston University London, UK
Editor in Chief British Journal of Nursing
Head of School, School of Health Studies
University of Gibraltar

 

 

 

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List of contributors

Ann L. Bevan RN, RSCN, PhD, MSc, FHEA, PGCED
Senior Lecturer, Children’s and Young People’s Nursing, Faculty of Health and Social Science, Bournemouth University, UK
Ann is senior lecturer in the Children’s and Young People’s nursing programme in the Faculty of Health and Social Science at Bournemouth University. She has been a registered nurse for nearly 40 years, has qualifications in adult nursing, midwifery and children’s nursing, and is a qualified teacher. Ann has nursed in many areas in the UK and also in Hong Kong. She returned to the UK in January 2010 after nursing and teaching for 16 years in Canada. Research interests are children’s nutrition and childhood obesity, and also all aspects of child health. Her primary research methodology is action research.

Mary Brady RN, RSCN, CHSM, BSc, PGCHE, MSc, SHEA
Senior Lecturer, Child Field Cohort Lead, Exams and Assessment Tutor, Kingston University, UK
Mary is a senior lecturer and field lead for children’s nursing at Kingston University. She has a lengthy and extensive knowledge of the clinical care required for children in a variety of settings (neonatal units, paediatric intensive care and general paediatric wards). She has held posts as sister in neonatal/infant surgery, a neonatal unit and a general children’s ward. Since 2004, she has been teaching pre‐ and post‐registration nurses, midwives and paramedics. In 2016, she took on the role of Exams and Assessment Tutor for the School of Nursing. Mary is also an external examiner at Huddersfield University.
In January 2015, she joined the RCN Children and Young People’s Professional Issues Forum and has contributed to RCN various publications.
Mary is interested in all aspects of children’s nursing and more recently has researched the preparation of first‐year student child nurses for their first clinical practice placements.

Petra Brown RGN, DP, SN, BSc (Hons), MA
Lecturer, Faculty of Health and Social Sciences, Bournemouth University, UK
Petra began her nursing a career in 1988 at Salisbury School of Nursing, becoming a staff nurse. She has worked in a variety of clinical areas including recovery, telephone triage, intensive and coronary care. On completion of her degree in critical care, Petra started her career in nurse education as a practice educator for critical care, A & E and orthopaedics. On completion of a Master’s degree in health and social care practice education, she was appointed as a lecturer at Bournemouth University on the overseas and pre‐registration nursing courses. Her key areas of interest are nursing practice, anatomy and physiology, nurse education, practice development, respiratory and critical care.

Usha Chandran RN (Mental Health, Adult, Child), PGCEA, MSc Critical Care Nursing (Adults), MSc Health and Disease
Lecturer/Practitioner Paediatric Intensive Care Unit (PICU), St George’s Hospital, Tooting, UK
Senior Lecturer, Child Health, Kingston University, UK
Usha trained as a mental health, adult and children’s nurse, specialising in postnatal mental health disorders and eating disorders in mental health and intensive and critical care nursing in adult and children’s nursing.
Usha has extensive experience both as an expert clinical nurse, nurse manager and nurse lecturer. She managed a mother and baby mental health unit and functioned as a practice development nurse for a nurse‐led eating disorder clinic (anorexia nervosa) at Springfield University Hospitals, Tooting, UK. Usha facilitated workshops at eating disorder nursing conferences delivered training as a nurse teacher for mental health nursing.
Usha is an expert intensive and critical care nurse with expertise in adult and children’s critical care nursing and enjoys teaching this subject very much and helping new and novice nurses develop in this area of care. Her main specialities are in applied physiology and intensive care management and interventions. She worked in a combined cardiac and general adult intensive care unit in Melbourne, Australia for a period of eight months and presented a poster on sedation scales – the next generation at the British Association of Critical Care Nursing in York, UK. Usha is particularly interested in simulation training.
Usha is the lead nurse for children’s critical care nurse training and development at St George’s Hospital, Tooting, London, UK, the nursing PI for a multi‐centre trial on sedation and weaning in children (SANDWICH) trial and the module leader for the PICU course modules at the joint faculty: Kingston University & St George’s, University of London.

Rosemary Court RGN, RSCN, RNT, BSc (Hons), MSc, FHEA
Senior Lecturer in Children’s Nursing, Sheffield Hallam University, Sheffield, UK
Rosemary began her nursing career in 1986 at Sheffield School of Nursing, becoming a registered general nurse and a registered sick children’s nurse working in a neonatal intensive care unit. She completed a course in special and intensive care of newborns and worked as a neonatal sister for 13 years. Rosemary went on to work in the community, becoming a community specialist practitioner children’s nurse and a nurse independent prescriber. She worked within a children’s complex care team for 5 years before taking up a position in nurse education. In 2012, Rosemary joined Sheffield Hallam University as a senior lecturer in children’s nursing, where she teaches on both pre‐ and post‐registration nursing courses. Her key areas of interest are children’s critical care nursing, children’s respiratory nursing, public health, advancing practice, and nurse education.

Susan Fidment RGN, RSCN, RNT, BSc, MSc, FHEA
Senior Lecturer in Children’s Nursing, Sheffield Hallam University, Sheffield, UK
Sue began her general nursing career in 1987 at Leeds General Infirmary. After she qualified as an RGN, she spent a brief period working in care of the elderly at Leicester General Hospital, before moving back to Leeds to commence a career in children’s nursing. She has worked in children’s orthopaedics and plastics at St James’s Hospital, moved on to commence RSCN education and then worked at Killingbeck Hospital in children’s cardiology. In 2012, after 16 years working within paediatric critical care both clinically and in education, she became a full‐time lecturer. Sue has a specialist interest in critical care of the child and teaches on advanced paediatric life support programmes. She is particularly interested in using simulation as a teaching methodology.

Liz Gormley‐Fleming RGN, RSCN, RNT, PGCert (Herts), PGDip HE (Herts), BSc (Hons), MA (Keele), SFHEA
Associate Director of Academic Quality Assurance, Centre for Academic Quality Assurance, University of Hertfordshire, UK
Liz commenced her nursing career in Ireland where she qualified as an RGN and RSCN. Initially working in paediatric oncology and bone marrow transplant, Liz moved to London and has held a variety of senior clinical nursing and leadership roles across a range of NHS Trusts both in the acute care setting and in the community. Liz has worked in education since 2001, initially as a clinical facilitator before moving into full‐time higher education in 2003.
Liz has held a number of senior leadership positions in higher education: Head of Nursing (Children’s, Learning Disability, Mental Health), Social Work Associate Dean of School, and Principal Lecturer in Learning and Teaching. Her areas of interest are care of the acutely ill child, healthcare law and ethics, the use of technology in higher education, curriculum development, and work‐based learning.

Kate Heaton‐Morley RNMH, RGN, RSCN, BSc (Hons), RNT, MSc, FHEA
Senior Lecturer Children’s Nursing, Sheffield Hallam University, Sheffield, UK
Kate’s career began in 1982 undertaking RNMH training (now RNLD) at Whittington Hall Hospital, Chesterfield. Subsequently training as a RGN and RSCN, Kate’s practice since 1991 has been dedicated to children’s nursing. She has worked and trained in the Sheffield Hospitals as a staff nurse, then sister, in acute and A & E settings. In 1998, Kate took up a senior sister post at Chesterfield Royal Hospital and, successively, positions of practice development advisor, matron, and senior matron. In 2007, to pursue her interest in nurse education, Kate joined Sheffield Hallam University as a senior lecturer in children’s nursing. She maintains her clinical skills and passion for children’s nursing through working as a staff nurse on the acute paediatric ward at Chesterfield Royal Hospital.

Sarah McDonald RSCN, BA (Hons), PGCert, RNT, FHEA
Senior Lecturer in Children’s Nursing, Sheffield Hallam University, Sheffield, UK
Sarah completed her RSCN Honours degree at Sheffield Hallam University in 1995. She consolidated her degree as a staff nurse in acute medicine at Rotherham District General Hospital. This was followed by positions as staff nurse then senior staff nurse at Sheffield Children’s Hospital in trauma, orthopaedics and plastics. Her other positions include sister in outpatient theatre at the Charles Clifford Dental Hospital and senior staff nurse in post‐anaesthetic care. Sarah became a clinical nurse educator at Sheffield Children’s Hospital in 2012. In 2014, she commenced a secondment as a lecturer in children’s nursing and is now a full‐time senior lecturer at Sheffield Hallam University. Sarah’s teaching interests include pain, tissue viability, and practical nursing skills. She has published guidelines for clinicalskills.net.

Elizabeth Mills RGN, RSCN, RNT, BSc (Hons), PGCert, PGDip, MSc, FHEA
Senior Lecturer in Children’s Nursing, Sheffield Hallam University, Sheffield, UK
Elizabeth began her nursing career in 1992 at West Yorkshire School of Nursing, Halifax, becoming a RGN and then a RSCN. After working in acute paediatric respiratory care, Elizabeth changed career direction and moved into neonatal intensive care, completing a course in the special and intensive care of newborns. Elizabeth worked in both district general and subregional neonatal intensive care units, and in 2005 she became a clinical educator within a large NHS Trust. In 2008, Elizabeth joined Sheffield Hallam University as a senior lecturer in children’s nursing, where she teaches on both pre‐ and post‐registration nursing courses. Her key areas of interest are children’s critical care nursing, children’s respiratory nursing, evidence‐based practice, and nurse education.

Helen Monks RGN, RSCN, BSc (Hons), RNT, MSc, FHEA
Senior Lecturer in Children’s Nursing, Sheffield Hallam University, Sheffield, UK
Helen started her career in 1986 and gained her RGN qualification at Bradford and a few years later her RSCN qualification at Manchester. She has experience in nursing children and families within the fields of general surgery, plastic surgery and general medicine. During her practice, Helen has sought to empower both families and nurses via education and partnership approaches. Her career progressed to sister and ward manager where she became more interested in education, took up project nurse roles within Bradford’s nursing development unit, and subsequently worked as a practice development nurse. She then commenced lecturing at the University of Bradford in 1997 where she was part of a team to set up the first children’s nursing course there. Helen moved to Sheffield Hallam University in 2008 bringing her experience of course leadership and curriculum development. She has a research interest in the subjective nature of assessment of student nurses in the practice environment, and is currently undertaking a PhD in this subject.

Alison Mosenthal RGN, RSCN, Dip N (London), Dip Nursing Education, MSc
Senior Lecturer in Children’s Nursing, School of Health and Social Work, University of Hertfordshire, UK
Alison began her nursing career at St Thomas’ Hospital London before undertaking her RSCN training at Great Ormond Street in 1979. After qualifying, she worked in the respiratory intensive care unit and then moved into nurse education in the School of Nursing at Great Ormond Street in 1983.
After a career break raising her family Alison returned to clinical nursing working as a clinical nurse specialist in paediatric immunology nursing at St George’s Healthcare NHS Trust in 1996. She remains in clinical practice part‐time and in 2010 returned to teaching in higher education at the University of Hertfordshire, where she currently works part‐time as a senior lecturer in paediatric nursing.

Michele O’Grady RGN, RSCN, MSc, PGCert
Senior Lecturer, University of Hertfordshire, UK
Michele trained in Dublin and worked as a qualified nurse until she went to Sudan with the voluntary agency GOAL, running a primary care programme. She moved to the UK in 1987 where she worked in several hospitals before moving to Oxford where she became the HIV liaison officer for 5 years. Michele returned to the NHS where she was a senior sister and an emergency nurse practitioner in the children’s emergency department at Watford General Hospital. Michele joined the child nursing lecturing team at the University of Hertfordshire in 2015.
Michele has had an interest in sexual health and health promotion since her time in Sudan.

Julia Petty RGN, RSCN, MSc, PGCert, MA
Senior Lecturer in Children’s Nursing, School of Health and Social Work, University of Hertfordshire, UK
Julia began her children’s nursing career at Great Ormond Street Hospital. After a period in clinical practice and education, she moved into higher education and worked as a senior lecturer at City University, London for 12 years before commencing her current post in 2013. Her key interests are neonatal health, outcome of early care and most recently, the development of digital learning resources in neonatal/children’s nursing care. Julia has a considerable publication portfolio and is on the editorial board of the Journal of Neonatal Nursing. She is a newborn life support instructor for the UK Resuscitation Council, executive member and chair of the Neonatal Nurses Association Special Interest Education and Research Group. Her recent research interest involves exploring the narratives and experiences of parents in neonatal care for the development and evaluation of a digital storytelling resource for children’s nurses.

Cathy Poole RGN, RSCN, MSc, Public Sector Management PGDip Ed ENB 147
Training and Education Manager, Fresenius Medical Care, Birmingham, UK
Cathy started her career as a nursery nurse not knowing that her career would lead on to nursing and the private health education sector. With over 35 years’ experience in a variety of health and education positions, Cathy has published several times and presented at local, national and international conferences. Her main area of interest is renal nursing. Her current post allows her to combine her two passions of renal nursing and education. Not wanting to abandon her third passion of children’s nursing, Cathy maintains her clinical practice as a bank staff nurse at Acorns Children’s Hospice.

Sheila Roberts RGN, RSCN, RNT, BA (Hons), MA
Senior Lecturer in Children’s Nursing, University of Hertfordshire, UK
Sheila began her nursing career in 1979 at the Queen Elizabeth School of Nursing in Birmingham, working primarily at Birmingham Children’s Hospital. She moved to general paediatrics at Kidderminster, Ipswich and finally to Bedford Hospital where she became ward sister. Sheila moved into nurse education in 2006. Her areas of interest include nursing practice and teaching nursing skills to students, along with an interest in the cardiac and respiratory systems and child development. More recently, Sheila has been taking part in projects involving children as service users within the pre‐registration nursing curriculum.

Tanya Urquhart‐Kelly RGN, RSCN, MSc, NMP, Dip H Onc
Child Field Nursing Lecturer, Sheffield Hallam University, Sheffield, UK
Tanya graduated from Sheffield School of Nursing and Midwifery in March 1993 as an RGN/RSCN and has worked in a variety of roles within the field of paediatric oncology/haematology nursing since qualifying. Most recently she worked as a Macmillan clinical nurse specialist in paediatric and teenage and young adult late effects at Sheffield Children’s NHS Foundation Trust. She has recently taken a substantive child field nursing lecturer post at Sheffield Hallam University. Her key areas of interest are teenagers and young adults with cancer, transition and survivorship; particularly the endocrine care for survivors of childhood cancer. She was awarded a distinction and the faculty prize for her contemporary Master’s degree in the care of teenagers and young adults with cancer from Coventry University, and holds certificates in endocrine nursing and research studies. She is recognised in the international arena of late effects following cancer in childhood, and has presented at numerous international symposiums. She was the previous chair of the CAN UK Nurses group (Cancer Aftercare Nurses group) and an active member of the CCLG (Children’s Cancer & Leukaemia Group) Late Effects group.

Peter S. Vickers Cert Ed, DipCD, RGN, RSCN, BA, PhD
Following several years as a schoolteacher, Peter began his nursing career in 1980 at York District Hospital, before specialising in paediatric nursing at The Hospital for Sick Children, Great Ormond Street. His nursing specialties were paediatric immunology and immunodeficiency, infectious diseases, and genetics. In 1999, he was awarded his PhD following his study of children with severe combined immunodeficiency who had survived bone marrow transplants in the UK and Germany (which was later published as a book). Following award of his PhD, Peter entered nurse education as a senior lecturer in paediatric nursing at the University of Hertfordshire, where he first began writing, and has gone on to publish widely in nursing textbooks and journals. He has also undertaken research into adult hospice care and written computer programmes on immunology for distance learning. He has also presented at conferences in many European countries, as well as North Africa. In 2012, Peter was elected President of INGID (the international organisation for immunology nurses), and in 2014, upon stepping down as INGID President, he was presented with a life‐time achievement award in immunology nursing by INGID.

Preface

In order to provide safe and effective care to children and families, it is essential that those who are providing that care are able to understand the pathophysiology that underpins the child’s condition.

The overall aim of this text is to help make the sometimes complex subject of pathophysiology accessible and exciting, and to enable the reader to apply their knowledge to various contexts of care. The body has an extraordinary ability to respond to disease in a variety of physiological and psychological ways. It is able to compensate for the changes that come about as a result of the disease process – the pathophysiological processes. The text can assist you in advancing your critical thinking; it fosters innovation and creativity in relation to the health and wellbeing of those to whom you have the privilege to offer care.

The text adopts a user‐friendly approach – inviting you to delve deeper, discover new facts, and to engender curiosity. There are many illustrations, which are used in such a way as to explain and assist in understanding and appreciating the complex disease patterns that are being discussed. Applying a fundamental approach will provide you with a crucial understanding of applied pathophysiology, while emphasising that at all times the child and the family must be at the centre of all that is done.

A series of activities are provided, which are intended to help you learn in an engaged way and support you as you apply your learning in the various care settings, wherever these may be. This text offers an up‐to‐date overview of pathophysiology and the key issues associated with care provision.

The need to constantly consider the wider context of care provision, supplementing a nursing focus and recognising the broadening of the professional base, is emphasised. In providing care that is contemporary, safe and effective, an integrated, multidisciplinary approach is a key requirement. Healthcare students are important members of any multidisciplinary care team. It should also be acknowledged that contemporary care provision is delivered in ever‐changing environments to a range of children, families, communities and circumstances.

Most chapters provide case studies that are related to chapter content. The chapters will stimulate reflection and further thought. In all case studies the names used are pseudonyms, in order to maintain confidentiality. Nurses owe a duty of confidentiality to all those who are receiving care (NMC, 2015). The majority of case studies have been extended further and include data concerning the patient’s vital signs and blood analysis. This can help you to relate important concepts to care, offering you further insight into the patient’s condition and therefore their needs. A selection of case studies include a Paediatric Early Warning Score (PEWS).

In England, nearly every hospital uses a different PEWS chart and calculates PEWS in varied ways. The PEWS charts included in this text are only there to demonstrate how they may be used. It must be remembered that infants (0–11months), preschool children (1–4 years), school‐age children (5–12 years), and teenagers (13–18 years) will all require a PEWS chart that is specific to their age. You should familiarise yourself with the PEWS chart used in the organisation where you work.

Where appropriate, significant information related to the chapter appears in boxed format to focus the reader, for example, red flags and medicines management. This can help you when you are offering care to children and families who may be vulnerable and scared.

A feature found in most chapters is the investigations box. One investigation has been chosen related to chapter content. This contains details about the test or investigation encouraging the reader to think about the pre‐, peri‐ and post‐procedural care that the child and family may require.

All chapters begin and end with questions, which are there to test your pre‐ and post‐knowledge. A range of learning resources are included at the end of the chapters, such as word searches, ‘fill in the blanks’, crosswords, and label the diagram activities. A list of further resources that you may wish to access with the intention of increasing and advancing your learning is provided at the end of each chapter. Each chapter also has a glossary of terms.

Pathophysiology is concerned with the cellular and organ changes that take place when disease is present, and the effects that these changes have on a person’s ability to function. When something happens that interrupts the normal physiological functioning of the body, for example, disease, it becomes a pathophysiological issue. It must always be acknowledged that normal health is not and cannot be exactly the same in any two children, and thus when the term ‘normal’ is used, it must be treated with caution. An understanding of pathophysiology ‘normal’ and ‘abnormal’ can assist the healthcare student in helping the child and family in a kind, sensitive, compassionate, caring, safe and holistic way.

This text is a foundation text providing support to the reader as you grow personally and professionally in relation to the provision of care. The text is primarily intended for nursing students who come into contact with children who may have a number of physically related healthcare problems, in the hospital and community setting. Illness and disease are discussed explicitly, highlighting the fact that children do become ill and they experience disease.

It is not imagined that you will read the text from cover to cover – we would encourage you to dip in and out of it. However, it may assist in your learning if you first read Chapter 1 (The cell and body tissue) and Chapter 2 (Genetics), as these provide a good starting point – they set the scene. The aim is to entice and encourage you, to whet your appetite, and inspire you to read further, and in so doing we hope to instill a sense of curiosity in you.

Reference

  1. Nursing & Midwifery Council (NMC) (2015). The Code. Professional standards of practice and behaviour for nurses and midwives. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc‐publications/nmc‐code.pdf (last accessed April 2018).

Liz Gormley‐Fleming, Hertfordshire
Ian Peate, Gibraltar

Acknowledgements

I would like to thank my family, Kieran my husband and my girls, Kate and Eilis. Thank you all for being you and providing me with real‐life case studies.

Liz Gormley‐Fleming

I would like to thank my partner Jussi Lahtinen for his support and encouragement and Mrs Frances Cohen who, without hesitation, provides me with her help and inspiration.

Ian Peate

About the companion website

This book is accompanied by a companion website:

www.wileyfundamentalseries.com/childpathophysiology

The website includes:

  • Multiple‐choice questions
  • Further resources
  • Word‐search exercises
  • Glossaries
  • Crosswords
  • ‘Fill in the blanks’ exercises
  • True or false questions

How to use your textbook

Features contained within your textbook

Learning outcome boxes give a summary of the topics covered in a chapter.

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Keyword boxes give a summary of the keywords covered in a chapter.

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Every chapter contains ‘Test your prior knowledge’ questions.

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Case studies

give an up‐close, in‐depth, and detailed examination of a subject.

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Red flags

provide quick summaries of alert signs and symptoms.

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Your textbook is full of illustrations and tables.

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