RSV
Jenna Enley, Elena Lee, Ally Spillane
Pathophysiology
- Respiratory Syncytial Virus
- Most common cause of bronciolitis
- Transmission: droplet
- Affects epithelial cells of respiratory tract. Inflammation occurs and cilia is lost from cells. Leads to narrowing lumen -> hyperinflation, atelactasis. Airways become dilated on inspiration, but constricted on expiration (air trapping)
Clinical Manifestations
- Initially, upper respiratory infection: Low grade fever, rhinorrhea, cough, sneezing
- In infants, poor feeding, lethargy, or irritability
- If it progresses, it becomes lower respiratory infection: shows signs of altered gas exchange, wheezing, retractions, crackles, dyspnea, tachypnea, apnea
Diagnosis testings
Medical Intervention
- Testings are not usually required
- Testings have been simplified with tests on nasopharyngeal secretion
- Nasal swab and blood test most common
- Direct fluorescent antibody (DFA) staining
- Enzyme linked immunosorbent assay (ELISA)
- Chest x-ray
Treatment
- Usually do not require hospitalization
- Humidified oxygen, hydration, airway maintnance, and medications
- Tx is mainly supportive care
- Regular suctioning esp. before feeding
- separate room
Prevention
Prevention
- Droplet and contact precaution
- Handwashing
- Breastfeeding encouraged
- Avoid kissing babies
- No smoking around babies
- Prevention medication
Pharmacology
Pharmacology
- Racemic epinephrine
- Typically used for temporary relief
- Improves ventilation status (chest tightness, shortness of breath, wheezing)
- Ribavirin
- Antiviral agent that is the only specific therapy approved for hospitalized children
- Should only be used for patients at high risk for mortality related to infection
- Antibiotics should not be used unless there is a coexisting bacterial infection such as pneumonia
Prevention
- palivizumab (Synagis)
- Monoclonal antibody given monthly in an IM injection for a maximum of 5 doses to prevent hospitalization associated with RSV
- Candidates for palivizumab are infants in their 1st year of life born before 29 weeks, 0 days of gestation or infants in the 1st year with chronic lung disease of prematurity (<32 weeks, 0 days) who needed less than 21% oxygen for at least 28 days after birth.
Holistic Nursing Interventions
- Promoting rest and comfort
- Clustering care, allowing parental presence
- Providing emotional support to the patient and family
- Essential oils such as eucalyptus will help relieve congestion
- Safe in infants > 3 months
- Never directly apply the oil to the skin or injest it.
- Know how to properly dilute the oil
Resources
Hockenberry, M.J., Wilson, D., Rodgers, C.C. (2017). Respiratory syncytial
virus and bronchiolitis. In Wong's essentials of pediatric nursing (10th ed., pp. 651-653). Elsevier.
Healthline. (2016, July 1). Safe essential oils for babies and how to use
them. Healthline Parenthood. https://www.healthline.com/health/parenting/essential-oils-for-babies#dilution
Resources