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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

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

Treatments

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

Title

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

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