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Bronchiolitis

The Patient

  • 9 month old male
  • wt. 10.1 kg
  • Hx of RSV infection (December 2019)
  • 2 siblings
  • 3 yo brother
  • 5 yo sister
  • Support system: mother, father and grandmother
  • Siblings have also had RSV infections
  • Little mucus produced with cough
  • Ventolin INH PRN Q4H
  • Ceftriaxone IM and Azithromycin PO

Impact on the Family

The Family

  • Anxiety

  • Change in daily routine due to hospitalization

  • Potential spread of RSV to siblings

What is it?

What's Happening?

  • The most common lower respiratory tract infection in infants

  • Most common in children <24 months

  • Caused by viral infection

  • Results in the inflammation and infection of the bronchioles, restricting airflow through the lungs

Pathophysiology

Pathophysiology

  • Viruses (commonly RSV) enter the lungs and spread to the bronchioles

  • Infection causes an immune response within the cells in these small airways

  • The lining of the epithelial cells become inflamed which results in an increase in mucus production, cell damage and necrosis and partial airway obstruction
  • This partial airway obstruction can lead to air trapping

Signs & Symptoms

Signs & Symptoms

  • Tachypnea
  • Wheezing or hacking cough
  • Shortness of Breath
  • Low SpO2
  • Accessory muscle use
  • Nasal flaring
  • Cyanosis
  • Crackles
  • Runny or stuffy nose
  • Productive cough
  • Decreased air entry in the lower lobes of the lungs
  • Tripod position
  • Fever

Typical Treatment

Treatment

  • Rest

  • Hydration

  • Adequate nutrition

  • Supplemental O2 (if needed)

  • Antibiotics (if needed)

  • Bronchodilators

  • Antipyretics

Nursing Diagnoses

Ineffective Breathing Pattern

Ineffective Breathing Patterns

Inspiration and/or expiration that doesn’t provide adequate ventilation

#1 nursing concern for this patient

  • wheezing, decreased breath sounds
  • Q4H Ventolin PRN

This is a risk for the patient due to the inflammation in the bronchioles, the increased work of breathing due to air trapping (which may also result in fatigue from the extra exertion), or compensation due to decreased gas exchange

Ineffective Airway Clearance

Ineffective Airway Clearance

The inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway

This is a risk for the patient due to the increased mucus production and narrowed airways

Anxiety & Fatigue

Anxiety & Fatigue

Anxiety may be experienced by the child or the family

  • Nebulizer
  • IVs
  • Injections
  • Hospital atmosphere
  • Reactions by the patient/family

Fatigue may occur for the patient due to the increased exertion to breathe

Fatigue may occur for the family due to the stress of the situation

Deficient Knowledge

Deficient Knowledge

The absence or deficiency of cognitive information related to specific topic

Relates toward parent/guardian knowledge regarding RSV

As the patient's RSV infections are recurring education about prevention strategies and how the virus is transmitted will aid in avoiding recurrences

Fluid & Electrolyte Imbalance

Fluid & Electrolyte Imbalances

The risk of imbalances occurring due to too much or too little fluid or too much or too little of a specific electrolyte

imbalances may occur due to altered nutritional intake or increased metabolic needs

As the body mounts immune responses and produces products like mucus it's metabolic needs increase, putting the person at risk for imbalances

Fluid levels contribute to the thickness of mucus

Goals

Priorities of Care

  • Maintenance of O2 perfusion and airway patency

  • Control of infection

  • Adequate rest, fluid and nutrient intake

  • Family education

O2 + Airway

O2 and Airway Patency

  • Monitor vitals regularly to assess for changes, especially in RR or SpO2

  • Auscultate the lungs regularly to assess lung sounds and air entry to all lobes

  • Watch for signs of laboured breathing (ie tripod position)

  • Assess skin tone for cyanosis

  • Administer bronchodilators and/or supplemental O2 when needed in accordance with physicians orders

  • Assess cough (productive? if so what does it look like?)

Infection Control

Infection Control

The patient currently has orders for the following:

  • Ceftriaxone 500mg IM Q24h
  • Azithromycin 100mg PO x 1 dose then 50 mg PO x 4 days

Antibiotics should be continued unless contraindicated or orders change

Labs should be routinely monitored to assess infection and immune responses

Contact precautions and appropriate PPE should be used

Appropriate nutrition and fluids should be assured to support metabolic needs to fight the infection

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