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Bronchiolitis case study
Transcript of Bronchiolitis case study
Diagnostic Reasoning Meet Drew ASSESSMENT Paeadiatric Assessment Triangle Social History Respiratory Hydration Saturating at 96-98% on air
Work of breathing:
- Tracheal Tug
- Subcostal indrawing
- Slight nasal flaring
- Widespread crepitations
- Expiratory wheeze Focused Assessments - One breast feed that day and four yesterday
- Three wet nappies that day and one damp that day
- Warm and well perfused
- Dry mucosa
- Not crying tears Developmental stage Clinical Reasoning Actions Reflection Bronchiolitis Viral lower respiratory infection
Respiratory Syncytial Virus
Usually affects children under 2 years
Clinical signs: cough, tachypnoea,
increased WOB, crepitations. Management oxygen
Fluids and feeding References (University of Virginia, 2012) (University of Maryland Medical Center, 2012) - Notified Doctor
- Feed was changed from bolus to continuous
- Continuing assessment
-Fluid balance chart
- Educated family
- Smoking cessation History - Immunised
- History of eczema
- Others with URTI at home
- Family history of asthma and eczema Our church Family Christmas Our House Drew 1100
Nursing: Pt alert, interactive. Warm and well perfused. Has had one bolus feed through NG of 65 mls EBM. Respiratory effort appears increased post feed. Subcostal and intercostal indrawing, tracheal tug. Slight nasal flaring. Widespread wheeze on expiration and crepes. Mother is concerned that he is 'getting worse'. Doctor informed.
Grace , RN1 Bronchiolitis Assessment Tool Evidence Based Recommendations 1. Breast feeds
2. Bolus feeds
3. Continuous feeds (Nagakumar & Doull, 2012) (Engel, 2006) (Starship, 2000) Social assessment (Pillitteri, 2010; Copstead & Banasik, 2010; Wood, 2010; Piedra & Stark, 2011) - Appropriate interactions within family
- Limited understanding of bronchiolitis
- Good support (Bickley, 2005) Social issues Importance of experience and knowledge Education = empowerment