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Outline
Overview
Pathophysiology
Bronchiolitis is a common infection of the lungs in children and infants that causes inflammation and mucus secretion in the bronchioles, which obstructs the flow of air. Atelectasis may occur or air may become trapped. Breastfed infants receive antibodies from the mother in the colostrum that help reduce the likelihood of developing bronchiolitis. Respiratory syncytial virus (RSV) is a common respiratory virus that causes cold-like symptoms in children and is the most common cause of bronchiolitis in infants. Premature babies and children with a compromised immune system can experience severe infection from RSV.
Etiology
Bronchiolitis is caused by a virus, most commonly the Respiratory Syncytial Virus (RSV) and rhinovirus, otherwise known as the common cold. These viruses get into the airways and cause inflammation, increased mucus production and obstruction. RSV and bronchiolitis are very contagious and are spread through airborne droplets and direct contact with mucus.
Desired Outcome
Patient will have adequate oxygenation and gas exchange; patient will be afebrile; patient will maintain adequate nutrition
Bronchiolitis / Respiratory Syncytial Virus (RSV) Nursing Care Plan
Subjective Data:
- Headache
- Sore throat
- Decreased appetite or poor feeding
Objective Data:
- Runny nose
- Persistent cough
- Wheezing
- Fever, low grade (may or may not be present)
- Tachypnea
- Labored breathing, retractions, nasal flaring
Nursing Interventions and Rationales
- Assess respiratory status, auscultate lungs for adventitious lung sounds
- Get baseline information.
- Note respiratory distress, infants may have nasal flaring or retractions of the chest.
- Wheezing is common and is the sound made when air struggles to get through the narrowed airways.
- Crackles may also be heard as air tries to get past the excess mucus in the lungs.
- Note the presence and quality of coughing, if secretions are thick, or bronchospasms.
- Assess vital signs and capillary refill
- Get a baseline to determine effectiveness of interventions.
- Low grade fever may or may not be present.
- Heart rate is increased as the patient works to breathe.
- Sluggish cap refill indicates poor perfusion
- Encourage oral fluids or initiate and administer IV fluids as necessary
- Position patient upright
- Provide suction as necessary, per facility protocol
- Monitor pulse oximetry and provide supplemental humidified oxygen via mask, tent or hood as required
- Administer medications and breathing treatments per facility protocol
- Antiviral medications like Ribavirin are given for the viral infection
- Bronchodilators and Corticosteroids are no longer recommended for bronchiolitis in infants and children
- Antibiotics are NOT recommended to treat viral illnesses and can cause patient to develop resistance over time.
- Antipyretics like acetaminophen may be given for fever or pain
- Monoclonal antibodies (Palivizumab) to decrease immune response
- Use incentive spirometer / practice deep breathing techniques
- Provide education to parents for home treatment
- Administer nasal saline drops
- Use bulb suction
- Control fever
- Encourage fluids
- Preventing the spread of infection to others
- Nasal saline drops and bulb syringe suctioning can help relieve nasal congestion and reduce respiratory fatigue.
- Teach parent proper use of bulb syringe.
- Educate parents on how and when to treat fever.
- Encourage oral hydration.
- RSV/bronchiolitis is very contagious and patients should not attend school or daycare during the time of illness to prevent infection of others.
- Practice good hand hygiene
References
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