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
Fluids help to thin the secretions and make it easier to suction or expel.
Infants may have difficulty feeding and children often refuse food and drink due to increased nasal congestion
To help the lungs expand and increase air exchange. Depending on the age of the patient, a child may sit forward leaning on a table while an infant can be held upright
- Provide suction as necessary, per facility protocol
To help clear airways. Avoid excessive or prolonged suction that can cause further inflammation of the airways.
- Monitor pulse oximetry and provide supplemental humidified oxygen via mask, tent or hood as required
If oxygen saturation drops below 90%, patient may benefit from supplemental oxygen. Humidification provides comfort and helps keep mucus thin and moveable.
- 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
Deep breathing helps open and clear bronchioles and can be effective for older children. Teach them to use incentive spirometer or try blowing a balloon or bubbles.
- 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
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nursing.com/cornell
