bronchiolitis and RSV ppt and readings

Question 1

outcomes for this section: diagnostic findings assoc w RSV and bronchiolitis

• etiology
• medical mgmt
• nursing care plan for infant

what is bronchiolitis

Answer 1

• Inflm of the fine bronchioles and small bronchi

Question 2

which viruses are most likely to cause bronchiolitis

Answer 2

• Viruses such as adenovirus, parainfluenza virus, and RSV, in particular appear to be the pathogens most responsible

Question 3

pts with ____ often have instances of bronchiolitis

Answer 3

asthma

Question 4

when is pt likely to have bronchiolitis?

age and season?

Answer 4

• Most often occurs in winter and spring and is the most common lower resp illness in children younger than 2. Peaking in incidence at 6 months of age

Question 5

what type of assessment findings follow the initial infect

s/s of dyspnea?
changes in bronchi/ioles?
changes to sounds of breathing?
systemic effects?

Answer 5

• Typically infants have 1 or 2 days of an upper respiratory tract infection, then begin to demonstrate an inc resp rate, nasal flaring, and intercostal and subcostal retractions on inspiration.
• Both accumulating mucus and inflm block the small bronchioles, so air can no longer enter or leave alveoli freely- therefore alveolar hyperinflation occurs from air being able to enter more easily than leaving inflamed, narrowed bronchioles.
• Inc expiratory phase of respiration and can create wheezing
• After initial hyperinflation, areas of atelectasis in alveoli may occur as the air that cannot be expired is absorbed
• Tachycardia and cyanosis develop from hypoxia
• Infants soon become exhausted from rapid respiration
-mild fever

Question 6

what type of diagnostics would you see for bronchiolitis pt

Answer 6

leukocytosis
inc erythrocyte sedimentation rate
• A CXR reveals pulmonary infiltrates caused by a secondary infection or collapse of alveoli (atelectasis).
• Throat culture shows offending organism
pt would also be hypoxic

Question 7

priorities for noncritical pt

Answer 7

• For children with less severe symptoms- antipyretics, hydration and monitor for progression

Question 8

nursing care of severely ill bronchilitis pt

Answer 8

• Hopsitalization if severe distress such as infant is tachypneic, marked retractions, seems listless, pulmonary disease may receive anti-RSV immunoglobulin if RSV if identified as the causative agent
• Symptoms are severe- need humidified o2 to counteract hypoxemia and adequate hydration to keep respiratory membranes moist

Question 9

how is feeding affcted by bronchiolitis

Answer 9

• Feeding is often a problem because infants tire easily and cannot finish feeding
• IV fluids may be given for the first 1 or 2 days to eliminate oral feeding

Question 10

how long is acute phase of bronchiolitis and what are they at risk of dev after

Answer 10

• Acute phase of bronchiolitis lasts 2-3 days. Condition improves rapidly after this
• Monrality is less than 1% but if not treated, certainly fatal. Some develop an inc incidence for hyperactivity that may turn into asthma

Question 11

are abx often used for bronchiolitis

Answer 11

no, usually its caused by viruses

Question 12

pt has bronchiolitis and RSV was the cause what are they now at risk of? v serious

Answer 12

apnea–>they need close observation

Question 13

what might be done for hypoxia

Answer 13

may need extracorporeal oxygen admin, may need ventilatory assistance

Question 14

what is most common cause of bronchiolitis

Answer 14

Respiratory syncytial virus

Question 15

t or f most RSV infections dev into bronchilitis

Answer 15

2-3 % of RSV infection develops into bronchiolitis

Question 16

when are most children exposed to RSV

Answer 16

2/3 within first RSV season

nearly all by 2-3 years

Question 17

ppt what do you see

Answer 17

Nasal Flaring
Head bob
Subcostal, intercostal & substernal indrawing
See saw belly breathing
copious thick secretions?
Oxygen saturation monitor? Sats? Heart rate?
The parent/caregiver? Are they anxious? Relaxed? ie. Is this normal for them?

Question 18

what do you hear

Answer 18

Cough? (barking, dry, wet, harsh, congested sounding) 
Wheezing? (without stethoscope)
Stridor
With stethoscope: Auscultation
Crackles, wheezes (describe exactly what you hear)
Inspiratory and expiratory phase
Air entry 
Compare both sides
Stridor

Question 19

what other system assessment do you want to do right way

Answer 19

• Circulation – cirumoral cyanosis?
• Hydration status
o Are they eating?
o Stool and voiding normal?
o Are they still making tears? If crying but no tears, vey dehydrated
• Children will compensate for a while with the accessory muscles…may be playing and everything, but then use all energy so then crash very quickly (also get better really quickly as well)

Question 20

what is NPW

Answer 20

• NPW = nasopharangeal washing; used to use this technique to take a sample for lab, but now just have long swab

Question 21

what is croup and how is it compared to RSV

Answer 21

• CROUP = virus, what causes laryngitis in adults; constriction + inflm of airways; not usually nearly as bad as RSV

Question 22

why are young children at such high risk of having and getting RSV

Answer 22

• 3-6 months tend to be those who are most likely be hospitalized from this….have passive immunity before this time so more at risk
• Premature babies more at risk
• Early days = obligate nose breathers….if become all full of secretions, breathing becomes impaired easily

Question 23

if a few month old child has resp rate >55 what should be done ? why is this?

Answer 23

• If resp rate >55breaths per minute (after new born phase…a few months old), you typically have child NPO
o 0.7 seconds to coorindate suck, swallow, and breath cycle in infant….if breathing too rapidly, resp compromised and won’t be able to coordinate this in safe fashion

Question 24

normal newborn breaths /min

Answer 24

30-60

Question 25

what Vs do you do for bronchiolitis pt

Answer 25

HR do an apical beat, hard to count 
RR 
Temp
BP
Weight (fifth vital sign in peds)

Question 26

what kind of interventions might kid need

Answer 26

VS routine and prn                            
Oxygen to keep sats above 96%
NP or Blow by?
NS drops prn
Suction prn
Cardiac sling
Sat probe
Strict intake and output
Daily weight
NPO if RR over 55 bpm
BF
? IV
Group care

Question 27

what is a cardiac sling

Answer 27

• Cardiac sling: nest that raises head of bed so not in as much distress

Question 28

what is a special consideration for a o2 sat probe

Answer 28

change q4h or it may cause burns

Question 29

how might the kid be feeding? consideration with this?

Answer 29

the mom should be hydrated well, she should have small freq feeds

tell the mother to care for herself or she wont be able to care for child

Question 30

what type of meds might pt with bronchiolitis receive

if it enough to just give to pt?

Answer 30

Glucocorticoid steroid (Budesonide)
*Causes thrush (yeast) in mouth so do mouth care
Mother must be treated
too if BF

Question 31

which med is good to dec fever in kids

Answer 31

tylenol. also helps w pain

Question 32

nursing dx for pt with bronchiolitis

Answer 32

Ineffective breathing pattern
Potential Fluid Volume Deficit
Potential Fluid and Electrolyte Imbalance
Potential Alteration in Nutritional Status
Potential Discomfort
Potential Anxiety
Potential Knowledge Deficit

Question 33

how can pt be immunized for RSV infection

Answer 33

o There isn’t an immunization for RSV! But do inject small amount of IgG in preterm babies and congenital immunocompromization….immuno globulins