bronchiolitis and RSV ppt and readings Flashcards
outcomes for this section: diagnostic findings assoc w RSV and bronchiolitis
- etiology
- medical mgmt
- nursing care plan for infant
what is bronchiolitis
• Inflm of the fine bronchioles and small bronchi
which viruses are most likely to cause bronchiolitis
• Viruses such as adenovirus, parainfluenza virus, and RSV, in particular appear to be the pathogens most responsible
pts with ____ often have instances of bronchiolitis
asthma
when is pt likely to have bronchiolitis?
age and season?
• 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
what type of assessment findings follow the initial infect
s/s of dyspnea?
changes in bronchi/ioles?
changes to sounds of breathing?
systemic effects?
• 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
what type of diagnostics would you see for bronchiolitis pt
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
priorities for noncritical pt
• For children with less severe symptoms- antipyretics, hydration and monitor for progression
nursing care of severely ill bronchilitis pt
- 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
how is feeding affcted by bronchiolitis
- 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
how long is acute phase of bronchiolitis and what are they at risk of dev after
- 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
are abx often used for bronchiolitis
no, usually its caused by viruses
pt has bronchiolitis and RSV was the cause what are they now at risk of? v serious
apnea–>they need close observation
what might be done for hypoxia
may need extracorporeal oxygen admin, may need ventilatory assistance
what is most common cause of bronchiolitis
Respiratory syncytial virus
t or f most RSV infections dev into bronchilitis
2-3 % of RSV infection develops into bronchiolitis
when are most children exposed to RSV
2/3 within first RSV season
nearly all by 2-3 years
ppt what do you see
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?
what do you hear
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
what other system assessment do you want to do right way
• 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)
what is NPW
• NPW = nasopharangeal washing; used to use this technique to take a sample for lab, but now just have long swab
what is croup and how is it compared to RSV
• CROUP = virus, what causes laryngitis in adults; constriction + inflm of airways; not usually nearly as bad as RSV
why are young children at such high risk of having and getting RSV
- 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
if a few month old child has resp rate >55 what should be done ? why is this?
• 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
normal newborn breaths /min
30-60
what Vs do you do for bronchiolitis pt
HR do an apical beat, hard to count RR Temp BP Weight (fifth vital sign in peds)
what kind of interventions might kid need
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
what is a cardiac sling
• Cardiac sling: nest that raises head of bed so not in as much distress
what is a special consideration for a o2 sat probe
change q4h or it may cause burns
how might the kid be feeding? consideration with this?
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
what type of meds might pt with bronchiolitis receive
if it enough to just give to pt?
Glucocorticoid steroid (Budesonide)
*Causes thrush (yeast) in mouth so do mouth care
Mother must be treated
too if BF
which med is good to dec fever in kids
tylenol. also helps w pain
nursing dx for pt with bronchiolitis
Ineffective breathing pattern
Potential Fluid Volume Deficit
Potential Fluid and Electrolyte Imbalance
Potential Alteration in Nutritional Status
Potential Discomfort
Potential Anxiety
Potential Knowledge Deficit
how can pt be immunized for RSV infection
o There isn’t an immunization for RSV! But do inject small amount of IgG in preterm babies and congenital immunocompromization….immuno globulins
