Bronchiolitis & RSV Flashcards
What is bronchiolitis ?
a viral infection that causes obstruction at the bronchiolar level
- can cause respiratory distress and failure in children under the age of 2
- most common infectious disease of the lower airways
Who does bronchiolitis mainly affect ?
children from 2-12 months
- rarely up to 2 yrs
What causes bronchiolitis ?
viruses
- most commonly RSV
- also adenoviruses, parainfluenza, human metapneumovirus
What are some common symptoms of bronchiolitis ?
- labored respirations
- poor feeding
- cough
- tachypnea
- retractions
- nasal flaring
- increased mucus
- wheezing
What are some common respiratory illness symptoms in infants ?
- tachypnea
- nasal flaring
- retractions
- head bobbing
- grunting
- poor feeding
What is respiratory syncytial virus (RSV) ?
the epithelial cells are impacted and cause swelling of the ciliated cells and loss of cilia
- causes the bronchiolar mucosa to swell and fill with mucus and exudate
How does RSV affect inhalation and exhalation ?
inhalation is normal but narrowing of bronchial passages prevents air from leaving the lungs during expiration
How long does RSV last ?
incubation between 4-8 days
- “3 days coming, 3 staying, 3 going”
What makes children more at risk for complications from RSV ?
- narrow airways
- obligatory nose breathers
- up until 6 months
- can breathe thru mouth but prefer nose
- difficulty feeding (coordinating suck and swallow) which leads to dehydration which thickens mucus
- smaller reserve of energy
- can compensate for a little but will tire out
Do only infants and kids get RSV ?
no
Which infants would be at high risk for RSV ?
- infants born before 32 weeks gestation
- infants with chronic lung disease
- infants 35 weeks gestation or less that have a sibling less than 5 or attend daycare
- children less than 2 with a hemodynamically significant congenital heart defect
- infants and children with known immunodeficiency
What can be given for high risk individuals for RSV ?
Palvizumab-Synagis
- immunoglobulin once a mouth to reduce symptoms/severity of illness in high-risk population
- will reduce infants symptoms if they were to contract RSV
What types of assessments are done for a infant with RSV ?
- neuro
- respiratory
- cardiac
- GI/GU
What are some S&S of RSV ?
- initial: rhinorrhea, pharyngitis, coughing, sneezing, wheezing, ear/eye drainage, fever
- progression: increasing cough, wheezing, tachypnea, retractions, cyanosis
- severe: tachypnea > 70 breaths per min, listlessness, apneic spells, poor gas exchange, diminished breath sounds
- can lead to respiratory failure and cardiac compromise
What are some labs & diagnostics for RSV ?
- ABGs: to determine respiratory status and needs
- respiratory viral panel via nasopharynz swab: to see if (+) for an identified virus
- complete blood count: WBC
- chest x-ray: to rule out a secondary pneumonia or other pulmonary disease
What do the medications given for RSV treat ?
we treat the symptoms not the virus itself
- you can’t cure a virus through antibiotics
What meds are given for RSV ?
- racemic epi: modest improvement in ventilation status
- corticosteroids: controversial
- antibiotics: no real evidence to support, unless bacterial is present (like otitis media or pneumonia)
- Ribavirin
What is Ribavirin ?
antiviral
- only one recommended for RSV
- toxic effect recommend against routine use
- use only in high risk mortality (related to infection- transplant)
What precautions are used for RSV ?
- pending respiratory viral panel: contact & droplet
- confirmed RSV: contact only
- hand washing & environmental cleaning: live on hands 30 mins & hard surfaces 6 hours
What is important to remember about hydration for RSV ?
no fluid restrictions
- can actually cause more harm to restrict/decrease fluid intake
- dehydration leads to thickening of the secretions which makes it more difficult to clear the airway
What is the positioning for a infant with RSV ?
have HOB elevated
- at home flat on their back
- when hospitalized for respiratory distress head of bed elevated is appropriate (if on cardiac apnea monitor)
- neck is extended and airway open (infants may naturally flex necks due to lack of control/muscle)
What is some nutritional support for a infant with RSV ?
when in respiratory distress they may not tolerate oral feedings
- IVF & NG feedings can be supplemented to maintain good nutrition during illness
- dehydrated infants will have increased respiratory distress
What is some airway maintenance/clearance for an infant with RSV ?
due to small nasal passages and weakness of muscle infants have impaired ability to clear their airway
- need diligent and clean suctioning should be done
- family education on use of bulb syringe for home care
