broncholitis/RSV Flashcards
1
Q
what is bronchiolitis?
A
inflammation of the fine bronchioles and small bronchi
- lower resp tract infection
- usually due to viruses (particularly respiratory syncytial virus (RSV))
- under 2 years old, peak at 6 months
2
Q
RSV?
A
most frequent cause of hospitalization in children less than 2 years of age
- higher rates in indigenous populations in Northern Canada
- 1% mortality rate, 3% in underlying conditions
- RSV to asthma link
- can live on surfaces for several hours, hands for 30 minutes
3
Q
increased risk of RSV
A
- if born in november, december, january
- siblings in day care
- more than 6 individuals
- low birth weight
- male
- formula fed (immune system isnt as good)
- eczema family history
4
Q
initial manifestations of RSV
A
- rhinorrhea
- pharyngitis
- coughing
- wheezing
- ear/eye drainage
- intermittent fever
5
Q
with progression the symptoms of RSV…
A
- increased coughing and wheezing
- tachypnea and retractions
- cyanosis
6
Q
severe RSV?
A
- tachypnea (over 70 breaths/min)
- listlessness
- apnea
- poor air exchange
- decreased breath sounds
7
Q
assessment for RSV?
A
- color
- movements (headbob)
- work of breathing
- auscultation (stridor, wheezing)
- secretions
- circulation and hydration
- caregivers
8
Q
work of breathing findings?
A
- resp rate
- nasal flare
- tracheal tug
- in drawing, retractions
- seesaw breathing
- sounds: grunting
- coughing
- crying
9
Q
circulation and hydration findings?
A
- mucous membranes (color, moisture)
- peripheral and central color mottling normal
- Ins and outs (IV hydration if nothing by mouth)
- weight: not only for intake and output, medications are weight based!!
- nutritional status: at a nutritional risk, if baby cannot coordinate movement for sucking at risk
- assess sucking reflex!
- RR greater than 55??/
10
Q
diagnostics for RSV?
A
o Nasopharyngeal swab- RSV antigen o Chest x-ray: hyperinflation o Arterial blood gases o CBC, electrolytes Any other associated infections?
11
Q
therapeutic management of RSV?
A
- treat symptoms
- cool humidified oxygen
- adequate fluids
- airway maintenance
- antipyretics (whether to treat or not??see how child is doing, may be a physiologic response, only treat if over 38.5…)
- home vs hospital (only children with resp distress and who are at risk (have other comorbidities) stay
- tachypnea
- supplemental humidified oxygen
- brochodilator (assess for response, not every child will be ordered them, only stay on if helpful)
- epinephrine nebs (hypertonic nebs, stimulate alpha and beta 2 receptors, relaxes smooth muscles of bronchial tree, relieving bronchial spasm)
- 3% NS nebs (improves mucociliary clearance- like a mucolytic)
12
Q
nursing diagnosis for RSV (common…)
A
- ineffective breathing pattern
- potential fluid volume deficit
- potential fluid and electrolyte imbalance
- potential alteration in nutritional status
- potential discomfort
- potential anxiety
- potential knowledge deficit
13
Q
nursing interventions for RSV?
A
- VS routine and PRN
- oxygen above 96%
- blow by (nasal prologns too big)
- NS drops prn
- cardiac sling
- sat probe change q4h (burns)
- stirct ins and outs
- daily weight
- NPO if RR over 55 bpm
- hydrate the mother if BF, small frequent feeds
- group care (everyone assessing the child)
- tylenol
- droplet precautions
- grouping with other RSV positive patients
- nursing assignment to limit contact with non-RSV patients
- encourage breastfeeding
- management of secretions
- provide meds (small masks, syringe meds)
- oral and IV hydration
- frequent monitoring
- health promotion opportunities
14
Q
goal of pharmacology care?
A
prevent and control symptoms
- reduce freq and severity of exacerbations, improve health status, improve exercise tolerance
- nursing considerations: pre/post resp assess, pt teaching, life span considerations
15
Q
drugs by inhalation: MDI
A
metered-dose inhaler
- pressured devices
- 1 minute in between
- teaching is important
- spacers
