C - Bronchiolitis and respiratory syncytial virus (RSV)

Question 1

Whats bronchiolitis & what isit caused by (4) ?

Answer 1

• Inflammation of the bronchioles - smallest airways of the lungs

Causes of Bronchiolitis
● respiratory syncytial virus (RSV)
● Adenovirus
● Influenza virus
● Rhinovirus

Question 2

Risk factors? (5)

Answer 2

• Young age:
  children < 2 years &
  infants < 3 mths - at the highest risk
• Premature birth
• crowded places like daycare
• older siblings who can catch it in school
• Underlying conditions:
  chronic lung disease, congenital heart disease, immunocompromised

Question 3

Symptoms of bronchiolitis and severe cases?

Answer 3

• similar to cold: low fever, congestion, rhinorrhea/runny nose, cough

Disease progresses:
- dyspnea (subjective sensation of difficulty or discomfort in breathing/SOB)
- tachypnea (objectively measured/counted increase in RR)
- wheezing, crackles, diminished breath sounds

Severe cases
- lethargic, irritable, poor feedings, and dehydration
- central apnea = short periods of time where they stop breathing -> hypoxia (insufficient O2 in body) → cyanosis
- Ultimately can cause respiratory failure!!! :(((

• symptoms worsen 3-5days -> peaks at 5-7days
• resolve by 2-3 wks

Question 4

Whats normal RR for infants?

Answer 4

30-60 breaths/min

Question 5

Treatment & Prevention of bronchiolitis? (4+1)
CONDENSED VERSION TO MEMO

Answer 5

1. Oxygenation > 95%
2. Hydration & nutrition might need NGT
3. Relieve nasal congestion
4. Bronchodilator if needed:
   eg: salbutamol SABA

Prevention: Vaccination

Question 6

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Treatment of bronchiolitis LONG VERSION

Answer 6

1. No proven antiviral therapy for bronchiolitis -> treatment focused on symptoms

Usually treated at home:
2. use a cool-mist humidifier -> more comfortable for child
3. keep head elevated while awake
4. saline nose drops & nasal suction to ease congestion
5. Promote adequate fluid intake to prevent dehydration
6. Maintain smoke free environment
7. Over-the-counter medications: acetaminophen or ibuprofen can be given to relieve pain and reduce fever

Severe cases (eg. difficulty breathing / cyanosis)
8. may need to be admitted to the hospital for observation and treatment
- focused on respiratory support: administering supplemental oxygen
- IV fluid therapy to prevent dehydration.

Question 7

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Diagnosis of bronchiolitis? (3)

Answer 7

• Typically based on: client & family history, physical examination: nasal flaring, wheezing, crackles grunting, use of accessory muscles, reduced breath sounds due to air trapping, tachypnea, o2 saturation < 95% (normal: 95-100%), pause in breathing > 15-20secs = MUST seek help immediately

2. diagnostic testing to confirm RSV can be done by swabbing secretions from the nasopharynx
   - do rapid antigen detection test (RADT) or
   - polymerase chain reaction (PCR) to determine presence of viral antigens
   - if Symptoms worsen Chest XRay

Question 8

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What are the nursing diagnoses from highest to lowest priority?

Answer 8

1. Ineffective airway clearance related to excess secretions -> risk for hypoxia -> can cause death
2. Risk for fluid volume deficit due to decreased intake, fever, and increased respiratory rate
3. Risk for fatigue related to increased respiratory effort -> risk for injury and death due to decreased perfusion to the organs and electrolyte imbalances.
4. Deficient parental knowledge related to unfamiliarity with the disease process and treatments

Question 9

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How are the viruses that causes bronchiolitis transmitted? (3)

Answer 9

1. direct contact with respiratory droplets when an infected person talks, sneezes, or coughs.
2. droplets can land in the mouths or noses of people nearby, or be inhaled into their lungs
3. virus can survive on surfaces for a few hours ⇒ possible to get the virus by touching an infected surface, then touch their own eyes, nose, or mouth

Question 10

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How does the virus enter the body? (5)

Answer 10

1. virus travels down the respiratory tract to the bronchioles and invades its epithelial cells, turning them into a virus factory: take over host cell machinery & keep producing viruses -> kill them
2. viral invasion attracts immune cells -> inflammatory reaction -> swelling and narrowing of the airway + increased mucus production
3. mucus, along with the dead epithelial cells, creates a plug that can obstruct the airway and cause the alveoli to deflate -> atelectasis = partial or complete collapse of lung
4. plug can allow air to enter the lungs via inhalation, but not leave via exhalation - positive pressure is generated as lungs & chest recoil -> compressing the already inflamed and narrowed bronchioles
5. lungs become more inflated with each inhalation, known as air-trapping.