Chapter 23: Respiratory Syncytial Virus (RSV) and Bronchiolitis Flashcards
Bronchiolitis
inflammation of the bronchioles and small bronchi
- “infectious asthma, asthmatic bronchitis, wheezy bronchitis or virus induced asthma”
- causes lower respiratory tract obstruction because of the inflammation and edema, which may lead to bronchospasms
- highly contagious and spreads by direct contact with respiratory secretions or from particles on contaminated objects
What is Bronchiolitis caused by?
viral pathogens such as respiratory syncytial virus (RSV), adenovirus, and parainfluenza virus (types 1, 2, and 3)
>RSV accounts for majority of cases, which peaks in the winter
Can Bronchiolitis be spread?
it is HIGHLY contagious
- spreads by direct contact with respiratory secretions or from particles on contaminated objects
- easily spread from hand to eye, nose, and mucous membranes
RSV and Bronchiolitis
-peak period for a child to develop RSV is December through March
-RSV often begins as an infection in the nasal epithelial cells
-RSV virus then replicated in the host cell
-the host cell is destroyed, and virus particles are released to propagate the infection; infection results in the destruction of the epithelial cells of the respiratory tract
>exposure to RSV triggers a humoral immune response
-Primary RSV infection results in only a weak antibody response with IgM, IgG, and IgA; this response is not enough to destroy the virus completely or to prevent upper respiratory tract replication of the virus; an upper respiratory tract illness develops
>high levels of neutralizing antibodies are required to prevent the progression of infection from the upper respiratory tract to the lower respiratory tract
Signs + Symptoms
- upper respiratory infection (URI) symptoms: cough, coryza (Inflammation and irritation of the mucous membrane of the nose; rhinitis), and rhinorrhea (Continuous discharge of mucus from nose) lasting 3 to 7 days
- respiratory distress marked by noisy, raspy breathing and cyanosis
- audible wheezing
- retractions
- rales and prolonged expiratory phase of respirations
- tachypnea
- low to moderate fever up to 102 Degrees F
- decreased appetite and poor feeding (failure to thrive)
- pharyngitis
- depending on the duration of symptoms and oral intake, dehydration may be manifested by poor tearing, dry mucous membranes, and poor skin turgor
- thick mucus, exudate, and mucosal edema obstruct the smaller airways (bronchioles) leading to a reduction in expiration, air trapping, and hyperinflation of the alveoli
- obstruction interferes with gas exchange, possibly leading to hypoxemia (decreased oxygen) and hypercapnia (increased carbon dioxide in the blood), which leads to respiratory acidosis
- may be accompanied by otitis media and conjunctivitis
- may result in hospitalization
Diagnosis
-positive identification of RSV is accomplished by:
>enzyme linked immunosorbent assay (ELISA)
>rapid immunofluorescent antibody from direct or aspiration of nasal secretions or nasopharyngeal washings
-chest x-ray films= reveal hyperaeration, hyperinflation, atelectasis, areas of collapse, and flattened diaphragm indicating air trapping
-ABG’s reveal decreased pH (acidic) and a PaCO2 greater than 45 mmHg
-CBC shows increased WBC = infectious process
-pulse oximetry= decreasing oxygen saturation
Prevention
-proper hand washing
-reducing exposures to and transmission of RSV
-avoiding secondhand smoke
>the monoclonal antibody palivizumab (Synagis) is given IM to high-risk infants and shown to be effective in reducing the complications of RSV, hospitalization, and associated morbidities
Nursing Care
-RSV is treated symptomatically through maintenance of hydration, fever control, oxygenation, and keeping mucous membranes clear of mucus
-may be managed at home
-hospitalization= for children who have some other underlying illness or are in a debilitated state
-in hospital: head elevation of 30 to 40 degrees, oxygen saturation monitoring, cool-mist therapy combined with oxygen administration by hood or tent in concentrations sufficient to alleviate dyspnea or hypoxia
-administers IV fluids until child shows signs of improvements
-strict isolation because RSV virus is easily spread from hand to eyes or nose and other mucous membranes
>emphasizes hand washing and contact precautions (gown, gloves, and masks)
>first 24 to 72 hours is the critical time and in most cases there is complete recovery
Care in the Hospital
- head elevation of 30 to 40 Degrees
- oxygen saturation monitoring
- cool-mist therapy combined with oxygen administration by hood or tent in concentrations sufficient to alleviate dyspnea and hypoxia
- IV fluids until shows signs of improvements
Medical Care
-goal= return child to normal respiratory status
-medical therapy= aimed at relief of respiratory distress, improvement in oxygenation, and alleviation of airway obstruction
-antiviral agent (RSV-IGIV or RespiGam) used as a prophylactic to prevent RSV in high-risk children
>may be administered via endotracheal tube, hood, or tent
-additional medical management: inhaled or oral corticosteroids, chest physiotherapy, and antibiotics
(antibiotics not routinely used unless associated bacterial infection)
Antiviral Agents
RSV-IGIV or RespiGam
- used as a prophylactic to prevent RSV in high-risk children
- administered via endotracheal tube, hood, or tent
- when antiviral agent is administered, crystallization of the medication can occur in the nares, endotracheal tube, or eyes
- can be teratogenic (environmental agent capable of producing birth defect) to the fetus
Education/ Discharge
- educate for signs of worsening conditions (respiratory distress, dehydration)
- when to seek care
- use of cool-mist humidification
- providing fluids
- fever control
- can manage rhinitis through use of saline drops and nasal suctioning
- feeding an infant with signs of mild respiratory distress: smaller, more frequent feedings, upright positioning, strategies to prevent vomiting, and observe for signs of respiratory distress while feeding
ATI: Bronchiolitis
- caused by Respiratory Syncytial Virus (RSV)
- affects the bronchi and bronchioles
- occurs at bronchiolar level
ATI: Expected Findings
> Initially:
- rhinorrhea (runny nose)
- intermittent fever
- pharyngitis
- coughing
- sneezing
- wheezing
- possible ear or eye infection
> With Illness Progression:
- increased coughing and sneezing
- fever
- tachypnea (fast breathing)
- retractions
- refusal to nurse or bottle feed
- copious secretions
> Severe Illness:
- tachypnea (greater than 70/min)
- listlessness
- apneic spells
- poor air exchange
- poor breath sounds
- cyanosis
ATI: Laboratory Tests
> Test Nasopharyngeal Secretions
- rapid immunofluorescent antibody-direct fluorescent antibody staining or
- enzyme-linked immunosorbent assay techniques for RSV antigen detection
