Bronchiolitis is an acute viral inflammation of the lower respiratory tract involving the bronchioles and alveoli. Accumulated thick mucus, exudate, and cellular debris and the mucosal edema from the inflammatory process obstruct the smaller airways (bronchioles). This causes a reduction in expiration, air trapping, and hyperinflation of the alveoli. The obstruction interferes with gas exchange, and in severe cases, causes hypoxemia and hypercapnia, which can lead to respiratory acidosis. Bronchiolitis is highly contagious. The virus that causes it is spread from person to person through direct contact with nasal secretions, airborne droplets, and fomites. Respiratory syncytial virus (RSV) is the most commonly isolated agent in 75% of children younger than 2 years who are hospitalized for bronchiolitis. Risk factors for the development of bronchiolitis include:
Bronchiolitis primarily affects young infants. Clinical manifestations are initially subtle. The infant may become increasingly fussy and have difficulty feeding during the two- to five-day incubation period. A low-grade fever, increasing coryza, and congestion usually follow the incubation period. In most cases, the disease is mild and self-limited. There is no definitive antiviral therapy for most causes of bronchiolitis. Management of these infants should be directed toward symptomatic relief and maintenance of hydration and oxygenation. Nursing Care PlansNursing care planning goals for a child diagnosed with bronchiolitis include maintenance of effective airway clearance, improved breathing pattern, relief of anxiety and fatigue, increased parental knowledge about the disease condition, and absence of complications. Here are seven (7) nursing care plans and nursing diagnoses for bronchiolitis:
Infants are affected most often because of their small airways, high closing volumes, and insufficient collateral ventilation. Recovery begins with the regeneration of bronchiolar epithelium after three to four days; however, cilia do not appear for as long as two weeks. Mucus plugs are instead predominantly removed by macrophages (Maraqa & Steele, 2021). Nursing Diagnosis
Possibly evidenced by
Desired Outcomes
Nursing Assessment and Rationales1. Assess the airway for patency. 2. Assess respirations. Note quality, rate, pattern, depth, flaring of nostrils, dyspnea on exertion, evidence of splinting, use of accessory muscles, and position for breathing. 3. Assess breath sounds by auscultation. 4. Assess cough (moist, dry, hacking, paroxysmal, brassy, or croupy): onset, duration, frequency, if it occurs at night, during the day, or during activity. Assess mucus production: when produced, amount, color (clear, yellow, green), consistency (thick, tenacious, frothy). Assess ability to expectorate or if swallowing secretions, stuffy nose or nasal drainage. 5. Assess for the occurrence of apnea, especially when the client is asleep. 6. Monitor the client’s intake and output. Nursing Interventions and Rationales1. Provide periods of rest by organizing procedures and care and disturbing infant/child as little as possible in acute stages of illness. 2. Elevate the head of the bed at least 30° for the child and hold the infant and young child in the lap or in an upright position with head on the shoulder; the older child may sit up and rest head on a pillow on an overbed table. 3. Encourage fluid intake at frequent intervals over 24-h time periods, and specify amounts. 4. Assist in performing deep breathing and coughing exercises and repositioning every two hours. 5. Teach parents and the older child about medication administration and its adverse effects. 6. Administer medications for bronchiolitis as prescribed:
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See AlsoOther recommended site resources for this nursing care plan: Other nursing care plans related to respiratory system disorders: References and SourcesTo further your reading and research about bronchiolitis, please check out these references below:
With contributions and updates by M. Belleza, RN. |