Bronchiolitis is a common viral respiratory infection that affects infants and young children. While most cases are mild, severe cases can lead to hospitalization and even death. Understanding the signs and symptoms of bronchiolitis, risk factors, and treatment options is crucial for parents, caregivers, and healthcare professionals to ensure the best outcomes for children (Iyer, 2022). This paper examines the psychopathology of bronchiolitis, and patent ductus arteriosus (PDA), focusing on the scenario of Vivi Mitchell. The patient’s priority diagnoses, SMART goals, and interventions are also examined.
Psychopathology of Bronchiolitis and Most Common Organism Causing the Infection
Bronchiolitis is a lower respiratory tract infection that primarily affects infants and young children. The inflammation and obstruction of the smallest airways in the lungs, known as bronchioles, cause respiratory distress, wheezing, and coughing. Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis, and other viruses, such as rhinovirus, adenovirus, and influenza, can also cause the infection (Silver & Nazif, 2019). Laboratory testing involves a nasal swab or a nasopharyngeal aspirate to detect the viral antigen or genetic material to confirm the suspicion of bronchiolitis. Rapid diagnostic tests are available that provide results within a few hours. A chest x-ray may also be used to rule out other respiratory conditions.
Psychopathology of PDA and Its Significance to the Scenario
Patent ductus arteriosus (PDA) is a congenital heart defect where the ductus arteriosus remains open after birth. This increases blood flow to the lungs, leading to pulmonary congestion and complications. The history of PDA is significant in this scenario as it indicates a pre-existing cardiac condition that may affect the child’s respiratory illness. Infants with PDA may be more susceptible to respiratory infections due to increased pulmonary blood flow and congestion (Silver & Nazif, 2019). Treatment of respiratory infections in infants with PDA may require additional consideration, such as potential medication interactions. Therefore, it is important to consider the child’s cardiac history when managing their respiratory illness.
Risk factors for the Development of Bronchiolitis
Several risk factors can increase a child’s risk for developing bronchiolitis, and some of these factors apply to Vivi Mitchell. One of these risk factors is age. Bronchiolitis is most common in infants younger than six months old, and Vivi Mitchell is only six months old. Another risk factor is prematurity. Vivi Mitchell was born at 36 weeks gestation, which is considered late preterm, and premature infants are at an increased risk for developing bronchiolitis. Cardiac history is another risk factor (Zhong, Lin, J., & Dai, 2020). Vivi Mitchell has a cardiac history of PDA, which can increase her susceptibility to respiratory infections. Exposure to other children also contributes to the development of bronchiolitis. Whereas Vivi Mitchell does not attend daycare, her two older siblings do. This increases the likelihood of exposure to respiratory infections.
Characteristic Signs and Symptoms of Bronchiolitis
Bronchiolitis is a common respiratory infection affecting infants and young children, usually during winter. The characteristic signs and symptoms of bronchiolitis include nasal congestion, rhinorrhea, cough, fever, and wheezing. Infants with bronchiolitis may also have difficulty breathing, rapid or shallow breathing, and retractions. In severe cases, infants may experience apnea. A viral infection typically causes bronchiolitis, most commonly respiratory syncytial virus (RSV), but other viruses can also cause the infection. Bronchiolitis is usually a self-limiting illness, but some infants may require hospitalization if they develop severe respiratory distress or dehydration.
The rationale for Medications Used for Medication Management
Three medicines have been administered to manage Vivi Mitchell’s symptoms of bronchiolitis. These are acetaminophen to manage her fever, an albuterol nebulizer to improve her breathing by opening up her airways, and corticosteroids to reduce inflammation. The potential contraindication for acetaminophen is an allergy to the medication. At the same time, albuterol may be contraindicated in patients with certain medical conditions like heart disease, high blood pressure, or seizures, and corticosteroids may not be suitable for those with certain medical conditions like fungal infections, tuberculosis, or herpes (Korppi, 2018). The healthcare provider must be aware of these potential contraindications and closely monitor Vivi for any adverse effects during treatment.
Priority Nursing Diagnoses, Goals, and Interventions
Vivi Mitchell’s priority nursing diagnoses are ineffective airway clearance and the risk of fluid volume deficit. She exhibits wheezing and retractions due to bronchial obstruction, which requires interventions such as albuterol nebulizer treatments every four hours and promoting hydration to thin secretions and clear airways. The SMART goals for this diagnosis are to maintain oxygenation levels of at least 95% within 24 hours and to demonstrate improved airway clearance within 48 hours of admission. In addition, Vivi’s risk of fluid volume deficit is due to increased respiratory effort and fever. This diagnosis aims to maintain hydration status with adequate urine output within 12 hours and show no signs of dehydration within 48 hours of admission. Effective interventions for this diagnosis include encouraging fluid intake, monitoring urine output, and assessing for signs of dehydration.
Short and Long-term Possible Complications for Nurses to Anticipate
The nurse should expect short-term complications like respiratory distress, hypoxemia, dehydration, and acute otitis media in a patient with bronchiolitis. These complications may lead to respiratory failure, inadequate oxygen delivery, and poor feeding. In the long term, the patient may be at an increased risk of developing asthma, chronic respiratory sequelae such as bronchiectasis, and developmental delays (Zhong, Lin, J., & Dai, 2020). Recurrent or severe episodes of bronchiolitis may increase the risk of long-term complications, particularly in infants with a family history of asthma or allergies. The nurse must monitor for these complications and provide appropriate interventions to prevent or manage them. By doing so, the nurse can help to promote optimal health and development in the infant.
Appropriate Client Education for the Patient
Upon Vivi Mitchell’s discharge from the after-care clinic, educating her mother on recognizing signs of worsening respiratory distress, administering medication correctly, and preventing infections is crucial. Her mother should be able to identify signs of respiratory distress and know when to seek medical assistance. Proper administration of medications and nebulizer usage should be explained, and accurate dosing of medications should be emphasized. Using a bulb syringe to suction Vivi’s nose and saline drops to keep her nasal passages moist should be demonstrated. Additionally, infection prevention measures should be practised, including proper hand hygiene, avoiding sick individuals, and maintaining distance from crowded areas (Korppi, 2018). Routine vaccinations must also be kept up to avoid respiratory illnesses. The nurse’s appropriate client education can promote a healthy and safe recovery for Vivi.
References
Iyer, S. (2022). A wheezin’ we will go Bronchiolitis/viral pathology. Pediatric Imaging for the Emergency Provider, pp. 22–24. https://doi.org/10.1016/b978-0-323-70849-4.00014-1
Korppi, M. (2018). Therapeutic strategies for pediatric bronchiolitis. Expert Review of Respiratory Medicine, 13(1), 95–103. https://doi.org/10.1080/17476348.2019.1554439
Silver, A. H., & Nazif, J. M. (2019). Bronchiolitis. Pediatrics In Review, 40(11), 568-576. https://doi.org/10.1542/pir.2018-0260
Tejedor-Sojo, J., Chan, K. N., Bailey, M., Williams, A., Killgore, M., Gillard, L., Campo, M., Hua, H., & Jain, S. (2019). Improving bronchiolitis care in outpatient settings across a health care system. Pediatric Emergency Care, 35(11), 791-798. https://doi.org/10.1097/pec.0000000000001966
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