Module 7-Maternal

Pediatric Assessment: Respiratory Syncytial Virus (RSV)

Bronchiolitis is an acute inflammation of the bronchioles and is usually caused by an acute viral infection. The most common viral infection in children under 2 years is viral bronchiolitis. An acute infection of the epithelial lining of the lower respiratory tract marks the beginning of the pathophysiology of this disease. This triggers an inflammatory response within the affected lung tissues, resulting in edema, increased production of mucus, and cellular necrosis and regeneration of the affected cells. This leads to hyperinflation, increased resistance of the airway, lung collapse, and mismatch of the respiratory perfusion. This eventually results in wheezing. The common cause of bronchiolitis is Respiratory Syncytial Virus (RSV), which is a nonsegmented, enveloped, and negative, single-stranded RNA virus that belongs to paramyxovirus. Other causes include influenza, adenovirus, parainfluenza, and human metapneumovirus. To confirm the diagnosis, a number of laboratory tests can be done, including complete blood count (CBC), viral culture, enzyme-linked immunosorbent assay for SRV, and immunofluorescence (Meissner, H, 2016).

Patent ductus arteriosus (PDA) is a congenital heart defect, and it is common in females. The closure of the ductus arteriosus begins 10 to 15 minutes after birth. This is always triggered by the decrease in the concentration of prostaglandin and an increase in PaO2 (arterial oxygen tension) concentration that allows the smooth cardiac muscles to constrict. The constriction of the smooth cardiac muscles leads to the development of profound ischaemic hypoxia by the ductus arteriosus and, thus, the formation of the vascular endothelial growth factor, inflammatory mediators, that convert the ductus into a non-contractile ligament. Failure of occurrence of this normal process leads to PDA. The history of PDA is significant in this scenario in that the risk of developing bronchiolitis is increased in children with congenital heart disease (Benitz, W. E. 2016)

The risk factors that placed Vivi Mitchell at greater risk of developing bronchiolitis are a history of PDA, premature birth (born at 36 weeks gestation), low birth weight, and age (below 2 years). Other risk factors for developing bronchiolitis include perinatal smoking, severe congenital or acquired neurological disease, chronic lung diseases such as bronchopulmonary dysplasia, anomalies of the airway, immunodeficiency diseases, low socioeconomic status, and a crowded living environment. The signs and symptoms of bronchiolitis include congestion, fever, cough, wheezing, shortness of breath, runny nose, and loss of appetite. Other clinical features include difficulty in swallowing, dehydration, cyanosis, and making grunting noises.

Acetaminophen, Albuterol Nebulizer, Corticosteroids

The commonly used medications for the treatment of bronchiolitis are bronchodilators and corticosteroids. Vivi Mitchell is prescribed acetaminophen, an albuterol nebulizer, and corticosteroids. Acetaminophen is a non-steroidal pain reliever, and it is used as a medication to treat fever and mild to moderate pain. This drug is safer for children and does not cause stomach pains. An albuterol nebulizer is a bronchodilator used to open up the airway. It is a short-acting B2 adrenergic receptor agonist that works by causing relaxation of the smooth muscles of the airway. This drug is used to treat shortness of breath and wheezing caused by bronchiolitis and other breathing problems such as asthma. Corticosteroids are a class of drugs that lower inflammation and suppress the immune system that is overactive and hormonal balance. However, these drugs have a wide range of side effects that include weight gain, glaucoma, cataracts, bruising, liver damage, osteoporosis, and mood disorders. Long-term use can impend the adrenal gland to stop producing cortisol hormone. Corticosteroids work by mimicking the effect of hormones such as the hormone cortisol. The use of corticosteroids is contraindicated for conditions like high blood pressure, recent heart attack, glaucoma, liver problems, and diabetes. The doctors should only use it in case other medications fail to work (Florin, T., et al. 2017).

The nursing working diagnosis for Vivi Mitchell is wet chest and breathing difficulties/increased work of breathing. The goal of my nursing care plan will be to clear the chest /effective airway clearance and to improve the breathing patterns of the patient, thus addressing the increased work of breathing. My interventions to effectively clear the airway will incorporate assessment of the airway for patency, respiratory rate, patterns dept, and dyspnea. Elevation of the head of the child to 30 degrees by holding the child in an upright position with the head on the shoulders or sitting up the child with his head resting on a pillow on the overbed. This is to limit the abdominal organs from pushing up into the thoracic cavity, thus limiting the chest expansion. Reposition the child after every two hours and assist and encourage coughing and deep breathing. Finally, to clear the airway, the nurses should administer the prescribed mediatization (albuterol nebulizers) as instructed by the doctor (Justice, N. et al. 2021)

The long-term complications that the nurses ought to be greatly concerned about Viva Mitchell are persistent wheezing and coughing, the possibility of developing asthma, bronchiolitis obliterans, congestive heart failure, myocarditis arrithimus, and chronic lung disease. The appropriate health education for Vivi Mitchell’s client upon discharge will be to educate the caregiver that wheezing may persist after recovery, and in some cases, it may take longer for infants to return to their normal status. It is also important to educate the mothers on the importance of doing a periodic assessment of their children for signs of chest congestion. The caregiver should also be educated that the child should be kept out of daycare or school until the fever and runny nose dissolve. A yearly vaccination of influenza will be of great importance to the child, and finally, the mother should be educated on the importance of following the doctor’s prescription.

References

Benitz, W. E. (2016). Patent ductus arteriosus in preterm infants. Pediatrics, 137(1). https://pediatrics.aappublications.org/content/137/1/e20153730

Florin, T. A., Plint, A. C., & Zorc, J. J. (2017). Viral bronchiolitis. The Lancet, 389(10065), 211-224. https://www.sciencedirect.com/science/article/abs/pii/S0140673616309515

Justice, N. A., Le, J. K., & Doerr, C. (2021). Bronchiolitis (Nursing). https://europepmc.org/article/nbk/nbk568705

Meissner, H. C. (2016). Viral bronchiolitis in children. New England Journal of Medicine, 374(1), 62-72. https://www.nejm.org/doi/full/10.1056/NEJMra1413456

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