Pediatric Assessment Concept Map PDA With RSV

Pediatric Assessment Concept Map PDA With RSV

Bronchiolitis is an inflammatory disease that affects the bronchioles and most commonly affects infants. Bronchioles are part of the respiratory system; they have no submucosal gland and cartilage. The lining of the bronchiolar is also made of surfactant that secretes and releases neuroendocrine and Clara cells that help in making bioactive products. Bronchial injury is most commonly caused by factors that cause bronchiole inflammation, such as the Respiratory Syncytial Virus (Smith et al., 2017). The entrance of this virus triggers the inflammatory process, which involves the release of chemokines and cytokines. These inflammatory chemicals released then trigger the interleukins 4, 8, and 9 into the respiratory system. They trigger increased cellular activity in the airways. The epithelium then goes into necrosis in the first 24 hours after infection. The goblet cells undergo proliferation, causing an increase in mucus secretion. Regeneration of the non-ciliated epithelial cells slows down the ability of mucus secretion.

The inflammation process has clinical signs of pain, fever, and swelling due to increased blood flow to the site of infection. The inflammation of bronchioles, edema in the respiratory tract, and necrotized epithelium cause debris resulting in bronchiole obstruction, which causes hyperinflation (Meissner., 2016). The obstruction of these bronchioles also increases airway resistance, which can lead to atelectasis mismatch in ventilation-perfusion. It affects children and infants severely because of their anatomically small airways and insufficient ventilation in the alveoli, especially collateral ventilation. The most common viral infection that causes bronchiolitis is the Respiratory Syncytial Virus (RSV) (Smith et al., 2017). The laboratory investigations that can be done include blood cultures, white blood cell count, c-reactive protein level, cerebrospinal fluid culture, cerebrospinal fluid analysis, urinalysis, and urine culture.

Patent Ductus Arteriosus is a congenital defect where the fetal ductus fails to close resulting in a communication between the pulmonary artery and descending thoracic aorta. The failure to close is necessitated by continuous production of PGE2 (Prostaglandin E2). When one has this condition, there is a right side shunt, allowing blood to circulate from the systemic to pulmonary circulation. This process increases the amount of blood flow in the pulmonary circulation, which could impair the vasculature of the pulmonary system and reduce pulmonary system compliance (Clyman, 2018). The history of PDA in Vivi Mitchel’s case is important because it acts as a predisposing factor to bronchiolitis and is responsible for reduced oxygen concentration.

The risk factors that predispose Vivi Mitchell to bronchiolitis include her lower birth weight, the history of Patent Ductus Arteriosus, and her young age of 6 months. Some of the classical signs and symptoms of bronchiolitis are fever, tachypnea, tachycardia, retractions, and wheezing (Gillam-Krakauer & Reese, 2018). Acetaminophen is an anti-pyretic drug that blocks pain signals generation. It also inhibits the synthesis of prostaglandin in the central nervous system minimizing the inflammatory process in bronchiolitis. This drug is contraindicated in those patients with liver or hepatic disease, kidney disease, and hypersensitivity to acetaminophen. Albuterol nebulizer is a beta II receptor agonist which causes relaxation in the smooth muscles of the bronchioles. It also helps to manage tachycardia. Albuterol is contraindicated for those who are sensitive to milk proteins and albuterol. It is also contraindicated during labor and delivery since it interferes with uterine myometrial contraction. Corticosteroids, on the other hand, are used to manage hyperproliferation and inflammation. It is also used to alleviate the adverse effects of other drugs like pruritic lesions. Some of the contraindications for using corticosteroids include liver impairments, either cirrhosis or impairments, the existence of hypertension, pregnancy, and untreated body system infection.

The first nursing diagnosis for this patient is dehydration. Vivi is losing more fluids via fever and fast breathing despite the reduced intake of fluids per oral. The goal is to replace fluid deficits by maintaining hydration. This is done by giving fluids intravenously. The second nursing diagnosis is shortness of breath. The goal here is to increase oxygen intake to the lungs. The interventions for this include positioning Vivi to drain the most congested lobes. The other intervention is initiating deep breathing and then triggering a coughing reflex for baby Vivi Mitchell to cough out secretions. The long-term complications associated with this disease are chronic lung disease, bronchitis obliterans, and secondary infection because of a lowered immune system. The short-term complications include lack of enough oxygen supply, leading to cyanosis, dehydration cases, acute respiratory distress syndrome, and myocarditis.

During discharge, Vivi’s mother, who is her caretaker, should be educated on how to improve respiratory distress without the use of supplemental oxygen, be taught how to manage the nasal congestion of the baby, and how to monitor for cases of cyanosis. She should be educated on the need to complete antibiotic doses while at home and advised to book sessions for follow-up purposes.

References

Clyman, R. I. (2018, June). Patent ductus arteriosus, its treatments, and the risks of pulmonary morbidity. In Seminars in perinatology (Vol. 42, No. 4, pp. 235-242). WB Saunders. https://doi.org/10.1053/j.semperi.2018.05.006

Gillam-Krakauer, M., & Reese, J. (2018). Diagnosis and management of patent ductus arteriosus. Neoreviews, 19(7), e394-e402. https://doi.org/10.1542/neo.19-7-e394

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

Smith, D. K., Seales, S. M., & Budzik, C. (2017). Respiratory syncytial virus bronchiolitis in children. American Family Physician, 95(2), 94-99. https://www.aafp.org/afp/2017/0115/p94.html

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Pediatric Assessment Concept Map PDA with RSV
Module 07 Content

Purpose of Assignment
This assignment will help to identify the normal growth and development by topic for each age group. In the final column of the assignment, you need to observe a child apply the information you gathered and document your findings in comparison by the particular age of that child.

Pediatric Assessment Concept Map PDA With RSV

Competency
Apply the foundations of pediatric nursing when caring for clients with health alterations.

Scenario
You are working in a large urban pediatric clinic after hours.

A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation, and on inspection, you identify retractions.

The child is in less than the 10th percentile of weight and has a cardiac history of Patent Ductus Arteriosus (PDA).
Born at 36 weeks gestation.
The mother states this child doesn’t go to daycare, but her two other children, ages 2 and 3, do attend daycare.
T- 102.1 HR 140 RR 40 BP 83/58 Pulse ox 96%
A swab for respiratory syncytial virus (RSV) is positive.

Doctor orders – Nasal bulb suction and saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, Albuterol nebulizer in office and push po fluids as tolerated.

After the albuterol neb treatment, respirations are 36 and oxygen saturation is 100%. Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that she has a nebulizer at home and can return to pediatric afterhours or ER if needed.

Client is discharged with these orders:

methylprednisolone 0.4 mg/kg oral BID for 3
Albuterol Q4 hours for 24 hours, then Q 6 hours for 24 hours, and Q6 as needed.
Call if needed prior to the Q4 dose.
Manage fever with Tylenol and continue hydration and nasal bulb suction Q6 while awake.
Return for re-evaluation in 3 days

Instructions
In a two to three-page APA formatted paper, provide reponses for these questions and requests for information:

Criteria:
Describe the pathophysiology of bronchiolitis and identify the most common organism causing this infection. What laboratory testing can confirm your suspicion?
Describe the pathophysiology of PDA and why the history of PDA is significant in this scenario.
What risk factors place Vivi Mitchell at a greater risk for the development of bronchiolitis?
What are the characteristic signs/symptoms of bronchiolitis?
Vivi Mitchell been prescribed the following medications; acetaminophen, albuterol nebulizer, corticosteroids. Provide the rationale for why each medication has been included as part of her medical management and explain any potential contraindications related to these medications.
You are designing Vivi Mitchell’s plan of care. Identify two priority nursing diagnoses to include in your plan. For each nursing diagnosis, identify two SMART goals, and two interventions for each goal.
What short and long-term possible complications should the nurse anticipate?
What client education is appropriate for Vivi Mitchell as she is d