Pediatric Assessment Concept Map PDA with RSV

Pediatric Assessment Concept Map PDA with RSV

Pathophysiology of Bronchiolitis

Bronchiolitis is a prevalent inflammatory process of the lower respiratory tract which mostly affects infants and young children. The respiratory syncytial virus (RSV) is the most frequent etiologic agent. Pathophysiology of Bronchiolitis is the mechanism through which RSV infiltrates the respiratory epithelial cells and causes inflammation and necrosis of the cells (Kaler et al., 2023). This process results in the epithelial lining of the bronchioles getting swollen and producing excessive mucus, which in turn gets rid of the airways. The smaller airways of infants are highly vulnerable to a marked decrease in dimensions. The bronchioles get increasingly obstructed which leads to air trapping or atelectasis (collapse of a part of the lung). The coexistence of air within the air passages, the increased production of mucus, and the existence of cellular debris obstruct the gas exchange and respiratory distress. These may include wheezing, coughing, tachypnea, and retractions which are among the common presenting signs in children suffering from this disease.

Risk Factors

Risk factors of bronchiolitis have several important constituting components. These risk factors are prematurity and low birth weight, which results in the lungs and immune systems of these infants being less developed. In the case of young age, say under six months, the small size of airways and immature immune responses make them more susceptible to the disease. People who are exposed to tobacco smoke will suffer respiratory conditions because it will damage the airway lining and reduce the body’s ability to fight infection (Atay et al., 2019). Further, daycare siblings’ attendance could serve as the source of the viral transmission within the family, as children are more prone to carrying infections at home.

Diagnostic Testing

The diagnosis of bronchiolitis most often involves a complete clinical evaluation, with the history and physical examination findings, including the signs of wheezing, retractions, and respiratory distress, being essential parts of it (Justice & Le, 2023). Confirmatory diagnostic tests might include a swab sample from the nose to check the presence of the respiratory syncytial virus, which is the most common etiological agent. In the same way, pulse oximetry is used as a monitoring instrument to track the oxygen saturation levels. The aim is to ensure that the patient is sufficiently oxygenated and to identify if the patient needs any supplemental oxygen or further intervention.

Signs and Symptoms

Bronchiolitis-related signs and symptoms comprise wheezing, retractions, tachypnea, fever, and rapidly increasing breathing difficulties and infection (Justice & Le, 2023). Stridor is the name for the narrowing of the small airways, while retractions are the effort made to breathe after the normal breathing process has been disturbed. The body does this through a process called tachypnea, which is breathing at a fast rate to keep enough oxygen. Fever is an indicative sign of an infection. Vivi’s symptoms are characterized by rhinorrhea (runny nose), congestion, fever (102°F), and a persistent cough. 1°F. Moreover, the announcement of the rattling and retractions is an additional symptom that relates to the diagnosis of bronchiolitis and clearly shows how serious the respiratory distress is.

Pathophysiology of PDA

Patent ductus arteriosus (PDA) refers to the discrepancy of the pulmonary duct, the fetal blood vessel that connects the aorta and the pulmonary artery, that does not close after the child is born. Moreover, this tube which usually becomes closed soon after birth is not shut in PDA, hence, the incorrect blood flow between the aorta and pulmonary artery starts. Hence main effect is the elevated pulmonary blood flow and pressure that overloads the heart and lungs. The overcirculation to the lungs can shorten breaths as a result, especially in cases of bronchiolitis, through pulmonary edema and reduced compliance of the lungs, which increases the difficulties in managing the clinical course and thus, the severity of the symptoms (Conrad & Newberry, 2019).

Medications

Methylprednisolone

Lower the inflammation only if used carefully. It’s contraindicated in immunosuppression.

Albuterol

Allows dilated bronchi to relax; check for possible additional side effects like tachycardia.

Tylenol

This drug helps control fevers; however, overdose should be avoided.

Nursing Diagnoses

Ineffective Airway Clearance Related to Increased Mucus Production

SMART Goal 1: In the next 24 hours Vivi can show the effectiveness of airway congestion as noted with less wheezing and breath sounds.

Intervention 1: Dose albuterol at the advised amount to open bronchioles.

Intervention 2: Instruct the mother to clear mucus using the proper nasal suction method.

Imbalanced Nutrition: Less than Body Requirements Related to Poor Feeding Due to Respiratory Distress

SMART Goal 2: In 2 days, she will start to experience balanced nutrition and gain stability in her weight.

Intervention 1: Promote regular intake of small meals to provide sufficient calorie feeds.

Intervention 2: Weigh daily and review feeding behaviors.

Complications

Short-term complications may include respiratory failure requiring mechanical ventilation, and dehydration as a result of decreased oral intake and increased loss of water insensibly because of fever and rapid breathing. The long-term concerns include chronic respiratory conditions including recurring wheezing or asthma, which occur due to constant inflammation and high reactivity of the airways. The prolonged respiratory infections that inhibit proper nutrition and energy absorption are the other concerns (Justice & Le, 2023). For instance, such episodes as recurrent bronchiolitis can lead to baby hospitalizations and missed feeding periods and, thus, affect his or her growth and development.

Discharge Teaching

For discharge teaching, the mother should be instructed on the correct administration of the medication, specifically on the use of the nebulizer and the dosing regimen for albuterol and methylprednisolone. Further, she should be informed about respiratory distress symptoms for which medical help should be sought right away, like increased wheezing and retractions. Also, the significance of being hydrated by way of several feedings and nasal suction to get rid of mucus should be highlighted. The mother should also be instructed regarding the management of fever with Tylenol and seeking medical attention for abnormal fever. Additionally, there should be an emphasis on the importance of avoiding sick contacts, particularly for Vivi’s siblings who are in daycare. Lastly, re-evaluation and reinforcement follow-up appointments should be made.

References

Atay, O., Pekcan, S., Gokturk, B., & Ozdemir, M. (2019). Risk factors and clinical determinants in bronchiolitis. Turkish Thoracic Journal, 21(3). https://doi.org/10.5152/turkthoracj.2019.180168

Conrad, C., & Newberry, D. (2019). Understanding the Pathophysiology, Implications, and Treatment Options of Patent Ductus Arteriosus in the Neonatal Population. Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses, 19(3), 179–187. https://doi.org/10.1097/ANC.0000000000000590

Justice, N. A., & Le, J. K. (2023, June 26). Bronchiolitis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441959/

Kaler, J., Hussain, A., Patel, K., Hernandez, T., & Ray, S. (2023). Respiratory Syncytial Virus: A Comprehensive Review of Transmission, Pathophysiology, and Manifestation. Cureus, 15(3). https://doi.org/10.7759/

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Describe the pathophysiology of bronchiolitis, including the most common causative
organism.
• Analyze risk factors associated with bronchiolitis.
• Choose diagnostic testing for bronchiolitis and support with rationale.

Pediatric Assessment Concept Map PDA with RSV

• Explain the signs and symptoms of bronchiolitis, including specific examples from the
scenario.
• Describe the pathophysiology of PDA, including why this is significant for this scenario.
• Describe the rationale for use and contraindications for each of the prescribed medications.
• Select two priority nursing diagnoses for this scenario, including supporting rationale for your choices.
• Write two SMART goals for each nursing diagnosis.
• Choose two interventions for each goal, including supporting rationale for your choices.
• Describe potential short and long-term complications, including specific examples and supporting rationale.
• Apply information from the scenario to create a plan for discharge teaching.
* Include a minimum of 2 scholarly sources
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