Normal Growth and Development for Age Group
Describe the pathophysiology of bronchiolitis and identify the most common organism causing this infection. What laboratory testing can confirm your suspicion?
Bronchiolitis is the inflammation of the bronchioles due to an acute viral infection. The most commonly implicated pathogen is the respiratory syncytial virus (RSV) (Meissner, 2016). It is a lower respiratory tract infection that starts as an acute infection of the lining of the bronchioles in the lungs (Meissner, 2016). This leads to pulmonary edema, enhanced mucus production, necrosis, and regeneration of the epithelial cells lining the bronchioles (Meissner, 2016). There are several laboratory tests to diagnose bronchiolitis. They include chest X-rays to visualize the abnormalities, complete blood count for infections, viral cultures, enzyme-linked immunosorbent assays (ELISA) tests, and immunofluorescence to test for RSV. These tests are used to rule out other diagnoses. Our assignment writing help is at affordable prices to students of all academic levels and academic disciplines.
Describe the pathophysiology of PDA and why the history of PDA is significant in this scenario.
A ductus arteriosus is an anatomical connection between the aorta and pulmonary, allowing for proper blood circulation in the fetus (Gillam-Krakauer & Mahajan, 2020). During birth, there is a rise in the partial pressure of oxygen and a decrease in prostaglandin concentration, leading to the closure of the ductus arteriosus (Gillam-Krakauer & Mahajan, 2020). Failure of this process will lead to the ductus arteriosus remaining in the patient. PDA results in increased blood flow into the lungs, causing pulmonary edema and presenting with congestion and tachypnea symptoms. The patient presented with these symptoms. PDA can also predispose the patient to lung infections.
What risk factors place Vivi Mitchell at a greater risk for the development of bronchiolitis?
The patient has many risk factors that predispose her to bronchiolitis. The risk factors include preterm birth, underlying heart conditions, and having siblings who go to school (Meissner, 2016). The patient was born at 36 weeks, has a cardiac history of PDA, and has two siblings who go to daycare.
What are the characteristic signs/symptoms of bronchiolitis?
The symptoms of bronchiolitis include rhinorrhea, fever, pulmonary congestion, cough, dyspnea, tachypnea, difficulty feeding, wheezing, retractions, nasal flarings, grunting, and labored breathing (Meissner, 2016). The lower respiratory tract symptoms help to rule in bronchiolitis.
Vivi Mitchell has been prescribed the following medications: acetaminophen, albuterol nebulizer, and 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.
Acetaminophen is an analgesic that works by inhibiting Cyclooxygenase enzymes in the brain (Gerriets et al., 2021). The patient has a fever, and hence acetaminophen will help to resolve this symptom. Contraindications include liver problems, caloric undernutrition, and liver problems (Gerriets et al., 2021). Albuterol is a beta-blocker that acts by relaxing smooth muscles in the respiratory tract, resulting in the opening of the airways and relieving wheezing and dyspnea (Williams & Rubin, 2018). The contraindications include diabetes, hypertension, hyperacidity, and hypokalemia (Williams & Rubin, 2018). Albuterol was prescribed for this patient since she had wheezing and shortness of breath. Corticosteroids suppress the inflammatory genes hence reducing the inflammatory process (Williams, 2018). The contraindications include osteoporosis, systemic fungal infections, and glaucoma (Williams, 2018). Corticosteroids will help reduce the inflammatory process in glaucoma.
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.
Nursing Diagnosis 1
Ineffective airway clearance related to infection as evidenced by fever
Goals
The child will be free of shortness of breath after 12 hours
The child will have clear breath sounds after 12 hours
Interventions
Encourage fluid intake over a twenty-four-hour period.
Assess patient breath sounds.
Nursing Diagnosis 2
Ineffective breathing pattern related to inflammation as evidenced by cough.
Goals
Dyspnea will be resolved after 12 hours
The patient will have normal breathing rates
Interventions
Monitor arterial blood gases.
Provide oxygen through a face mask.
What short and long-term possible complications should the nurse anticipate?
The short-term complications include cyanosis, apnea, and dehydration, while long-term complications include respiratory failure (Meissner, 2016).
What client education is appropriate for Vivi Mitchell as she is discharged from the after-care clinic?
The parent will be educated on the infectious nature of bronchiolitis. She will be advised on strict hygiene practices such as washing hands and avoiding large crowds. In addition to this, she will be educated on medication, such as frequency, dosage of administration, and use.
References
Gerriets, V., Anderson, J., & Nappe, T. N. (2021, March 25). Acetaminophen. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK482369/
Gillam-Krakauer, M., & Mahajan, K. (2020, November 20). Patent ductus arteriosus. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK430758/
Meissner, H. C. (2016). Viral bronchiolitis in children. New England Journal of Medicine, 375(12), 1204-1204. https://doi.org/10.1056/nejmx160031
Williams, D. M. (2018, June 1). Clinical pharmacology of corticosteroids. American Association for Respiratory Care. https://doi.org/10.4187/respcare.06314
Williams, D. M., & Rubin, B. K. (2018). Clinical pharmacology of Bronchodilator medications. Respiratory Care, 63(6), 641-654. https://doi.org/10.4187/respcare.06051
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Question 
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.
Normal Growth and Development for Age Group
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 discharged from the after-care clinic?
* Include a minimum of 2 scholarly sources