Nursing Case Study

Nursing Case Study

Q1: Pathophysiology of bronchiolitis

Bronchiolitis occurs due to the narrowing of the bronchioles, reducing the air passage in and out of the lungs. The virus affects the mucosal lining of the bronchial tubes, making them swell with fluids which reduces the function of cilia (Ozkaya-Parlakay et al., 2019). The impairment of the functions of the cilia will lead to mucus and debris accumulation in the bronchial tubes, which further enhances irritation. This inflammatory process will cause mucosal thickening and coughing. The most common causative agent is the respiratory syncytial virus (Ozkaya-Parlakay et al., 2019). Spirometry will be done to determine airflow obstruction and hyperresponsiveness (Ozkaya-Parlakay et al., 2019). A complete blood count will be done to confirm fever and infection.

Q2: Pathophysiology of PDA

The patent ductus is an opening present in the fetus’s circulatory system that usually closes after birth. Patent ductus arteriosus occurs as a result of a persistent ductus arteriosus after birth. It occurs due to the failure of the metabolism of prostaglandins by the lungs in a premature infant (Conrad & Newberry, 2019). PDA allows blood movement from the left to the right shunt leading to blood in the pulmonary system leading to pulmonary congestion (Conrad & Newberry, 2019). In this case study, PDA is significant since it might cause cough and pulmonary congestion leading to bronchitis. It can also be the cause of her poor growth.

Q3: Risk Factors

The first complication is her history of cardiac PDA. PDA is associated with pulmonary congestion, leading to bronchitis (Conrad & Newberry, 2019). She is also a preterm baby and may have had bronchopulmonary dysplasia, a risk factor for developing respiratory tract infections (Roggeri et al., 2016). Finally, even though she does not go to daycare, her two siblings go, and hence they may expose her to the causative agents.

Q4: Characteristic Signs/Symptoms of Bronchiolitis

The symptoms of bronchiolitis include rhinorrhea, fever, cough, wheezing, chest retractions, and shortness of breath (Gökçe, 2020).

Q5: Rationale for Each Medication

Acetaminophen is an analgesic that works by reducing prostaglandin production in the brain (Bateman, 2016). It should not be used in renal failure, hepatic failure, caloric undernutrition, and liver inflammation (Bateman, 2016). This medication has been prescribed as a pain reliever. Albuterol is a beta-agonist that works by relaxing the respiratory airways’ smooth muscles (Voelker, 2020). This results in relieving bronchospasm and shortness of breath. Contraindications include overactive thyroid glands, diabetes, hyperacidity, and hypertension (Voelker, 2020). It will relieve the congestion that the patient presented with. Corticosteroids are anti-inflammatory agents which will reduce the inflammation in the respiratory airways. They also reduce mucus production. The contraindications include glaucoma, joint infection, osteoporosis, and fungal infections (Williams, 2018). Corticosteroids will help with the cough and congestion.

Q6: Nursing Diagnoses

Nursing diagnosis #1

The first nursing diagnosis is ineffective airway clearance related to infections, as evidenced by fever and cough.

Goals

1. The patient will have clear breathing sounds and demonstrate effective coughing after forty-eight hours. The success of this goal will be determined by the resolution of cough and wheezing.
2. The patient will be free of dyspnea after two weeks. The success of this goal will be evidence by SP02 of 100%.

Interventions

1. Assess the patient’s cough, such as onset, frequency, consistency, mucus production, and expectoration ability. Coughing clears secretion. An effective cough mechanism can compromise airway clearance and prevent mucus expulsion. Ineffective coughing can be due to muscle fatigue and bronchospasm.
2. Assist the child in performing coughing and deep breathing exercise by using blowing bubbles. Vibration is critical in loosening and dislodging secretions. It promotes deeper breathing and initiates coughing to expel secretions.

Nursing Diagnosis #2

Ineffective breathing patterns related to inflammatory process as evidenced by dyspnea.

Goals

1. The child will have normal breathing rates after eight hours. This will be evidence by the absence of shortness of breath
2. The child will have effective breathing patterns after eight hours, as evidenced by the absence of tachypnea.

Nursing Interventions

1. Assess respiratory status every two hours. Changes in breathing patterns are due to the depletion of energy reserves. By assessing the respiratory status, the nurse can reveal the rate of air exchange.
2. Assess oxygen saturation and pulse rate using pulse oximetry. The pulse oximeter will help to detect oxygenation levels.

Q7: Short And Long-Term Possible Complications

The short-term complications of bronchiolitis include cyanosis, dehydration, respiratory distress, and sepsis, while the long-term complications include chronic lung disease, bronchiolitis, and congestive heart failure (Ozkaya-Parlakay et al., 2019).

Q8: Client Education

Small children can spread bronchiolitis through saliva and close contact. The mother will be educated on the symptoms of bronchiolitis and advised to keep her child away from individuals who show these symptoms. She will also be educated to wash her children’s hands after they return from daycare. She would wash their toys and discouraging the sharing of spoons, forks, and cups. She will be further advised to ensure the child is fully dehydrated by giving her plenty of fluids. In addition to this, she will be advised to ensure that no one smokes near Vivi. Finally, she will be instructed on the benefits of administering medications as indicated by the doctor, as compliance will improve patient outcomes.

References

Bateman, D. N. (2016). Acetaminophen (Paracetamol). Critical Care Toxicology, 1-25. https://doi.org/10.1007/978-3-319-20790-2_108-2

Conrad, C., & Newberry, D. (2019). Understanding the pathophysiology, implications, and treatment options of patent ductus arteriosus in the neonatal population. Advances in Neonatal Care, 19(3), E1-E2. https://doi.org/10.1097/anc.0000000000000632

Gökçe, Ş. (2020). One of the main problems of infants: Bronchiolitis. Update on Critical Issues on Infant and Neonatal Care. https://doi.org/10.5772/intechopen.89417

Ozkaya-Parlakay, A., Gulhan, B., Bedir-Demirdag, T., & Kanik-Yuksek, S. (2019). Viral etiology of bronchiolitis among pediatric patients. Pediatric Infectious Disease Journal, 38(9), e233-e233. https://doi.org/10.1097/inf.0000000000002382

Roggeri, A., Roggeri, D. P., Rossi, E., Cataudella, S., & Martini, N. (2016). Impact of hospitalizations for bronchiolitis in preterm infants on long-term health care costs in Italy: A retrospective case-control study. ClinicoEconomics and Outcomes Research, 8, 407-412. https://doi.org/10.2147/ceor.s111535

Voelker, R. (2020). Generic Albuterol inhaler approved. JAMA, 323(19), 1887. https://doi.org/10.1001/jama.2020.7282

Williams, D. M. (2018, June 1). Clinical pharmacology of corticosteroids. American Association for Respiratory Care. https://doi.org/10.4187/respcare.06314

Nursing Case Study

Purpose of Assignment

Top of Form

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 and apply the information you gathered and document your findings in comparison by the particular age of that child.

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.

1. • The child is in less than 10^th percentile of weight and has a cardiac history of Patent Ductus Arteriosus (PDA).
   • Born at 36 weeks gestation.
   • Mother states this child doesn’t go to day care 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:

1. • 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:

1. 1. Describe the pathophysiology of bronchiolitis and identify the most common organism causing this infection. What laboratory testing can confirm your suspicion?
   2. Describe the pathophysiology of PDA and why the history of PDA is significant in this scenario.
   3. What risk factors place Vivi Mitchell at a greater risk for the development of bronchiolitis?
   4. What are the characteristic signs/symptoms of bronchiolitis?
   5. 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.
   6. 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.
   7. What short and long-term possible complications should the nurse anticipate?
   8. What client education is appropriate for Vivi Mitchell as she is discharged from the after-care clinic?

* Include a minimum of 2 scholarly sources

Format

1. • Standard American English (correct grammar, punctuation, etc.)
   • Logical, original and insightful
   • Professional organization, style, and mechanics in APA format
   • Submit document through Grammarly to correct errors before submission

Resources

1. • https://guides.rasmussen.edu/apa

 

Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.

Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date.