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Friday, May 17, 2019

Pathophysiology of respiratory system and nursing care: Bronchiolitis

Bsc(Anatomy),Dip.HSE,Masters of public health(Epidemiology) in-view

Bronchiolitis is an acute viral inflammation of the lower respiratory tract involving the bronchioles and alveoli.

Accumulated thick mucus, exudate, and cellular debris and the mucosal edema from the inflammatory process obstruct the smaller airways (bronchioles). This causes a reduction in expiration, air trapping, and hyperinflation of the alveoli.

The obstruction interferes with gas exchange, and in severe cases causes hypoxemia and hypercapnia, which can lead to respiratory acidosis. Children in a debilitated state who experience this disorder with other serious diseases are hospitalized.

Nursing Care Plans

Nursing care planning goals for a child with bronchiolitis include maintenance of effective airway clearance, improved breathing pattern, relief of anxiety and fatigue, increased parental knowledge about the disease condition, and absence of complications.

Here are five (5) nursing care plans and nursing diagnosis for bronchiolitis:

Ineffective Airway Clearance

Ineffective Airway Clearance: Inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway.
May be related to
  • Tracheobronchial obstruction, secretions, infection
Possibly evidenced by

  1. Diminished or absent breath sounds
  2. Crackles, wheezes, rhonchi
  3. Paroxysmal, nonproductive, and harsh, hacking cough
  4. Change in rate and depth of respirations
  5. Dyspnea and shallow respiratory excursion
  6. Hyperresonance
  7. Increased mucus and nasal discharge
  8. Tachypnea
  9. Fever
Desired Outcomes
  • Child will demonstrate effective coughing and clear breath sounds; is free of cyanosis and dyspnea.
Nursing InterventionsRationale
Assess airway for patency.Maintaining patent airway is always the first priority, especially in cases like trauma, acute neurological decompensation, or cardiac arrest.
Assess respirations. Note quality, rate, pattern, depth, flaring of nostrils, dyspnea on exertion, evidence of splinting, use of accessory muscles, and position for breathing.A change in the usual respiration may mean respiratory compromise. An increase in respiratory rate and rhythm may be a compensatory response to airway obstruction.
Assess breath sounds by auscultation.Abnormal breath sounds can be heard as fluid and mucus accumulate. This may indicate airway is obstructed.
Assess cough (moist, dry, hacking, paroxysmal, brassy, or croupy): onset, duration, frequency, if it occurs at night, during day, or during activity; mucus production: when produced, amount, color (clear, yellow , green), consistency (thick, tenacious, frothy); ability to expectorate or if swallowing secretions, stuffy nose or nasal drainage.Coughing is a mechanism for clearing secretions. An ineffective cough compromises airway clearance and prevents mucus from being expelled. Respiratory muscle fatigue, severe bronchospasm, or thick and tenacious secretions are possible causes of ineffective cough.
Provide for periods of rest by organizing procedures and care and disturbing infant/child as little as possible in acute stages of illness.Prevents unnecessary energy expenditure resulting in fatigue.
Elevate head of bed at least 30° for child and hold infant and young child in lap or in an upright position with head on shoulder; older child may sit up and rest head on a pillow on overbed table.Upright position limits abdominal contents from pushing upward and inhibiting lung expansion. This position promotes better lung expansion and improved air exchange.
Encourage fluid intake at frequent intervals over 24-h time periods, specify amounts.Fluids help minimize mucosal drying and maximize ciliary action to move secretions.
Reposition on sides q 2h; position child in proper body alignment.Prevents accumulation and pooling of secretions.
Assist to perform deep breathing and coughing exercises in child when in a relaxed position for postural drainage unless procedures are contraindicated; use incentive spirometer in older child, blowing up balloon, blowing bubbles, blowing a pinwheel or blowing cotton balls across the table in younger child.Vibration loosens and dislodges secretions, and gravity drains the airways and lung segments through Promotes deeper breathing by enlarging tracheobronchial tree and initiating cough reflex to remove secretions.
Teach parents and possibly older child (specify) administration of medications via proper route with name and action of each drug: dosage; why given; frequency; time of day or night; side effects to report; how to administer in food—crushed, chewable, by measured dropper, or other recommended form; and method (nose drops, inhaler).

Ineffective Breathing Pattern

Ineffective Breathing Pattern: Inspiration and/or expiration that does not provide adequate ventilation.
May be related to
  1. Increased work of breathing
  2. Inflammatory process
  3. Tracheobronchial obstruction
Possibly evidenced by
  1. Cough
  2. Nasal flaring
  3. Dyspnea
  4. Tachypnea
  5. Shallow respiratory excursion
  6. Suprasternal and subcostal retractions
  7. Abnormal arterial blood gases (ABGs)
Desired Outcomes
  • Child will maintain effective breathing pattern, as evidenced by relaxed breathing at normal rate and depth and absence of dyspnea.
Nursing InterventionsRationale
Assess respiratory status, a minimum of every 2–4 hours or more often as indicated for a decreasing respiratory rate and episodes of apnea.Changes in breathing pattern may occur quickly as the child’s energy reserves are depleted. Assessment and monitoring baseline reveal rate and quality of air exchange. Frequent assessment and monitoring provide objective evidence of changes in the quality of respiratory effort, enabling prompt and effective intervention.
Assess configuration of the chest by palpation; auscultate for breath sounds that indicate a movement restriction (absent or diminished, crackles or rhonchi).This is to detect decreased or adventitious breath sounds.
Note for changes in the level of consciousness.Restlessness, confusion, and/or irritability can be early indicators of insufficient oxygen to the brain.
Assess pulse rate and oxygen saturation using pulse oximetry.Pulse oximetry is a helpful tool to detect alterations in oxygenation initially; but, for CO2 levels, end-tidal CO2 monitoring or arterial blood gases (ABGs) would require being obtained.
Monitor arterial blood gases.Monitors oxygenation and ventilation status.
Position head of the bed up or place child in position of comfort on parent’s lap, if crying or struggling in crib or bedPosition facilitates improved aeration and promotes a decrease in anxiety (especially in toddlers) and energy expenditure.
Encourage frequent rest periods and teach patient to pace activity.Extra activity can worsen shortness of breath. Ensure the patient rests between strenuous activities.
Assist and demonstrate proper deep breathing exercises.Promotes deep inspiration, which increases oxygenation and prevents atelectasis.
Maintain a clear airway by encouraging patient to mobilize own secretions with successful coughing.Facilitates adequate clearance of secretions.
Provide humidified oxygen via face mask, hood, or tent.Humidified oxygen loosens secretions and helps maintain oxygenation status and ease respiratory distress.
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