3 Nursing Care Plans For Bronchiolitis with Examples

Introduction

Bronchiolitis is a common lung infection in young children and infants. It causes inflammation and congestion in the lung’s small airways (bronchioles). A virus almost always causes bronchiolitis. Typically, the peak time for bronchiolitis is during the winter months.

Bronchiolitis starts out with symptoms similar to those of a common cold but then progresses to coughing, wheezing and sometimes difficulty breathing. Symptoms of bronchiolitis can last for several days to weeks.

This blog post discusses what bronchiolitis is, its symptoms nursing care plans and interventions with some examples .As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Symptoms of Bronchiolitis

For the first few days, the signs and symptoms of bronchiolitis are similar to those of a cold:

• Runny nose
• Stuffy nose
• Cough
• A slight fever (not always present)

After this, there may be a week or more of difficulty breathing or a whistling noise when the child breathes out (wheezing).

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Causes of Bronchiolitis

Bronchiolitis occurs when a virus infects the bronchioles, which are the smallest airways in the lungs. The infection makes the bronchioles swell and become inflamed. Mucus collects in these airways, making it difficult for air to flow freely in and out of the lungs.

Most cases of bronchiolitis are caused by the respiratory syncytial virus (RSV). RSV is a common virus that infects just about every child by 2 years of age. Outbreaks of RSV infection occur every winter, and individuals can be reinfected, as the previous infection does not appear to cause lasting immunity. Bronchiolitis also can be caused by other viruses, including those that cause the flu or the common cold.

The viruses that cause bronchiolitis are easily spread. A person can contract them through droplets in the air when someone who is sick coughs, sneezes or talks. A person can also get them by touching shared objects — such as utensils, towels or toys — and then touching the eyes, nose or mouth.

Risk Factors of Bronchiolitis

Bronchiolitis typically affects children under the age of 2 years. Infants younger than 3 months of age are at the greatest risk of getting bronchiolitis because their lungs and immune systems aren’t yet fully developed.

Other factors that are linked with an increased risk of bronchiolitis in infants and with more-severe cases include:

• Premature birth
• Underlying heart or lung condition
• Depressed immune system
• Exposure to tobacco smoke
• Never having been breast-fed (breast-fed babies receive immune benefits from the mother)
• Contact with multiple children, such as in a child care setting
• Spending time in crowded environments
• Having siblings who attend school or get child care services and bring home the infection

Complications of Bronchiolitis

Complications of severe bronchiolitis may include:

• Blue lips or skin (cyanosis), caused by lack of oxygen
• Pauses in breathing (apnea), which is most likely to occur in premature babies and in babies within the first two months of life
• Dehydration
• Low oxygen levels and respiratory failure

If these occur, a child may need to be in the hospital. Severe respiratory failure may require that a tube be inserted into the windpipe (trachea) to help the child’s breathing until the infection has run its course.

If a baby was born prematurely, has a heart or lung condition, or has a depressed immune system, watch closely for beginning signs of bronchiolitis. The infection can quickly become severe. In such cases, a child will usually need hospitalization.

Prevention of Bronchiolitis

Because the viruses that cause bronchiolitis spread from person to person, one of the best ways to prevent it is to wash hands frequently — especially before touching a baby when a person has a cold or other respiratory illness. Wearing a face mask at this time is appropriate.

If a child has bronchiolitis, keep him or her at home until the illness is past to avoid spreading it to others.

Other commonsense ways to help curb infection include:

1. Limit contact with people who have a fever or cold. If a child is a newborn, especially a premature newborn, avoid exposure to people with colds, especially in the first two months of life.
2. Clean and disinfect surfaces. Clean and disinfect surfaces and objects that people frequently touch, such as toys and doorknobs. This is especially important if a family member is sick.
3. Cover coughs and sneezes. Cover your mouth and nose with a tissue. Then throw away the tissue and wash your hands or use an alcohol-based hand sanitiser.
4. Use your own drinking glass. Don’t share glasses with others, especially if someone in your family is ill.
5. Wash hands often. Frequently wash your own hands and those of your child. Keep an alcohol-based hand sanitiser handy for yourself and your child when you’re away from home.
6. Breast-feed. Respiratory infections are significantly less common in breast-fed babies.

Diagnosis of Bronchiolitis

Doctor’s likely give a patient a physical exam. They may use a stethoscope to listen to their breathing and count the breaths per minute.

Doctors rarely order X-rays or blood tests for bronchiolitis. But if a child’s symptoms are severe or it’s unclear what’s causing them, they may get these tests:

Chest X-ray: This is done to look for possible signs of pneumonia.

Blood tests: Blood is taken to check the white blood cell count (these are cells that fight infection).

Pulse Oximetry: A sensor is taped to a child’s finger or toe to measure how much oxygen is in their blood.

Nasopharyngeal swab: a doctor will insert a swab into the nose to get a sample of mucus that will be tested for viruses.

Treatment of Bronchiolitis

There is no cure. It usually takes about 2 or 3 weeks for the infection to go away. Antibiotics and cold medicines are not effective in treating it.

Most children with bronchiolitis can be treated at home. There, you should watch to see if your child’s symptoms get worse or they have breathing problems.

A doctor may suggest these home treatments:

• Give them plenty of liquids.
• Use nose drops or sprays to help with a runny nose.
• Use a bulb syringe, which is an at-home method to remove mucus from the nose.
• Prop up their head with an extra pillow (but don’t do this if they are under a year old).

Nursing Diagnosis for Bronchiolitis

• Ineffective Airway Clearance
• Ineffective Breathing Pattern
• Deficient Knowledge

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Nursing Care Plans for Bronchiolitis Based on Diagnosis

Nursing Care Plan 1: Diagnosis – Deficient Knowledge

It may be related to a lack of information about the respiratory syncytial virus

Possibly evidenced by parents verbalize lack of understanding about RSV

Desired Outcomes

• Parents will verbalize understanding of the condition, prevention methods, and treatment of RSV.

Nursing Interventions	Rationale
Assess existing knowledge of disease prevention, transmission, and treatment.	Provides a baseline for the type of information needed to prevent infection transmission to the child.
Teach that the virus is transmitted by direct and indirect contact via the nose and eyes and that hands should be kept away from these areas.	Explains that kissing and cuddling infant/small child and fomites that are on hard, smooth surfaces are sources of contact with the virus.
Teach parents about the signs and symptoms of respiratory distress and infection, including fever, dyspnea, tachypnea, and expectoration of yellow/green sputum.	Encourages parents to seek prompt medical attention as needed.
Teach of potential for spreading the virus to other family members and the need for segregation of infant/small child from others.	Explains that the virus is easily transmitted, with an incidence as high as half of the family members acquiring viral infections.
Suggest that plastic goggles may be worn when caring for an infant/small child.	Prevents the risk of contact with the virus via the eyes.
Teach good handwashing techniques for children and family members.	It prevents transmission by the hands, which are the main sources of contamination and carriers of organisms to the face area.
Encourage parents to provide good nutrition and hydration, emphasizing a high-calorie balanced diet and increased fluids (specify amounts).	Promotes liquification of secretions and replaces calories used to fight infection, thereby boosting the child’s own natural body defence.
Teach parents about the administration of medications prescribed.	Improves consistency of medication administration and the recognition of adverse side effects.
If hospitalized, adhere to infection control policies for clients with RSV.	Protects from exposure to secretions and transmission of the virus to other patients.
Encourage and teach parents to provide care for the hospitalized child at a comfortable level and within the constraints of necessary treatments. Teach parents about the prophylactic drugs (if ordered) of RespiGam or Synagis (specify). These drugs are given to high-risk infants only during the RSV season to prevent RSV infection of compromised infants. RespiGam is RSV immune globulin that is administered once a month during RSV season by IV infusion lasting several hours. The drug interferes with vaccine effectiveness. Synagis is a synthetic monoclonal antibody that is administered IM once a month during RSV season. The drug does not interfere with vaccines. It is very expensive.	Promotes parental identity and control; may lessen anxiety and stress.
Instruct parents regarding the drug Ribavirin if used during hospitalization: Side effects Type and purposes of isolation, including the use of masks, gloves, and/or gowns as applicable. Precautions utilized for parents, staff, and visitors, including information regarding potential risks of environmental exposure; advise pregnant women not to directly care for the child; decrease potential exposure by temporarily stopping the aerosols when tent/hood is opened and administer the drug in well-ventilated rooms (at least 6 air exchanges per hour) Strict handwashing before and after leaving the child’s room)	Promotes understanding which may lessen anxiety; prevents accidental exposures to the drug.
Teach family members about the appropriate disposal of soiled tissues and so forth.	Prevent the transmission of the disease.
Instruct parents on the importance of limiting the number of visitors and screening them for a recent illness.	Prevent transmission of the disease to others; prevent further complications in the child with RSV.

Nursing Care Plan 2: Diagnosis – Ineffective Airway Clearance

It may be related to

• Tracheobronchial obstruction, secretions, infection

Possibly evidenced by:

• Diminished or absent breath sounds
• Crackles, wheezes, rhonchi
• Paroxysmal, nonproductive, and harsh, hacking cough
• Change in rate and depth of respiration
• Dyspnea and shallow respiratory excursion
• Hyperresonance
• Increased mucus and nasal discharge
• Tachypnea
• Fever

Desired Outcomes

• The child will demonstrate effective coughing and clear breath sounds; is free of cyanosis and dyspnea.

Nursing Interventions	Rationale
Assess airway for patency.	Maintaining a 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 the day, or during activity; mucus production: when produced, amount, colour (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 rest periods 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 the head of the bed at least 30° for the child and hold infant and young child in the lap or in an upright position with the head-on shoulder; an older child may sit up and rest head on a pillow on an 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 in performing deep breathing and coughing exercises in a child when in a relaxed position for postural drainage unless procedures are contraindicated; use incentive spirometer in an older child, blowing up a balloon, blowing bubbles, blowing a pinwheel or blowing cotton balls across the table in a younger child.	Vibration loosens and dislodges secretions, and gravity drains the airways and lung segments through Promotes deeper breathing by enlarging the tracheobronchial tree and initiating cough reflex to remove secretions.
Teach parents and possibly older children (specify) administration of medications via a 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).	Ensures compliance with correct drug dosage and other considerations for administrations for desired results and what to do if side effects occur.

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Nursing Care Plan 3: Diagnosis – Ineffective Breathing Pattern

It may be related to:

• Increased work of breathing
• Inflammatory process
• Tracheobronchial obstruction

Possibly evidenced by:

• Cough
• Nasal flaring
• Dyspnea
• Tachypnea
• Shallow respiratory excursion
• Suprasternal and subcostal retractions
• Abnormal arterial blood gases (ABGs)

Desired Outcomes

• The child will maintain an effective breathing pattern, as evidenced by relaxed breathing at a normal rate and depth and absence of dyspnea.

Nursing Interventions	Rationale
Assess respiratory status, a minimum of every 2–4 hours or more often, as indicated for a decreasing respiratory rate and apnea episodes.	Changes in breathing patterns 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 chest configuration 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 obtaining.
Monitor arterial blood gases.	Monitors oxygenation and ventilation status.
Position the head of the bed up or place the child in a position of comfort on the parent’s lap if crying or struggling in a crib or bed.	The position facilitates improved aeration and promotes a decrease in anxiety (especially in toddlers) and energy expenditure.
Encourage frequent rest periods and teach the 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 the patient to mobilize their own secretions with successful coughing.	Facilitates adequate clearance of secretions.
Provide humidified oxygen via face mask, hood, or tent.	Humidified oxygen loosens secretions, helps maintain oxygenation status and ease respiratory distress.

References

• ncbi.gov
• scholar.google.com