What is bronchiolitis?
Acute viral infection that affects the bronchioles
What causes bronchiolitis?
Most common = RSV subgroup A
Others: adenovirus and parainfluenza virus
How is RSV transmitted?
Direct contact w/ respiratory secretions
Hand --> eye or other mucous membranes
How long do RSV secretions last?
Several hours on countertops, gloves, etc
Half hour on skin
Can children be reinfected w/ RSV virus?
Yes, the antibody response in children is inadequate vs. subsequent infections, recurrent infections possible
When does RSV occur?
Begins in fall, peaks in winter, and declines in the spring
What is the patho of bronchiolitis?
Bronchioles become obstructed (air is trapped here) from inflammatory cells and debris, resulting in hypoxemia, hyperinflation, obstructive emphysema, and atelectasis
What are the s/sx of bronchiolitis?
Early phase: Beings w/ URI, rhinorrhea, low grade fever, cough and sneezing
Otitis media and conjuctivitis may be present (cold-like symptoms)
Late phase: Progresses lower resp. tract and causes wheezing, retractions, crackles, dyspnea, tachypnea, and diminished breath sounds
How can RSV be prevented?
Synagis - a monoclonal antibody given IM 1x/month during RSV season
Who is indicated for RSV prevention?
High risk kids - prematurity, heart disease, and immunocompromised
What is the medical treatment for bronchiolitis?
Uncomplicated, treat the symptoms - O2 prn, IV hydration, airways maintenance, and bronchodilators/antipyretics
In severe case - Riboviran, inhaled antiviral
What is the nursing treatment for bronchiolitis?
Droplet and contact precautions
Monitor resp. status
O2 prn
Suction nasal secretions prn
Elevated HOB
Administered meds
Monitor IV fluids/I&O
Nutrition - give small, frequent amounts and hold for tachypnea
What is bacterial pneumonia?
Inflammation/infection of the lung parenchyma
What is the onset of bacterial pneumonia?
Abrupt and follows a viral URI
What are the general s/sx of pneumonia?
fever, malaise, SOB, hacking, non-productive cough, and chest pain
What are the s/sx of pneumonia in older kids?
Will complain of HA, chills, abd and chest pain
What are the s/sx of pneumonia in infants and young kids?
More severe
Sudden fever, vomiting, diarrhea, and abd distension
May also be apneic, cyanotic, and have a dec activity level and food intake
What breath sounds will be heard in a patient in the acute stage of pneumonia?
Decreased BS and scattered rales
As a pneumonia infection is resolving, how will the physical exam change?
Cough will become productive w/ purulent sputum
Coarse rales and wheezing
How is pneumonia transmitted?
Bacteria enters lungs thru aspiration or by blood
How is pneumonia diagnosed?
Dx confirmed with chest x-ray
Will show pulmonary infiltrates and lobar consolidation
In severe cases, pleural effusions
Which labs will a physician order when suspecting pneumonia?
WBC, gram stain, sputum culture
Sometimes lung biopsy and aspiration
How is bacterial pneumonia treated in the hospital?
IV Abx
Cefuroxime
Cefotaxime
Ceftriaxone
CPT for those who cannot clear secretions
What are the nursing interventions for bacterial pneumonia?
Resp assessment
O2 prn
IV Abx and fluids
Monitor I&O/sats
Nebulized bronchodilators
How can pneumonia be prevented?
Pneumococcal Conjugate Vaccine
Given at 2, 4, 6 mos and again between 12-15 mos
