Homework
Purpose of Assignment
The goal of creating a nursing concept map is to create a plan of care for a child with bronchiolitis. The nursing interventions would reflect the underlying respiratory syncytial virus with patent ductus arteriosus (PDA) history.
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 10th 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:
· 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. 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
Answers:
- Pathophysiology of Bronchiolitis
Bronchiolitis is an acute inflammatory disease that affects the small airways of the lung, primarily in infants and young children. It is commonly caused by respiratory syncytial virus (RSV), which leads to inflammation and obstruction of the bronchioles. The virus spreads through direct contact with respiratory secretions or contaminated surfaces, and the incubation period is usually 2-8 days.
Laboratory testing can confirm the diagnosis of bronchiolitis, but it is not usually necessary. However, a nasopharyngeal swab can be used to identify RSV, which is the most common organism causing bronchiolitis in infants and young children.
- Pathophysiology of PDA
Patent ductus arteriosus (PDA) is a congenital heart defect that occurs when the ductus arteriosus fails to close after birth. The ductus arteriosus is a blood vessel that connects the pulmonary artery and the aorta in the fetus, allowing blood to bypass the non-functioning lungs. Normally, the ductus arteriosus closes within the first few days of life, but in some cases, it remains open, leading to increased blood flow to the lungs and decreased blood flow to the body.
The history of PDA is significant in this scenario because it can contribute to the severity of respiratory symptoms in bronchiolitis. Infants with PDA are at an increased risk of respiratory distress, hypoxemia, and pulmonary edema due to the increased blood flow to the lungs.
- Risk Factors for Bronchiolitis
Vivi Mitchell’s low weight percentile and cardiac history of PDA increase her risk for the development of bronchiolitis. Other risk factors include prematurity, young age, exposure to cigarette smoke, and attendance at daycare.
- Signs and Symptoms of Bronchiolitis
The characteristic signs and symptoms of bronchiolitis include rhinorrhea, cough, wheezing, and respiratory distress. In severe cases, there may be retractions, cyanosis, and apnea. Fever is also common, but it is not a reliable indicator of the severity of the illness.
- Medications for Bronchiolitis
- Acetaminophen: This medication is used to manage fever and discomfort associated with bronchiolitis. It is generally safe and well-tolerated, but overdose can lead to liver damage.
- Albuterol nebulizer: This medication is a bronchodilator that is used to relieve wheezing and improve breathing in bronchiolitis. It works by relaxing the smooth muscles in the airways, making it easier to breathe. However, it can cause side effects such as tremors, tachycardia, and hyperactivity.
- Corticosteroids: Methylprednisolone is a corticosteroid that is used to reduce inflammation and swelling in the airways. It can improve respiratory symptoms and shorten the duration of illness. However, it can cause side effects such as increased appetite, weight gain, and mood changes.
- Nursing Care Plan
Nursing Diagnosis 1: Impaired Gas Exchange related to bronchiolitis and history of PDA SMART Goals:
- Goal 1: Within 24 hours, the patient will have improved oxygen saturation levels to 95% or higher on room air.
- Goal 2: Within 72 hours, the patient will demonstrate improved respiratory effort and decreased use of accessory muscles.
Interventions:
- Monitor oxygen saturation levels and respiratory rate.
- Administer prescribed bronchodilators and corticosteroids as ordered.
- Administer supplemental oxygen as needed to maintain oxygen saturation levels.
