Bronchiolitis: Diagnosis and Management (Pediatric Nursing)

00:01 What are the signs and symptoms of bronchiolitis or RSV? Well, typically, they begin with normal, cold-like symptoms, including nasal congestion, cough, a fever, and a diminished appetite.

00:13 As the infection worsens, the child may develop tachypnea, or an increased respiratory rate, to help compensate for the decreased air movement and exchange due to the narrowed air passages and the presence of mucus.

00:26 The children will also develop wheezing and difficulty feeding, as the child will prioritize breathing over eating and drinking.

00:34 The nose can be obstructed by mucus making it really difficult for the child to feed and breath, especially if they're breastfed or bottle fed.

00:42 These kids have an incredible amount of mucus.

00:46 Some children will progress to severe bronchiolitis.

00:50 These children appear quite ill, and they require close observation in the hospital.

00:55 The child may show signs and symptoms of dehydration due to the increased work of breathing, and their decreased oral intake.

01:01 Remember, when the respiratory rate increases, the patient loses more water, through their respiration.

01:09 Retractions are seen in severe bronchiolitis.

01:12 This is a compensatory use of intercostal and chest wall muscles to further try to expand and compress the lungs.

01:20 The child may also have nasal flaring and this is when you attempt to enlarge the space for the air to flow through the nasal passageways.

01:27 The child may begin to grunt when they're breathing, which is heard during the expiratory phase.

01:32 And may also display signs and symptoms of hypoxia, or decreased oxygen levels that reach the tissue.

01:39 There is a resultant cyanosis from the decreased oxygen.

01:42 All of these signs and symptoms of severe bronchiolitis require immediate intervention to prevent further deterioration.

01:51 So how do you diagnose bronchiolitis or RSV? Well, it's a clinical diagnosis, which means the clinician combines data from the history and the physical exam, and excludes all other causes to try to diagnose the condition.

02:04 The clinician will then do a respiratory exam, evaluate the child for hypoxia by checking their pulse oxymeter, and sometimes, you'll do a chest X-ray to exclude other causes.

02:15 You can also perform nasopharyngeal testing and send this to the lab, but you wouldn't wait on this to diagnose a child with bronchiolitis.

02:24 The severity of bronchiolitis drives the interventions and the management.

02:28 A clinician can stratify a child based on these criteria, and can monitor for improvement or decompensation.

02:35 In mild disease, the child is alert and active, they're feeding well, and they may have minimal intercostal retractions.

02:44 Their respiratory rate is normal, and may be just mildly elevated.

02:49 In moderate bronchiolitis, the infant is still alert and able to be consoled.

02:54 They may have decreased feeding, and minimal to moderate intercostal retractions.

03:01 Their respiratory rate may be mildly to moderately elevated.

03:05 In severe bronchiolitis, the infant is a mess.

03:08 They're fussy, difficult to console, they have poor feeding, moderate to severe intercostal retractions, and their respiratory rate is going to be moderately to severely elevated.

03:21 Bronchiolitis is usually self-limiting because it's usually caused by a virus.

03:25 There's no specific treatment for these viruses, and remember, antibiotics are not effective, unless there's a rare bacterial cause of your patient's bronchiolitis, but that's not usually the case.

03:37 You would practice supportive measures, so keep these children hydrated, keep them comfortable.

03:42 You can administer anti-pyretics, if the fever is making them sore or grouchy, and this includes Tylenol and ibuprofen in infants >6 months old.

03:51 You can suction their nose, and this is actually a very helpful management technique.

03:57 These children get so much mucus in their airway and in their nose that remember, they don't feed as well.

04:02 So, the nurse can go in with a bulb syringe or with a deep suction catheter and can actually help remove those secretions for the baby.

04:08 These children are way too young to actually blow their nose.

04:12 And hydration.

04:14 Supplemental oxygen may be needed.

04:16 The benefits have been seen from delivering high flow oxygen.

04:20 The child will usually improve without any treatment in about 1 week's time.

04:25 Just like any other viral illness, the child can usually be managed at home.

04:29 Complications of bronchiolitis are rare.

04:32 They can be cyanosis, as the result of the lack of oxygen, and it's displayed as blue lips or skin.

04:39 The child can become apneic, which is a pause in their breathing.

04:43 This is most likely to occur in premature infants and in infants within their first 2 months of life, as their respiratory control center is still immature.

04:53 Dehydration.

04:54 This is because the child is going to choose breathing over feeding every time.

04:59 This needs to be watched and managed.

05:02 The children may develop secondary pneumonia.

05:04 This is a bacterial infection that would need treatment with antibiotics, and this is after they’ve already cleared the viral illness.

05:12 Hypoxia.

05:13 This is a low level of oxygen that's going to stress all of the body's organs.

05:18 Respiratory distress.

05:19 This is a sign that the child's worsening, and they may require hospitalization for observation and management.

05:27 Rarely, children will progress to respiratory failure, and this can result if these complications are not managed.