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:
- Describe the pathophysiology of bronchiolitis and identify the most common organism causing this infection. What laboratory testing can confirm your suspicion?
- Describe the pathophysiology of PDA and why the history of PDA is significant in this scenario.
- What risk factors place Vivi Mitchell at a greater risk for the development of bronchiolitis?
- What are the characteristic signs/symptoms of bronchiolitis?
- 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.
- 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.
- What short and long-term possible complications should the nurse anticipate?
- What client education is appropriate for Vivi Mitchell as she is discharged from the after-care clinic?
How to solve
Medical Health Competency
Introduction:
Bronchiolitis is a common respiratory infection that primarily affects infants and young children. It is characterized by inflammation and obstruction of the small airways in the lungs, resulting in symptoms such as wheezing, coughing, and difficulty breathing. The most common organism causing bronchiolitis is the respiratory syncytial virus (RSV). Laboratory testing, such as a swab for RSV, can confirm the presence of the virus and help in the diagnosis.
Patent Ductus Arteriosus (PDA) is a congenital heart defect characterized by the persistence of a blood vessel that should normally close after birth. This can result in abnormal blood flow between the aorta and pulmonary artery, leading to various complications. The history of PDA is significant in Vivi Mitchell’s case because it indicates a pre-existing cardiac condition that may increase her susceptibility to respiratory infections like bronchiolitis.
Several risk factors place Vivi Mitchell at a greater risk for the development of bronchiolitis. These include her young age (6 months), being born prematurely at 36 weeks gestation, and exposure to her two older siblings who attend daycare. These factors make her more vulnerable to respiratory infections, including RSV, which is the most common cause of bronchiolitis.
The characteristic signs and symptoms of bronchiolitis include rhinorrhea (runny nose), congestion, fever, cough, wheezing upon auscultation, and retractions. The presence of these symptoms, along with a positive RSV swab, further supports the diagnosis of bronchiolitis in Vivi Mitchell’s case.
The medications prescribed for Vivi Mitchell, namely acetaminophen (Tylenol), albuterol nebulizer, and corticosteroids (methylprednisolone), have specific roles in her medical management. Acetaminophen is prescribed to manage fever, albuterol nebulizer is used to relieve bronchospasm and improve breathing, and corticosteroids are given to reduce inflammation in the airways. It is important to consider potential contraindications or adverse effects associated with these medications, such as allergic reactions, side effects of corticosteroids, or interactions with other medications.
In designing Vivi Mitchell’s plan of care, two priority nursing diagnoses that can be considered are ineffective airway clearance related to bronchiolitis and impaired gas exchange related to respiratory distress. For each diagnosis, two SMART goals (Specific, Measurable, Achievable, Relevant, and Timely) and two corresponding interventions can be identified. These will focus on optimizing airway clearance, promoting adequate oxygenation, and providing supportive care.
Short-term complications that the nurse should anticipate include worsening of respiratory distress, dehydration due to fever and decreased fluid intake, and potential development of secondary bacterial infections. Long-term complications may include recurrent respiratory infections, chronic respiratory problems, and potential cardiovascular complications in relation to PDA.
For client education, Vivi Mitchell’s mother should be provided with instructions on managing fever with acetaminophen, proper administration of albuterol nebulizer, appropriate dosage and duration of corticosteroids, and the importance of monitoring respiratory status and seeking medical attention if necessary. Additionally, education should be given regarding general hygiene measures to prevent the spread of respiratory infections and the need for follow-up evaluation in 3 days to assess her progress.
In summary, bronchiolitis is a respiratory infection primarily caused by RSV, which can result in significant respiratory distress in infants and young children. In Vivi Mitchell’s case, the coexistence of bronchiolitis with a history of PDA necessitates careful management and monitoring. The plan of care should involve interventions to optimize airway clearance, improve gas exchange, and provide supportive care while considering the potential complications and educating the caregiver for appropriate home management.
