Pathologic Conditions
- Definition: Inflammation of the mucous membranes of the bronchioles.
- Pathophysiology: Swelling of the small airways leads to hyperinflation (distal to the obstruction) and emphysema. Resultant pneumonitis and patchy areas of atelectasis may be present.
- Etiology: Bronchiolitis is usually preceded by an upper respiratory viral infection in children. Respiratory syncytial virus (RSV) is responsible for the majority of cases (believed to be spread by hand to nose or eye transmission). Other causative organisms are adenoviruses and parainfluenza viruses.
- Manifestations: Nasal flaring, tachypnea, cough, wheezing, anorexia, and fever. Chest may appear barrel shaped, and suprasternal and subcostal retractions may be present. (Mimics asthma. Usually seen in children under age 2.)
- Med Tx:Ribavirin, bronchodilators, corticosteroids, high humidity (croup tent when hospitalized), supplemental O2 to maintain SaO2 at 95% or above, and increased fluid intake (1½ times maintenance; see Pediatric Maintenance Fluid Calculation.)
- Nsg Dx: Ineffective breathing pattern, ineffective airway clearance, impaired gas exchange, potential fluid volume deficit, anxiety.
- Nsg Care: Frequently monitor respiratory status. Provide 1½ times maintenance fluids. Allow liberal parent visitation to decrease child’s anxiety and oxygen needs. Adhere to strict handwashing regimen to avoid transmission of organism. Support. Warning: Pregnant personnel should be aware that RSV may be teratogenic.
- Prognosis: Most children recover normal lung function after several weeks. Lung problems may persist for years following severe bronchiolitis. A few, especially those who have smoking mothers, have an increased incidence of asthma.