Nursing Assessment of Bronchiolitis in Infants and Young Children

This report provides an overview of bronchiolitis, a common respiratory infection in infants and young children. It discusses the signs and symptoms of the infection and emphasizes the importance of early detection and proper treatment. The report also highlights the role of nursing assessment in providing effective care for patients with bronchiolitis.

Nursing Assessment
Table of Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY...................................................................................................................................3

Signs and Symptoms...................................................................................................................3
CONCLUSION................................................................................................................................5
REFERENCES................................................................................................................................6
INTRODUCTION
Bronchiolitis is a health care condition which involves a virus infects the bronchioles of a
person. The bronchioles are the smallest airways that are present in the lungs. A person who
suffers with the infection, have swollen and inflamed bronchioles (Papenburg and et. al., 2019).
The mucus gets collected in the airways which makes it difficult for the air to flow in and out of
the lungs easily. Bronchiolitis mainly affects young children, making it difficult for them to
breathe easily. The infection can make it difficult for the person to breathe. This report is based
on the case study of a 7 week infant Issy, who has been brought to the emergency department.

Her parents have brought her in as they are concerned about her condition. The report describes
'airway and breathing' of an acutely unwell child in detail.
MAIN BODY
Signs and Symptoms
Bronchiolitis is a viral infection and usually goes away on its own until and unless the
condition is very serious. In the given case, Issy, who is a 7 week old infant has been brought to
the emergency department by her parents. She has been dealing with rhinorrhoea and tachypnoea
since the last three days (Petrarca, Jacinto and Nenna, 2017). Also, she is normally well and has
also receive immunisations for 6 weeks. Issy is diagnosed with a moderate respiratory distress
which is caused by RSV. Some of her vital signs are described below-
Temperature : 38.4 degrees C
Heart Rate : 165 beats per minute
Blood Pressure : 90/50 mm Hg
Respiratory Rate : 55 breaths per minute
SpO2 : 95% on room air
Patients who suffer from bronchiolitis, show various symptoms that include shortness of
breath, fast breathing, cough, fatigue, wheezing, nasal flaring etc. Most children who suffer from
this condition have mild symptoms and take up to 2 to 3 weeks to recover (Rivera-Sepulveda and
et. al., 2019). Therefore, it is important to look out for any signs and symptoms if the patient is
not able to breathe easily. Therefore, it is important to seek medical advice in such a case. The
child is currently in the developmental stage and if her condition is not treated properly, it will
affect her overall health. Assessments that can be undertaken for her condition will include
respiratory rate, temperature, assessing the heart rate and level of respiratory distress.
My patient is a 7 week old baby named Issy who has been carried into the Emergency
Department through her parents at 1000hrs (Giger and Haddad, 2020). The patient was born at
term and had no birth problems. Issy is usually well and has inward her 6 week immunisations.
The symptoms of acute bronchitis in a child are dry or mucus filled cough, vomiting or gagging,
runny nose, often before a cough starts, chest congestion or pain, slight fever and back or muscle
pain (Acute Bronchitis in Children. 2020).

Comparing with normal important range, Issy has slight fever with rhinorrhoea and
tachypnoea. Her parents have carried her in because they are worried Issy is getting worse. Her
current situation is Issy is breastfed and for the last 2 days has not been noshing as well as
common and her mother informs that she regularly draw off the breast.
Bronchiolities is the most ordinary and normal, harsh, inferior respiratory area disease
mainly current in the baby whom ages is less than 1 year old. It is the irritation of the lungs,
fewest airways-Bronichioles due to the viral illness (Bronchiolitis. 2020). The patient who is
impacted with this problem is suffered from fever and lungs related issues. The Repiratory
Sysncytial Virus cause almost 50-90% of the cases of Bronchiolities. Other infections agents
consider parainfluenza, bocavirus, adenovirus, and human metapneumo virus, influenza and B
and rhino virus etc.
As per the view of Lewis, K & Spiotta, R., (2015), Pathophysiology of Bronchiolities is
the outcome of the disease and cellular collapse of the epithelial layers of the respiratory area due
to virus and infection. These outcomes in to the inflammation causing oedema and mucus
making directing into bronchospasm and eventually causing the necrosis of the epithelial coating
of the respiratory area (McDonald, Boulton and Davis, 2018). It is essential to become aware of
that the newborns are more vulnerable to bronchiolities cause if thin airway lumen and small
bronchioles, that can obtain jammed in easier manner to extreme mucus manufacture, oedema,
and poor compensatory aeration and cause acute respiratory suffering.
After scrutinizing and scrutinizing the accessible subjective and purpose information, i
would carry out the respiratory evaluation and consideration. This description however, will be
concentrated on the living factor of the respiratory evaluation of Issy. I would assess and
evaluate Issy’s breathing managing the peaceful and calm atmosphere, neglecting unrequired and
unnecessary impingements because it can disturb Issy and further make worse irritation and
repiratory distress (Mody and et. al., 2018). Before beginning with any kind of consideration it is
very significant to inquire with Issy’s mother about Issy’s physical condition make sure
recitation that before two days she is feeding well but now she regularly pulls off the breast.
Parental participation and family cantered method and approaches are absolutely essential in
paediatric care, I will seek answers to some crucial questions like:
 Her history of any current sickness and disease
 Past hospitalisation details

 Is she was born premature or has any congenital malformations
Bronchiolitis is one of the essential within children who born premature, bottle-fed or along with
deficiencies of immune. Moreover, this is surely important to evaluate knowledge of parental
related to child’s situation like how inactive or active the children been into last some days, its
hydration as well as status of feeding and respiratory distress signs like abnormal sounds of
breathing and others (Jarvis, 2018). Furthermore, children with possible obstruction of airway
required regular monitoring as well as never leave unattended.
I would consider the Issy breathing evaluation with help of some techniques, which would
be effective for his age. Initially I will observe in case Issy is responsive for agitating drowsy. I
will conduct physical assessment through examining if Issy is putting enhanced potential of
respiratory through utilising accessory muscle that cause head bobbing as well as gasping for air.
Also, I will seek for retraction of chest, tracheal tug and flaring nasal is caused through enhanced
effort of respiratory. I will monitor the rate or apnoea, deep and symmetry of Jack’s chest
through seeking at his bare movement of chest.
Though, I will provide great attention not for agitating Issy even as un performing his
clothing as well as assure that atmosphere is warm. Although counting the breathing rate of Issy,
I will count for one minute to obtain appropriate reading, as infant breathing may be not regular
as well as variable. Thereafter, I will auscultate the chest of Issy for listening to any other sound
of adventitious like crackles of inspiratory or wheeze. I will also try for auscultations when infant
is resting upon his mother’s arm as well as obviating using some kind of cold stethoscope as it
can agitate them as well as obstacle evaluation (Verkerk and et. al., 2018). In addition to this, I
will palpate their chest for inspecting muscle tone through assuring that my hand should be
warm.
As per the facilitated scenario of clinical, and provided that their present situation is
moderate distress of respiratory, expected identification from performed evaluation would be as
below:
1. Expiratory Wheeze: Wheezing is some kind of musical or high pitch sound that is formed
at time of expiration as hair rush out by constricted lumen of airway which is caused
through Bronchiolitis. Moreover, the cellular epithelial layers breakdown is cause by
responses of inflammatory those outcomes into oedema and bronchospasm. This also
cause extra mucus discharge. Along with this, bronchospasm as well as additional mucus

creation combination slim air lumen that cause congestion. As air rushes by packed
airway, the higher pitched sound of wheezing is generated.
2. Extended chest: Necrotic epithelial cell of respiratory area merged with tacky can
form mucus plug, that can either hinder bronchioles or block alveoli and work like one
way control device, hindering air to move out of alveoli that due to air tapping and
hyperinflation of alveoli and subsequently hyperinflation of lungs. This outcome in the
made bigger chest form.
3. Utilisation of ornament influence and head bobbin: Constant air tapping can reason
and rationale the lobular collapse of lungs directing tissue perfusion. As a compensatory
act, the corpse maximise the respiratory rate, therefore, tachypnoea. Utilisation of the
qccessory muscles like strenomastoid power is the symbol and indication if the
respiratory effectiveness to meet systemic oxygen need (Lucoveis and et. al., 2018). The
classic sign of respirartort efforts is the use of ornament muscle considered through head
bobbing.
CONCLUSION
From the above report, it can be concluded that bronchiolitis is a type of infection which
is common among infants and young children. The condition involves inflammation of the small
airways in the lungs due to which the normal breathing of the patient gets hindered. Bronchiolitis
can be treated by a medical professional. The different signs and symptoms of the infection
include breathing rapidly, being irritable, dry cough that is persistent, wheezing etc. It is always
caused by a viral infection in the respiratory system. The virus that is responsible for the same is
known as respiratory syncytial virus or RSV. Also, the condition usually occurs in infants and
young children during the winter months and the symptoms of the same can last for up to a
month.

REFERENCES
Books & Journals
Papenburg, J. and et. al., 2019. Inappropriate Antibiotic Prescribing for Acute Bronchiolitis in
US Emergency Departments, 2007–2015. Journal of the Pediatric Infectious Diseases
Society. 8(6). pp.567-570.
Petrarca, L., Jacinto, T. and Nenna, R., 2017. The treatment of acute bronchiolitis: past, present
and future. Breathe. 13(1). pp.e24-e26.
Rivera-Sepulveda, A. V. and et. al., 2019. Physician compliance with bronchiolitis guidelines in
pediatric emergency departments. Clinical pediatrics. 58(9). pp.1008-1018.
Stafler, P. and et. al., 2017. Feasibility of multiple breath washout measurements in infants with
bronchiolitis: A pilot study. Pediatric Pulmonology. 52(6). pp.763-770.
Giger, J.N. and Haddad, L., 2020. Transcultural Nursing-E-Book: Assessment and Intervention.
Elsevier Health Sciences.
McDonald, E.W., Boulton, J.L. and Davis, J.L., 2018. E-learning and nursing assessment skills
and knowledge–An integrative review. Nurse education today, 66, pp.166-174.
Mody, L. and et. al., 2018. Longitudinal assessment of multidrug-resistant organisms in newly
admitted nursing facility patients: implications for an evolving population. Clinical
Infectious Diseases, 67(6), pp.837-844.
Lucoveis, M.D.L.S. and et. al., 2018. Degree of risk for foot ulcer due to diabetes: nursing
assessment. Revista Brasileira de Enfermagem, 71(6), pp.3041-3047.
Jarvis, C., 2018. Physical Examination and Health Assessment-Canadian E-Book. Elsevier
Health Sciences.
Verkerk, E.W. and et. al., 2018. Low-value care in nursing: a systematic assessment of clinical
practice guidelines. International journal of nursing studies, 87, pp.34-39.
Online
NSW Health. 2011. Children and Infants - Recognition of a Sick Baby or Child in the
Emergency Department, North Sydney, viewed 10 October 2018.
<https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2011_038.pdf>.
NSW Health. 2017. Paediatric Patient Safety, North Sydney, viewed 9 October 2018.
<http://www.cec.health.nsw.gov.au/patient-safety-programs/paediatric-patient-safety/pqp-
between-the-flags>.
Lewis, K & Spiotta, R., 2015. ‘CLINICAL NOTES. Bronchiolitis - A Review of Updated
Guidelines’, Family Doctor: A Journal of the New York State Academy of Family Physicians, pp.
42–43, viewed 10 October 2018.

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