Nursing Case Study: Bronchiolitis, Activities of Life & Care Plan

This nursing case study analyzes bronchiolitis in an 18-month-old baby girl named Bree, focusing on the impact of the condition on her activities of life (AoL), specifically breathing and body temperature regulation. The case study details Bree's symptoms upon admission, including expiratory wheeze, shortness of breath, runny nose, coughing bouts, and a body temperature of 38.2 degrees Celsius. It discusses the importance of monitoring and managing the baby's body temperature to prevent complications like pyrexia and dehydration, as well as interventions to support her breathing, such as semi-Fowler's position, suctioning, and nebulizer treatments. The study includes a nursing care plan that outlines assessments, interventions, and evaluation methods for breathing difficulties. The conclusion emphasizes the need for clear communication, periodic documentation, and parental education to maintain Bree's health and well-being.

Running head: NURSING CASE STUDY
Nursing Case Study
Name of the Student
Name of the University
Author Note

NURSING CASE STUDY
Introduction
Bronchiolitis is a kind of ling infection that leads to the formation of congestion and
subsequent inflammation in the bronchioles (small airways) in the lungs. The main causative
micro-organism is respiratory syncytial virus (RSV) or penumovirus (Ricci et al., 2015, pp:
350). The most vulnerable population getting affected with bronchiolities are the new born
babies and children. The immune system of the infants is weak in comparison to the adults
and thereby making them vulnerable towards viral infection (Meissner, 2016, pp: 62-72). The
primary symptoms of bronchiolitis include runny nose, sneezing and coughing along with
mild rise in body temperature, this symptoms coincides with the symptoms of common cold
and thus the bronchiolitis is confused with common cold at its initial stages (Ricci et al.,
2015, pp: 350). However, as the disease progress, the condition becomes more severe with
symptoms like traumatic coughing bouts leading to breathless or shortness of breath. The
accumulation of mucus in the pulmonary airways further complicates the overall pathological
condition along with the increase in the respiratory rate, causing laboured breathing
(Meissner, 2016, pp: 62-72). The following essay aims of analyse bronchiolitis and its affect
of activities of life (AoL) based on the case study of a 18-month old baby girl, Bree. The AoL
that with be emphasized in this essay include breathing and rise in body temperature. At the
end, the essay will postulate nursing care plan for Bree.
Activities of Life (AoL)
The manifestation of Bronchiolitis in paediatric population occurs through increase in
body temperature. The increase in body temperature leads to fever (Meissner, 2016, pp: 62-
72). According to the case study, 18-month old Bree was admitted to the paediatric ward with
bronchiolitis and she was showing like expiratory wheeze, shortness of breath, runny nose
with clear mucus secretion, coughing bouts and body temperature of 38.2 degree Celsius. Via

NURSING CASE STUDY
examining these symptoms, it can be clearly gauzed that body temperature of Bree is few
notches higher in comparison to the normal body temperature (normal range: 37 to 37.5
degree Celsius). High body temperature is an indicator of inflammation or infection with the
body and in majority of the cases associated with shivering (Morrison, 2016, pp: 30 to 35).
This high body temperature (above 38 degree Celsius) generates threat for the paediatric
population as it give rise of Pyrexia. Pyrexia is again associated with several complications
like dehydration, lethargy and hyperalgesia (Morrison, 2016, pp: 30 to 35). Lathery and
dehydration further hampers the health and well-being of the child and therefore rise in the
body temperature must be handled with utmost care (Donna & Chris, 2013, pp: 1-74).
Breathing is another important AoL which is important for sustaining. In
bronchiolitis, coughing is associated with bouts of cough mixed with mucus which at times
lead to vomiting, breathless and even chocking (Philipson, et al., 2013, pp: 573-579). In case
of Bree, expiratory wheeze indicates the presence of mucus within the airways and this
creating obstruction in breathing. If such conditions sustains for few days, it may lead to
breathless, nausea, disturbances in sleep and thus further hampering the quality of life of
Bree.
AoL assessment and treatment plan
The temperature of the body is defined as the ratio of total heat generated in the body
and total heat loss of the body. In paediatric population, the preliminary manifestation of
inflammation or infection within the body is fever or high body temperature (Houdas & Ring,
2013, pp: 15 to 16). The rise in body temperature as indicated by the thermometer increases
discomfort among the infants (Houdas & Ring, 2013, pp: 15 to 16). According to the case
study, Bree’s body temperature at the time of admission is 38.2 degree Celsius. This high
body temperature above the normal might at tome accompanied with shivering and
subsequent drop in the body temperature under the effect of analgesic can cause profuse

NURSING CASE STUDY
sweating. This sweating in turn can further increase the discomfort level of Bree along with
increase in the tendency of dehydration. Moreover, congestion in the pulmonary cavity
mainly in the trachea and the larynx creates difficulty in swallowing which further limits the
fluid intake and thereby increasing the chances of dehydration (Corrard et al., 2013, p:6).
Common symptoms of dehydration include dry mouth, dry skin, and lack of proper discharge
of urine, pale of yellow colouration of urine and in extreme cases might lead to drowsiness
(Bell & Acarregui, 2014,pp: 10 to 12). As Bree is only 18-month old, she is incapable of
expressing her discomfort arising out of dehydration. It is the duty of the healthcare provider
to access the level of discomfort of Bree via tabulating the amount of fluid intake and
subsequent fluid output. This will further help the nursing professional to frame the care plan
accordingly. The monitoring of the nature of urine can be regarded as another hallmark in
accessing the level of dehydration (Bell & Acarregui, 2014,pp: 10 to 12). Since fever
indicates heightened response of infection, Bree must be kept in isolation. According to
Ricciet al. (2015), bronchiolitis is highly contagious and make infants immune-compromised
and thus increasing further chances of additional infection. So in order to check the chances
of rise in body temperature, apart from keeping Bree in isolation, proper dosage of analgesic
and proper maintenance of sterile condition is extremely important. Here the parents, the
direct caregivers of Bree are required to be educated about the importance of maintain aseptic
condition while handling Bree. Fernandeset al. (2014) stated that proper parent education is
the domain of contagious disease is important to maintain the health and well-being of the
infant. Meissner (2016) reported proper antiviral medication with dosage adjusted for the
infants on the basis of health and weight is also important for controlling the body
temperature and further spread of infection. In order to give comfort from sweating, light
fitted cotton clothes are suitable for Bree and diet plan of Bree will mainly strength over

NURSING CASE STUDY
increased fluid intake. Hay (2013) highlighted that in extreme cases, child are unable to
intake fluid, orally and in such cases, intravenous administration of fluid is recommended.
Normal breathing is a regular process and is assisted via involuntary movements. In
infants, the rate of breathing is higher in comparison to the adults (infants: 30 to 60 beats per
minute; adults: 12 to 20 best per minute) (Ricci et al., 2015, pp: 350). However, the attack of
bronchiolitis, the rate of breathing is increased further and it no longer remains effortless.
This condition is known as laboured breathing (Ricci et al., 2015, pp: 350). The nursing
professional is required to monitor the rate of breathing of Bree after every hour in order to
ascertain the severity of breathing rate. The affect of laboured breathing and its effected on
subsequent breathlessness must be monitored via looking at the colouration of the skin
(Ricciet al., 2015). In order to provide relief from the breathlessness and to ensure smooth
breathing position, Bree should be laid down in semi-fowler position. Semi-Fowler’s position
means lying in supine position over bed at 30 to 45 degree angle of inclination. This will
ensure proper respiratory alignments and thereby promoting breathing (Zolkafi, 2015, pp: 15
to 15). Suction can also be used in order to clear the mucus accumulated in larynx or trachea
and this will reduce the chances of developing asphyxia (Ricci et al., 2015, pp: 350).
Laboured breathing or shortness of breath causes lack of proper oxygen supply. This can be
monitored via pulse oxymetry and external supply of oxygen must be done via the help of
nebulizer if the oxygen saturation within the body is below 90 (partial pressure of oxygen).
Nebulizer delivers liquid medications into the body through the pulmonary airways. It is
electronically powered device that transforms liquid into fine droplets creating mist or aerosol
spray. This helps the infants easy to breathe (Sidler-Moix et al., 2013, pp:14).

Running head: NURSING CASE STUDY
The Nursing Care Plan for Bree (Breathing)
Assess Plan Implement Evaluate
Assessment of breathing rate Use of pulse oxy-metry to assess
breathing rate (Ricci et al., 2015, pp:
350)
Installation of pulse oxymetry machine
to monitor the breathing rate (Ricci et
al., 2015, pp: 350)
Comparing the breathing rate with
the normal range on hourly basis to
ascertain abnormal breathing if any
Assessment of mucus accumulation
Indicators to be monitored included
wheezing breathing and oozing out
mucus from sneezing and coughing
(Ricci et al., 2015, pp: 350)
Monitoring signs and symptoms of
Bree closely (Ricci et al., 2015, pp:
350)
Excretion of dilute mucus through
nose while sneezing indicates clear
thin mucus accumulation and thick
mucus through nose or via coughing
will cause coughing bouts and
vomiting

NURSING CASE STUDY
Assessment of the oxygen saturation
within the body
Use of pulse oxymetry to monitor the
level of oxygen saturation and provide
external supply of oxygen when
saturation is below 90 (Ricci et al.,
2015, pp: 350)
Installation of pulse oxymetry machine
and periodic monitoring of the rate of
saturation (Meissner, 2016, pp: 62-72)
Increase in the oxygen saturation
will cease the external supply of
oxygen
Shortness of breath or laboured
breathing
Use of nebulizers or supine position to
ease laboured breathing
Resting child on semi-fowler’s position
and use of nebulizer to ease pulmonary
airways (Meissner, 2016, pp: 62-72)
Monitoring child’s comfort while
sleep in order to evaluate her degree
of comfort and thereby indicating
the ease in breathing problem
(Meissner, 2016, pp: 62-72)

Running head: NURSING CASE STUDY
Conclusion
Thus from the above discussion, it can be concluded that, in this paediatric case study,
focus was given over two AoL, body temperature and breathing. Both body temperature and
breathing rate hampers the quality of life and thereby affecting the AoL. In order to control
body temperature monitoring and use of proper medication is required. While in order to
maintain the voluntary movement of breathing rate, Bree, must be laid in semi-fowler’s
position along with the use of nebulizer and suction pump to remove mucus accumulation.
Clear communication, periodic documentation and monitoring are required for maintaining
Bree’s health and well-being. It is also the duty of the nurse to ensure comfort of the infants
via dressing her in loosely fitted clothes. Lastly, parent education must be given by the nurse
in order to increase awareness of the parents in the domain of maintain of hygiene and
posture of the child.

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