Nursing Case Study: Managing Bronchiolitis in Paediatric Patients

This case study focuses on an 18-month-old female, Bree, admitted to the paediatric ward with bronchiolitis, presenting symptoms of shortness of breath, cough, expiratory wheeze, fever, and runny nose. The study examines the impact of bronchiolitis on Bree's Activities of Living (AoL), specifically breathing and controlling body temperature. It includes a discussion of how these AoLs are altered, assessment methods, and treatment strategies to manage Bree's symptoms. A nursing care plan is developed, focusing on monitoring body temperature, respiratory rate, fluid intake, and mucus secretion, along with interventions such as maintaining a clear airway, promoting lung expansion, and providing parent education. The case study highlights the importance of continuous monitoring, clear communication, and appropriate interventions to promote the patient's health and well-being.

Running head: NURSING CASE STUDY
NURSING CASE STUDY
Name of the Student
Name of University
Author’s note

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Introduction
Congestion and inflammation of the small airways of the lungs (bronchioles) lead to the
generation of Bronchiolitis. It is a kind of lung infection caused via the viral attack [respiratory
syncytial virus (RSV) or penumovirus]. Since the infants have underdeveloped immune system
or are immune compromised they are most vulnerable group of getting affected with
Bronchiolitis (Hasegawa, Tsugawa, Brown, Mansbach & Camargo, 2013). The primary
symptoms of Bronchiolitis are characterised via coughing, sneezing runny nose and rise in body
temperature. Such symptoms are often confused with common cold. However, as the disease
progress, the conditions become more severe with symptoms manifested like uncontrollable
coughing bouts that cause coughing spasms, breathlessness and even vomiting. Runny nose is
associated with mucus secretion along with respiratory wheeze (Hasegawa et al., 2013).
Paediatric bronchiolitis is further characterised via high body temperature and threats of coma
due to breathless, at times skin turn pale to blue due to the lack of oxygen supply (Hasegawa et
al., 2013). The following essay is based on the case study of paediatric bronchiolitis and how it
affects the activities of living and subsequent assessment and treatment plan in order to
overcome the same.
Activities of Living (AoL)
Overview of AoL
The AoL is mainly hampered by high body temperature during bronchiolitis. Paediatric
bronchiolitis is frequently associated with high fever which is characterised by high body
temperature (Ringer, 2013). According to the case study, Bree, 18-month old girl was admitted

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to paediatric unit of the hospitals for bronchiolitis and main symptoms include high body
temperature (38.2 degree Celsius, cough, runny nose with oozing clear mucous, shortness of
breath and expiratory wheeze. Thus analysis of the symptoms clearly indicates that body
temperature of Bree is high than the normal (normal limit: 36.5 to 37.5 degree Celsius). High
body temperature in viral infection like bronchiolitis might turn into shivering (Houdas & Ring,
2013). Purssell (2014) is of the opinion that high body temperature among infants has defined via
the medical term, Pyrexia. Pyrexia signifies high body temperature but also encompass
dehydration, Lathergy and hyperalgesia. Lathery and dehydration further hamper AoL and hence
high body temperature must be adequately accessed and treated,
Breathing is inevitable activity of AoL. However, in bronchiolitis, this involuntary AoL
is hampered due to mucus accumulation in pulmonary airway, blockage of nose, vomiting,
chocking and breathlessness (Pham, O'malley, Mayfield, Martin & Schibler, 2015). The
expiratory wheeze along with the presence of mucus nasal discharge clearly indicated that Bree
might have symptoms like laboured breathing. If breathless continues for a prolong period of
time then it might lead to coma or brain haemorrhage as due to breathless the oxygen supply
within the brain is decreased or ceased. This breathless affects the overall AoL (Mayfield,
Bogossian, O'Malley & Schibler, 2014).
Assessment and Treatment
Body temperature is the equilibrium between the heat loss and heat generated. The body
temperature is lowest during early morning and gradually rises during noon or early evening.
However, Bree’s body temperature of two notches above the normal level and in order to access
this body temperature proper documentation of temperature per hour is important. van den Anker
(2013) highlighted that use of medicines or analgesic immediately decreases body temperature

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and leads to the formation of sweat. This sweat further heightened cough, cough and
dehydration, making condition more severe. Dehydration in turn makes the skin scaly and at time
can lead to coma (Momtaz, Sabzehei, Rasuli & Torabian, 2014). The level of dehydration if any
can be monitored via tabulating the amount of fluid intake and output along with observation of
the colour of urine (Momtaz et al., 2014). Bofang (2013) highlighted that in infant high body
temperature is associated with shivering and chills which is again detrimental for health and the
child could not perform normal AoL. Since Bree is only 18-month old, it is obvious that she is
incapable of expressing her thoughts and discomfort thus constant monitoring of the symptoms is
important. Bree’s parents or direct care givers must be educated about disease symptoms so that
they can note down rate of shivering and chills when the fever is high. Fever is the main
symptom of infection so in order to reduce rise in temperature, Bree’s parents must also be
educated about the importance of hand hygiene and keeping Bree in isolation. Al-Tawfiq, Abed,
Al-Yami & Birrer (2013) stated that keeping in isolation helps in spread of communicable
disease along with increased protection to immune-compromised person. To give Bree supreme
comfort loosely fitted cotton cloths are recommended. Antibiotics are not the proper choice of
medication in case of Bronchiolitis as it is a viral disease. However, proper anti-viral medication
in order to reduce the infection must be done under active supervision of doctors and this
medication will further help to decrease high temperature (Da Dalt, Bressan, Martinolli,
Perilongo & Baraldi, 2013). Additional medication must be used for pain management. This
because child cannot express his or her pain and administration of pain management medication
might be helpful to provide relief. In order to control dehydration arising out of fever, electrolyte
balance must be maintained via increasing fluid intake, if Bree is unable to take fluid orally
intravenous fluid administration must be followed.

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Breathing is another important AoL. Normal breathing is an involuntary process and is
effortless (Tobaldini et al., 2013). Breathing rate in infants are greater than adults however,
during bronchiolitis, breathing rate is increased further and it can no longer be considered as
voluntary movement but rather becomes forced or laboured breathing (Tobaldini et al., 2013).
The care giver or the nursing professional needs to document the breathing rate of Bree in order
to assess whether the breathing is laboured (normal rate: 22 to 28 breaths per minute) (Tobaldini
et al., 2013). The effect of laboured breathing and coughing must also be monitored like
accessing the chances of breathless or sudden cessation of breath and symptoms include pale or
blue colouration of skin (Parshall et al., 2012). Proper semi-fowler can be used in order to
provide relief from laboured breathing (Parshall et al., 2012). Suction might also be used to clear
the obstruction from trachea or larynx as mucus blocking trachea might lead to asphyxia
(Parshall et al., 2012). Laboured breathing may lead to decrease in the oxygen content of the
body in that case, oxygen saturation must be monitored via pulse oxymetry and external supply
of oxygen must be given if necessary [SO2 below 90] (Parshall et al., 2012). Parents must be
educated about semi-fowler position and proper monitoring of oxygen level.

Running head: NURSING CASE STUDY
The Nursing Care Plan for Bree
Assess Plan Implement Evaluate
 Body temperature
 Signs of dehydration
 Respiratory rate
 Signs of laboured breathing
due to blockage of
pulmonary airways
 Mucus accumulation leading
to forceful coughs and
vomiting
 Controlling body
temperature via the use of
medication
 Controlling dehydration via
regulating fluid intake
 Avoidance of the risk of
pulmonary aspiration
 Maintenance of clear airway,
free from mucus
 Promotion effective
breathing pattern via
controlling body position
 Preventing inflammation via
isolation and maintenance of
 Monitoring body
temperature via thermometer
 Monitoring the level of fluid
intake and output
 Increase oral intake of fluid
to maintain the electrolyte
balance
 Monitoring dehydration
through colouration of urine
 Monitoring oxygen
saturation via pulse
oximetry
 Proper maintenance of semi-
fowler’s position for
 Evaluation of the respiratory
rate via comparing and
documentation
 Evaluation of hypoxemia
through monitoring oxygen
saturation
 Observance of child’s
comfort through her sleep
duration
 Comparing fluid intake and
output to evaluate the signs

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hand hygiene
 Parent education about
child’s posture and
importance of documenting
temperature of the body and
oxygen saturation
 Use of high-flow nasal
cannula oxygen therapy in
order to provide fast relief
( Mayfield, Bogossian,
O'Malley & Schibler, 2014)
adequate lung expansion and
promotion of maximum
ventilation efficiency
(Berman & Snyder, 2013,
pp. 123)
 Monitoring drainage of
mucus via suction pump
with bulb syringe
 Use of external supply of
humified oxygen to
maintenance oxygen (Meyer
et al., 2015)
 Administration of proper
medicines
of dehydration
 Evaluation of other signs of
dehydration like dry mouth
or yellow colouration of
urine and dry skin

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 Observance of aseptic
environment and use of
sterilized towel and bed
cover
 Monitoring for signs of
secondary complications like
dryness of skin, redness of
nose and eyes and swollen of
face due to infection
 Parents education about
therapeutic regimen and care
plan for Bree ()

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Running head: NURSING CASE STUDY
Conclusion
Thus from the above discussion, it can be concluded that AoL are essential for survival.
In this paediatric case study, focus was provided over two AoL and this include fever of body
temperature and breathing. In case of paediatric care plan special attention are required to be
undertaken as infants are unable to express their concerns or discomfort. Rise in body
temperature and labored breathing is detrimental for child’s health as it may lead to coma or
brain damage in extreme cases. Proper education of the parents or direct care givers must be
done to continuous support and for the reduction of unwanted apprehension and panic attacks.
Clear communication, periodic documentation and monitoring are optimal for promoting
patient’s health and well-being. Moreover, a nursing professional must document body
temperature, respiratory rate, fluid intake and mucus secretion in order to device the care plan
accordingly. It is also the duty of the nursing professional to take into consideration of the
comfort of the infants while actively monitoring them.

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