What to Do When your Patient Has Bronchiolitis

If you are a pediatric nurse, bronchiolitis might be everyday news for you. It is a diagnosis we see very often in the pediatric population. If you are a nursing student, you’re probably asking yourself “What in the world is bronchiolitis?” Well, you’re about to find out. Today we are talking Bronchiolitis, it’s most common cause of infection, signs and symptoms and the best treatments for this respiratory infection.

What is Bronchiolitis?

So, what is bronchiolitis? Bronchiolitis is a respiratory illness that primarily affects the bronchi and bronchioles. It is most commonly caused by the Respiratory Syncytial Virus, a.k.a RSV. You may find that providers may use Bronchiolitis and RSV interchangeably.

RSV is transmitted via droplet form. The virus lives in contaminated secretions therefore, sharing the same cups, water bottles, or utensils, and/or touching a contaminated surface (if someone coughed in their hand and then touched a door knob or a child putting a building block in their mouth and the next child picking it up and doing the same) can infect you.

Signs and Symptoms

Before we go into the signs and symptoms of this virus I want you to think for a second- what kind of virus is this? It’s a respiratory virus, correct? So, we will be seeing respiratory signs and symptoms. Think like this each time you review any disease or condition and their symptoms.

Initially patients will begin with mild symptoms…

• Rhinorrhea – runny nose which may lead to sneezing
• Fever
• Pharyngitis – throat discomfort/inflammation due to virus irritating throat.
• Coughing

As the virus progresses and takes on its course symptoms will get worse…

• Fever
• Increased cough and congestion (this is the MAIN symptom of bronchiolitis)
• Tachypnea – increased respiratory rate
• Retractions and wheezing – increased work of breathing
• Refusal to feed- decreased appetite

Not all children will manifest in severe signs and symptoms but with progression of RSV some children (especially infants) can… Severe illness can lead to the following signs and symptoms which are considered emergent.

• Lethargy
• Severe tachypnea (RR > 70/min)
• Apnea
• Poor oxygen exchange – leading to drops in oxygen levels (hypoxemia), cyanosis, and poor lung sounds.

What to monitor?

When an infant or child has bronchiolitis it is important to monitor the respiratory system above all. As mentioned earlier, bronchiolitis attacks the bronchi and bronchioles therefore, you will have most symptoms in this location.

Airway

The number 1 symptom to monitor in bronchiolitis is congestion. This is because as the virus progresses the buildup of secretions becomes not only copious but thicker making it very hard for infants or young children to breathe. Their is an increased risk for infants since they are primarily nose breathers (they can’t effectively breathe in through their mouth) in the first few months of life and obviously don’t know how to blow their nose.

Knowing this, consider how difficult it would be for a baby to drink milk while their nasal passage is occluded by thick secretions. Not only nearly impossible but dangerous. We will talk about what to do when we get to nursing interventions.

Oxygen levels

As a nurse you will be monitoring oxygen levels on your patient with RSV. This is because with progression of the virus you can have ineffective air exchange that could cause oxygen levels to drop. If an oxygen level drops you should notify a physician immediately.

Respiratory Rate, Retractions

Respiratory rate should also be monitored. Because of congestion occlusion your patient may be struggling to get adequate oxygenated air leading to increased work of breathing. Bronchioles might also be inflamed (hence the name- bronchiolitis: bronchiole inflammation) and become filled with congestion leading to wheezing and retractions.

Breath Sounds

Finally, it is also important to ensure you are listening to your patients lungs. It isn’t uncommon for a patient with bronchiolitis to have wheezing or poor breath sounds due to congestion.

If illness has progressed for many days to weeks these patients may be at risk for secondary infections such as pneumonia. This means you might even hear crackles if there is a possible pneumonia present. Listening to your patient’s lungs can tell you a lot about their illness progression.

Nursing interventions

Here is when you really get to treat your patient and help them get better as fast as possible.

Initiate your droplet, contact and standard precautions. You want to make sure anyone who goes into this room wears the proper PPE to limit spread of infection.

Remember, how I said congestion is the number 1 symptom? So, how will we remove all that congestion from their nasal passage? You guessed it!

Suction, suction, suction! We want to make sure we suction congestion before every feed (so they can feed well) and before they go to bed at night (so they can sleep well). You want to also suction as needed throughout the day. If the congestion is too thick it is common practice to use a little bit of nasal saline. Don’t over suction though as oddly enough this can also lead to secretion buildup.

Encourage fluid/PO intake. If patient is unable to tolerate PO fluids then an IV will need to be initiated with proper hydration protocol.

Provide supplemental oxygen as needed. The main treatment for bronchiolitis is suction, fluids and time. It is a viral illness therefore does not require antibiotics (unless a secondary bacterial infection is present). Making sure you assess your patient along the course of the virus is key in ensuring the safety and improvement of your patient.

Provide emotional support and education to parents. Make sure to teach the parents how to handle this virus at home. It is also important to teach them assessment skills they can perform at home and what s/s to look out for that indicate the need to go to the emergency room. Having an infant or small child sick can be a scary time for parents so letting them know what to expect and how to handle it is key.

Well, that’s all for today my friends! Hope you learned a little something new. Now it’s time to share your story.

Have you ever had a patient with RSV? What was the scariest moment for you and how did you handle it?

comment below

’till next time,

The RN Educator