Adult RSV - Nursing Case Study

Pathophysiology

• Primary mechanism: RSV (Respiratory Syncytial Virus) primarily invades the respiratory tract, mainly the bronchioles and lung tissues. It triggers an immune response, causing inflammation and increased mucus production, which can lead to difficulty breathing.

• Secondary mechanism: The virus can also cause cell death in the respiratory tract, leading to further obstruction of airflow. This damage can exacerbate existing lung conditions such as chronic obstructive pulmonary disease (COPD) or asthma.

• Key complication: In severe cases, the inflammation and excess mucus can lead to pneumonia, a serious lung infection that requires immediate medical attention. This complication is more common in adults with weakened immune systems or chronic lung diseases.

Patient Profile

Demographics:

52-year-old male, works as an office administrator.

History:

• Key past medical history: Hypertension, occasional bronchitis

• Current medications: Amlodipine 5mg daily for hypertension

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Mild cough and body aches for past 3 days

• Key symptoms: Low-grade fever, runny nose, tiredness, slight difficulty in breathing

• Vital signs: Blood pressure 130/85 mmHg, pulse 78 bpm, temperature 98.6 degrees Fahrenheit, respiratory rate 16 breaths/minute, oxygen saturation 97% on room air.

Section 1

Change in Patient Status:

After two days, the patient's cough and body aches have persisted. He reports an increased difficulty in breathing and feels more fatigued than before. On reassessment, his vital signs now demonstrate a blood pressure of 135/90 mmHg, pulse 80 bpm, temperature 99.2 degrees Fahrenheit, and his respiratory rate has increased to 20 breaths/minute. His O2 saturation levels have slightly dropped to 95% on room air, indicating a decrease in his oxygenation.

The progression of his symptoms suggests that his body is still actively fighting the RSV infection. The elevated blood pressure could be due to his body's response to the stress of illness. The increased respiratory rate and the drop in oxygen saturation suggest that his respiratory function might be compromised due to the virus's impact on the bronchioles and lung tissues. The mild fever indicates that his body is still trying to fight off the infection. This situation calls for further diagnostic tests to assess the severity of his condition and the need for therapeutic interventions.

Section 2

New Diagnostic Results:

The physician orders a chest X-ray and blood tests to evaluate the patient's condition further. The chest X-ray results show no signs of pneumonia, which is a common complication of RSV infection in adults. However, there are signs of inflammation in the bronchioles, which is consistent with bronchiolitis caused by RSV. The complete blood count (CBC) shows a slight elevation in white blood cells (WBC) at 12,000/mm3, suggesting the body's ongoing response to the infection.

The arterial blood gas (ABG) test results show a pH of 7.35, PaCO2 of 40 mmHg, and PaO2 of 80 mmHg. This indicates that the patient's respiratory function is still within the normal range, but it's on the lower side. The patient's body appears to be compensating for the decreased oxygenation by increasing his respiratory rate. This information will help guide the nurse's next steps in managing the patient's condition, including monitoring his respiratory status closely, providing oxygen therapy if needed, and offering supportive care to alleviate his symptoms.

Section 3

New Complications:

A few hours later, the nursing staff notice that the patient's respiratory rate has increased from 18 to 26 breaths per minute. Even though this is a common response to hypoxemia, it is important to monitor closely. His oxygen saturation has also dropped from 98% to 93% on room air. This decreased oxygen saturation level indicates a worsening of his respiratory function, which could potentially lead to hypoxemia if not addressed promptly. His heart rate has also increased from 72 to 86 beats per minute, indicating his body's response to the decreased oxygen levels and increased respiratory rate.

In response to these changes, the nurse administers supplemental oxygen at 2 liters per minute via nasal cannula as ordered by the physician to improve the patient's oxygenation. The nurse also reassesses the patient's lung sounds, noting an increase in wheezing and crackles compared to the previous assessment. The patient reports feeling more short of breath and fatigued, likely due to the increased work of breathing. The nurse will continue to monitor the patient's respiratory status closely and report any further changes to the healthcare team. The nurse also educates the patient on the importance of rest and hydration in aiding recovery. These new complications are significant and will need to be managed carefully to prevent further deterioration of the patient's condition.

Section 4

Response to Interventions:

After an hour of receiving supplemental oxygen, the patient's respiratory rate decreases to 22 breaths per minute and his oxygen saturation improves to 95%. His heart rate also stabilizes at 80 beats per minute, indicating a positive response to the intervention. However, the patient still reports feeling slightly short of breath and the nurse continues to hear wheezing upon auscultation. The nurse informs the physician of the patient's status and the physician orders a nebulizer treatment with albuterol to further assist in opening up the patient's airways.

Following the nebulizer treatment, the patient reports feeling much better and his breathing appears to be less labored. Upon reassessment, the nurse notes that the patient's wheezing has diminished significantly and his respiratory rate has further decreased to 20 breaths per minute with an oxygen saturation of 96% on 2 liters of supplemental oxygen. The nurse documents these changes and plans to continue monitoring the patient's respiratory status closely. The nurse's prompt response to the patient's changing condition and effective communication with the healthcare team have facilitated the patient's improvement. However, the nurse remains vigilant as the patient continues his recovery, prepared to respond to any new changes or complications that may arise.

Section 5

New Diagnostic Results:

The physician orders a chest X-ray to further investigate the cause of the patient's persistent symptoms. The results show no signs of pneumonia, which is a common complication of RSV, but reveal some inflammation in the lower lobes of the lungs. This confirms the diagnosis of RSV and suggests that the patient's symptoms are due to the viral infection rather than a secondary bacterial infection. Additionally, the physician orders a complete blood count (CBC) to assess the patient's overall health status. The CBC results indicate a slightly elevated white blood cell count (12,000 cells/mcL) indicating that the body is fighting an infection.

With these new diagnostic results, the nurse updates the care plan to include frequent monitoring of the patient's temperature and respiratory status, as well as providing supportive care to alleviate symptoms. The nurse continues to administer supplemental oxygen and nebulizer treatments as ordered, and educates the patient on the importance of maintaining good hydration and nutrition to support his immune system. The nurse also emphasizes the need for frequent hand hygiene to prevent the spread of the virus.