A 3-year-old male patient with confirmed RSV and a history of mild asthma is being treated with supplemental oxygen and albuterol inhaler due to borderline oxygen saturation and wheezing. The medical team has initiated IV fluid therapy to prevent dehydration. Which nursing intervention is the priority to monitor for potential complications in this patient?

B) Assess the child's respiratory rate and pattern every hour for signs of increased distress.

A) Monitor the child's urine output every shift to assess for dehydration.

B) Assess the child's respiratory rate and pattern every hour for signs of increased distress.

C) Check the child's blood glucose levels every four hours to monitor for hypoglycemia.

D) Evaluate the child's heart rate every two hours to detect tachycardia.

A 3-year-old male with confirmed RSV and a history of mild asthma is receiving supplemental oxygen and albuterol inhalation therapy. Despite these interventions, his oxygen saturation remains borderline at 92%. Which nursing intervention is the most appropriate to address this issue?

C) Administer a systemic corticosteroid as prescribed.

A) Increase the frequency of albuterol nebulization.

B) Initiate chest physiotherapy to mobilize secretions.

C) Administer a systemic corticosteroid as prescribed.

D) Elevate the head of the bed and encourage oral hydration.

A pediatric patient with a history of asthma and a current RSV infection is receiving oxygen therapy. The child shows increased respiratory effort and decreased oxygen saturation despite treatment. What is the most appropriate next step in nursing management to prevent further respiratory decline?

B) Initiate high-flow nasal cannula therapy

A) Increase supplemental oxygen to 4 liters via nasal cannula

B) Initiate high-flow nasal cannula therapy

C) Administer an increased dose of nebulized albuterol

D) Encourage oral fluid intake to improve hydration status

A 6-year-old patient with a history of asthma is admitted with respiratory distress secondary to RSV infection. Despite receiving oxygen therapy and albuterol, the child's condition is deteriorating. The healthcare team decides to administer a nebulized bronchodilator combined with an inhaled corticosteroid and considers escalating respiratory support if necessary. As the nurse, what is the most critical assessment to perform next to determine the effectiveness of the current interventions?

B) Observe for changes in respiratory rate and effort

A) Monitor the child's fluid intake and output

B) Observe for changes in respiratory rate and effort

C) Check for improvement in wheezing and breath sounds

D) Evaluate the child's level of consciousness and activity

A pediatric patient with RSV and asthma is showing worsening respiratory distress despite treatment. What is the most appropriate nursing intervention to prioritize at this time?

C) Reassess the patient's response to high-flow nasal cannula therapy

A) Increase the rate of intravenous fluids to improve hydration

B) Administer an additional dose of the bronchodilator

C) Reassess the patient's response to high-flow nasal cannula therapy

D) Position the child in a semi-Fowler's position to ease breathing

A pediatric patient with RSV and asthma is experiencing worsening respiratory distress despite initial treatment with nebulized bronchodilators and inhaled corticosteroids. The medical team has initiated high-flow nasal cannula therapy and broad-spectrum antibiotics. As a nurse, what is the most critical intervention to implement next?

B) Monitor and document the child's respiratory status and response to the high-flow nasal cannula therapy closely.

A) Increase the frequency of nebulizer treatments to every 2 hours.

B) Monitor and document the child's respiratory status and response to the high-flow nasal cannula therapy closely.

C) Administer a diuretic to prevent fluid overload due to intravenous hydration.

D) Encourage oral intake to improve hydration status.

A pediatric patient with respiratory syncytial virus (RSV) and a confirmed secondary bacterial infection is showing signs of respiratory failure despite being on high-flow nasal cannula therapy. The arterial blood gas analysis shows a pH of 7.30, PaCO2 of 55 mmHg, and PaO2 of 60 mmHg. Which of the following immediate actions should the nurse anticipate to best address the child's current condition?

B) Prepare for the initiation of non-invasive ventilation to support ventilation.

A) Increase the flow rate of the nasal cannula to improve oxygenation.

B) Prepare for the initiation of non-invasive ventilation to support ventilation.

C) Administer a bronchodilator to reduce airway resistance.

D) Continue current management and closely monitor the child's vital signs.

A pediatric patient with respiratory syncytial virus (RSV) and secondary bacterial pneumonia is experiencing worsening respiratory failure despite high-flow nasal cannula therapy. The patient's ABG results show a pH of 7.30, PaCO2 of 55 mmHg, and PaO2 of 60 mmHg. What is the most appropriate nursing action to prepare for the next step in management?

B) Prepare the patient for non-invasive ventilation or mechanical ventilation.

A) Administer a bronchodilator to improve airway patency.

B) Prepare the patient for non-invasive ventilation or mechanical ventilation.

C) Increase the flow rate of the nasal cannula to improve oxygenation.

D) Encourage deep breathing exercises to enhance alveolar ventilation.

A child with severe respiratory distress has been admitted to the PICU and is receiving non-invasive positive pressure ventilation. The arterial blood gas analysis shows persistent respiratory acidosis and hypoxemia. What is the most appropriate nursing action to prepare for the potential progression to mechanical ventilation?

B) Ensure all necessary equipment for intubation is readily available

A) Administer a bronchodilator to improve airway patency

B) Ensure all necessary equipment for intubation is readily available

C) Increase the flow rate of oxygen delivery to improve saturation

D) Perform chest physiotherapy to clear secretions

A pediatric patient in the PICU is experiencing persistent respiratory acidosis and hypoxemia despite high-flow oxygen therapy and non-invasive positive pressure ventilation. The arterial blood gas analysis shows a pH of 7.28, PaCO2 of 58 mmHg, and PaO2 of 58 mmHg. What is the nurse's priority action to prevent further deterioration of the patient's condition?

B) Prepare for immediate intubation and mechanical ventilation

A) Increase the flow rate of the current oxygen therapy

B) Prepare for immediate intubation and mechanical ventilation

C) Administer a bronchodilator to improve airway patency

D) Reassess the patient's fluid status to prevent overload

RSV in child - Nursing Case Study

Pathophysiology

• Primary mechanism: RSV targets epithelial cells of the respiratory tract, leading to cell death and sloughing. This causes airway inflammation and increased mucus production, which obstructs airways, particularly affecting infants with smaller airways.

• Secondary mechanism: Immune response further exacerbates inflammation. The infiltration of immune cells, including neutrophils and lymphocytes, leads to edema and additional mucus, worsening airway blockage and resulting in impaired gas exchange.

• Key complication: These mechanisms can lead to bronchiolitis, characterized by wheezing and difficulty breathing. In severe cases, hypoxemia may occur due to inadequate oxygenation, necessitating supportive care such as oxygen therapy.

Patient Profile

Demographics:

3-year-old male, attends daycare

History:

• Key past medical history: History of mild asthma

• Current medications: Albuterol inhaler as needed

• Allergies: Allergic to penicillin

Current Presentation:

• Chief complaint: Difficulty breathing and persistent cough

• Key symptoms: Wheezing, nasal congestion, decreased appetite, lethargy

• Vital signs: Temperature: 101.5°F, Heart rate: 140 bpm, Respiratory rate: 36 breaths/min, Oxygen saturation: 92% on room air

Section 1

As the clinical team continues to monitor the 3-year-old male patient with suspected RSV, new diagnostic results become available. A nasopharyngeal swab confirms the presence of respiratory syncytial virus (RSV), corroborating the initial clinical suspicion based on symptoms and history. In addition to the confirmed RSV, a complete blood count (CBC) reveals leukocytosis with an elevated white blood cell count of 15,000/mm³, indicating a heightened immune response. A chest X-ray is performed, showing hyperinflation and patchy infiltrates consistent with bronchiolitis, but no evidence of bacterial pneumonia.

Given the confirmed RSV infection and the child's history of mild asthma, the clinical team considers the potential for increased airway reactivity and obstruction due to the virus's inflammatory effects. The decision is made to initiate supplemental oxygen therapy to address the child's oxygen saturation, which remains borderline at 92% on room air. An increase in wheezing, noted during the physical examination, prompts the use of an albuterol inhaler, which temporarily improves breath sounds but does not significantly elevate oxygen levels.

The medical team recognizes the potential for further complications, such as dehydration due to decreased oral intake and increased respiratory demands. Therefore, they initiate IV fluid therapy to maintain hydration and support perfusion. Close monitoring of the child's respiratory status and oxygenation continues, with the plan to escalate care if hypoxemia worsens or if signs of respiratory distress become more pronounced. The focus remains on managing symptoms and preventing further complications while anticipating the need for possible escalation to more intensive respiratory support if the child's condition does not stabilize.

Section 2

As the clinical team continues to monitor the young patient, a change in his status becomes evident. Approximately 24 hours after the initiation of oxygen therapy and albuterol treatment, the child exhibits increased respiratory effort. His respiratory rate has risen to 50 breaths per minute, and retractions are observed in the intercostal spaces. His oxygen saturation, despite being on 2 liters of supplemental oxygen via nasal cannula, has decreased to 89%, indicating worsening hypoxemia. The patient appears more fatigued, with periods of lethargy alternating with irritability, suggesting the increased work of breathing is taking a toll on his overall energy levels.

The medical team reevaluates the situation, considering the potential complications associated with RSV and the child's history of asthma. The persistence of wheezing and the decreased effectiveness of albuterol suggest that airway inflammation and mucus plugging might be contributing to the current respiratory distress. Consequently, the decision is made to administer a nebulized bronchodilator combined with an inhaled corticosteroid to address both bronchospasm and inflammation. In addition, the team orders a repeat chest X-ray to assess for any progression of the lung infiltrates or development of atelectasis.

Despite these interventions, the child's condition remains tenuous, prompting discussions about the next steps in management. The potential need for escalation to high-flow nasal cannula or non-invasive positive pressure ventilation is considered if the child's respiratory status does not improve. Additionally, the team emphasizes the importance of maintaining vigilance for dehydration and ensuring the child receives adequate IV fluids, given his decreased oral intake. These measures are critical in stabilizing the patient's condition and preventing further deterioration as the team continues to manage the complexities of RSV in the context of underlying asthma.

Section 3

As the medical team continues to closely monitor the young patient, they observe a concerning change in his status. Approximately 12 hours after introducing the nebulized bronchodilator and inhaled corticosteroid therapy, his respiratory distress appears to intensify. His respiratory rate has climbed to 55 breaths per minute, and he is now exhibiting nasal flaring alongside the previously noted intercostal retractions. His oxygen saturation has further declined to 85% on 2 liters of oxygen via nasal cannula, prompting an immediate reassessment of his treatment plan. The child's heart rate has increased to 160 beats per minute, and his blood pressure is noted to be 95/60 mmHg, indicating a compensatory response to the increased respiratory demand.

A repeat chest X-ray reveals worsening bilateral infiltrates and areas suggestive of atelectasis, particularly in the right lower lobe. These findings correlate with the child's persistent hypoxemia and suggest a possible progression towards more significant lower respiratory tract involvement. Additionally, laboratory results indicate an elevated white blood cell count of 15,000/mm³ and a C-reactive protein level of 12 mg/L, which may reflect an inflammatory response to the viral infection or a superimposed bacterial process.

In response to these developments, the clinical team initiates high-flow nasal cannula therapy to deliver a higher concentration of oxygen and provide some degree of positive airway pressure to support the child's breathing efforts. Concurrently, a decision is made to start a broad-spectrum antibiotic to cover potential secondary bacterial pneumonia, despite the primary viral etiology. The team continues to emphasize close monitoring of the child's fluid balance and maintains intravenous hydration to prevent dehydration. This escalation in care is critical as the team aims to stabilize the patient's condition and mitigate the risk of respiratory failure while addressing the multifaceted complications presented by RSV and asthma.

Section 4

As the clinical team continues to manage the child's condition, they observe a change in his status that prompts further intervention. Despite the initiation of high-flow nasal cannula therapy, the child's oxygen saturation remains suboptimal, fluctuating between 87% and 89%. His respiratory rate remains elevated at 60 breaths per minute, and he continues to exhibit significant nasal flaring and retractions. The child's increased work of breathing is also reflected in his heart rate, which has climbed to 170 beats per minute. The team notes that the child's level of consciousness is beginning to decrease slightly; he is less interactive and more lethargic compared to his baseline.

In light of these concerning developments, the team orders an arterial blood gas analysis to assess the child's respiratory and metabolic status more precisely. The results reveal a pH of 7.30, PaCO2 of 55 mmHg, and PaO2 of 60 mmHg, indicating respiratory acidosis with hypoxemia. These findings suggest that the child is experiencing worsening respiratory failure, likely due to inadequate ventilation. The team also reviews the results of a recently performed blood culture, which has returned positive for Streptococcus pneumoniae, confirming the presence of a secondary bacterial infection.

Given the child's deteriorating condition, the team decides to escalate care by consulting the pediatric intensive care unit (PICU) for potential transfer. They discuss the possibility of more advanced respiratory support, such as non-invasive ventilation or mechanical ventilation, to address the child's respiratory failure. This decision is also informed by the need to provide more aggressive management of the confirmed bacterial pneumonia. The team continues to monitor the child's fluid status closely and adjusts his antibiotic regimen to more effectively target the identified pathogen. As the situation evolves, the team's focus remains on stabilizing the child and preventing further complications from RSV and the superimposed bacterial infection.

Section 5

The child's transfer to the pediatric intensive care unit is promptly arranged, and upon arrival, the PICU team conducts a thorough initial assessment. The child's respiratory distress has continued to escalate, with increased reliance on accessory muscles and intermittent grunting. Oxygen saturation levels remain critically low, fluctuating between 85% and 87% despite high-flow oxygen therapy. His heart rate is persistently elevated at 175 beats per minute, and his respiratory rate has decreased slightly to 55 breaths per minute, potentially indicating fatigue. The child is now minimally responsive to stimuli, raising concerns about his neurological status. Capillary refill time is prolonged, suggesting potential perfusion issues.

The PICU team initiates non-invasive positive pressure ventilation to improve alveolar ventilation and address the respiratory acidosis. However, within the first hour of this intervention, the child's condition does not significantly improve. His arterial blood gas analysis post-intervention shows a pH of 7.28, PaCO2 of 58 mmHg, and PaO2 of 58 mmHg, indicating persistent respiratory acidosis and hypoxemia. Given these results, the team considers the likelihood of progressing to mechanical ventilation to ensure adequate respiratory support and prevent further deterioration.

In parallel, the child's antibiotic regimen is adjusted to high-dose intravenous ceftriaxone, aimed at effectively managing the Streptococcus pneumoniae infection. Close monitoring of his fluid status is maintained to prevent fluid overload, particularly as the team is aware of potential complications such as acute respiratory distress syndrome (ARDS). With these measures in place, the focus remains on optimizing the child's respiratory function and addressing the superimposed bacterial pneumonia, while preparing for the possibility of further complications that may necessitate additional interventions.