A 2-year-old male is diagnosed with a mild RSV infection. Which initial nursing intervention is most important to ensure the child’s airway remains patent?

A) Administer prescribed bronchodilator

B) Encourage the child to drink small, frequent sips of fluids

D) Apply a cool mist humidifier in the child’s room

What is the most appropriate initial nursing intervention to address the respiratory distress observed in the 2-year-old child with RSV infection?

B) Encourage the child to lie flat to rest

D) Provide a high-protein diet to support immune function

What is the primary goal of using saline nasal drops and a bulb syringe in a child with nasal congestion?

B) To decrease nasal congestion

C) To increase oxygen saturation

What is the primary reason for using saline nasal drops and a bulb syringe in a child with nasal congestion due to respiratory illness?

B) To alleviate nasal congestion and improve breathing

A) To improve oxygen saturation levels

B) To alleviate nasal congestion and improve breathing

What is the primary purpose of administering nebulized saline treatments to a child with RSV?

B) To loosen mucus and improve airway clearance

A) To increase oxygen saturation levels

B) To loosen mucus and improve airway clearance

C) To directly kill the RSV virus

What is the primary purpose of administering nebulized saline treatments to a child with RSV?

B) To loosen mucus and improve airway clearance

A) To directly kill the RSV virus

B) To loosen mucus and improve airway clearance

C) To increase oxygen saturation levels

D) To prevent secondary bacterial infections

What is the primary reason for ensuring adequate hydration in a child with respiratory symptoms such as those described?

B) To thin mucus and facilitate easier clearance

A) To maintain electrolyte balance

B) To thin mucus and facilitate easier clearance

D) To increase oxygen saturation

What is the most important initial action the nurse should take when a child begins to show signs of increased respiratory fatigue?

C) Reassess the child's respiratory status

A) Increase the child's fluid intake

B) Notify the pediatrician immediately

C) Reassess the child's respiratory status

What is the primary purpose of chest physiotherapy in a pediatric patient with respiratory distress?

B) To loosen mucus in the airways

What is the primary purpose of chest physiotherapy in the management of the child's respiratory condition?

B) To loosen and mobilize retained secretions

A) To increase oxygen saturation levels

B) To loosen and mobilize retained secretions

C) To decrease respiratory rate

D) To eliminate the need for supplemental oxygen

RSV - Nursing Case Study

Pathophysiology

• Primary mechanism: RSV targets the epithelial cells lining the airways, leading to cell death and sloughing, which causes airway obstruction and inflammation. This results in symptoms like wheezing and difficulty breathing.

• Secondary mechanism: The immune response to RSV infection triggers the release of inflammatory mediators, causing increased mucus production and further narrowing of the airways, exacerbating respiratory symptoms.

• Key complication: In severe cases, RSV can lead to bronchiolitis, characterized by significant inflammation and obstruction of the small airways, which can result in hypoxia and require supportive care.

Patient Profile

Demographics:

2-year-old male, daycare attendee

History:

• Key past medical history: No significant past medical history

• Current medications: None

• Allergies: None

Current Presentation:

• Chief complaint: Cough and mild runny nose

• Key symptoms: Low-grade fever, nasal congestion, mild cough

• Vital signs: Temperature 99.1°F, Heart rate 100 bpm, Respiratory rate 28 breaths/min, Blood pressure 90/55 mmHg, Oxygen saturation 98% on room air

Section 1

Initial Assessment Findings:

Upon initial assessment, the nurse observes the 2-year-old male in his mother's arms, appearing mildly irritable yet alert and responsive. The child's breathing is slightly labored, with noticeable nasal flaring but no use of accessory muscles, indicating mild respiratory distress. The nurse performs an auscultation of the lungs, which reveals scattered wheezing throughout both lung fields, more pronounced on expiration. The presence of wheezing suggests that the small airways are affected, consistent with the early stages of RSV infection.

The assessment further notes clear nasal discharge, and the child intermittently rubs his nose, indicating nasal congestion. Palpation of the lymph nodes reveals slightly enlarged cervical nodes, a common finding in viral infections. The child's capillary refill time is less than 2 seconds, and his skin is warm and well-perfused, indicating adequate circulation despite the mild fever. Given these findings, the nurse prioritizes interventions aimed at maintaining airway patency and monitoring for any progression of symptoms.

The nurse educates the mother on the importance of maintaining hydration, suggesting small, frequent sips of fluids to prevent dehydration due to the child's increased respiratory rate and potential decreased intake. The nurse also advises on using saline nose drops and a bulb syringe to clear nasal congestion, helping to improve the child's comfort and ease of breathing. The initial assessment findings confirm the presence of a mild RSV infection, allowing the healthcare team to focus on supportive care and monitoring for any signs of deterioration.

Section 2

Response to Interventions

After implementing the initial interventions, the nurse reassesses the child to determine the effectiveness of the supportive care measures. The mother reports that using saline nasal drops and the bulb syringe has helped reduce the child's nasal congestion. The child seems more comfortable and is breathing slightly easier, though some nasal flaring is still noted. The child's respiratory rate is 32 breaths per minute, which is slightly elevated but stable. Oxygen saturation remains at 95% on room air, indicating that the child is maintaining adequate oxygen levels despite the mild respiratory distress.

The nurse observes that the child's irritability has decreased, and he is more interactive and responsive. The mother has been diligent in offering small sips of fluids, and the child has been accepting them well, which helps prevent dehydration. The child's urine output is adequate, with several wet diapers noted over the past few hours, confirming good hydration status. The mother expresses relief at these improvements but remains anxious about the possibility of the child's condition worsening.

The nurse continues to monitor for any signs of deterioration, such as increased respiratory distress or changes in behavior. The plan includes frequent reassessment of respiratory status, encouragement of fluid intake, and ongoing education for the mother. By maintaining a close watch on the child and providing reassurance to the mother, the healthcare team can ensure that any changes in the child's condition are promptly addressed, thus preventing the development of more serious complications. As the child's condition remains stable, the team plans to continue with supportive care and periodic evaluations, with the understanding that early intervention is key to managing RSV effectively in young children.

Section 3

As the day progresses, the nurse continues with regular assessments and notices a slight change in the child's respiratory status. During one of the routine checks, the child's respiratory rate has increased to 36 breaths per minute, which, although still manageable, indicates a potential need for closer monitoring. The nurse also detects a mild increase in nasal flaring and audible wheezing upon auscultation. Despite these changes, the child's oxygen saturation remains stable at 94% on room air, ensuring that oxygenation is still adequate.

The nurse discusses these observations with the attending pediatrician, who recommends initiating a trial of nebulized saline treatments to help loosen mucus and improve airway clearance. The nurse explains to the mother that this is a common supportive measure for RSV and that it should help in reducing the child's work of breathing. The mother agrees to the plan, and the nurse administers the first nebulized saline treatment.

Following the nebulization, the nurse monitors the child closely for any immediate changes. The child appears to breathe with slightly less effort, and the wheezing becomes less pronounced, suggesting a positive response to the intervention. The nurse uses this opportunity to educate the mother on the importance of continued hydration and the signs of worsening respiratory distress to watch for, such as increased lethargy or persistent cough. With these interventions in place and the child's condition being closely monitored, the healthcare team remains optimistic about managing the early-stage RSV effectively, while preparing for any potential complications that may arise.

Section 4

As the afternoon progresses, the nurse continues with regular assessments and notes a slight change in the child's condition. The child, who initially appeared to breathe with less effort after the nebulized saline treatment, begins to show signs of increased fatigue. Her respiratory rate has decreased to 32 breaths per minute, which might initially seem positive, but the nurse observes that the child is using accessory muscles to breathe, indicating that she could be tiring. The nurse listens to the child's lungs again and hears a reduction in wheezing, but now there is a soft crackling sound at the end of inspiration, suggestive of some atelectasis or retained secretions.

Recognizing the importance of hydration in managing secretions, the nurse checks the child's fluid intake and discusses with the mother the need to ensure that the child is drinking enough fluids. The nurse explains that adequate hydration can help thin mucus, making it easier to clear, and encourages the mother to continue offering small, frequent sips of water or an appropriate oral rehydration solution. The child’s oxygen saturation remains stable at 93% on room air, a slight decrease but still within an acceptable range, suggesting that oxygenation is not yet compromised.

In light of these findings, the nurse decides to collaborate with the pediatrician to review the child's treatment plan. Together, they consider the need for additional interventions, such as another round of nebulized saline or the introduction of chest physiotherapy to help mobilize secretions. The nurse remains vigilant, closely monitoring for any further signs of respiratory distress or new complications. She educates the mother on recognizing these signs, emphasizing the importance of seeking immediate assistance if the child's condition worsens. This proactive approach aims to manage the child's symptoms effectively and prevent the progression of the illness to a more severe stage.

Section 5

As the evening approaches, the nurse notices a slight change in the child's status, which prompts further assessment. The child's respiratory rate holds steady at 32 breaths per minute, but the use of accessory muscles has become more pronounced. Her oxygen saturation has dipped slightly to 91% on room air, marking a mild decrease that warrants close observation. Additionally, the crackling sounds in the lungs have become more distinct, particularly at the bases, suggesting that the atelectasis or retained secretions might be more pronounced than initially thought.

To address these concerns, the nurse initiates a round of chest physiotherapy. This involves gentle percussion on the child's back to help loosen mucus, followed by encouraging the child to cough. After the session, the child manages to expectorate a small amount of mucus, which is a positive sign indicating that the intervention is helping. The nurse reassesses the child's lung sounds and notes a slight improvement in air movement, although the crackles persist. The nurse documents these findings and communicates them to the pediatrician, who agrees to continue monitoring without immediate changes to the treatment plan.

The nurse takes this opportunity to reinforce education with the mother about the importance of hydration and ensuring the child remains comfortable and rested. She explains the signs of worsening respiratory distress, such as increased work of breathing, nasal flaring, or a further drop in oxygen saturation, and advises the mother on when to seek urgent care. By maintaining this vigilant approach, the nurse aims to prevent any further complications and support the child's recovery through consistent monitoring and timely interventions.