Which of the following is the most appropriate initial nursing intervention for an infant with RSV who exhibits mild nasal flaring and intermittent retractions?

A) Administer supplemental oxygen

C) Administer bronchodilator therapy

When caring for an infant with RSV, which of the following interventions should the nurse prioritize to help maintain the infant's comfort and respiratory function?

C) Performing nasal suctioning to relieve congestion

A) Administering antibiotics to treat the infection

B) Providing humidified oxygen to ease breathing

C) Performing nasal suctioning to relieve congestion

D) Offering oral rehydration solutions to prevent dehydration

When educating parents on signs of respiratory distress in their infant, which of the following should be included as a significant indicator?

D) Oxygen saturation of 97-98% on room air

What is the primary rationale for teaching parents how to perform nasal suctioning on their infant at home?

B) To improve the infant's respiratory status and feeding ability

A) To prevent bacterial infections

B) To improve the infant's respiratory status and feeding ability

C) To reduce the need for medication

D) To ensure the parents are actively involved in the care

Which of the following interventions should the nursing team prioritize to enhance mucus clearance in the infant?

B) Implementing chest physiotherapy techniques

A) Administering bronchodilator medication

B) Implementing chest physiotherapy techniques

C) Increasing the infant's fluid intake

D) Applying warm compresses to the chest

In monitoring an infant recovering from RSV, which intervention is most important to help clear retained secretions in the lung?

B) Encouraging chest physiotherapy

C) Providing cough suppressants

What is the primary purpose of chest physiotherapy in infants with respiratory issues like RSV?

B) To clear retained secretions from the lungs

A) To strengthen the respiratory muscles

B) To clear retained secretions from the lungs

C) To increase lung volume and capacity

D) To prevent the spread of infection

What is the primary purpose of using a humidifier for an infant with respiratory issues?

B) To maintain optimal air moisture levels

A) To increase the temperature in the room

B) To maintain optimal air moisture levels

C) To reduce the noise level in the room

D) To provide inhaled medication directly

Which intervention is primarily aimed at facilitating mucus clearance in the infant with mild increased opacity in the right lower lobe?

B) Implementing frequent chest physiotherapy

A) Administering bronchodilators

B) Implementing frequent chest physiotherapy

C) Providing supplemental oxygen

Infant RSV - Nursing Case Study

Pathophysiology

• Primary mechanism: Respiratory Syncytial Virus (RSV) infects the epithelial cells lining the infant's airways, leading to cell damage and death. This results in inflammation and swelling, which narrow the airways and make breathing difficult.

• Secondary mechanism: The infection triggers excessive mucus production, which further obstructs the already narrowed airways. This can cause wheezing and labored breathing, as the infant struggles to move air in and out of the lungs.

• Key complication: Severe RSV infection can lead to bronchiolitis, characterized by small airway obstruction, decreased oxygen exchange, and potential respiratory distress, requiring close monitoring and supportive care.

Patient Profile

Demographics:

6-month-old, male, infant

History:

• Key past medical history: No significant past medical history.

• Current medications: None.

• Allergies: No known allergies.

Current Presentation:

• Chief complaint: Mild cough and nasal congestion.

• Key symptoms: Runny nose, mild cough, low-grade fever, slightly decreased appetite.

• Vital signs: Temperature 99.2°F, Heart rate 110 bpm, Respiratory rate 38 breaths/min, Oxygen saturation 98% on room air, Blood pressure not typically measured in infants.

Section 1

Initial Assessment Findings:

Upon admission to the pediatric unit, the infant is observed to be alert and responsive, though slightly irritable due to discomfort from congestion. A focused respiratory assessment reveals mild nasal flaring and intermittent mild retractions, indicating the infant is working harder to breathe. Breath sounds are characterized by bilateral wheezes and crackles upon auscultation, consistent with the increased mucus production and airway inflammation associated with RSV. The infant's skin is warm and well-perfused, with a capillary refill time of less than 2 seconds, suggesting adequate circulation despite the mild respiratory symptoms.

The infant's parents report that his feeding schedule has been disrupted due to his decreased appetite, though he is still managing to take in small amounts of formula. They note that he is producing an adequate number of wet diapers, indicating that he is likely maintaining hydration status. Given the infant's stable oxygen saturation of 98% on room air, supplemental oxygen is not required at this time. However, the nursing team develops an initial care plan focused on monitoring for any signs of respiratory distress, ensuring adequate fluid intake, and providing supportive care measures such as nasal suctioning to relieve congestion.

This initial assessment provides a foundation for prioritizing interventions aimed at maintaining the infant's respiratory function and comfort. Nurses will continue to monitor vital signs closely, especially respiratory rate and effort, while educating the parents on signs of worsening symptoms that would necessitate further medical evaluation. The goal is to prevent progression to more severe complications, such as bronchiolitis, while supporting the infant's recovery from the RSV infection.

Section 2

Response to Interventions

Over the next 24 hours, the infant's response to the initial interventions is closely monitored by the nursing team. Regular nasal suctioning is performed to alleviate congestion, which helps improve his comfort and slightly enhances his feeding ability. The parents are taught how to perform gentle nasal suctioning at home using a bulb syringe, which they practice under the guidance of the nursing staff. Frequent, small feedings are encouraged to ensure the infant maintains adequate nutrition and hydration, and the parents report that he is more willing to take formula now that his nasal passages are clearer.

Vital signs are checked routinely, and the infant maintains a stable respiratory rate of 40 breaths per minute, with only mild retractions noted during periods of activity. Oxygen saturation remains consistently at 97-98% on room air, indicating effective gas exchange despite ongoing respiratory symptoms. The infant's temperature is monitored closely, and he remains afebrile, with a temperature of 98.6°F (37°C), which is reassuring and suggests no secondary bacterial infection at this time.

Despite the positive response to interventions, the nursing team remains vigilant for any signs of deterioration. Education is provided to the parents on recognizing increased work of breathing, such as persistent nasal flaring or worsening retractions, as well as signs of dehydration like reduced wet diaper output or lethargy. The parents express understanding and feel more confident in managing their infant's condition at home. As discharge planning begins, the nurse emphasizes the importance of follow-up appointments with the pediatrician to ensure continued recovery and to address any further concerns that may arise.

Section 3

The following morning, the nursing team conducts a thorough reassessment of the infant to ensure continued stability and to evaluate the effectiveness of the current care plan. Upon examination, the infant appears more alert and active than the previous day, indicating a positive overall response to treatment. The nasal congestion has improved, with less frequent nasal flaring observed, although mild retractions are still present intermittently during feeding. The infant's respiratory rate remains stable at 38 breaths per minute, and oxygen saturation continues to be satisfactory at 98% on room air, reinforcing the successful management of respiratory symptoms.

Auscultation of the lungs reveals slightly diminished breath sounds in the right lower lobe, accompanied by mild crackles, suggesting some retained secretions. In response, the nursing team implements chest physiotherapy techniques, such as gentle percussion and positioning, to enhance mucus clearance. The parents are educated on how to perform these techniques at home, reinforcing their role in ongoing care. The infant's heart rate is steady at 120 beats per minute, and his temperature remains normal at 98.7°F (37.1°C), with no signs of fever or distress.

As the day progresses, the infant's appetite improves, and he is able to consume slightly larger volumes of formula, which is encouraging for his nutritional status. The nursing staff observes that the infant is producing an adequate number of wet diapers, indicating proper hydration. The parents express relief at these improvements and demonstrate growing confidence in their ability to manage the infant's care. The nursing team begins to finalize the discharge plan, ensuring the parents have clear instructions on home care, signs of potential complications, and the importance of keeping follow-up appointments with their pediatrician for ongoing monitoring and support.

Section 4

As the afternoon progresses, the nursing team notes a slight change in the infant's status. Although the infant remains stable overall, the parents report a mild increase in irritability and fussiness, which they attribute to discomfort from the chest physiotherapy. Upon further assessment, the infant's respiratory rate is noted to have increased slightly to 42 breaths per minute, and oxygen saturation has dropped marginally to 96% on room air. While these changes are subtle, the nursing team recognizes the importance of closely monitoring these vital signs to prevent any potential deterioration.

In light of these findings, the team decides to reassess the infant's lung status with a focus on the right lower lobe where diminished breath sounds were previously noted. Auscultation reveals that the crackles are slightly more pronounced, suggesting that retained secretions might not be clearing as effectively as hoped. The nursing team reinforces the importance of chest physiotherapy, adjusting the frequency and duration of sessions to optimize mucus clearance and improve the infant's comfort. Additionally, they initiate a conversation with the parents about the infant's comfort measures, including the use of gentle humidification and ensuring an upright position during feeds to aid in respiratory ease.

Recognizing the need for vigilance, the nursing team arranges for a follow-up chest X-ray to evaluate the extent of any retained secretions or the development of atelectasis. The parents are reassured that these changes are being carefully monitored and are part of the expected course of RSV recovery. The nursing staff emphasizes the importance of maintaining hydration and adequate nutrition, as these will be crucial in supporting the infant's recovery process. With a comprehensive care plan in place, the team remains optimistic about the infant's continued progress and potential for discharge in the near future, pending the results of the follow-up diagnostic evaluation.

Section 5

As the evening progresses, the nursing team receives the results of the follow-up chest X-ray. The imaging indicates a mild increase in opacity in the right lower lobe, consistent with retained secretions, but there is no definitive evidence of atelectasis. This finding reinforces the team's decision to continue and perhaps intensify chest physiotherapy efforts. The infant's vital signs are monitored closely, and they remain stable with a respiratory rate of 40-42 breaths per minute and oxygen saturation fluctuating between 95-96% on room air. The infant is still exhibiting mild irritability, particularly during and shortly after physiotherapy sessions, but overall maintains a good level of alertness and responsiveness.

In response to these findings, the nursing team adjusts the care plan to include more frequent but shorter chest physiotherapy sessions to minimize discomfort while maximizing the potential for mucus clearance. This adjustment seems to soothe the infant, as evidenced by a decrease in irritability noted by both the staff and parents. Additionally, a humidifier is introduced in the infant's room to maintain optimal air moisture levels, supporting easier breathing and potentially aiding in the mobilization of secretions. The team continues to encourage the parents to hold the infant in an upright position during feeds and as much as possible during the day to promote lung expansion and comfort.

With these interventions in place, the infant shows slight improvements in comfort and respiratory effort. The parents are actively involved in the care process, which helps them feel reassured and empowered. The nursing staff remains vigilant, ready to adjust the care plan as needed, and they communicate clearly with the parents about the importance of maintaining hydration and nutrition. The team is optimistic about the infant's recovery trajectory, anticipating that with continued care and monitoring, the infant will soon be ready for discharge, contingent on further stabilizing and improving respiratory status.