NURSING CARE PLAN The Child with Bronchiolitis

1 450 CHAPTER 13resolution of all symptoms may take weeks. The same supportive therapies implemented inthe hospital may be needed at home: Use of the bulb syringe to suction the nares of an infant under 1 year of age Fluid intake to thin respiratory secretions (making them easier to clear) and provideglucose for energy (since the Child s appetite may not return to normal for several days) RestChildren are usually capable of recognizing their own activity limits. However, parentsshould encourage active toddlers to nap and take rest periods. Teach the parents proper ad-ministration of medications. Acetaminophen may be prescribed for persistent low-grade Changes in breathing pattern mayoccur quickly as the Child s energyreserves are depleted. Assessmentand monitoring baseline reveal rateand quality of air assessment andmonitoring provides objectiveevidence of changes in the qualityof respiratory effort, enablingprompt and effective intervention.

2 Humidified oxygen loosenssecretions and helps maintainoxygenation status and easerespiratory distress. Medications act systemically andlocally (on respiratory tissue) toimprove oxygenation and decreaseinflammation. Position facilitates improvedaeration and promotes decrease inanxiety (especially in toddlers) andenergy expenditure. Previous fluid loss may requireimmediate replacement. Monitoring proves objectiveevidence of fluid loss and ongoinghydration Suggested Outcome: Vitalsigns status:Temperature, pulse,respiration, and blood pressure withinexpected range for the Child s ageThe Child returns to respiratorybaseline within 48 72 Child s respiratory effort oximetry reading remains 94%oxygen saturation during Child tolerates therapeuticmeasures with no adverse Child rests quietly in position Suggested Outcome:Hydration:Amount of water inintracellular and extracellularcompartments of s hydration status is maintainedduring acute phase of takes adequate oral fluids after24 48 hours to maintain Priority Intervention: Respiratorymonitoring:Collection and analysisof patient data to ensure airwaypatency and adequate gas exchange.

3 Assess respiratory status (Table 13-1)a minimum of every 2 4 hours ormore often as indicated for adecreasing respiratory rate andepisodes of apnea. Cardiorespiratorymonitor and pulse oximeterattached with alarms set, if and report changes promptlyto physician. Administer humidified oxygen viamask, hood, or tent. Note Child s response to orderedmedications (nebulizer treatments). Position head of bed up or placechild in position of comfort onparent s lap, if crying or strugglingin crib or Priority Intervention: Fluidmanagement:Promotion of fluidbalance and prevention ofcomplications resulting fromabnormal or undesired fluid levels. Evaluate need for intravenous IV, if ordered. Maintain strict intake and outputmonitoring and evaluate specificgravity at least every 8 care PLANThe Child with BronchiolitisGOAL INTERVENTIONRATIONALEEXPECTED OUTCOME1.

4 Ineffective Breathing Pattern related to increased work of breathing and decreased energy (fatigue)The Child will return to respiratory baseline. The Child will not experience respiratory Child s oxygenation status will return to Risk for Fluid Volume Deficit related to inability to meet body requirements and increased metabolic s immediate fluid deficit is will be adequately hydrated, be able to tolerate oral fluids, and progress to normal diet.(continued)Skill 10-15: Performing Nasal SuctioningAlterations in Respiratory Function 451fevers and general discomfort. Advise parents that RSV infection can recur; therefore, theyneed to know how to recognize symptoms and when to call the outcomes of NURSING care are provided on the accompanying NURSING care is an inflammation or infection of the bronchioles and alveolar spaces of thelungs. It occurs most often in infants and young children.

5 Pneumonia in children often Further evidence of improvement ofhydration status. Moist mucous membranes andtears provide observable evidenceof hydration. Choice of fluid offered by parentgains the Child s cooperation. Provides opportunity to ventfeelings and receive timely, relevantinformation. Helps reduce parents anxiety and increase trust in nursingstaff. Familiar people, routines, andobjects decrease the Child s anxietyand increase parents sense ofcontrol over unexpected, uncertainsituation. Anticipate potential for family to be prepared shouldrespiratory symptoms recur afterdischarge. Written and oral instructionsreinforce knowledge. Parents maynot hear and remember theparticulars of home care ifpresented only s weight stabilizes after 24 48hours; skin turgor is shows evidence of Child accepts beverage of choicefrom parent or NURSING Suggested Outcome: Anxietycontrol:Ability to eliminate orreduce feelings of apprehension andtension from an unidentifiable and Child show decreasinganxiety and decreasing fear assymptoms improve and as Child andparents feel more secure in hospitalenvironment.

6 Parentfreely asks questions andparticipates in the Child s care . Thechildcries less and allows staff to holdand/or touch him or accurately describes respiratorysymptoms and initial home careactions. Perform daily weight measurementon the same scale at the same timeof day. Evaluate skin turgor. Assess mucous membranes andpresence of tears. Report changespromptly to physician. Offer clear fluids and incorporateparent in care . Offer fluid choicewhen Priority Intervention: Anxietyreduction:Minimizingapprehension, dread, foreboding, oruneasiness related to an unidentifiedsource of anticipated danger. Encourage parents to express fearsand ask questions; provide directanswers and discuss care ,procedures, and condition changes. Incorporate parents in the Child scare. Encourage parents to bringfamiliar objects from home. Askabout and incorporate in care planthe home routines for feeding andsleeping.

7 Explain symptoms, treatment, andhome care of Bronchiolitis . Provide written instructions forfollow-up care arrangements care PLANThe Child with Bronchiolitis (continued)GOAL INTERVENTIONRATIONALEEXPECTED OUTCOME2. Risk for Fluid Volume Deficit related to inability to meet body requirements and increased metabolic demand. (continued)3. Anxiety ( Child and Parent) related to acute illness, hospitalization, uncertain course of illness and treatment, and home care and parents will demonstrate behaviors that indicate decrease in will verbalize knowledge of symptoms of Bronchiolitis and use of home care methods before the Child s discharge from the hospital.