Running Head: Bronchiolitis


Shakira Wynter
Student No: N01044497
Date Submitted: November 24th 2015
Professor: Janet Jeffery
Humber College ITAL

Running Head: Bronchiolitis


Bronchiolitis is classified as a viral infection of the bronchioles (lower airways)
caused by a respiratory syncytial virus (RSV) that targets the epithelial cells of the
respiratory tract. The occurrence of bronchiolitis is often documented in children 2-12
months with occurrence after age 2 being rare (4Perry, Shannon, Marilyn Hockenberry,
Deitra Lowdermilk, David Wilson, Cheryl Sams, 2013). As stated by Perry et al. (2013)
the RSV causes changes on a cellular level resulting in multinucleated masses of
protoplasm as the infected cells fuse into one giant cell. Subsequently there is swelling of
the bronchiolar mucosa resulting in the lumina filling with sections. Inflammatory cells,
and peribronchiolar interstitial pneumonitis is usually present in the bronchi and the
bronchioles as a result of the increased mucus and exudate. As shedding of epithelial cells
occur the lumina becomes increasingly obstructed which results in diminished gaseous
exchange and subsequently reduced tissue perfusion (Perry et al., 2013). When the
disease progresses there is an increased occurrence of wheezing, cyanosis, poor feeding
and productive cough, crying and tachypnea among other symptoms and signs. This
paper will look at ineffective infant feeding and/or imbalanced nutrition less than body
requirements, which was one of the three nursing diagnoses, presented previously in the
concept map.
Bronchiolitis is often treated with oxygen therapy, adequate fluid intake, airway
maintenance and medication. When looking at this priority nursing intervention it is
important to utilize collaborative care providers such as a dietician, a
respirologist/pulmonologist and a clinical psychologist. It is important when
collaboration with health care providers that effective communication is utilized in the
best interest of the client as multidisciplinary clinical interventions have proven to

Running Head: Bronchiolitis


improve the outcomes for patients (Dobscha, S. K., Leibowitz, R. Q., Flores, J. A., Doak,
M., & Gerrity, M. S., 2007).
While most children can be treated at home, hospitalization becomes a necessity
when complications occur and the infant is no longer adequately hydrated or their
nutritional intake is less than their body requirements (Perry et al., 2013). As such
interventions need to be put in place to ensure homeostasis and prevent excessive weight
loss. Nutrition is important in the four stages of growth from prenatal to puberty but
more so in the infant stage as the growth rate is much higher and less dependent on
growth hormone (Rees, L., and Shaw, V. 2007). The dietitian will aid in determining any
alternative feeding options for the child that may exist and the best action to maintain the
infants body weight and balanced fluid intake. The dietician will also determine whether
current intake and output for the infant is accurate and suggest different types of feeds
and dietary constraints if any are to be implemented. Examples are using enteral feeds or
oral feeds and/or plus supplements.
Since the nutrition of the infant is of great importance emphasis should be place
on taking the infant’s weight every day and to encouraging mothers to continue
breastfeeding or pump breast milk to store so that the infant gets adequate nourishment
and antibodies from mom. It is also important to instill normal saline drops into the nares
and suction mucus with a bulb syringe before feeding and before bedtime to encourage
the child to feed effectively as their airways would be open facilitating gaseous exchange
(Perry et al. 2013). In order to rehydrate the infant and to encourage feedings, small
amounts of fluids (10-30ml) ought to be introduced every 10 minutes. If oral feeding is
not an option NG/G feeding tube can be utilized to ensure adequate nutrition of the infant

Running Head: Bronchiolitis


(Perry et al., 2013 and Mara, J., Gentles, E., Alfheeaid, H. A., Diamantidi, K., Spenceley,
N., Davidson, M., Gerasimidis, K., 2014). Mara et al (2014) states that, providing
adequate nutrition to a critically ill child is often challenging and requires enteral
nutrition practices to be implemented as the child is often malnourished and their system
undergoes deterioration.
As stated by Potter et al. (p.675, 2013) “good nutrition in infancy fosters optimal
growth and development. Infant feeding is more than the provision of nutrition; it
represents an opportunity for social and psychological interaction between parent and
infant. It can also establish a basis for developing good eating habits and influence
lifelong health habits.” Not only is eating habit important, adequate nutrition provides
energy for growth of the body organs including brain growth, the maintenance of
metabolic functions and physical activity. When discussing fluid balance an infant’s
variation in fluid could be detrimental to the life of the infant and as such intake and
output should be monitored for signs of imbalance (Potter et al. 2013).
The dietician would also work with the pulmonologist especially in acute cases where
fluid restrictions need to be implemented when fine or coarse crackles are heard in the lung fields.
The pulmonologist may opt for some variation of a pulmonary rehabilitation depending on the
age of the child and how severe their condition. The dietician may also recommend continued
monitoring of IV therapy should it compromise the health of the child and complete health
teaching for the parents explaining what to expect and dos and don’ts. The pulmonologist may
also suggest oxygen therapy, suctioning of the nares and the use of any prescribed

bronchodilators with which the MRP would sign off on (Perry et al., 2013). The
pulmonologist may also teach the parent how to look for signs for cyanosis and apnea.
Looking for wheezing, fast breathing axillary muscles use trouble sucking and

Running Head: Bronchiolitis


swallowing. The goal of the pulmonologist in this situation is to maximize tissue
perfusion and gaseous exchange to allow the child to breathe better and reduce coughing
during feeding subsequently increasing nutritional intake. The clinical psychologist
would be utilized to help the family come to terms with the ill infant and deal with any
psychosocial issues that the parents or siblings may be dealing with. The psychologist
would find appropriate solutions to fit the needs of the client in this case the entire family
so that individuals are not internalizing personal guilt ad/or pain due to the ill infant.
In conclusion bronchiolitis can be distressing to both the patient and the family
the interdisciplinary team has the ability to decrease the negative outcomes and give
adequate care to foster recovery of the viral infection. “Although nutritional support is
unlikely to reverse the course of illness, optimal nutritional support can minimize nutrient
deficits and delay establishment of malnutrition, thereby potentially improving the
clinical outcome of the patient” (Mara et al., p.1, 2014). The collaborative team greatly
helps patients to optimize the care they are receiving at facilities or in the home. As such
community healthcare plays a vital role upon discharge of the patients. Individuals are
able to utilize facilities like the “Kindercare Pediatrics” located at Suite 301 – 491
Eglinton Avenue West. Kindercare Pediatrics is a multidisciplinary team that has all three
specialists on site (a respirologist/pulmonologist, a dietician and a family and child
psychologist). The willow centre located at 45 Sheppard Ave East Suite 202, would help
the family by treating the infant with feeding difficulties. They also have a parent-infant
program to aid in secure attachments and help parents who are having a hard time
adjusting to the infant. The Clairhurst Pediatrics located at 1466 Bathurst St. Suite 201 in
Toronto is another facility that caters to the respiratory needs of the infant.

Running Head: Bronchiolitis


Dobscha, S. K., Leibowitz, R. Q., Flores, J. A., Doak, M., & Gerrity, M. S. (2007).
Primary care provider preferences for working with a collaborative support team.
Implementation Science, 2, 16. Retrieved

Mara, J., Gentles, E., Alfheeaid, H. A., Diamantidi, K., Spenceley, N., Davidson, M.,
Gerasimidis, K. (2014). An evaluation of enteral nutrition practices and
nutritional provision in children during the entire length of stay in critical care.
BMC Pediatrics, 14, 186. Retrieved

Perry, S., Hockenberry, M., Lowdermilk, D., Wilson, D., Sams, C. (2013). Maternal
Child Nursing Care in Canada, 1st Edition. [VitalSource Bookshelf Online].
Retrieved from

Rees, L., & Shaw, V. (2007). Nutrition in children with CRF and on dialysis. Pediatric
Nephrology (Berlin, Germany), 22(10), 1689–1702. . Retrieved from

Running Head: Bronchiolitis