Our Lady of Fatima University

College of Nursing

OUR LADY OF FATIMA UNIVERSITY

COLLEGE OF NURSING

In Partial Fulfilment of Requirements for RLE

BRONCHIOLITIS

A Case Study

Submitted & Presented By:

Ocampo, Regina Nicole

Oteyza, Jazzle George
Padul, Carla Joy
Pantaleon, Shane Shaira
Quilang, Kimberly Mae
Quion, Rachel
Ramos, Gillian Christel
Refugia, Allyn
Reyes, Rechel
Ricamara, Clariss

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TABLE OF CONTENTS

I. Introduction

II. Anatomy and Physiology

III. Pathophysiology

IV. Nursing Health History

V. Course in the Ward

VI. Laboratory and Diagnostic Examination

VII. Drug Study

VIII. Nursing Care Plan

IX. Discharge Planning

X. References

XI. Profile of the Members

XII. Contribution of the Members

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I. INTRODUCTION

Intense viral bronchiolitis happens prevalently in youngsters under 1 year. Approximately 1 out of 3

babies will create clinical bronchiolitis in the primary year of life and 2–3% of all newborn children

require hospitalization. The condition begins with an upper respiratory tract disease with nasal check that

more than 3–4 days advances to contribution of the bronchioles with related dynamic dyspnea and poor

sustaining. Most kids present to therapeutic administrations with respiratory distress or poor feeding, or,

in the very young, apnoea. When auscultated kids have a variable blend of wheeze and crackles. In

essential consideration, the condition may frequently be mistaken for a typical cold, however the nearness

of lower respiratory tract signs in a newborn child in mid winter would be reliable with this clinical

diagnosis.

Bronchiolitis is brought about by viral disease and in that capacity is occasional, cresting in the

winter months, most altogether over a 6–multi week time span. The most widely recognized viral

contamination is respiratory syncytial infection (RSV) which happens in up to 80% of cases, however the

condition can be brought about by numerous other respiratory infections. It is progressively perceived that

co-contamination of at least one respiratory infections is normal. Emergency clinic affirmations related

with RSV can be avoided by the utilization of a month to month infused monoclonal neutralizer

(Palivizumab), with some viability in high-hazard populaces. The Committee additionally noticed that no

immunization is accessible and that youngsters with comorbidities are defenseless to progressively

extreme severe disease.

The quantity of admissions to clinic with bronchiolitis has been expanding in the course of the

most recent 20 years, however there is a recommendation that rates are leveling. In medical clinic,

newborn children are furnished with nasal suction Children are admitted to hospital for supportive care

until clinical recovery has taken place. to encourage oral feeding, support for hydration by nasogastric or

intravenous liquids, and supplemental oxygen for hypoxaemia. A scope of medications has been trialed,

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including bronchodilators and steroids, however has not been suggested for use in past proof based

guidelinesab. When all is said in done, bronchiolitis is treated in different ways. The finding is clinical

and examinations are not viewed as accommodating. Viral demonstrative testing may help with

accomplice screening in emergency clinic (to empower babies with a positive determination of RSV to be

put in same open associate), yet it doesn't give strong proof to guess. Recuperation from the intense

illness happens over a 5–multi day time frame, however a determined hack happens in half of kids for

over about fourteen days. In certain kids an incessant, backsliding rambling wheeze with resulting viral

diseases may happen over the following a half year or something like that; the supposed 'post

bronchiolitis disorder'. This shows up the aftereffect of brief loss of cilial capacity during bronchiolitis

and poor.

recuperation during ensuing viral diseases. Newborn children with RSV bronchiolitis have an expanded

recurrence of resulting wheeze in the next year and there are likewise information proposing that babies

with bronchiolitis have a higher rate of asthma analyzed in later childhood.

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II. ANATOMY AND PHYSIOLOGY

The affected system of Bronchiolitis is the Respiratory system. It is the system responsible

for taking in oxygen to produce energy and discharges carbon dioxide, as the by-product of the

process. The respiratory system is divided into two: Upper respiratory tract and Lower respiratory

tract. The upper respiratory tract consists of nose, mouth, and the upper trachea. It is tract that takes

in air and let it out. The lower respiratory tract is where the act of breathing process happens and

consists of organs located in chest cavity and protected by the ribcage such as trachea, bronchi,

bronchioles, alveoli and lungs.

Figure 1. Anatomy of Human Respiratory System

The act of breathing consists of 2 stages: Inspiration and Expiration. Inspiration is the

expansion of chest volume due to intake of air and expiration is the contraction of chest volume

due to expulsion of air. During the act of breathing, 2 muscles involves the rib muscles and

diaphragm. During inspiration, diaphragms flatten and enlarges chest activity and rib muscles rises

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thus, increasing chest volume. When expiration happens, the diaphragm and rib muscles relax that

causes chest volume to decrease.

The process of breathing starts at the nasal cavity and oral cavity. Nasal cavity is the primary

passageway of air and it is in lined with mucous membrane with nose hairs that acts as a part of

cleansing system by entrapping microbes in it. Inside the nasal cavity, sinuses are hollow spaces

that is connected to the nasal cavity that regulates temperature humidity of the air which makes

the air warm and moist. Oral cavity also acts as secondary passageway when the nasal cavity is

blocked however, the air is dry because less filtering happens in it. after warming and filtering the

air, it will go to the pharynx that collects the air and passes it to trachea. As the air travels towards

trachea it passes by larynx or commonly known as the voice box that contains the vocal cords of

the person. Sounds are produced as air passes and the larynx vibrates. After passing through larynx,

it will go to the trachea or windpipe that serves as a passageway going into the bronchi of lungs.

Trachea and bronchi are also in lined mucous membrane with cilia that moves in wave like motion

to push secretions upward to be expelled or swallowed. Proceeding in the Lungs.

The bronchi further divide into bronchioles

that are smaller branches and goes into the

alveoli. Alveoli are small air sacs which is the

destination of air we breathe in. the

pulmonary capillaries are embedded into the

walls of alveoli where gas exchange occurs.

Figure 2. Bronchi and Bronchiole

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Figure 3. Anatomical Difference between Normal and Abnormal

Bronchial tubes

Normally bronchial tubes or bronchioles would be free from obstruction as needed for the

air to pass through the alveoli for Gas exchange. In bronchiolitis, the Bronchial tubes are

obstructed by the mucus that builds up and inflammation of the tissue that causes by the virus.

Bronchiolitis is the Infection of the airways and is usually caused by a virus. It results in the

build up of mucus which is audible when the person breathes. This turbulent airflow can be

heard as wheezing when auscultated.

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III. PATHOPHYSIOLOGY

Bronchiolitis is a viral infection of the lungs that causes a narrowing of the airways of the lungs

(bronchioles), making breathing difficult. It occurs most often in children under age 2 during winter and

early spring. The most common causes of bronchiolitis are the influenza (flu) virus and Respiratory

Syncytial Virus (RSV).

Mode of Risk Factors:

Transmission: • Prematurity
‘ • touching the nose
Etiology • Congenital Heart
or mouth by hand or disease
another object • Lung disease
exposed to the virus. • Immunization Status
• Inhaling respiratory
Virus enters the body Environmental Factor:
droplets from • Smoking in Household
coughing or • Seasonal change
sneezing.
Infect the epithelial
cells in the nasal
airway Signs of Early Stage
(Upper airway)
• Nasal Congestion
Virus continues to • Runny Nose
infect the epithelial
cells of the lower RS

Inflammation and
Mucus Production
(bronchiolitis)

Obstruction of the Signs of Late Stage

Signs: airway in the (Lower airway)
• Increase Heart Rate bronchioles • Wheezing
• Increase Respiratory • Air trapping
Rate • Tachypnea
• Fatigue (Lethargic)
Hypoxemia

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III. NURSING HEALTH HISTORY

Demographic Data
Name: A.D.A
Age: 2 years old
Gender: Male
Address: Sabalo St., Caloocan City
Nationality: Filipino
Religion: Roman Catholic

History of Present Illness

A week prior to admission, patient developed fever and cough. Patient’s mother gave over
the counter medicine such as paracetamol and the fever subsided. One day prior to admission,
patient developed difficulty of breathing and the mother noticed that he had not been eating well
since the previous night. Patient’s mother seek consultation and admission was advised. On
December 9, 2019 the patient was admitted at Caloocan City Medical Center with a chief
complaint of cough accompanied with fast and labored breathing. Upon admission, laboratory tests
were conducted and the patient was diagnosed with bronchiolitis.

Past Medical History

According to the mother, patient was not involved in any accidents or serious injuries. But
she stated that on March 2019, the patient was admitted at Caloocan City Medical Center for
pneumonia. Other childhood illness includes common colds and abdominal pain.. The patient
received complete childhood vaccination. Patient’s mother also denied any known allergies for the
patient and stated that he did not take any medication except for his daily vitamins.

Pregnancy and Birth History

He was born at full term by normal spontaneous vaginal delivery after an uncomplicated
gestation. The mother denied alcohol or drug use during pregnancy or currently. She did not
experience bleeding throughout the pregnancy. Vitamins were given to her from barangay health
center and she completed her vaccinations.

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Developmental History
As mentioned by the mother, the patient achieved the milestones on time. He began to sit
on his 6th month, crawled on 9th month, stand on the 10th month, and walk when he reached the
age of 1. Now, he can run and jump.

Feeding History
The mother stated that breast feeding was initiated immediately after birth. He was
breastfed every 2 hours for about 15-20 minutes until his 4th month and switched to bottle feeding
because his mother needs to work. Solid food was introduced on the 6th month, he transitioned
easily to baby foods like cereals and vegetables. He eats three meals a day and demands for milk.

Family History
MOTHER FATHER
(-) ASTHMA (+) ASTHMA
(-) CARDIAC DISEASE (-) CARDIAC DISEASE
(-) PTB (+) PTB

Social History
Patient lives with his parents, siblings and other relatives. They have extended family
support. His mother is 27 y/o, working as a sales lady while his father is 30 y/o and a part time
construction worker. Their monthly income is approximately ₱20,000, they are not financially
stable. Both parents did not finished secondary education.

Physical Assessment
 Date Assessed: Dec. 10, 2019
 Time: 2:15 PM
 General Survey: The patient was conscious and coherent, with signs of cardiorespiratory
distress (labored breathing, wheezing and cough)
 Vital Signs
- Respiratory Rate: 55cpm
- Cardiac Rate: 165bpm
- Temperature: 36.3°C
- Weight: 11.2kg

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HEENT HEAD: rounded and smooth skull contour, (-) anterior and
posterior fontanels, scalp is white and clean
EYES: symmetrical, pale conjunctiva, pupils are equally round and
reactive to light accommodation, eyelashes are equally distributed
EARS: symmetrical, (-) discharge, can hear normally
NOSE: (+) nasal discharge, (-) nasal flaring
MOUTH, THROAT, NECK: oral mucosa, gingival, and tongue
are pink, dry lips, (-) nodules
CHEST HEART: (-) murmur, tachycardia
LUNG: (+) crackles, (+) wheezes
EXTREMITIES UPPER: full ROM, (-) cyanosis, (-) lesions
LOWER: full ROM, (-) cyanosis, (-) lesions
SKIN Warm and dry

Gordon’s Functional Health Pattern Assessment

Functional Health Pattern
Health Perception/ Health
Management
Nutritional and Metabolic
Elimination
Prior to Admission During Hospitalization
 According to the  She became willing to
mother, they rarely accept and listen to
visits a doctor to have health teachings for
a check-up. the sake of her son.
 She buys and gives  Shows interest to help
over the counter drugs his son recover.
for the patient.
 Can recall that the
patient completed his
vaccines in barangay
health center.
 Patient eats three  Eats less than the
meals a day and usual.
demands for milk.  Decreased appetite.
 Can drink up to 4 to 5
bottles of milk per
day.
 Voids 5 to 6 times a  Decreased output due
day. to decreased intake.
 Urine is yellow as
described by the
mother.
 No difficulty
defecating every
morning.
 Still uses diapers.

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Activity-Exercise  The patient walks
outside with his
mother every morning
as part of his daily
routine.
Sleep-Rest  Can sleep 6 to 8 hours
every night.
 Straight hours of
sleep.
 Takes naps sometimes
at noon for about 1 to
3 hours.
Self-Perception  The mother convinced
the patient to be
treated in the hospital.
Cognitive-Perception  Follows and listens
well to his mother.
 Responds to stimuli
verbally.
Role-Relationship  He is close to his
mother.
 Youngest in their
family.
 Loved by his family.
Sexuality-Reproductive  No history of any
disease affecting his
genitals.
Coping/Stress  Takes a nap and rests
when tired.
 Cries as a coping
mechanism.
Values/Belief  A Roman Catholic.
 His family takes him
to attend mass every
Sunday.
College of Nursing
 Activity intolerance.
 His sleep is
interrupted due to
cough and difficulty
of breathing.
 Although weak, the
patient seemed to
appear calm and
relaxed.
 Cooperates with the
nurses by listening to
the simple
instructions.
 His family gives him
moral support.
 All of the
reproductive organs
are functioning well.
 Cries whenever he’s
having difficulties.
 Admission and
procedures don’t
interfere with their
religion.
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V. COURSE IN THE WARD

 December 9, 2019 (Day 1-On Duty)
A 2 years old male patient was admitted at 4:30am in the morning under the service
of Dra. Beltran with a chief complaint of cough accompanied with fast and labored
breathing. The doctor ordered for NPO temporarily and 1L of D5LR to run for 8 hours
hooked intravenously. The following diagnostic procedures were done such as CBC and
chest x-ray (ap/lat).
 December 10, 2019 (Day 2-On Duty)
The doctor ordered to discontinue the use of nebulizer and oxygen therapy, and ask
for an x-ray result. Thus, the medications and IV fluid were still continued. The doctor
ordered to monitor the patient’s vital signs every 4 hours.

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VI. LABORATORY AND DIAGNOSTIC EXAM RESULTS

Name: Albie Davidson Aniban Ward: Pediatric
Gender: Male Sample ID: 51
Age: 2 y/o Date/Time collected: 12-09-2019 11:56

TEST NAME RESULT REFERENCE INTERPRETATION

RANGE
WBC 15.25 4.00-12.00x10^9/L A high WBC counts
may indicate that the
immune system is
working to destroy an
infection. It may also be
a sign of physical or
emotional stress.
Neutrophil 76.0 M 50.0-70.0 % High neutrophil means
that the body has an
infection or under a lot
of stress. And it can also
be a symptom of more
serious conditions.
Lymphocytes 16.0 M 20.0-60.0% Lymphocyte counts
below the normal range
can also be temporary.
They can occur after a
cold or another
infection, or be caused
by intense physical
exercise, severe stress
or malnutrition.
Monocytes 5.0 3.0-12.0% NORMAL
Eosinophil 3.0 0.5-5.0 NORMAL
Basophil 0.0 0.0-1.0% NORMAL
RBC 4.30 3.50-5.20x10^12/L NORMAL
Hemoglobin 127 120-160 g/L NORMAL
Hematocrit 38.6 35.0-49.0% NORMAL
MCV 89.8 80.0-100.0 fL NORMAL
Remarks:

JONELLA CASTRO RMT 0075570 THOMAS JEFF LIAM Jr.M.D. DPSP

MEDICAL TECHNOLOGIST PATHOLOGIST

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VII. DRUG STUDY

Drug Data Classification Drug Indication Contraindication Adverse Nursing

Action & Dosage effect Consideration
Generic The drug Inhibits Acute •Use cautiously in •CV: •Culture
name: belongs to the cell wall Bacterial patients with Phlebitis, infection, and
cefuroxime Second – synthesis, Exacerbati hypersensitivity thrombophl arrange for
Brand generation promoting on of to penicillin ebitis sensitivity tests
name: cephalospor osmotic chronic because of •GI: before and
Zinacef, ins it works instability; bronchitis; possibility of Diarrhea, during therapy
Ceftin, by stopping usually 250-500 cross-sensitivity pseudomem if expected
Kefurox the growth of bactericidal mg PO q12 with other branous, response is not
bacteria for 10 betalactate colitis, seen.
days. antibiotics. nausea, •Give oral
Secondary •Use cautiously in anorexia, drug with food
bacterial patients with a vomiting. to decrease GI
infection history of colitis •Hematolo upset and
of acute (Inflammation of gic: enhance
bronchitis; the inner lining of Hemolytic absorption.
250-500mg the colon) and anemia, •Give oral drug
PO q12 for renal thrombocyt to children who
5-10days. insufficiency openia can swallow
(Poor functions of •Skin: tablets;
the kidneys) Maculopapu crushing the
•Some lar and drug results in
cephalosporins erythematou a bitter,
have been s, rash, unpleasant
associated with urticaria taste.
seizures in •Other: •Have vitamin
patients with Anaphylaxi K available in
renal impairment s, case
when the dosage hypersensiti hypoprothro
wasn’t reduced vity mbinemia
reaction occurs.
•Discontinue if
hypersensitivity
reaction occurs.

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Drug Classificatio Drug Indication Contraindicati Adverse Nursing

Data n Action & Dosage on effect Consideratio
n
Generic The drug Decreases Severe or •Contraindicate • •Determine
name: belongs in a inflammatio intractable d in patients whether
Hydrocortiso class of n, mainly by allergic states hypersensitive patient is
ne medication stabilizing (seasonal or to the drug or its sensitive to
Brand name: called leukocyte perennial ingredients, in other
Colocort corticosteroid lysosomal allergic those with corticosteroid
Cortef s. It works by membrane rhinitis, systemic fungal s
Solu-Cortef activating and bronchial infections, and •Most adverse
natural suppresses asthma, in those reactions to
substances in immune contact receiving corticosteroid
the skin to response dermatitis, immunosuppres s are dose-or
reduce atopic sive doses duration-
swelling, dermatitis, together with dependent
redness, and serum live-virus •For better
itching. sickness, drug vaccines. results and
hypersensitivi •Drug can cause less toxicity,
ty reaction, hypercorticism give a once-
transfusion or suppression daily dose in
reactions) of HPA axis, morning
Adults: 20 to particularly in •Only
240 mg P.O younger hydrocortison
daily. Or, children or e sodium
initially, 100 to patients succinate can
500 mg receiving high- be given I.V
succinate I.M. dose therapy. •Unless
or I.V; repeat Withdraw drug contraindicate
every 2, 4 or 6 slowly. d, give a low-
hours sodium diet
that’s high in
potassium and
protein.

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Drug Data Classification Drug Indication Contraindication Adverse Nursing

Action & Dosage effect Consideration
Generic The drug Is essentially To prevent or •Contraindicated • Drug may
name: belongs to a relaxing the treat in patients decrease
Albuterol class of drugs smooth muscles bronchospasm hypersensitive to sensitivity of
Sulfate known as of the airways. in patients drug or its spirometry
Brand bronchodilators. It activates the with ingredients. used for
name: It works in the beta2- reversible • Use extended - diagnosis of
Salbutamol airways by adrenergic obstructive release tablets asthma
opening receptors in the airway disease cautiously in • Monitor
breathing lungs, which Solution for patients with GI patient for
passages and begins a Inhalation: narrowing effectiveness.
relaxing cascade of Children ages •Use cautiously in Using drug
muscles. actions that 2 to 12 patients with CV alone may not
result in weighing more disorders, be adequate to
bronchodilation. than 15 kg: 2.5 hyperthyroidism, control asthma
mg by or diabetes in some
nebulizer given mellitus and in patients.
over 5 to 15 those who are • Drug may
minutes t.i.d or unusually cause
q.i.d with responsive to paradoxical
subsequent adrenergics bronchospasm.
doses adjusted Monitor
to response. patient
Inhalation closely;
Aerosol: discontinue
Adults and drug if occurs.
children age 4 Bronchospasm
and older: 1 to with inhaled
2 inhalations formulations
every 4 to 6 frequently
hours as occurs with
needed. first use of
Regular use for new canister
maintenance or vial.
therapy to • Tablets and
control asthma aerosol may
symptoms isn’t use together.
recommended. Monitor for
signs and
symptoms of
toxicity.

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Drug Data Classification Drug Indication Contraindication Adverse Nursing

Action & Dosage effect Consideration
Generic The drug Inhibits Bronchospasm •Contraindicated • If patient
name: belongs in a vagally in chronic in patients uses a face
Ipratropium class of mediated bronchitis and hypersensitive to mask for
Bromide medication reflexes by emphysema drug or its nebulizer, take
Brand called antagonizing Children age ingredients. care to prevent
name: bronchodilators.. acetylcholine 12 and older: •Use cautiously in leakage
Atrovent at 500 mcg every patients with around the
muscarinic 6 to 8 hours angle-closure mask because
receptors on (t.i.d to q.i.d) glaucoma, eye pain or
bronchial via oral prostatic temporary
smooth nebulizer hyperplasia or blurring of
muscle. Acute asthma bladder-neck vision may
exacerbations, obstruction occur
in •Drug isn’t • Safety and
combination indicated for effectiveness
with a short- initial treatment of intranasal
acting beta of acute episodes use beyond 4
agonist of bronchospasm, days in
Children ages for which rescue patients with a
6 to 12: 250 to therapy is common cold
500 mcg via required for rapid haven’t been
oral nebulizer response established.
every 2o •Safety and
minutes for effectiveness of
three doses, nebulization or
then as needed. inhaler in children
Children age 5 younger than age
and younger: 12 haven’t been
250 mcg via established.
oral nebulizer
very 20
minutes for 1
hours or 2
inhalations of
inhalation
aerosol every
20 minutes if
needed for 1
hour.

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VIII. NURSING CARE PLAN

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Ineffective 1)Establish rapport 1)To gain After 2 hours of effective

“Nahihirapan Airway clearance After 2 hours of to the patient cooperation and trust nursing intervention the
huminga ang anak related to effective from the patient patient was able to improve
ko.” As verbalized secretions and nursing 2)Monitor and airway clearance as
by the mother. airway intervention the record vital signs, 2)To obtain baseline evidenced by reduction at
obstructions as patient will be respiratory and data and assess congestion with breath
Objectives: manifested by able to improve rhythm possible areas of sounds clear.
- DOB crackles, airway immediate
- (+) nasal wheezes, and clearance as intervention The patient was able to feel
flaring, labored breathing. evidence by comfort gradually in the
wheezes, reduction at 3)Auscultate breath 3)To know status and continuation of care.
crackles, congestion with sounds note progress or
cough breath sounds complications Goal met
and clear.
labored 4) Elevate head of 4) Allows patient to
breathing The patient will bed at fowler’s improve its breathing
Vital Signs: be able to feel position and capacity and promote
PR – 165bpm comfort. reposition every 2 greater lung
RR – 55cpm hours if necessary. expiration.
T – 36.3

5) Keep back dry 5) To promote

and increase oral comfort and liquefy
fluid intake to the secretions;
maintain hydration. improve ventilation

6) Rest prevent
fatigue and decreases
6) Encourage oxygen demands.
adequate rest and
limit activities

7) CPT techniques
utilizes forces of
7) Perform chest gravity and motion to
physiotherapy. facilitate secretion
removal.

8) To conserve
8) Teach and energy and to reduce
supervise effective airway collapse.
coughing
techniques. 9) To give an
overview to specific
9) Educate the things to avoid.
mother of the
patient about things
they should avoid.

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IX. DISCHARGE PLANNING

Home Medication:

Exercise:

• The patient should be encouraged to aid the mobilization of secretions through coughing

and deep breathing during the day.

• Encourage the child to deep breathing exercises to promote deep inspiration to which

increases oxygenation and prevents atelectasis.

Treatment:

• The patient need plenty of rest

• Make sure your child drinks plenty of fluids to prevent dehydration. Ask your child's doctor

how much to give.

• Cool-mist humidifier in your child’s room

• Give all medicines to your child exactly as directed.

Health teaching:

• Try keeping your child's head elevated (raised) to make it easier for him or her to breathe.

• Use a rubber suction bulb to remove mucus from your child's nose. Ask your child's

healthcare provider to show you how to suction the nose if you are not sure how to do it.

• Clean your hands with alcohol-based hand cleaner before and after touching your child.

Your child, if old enough, should also use the hand cleaner.

• Don't smoke or allow anyone else to smoke around your child.

• Listen to your child's breathing for signs that it is getting better or worse.

• Advice the parents of the patient to cover the mouth of the child when coughing.

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Out-Patient:

• Instruct the parents of the patient to come back for a follow up check-up if the patient feels

any pain.

Spiritual:

• Encourage the family with the patient to visit church every Sunday.

• Encourage the child to pray every day.

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REFERENCES

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PROFILE OF THE GROUP MEMBERS

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