Pediatric Assessment Concept Map PDA With RSV

Bronchiolitis is an inflammatory disease that affects the bronchioles and most commonly affects infants. Bronchioles are part of the respiratory system; they have no submucosal gland and cartilage. The lining of the bronchiolar is also made of surfactant that secretes and releases neuroendocrine and Clara cells that help in making bioactive products. Bronchial injury is most commonly caused by factors that cause bronchiole inflammation, such as the Respiratory Syncytial Virus (Smith et al., 2017). The entrance of this virus triggers the inflammatory process, which involves the release of chemokines and cytokines. These inflammatory chemicals released then trigger the interleukins 4, 8, and 9 into the respiratory system. They trigger increased cellular activity in the airways. The epithelium then goes into necrosis in the first 24 hours after infection. The goblet cells undergo proliferation, causing an increase in mucus secretion. Regeneration of the non-ciliated epithelial cells slows down the ability of mucus secretion.

The inflammation process has clinical signs of pain, fever, and swelling due to increased blood flow to the site of infection. The inflammation of bronchioles, edema in the respiratory tract, and necrotized epithelium cause debris resulting in bronchiole obstruction, which causes hyperinflation (Meissner., 2016). The obstruction of these bronchioles also increases airway resistance, which can lead to atelectasis mismatch in ventilation-perfusion. It affects children and infants severely because of their anatomically small airways and insufficient ventilation in the alveoli, especially collateral ventilation. The most common viral infection that causes bronchiolitis is the Respiratory Syncytial Virus (RSV) (Smith et al., 2017). The laboratory investigations that can be done include blood cultures, white blood cell count, c-reactive protein level, cerebrospinal fluid culture, cerebrospinal fluid analysis, urinalysis, and urine culture.

Patent Ductus Arteriosus is a congenital defect where the fetal ductus fails to close resulting in a communication between the pulmonary artery and descending thoracic aorta. The failure to close is necessitated by continuous production of PGE2 (Prostaglandin E2). When one has this condition, there is a right side shunt, allowing blood to circulate from the systemic to pulmonary circulation. This process increases the amount of blood flow in the pulmonary circulation, which could impair the vasculature of the pulmonary system and reduce pulmonary system compliance (Clyman, 2018). The history of PDA in Vivi Mitchel’s case is important because it acts as a predisposing factor to bronchiolitis and is responsible for reduced oxygen concentration.

The risk factors that predispose Vivi Mitchell to bronchiolitis include her lower birth weight, the history of Patent Ductus Arteriosus, and her young age of 6 months. Some of the classical signs and symptoms of bronchiolitis are fever, tachypnea, tachycardia, retractions, and wheezing (Gillam-Krakauer & Reese, 2018). Acetaminophen is an anti-pyretic drug that blocks pain signals generation. It also inhibits the synthesis of prostaglandin in the central nervous system minimizing the inflammatory process in bronchiolitis. This drug is contraindicated in those patients with liver or hepatic disease, kidney disease, and hypersensitivity to acetaminophen. Albuterol nebulizer is a beta II receptor agonist which causes relaxation in the smooth muscles of the bronchioles. It also helps to manage tachycardia. Albuterol is contraindicated for those who are sensitive to milk proteins and albuterol. It is also contraindicated during labor and delivery since it interferes with uterine myometrial contraction. Corticosteroids, on the other hand, are used to manage hyperproliferation and inflammation. It is also used to alleviate the adverse effects of other drugs like pruritic lesions. Some of the contraindications for using corticosteroids include liver impairments, either cirrhosis or impairments, the existence of hypertension, pregnancy, and untreated body system infection.

The first nursing diagnosis for this patient is dehydration. Vivi is losing more fluids via fever and fast breathing despite the reduced intake of fluids per oral. The goal is to replace fluid deficits by maintaining hydration. This is done by giving fluids intravenously. The second nursing diagnosis is shortness of breath. The goal here is to increase oxygen intake to the lungs. The interventions for this include positioning Vivi to drain the most congested lobes. The other intervention is initiating deep breathing and then triggering a coughing reflex for baby Vivi Mitchell to cough out secretions. The long-term complications associated with this disease are chronic lung disease, bronchitis obliterans, and secondary infection because of a lowered immune system. The short-term complications