Bronchiolitis / Respiratory Syncytial Virus (RSV)

Bronchiolitis is defined as an inflammation of the bronchioles. It causes production of tick mucus that occludes bronchiole tubes and small bronchi. The common cause of bronchiolitis is respiratory syncytial virus that is higly communicable and usually transferred by the hands.

Signs and Symptoms:

• Upper respiratory infection symptoms: rhinorrhea and low-grad fever
• Tachypnea
• Lethargy, poor feeding and irritability
• Increased difficulty in breathing
• Expiratory wheeze and grunt
• Nasal flaring and retractions
• Diminished breath sounds

Nursing Interventions:

1. Maintain patent airway
2. Place child at a 30-50 degree angle with the neck is slightly extended to maintain an open airway as well as decrease pressure on diaphragm
3. Provide cool and humidified oxygen
4. Assess for any signs of dehydration
5. Encourage fluid intakes

Special Consideration in Giving Care Child with RSV:

• Isolate the child in a single room or in a room with another child with RSV
• Good hand washing procedures
• The nurses who care for these children do not care for other high-risk children
• Wear gowns when soiling of clothing may occur during care
• Administer ribavirin (Virazole) as prescribed
• Prepare for the administration of respiratory syncitial virus immune globulin ((RSV-IGIV or RespiGam or palivizumav)

Key Concept in Administration of Ribavirin (Virazole)

• Administer Ribavirin via aerosol by hood, tent, mask, or through ventilator tubing
• Pregnant health care providers should not care for a child receiving ribavirin
• The nurse who wear contact lenses should wear goggles when coming in contact with ribavirin since the mist may dissolve soft lenses

Respiratory Syncytial Virus Immune Globulin

• The immune globulin is used prophylactically to prevent respiratory syncytial virus infection in high-risk child
• The immune globulin is not administered to infants or children with congenital heart disease or with cyanotic congenital heart disease