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Scenario

You are working in a large urban pediatric clinic after-hours.

A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation and on inspection, you identify retractions.

The child is in less than 10th percentile of weight and has a cardiac history of Patent Ductus Arteriosus (PDA).
Born at 36 weeks gestation.
Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare.
T- 102.1 HR 140 RR 40 BP 83/58 Pulse ox 96%
A swab for respiratory syncytial virus (RSV) is positive.

Doctor orders – Nasal bulb suction and saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, Albuterol nebulizer in office and push po fluids as tolerated.

After the albuterol neb treatment, respirations are 36 and oxygen saturation is 100%. Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that she has a nebulizer at home and can return to pediatric afterhours or ER if needed.

Client is discharged with these orders:

methylprednisolone 0.4 mg/kg oral BID for 3
Albuterol Q4 hours for 24 hours, then Q 6 hours for 24 hours, and Q6 as needed.
Call if needed prior to the Q4 dose.
Manage fever with Tylenol and continue hydration and nasal bulb suction Q6 while awake.
Return for re-evaluation in 3 days

Instructions:

Criteria:

Describe the pathophysiology of bronchiolitis and identify the most common organism causing this infection. What laboratory testing can confirm your suspicion?
Describe the pathophysiology of PDA and why the history of PDA is significant in this scenario.
What risk factors place Vivi Mitchell at a greater risk for the development of bronchiolitis?
What are the characteristic signs/symptoms of bronchiolitis?
Vivi Mitchell been prescribed the following medications; acetaminophen, albuterol nebulizer, corticosteroids. Provide the rationale for why each medication has been included as part of her medical management and explain any potential contraindications related to these medications.
You are designing Vivi Mitchell’s plan of care. Identify two priority nursing diagnoses to include in your plan. For each nursing diagnosis, identify two SMART goals, and two interventions for each goal.
What short and long-term possible complications should the nurse anticipate?
What client education is appropriate for Vivi Mitchell as she is discharged from the after-care clinic?

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