Bronchiolitis in Infants and Small Children Essay

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Bronchiolitis in Infants and Small Children Essay

Bronchiolitis in Infants and Small Children Interamerican University of Puerto Rico School of Nursing Bronchiolitis in Infants and Small Children Introduction A common illness of the respiratory tract within infants and children under two is bronchiolitis. This illness causes inflammation in the bronchioles. Hospitalization is often required because small children and infants have smaller airways that become easily blocked. Children who become affected develop cough, wheeze and shortness of breath. This illness reoccurs.

I have chosen this topic because my daughter had bronchiolitis for the first time when she was ten months old and she still gets it about every other month. Condition and Illness Bronchiolitis is usually caused by a viral infection, most commonly respiratory syncytial virus also known as RSV, more than half of all bronchiolitis cases are because of RSV. Bronchiolitis in Infants and Small Children Essay. This infection is spread more during the season of winter and early in the spring. Rhinovirus, influenza, and human metapneumovirus are also associated with bronchiolitis.

This virus is usually caused because bronchiolar injury and inflammatory and mesenchymal cells leads to pathological and clinical syndromes. Some symptoms for this viral infection are: stuffiness, runny nose, fever, cough, rapid and shallow breathing, rapid heartbeat, retractions, flaring of the nostrils, irritability, trouble sleeping, poor appetite, vomiting, dehydration, fatigue and lethargy. Symptoms may worsen quickly, in occasions hospitalization is required. Pathophysiology

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The pulmonary epithelial cells recover in about three to four days however cilia, does not regenerate for about two weeks. Macrophages clear the debris. Statistics Infection is usually spread by direct contact with respiratory secretions. The clinical entity of bronchiolitis includes only infants and young children. In the United States, epidemics last two to four months beginning in November and peaking in January or February. While ninety three percent of cases occur between November and early April, cases may occur throughout the year.Infection of bronchiolar respiratory and ciliated epithelial cells causes more mucus secretion, cell death, and sloughing, followed by a peribronchiolar lymphocytic infiltrate and sub mucosal edema. When debris and edema combine, it causes narrowing and obstruction of small airways. Lessened ventilation of parts of the lung causes ventilation mismatching, results in hypoxia. In the expiratory phase of respiration, further dynamic narrowing of the airways produces disproportionate airflow decrease and results in air trapping.Bronchiolitis in Infants and Small Children Essay. Breathing is increased due to increased end-expiratory lung volume and decreased lung compliance.

Attack rates within families are as high as forty five percent and are higher in daycare centers. Rates of hospital-acquired infection range from twenty to forty seven percent. Previous infection with the common etiologic viruses does not confer immunity. Reinfection is common because there is no immunity against bronchiolitis. Seventy-five percent of cases of bronchiolitis occur in children younger than one year, and ninety five percent in children younger than two years. Ninety percent of the patients are aged between one and nine months old.

Bronchiolitis is the most common cause of hospitalization up to the first year of life. It is epidemic in winters. In the United States the annual incidence is eleven point four percent in children younger than one year and six percent in those aged one to two years. This illness accounts for ninety thousands of hospital admissions per year. Most deaths occur with infants under six months, the mortality rate is one to two percent of all hospitalized patients and three to four percent of patients with cardiac or pulmonary problems. Prescription and Treatment

Antibiotics do not work against viral infections, so they will not work with this illness. Drinking plenty of water, electrolyte drinks and fluids is recommended since dehydration is one of the symptoms. A humidifier is also recommended because the moist air helps loosen mucus. Getting plenty of rest is also important. No one should smoke or use cigarettes if they are going to be near the ill child. Some children need oxygen therapy and fluids thru IV. Albuterol, Proventil, Ventolin and Salbutamol are often prescribed; they cause bronchodilation and prevent airway obstructions. Prednisone and ethylprednisolone is used to block release of inflammatory mediators by inhibition of phospholipase, this is used more for patients with asthmatic qualities or asthma. Ribavirin is used for patients who have high risk or a severe RSV infection. Nursing Diagnosis, Intervention and Outcome The nursing diagnosis would be ineffective airway clearance related to excessive, thickened mucous secretions. The interventions would be to treat and maintain a patent airway and provide adequate respiration. This will include cool, oxygenated mist for very sick infants who require hospitalization and intravenous hydration.

Oral, nasal, and tracheal secretions should be clear as appropriate, smoking near the infant or child should be restricted, maintain airway patency, humidifier system can be used, administer supplemental oxygen as ordered, monitor the effectiveness of oxygen therapy, monitor pulmonary function, monitor temperature and fluid loss, check vital signs, monitor intake and output, administer medication to treat the cause of fever. Antiviral drugs are only used in the most severely ill infants.Bronchiolitis in Infants and Small Children Essay. Prevention is very important during RSV season. Observation of the airway is a must. Bronchiolitis in Infants and Small Children Essay.

Infants and children should have pillows to keep the head elevated to make breathing better; a 30 to 40 degree angle is recommended. Resting is necessary to the child should not be disturbed too often. Nursing outcomes and evaluation should be that the respiratory rate, respiratory rhythm, depth of inspiration auscultated breath sounds, vital capacity and pulmonary function is within normal range. Vital signs should be within normal range also. Conclusion Even though this illness does not have a high mortality rate it should be taken very seriously just like every disease or illness.

We have to consider that infants and small children are not capable of telling us their symptoms, so as nurses we have to trust our judgment and the parents or caregivers of those ill infants and children because no one knows them better. This research helped me to better understand this illness that as a mom and future nurse I have been treating at home for the past nine months. References Moorhead, S. , Johnson, M. , Maas, M. L. , & Swanson, E. (2008). Respiratory Status. Nursing outcomes classification (NOC) (4th ed. , p. 579). St. Louis, Missouri: Mosby/Elsevier.

Bulechek, G. M. , Butcher, H. K. , & Dochterman, J. M. (2008). Nursing Interventions Classification (NIC) (5th ed. ). St. Louis, Missouri: Mosby/Elsevier. Bronchiolitis: MedlinePlus Medical Encyclopedia. (2011, August 2). National Library of Medicine – National Institutes of Health. Retrieved October 10, 2011, from http://www. nlm. nih. gov/medlineplus/ency/article/000975. htm. Bronchiolitis . (n. d. ). KidsHealth – the Web’s most visited site about children’s health. Retrieved October 9, 2011, from http://kidshealth. org/parent/infections/lung/bronchiolitis. html#.

Acute bronchiolitis is the inflammation of the small airway tubes of the lungs that is known as the bronchioles. It’s an acute episode of obstructive lower airway disease that is caused by a viral infection in infants younger than 2 years of age (Nino, 2011). There are different types of viruses that cause the illness, such as adenovirus, influenza, parainfluenza, and the most common type of virus that is usually being the culprit is respiratory syncytial virus or commonly known by its abbreviation RSV.Bronchiolitis in Infants and Small Children Essay. When the virus gets to the bronchioles, it will infect the respiratory epithelial cells of the bronchioles causing it to necrose, get inflamed and produces mucous and secretions. The mucous plug that is formed obstructs proper air flow, hence causing air trapped inside the lungs. As air exits the lungs, wheezing sounds can be heard. The disease is infectious, as it can spread through physical contact from one individual to another. Bronchiolitis are more common in those who are not been breastfed and who live in crowded areas (Nino, 2011), and in the case of Baby A, she stopped being given breastfeeding at the age of 4 months old.

Bronchiolitis is inflammation of the bronchioles, the smallest air passages of the lungs. It usually occurs in children less than two years of age and presents with coughing, wheezing, and shortness of breath. This inflammation is usually caused by respiratory syncytial virus. Treatment is typically supportive and may involve the use of nebulized epinephrine or hypertonic saline.

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Bronchiolitis

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Not to be confused with bronchitis.

Bronchiolitis

Classification and external resources

http://upload.wikimedia.org/wikipedia/commons/thumb/7/77/RSV.PNG/230px-RSV.PNG

An x ray of a child with RSV showing the typical bilateral perihilar fullness of bronchiolitis.

ICD-10

J21

ICD-9

466.1

DiseasesDB

1701

MedlinePlus

000975

eMedicine

emerg/365

MeSH

D001988

Bronchiolitis is inflammation of the bronchioles, the smallest air passages of the lungs. It usually occurs in children less than two years of age and presents with coughing, wheezing, and shortness of breath. This inflammation is usually caused by respiratory syncytial virus. Bronchiolitis in Infants and Small Children Essay.Treatment is typically supportive and may involve the use of nebulized epinephrine or hypertonic saline.

1 Signs and symptoms

2 Causes

3 Diagnosis

4 Prevention

5 Management

5.1 Inhaled epinephrine

5.2 Inhaled hypertonic saline

5.3 Other medications

5.4 Non-effective treatments

6 Epidemiology

7 References

8 External links

Signs and symptoms

In a typical case, an infant under two years of age develops cough, wheeze, and shortness of breath over one or two days. The infant may be breathless for several days. After the acute illness, it is common for the airways to remain sensitive for several weeks, leading to recurrent cough and wheeze.

Causes

The term usually refers to acute viral bronchiolitis, a common disease in infancy. This is most commonly caused by respiratory syncytial virus[1] (RSV, also known as human pneumovirus). Other viruses which may cause this illness include metapneumovirus, influenza, parainfluenza, coronavirus, adenovirus, and rhinovirus.

Studies have shown there is a link between voluntary caesarean birth and an increased prevalence of bronchiolitis. A recent study by Perth’s Telethon Institute for Child Health Research has shown an 11% increase in hospital admissions for children delivered this way.[2] Bronchiolitis in Infants and Small Children Essay.

Diagnosis

The diagnosis is typically made by clinical examination. Chest X-ray is sometimes useful to exclude pneumonia, but not indicated in routine cases.[3]

Testing for the specific viral cause can be done but has little effect on management and thus is not routinely recommended.[3] RSV testing by direct immunofluorescence testing on nasopharyngeal aspirate had a sensitivity of 61% and specificity of 89%.[4] Identification of those who are RSV-positive can help for: disease surveillance, grouping (“cohorting”) people together in hospital wards to prevent cross infection, predicting whether the disease course has peaked yet, reducing the need for other diagnostic procedures (by providing confidence that a cause has been identified).

Infant with bronchiolitis between the age of two and three months have a second infection by bacteria (usually a urinary tract infection) less than 6% of the time.[5]

Prevention

Prevention of bronchiolitis relies strongly on measures to reduce the spread of the viruses that cause respiratory infections (that is, handwashing, and avoiding exposure to those symptomatic with respiratory infections). In addition to good hygiene an improved immune system is a great tool for prevention. One way to improve the immune system is to feed the infant with breast milk, especially during the first month of life[6]. Immunizations are available for premature infants who meet certain criteria (some cardiac and respiratory disorders) such as Palivizumab (a monoclonal antibody against RSV). Passive immunization therapy requires monthly injections every winter. Bronchiolitis in Infants and Small Children Essay.

Management

Treatment and management of bronchiolitis is usually focused on the symptoms instead of the infection itself (supportive therapies) since the infection will run its course and complications are typically from the symptoms themselves.[7]

Inhaled epinephrine

Nebulized and inhaled epinephrine (both racemic and levo(1)-epinephrine) has been shown to decrease hospitalization rates[8][9]. Sometimes inhaled hypertonic saline is used.

Inhaled hypertonic saline

Inhaled hypertonic saline (3%) appears to be effective in improving clinical outcomes and shortening the duration of hospital stay[3].

Other medications

Currently other medications do not yet have evidence to support their use[9].

Non-effective treatments

Ribavirin is an antiviral drug which does not appear to be effective for bronchiolitis.[10] Antibiotics are often given in case of a bacterial infection complicating bronchiolitis, but have no effect on the underlying viral infection.[10] Corticosteroids have no proven benefit in bronchiolitis treatment and are not advised.[10] DNAse has not been found to be effective.[11] Bronchiolitis in Infants and Small Children Essay.

Epidemiology

90% of the patients are aged between 1 and 9 months old. Bronchiolitis is the most common cause of hospitalization up to the first year of life. It is epidemic in winters.

References

^ Smyth RL, Openshaw PJ (July 2006). “Bronchiolitis”. Lancet 368 (9532): 312-22. doi:10.1016/S0140-6736(06)69077-6. PMID 16860701.

^ http://www.abc.net.au/news/2011-10-31/elective-caesarean-heightens-respiratory-risk/3611358

^ a b c Zorc, JJ; Hall, CB (2010 Feb). “Bronchiolitis: recent evidence on diagnosis and management”. Pediatrics 125 (2): 342-9. doi:10.1542/peds.2009-2092. PMID 20100768.

^ Bordley WC, Viswanathan M, King VJ, Sutton SF, Jackman AM, Sterling L et al. (2004). “Diagnosis and testing in bronchiolitis: a systematic review”. Arch Pediatr Adolesc Med 158 (2): 119-26. doi:10.1001/archpedi.158.2.119. PMID 14757603.

^ Ralston, S; Hill, V, Waters, A (2011 Oct). “Occult serious bacterial infection in infants younger than 60 to 90 days with bronchiolitis: a systematic review.”. Archives of pediatrics & adolescent medicine 165 (10): 951-6. doi:10.1001/archpediatrics.2011.155. PMID 21969396. Bronchiolitis in Infants and Small Children Essay.

^ Belderbos ME, Houben ML, van Bleek GM, et al. (February 2012). “Breastfeeding modulates neonatal innate immune responses: a prospective birth cohort study”. Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology 23 (1): 65-74. doi:10.1111/j.1399-3038.2011.01230.x. PMID 22103307.

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^ Wright, M; Mullett CJ, Piedimonte G et al. (October 2008). “Pharmacological management of acute bronchiolitis”. Veterinary Research 4 (5): 895-903. PMC 2621418. PMID 19209271.

^ Hartling L, Bialy LM, Vandermeer B, Tjosvold L, Johnson DW, Plint AC et al. (2011). “Epinephrine for bronchiolitis.”. Cochrane Database Syst Rev (6): CD003123. doi:10.1002/14651858.CD003123.pub3. PMID 21678340.

^ a b Hartling, L; Fernandes, RM, Bialy, L, Milne, A, Johnson, D, Plint, A, Klassen, TP, Vandermeer, B (2011 Apr 6). “Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis”. BMJ (Clinical research ed.) 342: d1714. doi:10.1136/bmj.d1714. PMC 3071611. PMID 21471175.

^ a b c Bourke, T; Shields, M (2011 Apr 11). “Bronchiolitis”. Clinical evidence 2011. PMID 21486501.

^ “BestBets: Do recombinant DNAse improve clinical outcome in an infant with RSV positive bronchiolitis?”. Bronchiolitis in Infants and Small Children Essay.