Bronchiolitis is a medical condition that involves the infection of the bronchioles in the lungs.
When air is inhaled, it moves from the windpipe to the primary bronchi, which are the major airways in each of the lungs. Air then travels via smaller bronchi before entering bronchioles, which are even smaller tubes, these lungs’ tiny airways may become infected by a virus, which results in swelling and obstruction of the bronchioles. Young children and infants frequently contract bronchiolitis, which is more common in the winter season.
Although it is generally considered a childhood condition, adults can also acquire bronchiolitis. When bronchiolitis develops, the cold-like symptoms progress to coughing, wheezing, and occasionally breathing difficulties which might linger for a few days to a few weeks.
Types of Bronchiolitis
1. Viral bronchiolitis. The respiratory syncytial virus is responsible for the majority of viral bronchiolitis cases. Every autumn and winter, there are viral outbreaks that mostly affect children under the age of two, with infants under the age of six months having the highest chance of developing severe disease.
2. Bronchiolitis obliterans. Popcorn lung, also known as bronchiolitis obliterans, is an uncommon and serious disorder that affects adults and can be brought on by serious lung infections or long-term exposure to airborne chemicals including formaldehyde, and ammonia, or metal oxide fumes. The bronchioles become scarred as a result of this condition. Scarring obstructs airways and leads to a blockage that cannot be removed.
Signs and Symptoms of Bronchiolitis
Initial symptoms may include:
- fever
- runny nose
- stuffy nose
- decreased appetite
- cough
Over the next several days:
- wheezing
- shortness of breath
- raspy and harsh cough
- brief pauses in breathing
- irritability
- vomiting after eating
- fatigue
- fever
- nasal flaring when breathing
Severe bronchiolitis with the following symptoms will need medical attention:
- audible wheezing sounds
- very fast shallow breathing which is more than 60 breaths a minute
- labored breathing or grunting
- sluggish appearance
- inability to drink and eat
- bluish discoloration of the lips and fingernails
Causes of Bronchiolitis
- Virus. Bronchiolitis may be brought on by viruses that enter and infect the respiratory tract. Viruses are microscopic organisms that pose a threat to the immune system due to their capacity for rapid reproduction.
- Respiratory Syncytial Virus (RSV). It is the most typical cause of bronchiolitis. All ages are susceptible to RSV, but children under 2 years old or older adults with compromised immune systems are most at risk for serious illness.
- Adenoviruses. It targets the mucous membranes. In children, they contribute to 5–10% and 1–7% of adult respiratory tract infections.
- Influenza virus. The lungs, nose, and throat become inflamed as a result of this virus. Both children and adults can get influenza. Infants with weak immune systems are particularly vulnerable.
- Uncommon conditions. These may develop for no apparent reason and if severe cases go untreated, they can be fatal:
- Lung or stem cell transplant complications
- Smoke from an electronic cigarette
- Chemical vapors from ammonia, bleach, and chlorine
- Respiratory infections
- Medications’ adverse reactions
Risk Factors to Bronchiolitis
- Environmental factors. Bronchiolitis can become more severe and harm the respiratory system when children or their mothers are exposed to environmental factors.
- allergens
- cigarette smoke
- crowded living situations where the virus is present
- particulate matter
- Host-related factors
- male gender
- congenital heart disease
- a history of premature birth
- neonatal artificial ventilation
- low birth weight, or short birth length
- Other risk factors.
- absence of breastfeeding
- elective cesarean birth
- maternal age
- insufficient prenatal care
- incomplete immunization history
- a family history of asthma
Complications of Bronchiolitis
- Cyanosis. A bluish discoloration on the lips or skin is caused by a lack of oxygen.
- Apnea. The pauses in breathing are most likely to occur in premature babies and in babies within the first two months of life.
- Dehydration or nutritional deficiencies. If persistent vomiting is present.
- Low oxygen levels and respiratory failure. In order to help the child with severe respiratory failure, a tube may be inserted into the windpipe or trachea to help in breathing until the infection has run its course.
- Severe infection. The infection may become severe very fast if the infant was born preterm, has a heart or lung disease, or has a weakened immune system. This will typically require hospitalization in such circumstances.
- Bacterial pneumonia. It occurs when the infection travels deeper into the lungs, resulting in the fluid build-up of the air sacs.
- Ear infection. When bacteria or viruses infect and trap fluid behind the eardrum, it results in ear infections, which cause pain and swelling or bulging of the eardrum. A cold or another respiratory infection is frequently followed by an ear infection.
Diagnosis of Bronchiolitis
- Physical assessment. The healthcare provider will typically be able to pinpoint the issue by observing the child and using a stethoscope to auscultate the lungs. The healthcare provider may also assess the signs of dehydration.
- Medical history. The healthcare provider may ask about potential environmental exposures.
- Imaging.
- Chest x-ray. This is done in order to check for signs of pneumonia.
- Viral analysis. The type of virus causing the infection can be determined by the healthcare provider using samples of mucus or nasal discharge.
- Blood test. The patient’s white blood cell count may occasionally be checked through blood tests. Typically, a rise in white blood cells indicates that the body is battling an infection. A blood test can also reveal the amount of oxygen and carbon dioxide in the blood using arterial blood gas testing.
- Pulse oximetry. The device called an oximeter gauges the blood’s oxygen content. A little sensor, resembling a bandage, is applied to the child’s finger or toe to take this measurement.
- Spirometry. This gauges how much and fast the air is inhaled with each breath.
Treatment for Bronchiolitis
- Perform breathing exercises. Coughing, incentive spirometer exercises, and deep breathing can all help to breathe effectively and reduce the chance of developing lung conditions like pneumonia.
- Promote sleep and rest. Adequate rest periods will reduce fatigue and help the patient to gain energy.
- Medical Management
- Administer corticosteroids. Can help reduce inflammation, open up the airways, and help loosen the mucus in the lungs.
- Supplement with oxygen. To help the patient with breathing.
- Administer IV (intravenous) fluids. To prevent dehydration if the patient cannot drink well or has persistent vomiting.
- Apply saline nasal drops. These drops are available over-the-counter (OTC). To use them, place a few drops in one nostril, followed by a quick bulb suction.
- Humidify the air. A cool-mist humidifier or vaporizer helps moisten the dry air in the room to aid with congestion and coughing. To stop the development of bacteria and molds, make sure the humidifier is kept clean.
- Suction the patient’s nose and mouth frequently. To aid in getting rid of thick mucus build-up which can obstruct the airway.
- Position the patient properly. Proper upright positioning will help in breathing comfortably.
- Avoid airborne irritants. Cigarette smoke, strong perfumes, or strong-smelling cleaners might make respiratory infection symptoms worse.
- Increase fluid intake. To avoid dehydration and thin the mucus in the lungs to make coughing up the mucus easier.
Nursing Diagnosis for Bronchiolitis
Bronchiolitis Nursing Care Plan 1
Nursing Diagnosis: Ineffective Airway Clearance related to tracheobronchial obstruction secondary to bronchiolitis, as evidenced by diminished breath sounds, harsh and hacking cough, tachypnea, increased mucus secretions, and nasal discharge.
Desired Outcomes:
- The patient will be able to maintain a clear and open airway as evidenced by normal breath sounds, normal respiratory rate, and the ability to cough effectively.
- The patient will be able to demonstrate an increased air exchange.
- The patient will be able to identify methods to enhance the removal of secretions.
| Bronchiolitis Nursing Interventions | Rationale |
| Assess the patient’s airway patency. | The preservation of a patent airway is always first priority, particularly in situations involving trauma, severe neurological impairment, or cardiac arrest. |
| Assess the patient’s breathing pattern. Take note of the quality, pace, pattern, depth, nostril flare-ups, dyspnea when exerted, splinting signs, usage of accessory muscles, and position when breathing. | A respiratory compromise could result from a shift in normal respiration. A compensatory reaction to airway blockage may involve an increase in respiratory rhythm and rate. |
| Auscultate the patient’s breath sounds. | Fluid and mucus buildup can cause abnormal breath sounds to be audible. This can be a sign that the airway is blocked. |
| Allow the patient to have rest and promote sleep by planning procedures and care and disturbing the patient, especially an infant/child as little as possible. | Avoids wasting the patient’s energy. Ineffective coughing is influenced by fatigue. Effective coughing requires sufficient energy and may involve the patient exerting additional effort. |
| Position the patient properly. For infants and young children, raise the head of the bed by at least 30 degrees. Older children may sit up and rest their heads on a pillow on the overbed table. | An upright posture prevents lung expansion by preventing the upward movement of the stomach contents. Better air exchange and lung expansion are encouraged in this position. |
| Encourage the patient to take fluids at frequent intervals within a 24-hour period. | Fluids reduce mucosal dryness and increase ciliary activity, which helps secretions move. |
| Educated the patient on how to breathe and cough properly. | Coughing is the most practical approach to get rid of most secretions. Therefore, it is essential to support the patient throughout this exercise. Contrarily, deep breathing encourages oxygenation prior to controlled coughing. |
| Educate the patient’s caregivers about proper suctioning procedures. Given the chance for a follow-up demonstration and adapt strategies for use at home. | The safe and efficient removal of secretions from the airway is encouraged by this procedure. |
Bronchiolitis Nursing Care Plan 2
Nursing Diagnosis: Ineffective Breathing Pattern related to increased work of breathing secondary to bronchiolitis, as evidenced by cough, nasal flaring, dyspnea, subcostal retractions, and abnormal arterial blood gas (ABGs) result.
Desired Outcomes:
- The patient will be able to continue to breathe effectively with normal respiratory depth, rate, and oxygen saturation.
- The patient’s ABG readings will be within the normal range.
- The patient will be able to perform breathing exercises to enhance the breathing pattern.
| Bronchiolitis Nursing Interventions | Rationale |
| Evaluate the patient’s respiratory status at least every 2-4 hours, or more frequently as needed. | As the child’s energy is reduced, changes in breathing patterns could happen quickly. Air exchange rate and quality are revealed via baseline assessment and monitoring. Regular evaluation and observation give verifiable proof of changes in the caliber of respiratory effort, allowing for quick and efficient action. |
| Palpate the patient’s chest to determine its structure and listen for breath sounds that might suggest a mobility restriction such as absent or diminished, crackles or rhonchi. | This is done to detect diminished or unexpected breath sounds. |
| Observe the patient for any shifts in consciousness. | Early signs of low brain oxygen levels include restlessness, disorientation, and/or irritation. |
| Determine the patient’s oxygen saturation and pulse rate using a pulse oximeter. | Pulse oximetry is a useful tool to initially identify changes in oxygenation; however, in order to determine CO2 levels, arterial blood gases (ABGs) or end-tidal CO2 monitoring would need to be obtained. |
| Determine the patient’s arterial blood gases. | Identify the status of ventilation and oxygenation. |
| Position the patient properly by raising the head of the bed or putting the child in a comforting position on the parent’s lap. | Position encourages better oxygenation, a reduction in anxiety particularly in young children, and a reduction in energy use. |
| Promote regular rest periods and educate the patient on how to pace the activity. | Increased activity can make breathing difficulties worse. Make sure the patient takes a break from demanding activities. |
| Instruct and encourage the patient to perform the right deep breathing exercises. | Deep breathing is encouraged, which boosts oxygenation and reduces the risk of atelectasis. |
| Encourage the patient to successfully cough out their own secretions to keep the airway open. | Allows for sufficient elimination of secretions. |
| Provide the patient with humidified oxygen by using a mask, hood, or tent. | In addition to helping to maintain oxygenation status and reduce respiratory discomfort, humidified oxygen loosens secretions. |
Bronchiolitis Nursing Care Plan 3
Nursing Diagnosis: Anxiety related to the shift in the health status secondary to bronchiolitis, as evidenced by increased apprehension that the condition will get worse, worrying about the need for hospitalization, and the need for minimally invasive treatment such as IV therapy.
Desired Outcomes:
- The patient will be able to recognize and share fears and concerns.
- The patient will be able to express ideas on how to handle anxiety.
- The patient will be able to develop problem-solving strategies.
- The patient will be able to maintain a regular sleep pattern.
| Bronchiolitis Nursing Interventions | Rationale |
| Assess the cause, severity, symptoms, and desire of the patient for information to reduce anxiety. | Describes the degree of anxiety and the necessity for actions to reduce it. Anxiety may be triggered by worry or uncertainty about a person’s condition, guilt over having a disease, the possibility of losing their parenting role, or a loss of duty if they are hospitalized. |
| Communicate openly with the patient and family. Provide an honest and calm answer to their questions. | Promotes a calming and encouraging environment. |
| Allow the patient or family to voice their worries and to ask questions regarding the illness and treatment of the patient especially if the patient is an infant. | Gives a chance to express emotions and obtain information that is necessary to lessen the anxiety. |
| Encourage the parents of the patient to take control of their emotions and participate in decisions involving their infant or young child. Ask the parents to note any progress that occurs. | Encourages close observation of the patient to check on any changes in their symptoms. |
| Allow the parents to stay with the patient, permit open visits and phone calls, ask them to help with care such as holding, feeding, and diapering the infant, and propose routines and treatment options. | Give parents the freedom to support and care for their baby or young patient; absence and uncertainty about the child’s well-being may make parents feel more anxious. |
| Educate the patient or the parents about the disease’s clinical manifestations, symptoms, and process. | By letting the patient or parents know what to expect, the information provided helps to reduce worry. |
| Explain to the patient or parents the reason behind each treatment or type of therapy, as well as the results of any diagnostic testing. | Reduces the fear of the unknown, which prevents anxiety. |
| Clarify any patient inquiries and explain any misunderstandings in simple words. | Prevents any unwarranted worry brought on by false knowledge, false beliefs, or inconsistent facts. |
Bronchiolitis Nursing Care Plan 4
Nursing Diagnosis: Fatigue related to increased respiratory effort secondary to bronchiolitis, as evidenced by irritability, frequent sleeping, exhausted appearance, and inability to eat and perform daily activities.
Desired Outcomes:
- The patient will be able to regain strength.
- The patient will be able to eat, drink and perform daily activities.
- The patient will be able to identify energy-conserving strategies.
| Bronchiolitis Nursing Interventions | Rationale |
| Assess the patient for excessive weakness and exhaustion. Determine the ability to rest and sleep. | Information is given to identify the impacts of dyspnea and labored breathing over time, which reduces an infant’s or young child’s capacity to rest, feed, and drink. |
| Schedule and allow the patient to have a rest period in a calm and cozy setting. | Minimizes stimuli and encourages relaxation in order to lower the risk of fatigue. |
| Infants and young children should only be disturbed when absolutely necessary. Care should not be spread across a long period of time. | Conserves energy and avoids sleep disruptions. |
| Encourage the parents of the patient to take steps to prevent infant and young child anxiety, such as holding or rocking the child, feeding in tiny amounts, playing with the child, and providing entertainment options like TV or toys. | Conserves energy while offering support to infants and young children. |
| Allow the infant patient to maintain bed rest while having quiet play. | While calm play prevents excessive activity that depletes energy and raises respiration, rest reduces fatigue and respiratory discomfort. |
| Advise the patient’s parents to pick up the patient who is wailing for more than a minute or two. | Prevents fatigue because sobbing for a long time is exhausting. |
| Help the patient’s parents in creating a strategy to schedule feeding, bathing, and diaper changes around times when children are sleeping. | Prevents sleep and rest interruptions. |
| Assess the patient’s nutritional status and dietary intake. | The level of fatigue can be influenced by consuming enough calories from healthy sources. Deficits brought on by a lack of meals might contribute to fatigue. Fatigue can result from vitamin and iron deficiencies. |
| Create a timetable for the patient that supports the most energetic hours of the day and allows for rest when needed. | Planning the patient’s daily activities and downtime could help lessen fatigue. Small-scale planning may encourage motivation and assist in completing daily activities. Tasks like housework can be spread out over a few days. |
Bronchiolitis Nursing Care Plan 5
Nursing Diagnosis: Deficient Knowledge related to lack of information about the causative agent, respiratory syncytial virus secondary to bronchiolitis, as evidenced by expressions of inability to understand the disease process and its cause.
Desired Outcomes:
- The patient and the family will be able to verbalize understanding of the condition.
- The patient and the family will be able to identify methods of prevention and treatment of the disease.
| Bronchiolitis Nursing Interventions | Rationale |
| Assess the patient’s current knowledge about the disease, prevention, transmission, and treatment. | Establishes a benchmark for the kind of knowledge required to stop the spread of injection and will help in developing the treatment plan. |
| Educate the patient and the family about the direct and indirect transmission of the virus. | Explains that kissing and cuddling the patient, and fomites that are on hard, smooth surfaces are possible sources of contact with the virus. |
| Advise the patient and family about the potential spread of the virus to other family members. | Explains how viruses are easily spread, with up to 50% of family members developing viral infections. |
| Assess the patient for the signs and symptoms of respiratory distress including fever, dyspnea, tachypnea, and expectoration of yellow-green sputum are all symptoms of infection. | A prompt medical attention will be given to the patient if the symptoms are quickly identified. |
| Educate the patient about proper handwashing techniques. | Prevents hand-to-hand transmission, one of the main sources of contamination. |
| Encourage the patient to have a nutritious dietary intake focusing on a high-calorie, balanced diet and increase the fluid intake. | Increases the natural bodily defense by encouraging the liquefaction of secretions and replacing calories utilized to fight illness. |
| Instruct the patient on how to take prescription medicines in the scheduled period. | Increases the detection of negative side effects and medication administration consistency. |
| Teach the patient and the family how to properly dispose of the contaminated and soiled items. | Prevent the spread of infection. |
| Implement a strict policy in limiting the patient’s visitors. | Prevent the spread of the illness to others and future RSV-related problems. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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