Bronchiolitis is a common lower respiratory tract infection primarily affecting infants and young children under 2 years of age. This nursing diagnosis focuses on identifying and treating bronchiolitis symptoms, preventing complications, and supporting respiratory function.
Causes (Related to)
Bronchiolitis can affect patients in various ways, with several factors contributing to its severity and progression:
- Viral infection (primarily Respiratory Syncytial Virus – RSV)
- Age (most common in infants under 12 months)
- Premature birth
- Compromised immune system
- Environmental factors
- Exposure to secondhand smoke
- Lack of breastfeeding
- Crowded living conditions
- Daycare attendance
Signs and Symptoms (As evidenced by)
Bronchiolitis presents with distinctive signs and symptoms that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient/Caregiver reports)
- Breathing difficulties
- Wheezing
- Poor feeding
- Irritability
- Cough
- Nasal congestion
- Decreased wet diapers
- Sleep disturbances
Objective: (Nurse assesses)
- Increased respiratory rate (>60 breaths/minute in infants)
- Nasal flaring
- Intercostal retractions
- Crackles and wheezing on auscultation
- Low oxygen saturation (<95%)
- Cyanosis
- Fever
- Dehydration signs
- Decreased breath sounds
Expected Outcomes
The following outcomes indicate successful management of bronchiolitis:
- The patient will maintain oxygen saturation >95% on room air
- The patient will demonstrate an improved respiratory pattern
- The patient will maintain adequate hydration
- The patient will show an improved feeding pattern
- The patient will remain free from complications
- Caregivers will demonstrate an understanding of home care instructions
- The patient will return to normal activity level within 2-3 weeks
Nursing Assessment
Monitor Respiratory Status
- Assess respiratory rate, effort, and pattern
- Monitor oxygen saturation
- Note the use of accessory muscles
- Evaluate breath sounds
- Document retractions and nasal flaring
Evaluate Hydration Status
- Monitor fluid intake and output
- Assess skin turgor
- Check mucous membranes
- Count wet diapers
- Monitor feeding patterns
Check Vital Signs
- Monitor temperature
- Track respiratory rate
- Assess heart rate
- Document oxygen saturation
Assess Risk Factors
- Review birth history
- Document environmental factors
- Check immunization status
- Evaluate living conditions
- Note exposure to illness
Monitor for Complications
- Watch for respiratory failure signs
- Assess for dehydration
- Monitor for secondary infections
- Check for apnea (especially in infants <2 months)
- Evaluate nutritional status
Nursing Care Plans
Nursing Care Plan 1: Ineffective Breathing Pattern
Nursing Diagnosis Statement:
Ineffective Breathing Pattern related to inflammation of bronchioles and increased mucus production as evidenced by tachypnea, retractions, and wheezing.
Related Factors:
- Airway inflammation
- Increased mucus production
- Bronchial obstruction
- Fatigue
- Anxiety
Nursing Interventions and Rationales:
- Position patient in semi-Fowler’s position
Rationale: Promotes optimal lung expansion and reduces work of breathing - Suction airways as needed
Rationale: Removes secretions and improves airway clearance - Monitor respiratory status frequently
Rationale: Enables early detection of deterioration
Desired Outcomes:
- The patient will maintain a respiratory rate within the age-appropriate range
- The patient will demonstrate decreased work of breathing
- The patient will maintain oxygen saturation >95%
Nursing Care Plan 2: Risk for Dehydration
Nursing Diagnosis Statement:
Risk for Dehydration related to increased respiratory rate and decreased oral intake as evidenced by decreased urine output and dry mucous membranes.
Related Factors:
- Increased respiratory rate
- Poor feeding
- Nasal congestion
- Fatigue
- Fever
Nursing Interventions and Rationales:
- Monitor intake and output strictly
Rationale: Provides early indication of fluid balance status - Offer small, frequent feeds
Rationale: Prevents exhaustion during feeding and maintains hydration - Assess hydration status regularly
Rationale: Enables early intervention for dehydration
Desired Outcomes:
- The patient will maintain adequate hydration
- The patient will demonstrate normal skin turgor
- The patient will have adequate urine output
Nursing Care Plan 3: Hyperthermia
Nursing Diagnosis Statement:
Hyperthermia related to inflammatory response to viral infection as evidenced by elevated body temperature and warm skin.
Related Factors:
- Viral infection
- Inflammatory response
- Dehydration
- Increased metabolic rate
Nursing Interventions and Rationales:
- Monitor temperature regularly
Rationale: Tracks fever progression and response to interventions - Administer antipyretics as ordered
Rationale: Reduces fever and improves comfort - Provide cooling measures
Rationale: Helps maintain normal body temperature
Desired Outcomes:
- The patient will maintain a normal temperature
- The patient will show improved comfort
- The patient will maintain adequate hydration
Nursing Care Plan 4: Impaired Gas Exchange
Nursing Diagnosis Statement:
Impaired Gas Exchange related to ventilation-perfusion mismatch as evidenced by decreased oxygen saturation and increased work of breathing.
Related Factors:
- Airway inflammation
- Bronchial obstruction
- Mucus accumulation
- Respiratory fatigue
Nursing Interventions and Rationales:
- Monitor oxygen saturation continuously
Rationale: Enables prompt recognition of deterioration - Administer oxygen therapy as ordered
Rationale: Maintains adequate oxygenation - Position for optimal breathing
Rationale: Improves ventilation-perfusion matching
Desired Outcomes:
- The patient will maintain oxygen saturation >95%
- The patient will demonstrate improved respiratory status
- The patient will show decreased signs of respiratory distress
Nursing Care Plan 5: Anxiety (Caregiver)
Nursing Diagnosis Statement:
Anxiety related to child’s illness and hospitalization as evidenced by expressed concerns and increased questioning.
Related Factors:
- Child’s illness
- Unfamiliar environment
- Limited knowledge
- Fear of complications
Nursing Interventions and Rationales:
- Provide clear explanations of care
Rationale: Reduces anxiety through understanding - Teach home care management
Rationale: Empowers caregivers and builds confidence - Encourage participation in care
Rationale: Promotes a sense of control and competence
Desired Outcomes:
- Caregivers will demonstrate decreased anxiety
- Caregivers will verbalize understanding of care
- Caregivers will participate effectively in care
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics. 2006 Oct;118(4):1774-93. doi: 10.1542/peds.2006-2223. PMID: 17015575.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Kou M, Hwang V, Ramkellawan N. Bronchiolitis: From Practice Guideline to Clinical Practice. Emerg Med Clin North Am. 2018 May;36(2):275-286. doi: 10.1016/j.emc.2017.12.006. Epub 2018 Feb 10. PMID: 29622322.
- Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, Johnson DW, Light MJ, Maraqa NF, Mendonca EA, Phelan KJ, Zorc JJ, Stanko-Lopp D, Brown MA, Nathanson I, Rosenblum E, Sayles S 3rd, Hernandez-Cancio S; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014 Nov;134(5):e1474-502. doi: 10.1542/peds.2014-2742. Erratum in: Pediatrics. 2015 Oct;136(4):782. doi: 10.1542/peds.2015-2862. PMID: 25349312.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
