Bronchiolitis is an acute viral inflammation of the lower respiratory tract involving the bronchioles and alveoli. Accumulated thick mucus, exudate, and cellular debris and the mucosal edema from the inflammatory process obstruct the smaller airways (bronchioles). This causes a reduction in expiration, air trapping, and hyperinflation of the alveoli. The obstruction interferes with gas exchange, and in severe cases causes hypoxemia and hypercapnia, which can lead to respiratory acidosis. Children in a debilitated state who experience this disorder with other serious diseases are hospitalized.
Nursing Care Plans
Nursing care planning goals for a child with bronchiolitis include maintenance of effective airway clearance, improved breathing pattern, relief of anxiety and fatigue, increased parental knowledge about the disease condition, and absence of complications.
Here are five nursing care plans and nursing diagnoses for bronchiolitis:
Ineffective Airway Clearance
May be related to
- Tracheobronchial obstruction, secretions, infection
Possibly evidenced by
- Diminished or absent breath sounds
- Crackles, wheezes, rhonchi
- Paroxysmal, nonproductive, and harsh, hacking cough
- Change in rate and depth of respirations
- Dyspnea and shallow respiratory excursion
- Hyperresonance
- Increased mucus and nasal discharge
- Tachypnea
- Fever
Desired Outcomes
- Child will demonstrate effective coughing and clear breath sounds; is free of cyanosis and dyspnea.
Nursing Interventions | Rationale |
---|---|
Assess airway for patency. | Maintaining patent airway is always the first priority, especially in cases like trauma, acute neurological decompensation, or cardiac arrest. |
Assess respirations. Note quality, rate, pattern, depth, flaring of nostrils, dyspnea on exertion, evidence of splinting, use of accessory muscles, and position for breathing. | A change in the usual respiration may mean respiratory compromise. An increase in respiratory rate and rhythm may be a compensatory response to airway obstruction. |
Assess breath sounds by auscultation. | Abnormal breath sounds can be heard as fluid and mucus accumulate. This may indicate airway is obstructed. |
Assess cough (moist, dry, hacking, paroxysmal, brassy, or croupy): onset, duration, frequency, if it occurs at night, during day, or during activity; mucus production: when produced, amount, color (clear, yellow , green), consistency (thick, tenacious, frothy); ability to expectorate or if swallowing secretions, stuffy nose or nasal drainage. | Coughing is a mechanism for clearing secretions. An ineffective cough compromises airway clearance and prevents mucus from being expelled. Respiratory muscle fatigue, severe bronchospasm, or thick and tenacious secretions are possible causes of ineffective cough. |
Provide for periods of rest by organizing procedures and care and disturbing infant/child as little as possible in acute stages of illness. | Prevents unnecessary energy expenditure resulting in fatigue. |
Elevate head of bed at least 30° for child and hold infant and young child in lap or in an upright position with head on shoulder; older child may sit up and rest head on a pillow on overbed table. | Upright position limits abdominal contents from pushing upward and inhibiting lung expansion. This position promotes better lung expansion and improved air exchange. |
Encourage fluid intake at frequent intervals over 24-h time periods, specify amounts. | Fluids help minimize mucosal drying and maximize ciliary action to move secretions. |
Reposition on sides q 2h; position child in proper body alignment. | Prevents accumulation and pooling of secretions. |
Assist to perform deep breathing and coughing exercises in child when in a relaxed position for postural drainage unless procedures are contraindicated; use incentive spirometer in older child, blowing up balloon, blowing bubbles, blowing a pinwheel or blowing cotton balls across the table in younger child. | Vibration loosens and dislodges secretions, and gravity drains the airways and lung segments through Promotes deeper breathing by enlarging tracheobronchial tree and initiating cough reflex to remove secretions. |
Teach parents and possibly older child (specify) administration of medications via proper route with name and action of each drug: dosage; why given; frequency; time of day or night; side effects to report; how to administer in food—crushed, chewable, by measured dropper, or other recommended form; and method (nose drops, inhaler). | Ensures compliance with correct drug dosage and other considerations for administrations for desired results, and what to do if side effects occur. |
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use. - Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively. - NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023Â (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales. - Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates. - Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing. - Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans. - Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you. - Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023. - All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
See Also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans related to respiratory system disorders:
- Asthma | 8 Care Plans
- Bronchiolitis | 5 Care Plans
- Bronchopulmonary Dysplasia (BPD) | 5 Care Plans
- Chronic Obstructive Pulmonary Disease (COPD) | 7 Care Plans
- Cystic Fibrosis | 5 Care Plans
- Hemothorax and Pneumothorax | 3 Care Plans
- Influenza (Flu) | 5 Care Plans
- Lung Cancer | 5 Care Plans
- Mechanical Ventilation | 6 Care Plans
- Near-Drowning | 5 Care Plans
- Pleural Effusion | 6 Care Plans
- Pneumonia | 11 Care Plans
- Pulmonary Embolism | 4 Care Plans
- Pulmonary Tuberculosis | 5 Care Plans
- Tracheostomy | 5 Care Plans