5 Bronchiolitis Nursing Care Plans

May 3, 2018

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 (5) nursing care plans (NCP) for bronchiolitis:

Ineffective Airway Clearance

Ineffective Airway Clearance: Inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway.

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.