Case Study: Bronchiolitis Case

This essay will look at a case of acute care needed by Jake. For the purpose of this essay the only intervention discussed will be the care surrounding Jake’s nutrition and hydration, with research and evidence being considered and applied appropriately. Jake’s initial assessment, using the ABCDE approach, will be discussed with an explanation of the pathophysiology behind his condition. This essay will also explore the impact on the family of having an infant with bronchiolitis with a focus on the importance of involving Jake’s mother, Clare, who was present throughout his stay.

Bronchiolitis is a common condition caused by a viral infection predominantly affecting infants under 24 months. In around 80% of cases the virus is Respiratory
The nurse will assess the effort of breathing, by looking at respiratory rate, signs of recession, use of accessory muscles or nasal flaring, and will record oxygen saturations (Kelsey and McEwing, 2010). An increased work of breathing may lead to poor feeding. This, paired with fever, which increases fluid loss, can lead to poor hydration (Mikalsen et al., 2014). For these observations the nurse will need to see Jake’s chest and abdomen. So, after explaining the observations, she could help to involve Jake’s mother, Clare, by asking her to undress Jake or offering to undress him if Clare would prefer. Assisting parents to participate in as much of the care as possible, promotes emotional security (Tolomeo, 2012). Jake demonstrated signs of respiratory distress with mild intercostal and subcostal recession and slight tachypnoea. These symptoms are caused by a reduction in oxygen and increase in carbon dioxide in the blood stimulating chemoreceptors, which send messages to the respiratory centre (Kelsey and McEwing, 2010), resulting in the body working harder to absorb oxygen (Conquest et al., 2013). Jake’s expected respiratory rate falls between 30-40 breaths per minute (University Hospital Southampton NHS Foundation Trust [UHS], 2008), but Jake’s was 47. Jake’s oxygen saturations were measured with a pulse oximeter and observed to be between 94% and 96%. National Institute for Health and Clinical Excellence (NICE) (2015) recommend that
Bzezinsky et al. (2013) add to this discussion, concluding that gastric-tube feeding is of comparable standard to intravenous hydration. Alverson et al (2014) conclude that gastric-tubes have been shown to have a higher success rate of insertions, making the process less stressful for both child and family. This is crucial for Jake, as children with bronchiolitis should be kept calm, with minimal handling, as distress could narrow the airway and worsen symptoms (Shanley et al., 2007). Several pieces of literature suggest that gastric-tube feeding should be the first choice, with intravenous hydration only recommended if the patient is too unwell to tolerate a gastric-tube (Alverson et al., 2014; Harris et al., 2008