PATHOPHYSIOLOGY FOR BRONCHIOLITIS

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You are working in a large urban pediatric clinic after hours.
A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation and on inspection, you identify retractions.

The child is in less than 10th percentile of weight and has a cardiac history of Patent DuctusArteriosus (PDA).
The child is in less than 10th percentile of weight and has a cardiac history of patent ductus arteriosus (PDA).
Born at 36 weeksgestation.
Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare.
Temperature: 102.1F, pulse: 140 beats/minute, respirations: 40 breaths/minute, blood pressure: 83/58mmHg, pulse oximeter 96% on room air.
A swab for respiratory syncytial virus (RSV) is positive.

Doctor orders – Nasal bulb suction and nasal saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, albuterol nebulizer in office and encourage oral fluids as tolerated.
After the albuterol nebulizer treatment, respirations are 36 breaths/minute and oxygen saturation is 100% on room air.
Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that client has a nebulizer at home and can return to pediatric after-hours clinic or ER if needed.
Client is discharged with these orders:

Methylprednisolone0.4 mg/kg oral BID for 3
Albuterol Q4 hours for 24 hours, then Q 6 hours for 24 hours, and then Q6 hours as needed. Call doctor if needed prior to the Q4 dose.
Manage fever with Tylenol and continue hydration and nasal bulb suction Q6 hours while awake.
Return for re-evaluation in 3 days

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