Respiratory Syncytial Virus Bronchiolitis Respiratory syncytial virus affects children around the globe at varying times of the year based on geographical type of weather. According to the National Institute of Allergy and Infectious Diseases (NAID), a figure of 75,000 to 125,000 children has hospital admission due to respiratory syncytial virus infections (cited in NIAID 2008). The respiratory syncytial virus causes lung infections most commonly affect children less than one year of age as a bronchiolitis. Bronchiolitis is an acute inflammatory process of the bronchioles and small bronchi (Kyle & Kyle 2007).
Respiratory syncytial virus is held responsible for a most cases of bronchiolitis, as well as adenovirus, parainfluenza, and human meta-pneumovirus as other causative organisms. The purpose of this paper is to review the background, pathophysiology, signs and symptoms, treatments, diagnostic tests, and relevance on the importance of treating RSV Bronchiolitis among infants and children.Signs and Symptoms Children and infants, who are suffering from bronchiolitis caused by respiratory syncytial virus, can be physically examined by inspection, observation, and auscultation. An infant with respiratory syncytial virus bronchiolitis would appear hungry for air, exhibiting different degrees of cyanosis and respiratory distress. It includes tachypnea, accessory muscle use, retractions, grunting, and episodes of apnea.
The infant or child would look disinterested in feedings, parents, and the surroundings. Upon auscultation, audible scattered wheezes are heard throughout the lungs. For serious and critical cases, there is no wheezes heard that is caused to a significant hyperexpansion of the lungs with a very low air exchange. Some common signs and symptoms reported to be present during health history are pharyngitis, low-grade fever, poor feeding, clear runny nose during the onset of infection, and development of cough during the first 1 to 3 days. Pathophysiology Respiratory syncytial virus belongs to the paramyxovirus family that has a single strand of RNA related to measles, mumps, and parainfluenza virus. The A-strain of RSV is the cause of most severe cases of RSV Bronchiolitis (Martinello, Chen, Weibel, & Kahn, 2002). The researchers found out that a subgroup of the A-strain was linked to the more severe disease.
RSV causes inflammation and edema in the bronchiolar epithelial cells. Once the A-strain of RSV invaded the membranes, it creates a large mass of cells called syncytia (McIntosh, 2000). The mucosa of the bronchiole starts to swell, while the lumina are filled up with exudates such as mucus. The obstruction of the small airway passages or bronchioles is a result of the shed, dead epithelial cells as products of the inflammation process. The presence of RSV infection causes bronchiole obstruction leading to poor gas exchange, trapping of air, increased breathing effort, and an expiratory wheeze (Mlinaric-Galinovic et al. 2000).
Studies/Tests/DiagnosisSeveral diagnostic tests and laboratory studies are routinely ordered to assess RSV bronchiolitis namely pulse oximetry, chest x-ray, blood gases, and nasal-pharyngeal washings (cited in Kyle & Kyle, 2007).Pulse oximetry is ordered to monitor oxygen saturation level that may potentially be significantly decreased to the inflamed bronchioles secondary to respiratory syncytial virus. The chest x-ray can reveal hyperventilation and patchy areas of infiltration or atelectasis.
The arterial blood gases test is also ordered to show whether there is a presence of carbon dioxide retention and hypoxemia. Lastly, the nasal-pharyngeal washings can indicate positive identification of respiratory snycytial virus through enzyme-link immunosorbent assay (ELISA or imunofluorescent antibody (IFA) testing.Treatments The treatment of respiratory syncytial virus bronchiolitis is to treat its symptoms as supportive care. The severity of the disease is given corresponding treatments. Children with less serious state of the disease would only need antipyretics, sufficient hydration, and monitoring. Parents or primary caregivers are instructed to closely watch their child in case of signs of worsening that needs immediate hospitalization.
Children with more serious progression of the disease should be hospitalized. The nursing diagnosis for RSV Bronchiolitis are ineffective airway clearance related to the presence of tenacious secretions upon expectoration and impaired gas exchange due to hypoxemia. The first nursing diagnosis, ineffective airway clearance related to the presence of tenacious secretions upon expectoration, can be given managed by maintaining a patent airway through the use of bronchodilators, chest physiotherapy, and provide mechanical ventilatory support. In order to monitor whether the nursing intervention done has been effective, the measurable outcomes should be patient have an effective airway clearance that is able to easily breathe without the presences of tenacious secretions.
The second nursing diagnosis that is impaired gas exchange due to hypoxemia can be managed by administering bronchodilators, corticosteroids, and antivirals. Additionally, it can be managed by administering prescribed alkaline medications based on the results of the ABG.Conclusion Respiratory syncytial virus is known to cause bronchiolitis in infancy that can be so severe enough to cause hospitalization. There is a need to educate parents and caregivers on how to watch out for signs of the said disease and when to bring their child to the hospital. Bronchiolitis is associated with the development of asthma and allergic sensitization up to the age of seven and a half years old. Without the proper identification and correct home or hospital treatments, the infant’s growth and quality of life can be negatively affected given that the infant will have recurrent bouts of asthma and allergic sensitization when growing up (cited in Sigus et al. 2000).ReferencesHall, C.
B. (2001). Respiratory syncytial virus and parainfluenza virus. New England Journal of Medicine, 344 (50), 1917-1928.
Kyle, T. & Kyle T. (2007).
Essentials of pediatric nursing. Philadelphia: Lippincott Williams & Wilkins.Martinello RA, Chen MD, Weibel C, Kahn JS. Correlation between respiratory syncytial virus genotype and severity of illness.
J Infect Dis. 2002;186:839-842.McIntosh ED, De Silva LM, Oates RK. Clinical severity of respiratory syncytial virus group A and B infection in Sydney, Australia. Pediatric Infect Dis J. 1993; 12:815-819.Mlinaric-Galinovic G, Varda-Brkic D.
Nosocomial respiratory syncytial virus infections in children’s wards. Diagn Microbiol Infect Dis. 2000; 37:237-246.National Institute of Allergy and Infectious Diseases. 8, December 2008. Quick Facts on Respiratory Syncytial Virus.
Retrieved August 14, 2010, from http://www.niaid.nih.gov/topics/rsv/understanding/Pages/quickFacts.aspx.Sigurs, N., Bjarnason, R.
, Sigurbergsson, F., ; Kjellman, Bengt (2000). Respiratory Syncytial Virus Bronchiolitis in Infancy Is an Important Risk Factor for Asthma and Allergy at Age 7 . Respiratory and Critical Care Medicine, 161, 1501-1507.