Topic Module 07 Assignment: Pediatric Assessment Of PDA With

Topic Module 07 Assignment Pediatric Assessment Pda With Rsvpurpos

The goal of creating a nursing concept map and create a plan of care for a child with bronchiolitis. The nursing interventions would reflect the underlying respiratory syncytial virus with patent ductus arteriosus (PDA) history. Provide responses for these questions and requests for information in a two to three-page APA formatted paper:

1. Describe the pathophysiology of bronchiolitis and identify the most common organism causing this infection. What laboratory testing can confirm your suspicion?
2. Describe the pathophysiology of PDA and why the history of PDA is significant in this scenario.
3. What risk factors place Vivi Mitchell at a greater risk for the development of bronchiolitis?
4. What are the characteristic signs/symptoms of bronchiolitis?
5. Vivi Mitchell has been prescribed acetaminophen, albuterol nebulizer, corticosteroids. Provide the rationale for each medication and explain potential contraindications.
6. Design Vivi Mitchell’s plan of care by identifying two priority nursing diagnoses. For each diagnosis, include two SMART goals and two interventions per goal.
7. What short-term and long-term complications should the nurse anticipate?
8. What client education is appropriate for Vivi Mitchell upon discharge?

Paper For Above instruction

Bronchiolitis is a common lower respiratory tract infection primarily affecting infants and young children, characterized by inflammation of the small airways (bronchioles). The most prevalent causative agent is respiratory syncytial virus (RSV), which accounts for the majority of cases during peak seasons. The pathophysiology of bronchiolitis involves viral invasion of the epithelial cells lining the bronchioles, leading to cell death, inflammation, edema, and increased mucus production (Hall et al., 2013). These pathological changes result in airway narrowing, mucus plugging, and air trapping, which manifest clinically as cough, wheezing, retractions, and decreased oxygenation.

Laboratory testing confirming RSV infection includes a nasal swab or aspirate analyzed via rapid antigen detection tests and PCR assays. These tests offer rapid and specific identification of RSV, aiding in diagnosis and management planning (Reichman & Greenberg, 2014). PCR assays are considered the gold standard due to high sensitivity and specificity, especially in hospitalized patients or severe cases (Mandell et al., 2019).

Patent Ductus Arteriosus (PDA) is a congenital heart defect characterized by the persistence of the ductus arteriosus, which normally closes shortly after birth. The ductus arteriosus is a fetal vessel connecting the pulmonary artery to the aorta, allowing blood to bypass the non-functioning fetal lungs. In PDA, the persistent connection causes shunting of blood from the aorta into the pulmonary artery, leading to increased pulmonary blood flow, pulmonary congestion, and potential heart failure if untreated (Bouwmeester et al., 2014). The significance of Vivi's history of PDA lies in the increased risk of pulmonary congestion and compromised respiratory capacity, which predisposes her to greater severity of respiratory infections like bronchiolitis, as her cardiovascular system is already burdened.

Several risk factors increase Vivi Mitchell’s susceptibility to bronchiolitis, including prematurity (born at 36 weeks gestation), low birth weight (less than 10th percentile), exposure to daycare attendees, and a history of PDA. Prematurity and low birth weight are associated with immature lung development and reduced immune function, making infants more vulnerable to viral infections (Meissner, 2016). Additionally, exposure to other children in daycare increases the likelihood of contact with infectious agents like RSV. The presence of PDA can exacerbate respiratory compromise because of altered pulmonary hemodynamics, further increasing the risk of severe illness.

Characteristic signs and symptoms of bronchiolitis include initial mild rhinorrhea and congestion, progressing to coughing, wheezing, accessory muscle retractions, tachypnea, and hypoxia. Fever is common, and symptoms often follow a pattern of worsening over 2-3 days (Shay et al., 2016). In severe cases, respiratory distress can lead to apnea, cyanosis, and respiratory failure if not promptly managed.

Vivi Mitchell’s medication regimen includes acetaminophen, albuterol nebulizer, and corticosteroids. Acetaminophen is administered to reduce fever and discomfort caused by respiratory infection (Liu et al., 2015). The albuterol nebulizer acts as a bronchodilator, which helps relax airway smooth muscle, relieve wheezing, and improve airflow, especially beneficial given her wheezing and retractions. Corticosteroids, such as methylprednisolone, are used to decrease airway inflammation, which may be beneficial in bronchiolitis with significant airway obstruction (Silvestri et al., 2014). Potential contraindications include hypersensitivity to these medications, and corticosteroids should be used cautiously in immunocompromised children or those with systemic infections.

In designing Vivi's care plan, two priority nursing diagnoses are “Impaired Gas Exchange” and “Risk for Decreased Cardiac Output.”

Impaired Gas Exchange

• Goals:
• 1. The patient will maintain oxygen saturation >92% within 24 hours.
• 2. The patient will demonstrate effective ventilation as evidenced by normal respiratory rate (

• Interventions:
• 1. Administer oxygen therapy as ordered and monitor oxygen saturation continuously.
• 2. Promote airway clearance through nasal suctioning and positioning to facilitate optimal airway patency.

Risk for Decreased Cardiac Output

• Goals:
• 1. The child's heart rate and rhythm will remain within normal limits for age within 24 hours.
• 2. No signs of heart failure (e.g., hepatomegaly, edema) will develop during hospitalization.

• Interventions:
• 1. Monitor for signs of increased work of breathing and fluid overload, including monitoring intake/output and daily weights.
• 2. Educate caregivers about signs of heart failure and when to seek immediate medical attention.

Potential short-term complications include worsening hypoxia, respiratory failure requiring mechanical ventilation, and dehydration from increased respiratory effort and fever. Long-term, recurrent bronchiolitis can lead to airway hyperreactivity, predispose to asthma development, and impact overall lung function (Anderson et al., 2016). The existing PDA may complicate recovery, increasing the risk of pulmonary hypertension and cardiac strain if not carefully managed.

Patient education upon discharge should focus on infection prevention, recognition of worsening symptoms, medication adherence, and hydration. Instructions should include avoiding exposure to other infected children, maintaining good hand hygiene, and ensuring follow-up care with the pediatrician. Parents should be informed about signs indicating deterioration such as increased respiratory distress, persistent hypoxia, or feeding difficulties, emphasizing prompt medical attention (American Academy of Pediatrics, 2014).

References

• American Academy of Pediatrics. (2014). Red Book: 2012 Report of the Committee on Infectious Diseases. American Academy of Pediatrics.
• Anderson, E. L., et al. (2016). Long-term pulmonary outcomes in children with bronchiolitis. Pediatric Pulmonology, 51(4), 425–436.
• Bouwmeester, P., et al. (2014). Patent ductus arteriosus in preterm infants. Neonatal Review, 11(4), 45–50.
• Hall, C. B., et al. (2013). Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics, 132(2), 253–262.
• Liu, L., et al. (2015). Acetaminophen in pediatric febrile illnesses: safety and efficacy review. Journal of Pediatric Pharmacology, 20(4), 345–351.
• Mandell, L. A., et al. (2019). Infectious Diseases of the Respiratory Tract in Children. Springer.
• Meissner, H. C. (2016). Prevention of respiratory syncytial virus infections: recommendations for the use of palivizumab. Pediatrics, 138(3), e20161235.
• Reichman, R. C., & Greenberg, D. (2014). Diagnosis of respiratory syncytial virus infections. Infectious Disease Clinics, 28(3), 625–637.
• Shay, D. K., et al. (2016). Epidemiology of respiratory syncytial virus. Journal of Pediatric Infectious Diseases, 20(5), 469–477.
• Silvestri, N., et al. (2014). Corticosteroid therapy in infants with bronchiolitis: a review. Pediatric Health, Medicine and Therapeutics, 5, 33–40.