450 ■ CHAPTER 13

NURSING CARE PLAN The Child with Bronchiolitis

GOAL INTERVENTION RATIONALE EXPECTED OUTCOME

1. Ineffective Breathing Pattern related to increased work of breathing and decreased energy (fatigue)

NIC Priority Intervention: Respiratory NOC Suggested Outcome: Vital

monitoring: Collection and analysis signs status: Temperature, pulse,
of patient data to ensure airway respiration, and blood pressure within
patency and adequate gas exchange. expected range for the child’s age

The child will return to respiratory
baseline. The child will not experience
respiratory failure.
The child’s oxygenation status will
return to baseline.
■ Assess respiratory status (Table 13-1)
a minimum of every 2–4 hours or
more often as indicated for a
decreasing respiratory rate and
episodes of apnea. Cardiorespiratory
monitor and pulse oximeter
attached with alarms set, if ordered.
Record and report changes promptly
to physician.
■ Administer humidified oxygen via
mask, hood, or tent.
■ Note child’s response to ordered
medications (nebulizer treatments).
■ Position head of bed up or place
child in position of comfort on
parent’s lap, if crying or struggling
in crib or bed.
■ Changes in breathing pattern may The child returns to respiratory
occur quickly as the child’s energy baseline within 48–72 hours.
reserves are depleted. Assessment
and monitoring baseline reveal rate
and quality of air exchange.
Frequent assessment and
monitoring provides objective
evidence of changes in the quality
of respiratory effort, enabling
prompt and effective intervention.
■ Humidified oxygen loosens The child’s respiratory effort eases.
secretions and helps maintain Pulse oximetry reading remains 94%
oxygenation status and ease oxygen saturation during treatment.
respiratory distress.
■ Medications act systemically and The child tolerates therapeutic
locally (on respiratory tissue) to measures with no adverse effects.
improve oxygenation and decrease
inflammation.
■ Position facilitates improved The child rests quietly in position of
aeration and promotes decrease in comfort.
anxiety (especially in toddlers) and
energy expenditure.

2. Risk for Fluid Volume Deficit related to inability to meet body requirements and increased metabolic demand.

NIC Priority Intervention: Fluid NOC Suggested Outcome:

management: Promotion of fluid Hydration: Amount of water in
balance and prevention of intracellular and extracellular
complications resulting from compartments of body.
abnormal or undesired fluid levels.

Child’s immediate fluid deficit is
corrected.
Child will be adequately hydrated,
be able to tolerate oral fluids, and
progress to normal diet.
■ Evaluate need for intravenous fluids.
Maintain IV, if ordered.
■ Maintain strict intake and output
monitoring and evaluate specific
gravity at least every 8 hours.
■ Previous fluid loss may require
immediate replacement.
■ Monitoring proves objective
evidence of fluid loss and ongoing
hydration status.
Child’s hydration status is maintained
during acute phase of illness.
Child takes adequate oral fluids after
24–48 hours to maintain hydration.

(continued)

resolution of all symptoms may take weeks. The same supportive therapies implemented in
the hospital may be needed at home:
Skill 10-15: Performing
Nasal Suctioning ■ Use of the bulb syringe to suction the nares of an infant under 1 year of age
■ Fluid intake to thin respiratory secretions (making them easier to clear) and provide
glucose for energy (since the child’s appetite may not return to normal for several days)
■ Rest
Children are usually capable of recognizing their own activity limits. However, parents
should encourage active toddlers to nap and take rest periods. Teach the parents proper ad-
ministration of medications. Acetaminophen may be prescribed for persistent low-grade
 Alterations in Respiratory Function ■ 451

NURSING CARE PLAN The Child with Bronchiolitis (continued)

GOAL INTERVENTION RATIONALE EXPECTED OUTCOME

2. Risk for Fluid Volume Deficit related to inability to meet body requirements and increased metabolic demand. (continued)

■ Perform daily weight measurement
on the same scale at the same time
of day. Evaluate skin turgor.
■ Assess mucous membranes and
presence of tears. Report changes
promptly to physician.
■ Offer clear fluids and incorporate
parent in care. Offer fluid choice
when tolerated.
■ Further evidence of improvement of
hydration status.
■ Moist mucous membranes and
tears provide observable evidence
of hydration.
■ Choice of fluid offered by parent
gains the child’s cooperation.
Child’s weight stabilizes after 24–48
hours; skin turgor is supple.
Child shows evidence of improved
hydration.
The child accepts beverage of choice
from parent or nursing staff.

3. Anxiety (Child and Parent) related to acute illness, hospitalization, uncertain course of illness and treatment,
and home care needs.

NIC Priority Intervention: Anxiety NOC Suggested Outcome: Anxiety

reduction: Minimizing control: Ability to eliminate or
apprehension, dread, foreboding, or reduce feelings of apprehension and
uneasiness related to an unidentified tension from an unidentifiable source.
source of anticipated danger.

Child and parents will demonstrate
behaviors that indicate decrease in
anxiety.
Parents will verbalize knowledge of
symptoms of bronchiolitis and use of
home care methods before the
child’s discharge from the hospital.
■ Encourage parents to express fears
and ask questions; provide direct
answers and discuss care,
procedures, and condition changes.
■ Incorporate parents in the child’s
care. Encourage parents to bring
familiar objects from home. Ask
about and incorporate in care plan
the home routines for feeding and
sleeping.
■ Explain symptoms, treatment, and
home care of bronchiolitis.
■ Provide written instructions for
follow-up care arrangements as
needed.
■ Provides opportunity to vent
feelings and receive timely, relevant
information. Helps reduce parents’
anxiety and increase trust in nursing
staff.
■ Familiar people, routines, and
objects decrease the child’s anxiety
and increase parents’ sense of
control over unexpected, uncertain
situation.
■ Anticipate potential for recurrence.
Assist family to be prepared should
respiratory symptoms recur after
discharge.
■ Written and oral instructions
reinforce knowledge. Parents may
not “hear” and remember the
particulars of home care if
presented only orally.
Parents and child show decreasing
anxiety and decreasing fear as
symptoms improve and as child and
parents feel more secure in hospital
environment.
Parent freely asks questions and
participates in the child’s care. The
child cries less and allows staff to hold
and/or touch him or her.
Parent accurately describes respiratory
symptoms and initial home care
actions.

fevers and general discomfort. Advise parents that RSV infection can recur; therefore, they
need to know how to recognize symptoms and when to call the physician.

Evaluation
Expected outcomes of nursing care are provided on the accompanying nursing care plan.

PNEUMONIA
Pneumonia is an inflammation or infection of the bronchioles and alveolar spaces of the
lungs. It occurs most often in infants and young children. Pneumonia in children often