Case Study On A Three Year Old With Bronchiolitis

2035 words - 9 pages

Introduction:
This paper will discuss a case study of Liam, a three-month-old boy who is transferred from the General Practitioner (GP) to paediatric ward with bronchiolitis. Initially, Liam’s chief health issues will be identified, following by nursing assessment and diagnoses of the child’s need. Focus will be made on the management of two major health problems: respiratory distress and dehydration, and summary and evaluation of the interventions with evidence of learning. Lastly, a conclusion of author’s self-evaluation will be present.
Identification of specific key issues:
Liam is a previously healthy boy who has experienced rhinorrhoea, intermittent cough, and poor feeding for the past four days. His positive result of nasopharyngeal aspirate for Respiratory Syncytial Virus (RSV) indicates that Liam has acute bronchiolitis which is a viral infection (Glasper & Richardson, 2010). “Bronchiolitis is the commonest reason for admission to hospital in the first 6 months of life. It describes a clinical syndrome of cough tachypnoea, feeding difficulties and inspiratory crackles on chest auscultation” (Fitzgerald, 2011, p.160). Bronchiolitis can cause respiratory distress and desaturation (91% in the room air) to Liam due to airway blockage; therefore the infant appears to have nasal flaring, intercostal and subcostal retractions, and tachypnoea (54 breathes/min) during breathing (Glasper & Richardson, 2010). Tachycardia (152 beats/min) could occur due to hypoxemia and compensatory mechanism for low blood pressure (74/46mmHg) (Fitzgerald, 2011; Glasper & Richardson, 2010). Moreover, Liam has fever and conjunctiva injection which could be a result of infection, as evidenced by high temperature (38.6°C) and bilateral tympanic membranes erythema (Thanathanee & O'Brien, 2011; Youngman, 2010). Furthermore, Liam may have a risk of dehydration as evidenced by sunken anterior fontanel, tacky mucous membranes on lips, and diminished urine output (dry nappies) (Glasper & Richardson, 2010; Harris, Mazza, Turner, & Wilkinson, 2008). Dehydration may occur due to poor feeding, as respiratory distress causes fatigue which reduces Liam’s ability of sucking. (Nagakumar & Doull, 2012). Tachypnoea, coughing and fever also increase water loss (Nagakumar & Doull, 2012). Liam may have a risk of further infection due to his young age (three months old), increased respiratory secretions and hospitalisation (Axton & Fugate 2009). Parental stress and anxiety could be a nursing problem as Liam’s mother may have deficit knowledge of the disease (Pillitteri, 2010).
Description of the assessment of the child’s needs:
There are a number of assessments that need to be carried out after Liam’s admission in the hospital. First of all, Liam’s health history, including past health history, family history, and environmental history, may need to be collected to identify the cause and risk factors of Liam’s illness (Crisp, Taylor, Douglas, & Rebeiro, 2013). Pillitteri (2010) states...

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