Al Riyada College for Health Sciences Jamjoom

Center, Jeddah, KSA

Case study OF PATIENT with

bronchiolitis

Student name :Eithar Ahmed

ID:
SUPERVISOR:
 Objective OF THE CASE STUDY

1. Identify Patient Data and medical history

2. Identify Physical Assessment of patient
3. Explain anatomy and Pathophysiology of Acute bronchiolitis
4. Discuss the drugs used in the treatment Pt with bronchiolitis disease.
5. Identify diagnostic studied used to monitor Pt with bronchiolitis disease.
6. Identify the nursing care plan of bronchiolitis disease
BIOGRAPHICAL DATA

Name IBRAHIM AHMED IBRAHIM ALZAHRANI

Name of Hospital): Dr. Erfan & Bagedo General Hospital

MR 10101587 Area .
Gender Male Nationality Saudi
Age 2 months old Marital Status Child/single
DOA (Date of Admission) 8 / 11 / 2023 Medical Diagnosis Bronchiolitis
For further management
Reason for admission

2 month old boy admitted to hospital with chief complaint of difficult breathing with cough
Chief complaints associated with fever before 2 days of admission
Present history • 2 month old boy admitted to hospital with chief
complaint of difficult breathing with cough associated
with fever before 2 days of admission , And physician
discovered that the baby has bronchiolitis with sepsis. In
emergency room assess the Oxygen Saturation was
hypoxia

PAST HISTORY

History of Past Illness Nil

Previous Immunization All vaccines had been given up to date according to EPI schedule from the
Ministry of Health. Last vaccine given since 1 week (Pentavalent, OPV1st dose)
Previous surgery Nil
 Social History

• He lives with his 1 brother parent and grand parent.

• They have extended family support.
• Father is 38 years old and he is a teacher.
• Mother is 30 years old and she is a housewife.
• Monthly income 9000 SAR= financially stable. Both parent
have studied up to the advance levels.
• Baby is not exposure to the cigarette smoke, Home environment
is clean no dust.
• They do not use fire wood for cooking.
Physical Examination
 Physical Assessment (by body system)
Integumentary System : Inspection the skin is intact a with pink color EENT:Head: Symmetrical and in normal contour without c/o
and Temperature is 37.6 c .. no pressure ulcer observed, mucous deformities .
membranes is dry skin turgor is Recoil in <2 seconds Eye are symmetrical, vision is good, brown in color with pinkish
Nails is bright. Clean, Short no deformities. conjunctivas, No edema of the eyelids no ulcer.
Inspection of the hair is Healthy condition short black color No signs of Mouth: pink in color, moist and there were no lesions nor inflammation
infection and infestation or pressure ulcer observed note.
Nose : Nose in the midline . No deviation noted. No discharges or
congestion seen , No tenderness noted.
The ear Ears are clean, and approximately of the same size and shape.
There is no pain or tenderness on the palpation, no ringing in the ears,
no discharges noted.
Cardiovascular system : Patient has an audible heart sound. Heart is Neurological system : Cranial nerves -Baby was alert , conscious and
pumping well with a pulse rate of 99 bpm, femoral and brachial pulses responsive • Make eye contact Turns head to sound
palpable and strong. No palpitations No murmur., BP:128/71 mmhg Muscle tone-Muscle tone of upper and lower limb was normal
Capillay refill is 1sc, Reflexes->The reflexes of upper and lower limbs were present with
normal intensity
Respiratory system The patient on room air oxygenation ,Respiratory Urinary system: The urine Frequency is normal of urination is, he
rate is 56 breath per minute, the infant breathing sounds with little urinate 3 times per day , yellow color no catheterization observed..
cough associated with Chest wheezing observed. .
Digestive system :Abdomen soft/non masses or tender areas on
superficially or deep palpation, bowel sounds audible per auscultation in
all four quadrants ,No vomiting or distention noted .
ABOUT THE DISEASE
 Anatomy & Physiology

• The terminal bronchioles divide into respiratory

bronchioles, which contain alveolar ducts and alveoli
and form the last three to five generations of the
respiratory system.
• Gas exchange occurs in the alveoli via a dense mesh-like
network of capillaries and alveoli called the alveolar-
capillary network.
• The alveolar-capillary unit consists of the respiratory
bronchioles, the alveolar ducts, the alveoli and the
pulmonary capillary bed.
• It is the basic physiological unit of the lung and is
characterized by a large surface area and a blood supply
that comes from the pulmonary arteries
 Bronchi, Bronchioles

◼ Structure of bronchial tree

❑ Bronchi contain cartilage rings
❑ Primary bronchi enter the lungs medially
❑ In lungs, branching→ secondary bronchi
◼ One for each lobe of lung: 3 in right, 2 in left
❑ Tertiary bronchi → → → terminal bronchioles
◼ These smaller airways ..
❑ Have less cartilage, more smooth muscle. In asthma, bronchiolitis, these airways can
close.
❑ Can be bronchodilated by sympathetic nerves, epinephrine, or related medications.
Pathophysiology
Definition of the disease
• Bronchiolitis is an infection of the small airways in
the lungs, called bronchioles, which usually affects
infants and children under two years of age.
• The incidence is higher in premature babies and
children with congenital lung or heart disease.
• In general, bronchiolitis is more common during the
winter months.
RISK FACTORS
• Chronic lung disease
• Congenital heart disease
• Younger than 3 months old
• Prematurity
• Down's syndrome
• Congenital or acquired immune deficiency diseases
• Parental smoking.
• Chronic lung disease, particularly bronchopulmonary dysplasia.
• Environmental and genetic factors do contribute to severity of disease
CAUSES
1. Bronchiolitis is usually caused by a viral infection with respiratory
syncytial virus (RSV). Other less common causes of bronchiolitis
include:
• other viruses such as rhinovirus, adenovirus, human oral virus,
human metapneumovirus
2. Bacteria infection such as Mycoplasma pneumonia.
3. Environmental factors: such as smoke, chemical fumes and air
pollution.
4. Association with other diseases: such as chronic bronchitis or asthma.
Disease process

• Bronchiolitis is an infectious disease. The infections that

cause bronchiolitis are contagious.
• The virus can spread through small liquid droplets from the
nose and mouth of an infected person, which can become
airborne when sneezing, coughing or laughing, and can also
land on objects the person has touched, such as tissues of
paper or used toys.
• The incubation period (time between infection and the
appearance of symptoms) varies from several days to a week,
depending on the infection causing bronchiolitis.
• Most babies with viral bronchiolitis recover completely
within 7 to 12 days.
SIGNS AND SYMPTOMS
1. Runny nose, usually before a cough starts
2. Progress in 3-6 days to rapid respirations, chest retractions,
wheezing
3. Malaise (an overall body discomfort or not feeling well )
4. Body aches and chills
5. A fever of 38.5°C or higher is seen in 50 children with
bronchiolitis.
6. Apnea may be a feature of the presentation, especially in very
small, premature or low birth weight infants.
7. Sore throat
8. Possible dehydration
DIAGNOSTIC STUDIES
Laboratory Test Normal Values Patient value Analysis
WBC 4 _ 10 *10^9 /l 18.88 *10^9 /ul leukocytosis
The patient has infection
RBC 3.5 _5. 6 *10^12 /ul 4.5 *10^12 /ul Normal
Hematocrit 31.0 _45 % 41.0 % Normal
HGB 12.5 _ 15.5 g/dl 13.7 g/dl Normal
Neutrophil 40_60 %
Lymph 20 _40 %
Platelets count 150_450 *10^3/ul 402 *10^3 /ul
PH:. 7,35-7.45 7.372 Normal
PaO2 70 _100 mmhg 40.8 mmhg
Paco2 35 _ 45 mmhg Normal
Hco3 22 _ 26 mE q/L 24 mE q/L Normal
SaO2 92 _ 98 %
Potassium 3.5 _5.1 mmol/L Normal
Chloride 98 _107 mmol/L Normal
Creatinine 0.6 _ 1.1 mg /dL 1.0 mg /dL Normal
DRUG STUDY
Name Classification & Action Indication Adverse Reactions& BASELINE ASSESSMENT
of Drug Contraindication
Generic Treatment of susceptible Adverse Reactions BASELINE ASSESSMENT
Name PHARMACOTHERAPEUTIC: infections due to gram- CNS: Chills, fever, Obtain CBC, renal function
Ceftriaxone Third generation negative aerobic headache, hypertonia, tests.
Brand cephalosporin. organisms, some gram- seizures Question for history of
Name: CLINICAL: Antibiotic. positive organisms, GI: Abdominal allergies, particularly
Rocephin including respiratory cramps, cholestasis cephalosporins, penicillins.
tract, GU tract, skin and RESP: Allergic INTERVENTION/EVALUATION
Dosage, skin structure, bone and pneumonitis, dyspnea • Assess oral cavity for
Route & joint, intra abdominal, SKIN: Allergic whitebpatches on mucous
Frequency: Action: pelvic inflammatory dermatitis, membranes, tongue (thrush).
125 mg IV Chemical Effect: disease (PID), acute ecchymosis, erythema • Monitor daily pattern of
every 12 Binds to bacterial cell exacerbations of chronic Contraindication: bowel activity, stool
hours for 2 membranes, inhibits cell wall bronchitis, meningitis, Hypersensitivity to consistency.
days synthesis. Therapeutic Effect: perioperative cephalosporins, • Monitor I&O, renal function
Bactericidal. prophylaxis, acute infants 1 mo tests for nephrotoxicity,
Indications bacterial otitis media. Precautions: CBC.
Pregnancy, • Be alert for superinfection:
breastfeeding, fever, vomiting, diarrhea
children, PATIENT/FAMILY TEACHING
hypersensitivity to • Discomfort may occur with
penicillins, GI/renal IM injection.
disease • Doses should be evenly
spaced.
• Continue antibiotic therapy
for full length of treatment.
Drug name Classification&action Use/Action/ Adverse Contraindication Nursing implications/
Indication Reactions s Teaching
Generic Indications: Frequent: Pain at Hypersensitivity INTERVENTION/EVALUATI
name: Classification: Treatment of IM injection site, to penicillins, ON
ampicillin susceptible GI disturbances sulbactam Promptly report rash
PHARMACOTHERAPE infections due to (mild diarrhea, Precautions: (although common with
Brand UTIC: Penicillin. streptococci, S. nausea, Pregnancy, ampicillin, may indicate
name: CLINICAL: Antibiotic. pneumoniae, vomiting), oral or breastfeeding, hypersensitivity).
Unasyn Action: staphylococci (non– vaginal Evaluate IV site for phlebitis.
Inhibits cell wall synthesis penicillinase candidiasis. Check IM injection site for
Dosage, in susceptible producing), Occasional: pain, induration.
Route & microorganisms by meningococci, Generalized rash, Monitor I&O, urinalysis, renal
Frequency: binding to PCN binding Listeria, some urticarial, function tests.
protein. Klebsiella, E. coli, phlebitis, Be alert for superinfection:
125 mg IV Therapeutic Effect: H. influenzae, thrombophlebitis fever, vomiting, diarrhea).
every 6 Bactericidal in susceptible Salmonella, (with IV PATIENT/FAMILY
hours for 2 microorganisms . Shigella, including administration), TEACHING
days GI, GU, respiratory headache. • Continue antibiotic for full
infections, Rare: Dizziness, length of treatment. • Space
meningitis, seizures (esp. doses evenly. • More effective if
endocarditis with IV therapy). taken 1 hr before or 2 hrs after
prophylaxis. food/beverages. • • Report rash,
diarrhea, or other new
symptoms.
 PATIENTS MEDICATION LISTS

Generic NAME BRAND NAME DOSAGE FREQUENCY ROUTE DATE discontinued ONGOING

1. 40 mg 1. Once Daily 1. 5/5/2023 1. 2 weeks

2. 15 ml 2. Bid 2. 29/4/2023 2. 1 week
Nursing Care Plan
 References

1. Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses,interventions, & outcomes. St.
Louis, MO: Elsevier.
2. Oymar, K., Skjerven, H. O., & Mikalsen, I. B. (2014). Acute bronchiolitis in infants, a review.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 22(1).
https://doi.org/10.1186/1757-7241-22-23
3. Wylie, S. L., Langlois, D. K., Carey, S. A., Nelson, N. C., & Williams, K. J. (2019). Constrictive
bronchiolitis obliterans in a dog. Journal of the American Animal Hospital Association, 55(2).
https://doi.org/10.5326/jaaha-ms-6821
4. Øymar, K., Skjerven, H. O., & Mikalsen, I. B. (2014b). Acute bronchiolitis in infants, a review.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 22(1).
https://doi.org/10.1186/1757-7241-22-23
Any questions