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·An overview of how the two AoL’s may be affected

·How you would assess Bree in relation to the two identified AoL’s

·How you would you treat Bree’ssymptoms for each AoL

Bronchiolitis and its Symptoms

Bronchiolitis is a type of lung infection which causes congestion and inflammation in the bronchioles (small airways) of the lungs. The causative agent of bronchiolitis is virus which is popularly known as respiratory syncytial virus (RSV) or pneumovirus. The main target group of this inflammatory viral infection is young children and infants. The initial symptoms of bronchiolitis might be confused with common cold as both of them share common symptoms like running nose, sneezing, coughing and mild rise in body temperature. However, in case of bronchiolitis, the conditions become serious after few days with the appearance of symptoms like distinguishing coughing bouts. Moreover, paediatric bronchiolitis is also characterised by high body temperature which leads to the generation of several complications like seizures, haemorrhage or skin turning blue that might cause permanent brain damage.

The following essay is based on the case study of 18-month old girl child, Bree and will highlight the activities of living (AoL) in relation to high body temperature and breathing. The essay will also frame nursing care plan of the child that will promote fast recovery along with well-being.

Bronchiolitis among the paediatric patients is associated with high body temperature. The rise in body temperature leads to fever (Ralston et al., 2014). As per the case study, Bree, 18-month old girl child was admitted to the paediatric ward with bronchiolitis and was expressing symptoms like shortness of breath, expiratory wheeze, cough, runny nose with oozing clear mucous and body temperature of 38.2 degree Celsius.  By analysing these prevailing symptoms it can be said that her body temperature is few notch higher than normal body temperature. According to Sloane et al. (2014), body temperature above 38 degree Celsius is risk for infants and the condition is commonly known as Pyrexia. Pyrexia is associated with complications like lethargy, dehydration and hyperalgesia. Lathergy dehydration was hamper the health and well-being of the child and thus high body temperature must be controlled on highest priority.

Breathing is an important activity of life which is crucial for sustaining. In bronchiolitis coughing is frequently associated with vomiting, breathless and chocking due to presence of mucus in the pulmonary airways. During cough associated with expiratory wheeze and mucus, Bree’s pulmonary pathway might get obstructed resulting in breathing blockage at the end of each coughing bout. This sudden cessation of breathing might turn the child red or blue within very short span to time (Mecklin et al., 2014). If these conditions continue for few days or week, it might lead to nausea, tiredness, sleep disturbances and laboured breathing. All these in turn affect the quality of life of the infant.

Assessment of Bree's Breathing and Body Temperature

Body temperature is the ratio of total heat generated in the body and total heat loss. Among the paediatric population, the primary symptom of bacterial and viral infection is increase in body temperature which in turn is transformed into fever (Houdas, & Ring, 2013). Normal body temperature of infant ranges in between 36.5 to 37.5 degree Celsius. The body temperature is lowest during early hours in the morning which gradually increase and reaches peak during late hours of afternoon or evening. Increase in body temperature from the normal permissible limit increases discomfort among children (Houdas, & Ring, 2013). According to the case study, Bree’s body temperature at the time of admission is 38.2 degree Celsius. Under the action of inflammation, the hypothalamic point is raised and this causes vasoconstriction and shutting of blood flow. Such mechanism causes decrease in body temperature partially due to lack of blood flow along with shivering (Houdas, & Ring, 2013). Drop in body temperature will be associated with profuse sweating. This sweating might in make Bree feel dehydrated. Common symptoms of dehydration among paediatric population include dry mouth, lack of adequate urine or discharge of pale or yellow urine and drowsiness. As Bree is only 18 months old, she is unable to express her concerns and discomfort and thus proper fluid balance chart (input and output of fluid) is important to document any signs of dehydration.  It is the duty of the nursing professional to comprehend and understand the problems and discomfort of Bree and this will help to frame for assessment and care plan for Bree which is focused, competent and safe. Nursing professional or the care giver must also note vital signs of Bree in a periodic manner in order to highlight any signs of abnormality. At present, Bree has symptoms like expiratory wheeze, runny nose with oozing clear mucous. Thus isolation in a single room will be best suited for Bree. Single room isolation will help to prevent the spread of infection (Bekhof et al., 2013). Since Bree is a new born child, liquid antibiotic will be suitable for her in order to reduce the infection and body temperature but administration of medication can only be done under the medication orders prescribed by the doctors. However, Hasegawa et al. (2013) are of the opinion that antibiotics are not recommended for bronchiolitis as it is a viral disease unless and until it is corss-infected with pneumonia bacteria. The direct care givers of Bree like her parents are also required to adequate precautions like maintenance of proper hand hygiene and covering of nose in order spread the chances of cross infection as bronchiolitis is a communicable disease. In order to give her supreme comfort, it is best to dress her in light cotton garments and her diet plan must include clear fluid intake through mouth. Excessive dehydration indicates increased severity of the disease leading to difficulty in swallowing and thus might require intra venous administration of fluid (Ralston et al., 2014).

Treatment and Management of Bree's Bronchiolitis


Normal breathing is regular, effortless and involuntary process and the rate of breathing of child is higher than normal adults (O’Brien et al., 2018). In order to access breathing of Bree, the care giver is required to count the number of times Bree is inhaling and exhaling during the tenure of 1 minute. The normal breathing rate of a child is 22 to 28 breaths per minute. Since Bree has cough and runny nose, her breathing will be laboured. Further accumulation of cough as evident from expiratory wheeze might cause cessation of breathing. The effect of laboured breathing or coughing over Bree must be strictly monitored. The nature of sputum must also be record in order to denote the severity of disease. Proper semi-fowler can be noted in order to provide relief from obstructive breathing.   Suction might also be important in order to clear the mucus of pulmonary airways. Immediate actions are required to be undertaken if the obstructions is at larynx or trachea as such lockage may increase fatal treats as a result of asphyxia (O’Brien et al., 2018). External supply of oxygen must be given in case the oxygen saturation drops below 90 (O’Brien et al., 2018). Parents must be educated about the semi-fowler position and steps required to be undertaken to monitor oxygen saturation.


The Nursing Care Plan for Bree (Breathing)

Assess

Plan

Implement

Evaluate

Assessment of the rate of breathing of Bree

Pulse oxy-metry to assess the rate of breathing rate (Ricci et al., 2015)

Installation of pulse oxymetry machine to monitor rate of breathing rate (Ricci et al., 2015)

Results from breathing rate comparison with the normal breathing rate per hour to ascertain abnormal breathing condition

Assessment of the amount of mucus accumulation in the lungs or the pulmonary airways

Monitoring indicators like wheezing breath and oozing of mucus through sneezing and coughing (Ricci et al., 2015)

Monitoring signs and discomfort of Bree closely like redness of face or fatigue (Ricci et al., 2015)

Excretion of dilute mucus through nose (runny nose) indicates mucus accumulation

Assessment of oxygen saturation

Use of pulse oxymetry to monitor oxygen saturation and external supply of oxygen when saturation is low (Meissner, 2016)

Installation of pulse oxymetry machine and monitoring oxygen saturation (Meissner, 2016)

Increase in the oxygen saturation as indicated by monitoring machine

Shortness of breath  

Use of nebulizers or semi-fowler’s position to ease shortness breathing

Resting child on semi-fowler’s position and use of nebulizer (Meissner, 2016)

Monitoring child’s comfort while sleep (Meissner, 2016) via ascertaining the total duration of sleep at night

 

Conclusion

The above mentioned case study analysis is based on two AoL including breathing and body temperature. Here 18-month old Bree is suffering from bronchiolitis and main reason for concern is high body temperature and breathlessness. So it will be the duty of the nurse to monitor the body temperature and respiratory rate in order to design the care plan for Bree. Apart from this, dehydration, proper administration of medication and maintenance of sterile condition must be done for the promotion of health and well-being of Bree. In case of paediatric care plan special attention are required to be undertaken as infants are unable to express their concerns or discomfort. In relation to Bree it can be said that she should be given proper comfort like proper sitting position and lying posture, cotton cloths and proper fluid maintenance. Proper education of the parents or direct care givers must be done to continuous support and for the reduction of unwanted apprehension and panic attacks. Clear communication, periodic documentation and monitoring are optimal for promoting patient’s health and well-being.

References

Bekhof, J., Bakker, J., Reimink, R., Wessels, M., Langenhorst, V., Brand, P. L., & Ruijs, G. J. (2013). Co-infections in children hospitalised for bronchiolitis: role of roomsharing. Journal of clinical medicine research, 5(6), 426. doi:  10.4021/jocmr1556w

 Berman, A. J., & Snyder, S. (2013). Kozier & Erb's fundamentals of nursing. Pearson Education UK. Retrieved from: https://dlvqj9fdw01.storage.googleapis.com/MDEzMTcxNDY4Ng==01.pdf

Hasegawa, K., Tsugawa, Y., Brown, D. F., Mansbach, J. M., & Camargo, C. A. (2013). Trends in bronchiolitis hospitalizations in the United States, 2000–2009. Pediatrics, peds-2012. Retrieved from: https://pediatrics.aappublications.org/content/early/2013/05/29/peds.2012-3877.short

Houdas, Y., & Ring, E. F. J. (2013). Human body temperature: its measurement and regulation. Springer Science & Business Media. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=LDcLBgAAQBAJ&oi=fnd&pg=PA1&dq=body+temperature+infant&ots=Fr0D1UD2Xu&sig=us0pNr3AmieeJrr_-td480N25b8#v=onepage&q=body%20temperature%20infant&f=false

Mecklin, M., Hesselmar, B., Qvist, E., Wennergren, G., & Korppi, M. (2014). Diagnosis and treatment of bronchiolitis in F innish and S wedish children's hospitals. Acta Paediatrica, 103(9), 946-950. https://doi.org/10.1111/apa.12671

Meyer, M. P., Hou, D., Ishrar, N. N., Dito, I., & te Pas, A. B. (2015). Initial respiratory support with cold, dry gas versus heated humidified gas and admission temperature of preterm infants. The Journal of pediatrics, 166(2), 245-250. https://doi.org/10.1016/j.jpeds.2014.09.049

O’Brien, S., Wilson, S., Gill, F. J., Cotterell, E., Borland, M. L., Oakley, E., & Dalziel, S. R. (2018). The management of children with bronchiolitis in the Australasian hospital setting: development of a clinical practice guideline. BMC medical research methodology, 18(1), 22. doi:  10.1186/s12874-018-0478-x

Piedra, P. A., & Stark, A. R. (2013). Bronchiolitis in infants and children: Treatment; outcome; and prevention. UpToDate. Retrieved from: https://www.uptodate.com/contents/bronchiolitis-in-infants-and-children-treatment-outcome-and-prevention 

Ralston, S. L., Lieberthal, A. S., Meissner, H. C., Alverson, B. K., Baley, J. E., Gadomski, A. M., ... & Phelan, K. J. (2014). Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics, peds-2014. Retrieved from: https://pediatrics.aappublications.org/content/pediatrics/early/2014/10/21/peds.2014-2742.full.pdf

Sloane, P. D., Kistler, C., Mitchell, C. M., Beeber, A. S., Bertrand, R. M., Edwards, A. S., ... & Zimmerman, S. (2014). Role of body temperature in diagnosing bacterial infection in nursing home residents. Journal of the American Geriatrics Society, 62(1), 135-140. https://doi.org/10.1111/jgs.12596

Walter, E. J., Hanna-Jumma, S., Carraretto, M., & Forni, L. (2016). The pathophysiological basis and consequences of fever. Critical Care, 20(1), 200. doi:  10.1186/s13054-016-1375-5

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