Pediatric Simulation RSV Bronchiolitis
1. Compare the s/s of an upper respiratory tract infection with those of a lower respiratory tract infection.
Upper Respiratory: aka Common Cold (viral ), Bronchitis; stuffy/runny nose, nasal discharge thin & watery thick & discolored, hoarse/sore throat, cough produces very little sputum, fever, sneezing, fatigue, watery eyes, appetite loss; lasts < 10 days
Lower Respiratory: aka Bronchiolitis, Pneumonia, Laryngotracheobronchitis (Croup); ↑ work of breathing especially AW restlessness & anxiety; cough, tachypnea, grunting, chest retractions, irritability, wheezing, rales/crackles, chest/abdominal pain
2. Identify risk factors AW development of respiratory syncytial virus (RSV) bronchiolitis.
• < 2 y/o (more severe if < 6 mos)
• Multiple births
• Birth during April to September
• Hx of chronic lung disease (bronchopulmonary disease)
• Cyanotic or complicated congenital heart disease
• Exposure to passive tobacco smoke
• Crowded living conditions
• Day care attendance
• School-age siblings
• Low SES
• Lack of breastfeeding
3. Discuss the pathophysiology of RSV-bronchiolitis.
Highly contagious virus; may be contracted through direct contact with respiratory secretions or from particles on objects contaminated with virus. Invades nasopharynx where it replicates & spreads down to lower airway via aspiration of upper airway secretions. Causes necrosis of respiratory epithelium of small airways, peribronchiolar mononuclear infiltration & plugging of the lumens with mucus and exudate. The small airways become variably obstructed; this allows adequate inspiratory volume but prevents full expiration. This leads to hyperinflation & atelectasis. Serious alterations in gas exchange occur with arterial hypoxemia & CO2 retention resulting from mismatching of pulmonary ventilation (gas exchange w/in lungs) and perfusion. Hypoventilation occurs secondary to markedly increased...