A 6-month-old infant is admitted to the pediatric unit with bronchiolitis caused by respiratory syncytial virus (RSV). The infant has increased work of breathing, nasal flaring, and subcostal retractions. Which nursing intervention should be the priority?

Priority Nursing Intervention: For an infant with RSV bronchiolitis exhibiting increased work of breathing, nasal flaring, and subcostal retractions, the immediate priority is to optimize the airway and breathing. This is achieved by positioning the infant in a semi-Fowler's position and continuously monitoring oxygen saturation.

Rationale for Positioning: Elevating the head of the bed to 30-45 degrees lowers the diaphragm, reduces pressure from abdominal contents on the thoracic cavity, and improves lung expansion. This non-invasive intervention directly addresses the mechanical component of respiratory distress caused by airway inflammation, edema, and mucus plugging.

Key Assessment Findings:

• Nasal flaring: A compensatory mechanism to decrease upper airway resistance.
• Subcostal retractions: Indicate the use of accessory muscles to overcome increased lower airway resistance.
• Oxygen saturation: Continuous pulse oximetry is essential to detect hypoxemia and guide the need for supplemental oxygen.

Interventions to Avoid or Defer:

• Bronchodilators: Not routinely recommended as the primary pathology is not bronchospasm but inflammation and debris. A trial may be considered only if a strong atopic history suggests a reactive airway component, but it is not the priority.
• Chest Physiotherapy (CPT): Contraindicated in acute bronchiolitis. It does not improve clinical outcomes and can increase infant distress and oxygen consumption.
• Oral Fluids: Should be withheld if the respiratory rate is significantly elevated (e.g., >60-70 breaths/min) due to the high risk of aspiration. Hydration should be maintained via intravenous or nasogastric route as ordered.

Supportive Care Cornerstones: The mainstay of treatment remains supportive, including ensuring adequate oxygenation, maintaining hydration through appropriate routes, and providing nasal suctioning to clear secretions before feeding and sleeping.