A 9-month-old infant is admitted to the pediatric unit with … | 마이메르시 MyMerci
Infectious Diseases
문제

A 9-month-old infant is admitted to the pediatric unit with a diagnosis of RSV bronchiolitis. The infant is experiencing moderate respiratory distress with nasal flaring, subcostal retractions, and oxygen saturation of 85% on room air. Which nursing intervention should be the priority?

해설
The priority intervention is providing supplemental oxygen to maintain saturation above 90% for adequate oxygenation. Bronchodilators are often ineffective, and supine positioning or oral feeding can worsen respiratory distress.

심화 해설

Core Nursing Explanation Key Concept Analysis: This question assesses the ability to prioritize nursing interventions for an infant with Respiratory Syncytial Virus (RSV) bronchiolitis in moderate respiratory distress. The core principle is the ABC (Airway, Breathing, Circulation) priority framework. The infant's clinical signs (nasal flaring, subcostal retractions) and low oxygen saturation (85%) indicate Key Point! hypoxemia, which is an immediate threat to life and must be addressed first.

Answer Rationale: The correct answer is to provide supplemental oxygen. In pediatric nursing, maintaining adequate oxygenation is the top priority. The goal is to keep oxygen saturation (SpO2) above 90-92% to prevent tissue hypoxia and further respiratory compromise. This directly addresses the most critical problem identified in the assessment.

Distractor Analysis:
Watch out for confusion! Option ①: While bronchodilators are sometimes tried, they are often ineffective in typical RSV bronchiolitis because the primary pathology is inflammation and mucus plugging in the small airways (bronchioles), not bronchospasm. This is not the first-line or priority intervention.
Option ②: Encouraging oral feeding in a distressed infant can lead to aspiration and increased work of breathing. Nutrition is important but secondary to oxygenation. IV fluids may be needed if the infant cannot feed safely.
Option ③: Placing an infant with respiratory distress in a supine position can worsen breathing effort. The preferred position is with the head of the bed elevated or in an infant seat to maximize lung expansion.

Related Concepts: RSV is the most common cause of bronchiolitis. Management is primarily supportive: oxygen therapy, hydration, and suctioning. Severe cases may require non-invasive ventilation (e.g., High-Flow Nasal Cannula (HFNC)) or intubation.
Concept Summary
ConceptKey Points
RSV BronchiolitisViral lower respiratory infection in infants. Causes inflammation, edema, and mucus in bronchioles.
Signs of Respiratory DistressTachypnea, nasal flaring, grunting, retractions (subcostal, intercostal), hypoxemia.
Nursing Priority (ABCs)Airway and Breathing first. Oxygen therapy is critical for hypoxemia.
Supportive CareOxygen, suctioning, hydration (IV if needed), fever management.

Side-by-Side Comparison!
InterventionRationale for RSV BronchiolitisCommon Misconception
Supplemental OxygenKey Point! First-line treatment for hypoxemia (SpO2

임상 시나리오

Nursing Clinical Practice Guide Clinical Scenario: You are the nurse in a pediatric emergency department. A frantic mother brings in her 9-month-old, Liam, who has had a runny nose and cough for 3 days but today is breathing fast, making grunting noises, and his lips look pale. Your rapid assessment confirms nasal flaring, subcostal retractions, and SpO2 of 85% on room air.

Nursing Intervention Strategy:
1. Immediate Action (Assessment & Intervention): Apply supplemental oxygen via nasal cannula or blow-by O2 to achieve SpO2 >90%. Attach a cardiorespiratory monitor. Perform a focused respiratory assessment (rate, effort, breath sounds).
2. Facilitate Medical Management: Notify the provider. Prepare for possible orders: bulb or nasal suctioning to clear secretions, IV access for fluids, and possibly a trial of nebulized hypertonic saline (not a bronchodilator).
3. Ongoing Care & Monitoring: Maintain the infant in an upright or semi-Fowler's position. Monitor vital signs and SpO2 continuously. Provide NPO (Nothing by mouth) or minimal, frequent feeds if not in severe distress, with close monitoring for aspiration. Cluster care to allow rest.
4. Family Education & Support: Explain RSV to the parents in simple terms. Teach them signs of worsening distress (stopping breathing, turning blue). Emphasize the importance of hand hygiene and isolating the infant from other young children.

Patient Safety and Precautions:
* Airway Safety: Never leave a distressed infant unattended. Suction gently to avoid mucosal trauma.
* Infection Control: RSV is highly contagious. Use contact and droplet precautions (gown, gloves, mask). Isolate the infant in a private room if possible.
* Medication Caution: If a bronchodilator is prescribed, monitor for tachycardia and agitation, which are common side effects.
Nursing Procedure & Medication Flow Oxygen Administration in Infants:
1. Choose appropriate device: Nasal cannula for low flow, oxygen hood or high-flow nasal cannula for higher needs.
2. Start at a low flow (e.g., 0.5-2 L/min for cannula) and titrate to achieve target SpO2 (>90%).
3. Secure tubing to avoid pressure on skin. Humidify oxygen to prevent drying of mucous membranes.
4. Monitor for oxygen toxicity with prolonged high concentrations (>FiO2 0.6).

Suctioning Procedure: Use a bulb syringe or a suction catheter. Limit suctioning to

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