# A 6-month-old infant with bronchiolitis is admitted to the pediatric unit. The infant has a fever of 101.8°F (38.8°C), wheezing, and nasal congestion. Which nursing intervention should be the priority?

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> subject: Adult Health

## 문제

A 6-month-old infant with bronchiolitis is admitted to the pediatric unit. The infant has a fever of 101.8°F (38.8°C), wheezing, and nasal congestion. Which nursing intervention should be the priority?

## 보기

1. Administer acetaminophen for fever reduction
2. Position the child with the affected side down to promote drainage
3. Encourage increased fluid intake to thin secretions **✔ 정답**
4. Provide chest physiotherapy every 2 hours

**정답: 3**

## 해설

Encouraging increased fluid intake is the priority supportive intervention for an infant with bronchiolitis. Fluids help thin thick secretions, promote airway clearance, and prevent dehydration.

## 심화 해설

Understanding the Priority in Bronchiolitis Management

For a 6-month-old infant with bronchiolitis presenting with fever, wheezing, and nasal congestion, the priority nursing intervention is to encourage increased fluid intake to thin secretions. The cornerstone of bronchiolitis management is supportive care, and maintaining hydration is fundamental to this approach. The primary pathophysiological problem in bronchiolitis is not simply lung consolidation, but rather airway obstruction caused by inflammation, edema, and necrotic debris plugging the small airways . Thick, tenacious secretions exacerbate this obstruction, leading to the characteristic wheezing and increased work of breathing.

Increased fluid intake directly supports the body's ability to thin these respiratory secretions, making them easier to mobilize and clear, which in turn reduces airway resistance. Dehydration, a common complication due to fever, tachypnea, and poor feeding from nasal congestion, will thicken secretions further, worsening the infant's respiratory distress. Therefore, ensuring adequate hydration through frequent breastfeeding or bottle-feeding is a critical, evidence-based supportive measure that addresses the core issue of secretion clearance .

Let's examine why the other interventions are not the immediate priority in this scenario.

Analysis of Other Options

1.  Administer acetaminophen for fever reduction: While managing a fever of 101.8°F (38.8°C) is a comfort measure, it does not address the primary pathophysiological process of airway obstruction from secretions. Fever is a physiological response to the viral infection, and its reduction is secondary to ensuring airway patency and effective ventilation. The infant's respiratory status takes precedence.

2.  Position the child with the affected side down to promote drainage: This positioning strategy, known as postural drainage, is typically used for lobar consolidations, such as in pneumonia, to use gravity to drain a specific lung segment. Bronchiolitis is a diffuse, bilateral disease affecting the bronchioles throughout the lungs, not a localized area. Therefore, positioning for segmental drainage is not a physiologically appropriate intervention for this condition.

4.  Provide chest physiotherapy every 2 hours: The evidence does not support the routine use of chest physiotherapy (CPT) in infants with bronchiolitis. Guideline recommendations explicitly advise against this practice for infants who do not have pre-existing neuromuscular disease or a severe requirement for invasive ventilation . CPT, which includes percussion and vibration, has not been shown to improve clinical outcomes, reduce length of stay, or shorten the duration of symptoms in typical bronchiolitis cases and may cause unnecessary distress and discomfort to the infant [1,2].

Connecting Pathophysiology to Clinical Practice

The management of bronchiolitis is largely supportive, focusing on the natural progression of the viral illness. The evidence highlights a critical principle of minimal handling and avoiding low-value interventions. For instance, continuous pulse oximetry is often overused in stabilized infants, leading to unnecessary alarms and interventions without improving outcomes . Similarly, the focus should be on essential care: maintaining hydration and ensuring a patent airway through gentle nasal suctioning. The nurse's role is to assess the infant's respiratory status, monitor hydration by tracking wet diapers and mucous membranes, and support feeding. By prioritizing increased fluid intake, you are directly intervening in the pathophysiological cycle of secretion retention and airway obstruction, which is the most impactful nursing action for this infant [1,2].

## 임상 시나리오

Bronchiolitis: Hydration PrioritySupportive care for airway clearance
The primary problem in bronchiolitis is airway obstruction from inflammation, edema, and thick secretions plugging small airways. Maintaining hydration is the cornerstone of care to thin these secretions and reduce respiratory distress.

Infants are at high risk for dehydration due to fever, tachypnea, and poor feeding from nasal congestion. Dehydration thickens secretions, worsening the obstruction. Encourage frequent breastfeeding or bottle-feeding.

CautionChest physiotherapy is not recommended for bronchiolitis. It does not improve outcomes and can increase infant distress. Focus on supportive measures like hydration and gentle nasal suctioning.

## 핵심 개념

- **Bronchiolitis** — A common lower respiratory tract infection in infants, causing inflammation and congestion in the bronchioles, leading to airway obstruction.
- **Airway Obstruction** — In bronchiolitis, this is caused by edema, mucus, and cellular debris plugging the small airways, not just bronchospasm.
- **Supportive Care** — The mainstay of bronchiolitis treatment, focusing on hydration, oxygenation, and suctioning, rather than medications.
- **Secretions** — Thick mucus produced during infection that can worsen airway blockage; thinning them with hydration is a key nursing goal.

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