Bronchiolitis

Bronchiolitis is an acute viral lower respiratory tract infection that primarily affects children 1–24 months of age. A typical illness starts with rhinorrhoea and congestion, then progresses to cough, tachypnoea, wheeze or crackles, and increased work of breathing. Picture a six-month-old on day 4 of a cold: the infant is breathing quickly with subcostal recession, pauses frequently during a feed and is taking 40% of the usual amount. The immediate nursing problem is not identifying the virus. It is deciding whether the infant can maintain oxygenation, hydration and respiratory effort without support. The mechanism explains the priorities. Oedema, injured bronchiolar epithelium and thick mucus narrow already-small airways. Nasal obstruction adds resistance during feeding, while rapid breathing makes coordinated sucking, swallowing and breathing difficult. Supportive care, a calm environment, appropriate oxygen, selective nasal clearance and early escalation address those predictable consequences. An RPN assesses and intervenes within provincial regulation, employer policy and the assigned plan of care. In a deteriorating infant, promptly involve the RN, NP, physician and respiratory therapist according to the local escalation pathway.