Oxygenation/RSV
Immunization for RSV
Generic: Palivizumab Trade name: Synagis
Impaired gas exchange may occur in the following conditions:
-Inadequate muscle or nerve function to move air into the lungs such as cervical spinal cord injury -narrowed air airways (takes place in bronchioles; bronchoconstriction such as asthma -obstruction such as bronchitis or cystic fibrosis -poor gas diffusion (takes place in alveoli) such as pulmonary edema, acute respiratory distress syndrome, pneumonia
Clinical Treatment for RSV
place in isolation, provide humidified O2 to maintain SpO2 greater than 90%, hydration (IV fluids, oral), strict I's & O's, monitor daily weight, nasal suctioning, provide small frequent meals, meds such as solu-medrol, elevate head of bed, observe contact precautions
Gas Exchange
process which oxygen transports to cell, CO2 transports out of cells
Manifestation of RSV
rhinitis (runny nose), cough, low grade fever, audible wheezing or crackles, tachypnea, poor feeding, vomiting, diarrhea, sunken fontanelle, dry mucus membranes; at risk for dehydration
Manifestation in Severe cases
tachypnea (70 breaths or more), grunting, sternal retractions, nasal flaring in infants, irritability, poor fluid intake, distended abdomen (over expanded lungs), can become cyanotic, decrease in mental status *As air flow continues to decrease, breath sounds will diminish (acute respiratory distress)
Side effects of Palivizumab (Synagis)
Rash, erythema, induration, hypersensitivity
What is caused if elimination of CO2 is impaired? 1) Respiratory alkalosis 2) Respiratory Acidosis 3) Metabolic Alkalosis 4) Metabolic acidosis
Respiratory Acidosis
Who is at risk for poor gas exchange?
Smokers, COPD, Pediatrics, infants and older adults greatest risk is infants, young children and older adults
Nursing interventions for RSV
Suction PRN Position HOB Admin O2 per order Adequate IV intake (Strict I&O) Daily Weight Small frequent meals Contact precaution
RSV months of epidemic?
* Annual epidemics from October-March
RSV is normally found in children ages of?
* Found in clients 2 months-24 months *Severe infections are rare in children that 6 weeks old or less due to maternal antibodies *Nearly all children have been infected by 2 years of age
Respiratory Syncytial Viral Infection RSV
*Highly Contagious pathogen *Effects Lower Respiratory Tract primarily
RSV incubation period
*Incubation period of 5-8 days *After incubation creates upper respiratory tract symptoms
Palivizumab (Synagis)
*MoA (monoclonal antibody): neutralizing and fusion-inhibition against RSV, inhibits RSV replication in lab and clinical studies
What does RSV do?
*Virus invades by mucosal cells that line the bronchi and bronchioles, debris from the virus obstructs the bronchioles and causes irritation on the airway *In response to irritation the lining of the airway will swell, and this swelling causes excess mucus production (mucus can cause vomiting, looks like gel blob) *Causes partial airway obstruction and bronchospasms; can't get CO2 out which can lead to hypoxia
RVS precaution 1) Standard 2) Contact 3) airborne 4) Droplet
*Wear gloves, gown, and mask (contact or droplet)
RVS mode of transmission
*is direct contact with respiratory secretions by direct handling of infected individuals or objects contaminated with the virus
411. the nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus (RSV). Which interven- tions should the nurse include in the plan of care? Select all that apply. 1. Place the infant in a private room. 2. Ensure that the infant's head is in a flexed position. 3. Wear a mask at all times when in contact with the infant 4. Place the infant in a tent that delivers warm humidified air. 5. Position the infant on the side, with the head lower than the chest. 6. Ensure that nurses caring for the infant with RSV do not care for other high-risk children.
1, 6 Rationale: RSV is a highly communicable disorder and is not transmitted via the airborne route. The virus usually is transferred by the hands. Use of contact and standard precau- tions during care (wearing gloves and a gown) reduces nosocomial transmission of RSV. Amask is unnecessary. In addition, it is important to ensure that nurses caring for a child with RSV do not care for other high-risk children to prevent the transmis- sion of the infection. An infant with RSV should be isolated in a private room or in a room with another infant with RSV infection. The infant should be positioned with the head and chest at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm. Cool humidified oxygen is delivered to relieve dys- pnea, hypoxemia, and insensible water loss from tachypnea.
Dosage/Route Palivizumab (Synagis)
15mg/kg/month during RVS season (first dose prior to season) RSV season Oct-march 3 doses for patients born at gestation age 32-34 weeks without heart of lung disease Maximum of 5 doses for all other individuals
402. A 10-year-old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child should monitor for which sign, knowing that it indicates a worsening of the condition? 1. Warm,dryskin 2. Decreased wheezing 3. Pulse rate of 90 beats/minute 4. Respirations of 18 breaths/minute
2: Decreased wheezing Rationale: Asthma is a chronic inflammatory disease of the air- ways. Decreased wheezing in a child with asthma may be inter- preted incorrectly as a positive sign when it may actually signal an inability to move air. A "silent chest" is an ominous sign during an asthma episode. With treatment, increased wheezing actually may signal that the child's condition is improving. Warm, dry skin indicates an improvement in the child's condi- tion because the child is normally diaphoretic during exacerba- tion. The normal pulse rate in a 10-year-old is 70 to 110 beats/ minute. The normal respiratory rate in a 10-year-old is 16 to 20 breaths/minute.
410. The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the most appropriate nursing action? 1. Initiate strict enteric precautions. 2. Move the infant to a room with another child with RSV. 3. Leave the infant in the present room because RSV is not contagious. 4. Inform the staff that they must wear a mask, gloves, and a gown when caring for the child.
2: Move the infant to a room with another child with RSV. Rationale: RSV is a highly communicable disorder and is not transmitted via the airborne route. The virus usually is trans- ferred by the hands. Use of contact and standard precautions during care is necessary. Using good hand-washing technique and wearing gloves and gowns are also necessary. Masks are not required. An infant with RSV is isolated in a single room or placed in a room with another child with RSV. Enteric precau- tions are unnecessary.Test-Taking Strategy: Note the strategic words, most appropri- ate. Focus on the subject, the method of transmission of RSV. Remember that the virus is not transmitted via the airborne route and is usually transferred by the hands. An infant with RSV is isolated in a single room or placed in a room with another child with RSV.
Assessment for adequate or inadequate ventilation
Capillary Refill Respiration Rate O2 Sat Skin (appropriate color) Nail Beds (appropriate color) Lips (appropriate color) Look bilateral Lungs (Clear A&P) Sternum is it centered symmetrical Trachea midline
Signs and symptoms of Respiratory Acidosis?
Disorientation Tremors Seizures Coma
Why are Older adults at risk for poor gas exchange?
Due to physiological changes as aging occurs
Why are Infants and young children at risk for poor gas exchange?
Less alveolar surface area, narrowing branching peripheral airway that is easily obstructed by mucus, edema, or foreign objects
What happens when delivery of O2 is impaired?
Tissue becomes ischemic
What are you assessing for in RSV
audible wheezing, crackles, hypoxemia, pulmonary edema, and apnea