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Bronchiolitis: treatment and management in an urgent out of hours care setting

02 June 2020
Volume 31 · Issue 6


Justine Dexter and Gerri Mortimore explore ways to manage the common lung infection bronchiolitis in small children

Bronchiolitis is an acute inflammation of the bronchioles that predominately affects children but is most common in the first 12 months of life. Viral bronchiolitis is the principal cause of admission in England and Wales, with numbers exceeding 30 000 annually. Occurrence is seasonal, in winter months incidence is typically at epidemic proportions for approximately six weeks. Bronchiolitis presents initially with coryza and a persistent cough; as the infection progresses, tachypnoea, chest recession, or both, may be present alongside wheeze or crackles. The assessment of an unwell child is challenging and as an advanced nurse practitioner, working in an out of hours service, the importance to prevent further deterioration should focus on spotting the sick child at an early stage. Therefore, an initial assessment should be undertaken, prior to taking a history and examination, to ensure patient safety. Bronchiolitis is usually a self-limiting illness, that requires supportive management only with treatment directed at fluid input. However, management approaches to bronchiolitis continue to be a subject of substantial debate with vast differences in practice exhibited in the UK, and beyond. with a lack of consensus regarding management. Therefore, the appropriate management of children presenting with bronchiolitis is challenging and can be overwhelming. Nurses must be aware of the pathophysiology, presentation, diagnosis, and management of children presenting to an out of hours service with bronchiolitis, to manage patients safely.

This article will focus on the assessment and management of bronchiolitis and critically reflect on the practice of an advanced nurse practitioner (ANP), working in an urgent care out of hours (UCOOH) service. The pathophysiology and epidemiology of bronchiolitis will be briefly outlined, and the process of assessment, diagnosis and management of this condition will be critiqued, based on the existing evidence. Dilemmas associated with differing treatments will also be discussed and recommendations provided for the development of future practice.

Bronchiolitis is an acute inflammation of the bronchioles that predominately affects children under the age of two years, but most common in the first 12 months of life. Respiratory syncytial virus remains (RSV) the most frequent cause (National Institute for Health and Care Excellence [NICE], 2015). Epithelial cells within the bronchial tree become infected: mucus and slough from cell death, partially or completely obstruct the small airways resulting in diminished gas exchange, breathlessness, and hypoxia (DeVincenzo, 2007).

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