Begins with cold-like symptoms (runny nose, cough, low-grade fever) that progress to wheezing and respiratory distress.
Before you read
Test yourself first: 2 questions
Question 1 of 2
A nurse is caring for a 6-month-old with bronchiolitis. Which intervention is most appropriate to support oxygenation and comfort?
Answer: B. Elevating the head of the bed and frequent nasal suctioning of secretions improve airway patency and ease the work of breathing in an infant with bronchiolitis. Clustering care also conserves energy.
Question 2 of 2
A 6-month-old infant is admitted with bronchiolitis caused by respiratory syncytial virus (RSV). Which assessment finding should the nurse report to the provider as the priority concern?
Answer: C. Nasal flaring and intercostal retractions indicate increased work of breathing and impending respiratory failure, the priority in RSV bronchiolitis. Clear nasal drainage, a low-grade fever, and mild cough are expected, less acute findings.
Keep the streak going with more questions like these, each with a full rationale.
What is bronchiolitis (rsv)?
It is the leading cause of hospitalization in infants under 1 year and is most dangerous in young, premature, or chronically ill babies. RSV is highly contagious and spreads by droplet and direct contact.
Key points to remember
- Begins with cold-like symptoms (runny nose, cough, low-grade fever) that progress to wheezing and respiratory distress.
- Thick copious nasal secretions, tachypnea, retractions, and nasal flaring are common.
- Air trapping causes wheezing, prolonged expiration, and hyperinflated lungs.
- Poor feeding and dehydration occur because nasal congestion and tachypnea interfere with sucking.
- Apnea can be the first or only sign in very young or premature infants.
- Diagnosis is often confirmed with a nasopharyngeal swab for RSV.
Common causes
- RSV virus, fall–winter
- Inflamed bronchioles, mucus plug
Signs & symptoms
- Wheezing, tachypnea, retractions
- Nasal flaring, copious secretions
- Poor feeding, apnea spells
Nursing priorities
- Maintain a patent airway: suction the nose and mouth (bulb or nasopharyngeal) before feeds and as needed.
- Place the infant on contact and droplet precautions in a private room or cohort with other RSV patients.
- Administer humidified oxygen and monitor oxygen saturation continuously.
- Promote hydration with small frequent feeds or IV fluids; monitor intake, output, and weight.
- Elevate the head of the bed and cluster care to allow rest and reduce energy expenditure.
Labs & values
Patient teaching
- Wash hands frequently and keep infants away from sick contacts and cigarette smoke.
- Suction the nose with saline drops and a bulb syringe before feeds to ease breathing and eating.
- High-risk infants may receive monthly palivizumab (or nirsevimab) during RSV season for prevention.
- Return for fast or labored breathing, refusal to feed, fewer wet diapers, or bluish lips.
Red flags: report now
- Apnea, cyanosis, or oxygen saturation that stays low despite oxygen requires immediate escalation.
- Severe retractions, grunting, head bobbing, or rising respiratory rate signal worsening distress and fatigue.
- Signs of dehydration (no wet diapers, sunken fontanelle, poor feeding) need prompt intervention.
- Strict hand hygiene and contact precautions are mandatory to prevent unit outbreaks.
References
Clinical references for this topic
