Introduction 

Respiratory syncytial virus (RSV) is a common respiratory infection virus for the children under the age of 2 years (Hall et al., 2013). This is mainly responsible for the various breathing problems and other respiratory disorder. In this report, a 4-month-old children Jack’s case study is described who was suffering from the rhinorrhea and tachypnea for three days. He had no history of healthiness although he was a preborn baby. Recently he had symptoms of pyrexia. He had a slightly higher heart rate as well. He had the higher breathing rate than the normal range as well.  In this report, the airway condition of the Jack is described as he was breath shortening during breastfeeding. As per Jack’s mother, Jack had a funny breathing sound although he had no issue of a cough.

Assessment procedure 

In this case, Jack mainly has the problem of shortness of breathing as his mother complained that Jack had more short breastfeeds which was quite unusual. Moreover, during breathing there was unusual sound from the lung and his chest was also not so normal. To assess this condition, breathing assessment can be done. In breathing assessment, at first, the history of patient’s health condition and other medical issues should be considered. Along with this, nursing personnel should document the information of respiratory problems of patient. In this case, Jack has the problem of rhinorrhea and as well as rapid breathing. The rate of breathing and other major problem related to the breathing can be recorded. This will help in assessing the severity of the condition. The sound of the breathing should be examined by the nurses as Jack had rhinorrhea for last three days.  The presence of a cough should be assessed and the symptoms of a cough should be collected (Edwards, Kotecha and Kotecha, 2013).  After that, the general history like the birth history, presence of diarrhea, social history, exposure to cigarette smoke, history of fever of the children should be recorded. After that, in order to examine the upper airway, the chest shape should be examined if there was any unusual shape of the chest like the asymmetry of the chest, chest expansion (Gattinoni et al., 2013). The chest should be examined by recording the respiratory rate of patient . By observing the breathing, the proper functioning of the breathing muscle can be checked. After that, the respiratory cycle should be examined to check any obstruction in the breathing pathway (Ferguson et al., 2013). In this section, the presence of tachypnea can be addressed and along with this, the frequency of breathing was also examined. The lung sound should be also examined to observe if there was any unusual sound or not (Edwards, Kotecha and Kotecha, 2013).

Findings from the Assessment

From the assessment, the condition of Jack can be depicted and this will ultimately help the nursing personnel to assess the exact condition of Jack. The primary problems of jack were he had the breath shortness during the breastfeeding session. The origin may be the obstruction in the nasal pathway. During the cough assessment, it was seen that there was no sign of a cough. In the general history assessment period, it was revealed that Jack was a premature baby and recently having a high temperature, tachypnea, and rhinorrhea for last three days as well. Although, he had no symptoms of diarrhea and vomiting in recent times.  During the chest shape examination, Jack’s mother had informed that Jack had an unusual shape of the chest and also he had a higher breathing rate of about 52 breaths per minute. The normal rate is about 20-40 breath per minute for the age group of 3 months to 2 years (Nunn, 2013). During the respiratory cycle observation, it was seen that Jack had tachypnea that is the abnormal condition of rapid breathing. During the lung sounds examination, It was confirmed by Jack’s mother that, during breathing, she had heard some unusual sounds that indicated towards the fact that Jack had been suffering from a moderate respiratory problem and which is mainly caused by the RSV bronchiolitis.

Pathophysiology of Bronchiolitis

RSV bronchiolitis is a virus-borne infant disease. Children with lower immune response are mainly affected by this viral disease. The transmission of this virus is mainly occurred through the inoculation of the nasopharyngeal and along with this direct contact with infected people can also be a path of transmission (Ralston et al., 2014). The virus has a prolonged survival rate and that allows the virus to be in the prolonged incubation period. In the terminal bronchiole region, the replication rate of the bacteria is very high. The incubation period of this virus is almost 2 to 8 days and the immunocompetent individuals can slough the virus for up to 3 weeks. The influx of polymorphonuclear neutrophils in to the air pathway is replaced rapidly by the lymphomononuclear infiltration of peribronchiolar tissues and as well as increase the level of microvascular permeability. This results in the edema and swelling of submucosal cells and as a result, the secretion of mucous is increased. The increased rate of secretion and higher viscosity of mucous is due to the decreasing number of ciliated epithelium. The exponential rate of virus replication in the bronchioles results in airway obstruction and causes moderate respiratory distress (Piedimonte and Perez, 2014.). The premature born of Jack may promote the chances of infection in Jack as prematurity is a causative factor RSV infection.  The innate immunity of the child provides the first line of defense against this infection. However this, the response is not enough for the complete protection of this disease. The cytotoxic T lymphocytes play a major role in fighting against this infection. The mucosal inflammation is the main cause of rhinorrhea and tachypnea (Openshaw and Chiu, 2013).

Conclusion

Lastly, it can be concluded that the airway obstruction and breathing shortness is observed due to the infection of RSV and it attacks mainly the infants because the children have comparatively lower immunity. As Jack was a premature child, he had the more chances to be infected by this virus. In this report, the pathophysiology of the viral disease is highlighted along with the infection assessment of this disease.

References

Edwards, M.O., Kotecha, S.J. and Kotecha, S., 2013. Respiratory distress of the term newborn infant. Paediatric respiratory reviews, 14(1), pp.29-37.

Ferguson, N.D., Cook, D.J., Guyatt, G.H., Mehta, S., Hand, L., Austin, P., Zhou, Q., Matte, A., Walter, S.D., Lamontagne, F. and Granton, J.T., 2013. High-frequency oscillation in early acute respiratory distress syndrome. New England Journal of Medicine, 368(9), pp.795-805.

Gattinoni, L., Taccone, P., Carlesso, E. and Marini, J.J., 2013. Prone position in acute respiratory distress syndrome. Rationale, indications, and limits. American journal of respiratory and critical care medicine, 188(11), pp.1286-1293.

Hall, C.B., Weinberg, G.A., Blumkin, A.K., Edwards, K.M., Staat, M.A., Schultz, A.F., Poehling, K.A., Szilagyi, P.G., Griffin, M.R., Williams, J.V. and Zhu, Y., 2013. Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics, pp.peds-2013.

Nunn, J.F., 2013. Applied respiratory physiology. Butterworth-Heinemann.

Openshaw, P.J. and Chiu, C., 2013. Protective and dysregulated T cell immunity in RSV infection. Current opinion in virology, 3(4), pp.468-474.

Piedimonte, G. and Perez, M.K., 2014. Respiratory syncytial virus infection and bronchiolitis. Pediatrics in review, 35(12), p.519.

Ralston, S.L., Lieberthal, A.S., Meissner, H.C., Alverson, B.K., Baley, J.E., Gadomski, A.M., Johnson, D.W., Light, M.J., Maraqa, N.F., Mendonca, E.A. and Phelan, K.J., 2014. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics, pp.peds-2014.