Wheezy Winnie — Bronchiolitis & RSV
Infant, wheezing, nasal flaring — suction, humidified O2, no routine antibiotics
Six-week-old Winnie has been congested for three days and now her breathing is fast and noisy. Her mother says she is too tired to finish a bottle.
Winnie is a young infant with respiratory syncytial virus (RSV) causing inflammation and mucus plugging of the small airways. She presents with tachypnea, wheezing, crackles, nasal flaring and retractions after a few days of cold symptoms. Treatment is supportive — nasal suctioning, humidified oxygen, and adequate hydration — because bronchiolitis is viral and antibiotics do not help. The youngest and premature infants are at highest risk for apnea and respiratory failure.
Read Wheezy Winnie's full story →The story arc
The setup
Winnie catches RSV from her older sibling's daycare cold, starting with a runny nose and mild cough.
The turn
Her breathing quickens to 68 breaths per minute, her nostrils flare with each breath, and she wheezes audibly.
The crisis
She struggles to feed, tires after only an ounce, and her oxygen saturation drops to 89% with retractions visible at her ribs.
The save
The nurse suctions her nares before feeds, provides humidified oxygen, offers small frequent feeds or IV fluids, and monitors for apnea, especially since she is young and was born early.
NCLEX study section — Bronchiolitis & RSV
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Pediatrics
Take this chapter into practice questions on the same topic.