Respiratory Syncytial Virus (RSV)
Bronchiolitis
UNFOLDING Reasoning
Landon Brown, 9 months old
Primary Concept
Gas Exchange
Interrelated Concepts (In order of emphasis)
1. Infection
2. Thermoregulation
3. Stress
4. Clinical Judgment
5. Patient Education
6. Communication
7. Collaboration
UNFOLDING Reasoning: STUDENT
© 2016 Keith Rischer/www.KeithRN.com
, Respiratory Syncytial Virus (RSV) Bronchiolitis History
of Present Problem:
Landon Brown is a 9 month old male infant who presents with his mother, Ann to the after hours pediatric clinic. Ann
reports that Landon has had a runny nose for several days, but it has worsened today. He has not had any fever, although
he has “felt warm.” He has had trouble clearing his nose of mucous and Ann does not like suctioning his nose so she does
it only when it is excessive. She has been giving Landon acetaminophen and ibuprofen for the subjective fever.
Personal/Social History:
Landon was a full-term infant, born at 38 weeks. His birth weight was 6 lbs 2 oz (2.78 kg), and length was 19 inches
(47.5 cm). He was delivered vaginally, transitioned in the hospital and discharged at 24 hours of age. He has been a
“healthy baby” per Ann. She does, however, report 3 ear infections with the first one occurring when Landon was 4
months of age. He has frequent runny nose. He is up to date on immunizations. Weight today: 18.0 lbs (8.16 kg)
Ann is a single mother of 3 children, aged 9 months (Landon), 4 years (female), and 6 years (female). Ann smokes 1
ppd. The family is on Supplemental Nutrition Assistance Program (SNAP) and Housing and Urban Development (HUD)
assistance. Landon is on Women, Infants, and Children (WIC).
What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
9m Baby’s age can be helpful in deciding treatment course, and
Runny nose several days help in diagnosis
No fever, felt warm Runny nose can be indicative of how long issues have been
Trouble clearing nose going on
Mom doesn’t like to suction No fever but feeling warm could be low grade fever or possibly
Taking acetaminophen and education for mom on how to take temp and what temp is
ibuprofen Congested will show in assessment and lends to diagnosis
Mom not liking to suction is a point for education
Medication used to manage, can be education and assess
dosing
RELEVANT Data from Social History: Clinical Significance:
Full term, 38w, vaginal birth Premature and late term babies can be more prone to issues so
6lb 2oz(2.78kgs), 19in it’s helpful to know birth status
3 ear infections Birth weight important for assessment
Frequent runny nose Recurrent ear infections can weaken immune system and
UTD vaccines indicate further issues
Mother smokes 1 ppd Frequent runny nose could be allergies, important to know for
SNAP, HUD, WIC proper diagnosing and treatment
UTD vaccines helps to eliminate those diseases
Smoking in house can exacerbate respiratory issues and ear
infections
Household situation is important to help identify food
insecurity or issues preventing care and treatment
Patient Care Begins:
Current VS: FLACC Scale (0-3 is considered comfortable):
T: 101.2 F/38.4 C (rectal) Faces: 1 Occasional grimace or frown, withdrawn, disinterested
P: 130 (regular) Legs: 0 Normal position or relaxed
R: 66 (regular) Activity: 0 Lying quietly, normal position, moves easily
BP: 105/72 Cry: 1 Moans or whimpers; occasional complaint
O2 sat: 94% room air Consolability: 1 Reassured by occasional touching, hugging, or being talked to;
distractible
© 2016 Keith Rischer/www.KeithRN.com
Bronchiolitis
UNFOLDING Reasoning
Landon Brown, 9 months old
Primary Concept
Gas Exchange
Interrelated Concepts (In order of emphasis)
1. Infection
2. Thermoregulation
3. Stress
4. Clinical Judgment
5. Patient Education
6. Communication
7. Collaboration
UNFOLDING Reasoning: STUDENT
© 2016 Keith Rischer/www.KeithRN.com
, Respiratory Syncytial Virus (RSV) Bronchiolitis History
of Present Problem:
Landon Brown is a 9 month old male infant who presents with his mother, Ann to the after hours pediatric clinic. Ann
reports that Landon has had a runny nose for several days, but it has worsened today. He has not had any fever, although
he has “felt warm.” He has had trouble clearing his nose of mucous and Ann does not like suctioning his nose so she does
it only when it is excessive. She has been giving Landon acetaminophen and ibuprofen for the subjective fever.
Personal/Social History:
Landon was a full-term infant, born at 38 weeks. His birth weight was 6 lbs 2 oz (2.78 kg), and length was 19 inches
(47.5 cm). He was delivered vaginally, transitioned in the hospital and discharged at 24 hours of age. He has been a
“healthy baby” per Ann. She does, however, report 3 ear infections with the first one occurring when Landon was 4
months of age. He has frequent runny nose. He is up to date on immunizations. Weight today: 18.0 lbs (8.16 kg)
Ann is a single mother of 3 children, aged 9 months (Landon), 4 years (female), and 6 years (female). Ann smokes 1
ppd. The family is on Supplemental Nutrition Assistance Program (SNAP) and Housing and Urban Development (HUD)
assistance. Landon is on Women, Infants, and Children (WIC).
What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
9m Baby’s age can be helpful in deciding treatment course, and
Runny nose several days help in diagnosis
No fever, felt warm Runny nose can be indicative of how long issues have been
Trouble clearing nose going on
Mom doesn’t like to suction No fever but feeling warm could be low grade fever or possibly
Taking acetaminophen and education for mom on how to take temp and what temp is
ibuprofen Congested will show in assessment and lends to diagnosis
Mom not liking to suction is a point for education
Medication used to manage, can be education and assess
dosing
RELEVANT Data from Social History: Clinical Significance:
Full term, 38w, vaginal birth Premature and late term babies can be more prone to issues so
6lb 2oz(2.78kgs), 19in it’s helpful to know birth status
3 ear infections Birth weight important for assessment
Frequent runny nose Recurrent ear infections can weaken immune system and
UTD vaccines indicate further issues
Mother smokes 1 ppd Frequent runny nose could be allergies, important to know for
SNAP, HUD, WIC proper diagnosing and treatment
UTD vaccines helps to eliminate those diseases
Smoking in house can exacerbate respiratory issues and ear
infections
Household situation is important to help identify food
insecurity or issues preventing care and treatment
Patient Care Begins:
Current VS: FLACC Scale (0-3 is considered comfortable):
T: 101.2 F/38.4 C (rectal) Faces: 1 Occasional grimace or frown, withdrawn, disinterested
P: 130 (regular) Legs: 0 Normal position or relaxed
R: 66 (regular) Activity: 0 Lying quietly, normal position, moves easily
BP: 105/72 Cry: 1 Moans or whimpers; occasional complaint
O2 sat: 94% room air Consolability: 1 Reassured by occasional touching, hugging, or being talked to;
distractible
© 2016 Keith Rischer/www.KeithRN.com
