U Assessment

HISTORY. Ask if any members of the household have had a cold or upper respiratory infection. The infant usually has a history of an upper respiratory infection and runny nose (rhinorrhea) that lasts for several days. Infants may have increasing restlessness or depressed sensorium. Infants often have a moderate fever of approximately 102°F, a decrease in appetite, poor feeding, and gradual development of respiratory distress. A cough usually appears after the first few days of symptoms. Some children wheeze audibly.

PHYSICAL EXAMINATION. The infant or child appears to be in acute respiratory distress with a rapid respiratory rate, air hunger, nasal flaring, hyperexpansion of the lungs, and even intercostal and subcostal retractions with cyanosis. When you auscultate the infant's chest, you will likely hear diffuse rhonchi, fine crackles, and wheezes. The liver and spleen are easily palpable because they are pushed down by the hyperinflated lungs. Signs of life-threatening respiratory distress include listlessness, central cyanosis, tachypnea at a respiratory rate of over 70 breaths a minute, and apnea. Usually, the most critically ill infants have greatly hyper-expanded chests that are silent to air movement upon auscultation. Inspect the infant for a rash and conjunctivitis.

PSYCHOSOCIAL. The parents and child will be apprehensive. Assess the parents' ability to cope with the acute or emergency situation and intervene as appropriate. Note that many children are treated at home rather than in the hospital; your teaching plan may need to consider home rather than hospital management.

Diagnostic Highlights

General Comments: Diagnostic testing involves identifying the causative organism, determining oxygenation status, and ruling out masses as a cause of obstruction.

Test

Normal Result

Abnormality with Condition

Explanation

Pulse oximetry Chest x-ray

Air trapping or hyperexpansion, peribronchial thickening or interstitial pneumonia, segmental consolidation

Low oxygen saturation is present if there is obstruction in the lung passages

Results of inflammation and mucous plugs

Other Tests: Complete blood count; arterial blood gases; differential, bacterial cultures; immunofluorescence analysis of nasal washings to detect RSV

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