Bronchiolitis & RSV Nursing Care Plan
Infant lower airway infection; suctioning, hydration, oxygen and contact precautions.
Quick answer
A Bronchiolitis & RSV nursing care plan centers on monitor respiratory status closely for signs of increasing work of breathing or fatigue; maintain oxygenation with supplemental oxygen as needed; perform nasal suctioning to relieve obstruction from an infant who cannot clear secretions independently. Priority nursing diagnoses are Ineffective airway clearance, Impaired gas exchange, Deficient fluid volume. The plan below gives assessment cues, measurable goals, 5 intervention sets with rationales, and patient teaching.
Overview
Bronchiolitis is a viral lower respiratory tract infection of infants and young children, most often caused by respiratory syncytial virus (RSV), that inflames and narrows the small bronchioles. Because an infant's airways are already narrow, even modest mucosal swelling and mucus plugging cause disproportionate airflow obstruction, air trapping, and increased work of breathing.
The illness typically starts with upper respiratory symptoms and progresses over 2-3 days to wheezing, tachypnea, and increased respiratory effort, peaking around day 3-5 before gradual improvement over 1-2 weeks. Infants under 2 months, those born prematurely, and those with underlying cardiac or pulmonary disease are at highest risk for severe disease, apnea, and respiratory failure.
There is no specific antiviral treatment for most cases; care is supportive — maintaining oxygenation, hydration, and airway clearance while the illness runs its course. Nursing vigilance for the earliest signs of respiratory fatigue, rather than reflexive bronchodilator or steroid use (which have limited evidence in bronchiolitis), is the core of safe, guideline-based care.
Key numbers to know
Most common cause
RSV, though rhinovirus, parainfluenza, and human metapneumovirus can also cause bronchiolitis.
Peak severity
Typically days 3-5 of illness, so a child who was mild on day 1 may worsen before improving.
Evidence-based care
Supportive care (suctioning, oxygen, hydration) is the mainstay; routine bronchodilators, steroids, and antibiotics are not recommended for uncomplicated cases.
Highest risk group
Infants under 12 weeks, former premature infants, and those with chronic lung or heart disease are most likely to need hospitalization.
Apnea risk
Young infants, especially former preterm infants, can present with apnea before typical respiratory distress appears.
Nursing priorities
- Monitor respiratory status closely for signs of increasing work of breathing or fatigue.
- Maintain oxygenation with supplemental oxygen as needed.
- Perform nasal suctioning to relieve obstruction from an infant who cannot clear secretions independently.
- Support adequate hydration despite feeding difficulty from tachypnea and nasal congestion.
- Use contact and droplet precautions to prevent nosocomial spread.
- Avoid unnecessary interventions (bronchodilators, chest X-rays, antibiotics) that do not change outcomes in typical bronchiolitis.
- Educate caregivers on home monitoring and red flags for return to care.
Nursing assessment
Subjective data
- Caregiver report of difficulty feeding or shorter, more frequent feeds
- Caregiver observation of noisy or fast breathing
- Report of poor sleep due to congestion or coughing
- Caregiver concern about decreased wet diapers
- History of preceding cold symptoms, runny nose, mild fever
Objective data
- Tachypnea, nasal flaring, retractions (subcostal, intercostal, suprasternal)
- Expiratory wheeze and/or crackles on auscultation
- Grunting, head bobbing, or accessory muscle use in more severe cases
- Oxygen saturation trend, particularly with feeding or sleep
- Signs of dehydration: dry mucous membranes, decreased urine output, sunken fontanelle
- Apneic episodes, especially in young or premature infants
- Fatigue pattern: paradoxically, a tiring infant may look calmer with slowing respiratory rate — a warning sign, not improvement
Related factors
- Viral infection of the small airways causing mucosal edema and mucus plugging
- Immature airway caliber and collateral ventilation in infants
- Young age, prematurity, or underlying cardiopulmonary disease increasing severity risk
- Exposure to secondhand smoke or daycare settings increasing transmission
- Inability to coordinate nasal breathing, feeding, and increased respiratory effort simultaneously
Key nursing diagnoses
Goals and expected outcomes
- The infant will maintain oxygen saturation within the ordered parameters.
- The infant will show a respiratory rate and effort appropriate for age without significant retractions.
- The infant will maintain adequate hydration with sufficient wet diapers and stable weight.
- The infant will remain free of apnea or will have episodes promptly recognized and managed.
- The caregiver will demonstrate correct nasal suctioning technique.
- The caregiver will verbalize signs requiring immediate return to care.
Nursing interventions and rationales
1. Monitoring respiratory status
- Assess respiratory rate, effort, and work of breathing frequently, comparing to the infant's baseline and trend rather than a single reading.
- Auscultate breath sounds for wheeze, crackles, and equality of air entry bilaterally.
- Monitor continuous or intermittent pulse oximetry as ordered, especially during feeds and sleep when desaturation is more likely.
- Recognize that a slowing respiratory rate in a previously tachypneic, distressed infant may signal fatigue and impending respiratory failure rather than improvement.
- Watch closely for apnea in infants under 2-3 months or with a history of prematurity.
2. Supporting airway clearance and oxygenation
- Perform gentle nasal suctioning (bulb or wall suction) before feeds and as needed, since infants are obligate nose breathers and congestion directly impairs feeding and breathing.
- Provide supplemental oxygen via nasal cannula or blow-by to maintain saturation goals.
- Position with the head of the bed slightly elevated to ease work of breathing.
- Avoid routine chest physiotherapy and bronchodilator nebulization, which guidelines do not support for typical bronchiolitis, unless a trial is specifically ordered and shows objective benefit.
- Escalate to high-flow nasal cannula or higher level of care for worsening distress, hypoxemia, or fatigue.
3. Maintaining hydration and nutrition
- Offer smaller, more frequent feeds to reduce the respiratory demand of a full feeding while congested and tachypneic.
- Suction the nose before feeding attempts to improve the infant's ability to coordinate suck-swallow-breathe.
- Monitor intake, output, weight, and signs of dehydration closely.
- Consider IV or nasogastric fluids when oral intake is insufficient or respiratory distress prevents safe oral feeding.
4. Preventing transmission
- Implement contact and droplet precautions for suspected or confirmed RSV or other viral bronchiolitis.
- Practice strict hand hygiene before and after each contact, as RSV survives on surfaces and hands for hours.
- Cohort or isolate infected infants per facility policy to prevent nosocomial spread, particularly to other vulnerable infants.
- Educate families on hand hygiene and limiting exposure of the infant to sick contacts at home.
5. Supporting family coping and discharge readiness
- Explain the expected course — worsening before improvement over the first several days — so families are not alarmed or falsely reassured.
- Teach nasal suctioning technique with return demonstration before discharge.
- Review red-flag symptoms requiring urgent reassessment: increased work of breathing, poor feeding, lethargy, apnea, or bluish color.
- Discuss safe sleep and smoke-free environment to reduce risk of future respiratory illness severity.
Patient and family teaching
- Use a bulb syringe or nasal aspirator with saline drops before feeds and sleep to clear congestion.
- Expect symptoms to worsen for the first 3-5 days before gradually improving over 1-2 weeks.
- Offer smaller, more frequent feeds if the baby tires quickly or breathes fast during feeding.
- Keep the infant away from smoke exposure, which worsens airway irritation and recovery.
- Wash hands frequently and limit contact with sick individuals to prevent spreading the virus, especially to other young infants.
- Seek immediate care for bluish lips, pauses in breathing, grunting, significant chest retractions, or refusal to feed.
- Do not give over-the-counter cough and cold medications to infants and young children; they are not effective and can be harmful.
- Return to care if fever persists beyond a few days or if the child seems to be getting worse rather than better after day 5.
How to build this plan
- 1Assess the patient. Collect subjective and objective data through interview, physical assessment, labs and chart review. Complete, accurate data is the foundation of every later step.
- 2Analyze and cluster the data. Group related cues, compare them with normal findings, and identify patterns that point to actual or potential problems.
- 3Formulate nursing diagnoses. Write the problem statement using a recognized diagnostic label plus related factors and evidence (problem related to cause as evidenced by signs).
- 4Set priorities. Rank diagnoses as high, medium or low using ABCs, Maslow's hierarchy and the patient's own stated priorities. Life-threatening problems come first.
- 5Establish goals and outcomes. Write SMART, patient-centered outcomes: specific, measurable, attainable, realistic and time-bound (short-term and long-term).
- 6Select nursing interventions. Choose independent, dependent and collaborative actions that are safe, evidence-based and matched to the outcome.
- 7Provide rationales. State the scientific reason each intervention works. Rationales are what turn a task list into clinical reasoning.
- 8Evaluate the plan. Compare the patient's actual response with the expected outcome: met, partially met or not met — then continue, revise or discontinue.
- 9Document and communicate. Record the plan and the patient's response in the health record so the whole team works from the same information.
Summarized for study use. Always follow your school's or facility's approved care plan format and current clinical policy.
Practice Bronchiolitis & RSV questions
These concepts are tested on the ATI proctored exams below — every set has answers and rationales.
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Common questions
What are the nursing diagnoses for Bronchiolitis & RSV?
Priority nursing diagnoses for Bronchiolitis & RSV: Ineffective airway clearance; Impaired gas exchange; Deficient fluid volume.
What are the nursing interventions for Bronchiolitis & RSV?
Assess respiratory rate, effort, and work of breathing frequently, comparing to the infant's baseline and trend rather than a single reading. Auscultate breath sounds for wheeze, crackles, and equality of air entry bilaterally. Monitor continuous or intermittent pulse oximetry as ordered, especially during feeds and sleep when desaturation is more likely. Recognize that a slowing respiratory rate in a previously tachypneic, distressed infant may signal fatigue and impending respiratory failure rather than improvement. Watch closely for apnea in infants under 2-3 months or with a history of prematurity. Perform gentle nasal suctioning (bulb or wall suction) before feeds and as needed, since infants are obligate nose breathers and congestion directly impairs feeding and breathing.
What are the nursing care goals for Bronchiolitis & RSV?
The infant will maintain oxygen saturation within the ordered parameters. The infant will show a respiratory rate and effort appropriate for age without significant retractions. The infant will maintain adequate hydration with sufficient wet diapers and stable weight. The infant will remain free of apnea or will have episodes promptly recognized and managed. The caregiver will demonstrate correct nasal suctioning technique. The caregiver will verbalize signs requiring immediate return to care.
What should you assess in a patient with Bronchiolitis & RSV?
Caregiver report of difficulty feeding or shorter, more frequent feeds; Caregiver observation of noisy or fast breathing; Report of poor sleep due to congestion or coughing; Caregiver concern about decreased wet diapers; History of preceding cold symptoms, runny nose, mild fever; Tachypnea, nasal flaring, retractions (subcostal, intercostal, suprasternal); Expiratory wheeze and/or crackles on auscultation; Grunting, head bobbing, or accessory muscle use in more severe cases; Oxygen saturation trend, particularly with feeding or sleep; Signs of dehydration: dry mucous membranes, decreased urine output, sunken fontanelle; Apneic episodes, especially in young or premature infants; Fatigue pattern: paradoxically, a tiring infant may look calmer with slowing respiratory rate — a warning sign, not improvement
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