NRS 455 Pathophysiological Processes of Disease Essay

NRS-455: Pathophysiology Course builds upon the existing knowledge of the pathophysiological processes of disease as they affect patients across the life span, recognizing the nurse’s multidimensional role in health promotion and disease management and prevention, which include biological, environmental, social, psychological, and spiritual dimensions. Integration of nutritional and pharmacological concepts encourages critical thinking and application of nursing interventions. Prerequisite: NRS-420.

Pathophysiology of Bronchiolitis Example Paper

Bronchiolitis is a common lower respiratory tract infection primarily affecting infants and young children. It is characterized by inflammation of the small airways, leading to airway obstruction, mucus production, and respiratory distress. Bronchiolitis is particularly prevalent during winter and autumn, with sporadic occurrence witnessed throughout the year. It mainly affects children under 2, with the occurrence within the initial year of life at 11% to 15%, with a minimum of 5 hospitalizations in every 1000 children below two years old (O’Brien et al., 2019).

In Australia, an estimated 13,500 children are hospitalized annually due to bronchiolitis. This paper delves into a case study of Joe, a 21-month-old boy with bronchiolitis secondary to an RSV infection; the paper will also focus on the pathophysiology of bronchiolitis, outline the nursing assessments and management strategies for Joe, and address health promotion measures for Joe and his family upon discharge.


The pathophysiology of bronchiolitis is attributed primarily to the respiratory syncytial virus (RSV). However, various other viruses, including human rhinovirus, coronaviruses, human metapneumovirus, adenovirus, parainfluenza virus, and human bocavirus, have also been recognized over time (Justice & Le, 2022). These viruses infiltrate the respiratory epithelial cells, inducing inflammation and necrosis of the epithelial lining.

This inflammation causes small airway obstruction, increased mucus production, and decreased mucociliary clearance. As a result, airway resistance increases, leading to impaired airflow, hyperinflation, and respiratory distress. The combination of inflammation, mucus plugging, and airway narrowing results in decreased ventilation and poor oxygen exchange, leading to hypoxemia (Erickson et al., 2020).

Joe’s clinical presentation aligns with the progression of bronchiolitis. The increased respiratory rate of 57 breaths per minute compensates for maintaining oxygenation due to the narrowed airways. As highlighted by Ozdemır and Songül Yalçın (2021) in their study of “the role of body temperature on the respiratory rate in children with acute respiratory infections,” the elevated temperature of 39.5°C indicates the presence of infection and the body’s immune response.

The decreased % oxygen saturation of 90% suggests impaired oxygen exchange due to compromised airway function. The rapid heart rate of 148 beats per minute responds to the increased respiratory effort. At the same time, the elevated blood pressure of 105/70 mmHg may be related to the fever and respiratory distress. The prolonged capillary refill time reflects poor perfusion, likely due to increased respiratory effort and oxygen demand.

Joe’s restlessness, apathy, and disinterest in his environment are consistent with the general malaise associated with the illness. The increased work of breathing, intercostal retractions, and nasal flaring indicate significant respiratory distress as his body attempts to overcome the compromised airway function. Furthermore, Joe’s continued feeding difficulties can be attributed to his respiratory symptoms. The increased effort required for breathing may make it challenging for him to coordinate feeding, leading to poor intake and potentially contributing to his lethargy and dehydration.

Nursing Assessments and Management:

The nursing assessment and management of a child with bronchiolitis involve a comprehensive approach to relieve symptoms, prevent complications, and promote recovery. The initial step in managing a child with bronchiolitis involves thoroughly assessing the child’s respiratory status. As Justice and Le (2022) highlight, the nurse should monitor the child’s respiratory rate, depth, and effort, looking for signs of increased work of breathing such as nasal flaring, intercostal and subcostal retractions, and use of accessory muscles. Auscultation of lung sounds is also critical in identifying wheezing, crackles, and decreased breath sounds indicative of airway obstruction and reduced ventilation.

In the given case study, Joe, a 21-month-old boy, has been admitted to the pediatric short-stay unit due to bronchiolitis from a respiratory syncytial virus (RSV) infection. A comprehensive assessment of the initial observations reveals potential nursing issues requiring timely and focused interventions. These issues include fever, tachypnea, increased work of breathing, oxygen desaturation, increased heart rate, elevated blood pressure, poor feeding, restlessness, lethargy, and signs of respiratory distress.

A range of nursing assessments needs to be undertaken to provide comprehensive nursing care for Joe. The primary assessments should focus on the child’s airway, breathing, circulation, and level of consciousness (ABC). These assessments are critical in identifying any immediate threats to Joe’s life (Peate & Brent, 2021). Given the signs of respiratory distress and decreased oxygen saturation, assessing his respiratory status is a priority. The ABCDE (Airway, Breathing, Circulation, Disability, Exposure) framework can help guide the nursing assessment.

Starting with the airway assessment, the nurse should examine Joe’s airway for any obstruction or signs of distress. His intercostal retractions, nasal flaring, and increased work of breathing indicate compromised airway patency (Yadav et al., 2022). The breathing assessment shows that Joe’s respiratory rate of 57 breaths per minute, along with the intercostal retractions and nasal flaring, suggests respiratory distress. His oxygen saturation of 90% indicates poor gas exchange and the need for supplemental oxygen. The circulation assessment reveals a heart rate of 148 beats per minute and blood pressure of 105/70mmHg, which shows an increased cardiac workload likely due to fever and respiratory distress.

The disability assessment highlights Joe’s lethargy and poor feeding, indicating altered neurological status and dehydration. After the initial ABC assessment, other assessments are necessary to gather more information about Joe’s condition. His elevated temperature of 39.5°C indicates a fever that can exacerbate his distress. Addressing his poor feeding is crucial to ensure proper nutrition and hydration. Additionally, a general assessment of Joe’s appearance, responsiveness, and signs of discomfort is essential. His restlessness, apathy, and disinterest in the environment indicate his discomfort and distress (Nurseslabs, 2019). Capillary refill time of 2-3 seconds suggests adequate perfusion but needs ongoing monitoring.

Considering these assessments, it is crucial to tailor Joe’s nursing management to his specific needs. Given his respiratory distress and oxygen desaturation, providing supplemental oxygen as prescribed by the physician is essential to improve oxygenation and alleviate the work of breathing. According to a study by Brekke et al. (2020) on the value of vital signs in predicting clinical deterioration, early detection of changes in vital signs before clinical deterioration has been proven crucial in timely intervention. Close monitoring of vital signs, particularly heart rate, respiratory rate, oxygen saturation, and blood pressure, is necessary to track Joe’s response to interventions and identify any deterioration.

Family-centered care is crucial in pediatric nursing as it focuses on involving and supporting the entire family unit to ensure comprehensive and effective healthcare for the child. A scoping review by Kokorelias et al. (2019) found that family plays a vital role in ensuring the health and well-being of infants by providing essential care, emotional support, a safe environment, and the foundation for healthy development.

The relationships, experiences, and interactions within the family unit during this crucial stage of life can have a profound and lasting impact on the child’s well-being. In this case, involving Joe’s mother, Molly, in the care plan by explaining the interventions and rationale will help her understand the importance of interventions such as oxygen therapy, which can be unfamiliar and unsettling for parents.

Holistic health considerations consider all aspects of an individual’s well-being, recognizing that various interconnected factors influence health. This approach goes beyond addressing physical symptoms and encompasses emotional, mental, and social dimensions (Wopker et al., 2021). In the context of a child’s health, this means that nurses should not only focus on treating the child’s physical ailments but also pay attention to their emotional and psychosocial needs and those of their family. For Joe, reducing distress through comfort measures, such as creating a calm and soothing environment, may help decrease his anxiety. Additionally, ensuring Molly is well-informed and emotionally supported can positively impact her coping abilities and, consequently, Joe’s overall well-being.

Regular reassessments are essential in determining the effectiveness of interventions and identifying any changes in Joe’s condition. If there is an improvement in his oxygen saturation, respiratory rate, and general appearance, this could indicate a positive response to the interventions. However, escalating care to higher levels, such as the pediatric intensive care unit, would be necessary if his distress worsens.

Health Promotion

After discharge, health promotion strategies should be implemented to support Joe and his family. Educating the family about proper hand hygiene, avoiding exposure to sick individuals, and maintaining a smoke-free environment can help prevent future infections. Demonstrating proper administration of medications and explaining their purposes is essential to ensure compliance. Referring the family to community support resources, such as local pediatric clinics, support groups, and online resources related to bronchiolitis and RSV infections, can provide ongoing assistance. Additionally, arranging a follow-up appointment with Joe’s primary care provider will facilitate ongoing recovery monitoring.


This paper has explored the multifaceted aspects of bronchiolitis through the lens of a case study involving Joe, a 21-month-old boy. The pathophysiology of bronchiolitis, predominantly linked to the respiratory syncytial virus, was examined, highlighting its impact on airway obstruction and compromised respiratory function. The nursing assessments and management strategies demonstrated a comprehensive approach to addressing Joe’s distressing symptoms and guiding his care. Family-centered care and holistic health considerations were emphasized in promoting Joe’s well-being and his mother’s understanding. Integrating health promotion measures post-discharge underscores the importance of preventative education and ongoing support for Joe’s recovery.


Atay, O., Pekcan, S., Gokturk, B., & Ozdemir, M. (2020). Risk factors and clinical determinants in bronchiolitis. Turkish Thoracic Journal.

Brekke, I. J., Puntervoll, L. H., Pedersen, P. B., Kellett, J., & Brabrand, M. (2020). The value of vital sign trends in predicting and monitoring clinical deterioration: A systematic review. PLoS One, 14(1).

Erickson, E. N., Bhakta, R. T., & Mendez, M. D. (2020). Pediatric bronchiolitis. PubMed; StatPearls Publishing.

Justice, N. A., & Le, J. K. (2022, July 29). Bronchiolitis. PubMed; StatPearls Publishing.

Kokorelias, K. M., Gignac, M. A. M., Naglie, G., & Cameron, J. I. (2019). Towards a universal model of family-centered care: A scoping review. BMC Health Services Research, 19(1), 1–11.

Martin, P. (2023, April 30 – Updated). 7 Bronchiolitis & Respiratory Syncytial Virus (RSV) Nursing Care Plans. Nurseslabs.

O’Brien, S., Wilson, S., Gill, F. J., Cotterell, E., Borland, M. L., Oakley, E., & Dalziel, S. R. (2019). The management of children with bronchiolitis in the Australian hospital setting: Development of a clinical practice guideline. BMC Medical Research Methodology, 18(1).

Ozdemır, B., & Songül Yalçın, S. (2021). The role of body temperature on respiratory rate in children with acute respiratory infections. African Health Sciences, 21(2), 640–646.

Peate, I., & Brent, D. (2021). Using the ABCDE approach for all critically unwell patients. British Journal of Healthcare Assistants, 15(2), 84–89.

Wopker, P. M., Schwermer, M., Sommer, S., Längler, A., Fetz, K., Ostermann, T., & Zuzak, T. J. (2021). Expert consensus-based clinical recommendation for an integrative anthroposophic treatment of acute bronchitis in children: A Delphi survey. Complementary Therapies in Medicine, 60, 102736.

Yadav, S., Lee, B., & Kamity, R. (2022, July 25). Neonatal respiratory distress syndrome. PubMed; StatPearls Publishing.