Martina Rigdon
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
, Martina Rigdon
UNFOLDING Reasoning: STUDENT
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 afterhours 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:
9-month-old Baby is having increased secretions and is at risk for ineffective airway
Runny nose and aspiration due to the mother not liking to suction. Mother has been
No fever alternating acetaminophen and ibuprofen in baby, which may make a
Trouble clearing mucous fever undetectable if he were present.
Acetaminophen
Mother doesn’t suction unless excessive
RELEVANT Data from Social History: Clinical Significance:
Born full term Mothers smoking increases babies risk for SIDS , ear infections, and
6lbs 2oz 19in respiratory infections. Ear infections may be related to secondhand
3 ear infections smoke, which causes irritation to the tubes.
Frequent runny nose
Up to date on immunizations
18lbs
Single mother of 3
Heavy smoker
SNAP, HUD, & WIC assistance
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
What VS data is RELEVANT that must be recognized as clinically significant to the nurse?
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
, Martina Rigdon
UNFOLDING Reasoning: STUDENT
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 afterhours 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:
9-month-old Baby is having increased secretions and is at risk for ineffective airway
Runny nose and aspiration due to the mother not liking to suction. Mother has been
No fever alternating acetaminophen and ibuprofen in baby, which may make a
Trouble clearing mucous fever undetectable if he were present.
Acetaminophen
Mother doesn’t suction unless excessive
RELEVANT Data from Social History: Clinical Significance:
Born full term Mothers smoking increases babies risk for SIDS , ear infections, and
6lbs 2oz 19in respiratory infections. Ear infections may be related to secondhand
3 ear infections smoke, which causes irritation to the tubes.
Frequent runny nose
Up to date on immunizations
18lbs
Single mother of 3
Heavy smoker
SNAP, HUD, & WIC assistance
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
What VS data is RELEVANT that must be recognized as clinically significant to the nurse?
