RSV

[Billy 1LT/AN]

Hello, I am a pediatric/neonatal nurse in North Carolina. RSV season is about to hit and I have been through three seasons of treating it. Most of the therapy for RSV is supportive, such as oxygen, suction, positioning etc.. For newborns/toddlers that don't tolerate nasal cannulas we tend to use blow by cool mist titrating from 35% up (make sure you run it at 10L or it won't be effective) Using chest PT, bulb syringe suctioning is also effective for the newborn/toddler. A really good way to chest pt a baby is to use the smallest face mask you would for bag valve masking, tape it to a tongue depressor and make sure the top where it would connect to the bag is closed/taped. As far as medications are concerned there tends to be a differing opinion on how to treat (especially depending if its Family malPractice or Pediatrics that are treating). Nebulized albuterol tends to be a generally used treatments. Starting off at Q2 and then backing them off to Q4 and then Q6. Some may use atrovent also but not frequently. Sometimes Prelone is used of course that is case dependent. Nasal drops such as Neosynephrine (I think the spelling is off) is used but for no more than 3 days. You can use saline drops to help loosen secretions before suctioning occurs which helps alot for the babies. I don't know the hospitals capability for monitoring but pulse oximetry is vital, cardio/respiratory monitoring if on an inpatient setting will be helpful during the acute phase of RSV. Monitoring Resps/ effort of breathing, recognizing flaring, retracting both suprasternally and intercostally and abdominal breathing are good things to teach not only other staff members but also the parents.

One of the two complications I normally see from RSV is dehydration. The little obligatory nose breathers and the still bottle fed tend to dehydrate quickly. They frustrate at the difficulty of breathing and the effort of swallowing. Not only this but many times vomiting due to the coughing caused by the draining of the upper airway into the throat. Good suctioning before feeding improves intake along with positioning. Letting the infant take breaks during the feeding helps....let them feed a few minutes...take the bottle out so they concentrate on breathing for a minute or two and then starting again. If there normal intake is down but are still willing to feed smaller, more frequent feedings become indicated. Of course if they are unwilling to feed then maintainence fluids must be started or 1/2 maintainence. We tend to use D51/4 with 20K for the infants. As the virus takes its course and the congestion lessens they will want to eat and of course cut down the fluids after each successful feed.

Education of the parents is a benefit ,if the child is not going to be admitted, the ER staff must teach the parents, if they are it is the responsibility of the inpatient nurse of course. When RSV season starts it spreads like wildfire! Daycares, schools, sibling to sibling transmission, neighbor children infect each other alarmingly. Parents of newborns should be taught and encouraged to separate other sick siblings from the newborn. Not allowing them to play with other sick toddlers etc. Handwashing can be taught to the parents with multiple children as a means of preventing the spread. Teaching parents of the proper use of the bulb syringe is beneficial.

As I read this I am probably telling you nothing new so sorry for the dissertation. E-mail with any questions if I can help!

[meta]

I´m a swedish childrens nurse working at the emergency department at Malmö Childrens Hospital. I´m interested in the way children with an RSV (respiratory syncytial virus) infection is treated at other hospitals. Medication, nursing, physiotherapy etc. Please mail me!

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