| Course | NUR-4220 Nursing Care of Infants, Children, and Adolescents |
|---|---|
| Module | Module 1 |
| Paper type | Pediatric nursing paper: bronchiolitis |
| Length | About 1,031 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | B.S.N., Accelerated Second Degree |
| Updated | October 2026 |
Free sample paper for NUR 4220 Module 1
Less Is More for Small Lungs: Supportive Nursing Care in Infant Bronchiolitis
Student Name
B.S.N., Accelerated Second Degree, Thomas Edison State University
NUR-4220: Nursing Care of Infants, Children, and Adolescents
Mentor Name
Month Day, Year
Less Is More for Small Lungs: Supportive Nursing Care in Infant Bronchiolitis
The Patient
Baby Sofia is invented for this paper. She is 3 months old, born at term, and lives with her parents and a 4-year-old brother who attends preschool. Four days ago she developed a runny nose and cough. Today her breathing rate was 64, with her chest pulling in between the ribs and her nostrils flaring, taking only half her usual bottles and producing fewer wet diapers. Pulse oximetry read 89 percent without oxygen. Testing of a nasal sample confirmed respiratory syncytial virus. Her parents were exhausted and frightened.
What Bronchiolitis Is
Zorc and Hall (2010) reviewed how bronchiolitis, a virus-driven inflammation of the smallest airways and the leading cause of hospital stays in the first year of life, is diagnosed and managed. Respiratory syncytial virus causes most cases. The virus infects the cells lining the bronchioles, causing inflammation, swelling, sloughing of cells and mucus that plug the narrow airways of infants. Symptoms usually worsen over the first three to five days and then improve, though cough can last weeks. Young infants, especially those born early or under two months, may have pauses in breathing. The authors emphasized that diagnosis is clinical and that care is mainly supportive.
The Guideline
Ralston et al. (2014) wrote the American Academy of Pediatrics guideline on bronchiolitis. It recommends that clinicians diagnose bronchiolitis by history and examination without routine laboratory tests or chest x-rays. It advises against giving albuterol, epinephrine or systemic corticosteroids routinely, against chest physiotherapy and against antibiotics unless there is a bacterial infection. It lets clinicians hold supplemental oxygen while saturation remains 90 percent or higher and not to use continuous pulse oximetry in every infant. It supports feeding by nasogastric tube or giving IV fluids when an infant cannot take enough by mouth, and emphasizes hand hygiene and avoiding tobacco smoke.
High-Flow Oxygen on the Ward
Franklin et al. (2018) randomly assigned more than 1,400 infants under 12 months with bronchiolitis needing oxygen in 17 hospitals in Australia and New Zealand to heated, humidified high-flow oxygen or standard low-flow oxygen on general wards. Treatment failure, defined as needing escalation of care, occurred in 12 percent of the high-flow group compared with 23 percent of the standard group. There were no differences in time in the intensive care unit or total time on oxygen. The authors noted that high-flow oxygen could be used on wards as a rescue step.
| Source | Key point | Nursing application |
|---|---|---|
| Zorc and Hall (2010) | Viral illness; worst around days three to five; apnea risk in young infants | Expect worsening before improvement; watch for apnea |
| Ralston et al. (2014) | Supportive care; no routine bronchodilators, steroids or chest physiotherapy | Suction, position, hydrate; avoid unhelpful treatments |
| Franklin et al. (2018) | High-flow on wards halved treatment failure | Escalate to high-flow per protocol when standard oxygen fails |
Nursing Diagnoses
The student identified ineffective airway clearance related to mucus and airway swelling, impaired gas exchange related to small airway obstruction and risk for deficient fluid volume related to fast breathing and poor feeding.
Nursing Care
Gentle nasal suctioning before feeds and as needed cleared Sofia's nose, which matters because infants this young rely on breathing through the nose. The student positioned her with her head slightly raised. Nasal cannula oxygen was started with a target saturation of 90 percent or higher. When her work of breathing increased overnight despite 2 liters of oxygen, the team moved her to high-flow oxygen according to the unit's protocol, and within two hours her breathing rate fell to 50 and her retractions eased.
Feeding was a central concern. Infants who breathe very fast may not coordinate sucking and breathing safely. The nurse offered small, frequent feeds when her breathing rate was lower and, when she could not keep up, the team placed a nasogastric tube for feeds. The student tracked her intake, output and weight.
The student clustered care so that Sofia had periods of rest, kept her warm and watched her on a monitor for pauses in breathing.
Watching for Apnea
Because Sofia was only 3 months old, the team placed her on a cardiorespiratory monitor for the first two days. Pauses in breathing are more common in very young infants and in those born early, and they can appear before other signs of worsening. The student learned to check the monitor alarms, look at her color and chest movement when an alarm sounded and stimulate her gently if needed. None occurred.
Supporting the Parents
Her parents asked whether antibiotics or a breathing treatment would help. The student explained, using the guideline, that because a virus causes the illness, antibiotics do not help, and that breathing treatments usually do not help infants with bronchiolitis. The student taught them how to suction her nose and how to recognize signs of worsening, such as faster breathing, grunting, color change or fewer wet diapers.
Preventing Spread
Respiratory syncytial virus spreads easily. The student reinforced hand hygiene for everyone entering the room and taught the family that her brother, who likely brought the virus home from preschool, should wash hands frequently and avoid kissing the baby's face while sick. Exposure to tobacco smoke worsens respiratory illness, and her father agreed to smoke only outside and to change his shirt before holding her.
Evaluation
By day four Sofia was back on low-flow oxygen, by day five she no longer needed oxygen, holding saturations in the low to mid 90s, and was taking full feeds by mouth. She went home on day six. Her parents could demonstrate nasal suctioning and name the warning signs.
Limits
The high-flow trial was conducted in Australia and New Zealand. Practices for pulse oximetry and oxygen thresholds vary. A student assists with care but does not change oxygen settings independently. Sofia is invented.
Conclusion
Sofia's bronchiolitis followed the typical course Zorc and Hall described, worsening before it improved. The guideline steered care away from treatments that do not help and toward suctioning, oxygen, hydration and monitoring, and Franklin and colleagues' trial supported high-flow oxygen as a ward-level rescue. Teaching her parents to understand supportive care, suction her nose and prevent spread completed the nursing role.
References
Franklin, D., Babl, F. E., Schlapbach, L. J., Oakley, E., Craig, S., Neutze, J., Furyk, J., Fraser, J. F., Jones, M., Whitty, J. A., Dalziel, S. R., & Schibler, A. (2018). A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. New England Journal of Medicine, 378(12), 1121-1131. https://doi.org/10.1056/NEJMoa1714855
Ralston, S. L., Lieberthal, A. S., Meissner, H. C., Alverson, B. K., Baley, J. E., Gadomski, A. M., Johnson, D. W., Light, M. J., Maraqa, N. F., Mendonca, E. A., Phelan, K. J., Zorc, J. J., Stanko-Lopp, D., Brown, M. A., Nathanson, I., Rosenblum, E., Sayles, S., & Hernandez-Cancio, S. (2014). Clinical practice guideline: The diagnosis, management, and prevention of bronchiolitis. Pediatrics, 134(5), e1474-e1502. https://doi.org/10.1542/peds.2014-2742
Zorc, J. J., & Hall, C. B. (2010). Bronchiolitis: Recent evidence on diagnosis and management. Pediatrics, 125(2), 342-349. https://doi.org/10.1542/peds.2009-2092
What the NUR 4220 Module 1 instructions ask for
Acute health alterations in infants are central to TESU's catalog description of NUR-4220, and with the course syllabus kept private, module one is planned as a bronchiolitis paper. Describe the infant's history, breathing, feeding and hydration with numbers, explain what happens in the small airways and the usual course of the illness and report the national guideline, noting which common treatments it discourages. Add evidence on oxygen delivery, write nursing diagnoses and describe suctioning, positioning, oxygen, feeding support and monitoring for apnea. Finish with family teaching, infection prevention and evaluation. Some sections assign croup or pneumonia instead. Ask whether your unit's escalation protocol for high-flow oxygen should be summarized, and whether you should describe a specific feeding plan. Include apnea monitoring for young infants.
How the NUR 4220 Module 1 example is put together
A fictional 3-month-old with respiratory syncytial virus arrives at a Neptune hospital breathing 64 times a minute, retracting and feeding poorly, with a saturation of 89 percent. The paper explains the illness from Zorc and Hall, then sets out the 2014 AAP guideline and Franklin and colleagues' high-flow trial each paired with a nursing action in a table. The nursing diagnoses, nasal suctioning before feeds, oxygen and a move to high-flow overnight, nasogastric feeding, clustered care and apnea monitoring follow, along with teaching her parents why antibiotics and breathing treatments are not used, hand hygiene for her brother, smoke exposure, evaluation, limits and a conclusion. A section on apnea monitoring is included.
Reading the NUR 4220 Module 1 grading rubric
Bronchiolitis papers are strongest when they explain the illness's course and physiology, report the guideline accurately, including what not to give, and apply trial evidence on oxygen to a specific decision such as escalating to high-flow. Readers look for nasal suctioning tied to feeding, careful tracking of intake, output and weight and monitoring suited to an infant at risk of apnea. Teaching parents why supportive care is the treatment, and how to recognize worsening, shows that the student can translate evidence for families. Prevention through hand hygiene and smoke avoidance, and leaving oxygen changes to the nurse and protocol, show completeness and good judgment about scope. Recognizing apnea risk in young infants shows age-specific assessment.
Common NUR 4220 Module 1 mistakes, and how to avoid them
Bronchiolitis papers often list albuterol and steroids as standard care; check the guideline, which advises against routine use. Another common gap is ignoring feeding and hydration, which often decide whether an infant needs to stay. Describe breathing, feeding and diapers with numbers, explain the expected course, suction before feeds and know when to escalate oxygen. Teach parents warning signs and suctioning, address siblings and smoke and keep good records of intake and weight. If you send the module prompt with your patient's details, a free first draft can be prepared around them. Watch very young infants for pauses in breathing.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 4220 Module 1 questions, answered
Where can I find a free NUR 4220 Module 1 sample paper?
The bronchiolitis paper about a fictional 3-month-old in a Neptune hospital, from the AAP guideline to high-flow oxygen, is on this page.
Should infants with bronchiolitis get albuterol or steroids?
The 2014 AAP guideline advises against routine use of bronchodilators and systemic corticosteroids.
When do bronchiolitis symptoms peak?
Usually around days three to five of illness, before gradual improvement.
Does high-flow oxygen help infants with bronchiolitis?
Franklin and colleagues found high-flow on general wards cut treatment failure from 23 to 12 percent.
Why suction an infant's nose before feeds?
Infants this young rely on nasal breathing, so a clear nose makes both feeding and breathing easier.