| Course | NUR 636 Primary Care of Infants, Children and Adolescents |
|---|---|
| Module | Module 2 |
| Paper type | SOAP note for infant bronchiolitis |
| Length | About 1,030 words, 6 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 636 Module 2
SOAP Note: Bronchiolitis in a Six-Month-Old Infant Managed at Home
[Student Name]
Southern New Hampshire University
NUR 636: Primary Care of Infants, Children and Adolescents
Module Two SOAP Note
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
SOAP Note: Bronchiolitis in a Six-Month-Old Infant Managed at Home
Each winter, bronchiolitis, most often driven by respiratory syncytial virus inflaming the smallest airways, fills more infant hospital beds in the United States than any other illness. Most infants recover with supportive care, yet many receive treatments that do not help, such as bronchodilators, steroids and chest radiographs, and some are admitted who could safely go home. This SOAP note documents the assessment of a six-month-old with bronchiolitis. It argues that careful documentation of hydration and work of breathing, applied against the American Academy of Pediatrics guideline, supports home management and allows the clinician to avoid unhelpful interventions while giving parents clear guidance on when to return.
Subjective
Chief concern, reported by the mother: "He's been wheezing and not eating well."
History of present illness: Leo is a six-month-old boy who developed clear nasal discharge and a mild cough four days ago. Over the last two days the cough has become more frequent and his mother hears wheezing. He is taking about four ounces per feeding instead of his usual six to seven, about 60% of normal intake, and has had four wet diapers in the past 24 hours compared with his usual six. His highest temperature at home was 38.3 degrees Celsius yesterday, treated with acetaminophen. There has been no vomiting, no pauses in breathing, no color change and no choking. Two children in his daycare room have had colds.
Past history: born at 39 weeks by vaginal delivery, birth weight 3.4 kg, no neonatal complications. No prior wheezing or hospitalizations. No heart or lung disease. Immunizations up to date for age, including the six-month vaccines last week. Medications: acetaminophen as needed. Allergies: none known. Social: lives with both parents and a 3-year-old sister; no smokers in the home. Family history: father had childhood asthma.
Objective
Vital signs: temperature 38.1 degrees Celsius, heart rate 148, respiratory rate 52, oxygen saturation 94% on room air when calm and 92% during crying. Weight 7.9 kg (50th percentile), unchanged from his visit last week.
General: alert, consolable, interactive, smiles at the examiner between coughing spells. Head: anterior fontanelle soft and flat. Eyes: tears present. Mouth: mucous membranes moist. Nose: copious clear secretions. Chest: mild subcostal retractions, no suprasternal retractions, no nasal flaring or grunting. Scattered fine crackles and end-expiratory wheezes bilaterally, with good air entry throughout. Heart: tachycardic, regular, no murmur. Abdomen: soft. Skin: capillary refill under 2 seconds; no rash. After nasal suctioning in the clinic, his respiratory rate fell to 46 and retractions became minimal, and he took two ounces from a bottle without distress.
Assessment
Acute viral bronchiolitis, mild to moderate, day four of illness, in a previously healthy term infant. The diagnosis is clinical: a first episode of wheezing with crackles after a viral upper respiratory prodrome in an infant under two years. The AAP guideline recommends diagnosing bronchiolitis on history and examination and advises that clinicians should not routinely order laboratory tests or radiographs (Ralston et al., 2014). Leo shows no signs of severe disease: he is alert, has only mild retractions that improved after suctioning, has an oxygen saturation above 90% and is taking more than half his usual feeds, with adequate urine output. He has no high-risk features such as prematurity, age under 12 weeks, heart or lung disease or immunodeficiency. Illness in bronchiolitis often peaks around days three to five, so he may worsen slightly before improving (Florin et al., 2017). The differential includes a first asthma episode, less likely at this age despite his father's history, and pneumonia, which is unlikely without focal findings or toxicity.
Plan
Disposition: home management with close follow-up, since he meets the criteria of adequate oxygenation, hydration and mild work of breathing. Supportive care: gentle nasal saline drops and bulb suction before feeds and sleep, smaller more frequent feeds and acetaminophen at 15 mg/kg, about 120 mg for his weight, no more often than every 6 hours when fever or fussiness bothers him. Treatments not ordered and why: the guideline recommends against albuterol, epinephrine and systemic corticosteroids for bronchiolitis, because trials have not shown that they improve outcomes, and against antibiotics unless a bacterial infection is present; it also recommends against chest physiotherapy (Ralston et al., 2014). No chest radiograph or viral testing is needed, because results would not change management. Follow-up: clinic recheck tomorrow, or phone call if the family cannot come, to reassess feeding and breathing. Because Leo attends daycare, his parents were advised to keep him home until he has been fever-free for 24 hours and is feeding well, and to wash hands and toys often to limit spread to his 3-year-old sister. Documentation includes the specific criteria met for home care, so that any clinician reviewing the chart at the next visit can see why he was not referred.
Education
Leo's parents were told that the cough may last two to three weeks, even as he recovers, and that the next day or two may be the worst. They should return immediately or call 911 for any pause in breathing or blue or gray color around the lips, and return to clinic or the emergency department the same day if he is breathing so hard that his ribs pull in deeply, is feeding less than half his usual amount, has fewer than three wet diapers in 24 hours, is unusually sleepy or hard to wake or has a fever lasting more than three days. They practiced suctioning with the nurse. For future seasons, they were told that RSV prevention is now available for infants: in a randomized trial, one injection of the long-acting antibody nirsevimab cut doctor visits for RSV chest infections by roughly three quarters among healthy babies born at or near term (Hammitt et al., 2022), and a future sibling born before or during RSV season could be protected by nirsevimab or maternal vaccination.
Conclusion
Leo has bronchiolitis with adequate oxygenation, hydration and mild work of breathing. Documenting those findings, and his response to suctioning and a feeding trial, supports caring for him at home with supportive measures, avoiding treatments the guideline advises against and giving his parents clear, specific reasons to return.
References
Florin, T. A., Plint, A. C., & Zorc, J. J. (2017). Viral bronchiolitis. The Lancet, 389(10065), 211-224. https://doi.org/10.1016/S0140-6736(16)30951-5
Hammitt, L. L., Dagan, R., Yuan, Y., Baca Cots, M., Bosheva, M., Madhi, S. A., Muller, W. J., Zar, H. J., Brooks, D., Grenham, A., Wahlby Hamren, U., Mankad, V. S., Ren, P., Takas, T., Abram, M. E., Leach, A., Griffin, M. P., & Villafana, T. (2022). Nirsevimab for prevention of RSV in healthy late-preterm and term infants. New England Journal of Medicine, 386(9), 837-846. https://doi.org/10.1056/NEJMoa2110275
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
What the NUR 636 Module 2 instructions ask for
NUR 636 SOAP notes typically present an infant or child with a common acute illness and ask for history from the appropriate informant, a focused examination, an assessment with differential and severity and a plan with education and follow-up. The bronchiolitis version usually tests whether you can judge severity and disposition and follow the guideline's recommendations about what not to do. Expect three to five pages in APA 7. Document hydration and work of breathing in measurable terms, state the disposition criteria you applied, calculate any doses by weight and list the treatments you deliberately withheld with reasons, because pediatric graders look for evidence-based restraint as well as action. Write the criteria you used.
How this NUR 636 Module 2 soap note example is built
This note documents a composite six-month-old daycare attendee on day four of illness with cough, wheeze and feeding at 60% of normal. The history covers intake, wet diapers, fever, apnea and risk factors, and the examination records respiratory rate, retractions, saturation, hydration and the response to suctioning and a feeding trial. The assessment uses the Ralston AAP guideline to diagnose clinically and avoid tests, and Florin's review to anticipate the day three to five peak. The plan chooses home care, doses acetaminophen at 15 mg/kg and explains why albuterol, steroids, antibiotics and chest physiotherapy are not used. Return precautions and the Hammitt nirsevimab trial close the note.
Where the NUR 636 Module 2 rubric puts the points
Grading of a NUR 636 SOAP note usually covers the history from the parent, a focused examination with pediatric vital signs, a severity assessment, an evidence-based plan with weight-based dosing, family education and APA 7 support. Top-band notes document the specific findings that determine disposition, cite the guideline for both what is done and what is withheld and give return precautions that parents can measure, such as wet diaper counts. Graders reward notes that anticipate the illness course and include prevention for the family. Clear reasoning about why a child can go home safely demonstrates the judgment pediatric primary care requires and tends to earn full credit.
NUR 636 Module 2 help: the mistakes that cost points
Bronchiolitis notes lose points when they order albuterol, steroids or a chest x-ray without justification, when hydration and work of breathing are not documented, when doses are not calculated by weight or when return precautions are vague, such as call if worse. A common gap is omitting the illness timeline, which leaves parents alarmed when the child worsens on day four. Document intake, output, retractions and saturation, apply the AAP disposition criteria, calculate doses, list withheld treatments with reasons and give measurable return precautions. If your case is croup, otitis media or gastroenteritis instead, share the scenario and your template for NUR 636, and the note will follow that condition's guideline instead.
Get NUR 636 Module 2 written to your instructions
Send the pediatric case, your SOAP template and the rubric. The note you receive will document severity and hydration precisely, apply the AAP guideline, calculate doses by weight, explain what is withheld and give measurable return precautions, within 24 to 48 hours, free the first time. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
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NUR 636 Module 2 questions, answered
Where can I find a free NUR 636 Module 2 SOAP Note sample?
A complete note is posted on this page: bronchiolitis in a six-month-old managed at home, with severity criteria, treatments the AAP guideline advises against and specific return precautions.
Should infants with bronchiolitis get albuterol?
No. The AAP guideline recommends against albuterol for bronchiolitis because trials have not shown it improves outcomes such as hospital admission or length of illness.
When can an infant with bronchiolitis be managed at home?
When the infant is alert, has adequate oxygen saturation, mild work of breathing, is feeding at least about half the usual amount with adequate wet diapers and has no high-risk features.
Does bronchiolitis need a chest x-ray?
Not routinely. The diagnosis is clinical, and the guideline advises against routine radiographs and laboratory tests because they rarely change management.
Is there a way to prevent RSV in infants?
Yes. The long-acting antibody nirsevimab reduced medically attended RSV lower respiratory infection by about three quarters in a trial, and maternal RSV vaccination is another option.