1229 Exam 6 Croup Syndromes Flashcards
What is Croup Syndromes?
Croup is a generalized term applied to a symptom complex characterized by hoarsness, a resonant cough described as “barking” or “brassy”, varying degrees of inspiratory stridor, and varying degress of respiratory distress.
What does Croup Syndromes affect?
larynx, trachea, and bronchi Laryngeal involvement often dominates the clinical pictures because of the severe effects on the voice and breathing.
Important to remember:
Acute inections of the larynx are of greater importance in infants and small children because of the increased incidence in this age group and the smaller diameter of the airway, which reners it to greater narrowing with the same degree of inflammation.
What is Laryngotracheobronchitis?
(viral croup) LTB usually occurs in very young children, most often aged 3 months to 3 years of age. It can be seen in children as old as 8 years old.
usually viral, but may be bacterial
What is the most common of the croup syndromes?
LTB–laryngotracheobronchitis
What is the parainfluenza viruses?
group of viruses that cause acute respiratory infections in humans, esp. children.
**Virtually all children the the US have been infected with this by age 6.
What does LTB look like?
Gradual onset-- the child may have a history of a previous episode 2-5 days earlier or a history of recent URI mild fever up to 102.2 barky metallic cough sore throat runny nosemay have inspiratory stridor and may progress to labored resp.
Nursing/Medical Management for LTB
Pulse ox and use of supplemental Oxygen. maintain hydration albuterol or racemic epinephrine aerosolized through face mask corticosteroids to reduce edema provide reassurance to child and parents
What do you hydrate with for LTB?
frequent, small amounts of clear liquids.
Avoid any milk or cold fluids.
***could cause spasm.
What is Acute Spasmodic Laryngitis?
(Spasmodie Croup)
the least serious of the croup syndromes.
usually occurs in children aged 3 months to 3 years.
has abrupt onset. –peaks at night and usually resolves in the morning. (tends to reoccur)
may be treated at home in a steamy bathroom or with a cool mist humidifier or vaporizer.
How do I assess Acute Spasmodic Laryngitis?
The child is usually afebrile.
There is mild respiratory distress
A barking, seal like cough is noted
What causes Acute Spasmodic Laryngitis?
Unknown, but it is suspected to be viral or allergic. It may also be linked to emotional influences.
What is Bacterial Tracheitis?
secondary infection of the upper traches after viral LTB associated with airway edema and copius purulent secretions that can cause obstruction of the airway.
How can you tell child has Bacterial Tracheitis?
Instead of improving with therapy after LTB, the child’s condition becomes worse
Assessment for Bacterial Tracheitis:
Child prefers lying flat to sitting up.
High fever greater than 102.2
Respiratory distress with stridor and purulent secretions.
How is Bacterial Tracheitis diagnosed?
Blood cultures after the child is unresponsive to treatment for LTB.
How is Bacterial Tracheitis treated?
IV antibiotics during hospitalization; child may require ventilatory support.
What is the most severe croup syndrome?
Epiglottitis
What is Epiglottitis?
(Supraglottitis)
acute Epiglottitis is an infection of the epiglottis producing a greatly enlarged cherry red epiglottis which will eventually obstruct the airway.
Seen in children age 2-8.
What causes Epiglottitis?
primarily caused by bacterial H. Influenza and Group A streptococcus.
What does Epiglottitis look like?
The onset is abrupt --- leads to rapid progression of respiratory distress. child will appear very ill. high fever hoarseness restlessness agitation sore throat muffled voice respirtory rate of 45-50 mouth breathing dyspnea **The child will take the tripod positon with mouth open and drooling saliva with tongue thrust out, chin thrust out, and sitting up while leaning forward
How do I diagnose Epiglottitis?
Lateral neck xray shows a wide round inflammed epiglottis (thumb sign)
If epiglottitis is suspected…
Treat as an acute emergency! The child could experience acute loss of the airway within minutes after arrival to the ER.
DO NOT AGITATE OR EXCITE THE CHILD.
Points to remember for Epiglottitis:
no exam of the throat should be attempted until immediate intubation can be performed!
The MD?DO will perform the throat inspection.
If there is a high index of suspicion of epiglottitis, the xray may be omitted and the physician will proceed with the exam.
most resources recommend prophylactic intubation as greater than half of these children will eventually need it.
younger children within the household will be treated with Rifampin 20mg/kg x4days
Nursing/med management for Epiglottitis
observe for signs of hypoxia and airway obstruction.
assess breath sounds
continuous pulse ox
blood gases
maintain hydration with IV therapy
infection control measures (IV antibiotics)
provide rest and support for child in upright position
fever control measures
provide support to family and prepare them for possible need for intubation or tracheostomy
What do you do when your child has an attach of croup?
take child into bathroom–close door and turn on hot water.
after breathing has improved, use a cool mist humidifer in the room where the child will be resting
give your child tepid liquids that he/she likes every hour awake.
let child choose what position they are comfortable resting in
keep watch over and notif your HCP if s/s worsen.
Cough assessment: Type
dry hacking moist (EW) barking brassy
Cough Assessment: Progress:
Improved
worse
unchanged
persistent
Cough Assessment: Pattern
daytime
nighttime
both
different intensity with time or activity
Cough Assessment: Associated symptoms
sore throat
dyspnea
pain and pain location
runny nose
Cough Assessment: Secretions
sputum presence consistency color frequency evidence of swallowing sputum postnasal drip
A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because this environment facilitates which of the following? Liquifies secreation improve oxygenation promotes ventilation soothes inflamed mucous membranes
soothes inflamed mucous membranes
Rationale: by humidifying the inspired air, the membranes inflamed by the infection and dry air are soothed.
A four year old girl is brought to the ER. She has a “froglike” croaking sound on inspiration, is agitated, and is drooling. She insist on sitting upright. The nurse should do which of the following?
Examine her oral pharynx and report to MD
Make her lie down and rest quietly
Auscultate her lungs and make preparations for placement in mist tent
notify the MD immediately and be prepared to assist with a tracheostomy or intubation.
notify the MD immediately and be prepared to assist with a tracheostomy or intubation.
Rationale: sitting upright, drooling, agitation, and a froglike cough are indications of epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary.
Cough Assessment: Progress:
Improved
worse
unchanged
persistent
Cough Assessment: Pattern
daytime
nighttime
both
different intensity with time or activity
Cough Assessment: Associated symptoms
sore throat
dyspnea
pain and pain location
runny nose
Cough Assessment: Secretions
sputum presence consistency color frequency evidence of swallowing sputum postnasal drip
A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because this environment facilitates which of the following? Liquifies secreation improve oxygenation promotes ventilation soothes inflamed mucous membranes
soothes inflamed mucous membranes
Rationale: by humidifying the inspired air, the membranes inflamed by the infection and dry air are soothed.
A four year old girl is brought to the ER. She has a “froglike” croaking sound on inspiration, is agitated, and is drooling. She insist on sitting upright. The nurse should do which of the following?
Examine her oral pharynx and report to MD
Make her lie down and rest quietly
Auscultate her lungs and make preparations for placement in mist tent
notify the MD immediately and be prepared to assist with a tracheostomy or intubation.
notify the MD immediately and be prepared to assist with a tracheostomy or intubation.
Rationale: sitting upright, drooling, agitation, and a froglike cough are indications of epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary.
