1229 Exam 6 Croup Syndromes

Question 1

What is Croup Syndromes?

Answer 1

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.

Question 2

What does Croup Syndromes affect?

Answer 2

larynx, trachea, and bronchi Laryngeal involvement often dominates the clinical pictures because of the severe effects on the voice and breathing.

Question 3

Important to remember:

Answer 3

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.

Question 4

What is Laryngotracheobronchitis?

Answer 4

(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

Question 5

What is the most common of the croup syndromes?

Answer 5

LTB–laryngotracheobronchitis

Question 6

What is the parainfluenza viruses?

Answer 6

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.

Question 7

What does LTB look like?

Answer 7

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.

Question 8

Nursing/Medical Management for LTB

Answer 8

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

Question 9

What do you hydrate with for LTB?

Answer 9

frequent, small amounts of clear liquids.
Avoid any milk or cold fluids.
***could cause spasm.

Question 10

What is Acute Spasmodic Laryngitis?

Answer 10

(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.

Question 11

How do I assess Acute Spasmodic Laryngitis?

Answer 11

The child is usually afebrile.
There is mild respiratory distress
A barking, seal like cough is noted

Question 12

What causes Acute Spasmodic Laryngitis?

Answer 12

Unknown, but it is suspected to be viral or allergic. It may also be linked to emotional influences.

Question 13

What is Bacterial Tracheitis?

Answer 13

secondary infection of the upper traches after viral LTB associated with airway edema and copius purulent secretions that can cause obstruction of the airway.

Question 14

How can you tell child has Bacterial Tracheitis?

Answer 14

Instead of improving with therapy after LTB, the child’s condition becomes worse

Question 15

Assessment for Bacterial Tracheitis:

Answer 15

Child prefers lying flat to sitting up.
High fever greater than 102.2
Respiratory distress with stridor and purulent secretions.

Question 16

How is Bacterial Tracheitis diagnosed?

Answer 16

Blood cultures after the child is unresponsive to treatment for LTB.

Question 17

How is Bacterial Tracheitis treated?

Answer 17

IV antibiotics during hospitalization; child may require ventilatory support.

Question 18

What is the most severe croup syndrome?

Answer 18

Epiglottitis

Question 19

What is Epiglottitis?

Answer 19

(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.

Question 20

What causes Epiglottitis?

Answer 20

primarily caused by bacterial H. Influenza and Group A streptococcus.

Question 21

What does Epiglottitis look like?

Answer 21

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

Question 22

How do I diagnose Epiglottitis?

Answer 22

Lateral neck xray shows a wide round inflammed epiglottis (thumb sign)

Question 23

If epiglottitis is suspected…

Answer 23

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.

Question 24

Points to remember for Epiglottitis:

Answer 24

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

Question 25

Nursing/med management for Epiglottitis

Answer 25

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

Question 26

What do you do when your child has an attach of croup?

Answer 26

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.

Question 27

Cough assessment: Type

Answer 27

dry 
hacking
moist (EW)
barking
brassy

Question 28

Cough Assessment: Progress:

Answer 28

Improved
worse
unchanged
persistent

Question 29

Cough Assessment: Pattern

Answer 29

daytime
nighttime
both
different intensity with time or activity

Question 30

Cough Assessment: Associated symptoms

Answer 30

sore throat
dyspnea
pain and pain location
runny nose

Question 31

Cough Assessment: Secretions

Answer 31

sputum presence 
consistency
color
frequency
evidence of swallowing sputum
postnasal drip

Question 32

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

Answer 32

soothes inflamed mucous membranes

Rationale: by humidifying the inspired air, the membranes inflamed by the infection and dry air are soothed.

Question 33

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.

Answer 33

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.