Croup and Bacterial Epiglottitis.pdf

Croup and Bacterial Epiglottitis Acute Laryngotracheobronchitis Acute Laryngotracheobronchitis Acute laryngotracheobronchitis is the most common type of croup and primarily affects infants and children less than 5 years old. It is caused by viruses such as influenza types A and B, adenovirus, respir...

Croup and Bacterial Epiglottitis Acute Laryngotracheobronchitis Acute Laryngotracheobronchitis Acute laryngotracheobronchitis is the most common type of croup and primarily affects infants and children less than 5 years old. It is caused by viruses such as influenza types A and B, adenovirus, respiratory syncytial virus, and measles. Clinical manifestations include: low-grade fever barky, brassy cough inspiratory stridor respiratory distress, which may include retractions, nasal flaring, and tachypnea SIGNS TO WATCH OUT FOR The child has a history of illness. progressive onset usually preceded by an upper respiratory infection and low-grade fever The child awakens in the night with a barking, brassy cough and at times inspiratory stridor. Symptoms are typically worse at night, and agitation and crying tend to exacerbate the symptoms. Acute Epiglottitis Acute Epiglottitis Acute epiglottitis is a serious obstructive inflammatory process that can rapidly progress to complete respiratory obstruction, severe respiratory distress, and even sudden death. It typically affects children ages 2 to 5 years old and is often caused by haemophilus influenzae. The haemophilus influenza type B vaccine has dramatically reduced cases of acute epiglottitis in recent years. Clinical manifestations include: high fever sore throat sitting upright and leaning forward (“tripod” position) with mouth open drooling irritability cherry-red, edematous epiglottis The child has a history of illness. The child will often awaken in the middle of the night with a high fever and complain of a sore throat and painful swallowing. rapid onset often preceded by a sore throat desire to sit upright and lean forward (“tripod” position) with mouth open drooling irritable and restless red and inflamed throat with cherry red, edematous epiglottis Three classic signs of epiglottitis are: absence of spontaneous cough presence of drooling Agitation Most cases of acute epiglottitislaryngotracheobronchitis can be prevented by the diphtheria, tetanus, and acellular pertussishaemophilus influenza type B vaccine. THERAPUTIC MANAGEMENT OF Acute Laryngotracheobronchitis Acute Laryngotracheobronchitis Children with mild croup (no stridor at rest) are managed at home. Cool mist constricts edematous blood vessels. In the home: Parents can take the child outside to breathe in cool night air, use a cold-water vaporizer or humidifier, stand in front of the open freezer, or take the child to a cool basement or garage. In the hospital: Cool mist will be administered by face mask or blow by. For moderate to severe cases, nebulized racemic epinephrine is administered as quickly as possible. Corticosteroids may be used to reduce edema early in treatment. Supplemental oxygen is administered as needed. Intubation is implemented if airway obstruction is severe. Fluid intake is encouraged for mild cases. NPO status is implemented for children with severe respiratory distress to prevent aspiration. THERAPUTIC MANAGEMENT OF ACUTE EPIGLOTTITIS Acute Epiglottitis Intensive observation of respiratory status is needed to ensure action is taken quickly. If the status deteriorates: For less severe distress, mask or blow-by humidified oxygen is administered as needed. For severe respiratory distress, children are intubated. Administer intravenous antibiotics for children with suspected bacterial epiglottitis, followed by oral administration to complete a 7- to 10-day course. Corticosteroids may be used to reduce edema early in treatment. NPO status is implemented to prevent aspiration. Epiglottal swelling usually decreases after 24 hours of antibiotic therapy, and the epiglottis is near normal by the third day. Nursing care management There are several similarities between nursing care for children hospitalized with acute laryngotracheobronchitis or acute epiglottitis. Similarities include that the nurse should: Continuously monitor respiratory status, including pulse oximetry, so that impending respiratory failure is recognized quickly. Ensure resuscitation and suction equipment are available at the child’s bedside. Encourage the child to be held and comforted by parents to conserve energy and prevent exacerbation. Some nursing actions that are specific to caring for a child with acute epiglottitis include: Administer intravenous antibiotics. Follow droplet isolation precautions for the first 24 hours of antibiotic therapy. If epiglottitis is suspected, the child should be seen by the healthcare provider immediately. Do not attempt to visualize the epiglottis or take a throat culture, as this may cause complete airway obstruction.