LaryngoTracheoBronchitis

CROUP

Inflammation of the LARYNX, TRACHEA & BRONCHI

d/t a viral infection

PATHO
 Para influenza *
 RSV
 Influenza types A & B

ETIOLOGY (3 S)
 More common the epiglottitis
 Mostly seen in children < 5 years

MANIFESTATION
 Mild, moderate, severe croup child usually looks well
o Slow onset
 Inflammation & edema obstruct airways
 Stridor
 Subglottic swelling (causes hoarseness in voice)
 Seal-bark or cough
 Runny nose
 Low-grade fever, tachypnea

DIAGNOSIS
 Medical = usually only need history most kids have this
several times
o History and Physical
o Xray or scope
 o Chest x-ray
 Nursing =
o Ineffective airway clearance
o Impaired gas exchange
o Acute pain
o Fear

TREATMENT:
 HOME CARE
o Usually resolves on own
o Corticosteroids (decrease inflammation)
o Racemic epinephrine
o Humidified air (steamy bathroom, cool mist)
o Encourage rest and fluid intake
o Calm environment for child
 SEEK HELP
o When child is indicating respirator distress
o Child is confused or restless
o Blue lips/nails
o Increased respiratory rate (breathing faster, but
less air is going in)
o Retractions
o Nasal flaring
o Drooling or cant swallow

NUURSING INTERVENTIONS
1. Droplet isolation precautions
2. Ensure Pt has adequate airway clearance & oxygen
a. Administer antibiotics if indicated
b. Administer racemic epinephrine if needed
 c. Humidified Oxygen if needed
d. HOB elevated
e. IVFs as prescribed
3. Provide comfort
a. Cool mist
b. Cool/warm liquids
c. Antipyretics
d. analgesics
4. Close monitoring of respiratory status
a. Assess outcomes of nursing interventions
b. EDUCATE family signs and symptoms of
respiratory distress

Epiglottitis
Inflammation of the epiglottis leading to an upper airway obstruction
This is an EMERGANCY

Epiglottitis: piece of cartilage at the back of the tongue that closes entry to the
trachea during swallowing to prevent aspiration
 HIB biggest problem

Risk Factor:
 HAEMOPHILUS INFLUENZA TYPE B (HIB)
o Not as much due to Hib vaccination
 Streptococcus pneumonia
 Seen in 2-5 years of age

Signs & Symptoms

Initial:
¬ High Fever
Subsequent:
¬ Dysphonia
¬ Dysphagia
¬ Drooling
 ¬ Distress (resp distress with inspiration stridor)

¬ Tachycardia Sore throat

¬ High fever Nasal flaring
¬ Stridor(frog like croak on inspiration)
¬ Difficulty speaking (kids are in distress)
Nursing Management
 Never leave patient
 Assess oxygen status
 IV access
 May need emergency intubation
 Calm environment
o Stay with parents
o Don’t restrain child
o Help to avoid crying
o Most comfortable positions (tripod)
o NPO
o Medications
 Antibiotics
 Antipyretics
 Corticosteroid (decrease inflammation)
 IV fluids
 Do not place Pt in the supine position it becomes harder to breather

***DO NOT visualize the throat with a tongue blade, take oral temperature or
throat culture***
 This can cause REFLEX LARYNGOSPASMS (cuts off air)

¬ Goal is airway management

¬ Droplet isolation