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28 Cards in this Set
- Front
- Back
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What are the 4 croup syndromes?
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epiglottitis or
supraglottitis laryngitis laryngotracheobronchitis tracheitis |
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What age group is affected by acute laryngotracheobronchitis?
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3 months to 8 years
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What is LTB?
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most common croup syndrome, primarily affecting children younger than 5 years old...not as serious as epiglottitis or tracheitis
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What causes LTB?
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parainfluenza virus
RSV influenz A and B Mycoplasma pneumoniae |
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What is LTB usually preceded by?
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upper respiratory infection (URI) which gradually descends to adjacent structures
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LTB is characterized by gradual onset of?
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low-grade fever
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What causes narrowing of airway?
stridor...as well as suprasternal retractions |
inflammation of mucosa lining of larynx and trachea...causing child to struggle to inhale air past obstruction and into lungs...
and what high-pitched sound does this produce? |
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What does the typical child with LTB present with?
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classic barking or seal-like
cough and acute stridor after several days of coryza (acute inflammation hypoxia is imminent... exhalation of CO2 inhibited which causes respiratory acidosis and eventual respiratory failure of nasal mucosa accompanied by profuse nasal discharge) |
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What is Stage I of LTB?
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fear
hoarseness croupy cough inspiratory stridor when disturbed provide high hummidity with cool mist for most children in the way of a cool-air vaporizer (child with no stridor at rest can be managed at home by educated parent...children who progress to Stage II, need medical attention) |
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What is Stage II of LTB?
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continuous respiratory
stridor lower rib retraction retraction of soft tissue of neck use of accessory muscles of respiration labored respiration |
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What is Stage III of LTB?
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signs of anoxia and carbon
dioxide retention restlessness anxiety pallor sweating rapid respiration |
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What is Stage IV of LTB?
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intermittent cyanosis
permanent cyanosis cessation of breathing |
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Nursing Alert!
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Children with severe respiratory distress (traditionally, a respiratory rate greater than 60 breaths/min for infants) should not be given anything by mouth to prevent aspiration and decrease the work of breathing
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What can be used in the hospital to provide increased
humidity and supplemental oxygen? |
hoods for infants
tents for toddlers |
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What med is often used in children with severe disease, stridor at rest, retractions, or difficulty breathing?
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nebulized racemic
epinephrine |
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What is epinephrine (racemic)?
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antiasthmatic
bronchodilator vasopressor classified as an adrenergic |
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How does epinephrine work?
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the alpha-adrenergic effects of epinephrine cause mucosal vasoconstriction and subsequently decrease subglottic edema
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What is the onset time of epinephrine?
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IV - rapid
inhalation - 3 to 5 min subcut - 6-12 min IM - 6-12 min safety not established in children less than 2 years old (Davis Drug, pg 367) |
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Peak effect of epinephrine is?
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observed in 2 hours
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Additional doses of epinephrine should be administered?
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every 20 to 30 minutes in ICU or 3 to 4 hours in the regular hospital unit
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What other med is given besides epinephrine?
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corticosteroids because of the antiinflammatory effects which decrease subglottic edema
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What is the onset of action for corticosteroids?
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clinically detectable as early as 6 hours after administration, with continued improvement over 12 to 24 hours
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Parents can help the child with mild croup by?
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providing ample beverages that the child likes...if the child can't take oral fluids, then IV may be needed
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Nursing Alert!
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Early signs of impending airway obstruction include increased pulse and respiratory rate; substernal, suprasternal, and intercostal retractions; flaring nares; and increased restlessness
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The nursing care of a patient with LTB includes?
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assess respiratory status
assess VS assess hydration give them frequent periods of rest to conserve energy comfort and reassure them if a small child, then have parent hold them as much as possible comfort parents by keeping them informed and keeping them informed of child's progress, how antibiotics and treatment are going to help them to breathe easier have emergency intubation equipment available because a lot of time child has to have a trach put in |
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What are key things to remember about hydrating a patient with LTB?
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no fluids by mouth due to possibility of aspiration, difficulty breathing which makes it more tiring for patient...don't offer liquids by mouth if respirations are greater than 60 beats per minute
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Nursing Alert!
Nurses who suspect epiglottitis should not attempt to visualize directly with a tongue depressor or take a throat culture, because it can cause? |
laryngospasm
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If on discharge, the parent is providing humidity, but symptoms don't improve within 1 HOUR and grow worse in the way of rapid and labored breathing?
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CALL the physician
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