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28 Cards in this Set

  • Front
  • Back
What are the 4 croup syndromes?
epiglottitis or
What age group is affected by acute laryngotracheobronchitis?
3 months to 8 years
What is LTB?
most common croup syndrome, primarily affecting children younger than 5 years old...not as serious as epiglottitis or tracheitis
What causes LTB?
parainfluenza virus
influenz A and B
Mycoplasma pneumoniae
What is LTB usually preceded by?
upper respiratory infection (URI) which gradually descends to adjacent structures
LTB is characterized by gradual onset of?
low-grade fever
What causes narrowing of airway? 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?
What does the typical child with LTB present with?
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)
What is Stage I of LTB?
croupy cough
inspiratory stridor when

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)
What is Stage II of LTB?
continuous respiratory
lower rib retraction
retraction of soft tissue of
use of accessory muscles of
labored respiration
What is Stage III of LTB?
signs of anoxia and carbon
dioxide retention
rapid respiration
What is Stage IV of LTB?
intermittent cyanosis
permanent cyanosis
cessation of breathing
Nursing Alert!
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
What can be used in the hospital to provide increased
humidity and supplemental oxygen?
hoods for infants
tents for toddlers
What med is often used in children with severe disease, stridor at rest, retractions, or difficulty breathing?
nebulized racemic
What is epinephrine (racemic)?

classified as an adrenergic
How does epinephrine work?
the alpha-adrenergic effects of epinephrine cause mucosal vasoconstriction and subsequently decrease subglottic edema
What is the onset time of epinephrine?
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)
Peak effect of epinephrine is?
observed in 2 hours
Additional doses of epinephrine should be administered?
every 20 to 30 minutes in ICU or 3 to 4 hours in the regular hospital unit
What other med is given besides epinephrine?
corticosteroids because of the antiinflammatory effects which decrease subglottic edema
What is the onset of action for corticosteroids?
clinically detectable as early as 6 hours after administration, with continued improvement over 12 to 24 hours
Parents can help the child with mild croup by?
providing ample beverages that the child likes...if the child can't take oral fluids, then IV may be needed
Nursing Alert!
Early signs of impending airway obstruction include increased pulse and respiratory rate; substernal, suprasternal, and intercostal retractions; flaring nares; and increased restlessness
The nursing care of a patient with LTB includes?
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
have emergency intubation
equipment available because
a lot of time child has
to have a trach put in
What are key things to remember about hydrating a patient with LTB?
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
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?
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?
CALL the physician