Upper Respiratory Disorders

Which upper respiratory disorder is characterized by subglottic inflammation and a 'barking' cough?

Croup

What age group is most commonly affected by Croup?

Infants and young children between 6 months and 3 years of age

In Croup, where specifically does the swelling occur in the airway?

Below the vocal cords in the subglottic area

How does inspiratory stridor in Croup change in clinical significance when it occurs at rest?

Stridor at rest indicates a more significant airway obstruction than stridor only with agitation

Which medication is typically administered to quickly reduce swelling in moderate to severe Croup?

Nebulized epinephrine

What classic sign of Epiglottitis results from the patient's inability to handle secretions?

Drooling

In Epiglottitis, what sitting position is often adopted by patients to help maintain their airway?

Tripod

Which physical examination technique must be avoided in a patient suspected of having Epiglottitis?

Unnecessary throat manipulation, such as using tongue depressors

Why should a patient with Epiglottitis NOT be forced into a supine position?

The supine position can cause the inflamed epiglottis to completely block the airway

Epiglottis

Epiglottic inflammation and edema that has the potential for an airway obstruction

Croup

Subglottic inflammation and edema that causes barking cough and stridor

What is the number one cause of epiglottitis?

H. fluenza A

Key Clinical Findings in Croup

• Barking cough

• Stridor

• Hoarseness

Key Pathophysiology of Epiglottitis

Inflammation and edema of epiglottis can obstruct the airway

• The epiglottis is the flap of cartilage behind the throat and in front of the larynx

Key clinical findings in Epiglottitis

• Severe sore throat

• Muffled voice

• Tripod position

• Fever

• Drooling

• Dysphagia

To prevent rebound congestion, patients using topical decongestants like oxymetazoline should be instructed to limit use to how many days?

3-5 days

Which medication functions by chemically breaking disulfide bonds in mucus to decrease its viscosity?

Acetylcysteine

What is the primary site of action for the antitussive dextromethorphan?

Cough center in the medulla

When administering guaifenesin, what is the most important nursing consideration to ensure the drug's effectiveness?

Encourage increased fluid intake

Why is it important to monitor blood pressure when a patient is taking Pseudoephedrine?

Because it stimulates α-adrenergic receptors, which can lead to hypertension

What is the primary risk of using Acetylcysteine in patients with a history of asthma?

Bronchospasm

Which medication is specifically used for a 'dry, nonproductive cough'?

Dextromethorphan

Retropharyngeal abscess

Deep neck infection behind the pharynx

Epiglottitis

Epiglottic inflammation/edema → potential airway obstruction

Medication management for Croup

Dexamethasone

What is historically the leading cause of Epiglottitis?

Haemophilus influenzae type b

Antihistamines MOA

Block H1 receptors → ↓ histamine effects → ↓ itching, sneezing, rhinorrhea & swelling

Pseudoephedrine (Sudafed) MOA

Stimulates α-adrenergic receptors → vasoconstriction → ↓ nasal mucosal edema

Fluticasone (Flonase) MOA

↓ inflammatory mediator release → ↓ nasal inflammation & edema

Dextromethorphan (Delsym, Robitussin DM) MOA

Acts centrally on the cough center in the medulla → suppresses cough reflex

Nursing Considerations with Antittusives

• Avoid alcohol/CNS depressants

• Avoid with MAOIs

• Use caution with serotonergic medications

**Suppresses cough but does NOT remove mucus

high doses have abuse/toxicity potential.

Pathophysiology of Croup

Subglottic inflammation and edema narrow the upper airway

Dextromethorphan uses

Dry, nonproductive cough

Guaifenesin (Mucinex) MOA

Increases respiratory tract fluid → decreases mucus viscosity → easier expectoration

Acetylcysteine MOA

Breaks disulfide bonds in mucus → decreases viscosity

Acetylcysteine uses

• thick respiratory secretions

• acetaminophen overdose

How does airway narrowing directly affect airflow resistance?

Airway narrowing increases resistance to airflow

Why do small amounts of edema or mucus cause a disproportionately large increase in airway resistance in pediatric patients?

Pediatric patients have smaller and more compliant airways

What anatomical region becomes inflamed and edematous in Croup?

The subglottic airway, located below the vocal cords

Why does Diphenhydramine cause significant central nervous system sedation compared to second-generation antihistamines?

It readily crosses the blood-brain barrier

What is the mechanism of action of Pseudoephedrine?

It stimulates alpha-adrenergic receptors, causing vascular constriction and reduced nasal mucosal edema

What cardiovascular adverse effects must be monitored when a patient takes Pseudoephedrine?