NSG 426, LTB/Epiglottitis

- laryngotracheobronchitis
- epiglottitis
- tracheitis

What conditions can cause croup?

croup

the inflammation of the epiglottis, larynx, trachea, and possibly even the bronchi

croup

What is the most common cause of cough, hoarseness, and stridor in children?

small diameter of airway

What feature do children have that makes croup potentially life threatening?

- viral
- bacterial

What are the classifications of croup syndromes?

- spasmodic laryngitis
- laryngotracheobronchitis

What are the types of viral croup?

- epiglottitis
- bacterial tracheitis

What are the types of bacterial croup?

distance from home to ER

What is an important consideration when deciding to discharge a child with croup?

night

When does croup get worse?

long distance from ER

Why would you admit a child with a mild case of croup to the hospital?

laryngotracheobronchitis

What is the most common croup syndrome?

laryngotracheobronchitis

viral infection of the upper airway which includes the throat, larynx, and trachea

upper airway infection

What precedes LTB?

6 months-3 years

What age range is LTB most commonly diagnosed in?

boys

Which gender is more affected by LTB?

stridor

What is a hallmark sign of LTB?

- inflammation
- edema

What causes narrowing of airway in LTB?

- parainfluenza virus
- influenza A or B
- RSV

What are causes of LTB?

- direct contact of contaminated hands
- inahaled from cough/sneeze

What is the mode of transmission for LTB viruses?

laryngotracheobronchitis

- hx of URI or cold
- awake at night w/ low grade fever
- barking cough
- noisy breathing
- stridor
- sore throat
- rhinorrhea

Downes and Raphaely Croup Score

What scale can be used to assess croup?

mental status

What assessment is imperative to ascertain if a child with LTB is suffering from hypoxia or respiratory failure?

clinical signs

What is used to make a diagnosis of LTB?

airway narrowing

What should you see in the x-ray of a child with LTB?

steeple sign

What is the narrowing of the airway seen in x-rays with LTB known as?

held upright over parent's shoulder

What may be a position of comfort to maximize breathing for children with LTB?

- corticosteroids
- racemic epinephrine

What drugs can be given to help reduce airway inflammation with LTB?

resuscitation equipment

What should be kept at the bedside of a child with LTB?

- mild symptoms do not improve with cool air
- increased labored breathing
- increased respiratory rate
- increased lethargy
- inadequate urine output

When should parents of children with LTB call the provider when discharged to home?

epiglottitis

inflammation and swelling of the epiglottis

epiglottitis

What croup syndrome is a medical emergency?

epiglottis

What structure covers the larynx during swallowing to prevent food from entering the trachea?

airway obstruction

What is the main concern of epiglottitis?

Haemophilus influenzae B

What is the predominant cause of epiglottitis?

Hib vaccine

What vaccine dramatically decreased the incidence of epiglottitis?

2-6 years

In what age range is epiglottitis most common?

males

Which gender does epiglottitis affect more?

epiglottitis

- high fever
- stridor
- secretions in pharynx and larynx
- drooling
- respiratory distress

cherry red and swollen

How does the epiglottis present in epiglottitis?

2-6 hours

What is the onset of epiglottitis?

sniffing position

position assumed in small children with epiglottitis in which the neck is extended

tripod position

involves the child sitting upright with hands on knees; seen in older children with epiglottitis

keep the child calm

What is an important intervention when a child has epiglottitis?

- soft tissue edema
- steeple sign
- large, rounded epiglottis

What is seen in an x-ray with epiglottitis?

ET tube insertion

What is the first intervention for epiglottitis?

antibiotics

What should be administered after the airway is secured in epiglottitis?

nothing

What can be administered by mouth if a child has epiglottitis?

do not put anything in the child's mouth

What is an important nursing consideration for epiglottitis?

supraglottic obstruction

What could increased drooling with epiglottitis indicate?