Nursing Care of the Child

Nursing Care of the Child with Acute Epiglottitis

Definition of Epiglottitis

  • Medical Emergency: Epiglottitis is defined as an inflammation of the epiglottis, primarily due to infections that can lead to a potentially fatal airway obstruction.

Clinical Manifestations

  • Age Range: Most commonly affects children between 1-5 years of age.
  • Initial Symptoms:
    • Often begins with mild upper respiratory infection (URI) symptoms.
  • Progressing Symptoms:
    • Sore Throat: The child may complain of a sore throat.
    • Dysphagia: Difficulty swallowing.
    • High Fever: Ranges from 102.2°F102.2°F to 104°F104°F.
    • Drooling: Increased saliva production due to swallowing difficulties.
    • Anxiety: The child may exhibit anxiety, preferring to sit up, leaning forward with the mouth open and tongue out, also known as the “tripod position”.
    • Respiratory Distress: Difficulty breathing is typically noted as a significant distress signal.

Treatment and Nursing Care

  • Immediate Interventions:
    • Possible intubation or tracheostomy may be required due to airway obstruction.
    • Administering moist air to help ease breathing.
    • Constant monitoring of pulse oximetry (pulse ox) to assess oxygen saturation levels.
    • Initiating intravenous (IV) antibiotics to treat underlying infection.
  • Monitoring Recovery:
    • Patients may be extubated after 24−4824-48 hours if their condition improves.

Etiology

  • Common Causes:
    • Usually caused by Haemophilus Influenzae Type B (HiB).
    • Notable for its rapid onset.

Signs and Symptoms of Epiglottitis

  • Key symptoms associated with epiglottitis include:
    • Drooling: Indicative of swallowing difficulty.
    • Dysphagia: Difficulty in swallowing food or liquids.
    • Dysphonia: Difficulty in speaking or abnormal voice changes.
    • Respiratory Distress: Strain and discomfort while breathing.
    • Tripod Position: Characteristic position where the child sits upright, leaning forward to facilitate easier breathing.
    • Anxiety: Child often appears anxious due to difficulty breathing.
    • High Fever: Presence of significant fever.
    • Sore Throat: Pain experienced in the throat area.
    • Visual Symptoms: Examination may reveal a red and inflamed throat with a large, cherry-red epiglottis.

Medical Care for Croup and Epiglottitis

  • Medications and Interventions:
    • Administering beta agonists (e.g., albuterol) and beta-adrenergics (e.g., epinephrine) through a facemask to relieve bronchospasm.
    • Corticosteroids: Not recommended for acute attacks, but may be used at other times.
    • Oxygen Therapy: Utilizing an oxygen tent with a mask and monitoring via pulse oximetry.
    • Antibiotics: Specific to address the infection related to epiglottitis.
    • Endotracheal Tube: Should be kept at the bedside for emergencies involving epiglottitis.

Nursing Care for the Child with Croup and Epiglottitis

  • Observational Assessments:
    • Monitor for signs and symptoms of respiratory distress.
    • Regularly assess respiratory rates to identify any changes.
    • Keep track of elevated temperatures, indicating potential infection.
  • Safety Protocols:
    • The child must NEVER be left alone due to the risk of rapid deterioration.
    • Avoidance of Oral Ingestion: Nothing should be placed in the child's mouth to prevent potential laryngeal spasms, which could exacerbate the situation.

Nursing Diagnoses and Management

  • Prioritization of Nursing Diagnoses: List priority nursing diagnoses relevant to the child's condition, state expected outcomes, and specify interventions.
    • Include necessary patient/family education relating to care and condition management as part of the nursing plan.