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Terms in this set (49)
Croup is characterized by
hoarseness, "barking" cough, inspiratory stridor and varying degrees of respiratory distress resulting from swelling in or obstruction in the region near the larynx.
Croup syndromes effect what 3 areas?
Larynx, trachea and bronchi
5 Croup syndromes
*Acute LTB (Laryngotracheobronchiti)
*Acute Spasmodic Laryngitis (Midnight Croup)
The cause of most cases of croup are?
Viral. This is due to the widespread immunization program aimed at H. Influenza type b using the Hib vaccine.
Acute Epiglottis typical age range?
2yrs to 8 yrs
Is Acute Epiglottis usually viral or bacterial in nature?
bacterial. Specifically H. Influenze type b.
Describe the type of obstruction involved with Acute Epiglottis?
It is Supraglottic, as opposed to subglottic obstruction of laryngitis.
The onset of epiglottis is abrupt and can rapildy progress to severe respiratory distress. T or F?
Clinical manifestations of Acute Epiglottis?
Dysphagia, Stridor worse supine (Child often sits upright in tripod position), Drooling (due to difficulty swallowing or pain), Agitation, Voice is thick and muffled (not hoarse). High Fever, Rapid pulse, respiration. sore throat. Absence of cough
3 clinical observations that are predictive of epiglottis are:
Absence of spontaneous cough, presence of drooling, and agitation.
A child who is suspected of having epiglottis should be examined in a setting where emergency airway equipment is availabe. T or F.
Use a tongue depressor to examine child suspected to have epiglottis as soon as you, an inexperienced nurse suspect it. True or False.
False. Examination is contraindicated until experienced personnel and equipment are available to proceed with immediate intubation or tracheostomy in the event the examiniation precipitate further obstruction.
Therapeutic management of epiglottis include:
Airway protection, humidified oxygen, administration of racemic epinephine or mix or helium and O2, corticosteroids to reduce edema, reassurance, fluids.
Nursing care management of epiglottis includes
avoid throat inspection, act quickly and calmly, allow child to stay in position of most comfort to try to decrease anxiety, reassure parents, child. Get intubation equipment, Hib Vaccination.
Acute laryngitis is a common illness in
older children and adolescents
When are steroids used when extubation occurs in episodes of acute epiglottis?
24 hours before extubation and 2 to 3 days after
Acute laryngitis is usually caused by:
A virus (RSV, rhino, adeno)
Acute laryngitis is supraglottic or subglottic?
Clinical manifestations of laryngitis?
rhinitis, sore throat,nasal congestion, principal complaint is hoarsenes (no stridor or lung sounds)
Therapeutic management of laryngitis?
Disease is self limiting, treatment is symptomatic with fluids and humidified air.
Acute LTB (Laryngo-tracheo-bronchitis primarily affects who?
Infants, child under 5 years old.
is Acute LTB caused by viruses or bacteria and which type of virus or bacteria?
Virus. parainfluenza type 1 and 2, RSV, etc)
Clinical manifestations of Acute LTB?
Preceded by URI which gradually descends, low grade fever, barky brassy cough, stridor, hoarseness, dyspnea, restlessness, irritability, hypoxia, suprasternal retractions
Describe Acute LTB stridor and why it occurs:
Inflammation of mucosa lining of larynx and trachea causes narrowing of airway. Child struggles to inhale past the obstruction into the lungs; producing stridor and suprasternal retractions
Respiratory distress in infants and toddlers associated with Acute LTB manifested by?
nasal flaring, intercostal retractions, tachypnea, continuous stridor
Typical child with LTB, describe them
Toddler who develops classic barking and sal like cough and acute stridor after several days of rhinitis. When child can't inhale enough air, hypoxia develops
Therapeutic management of Acute LTB
High humidity, racemic epinephrine (used when child has stridor at rest, retractions or difficulty breathing), corticosteroids (dexamethasone), heliox, fluids, reassurance
Nursing management of Acute LTB
Teach parents signs of respiratory distress, continuous assessments, intubation equipment standing by, give parents reassurance.
mild croup can be described in relation to stridor as:
No stridor at rest
Stage 1 of Acute LTB
Fear, hoarseness, croupy cough, inspiratory stridor when disturbed
Stage 2 of Acute LTB
continuous stridor, lower rib retraction, retraction of soft tissue in neck, labored respiration
Stage 3 of Acute LTB
Signs of anoxia and CO2 retention, restlessness, anxiety, pallor, sweating, rapid respirations
Intermittent cyanosis, permanent cyanosis, cessation of breathing
Children who reach stage II of Acute LTB should
receive medical attention.
Acute spasmodic Laryngititis is also called
Acute spasmodic laryngitis affects typically...what age range?
1 yr to 3 yrs old
What causes Acute spasmodic laryngitis
Virus, with some allergy involvement in some cases
Describe Acute spasmodic laryngitis
Child goes to bed feeling well. Wakes suddenly with barking cough, hoarseness, noisy inspirations and restlessness. Child becomes anxious, frightened. No fever. Attack subsides in a few hours. Child appears well the next day
Symptions of spasmodic laryngitis
URI, Croupy cough, stridor, hoarseness, dyspnea, restlesness, night time occurrence.
Therapeutic management of spasmodic laryngitis
Usually self limiting, most can be managed at home. Cool mist humidifier, steam from shower, sudden exposure to cold air. Steroids are used in some cases
Bacterial Tracheitis affects what age group? What is it?
1 month to 6 years (but book says < 3 yrs); It is infection of the mucosa of the upper trachea. Features of both croup and epiglottis.
What causes Bacterial Tracheitis?
Bacteria obviously but specifically, usualy staphylococcus aureaas
What is Bacterial Tracheitis thought to be a complicaiton of?
Manifestations of Bacterial Tracheitis?
Those similar to Acute LTB but it is unresponsive to treatments used in LTB. URI, croupy cough, purulent secretions (which can result in respiratory distress), high fever 104, 105
Therapeutic management of Bacterial Tracheitis
vigorous management with antipyretics and antibiotics., endotracheal intubation and mechanical ventilation, fluids
Nursing management of Bacterial Tracheitis
Airway management (frequent trach suctioning to prevent airway obstruction), continous assessment, humidified oxygen
How can Bacterial Tracheitis be a complication of Acute LTB?
LTB is viral in nature but Bacterial Tracheitis is bacterial infection that can occur due to lowered immune system response).
Bacterial Tracheitis has no response to LTB therapy. T or F
True. Ony thing that works is antibiotics. Probably have to be intubated, once swelling decreases, extubate and hydrate and give antipyretics.
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