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Croup Syndromes charactarized by:
- - Hoarseness
- – Brassy, barky cough
- – Inspiratory stridor
- – Varying degrees of respiratory distress
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Classifications of Croup
• Acute Epiglottitis or Acute Supraglottitis
• Acute Laryngitis
• Acute Laryngotracheobronchitis (Viral croup)
• Acute Spasmodic Laryngitis
• Bacterial Tracheitis
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Acute Epiglottitis
• Occurs primarily in
• Requires
• Onset is _________ and can progress QUICKLY to
children ages 2‐5 as a result of H flu
immediate attention
abrupt; respiratory distress
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if suspected epiglottitis then treat as
EPIGLOTTITS
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Clinical manifestations of epiglottitis
- Child awakens with a sore throat and pain when
• Sudden onset
- how do they look
• Insists on sitting in
• how will they act?
• Voice is
• may be visible
• Mild hypoxia may progress to
• Throat is
- cherry red epiglottis is
- swallowing
- Fever (102), “toxic‐looking”
- “tripod” position
- Drooling, irritability, restless, anxious
- muffled, froglike croaking on inspiration
- Retractions
- cyanosis
- red and inflamed,
- visible
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Therapeuitc Mgt for epiglottitis
- Presumptive diagnosis constitutes
• Emergency equipment must be
• Examination of throat with a tongue depressor is
• Intubation for _________, most often done in
• Swelling usually decreases after
• consider...
• Key to management is
- an emergency
- readily available
- contraindicated
- severe respiratory distress, OR (IV, labs, etc done in OR as well)
- 24 hours of antibx.
- Corticosteroids, Antipyretics
- prevention
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position for epiglottitis
whatever position they are most comfortable in
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emergency equipment to have available with epiglottitis
CR monitor, crash cart, ambubag
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Nursing Consideration with epiglottitis
- Intensive observation
- • Know the warning signs
- • Provide support to family members
- • Allow child to remain in a position of comfort
- • Continuous respiratory monitoring
- • Maintain IV
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Acute Laryngitis
- Usually caused by
• S/Sx include
• Disease is
• Treatment is
- viruses
- hoarseness, coryza, sore throat, nasal congestion, fever, headache, malaise
- self‐limiting
- symptomatic care with humidified air and fluids
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Acute Laryngotracheobronchitis
• Most often affects children
• Most often caused by
• Usually is preceded by
- <5 yrs old
- parainfluenza virus, RSV, Flu A and B, and mycoplasma pneumoniae
- URI
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Clinical Manifestations of Acute Laryngotracheobronchitis
- Gradual onset
• Significant narrowing of the airway leading to
• cough
• Can lead to
- of low grade fever
- inspiratory stridor and suprasternal retractions
- Barky, seal‐like
- respiratory failure
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Therapeutic Mgt of Acute Laryngotracheobronchitis
• Children with no stridor at rest are managed________; parents taught...
• Children with stridor at rest, retractions, labored breathing need
• for oxygen administration and humidification
• pharm
• hydration
• Position of
- at home and parents are taught signs and symptoms of respiratory distress
- medical attention
- Cool mist humidifier, croup tents
- Racemic epinephrine, corticosteroids, bronchodilators
- IV fluids or PO as indicated
- comfort, comfort care by parents
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Nursing considerations with Acute Laryngotracheobronchitis
- Continuous observation and accurate assessment
- • Cardiorespiratory monitoring is preferred
- • Intubation equipment must be readily available
- • Rest
- • Croup tent vs. parents lap or arms
- • Parental reassurance
- • Adequate hydration, nutrition, and EDUCATION!
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Acute Spasmodic Laryngitis
•AKA
• Characterized by
• Occurs primarily
• Signs of inflammation are
• Occurs in children ages
•_________ may be implicated
- “Spasmodic croup”
- paroxysmal attacks of laryngeal obstruction
- at night
- absent
- 1‐3 primarily
- Allergies
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Clinical manifestations of Acute Spasmodic Laryngitis
• Child goes to bed feeling
• Awakes suddenly with
• Child is
• Dyspnea aggravated by
• Attack subsides and child appears well
- well for the most part
- barking, metallic cough, hoarseness, noisy inspirations, restlessness
- anxious and frightened
- excitement
- the next day
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Therapeutic Management and Nursing Considerations of Acute Spasmodic Laryngitis
• Most children managed
• Cool mist in
• Warm mist from shower may
• If hospitalized, treatment similar to
• Close observation by
- at home
- child’s room
- alleviate
- LTB with humidity and possibly O2, racemic epi and corticosteroids
- parents, nursing staff
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Bacterial Tracheitis
• Infection of the
• Most often occurs
• Most often caused by
- mucosa of the upper trachea
- in children 1 month to 6 years
- staph aureus, H flu and group A ß‐hemolytic strep have been implicated
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clinical manifestations in Bacterial Tracheitis
• Airway obstruction can be
• Other signs and symptoms similar to
• History of
• Thick purulent tracheal secretions most often
- severe enough to cause respiratory arrest
- LTB but are unresponsive to treatment
- URI with stridor that is unaffected by position, fever, and toxicity
- the cause of respiratory difficulty
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