What is the nurses priority action when caring for a child with acute laryngotracheobronchitis
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Show Respiratory illness is a common reason for parents or care givers to access primary healthcare settings. Croup or laryngotracheobronchitis is an acute respiratory condition that causes distress and concern1. Croup affects approximately 3% of children between the ages of 6 months and 3 years but can also be diagnosed in older children and young people, although this is less frequently observed in this age range2. The peak incidence for croup is in the 2-year age group mainly because of changes in their immunity status and the fact that they have a relatively small subglottic space1. Of this figure 6% may need hospital admission. However this is only approximate as treatment using corticosteroids and nebulised adrenaline, introduced as treatment in the 1990s, may have influenced this number3, 4. The majority of parents and care givers therefore, are accessing healthcare services with children who have mild to moderate croup and these patients can be safely managed at home with support and guidance5. As croup is most prevalent from September to December1, admission to hospital should not always be considered as the first line of treatment, especially for children with a diagnosis of mild croup, as pressure for beds increases at this time of year.
VOL: 101, ISSUE: 03, PAGE NO: 30 What is it?- Croup is the common name for laryngotracheitis (inflammation and narrowing of the larynx, trachea and bronchi caused by viral infection). - It reduces airflow, causing breathing difficulty. - It affects children aged six months to six years and boys are more commonly affected than girls. - It occurs mainly in winter or early spring, usually in epidemics. Symptoms- Mild fever. - A harsh ‘barking’ cough. - Hoarseness. - Difficult, painful breathing, especially on inhaling. - Inspiratory stridor (rasping) on inhalation, coughing or crying - usually only seen in severe cases, but can happen when the child is sleeping or resting. - Symptoms often worse at night. - They usually diminish after three days, although a mild cough may persist for a further week. - If the child has serious breathing difficulties, the soft tissues of the neck and the area below the ribcage may pull inwards during attempts to inhale; the child may also be cyanotic. Causes- Croup is commonly caused by the parainfluenza virus; other viruses such as measles or the influenza virus may also cause it, but do not always lead to breathing difficulties. - It is spread through airborne droplets or by touch. - Children born prematurely or with narrow upper airways are more prone to croup. - Rarely, it is caused by bacteria or an allergic reaction. - Incidence of life-threatening, bacterially mediated croup declined significantly when diphtheria and Haemophilus influenzae type B vaccines became available. Diagnosis- Diagnosis is on the basis of symptoms, especially the characteristic cough and appearance of the throat. - The child should also be checked for fever, cold symptoms or recent viral illness. - If symptoms are severe and do not respond to treatment, a neck X-ray may be necessary to rule out other conditions such as epiglottitis or a foreign object stuck in the throat. Treatment- Most children recover without medical treatment. - The condition can be distressing and parents should try to keep the child calm. - Sitting upright or carrying the child in cool fresh air can aid breathing. - Plenty of cool drinks will prevent dehydration. - If the child has a fever, paracetamol liquid (Calpol or Disprol, for example) or ibuprofen should be given. - The child’s clothing can be removed if the room is warm. - Cough medicines that cause drowsiness should be avoided. - The child should avoid smoky environments. Rare complications- Severe croup may lead to life-threatening airway obstruction, when admission to hospital for ventilation is required. - Children born prematurely or those with a history of lung disease, such as asthma, may develop severe breathing difficulties requiring hospital treatment. - Some children show allergic reactions to the croup virus, such as redness, swelling and respiratory distress. - Some develop secondary infections such as an ear infection or pneumonia. Prevention- Regular handwashing can help prevent transmission by touch. - Avoiding contact with people with respiratory infections can help prevent airborne transmission. Websites Kids Health: www.kidshealth.org/parent/infections/bacterial_viral/ croup.html NHS Direct: www.nhsdirect.nhs.uk Prodigy: www.prodigy.nhs.uk When caring for a child with croup the priority nursing action should be to?Nursing treatment for a child with croup must focus on: Humidified air. Cool mist from a humidifier and/or sitting with the child in a bathroom (not in the shower) filled with steam generated by running hot water from the shower, help minimize symptoms. Antipyretics.
Which intervention would the nurse perform when caring for an infant with RSV infection?Nursing interventions for a child with RSV are: Use of humidified air. Keep the room warm but not overheated; if the air is dry, a cool-mist humidifier or vaporizer can moisten the air and help ease congestion and coughing; be sure to keep the humidifier clean to prevent the growth of bacteria and molds.
Which safety measure would be taken in terms of handling the oxygen o2 )?Never place the tank or machine near an open flame (e.g., matches, lit candles, a stove in use). Keep the oxygen tank at least six feet away. Always turn your oxygen off when not in use. Always check the oxygen levels on your oxygen tank.
What is croup nursing?- Croup is the common name for laryngotracheitis (inflammation and narrowing of the larynx, trachea and bronchi caused by viral infection). - It reduces airflow, causing breathing difficulty. - It affects children aged six months to six years and boys are more commonly affected than girls.
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