Osmosis from Elsevier - Laryngotracheobronchitis (LTB) & croup: Nursing Process (ADPIE)
Sarah, a 2-year-old, is brought to the emergency department with symptoms of croup, including a barking cough and inspiratory stridor. Croup is a viral infection causing inflammation of the upper airway, common in children aged 3 months to 6 years. The transcript outlines the typical symptoms, causes, and seasonal occurrence of croup, as well as its transmission through respiratory droplets. Treatment focuses on airway management, using medications like racemic epinephrine and dexamethasone to reduce inflammation and improve breathing. The importance of monitoring respiratory status and ensuring adequate fluid intake is highlighted. The transcript also emphasizes educating parents on managing symptoms at home and recognizing when to seek further medical attention.
Key Points:
- Croup is a viral infection affecting the upper airway, common in young children, and characterized by a barking cough and stridor.
- Treatment includes medications like racemic epinephrine and dexamethasone to manage airway inflammation and improve breathing.
- Parents should be educated on home management, including keeping the child's head elevated and ensuring fluid intake.
- Monitoring respiratory status and oxygen saturation is crucial in managing croup effectively.
- Recognizing signs of respiratory distress and knowing when to seek medical help are essential for parents.
Details:
1. 🚨 Emergency Department Arrival
1.1. Sarah's Initial Symptoms and Progression
1.2. Pediatrician's Assessment and Emergency Referral
2. 🤒 Diagnosis of Croup
- Sarah presented with a barking cough, inspiratory stridor, and a respiratory rate of 42 per minute.
- The diagnosis is lingotracheobronchitis (LTB), commonly referred to as croup.
- Croup is characterized by inflammation of the upper airway and is typically viral in origin.
- Common viruses causing croup include parainfluenza, adenovirus, influenza A or B, and respiratory syncytial virus (RSV).
3. 🔬 Pathophysiology and Symptoms
3.1. Pathophysiology
3.2. Symptoms
4. 🩺 Clinical Presentation and Diagnosis
4.1. Symptoms
4.2. Diagnosis
5. 💊 Treatment and Management
- Focus is placed on airway management based on symptom severity.
- Inhaled bronchodilators, such as racemic epinephrine and albuterol, are common treatments to alleviate symptoms.
- Corticosteroids, like dexamethasone, are used to reduce inflammation and are critical in managing more severe cases.
- Antipyretics, including acetaminophen, are recommended to control fever associated with airway issues.
- Humidified supplemental oxygen is often employed to ensure adequate oxygenation and comfort.
- Intubation and mechanical ventilation are necessary interventions in cases of imminent respiratory failure to secure the airway and provide respiratory support.
- For mild cases, initial treatments focus on bronchodilators and corticosteroids, while severe cases may require more aggressive interventions such as mechanical ventilation.
6. 📝 Care Plan Development
6.1. Patient Symptoms and Assessment
6.2. Care Plan and Interventions
7. 🏥 Implementation of Care Plan
- Sarah should achieve an effective breathing pattern by shift-end, with normal respiratory rate, unlabored breathing, absence of Stridor and barking cough, and SpO2 above 92%.
- Ensure adequate fluid volume through moist mucous membranes and wet diapers.
- Decrease Sarah's fear, evidenced by calmness and easy respirations.
- Mrs. Little will understand home management for mild symptoms and when to seek medical attention.
- Keep Sarah on her mother’s lap for comfort; monitor respiratory status, vital signs, and oxygen saturation closely.
- Administer humidified oxygen and racemic epinephrine via nebulizer to improve oxygenation and airway opening.
- Give dexamethasone IM to reduce airway inflammation and acetaminophen for fever.
- As Sarah's respiratory status improves, offer flavored ice pops to encourage fluid intake.
- Instruct Mrs. Little to report if Sarah produces a wet diaper.
- Educate Mrs. Little on home management: emphasize fluid intake, acetaminophen for fever, head elevation, and cool air breathing at night.
- Highlight the importance of seeking immediate medical attention if symptoms return.
8. 📈 Evaluation and Discharge Planning
- Sarah is alert and comfortable, with no signs of respiratory distress, indicated by a respiratory rate of 32 per minute and oxygen saturation of 98% on room air.
- Sarah's condition has improved, shown by the absence of Strider, respiratory retractions, nasal flaring, and cough, and clear breath sounds upon auscultation.
- Her hydration status is adequate, indicated by three ice pops consumed, two wet diapers, and moist mucus membranes.
- Sarah's axillary temperature is stable at 98.8°F (37°C).
- Sarah's mother understands home management of the illness, signs of respiratory distress, and when to return to the hospital.
- A follow-up appointment with Sarah's pediatrician is planned 24 hours post-discharge.
- Initial assessment revealed symptoms of croup, including a barking cough, inspiratory Strider, fever, and dehydration.
- Nursing diagnoses included ineffective breathing pattern, fluid volume deficit, fear, and knowledge deficit.
- Care goals were effective breathing, adequate fluid volume, absence of fear, and parental understanding of the disease process and treatment.
- Nursing interventions are in place and will continue to be evaluated.