Acute Laryngotracheo Bronchitis-Infectious Croup-Croup is a syndrome characterised by brassy and hacking cough and varying degree of inspiratory stridor, hoarseness and signs of respiratory distress which is due to varying degree of laryngeal obstruction . It occurs more in females other then males and also occurs more in during cold months of the year than in summer. This condition usually take place in late infancy and the toddler period. There may be a family history:
There is inflammation, congestion and oedema of the mucosa and submucosa of the larynx, trachea and bronchi, which is associated with mucoid or mucopurulent discharge. This purulent exudate may produce crisis and obstruct the air ways.
It is caused by viruses: Parainfluenza virus, influenza virus, adenovirus and respiratory syncitial virus. It may also occur as a result of diptheria, pertusis and acute inflammation of epiglotis is due to streptococci.
On assessment of a child with croup you will find that child with croup presents with the clinical manifestations like, croupy cough, which may progress to respiratory distress with tachypnoea, inspirtory stridor, and hoarseness. There may be dyspnoea and respiratory distress evidenced by flaring of alae nasi, supraclavicular, epigastric and intercostal retractions and use of excessory
muscles of respiration, temperature is elevated, pulse is fast and poor in volume and respiration is rapid. Child is irritable, apprehensive and restless and may have difficulty in swallowing.
some children severity of this illness may progress rapidly and leading to shock and impaired consciousness. Diagnostic evaluation include laboratory examination and culture of the exudate, blood culture to rule out diptheria. Fluroscopy and bronchoscopy may be done to rule out aspirated foreign body.
Planning of Nursing Care
- Monitor and facilitate respirationJrespiratory effort
- Administer medication as prescribed
- Maintain hydration
- Promote rest
- Support and educate parents
See Also : Scope in Nursing Profession
Implementation of Nursing Care of Acute Laryngotracheo Bronchitis-Infectious Croup
Monitor and Facilitate Respiration
Monitor respiratory rate for depth and type and heart rate, observe the signs of distress; flaring of alae nasi and retractions, hoarseness; cough, cyanosis and pallor.Nurse the child in humid atmosphere to liquify secretions, hot steam or cool vapour may be used for this purpose. Usually cool vapour is preferred as it tends to reduce mucosal edema .
Give oxygen inhalation. Artificial airway may be inserted if child has airway obstruction. Change position every 2 hours to prevent pooling of secretions. Encourage older child to turn, cough and deep breathe every 2 to 4 hours. Give chest physiotheraphy as advised and suctioning may be needed.
Administration of Medication
In case of bacterial croup ampicillin is usually given. Viral infections do not respond to antibiotics. Corticosteroids (50 mg to 75 mg per kg) can be given as a means of diminishing the oedema and spasms of croup. Recemic epinephrine, (0.1 ml per kg) with or without intermittent positive pressure breathing helps relieve symptoms. You should monitor the heart rate during such treatment.
If the child is unable to take by mouth, and is in shock or the intake is less, then intravenous fluids are given tc prevent dehydration. high calorie liquids diets are given orally to child and record should be maintained. urine and hydration status should be assessed.
If the child is crying,then his oxygen demand will increased to conserve energy. Provide rest in fowlers position to facilitate respiration. Familiar toys should be used to relieve apprehension. Mild sedation is given to promote rest and sleep if needed. A quiet restful environment is important for child and nursing procedures should be carried cautiously to maximise rest periods.
Support and Educate the Parents
Keep the parents informed about the disease, its progress ahd treatment of the child. Allow them to remain with their child and express their feelings. Reassure them and involve them in care of the child. Educate them for importance of nutrition, fluids, rest and humidity at home.
The child who receives prompt care, usually progresses well.