NCLEX RN Practice Question # 399
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Respiratory Disorders
EPIGLOTTITIS
Description
- Bacterial form of croup
- Inflammation of the epiglottis occurs, which may be caused by Haemophilus influenzae type b or Streptococcus pneumoniae; children immunized with H. influenzae type b (Hib vaccine) are at less risk for epiglottitis.
- Occurs most frequently in children 2 to 8 years old, but can occur from infancy to adulthood
- Onset is abrupt, and the condition occurs most often in the winter.
- Considered an emergency situation because it can progress rapidly to severe respiratory distress
Assessment
- High fever
- Sore, red, and inflamed throat (large, cherry red, edematous epiglottis) and pain on swallowing
- Absence of spontaneous cough
- Drooling
- Agitation
- Muffled voice
- Retractions and child struggles to breathe
- Inspiratory stridor aggravated by the supine position
- Tachycardia
- Tachypnea progressing to more severe respiratory distress (hypoxia, hypercapnia, respiratory acidosis, decreased level of consciousness)
- Tripod positioning: While supporting the body with the hands, the child leans forward, thrusts the chin forward and opens the mouth in an attempt to widen the airway
Interventions
- Maintain a patent airway.
- Assess respiratory status and breath sounds, noting nasal flaring, the use of accessory muscles, retractions, and the presence of stridor.
- Assess temperature by the axillary route, not the oral route.
- Monitor pulse oximetry.
- Prepare the child for lateral neck films to confirm the diagnosis (accompany the child to the radiology department).
- Maintain NPO status.
- Do not leave the child unattended.
- Avoid placing the child in a supine position because this position would affect the respiratory
- status further.
- Do not restrain the child or take any other measure that may agitate the child.
- Administer intravenous fluids as prescribed; insertion of an intravenous line may need to be delayed until an adequate airway is established because this procedure may agitate the child.
- Administer intravenous antibiotics as prescribed; these are usually followed by oral antibiotics.
- Administer analgesics and antipyretics (acetaminophen [Tylenol] or ibuprofen [Motrin]) to reduce fever and throat pain as prescribed.
- Administer corticosteroids to decrease inflammation and reduce throat edema as prescribed.
- Nebulized epinephrine (racemic epinephrine) may be prescribed for severe cases (causes mucosal vasoconstriction and reduces edema); heliox (mixture of helium and oxygen) may also be prescribed to reduce mucosal edema.
- Provide cool mist oxygen therapy as prescribed; high humidification cools the airway and decreases swelling.
- Have resuscitation equipment available, and prepare for endotracheal intubation or tracheotomy for severe respiratory distress.
- Ensure that the child is up to date with immunizations, including Hib conjugate