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