NCLEX RN Practice Question # 399


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Respiratory Disorders



  • 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


  • 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


  • 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

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