Croup

CroupCroup

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Respiratory Disorder

Croup

Croup•is not a DISEASE but a group of disorders typically involving a barking cough, hoarseness and inspiratory stridor.

• shrill, harsh resipatory sound produced by an obstruction of the trahea/larynx that heard during inspiration and expiration.

•Syndrome is infection of the larynx, trachea, and large bronchi.•Inflammatory process associated with infection leads to airway obstruction.•Disease most commonly affects infants and small children between 3 months and 3 years of age and occurs in the winter months.

Types of Croup

Laryngotracheobronchitis (LTB)characterized by an acute viral infection of larynx, trachea,

bronchi which causes obstruction below the level of the vocal cords.

 Spasmodic laryngitis (Spasmodic Croup)sudden onset, occurring mainly at night and characterized

by laryngeal obstruction at the level of vocal cord caused by viral infections/allergies.

 Bacterial tracheitis less common than laryngotracheobrochitis and spasmodic

croup. It progress from upper respiratory tract infection and may be confused with laryngotracheobronchitis because of similar manifestations

 Epiglottitis is swelling of the tissues above the vocal cords, that is,

supraglottic swelling, that result in narrowing of the airway inlet, with the possibility of total obstruction.

 

Spasmodic Laryngitis

Laryngothraceobronchitis Epiglottitis Bacterial tracheitis

Age usually affected

1-3 years old 3 months-3 years old 3-7 years old 1 month- 6 years old

Location of swelling and inflammation

Subglottic(below the vocal cords).

Vocal cords, subglottic, and tissue below vocal

cords, including bronchi.

Supraglottic(above the vocal

cords).

Mucosa of the upper trachea.

Causes Viral, emotional or genetic

predisposition.

Usually viral but may be bacterial.

Bacterial(usually H. influenza,

type B).

Staphylococcus(most common).

Assessment Sudden onset, usually at night.

Child awakens with harsh cough,

insiparatory stridor, dyspnea, and hoarseness.

Gradual onset, usually at night.

Child awakens with harsh cough and insiratory

stridor.

Sudden onset, which may

rapidly progress to complete

airway obstruction and

death.Sore throat,

dyspnea, high fever.

Progresses from upper respiratory infection

(1-2 days).High fever

StridorCroupy cough

Purulent secretion

Severe CroupAlthough most cases of croup are mild and can be

treated with home treatments, some children do have more severe symptoms and do need immediate medical attention when they began having croup symptoms.

These more severe symptoms can include: difficulty breathing or stridor when your child is

sleeping, calm, or not agitated having croup and being very fussy drooling and having trouble swallowing being very pale or having a bluish discoloration of his

fingernails or around his mouth

Tracheostomy performed in severe cases

pathophysiology

Croup is a viral infection of the upper airway. Although the entire upper, or nonreactive, airway is involved to some extent in all forms of croup, each type is named according to the anatomic area most severely involved.

For example, Laryngotracheobronchitis affects the larynx, trachea, and bronchi. In spasmodic croup, larynx is the area of most severe inflammation.

In all forms of croup. Mucosal inflammation and edema cause narrowing of the airway.

This narrowing is more dangerous in infants and young children than adults because of their small airway diameter and flexible larynx, which more susceptible to spasm.

 

Mucosal inflammation and edema narrow airway

Sudden onset of harsh, metallic cough, inspiratory stridor or hoarseness

Respiratory distress

substernal or suprasternal agitation pallor or cyanosisretractions

Increased heart rate, extreme restlessness

Hypoxia

Nursing Diagnosis

Ineffective Airway ClearanceRisk for Deficient Fluid VolumeIneffective Breathing Pattern Disturbance Sleep Pattern

Assessment Findings (signs and symptoms)

Croup often begins at night and may be preceded by several days of symptoms of upper respiratory tract infection.

Laryngotracheobronchitis have fever usually high as 40 Celsius or 104 Fahrenheit.

Spasmodic Croup don't have fever.The sudden onset of a harsh, metallic barky cough, sore throat;

inspiratory stridor; and hoarseness.The use of accessory muscles to breathe; DOB Frightened appearanceAgitationCyanosisMuffled voiceSpontaneous cough Colds progressing to hoarsenessAgitationMuffled voices

 

Diagnostic Test Findings

• Chest/Neck X-Ray: differentiate between croup disorders and epiglottitis.

• Throat Culture: reveals identifies infectious agent and sensitivity to specific antimicrobial therapy.

• Arterial Blood Gases: reveal hypoxemia state that require oxygen therapy; decreased pH, and changes in oxygen and carbon dioxide levels, indicating respiratory acidosis or failure in severe cases.

• Complete Blood Count: reveals increased WBC if infection present.• pulse oximetry - an oximeter is a small machine that measures the

amount of oxygen in the blood. To obtain this measurement, a small sensor (like a Band-Aid®) is taped onto a finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.

Medical Management

• Antipyretics: acetaminophen to reduce fever; ibuprofen(nonsteroidal

anti- inflammatory) for children 6 months to 12 years; to decrease fever and inflammation.

• Bronchodilators: racemic epinephrine inhalant given by nebulizer or intermittent positive pressure breathing device (IPPB) to relax respiratory smooth muscle and relive stridor respirations.

• Corticosteroids: to reduce inflammation and edema around the vocal cords.

• Antibiotics: selecting antibiotics dependent on culture sensitivity results.• Oxygen Therapy: treats hypoxemia based on reduced pO2 levels of ABGs,

administered by tent or hood.

Nursing Management • Airway• Assess respiratory status• Assess temperature • Do not visualize• Prepare for lateral neck films• NPO status• Don’t leave the child unattended• Don’t restrain• IV fluids • Resuscitation equipment available • Immunization (Haemophilus type B)• Imperative to keep child and family calm• Facilitate breathing and oxygenation

Special considerationsAt home treatment, take your child into the

bathroom, close the door and turn on all of the hot water (don't leave your child unattended around hot water though). As the room gets "steamy," it should help to relieve your child's symptoms decreases swelling. Cool mist therapy moistens secretions, facilitates expectoration, and has vasoconstriction benefits.

Close monitoring of the breathing of a child with croup is important, especially at night.

Antibiotic are not indicated unless a bacterial infection is present.

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