Laryngotracheobronchitis (Croup)

• Definition: An acute infection and inflammation of the larynx, trachea, and bronchi.
• Pathophysiology: Airway mucosa becomes swollen, decreasing airway diameter and greatly increasing the difficulty of respiratory effort.
• Etiology: Condition is often preceded by an upper airway viral infection. Common causative organisms are parainfluenza viruses and respiratory syncytial virus.
• Manifestations: Harsh, "barking" cough, inspiratory stridor, hoarseness, and tachypnea.
• Med Tx: High humidity (steam in bathroom for home treatment, croup tent if hospitalized), oxygen to maintain SaO₂ above 95%, aerosol administration of epinephrine, and IV fluids at 1½ times maintenance amount (see Pediatric Maintenance Fluid Calculation). Corticosteroids may be ordered.
• Nsg Dx: Ineffective airway clearance, potential fluid volume deficit, potential sleep pattern disturbance related to respiratory distress, anxiety.
• Nsg Care: Monitor VS and SaO₂ frequently. Assure proper fluid intake (see Med Tx). Encourage parent visitation to decrease anxiety and oxygen need. Keep excess humidity wiped from walls of croup tent. Change bedding as needed to keep the child dry and prevent chilling. Elevate head of bed.
• Prognosis: Croup can be life-threatening but usually resolves in 3 to 7 days.
• Attention: A condition that presents symptoms similar to croup (and is sometimes also called croup) is epiglottitis. This condition is caused by a bacteria. Its onset is sudden and it progresses rapidly. The child presents with fever, drooling, muffled voice, retractions, and refusal to lie down. This is a medical emergency, and the nurse should not attempt to examine the throat but should contact the physician immediately and prepare for insertion of an artificial airway (endotracheal tube or tracheostomy).