Assessment
A 3yo presents with a barking cough and inspiratory stridor. Which finding indicates the condition is worsening?
Stridor heard at rest
Which symptom helps differentiate LTB from epiglottitis?
Absence of drooling
Which medication should the nurse anticipate for immediate airway relief?
Racemic epinephrine nebulizer
Which nursing action prevents further airway swelling?
Keeping the child calm and minimizing crying
True or false:
The sypmtoms will likely get better at night and see over all improvement over the next several days
FALSE
Symptoms get WORSE at night but better within a few days
Which assessment finding requires immediate intervention?
Increasing intercostal retractions with decreased air entry.
A parent reports that symptoms worsen at night and improve with cool air. This is consistent with...?
Viral Croup (LTB)
A child with LTB is ordered dexmethasone. What rationale supports this treatment?
Reduces laryngeal edema and prevents symptom recurrence
Which positioning is most appropriate for a child with respiratory distress from LTB?
Upright or in parent's arms to reduce the work of breathing and to promote comfort
If _________ happens, parents should seek immediate emergency care.
Stridor at rest or difficulty breathing
The nurse anticipates which priority assessment after racemic epinephrine?
Rebound airway obstruction within 2-3 hours
Which clinical manifestation indicates moderate LTB?
Stridor only with agitation and mild retractions
The nurse receives an order for albuterol. What is the correct response?
Question order because the nurse knows it is NOT effective for upper airway obstruction
Which situation requires emergent intervention?
Cyanosis or decreased LOC
True or False:
Taking child outside in the cool evening air helps relieve mild nighttime symptoms?
TRUE
The cool air helps reduce airway swelling
A child with suspected LTB appears to be very anxious. Which assessment should the nurse avoid performing?
Inspecting the throat with a tongue depressor
A child suddenly becomes very quiet with decreased stridor. What does this suggest?
Airway obstruction is worsening
After racemic epinephrine, which action is most appropriate?
Monitor child for at least 3 hours for rebound stridor.
What is the priority action if the child starts having severe stridor and retractions?
Prepare for possible airway support and notify the provider immediately
A parent asks why the child isn't being sent home with antibiotics. What is the best response from the nurse?
Croup is typically viral. Antibiotics are NOT effective against viruses.
Which diagnostic test is appropriate if the child is stable and a diagnosis has not yet been confirmed?
AP neck x-ray showing steeple sign
Which finding is consistent with upper airway obstruction rather than lower airway disease?
Inspiratory stridor
The provider orders humidified oxygen. What is the primary goal of this treatment?
Reduce airway irritation and support oxygenation.
What should the nurse avoid to prevent laryngospasm?
Performing oral exams or cultures
Upon discharge, the parent is teaching back the information you gave, stating:
"He should be better in a few days, but he will be worse at night. If his cough quiets down, that means that his throat is less irritated and he's getting better."
What indicates the need for further teaching?
Quiet cough
This indicates increasing obstruction. Parents should seek help immediately!