Chapter 23: Acute Epiglottitis (Supraglottitis)

Question 1

What is Acute Epiglottitis (Supraglottitis)

Answer 1

(CROUP)
sudden, potentially lethal condition; MEDICAL EMERGENCY
-characterized by high fever, sore throat, dyspnea, and rapidly progressing respiratory obstruction
-serious obstructive inflammatory condition that requires immediate attention

Question 2

Nursing Insight: Epiglottitis Example

Answer 2

Common Scenario:

• child goes to bed asymptomatic and awakens with complaints of sore throat and pain or swelling accompanied by a febrile state
• the classic sign of acute epiglottitis is when the child sits upright in a tripod position with the chin thrusted out (sniff position)
• the child’s mouth is open with drooling, a protruding tongue, and dysphagia
• child is irritable and restless with a thick and muffled voice and frog-like croaking sound on inspiration
• suprasternal and substernal retractions may be visible
• nurse notes that child breathes slowly, throat is red and inflamed, and there is a large, cherry-red, edematous epiglottis

Question 3

Classic Sign of Acute Epiglottitis

Answer 3

when the child sits upright in a tripod position with the chin thrusted out (sniff position)

Question 4

Symptoms that Warrant Hospitalization

Answer 4

• progressive stridor
• severe stridor at rest
• respiratory distress
• hypoxia
• depressed mental status (confusion, altered level of consciousness)

Question 5

Diagnosis

Answer 5

• blood cultures are ordered to identify the causative organism
• a radiograph of the lateral neck may present with the “thumb sign”, which describes the x-ray appearance of the epiglottis
• classic symptoms present

Question 6

Prevention

Answer 6

• routine immunization of Hib

- good handwashing, proper tissue disposal, and covering of the nose and mouth when coughing to prevent the spread

Question 7

What to do if Epiglottitis is Suspected

Answer 7

• DO NOT attempt to visualize the throat with a tongue blade b/c this may cause a laryngospasm leading to an immediate airway occlusion
• if provider decides to do a direct laryngoscopy, the nurse prepares for tracheal intubation b/c of potential for airway occlusion; insertion of an artificial airway may rapidly improve the child’s respiratory status

Question 8

Nursing Care

Answer 8

-goal is maintaining the airway and providing adequate respiratory exchange
-nurse stays at the child’s side to reduce child and parent anxiety, observes for worsening symptoms, and helps the child maintain a position that supports maximum airway and respiratory exchange
-Key areas of Nursing: maintaining the airway, providing rest and humidification, monitoring fluid balance, and administering medications as prescribed
>changes in condition are based on observations and assessment of the child’s response to therapy, including careful observation of the child’s response to his or her surroundings (changes in level of consciousness)

Question 9

Medical Care

Answer 9

-cool mist; a high-humidity, cool air vaporizer may be used at home in child’s room
-oxygen hoods for infants
-oxygen tents for toddlers
>cool mist is thought to moisten airway secretions to facilitate clearance, soothe inflamed mucosa, and provide comfort and reassurance to the child thereby lessening anxiety
-Nebulized racemic epinephrine (Micronefrin or Vaponefrin) or l-epinephrine are equally effective to cause mucosal vasoconstriction and decrease subglottic edema this relieving symptoms; indicated for those with moderate to severe stridor at rest or when stridor does not respond to cool mist
>observe the child after nebulization to assess the airway and side effects of the medication
-corticosteroids= to decrease edema in the laryngeal mucosa through their anti-inflammatory action (IM dexamethasone and nebulized budesonide)
-antibiotic therapy for epiglottitis (combinations of ampicillin and sulbactam)

Question 10

Education/ Discharge

Answer 10

• instructed on the use of cool-mist humidification; use of a steamy bathroom to help modify respiratory symptoms
• if hospitalized and discharged on medications, parents need instruction on compliance and proper administration and dosage of medications
• instructed on symptoms of potential side effects of the medications
• symptoms of worsening condition (increased signs of respiratory distress, restlessness, confusion)