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Laryng0 tracheal bronchitis (croup).
- 2. • DEFINATION: It is a chronic obstructive airway disease involving the larynx, trachea and bronchi. • A child has a characteristic symptom of a bark like cough known as CROUP. • Stridor is noisy breathing that occurs due to obstructed air flow through a narrowed airway. • wheezing is a high-pitched, continuous whistling sound heard during breathing.
- 3. CAUSES Viral • parainfluenza virus • Measles • adenovirus • Respiratory Syncytial Virus (RSV). Bacterial • Corynebacterium diphtheria • Staphylococcus aureus • Streptococcus pneumoniae • Hemophilus influenzae .
- 4. PATHOPHYSIOLOGY • The cough and other signs and symptoms of croup are the result of swelling around the larynx, trachea and bronchial tree (bronchi). The inflammation reduces the size of the tracheal lumen leading to dyspnea. Due to the inflammatory process, there's increase in secretion of mucus and fluid ,which further reduces the lumen and causes child to cough. • When a cough forces air through this narrowed passageway, the swollen larynx produces a noise similar to a seal barking. • Likewise, taking a breath often produces a high-pitched whistling sound (stridor). • Croup typically occurs in younger children. Croup usually isn't serious and most children can be treated at home.
- 6. SIGNS/SYMPTOMS • Inspiratory stridor and wheezing • Barking cough • Hoarseness and difficult breathing which usually worsens at night. • Flaring of the nostrils (nares) • The child looks anxious, frightened and restless due to fear and suffocation. • There is intercostal retraction (in drawing of intercostal and subcostal spaces during inspiration) •Low grade fever
- 7. DIAGNOSIS/INVESTIGATIONS -Sputum for m/c/s will isolate the causative microbe and the appropriate antibiotic -X-ray of the neck will show laryngeal oedema -Blood gases will show a reduced partial pressure of oxygen and increased partial pressure of carbon dioxide -Full blood count will show increased WBCs
- 8. TREATMENT • Oxygen therapy with high humidity preferably in a steam room or using a steam tent • Suctioning to remove the secretion in order to provide a clear air- way • Antibiotics e.g. Ampicillin ,amoxyl or septrin • Paracetamol 125-250 mg can also be given to reduce fever • Oral steroids ie prednisolone or IM dexamethazone to reduce on inflammation. • In severe cases, a tracheotomy may be performed for easy suctioning
- 9. SPECIFIC NURSING CARE • The baby should be nursed in a humidified room preferably in oxygen tent or steam kettle • Keep the baby warm and dry to promote comfort • Oxygen apparatus should be at hand ready for use when need arise and the suction machine in order to maintain a patent airway. • If a tracheotomy has been performed,ensure that the tube is not blocked by secretions
- 10. OBSERVATIONS • Observe restlesness,stridor,cyanosis and dyspnoea for improvement or deterioration • Be alert for s/s of suffocation from complete occlusion of the airway • If the child is on i.v line, observe the rate of flow and the insertion site • Be alert for on-set of dehydration
- 11. HYGIENE -The tracheostomy tubes must be washed regularly in sodium bicarbonate -Extra tracheostomy tube must be available at the bed side -Baths should also be provided atleast once a day -Nails should be kept short to prevent auto-infection -Linen should be changed when soiled -Nappies should be as well changed when soiled to promote comfort
- 12. PREVENTION OF SPREAD OF INFECTION • Any discharge from the tube must be cleaned immediately using the gauze swab and treated as infectious • Dissecting forceps must also be disinfected • General preventive measures apply • General nsg care for resp.conditions apply
- 13. COMPLICATIONS • Dehydration • Atelectasis • Pharyngitis • Septicemia • Pneumonia