A nurse is assessing the respiratory status of a client who has suffered a fractured rib. The nurse would expect to note which of the following?
1. Slow deep respirations
2. Rapid deep respirations
3. Paradoxical respirations
4. Pain, especially with inspiration
Respiratory Disorders
EPIGLOTTITIS
Description
Bacterial form of croup
Inflammation of the epiglottis occurs, which may be caused by Haemophilus influenzae type b or Streptococcus pneumoniae; children immunized with H. influenzae type b (Hib vaccine) are at less risk for epiglottitis.
Occurs most frequently in children 2 to 8 years old, but can occur from infancy to adulthood
Onset is abrupt, and the condition occurs most often in the winter.
Considered an emergency situation because it can progress rapidly to severe respiratory distress
Assessment
High fever
Sore, red, and inflamed throat (large, cherry red, edematous epiglottis) and pain on swallowing
Absence of spontaneous cough
Drooling
Agitation
Muffled voice
Retractions and child struggles to breathe
Inspiratory stridor aggravated by the supine position
Tachycardia
Tachypnea progressing to more severe respiratory distress (hypoxia, hypercapnia, respiratory acidosis, decreased level of consciousness)
Tripod positioning: While supporting the body with the hands, the child leans forward, thrusts the chin forward and opens the mouth in an attempt to widen the airway
Interventions
Maintain a patent airway.
Assess respiratory status and breath sounds, noting nasal flaring, the use of accessory muscles, retractions, and the presence of stridor.
Assess temperature by the axillary route, not the oral route.
Monitor pulse oximetry.
Prepare the child for lateral neck films to confirm the diagnosis (accompany the child to the radiology department).
Maintain NPO status.
Do not leave the child unattended.
Avoid placing the child in a supine position because this position would affect the respiratory
status further.
Do not restrain the child or take any other measure that may agitate the child.
Administer intravenous fluids as prescribed; insertion of an intravenous line may need to be delayed until an adequate airway is established because this procedure may agitate the child.
Administer intravenous antibiotics as prescribed; these are usually followed by oral antibiotics.
Administer analgesics and antipyretics (acetaminophen [Tylenol] or ibuprofen [Motrin]) to reduce fever and throat pain as prescribed.
Administer corticosteroids to decrease inflammation and reduce throat edema as prescribed.
Nebulized epinephrine (racemic epinephrine) may be prescribed for severe cases (causes mucosal vasoconstriction and reduces edema); heliox (mixture of helium and oxygen) may also be prescribed to reduce mucosal edema.
Provide cool mist oxygen therapy as prescribed; high humidification cools the airway and decreases swelling.
Have resuscitation equipment available, and prepare for endotracheal intubation or tracheotomy for severe respiratory distress.
Ensure that the child is up to date with immunizations, including Hib conjugate