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Colin is 3 years old and is on your ward due to a croup episode. Describe the symptoms of croup and consider the anatomical differences between a child of 3 years and an adult’s upper airway. Discuss how you could communicate with him to prevent becoming more agitated.

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Croup or laryngotracheobronchitis is  a respiratory condition that is usually triggered by acute viral infection and obstruction of the upper airways (McCance and Heuter 2014).
Croup is a generic term applied to any condition producing inspiratory stridor.

Stridor- noise heard on breathing in when the trachea or larynx is obstructed. It tends to be louder and harsher than wheeze. (Martin and McFerran, 2008)

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Croup illnesses can be divided into two categories:

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Croup illnesses can be divided into two categories:

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1. Acute laryngotracheobronchitis- inflammation of the larynx, trachea, and bronchi. Most commonly occurs in children from 6 months to 3 years of age, with incidence at 2 years of age. In 85% of cases is caused by a virus, most commonly parainfluenza, however, other viruses such as influenza A virus, respiratory syncytial virus (RSV), rhinovirus, adenovirus, and rubella virus (measles).

2. Spasmodic croup-characterised by similar hoarseness, barking cough, and stridor, sudden onset usually at night. It often resolves as quickly as it develops and usually occurs in older children
(McCance and Heuter 2014).

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Symptoms:

·         Inspiratory Stridor

·         Barking Cough

·         Harsh cry / Hoarseness

·         Severe – Tachypnoea

·         Recession

·         Cyanosis

·         Restlessness

Infection begins in the upper respiratory tract and then slowly spreads down the tract (unlike cold, which stays in the upper respiratory tract).

Swelling affects the area around the child’s larynx (voice box) and into the trachea.

Croup may be accompanied by stridor, a high-pitched sound usually heard when the child breathes in (inspiration).

Boys seem to be more affected than girls and occurs more often in the autumn and winter

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https://youtu.be/-559Vvq4-fA

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What is Croup? Barking Cough & Treatment | Nurse Stefan

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anatomical differences between a 3 years and an adult’s upper airway

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anatomical differences between a 3 years and an adult’s upper airway

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Very contagious

Spread from person to person

Usually from nasal secretions and from fingers of the affected person

Most contagious in the first 3 days after symptoms begin

Viruses can last up to 5 hours on the skin and hard surfaces.

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Mild croup is largely self-limiting, but treatment with a single dose of a corticosteroid by mouth may be of benefit (e.g. dexamethasone)
Keep child calm, comfort them if they're distressed (crying can make the symptoms worse)
Sit the child in upright to ease their breathing and maintain airway
Give them plenty of fluids -Warm, clear fluids can help loosen mucus and take pressure off her vocal cords.

More severe croup (or mild croup that might cause complications) may need hospital admission; a single dose of a corticosteroid (e.g. dexamethasone or prednisolone by mouth). In hospital, dexamethasone (by mouth or by injection) or budesonide (by nebulisation) will often reduce symptoms; helps open child’s airways, allowing easier breathing.

For severe croup not effectively controlled with corticosteroid treatment, nebulised adrenaline/epinephrine solution 1 in 1000 (1 mg/mL) should be given with close clinical monitoring; the effects of nebulised adrenaline/epinephrine last 2–3 hours and the child needs to be monitored carefully for recurrence of the obstruction.
Oxygen- children with low oxygen and significant respiratory distress.
IV fluids can be given if dehydrated
They can deteriorate quickly – may need intubation

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Viral croup is cause primarily by subglottic oedema from the infection. The mucous membranes of the larynx are tightly adherent to the underlying cartilage, whereas those of the subglottic space are looser and thus allow accumulation of mucosal and submucosal oedema. The cricoid cartilage that is structurally the narrowest point of the airway are in critical condition due to oedema. The increase resistant in airflow leads to increased work of breathing, which generates more negative intrathoracic pressure, which in turn may exacerbate dynamic collapse of the upper airway.

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According to Piaget’s Pre-Operational Stage Two to seven years

•At three years they are unable to see things from someone else's point of view (do not have ‘theory of mind’).

•Piaget thought that pre-schoolers were unable to understand the world as they are intuitive and highly subjective.

•They fail to understand the underlying reality remains constant despite change in appearances (they ‘do not conserve’).

•Non-principled, non-logical thinking.

Interaction

play imaginative games; for example, pretending a block is a phone

can talk about things that are not present

take an interest in playing with words; for example, rhyming words

reading books-talk about the story and characters and make it exciting

singing, playing word games

play specialist can be included.

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Martin, E. and McFerran, T. (2008) Dictionary of Nursing. 5th ed. Oxford: Oxford University Press

McCance, KL, & Huether, SE 2014, Pathophysiology : The Biologic Basis for Disease in Adults and Children, Elsevier, Saint Louis. Available from: ProQuest Ebook Central. [14 November 2019].