Croup refers to a variety of conditions characterized by a harsh “barking” (croupy) cough, inspiratory stridor, hoarseness, and marked respiratory retraction. The condition usually affects infants and small children between 3 months and 3 years of age and occurs during the cold weather.
The most common form of croup is laryngotracheobronchitis (LTB). It is caused by an acute viral infection of the larynx, trachea, and bronchi resulting in the obstruction below the level of the vocal cords. Spasmodic croup is croup of sudden onset, developing at night and characterized by laryngeal obstruction at the level of the vocal cords caused by viral infections or allergens. Both occur as a result of upper respiratory infection, edema, and spasms that cause respiratory problems in varying degrees depending on the severity of obstruction.
Nursing Care Plans
Nursing care planning goals for a child with croup include maintaining airway clearance, demonstrating increased air exchange, relieving anxiety, decreasing fatigue, and (parental) management of the condition.
Here are five (5) nursing care plans (NCP) and nursing diagnosis (NDx) for croup:
Ineffective Airway Clearance
Nursing Diagnosis
May be related to
- Presence of thick, tenacious mucus
- Edema and constriction of the airway
Possibly evidenced by
- Persistent barking (croupy) cough
- Thick secretions
- Dyspnea
- Diminished breath sounds, with diffuse crackles and rhonchi
- Tachypnea, Tachycardia
- Hoarseness
- Hypercapnia, Hypoxemia
- Cyanosis
- Restlessness, irritability
Desired Outcomes
- Client will maintain clear, open airways as evidenced by normal breath sounds, normal rate and depth of respiration, and ability to effectively cough up secretions after treatments and deep breaths.
| Nursing Interventions | Rationale |
|---|---|
| Observe the sound of cough. | Grunting is produced during expiration by a premature glottic closure. It is an effort to maintain or increase functional residual capacity. |
| Assess the use of accessory muscles with nasal flaring | As the trachea and larynx become inflamed and swollen, a child with croup produces a bark-like cough and hoarse or muffled vocal sounds. When it progresses, the child may manifest further upper airway obstruction with severely compromised oxygenation. |
| Advise increase fluid intake and maintain intravenous fluid as prescribed. | Adequate hydration can help loosen mucus in the oropharynx and prevent dehydration. |
| Place the child elevated in a semi-Fowler’s to high Fowler’s position; Reposition the child frequently. | Facilitates breathing and maximal lung expansion by lowering the diaphragm. Frequent reposition prevents pooling and stasis of secretions. |
| Use a cool mist humidifier or allow a hot shower to run for 10 minutes until the bathroom becomes humid and steamy, then let the child sit or stand in the bathroom. | Cool mist and humidity soothe inflamed airways and decreases the viscosity of the mucus thus helps in clearing the airway. |
| Perform chest physiotherapy as indicated. | Promotes expansion of the lungs, strengthen respiratory muscles and mobilization of secretions. |
| Administer the following medications: | |
|
Epinephrine produces bronchodilation and widening lumen of airway. |
|
Decreases both laryngeal mucosal edema;Â Suppress inflammation and normal immune response. |
Excellent