5 Croup Nursing Care Plans


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:

  1. Ineffective Airway Clearance
  2. Ineffective Breathing Pattern
  3. Anxiety
  4. Fatigue
  5. Deficient Knowledge

Ineffective Breathing Pattern

Nursing Diagnosis

May be related to

  • Inflammatory process
  • Laryngotracheobronchial obstruction.

Possibly evidenced by

  • Barking, metallic sounding cough
  • Nasal flaring
  • Inspiratory stridor
  • Dyspnea
  • Tachypnea
  • Abnormal ABGs
  • Subclavicular and substernal retractions
  • Cyanosis or pallor
  • Restlessness, irritability

Desired Outcomes

  • Child will manifest adequate ventilation as evidenced by respiratory rate within parameters for age, absence of retractions, accessory muscle use, and grunting, clear breath sounds, and oxygen saturation >94%.
Nursing Interventions Rationale
Assess pulse, respiration, and auscultate lung sounds. An increasing pulse or respiratory rate, or a loud, high-pitched crowing breath sound (stridor) signifies decreasing oxygenation.
Monitor oxygen saturation using pulse oximetry; Assess arterial blood gases (ABGs) as ordered. Determines oxygenation status and enables early detection of hypoxemia/hypercapnia.
Observe changes in the level of consciousness. Restlessness, confusion, and irritability are early indicators of insufficient oxygen to the brain (hypoxemia).
Place the child in a comfortable upright position. Use pillows or padding if necessary. Ensure optimal ventilation through maximum lung expansion.
Allow adequate rest periods and stress the importance of keeping the child relaxed by cuddling. Incessant crying increases oxygen demands and respiratory muscle fatigue can worsen the airway obstruction.
Encourage clearance of secretions through gentle suctioning and coughing exercises. Promote airway clearance through mobilization of secretions.
Administer humidified supplemental oxygen via tent or hood as prescribed. Humidified oxygen promotes adequate oxygenation without drying the mucous membrane.
Administer corticosteroid (e.g., dexamethasone) and racemic epinephrine as indicated. Corticosteroids are used to help reduce airway inflammation and edema; Epinephrine shortened the duration of croup and need for intubation.

See Also

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