5 Croup Nursing Care Plans

Ineffective Airway Clearance

Croup is a viral infection that causes inflammation of the upper airways, leading to the narrowing of the air passages. This narrowing makes it difficult for the child to breathe, and can also make it harder to effectively clear mucus and other secretions from the airways. Additionally, the cough reflex can be impaired due to the inflammation, further contributing to ineffective airway clearance.

Nursing Diagnosis

• Ineffective Airway Clearance

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

• The client will maintain clear, open airways as evidenced by normal breath sounds, normal rate and depth of respiration, and the ability to effectively cough up secretions after treatments and deep breaths.

Nursing Assessment and Rationales

1. Observe the sound of a cough.
Grunting is produced during expiration by a premature glottic closure. It is an effort to maintain or increase functional residual capacity.

2. 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.

Nursing Interventions and Rationales

1. Advise increase fluid intake and maintain intravenous fluid as prescribed.
Adequate hydration can help loosen mucus in the oropharynx and prevent dehydration.

2. 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 repositioning prevents the pooling and stasis of secretions.

3. 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 decrease the viscosity of the mucus thus helping in clearing the airway.

4. Perform chest physiotherapy as indicated.
Promotes expansion of the lungs, strengthens respiratory muscles, and mobilization of secretions.

5. Administer the following medications:

• 5.1. Racemic epinephrine
  Epinephrine produces bronchodilation and widens the lumen of the airway.

• 5.2. Corticosteroids (Inhalation)
  Decreases both laryngeal mucosal edema; Suppresses inflammation and normal immune response.