5 Epiglottitis Nursing Care Plans

Ineffective Airway Clearance

Epiglottitis is a condition where the epiglottis, which covers the trachea during swallowing, becomes swollen and obstructs the airway. This obstruction can lead to ineffective airway clearance due to the increased production of mucus and edema in the upper airways, making it difficult for the patient to breathe properly.

Nursing Diagnosis

• Ineffective Airway Clearance

May be related to

• Obstruction associated with edema and excessive mucus production in the upper airways

Possibly evidenced by

• Sudden high fever
• Muffled voice
• Sore throat
• Dyspnea
• Drooling
• Dysphagia
• Decreased breath sounds
• Rapid breathing with respiratory distress
• Bright red epiglottis with edema

Desired Outcomes

• The child’s airway will maintain a patent airway with improved airway clearance, as evidenced by clear breath sounds, normal respiratory rate, and adequate oxygenation.
• The child will demonstrate a reduction in signs and symptoms of respiratory distress, such as retractions, and the use of accessory muscles.

Nursing Assessment and Rationales

1. Assess respiratory rate, effort, pattern, and depth.
Nasal flaring, rapid breathing, dyspnea, chest retractions, and apnea are signs of severe respiratory distress that may require immediate airway support. These symptoms may indicate that the patient is struggling to breathe and may require interventions such as oxygen therapy, mechanical ventilation, or airway management.

2. Auscultate lungs for the presence of normal or adventitious lung sounds.
Absent or decreased lung sounds may reveal the presence of a mucous plug or airway obstruction. Stridor is a late ominous sign of epiglottitis that indicates emergency airway management.

3. Use pulse oximetry to monitor oxygen saturation; assess arterial blood gases (ABGs).
Pulse oximetry is used to detect changes in oxygenation. Oxygen saturation should be maintained at 90% or greater. Alteration in ABGS may result in increased pulmonary secretions and respiratory fatigue.

Nursing Interventions and Rationales

1. Encourage oral intake by offering warm, clear fluids.
Adequate hydration liquefies thick mucus/secretions.

2. Position the child in a sitting up and leaning forward position with mouth open and tongue out (“tripod” position).
Allows maximum entry of air into the lungs for improved oxygenation.

3. Keep suction equipment readily available.
Suction equipment should be readily available at the bedside to clear any secretions or debris that may obstruct the airway.

4. Advice parents to limit the patient’s activities such as excessive movement or talking.
Any activity that causes the patient to become agitated can worsen respiratory distress by increasing the demand for oxygen.

5. Administer humidified oxygen
Children need moist air to decrease epiglottal inflammation and facilitate expectoration.

6. Administer IV antibiotics as ordered.
After obtaining blood and epiglottic cultures, second-or-third generation cephalosporins and beta-lactamase-resistant antibiotic should be started as soon as possible.

7. Administer corticosteroids (Dexamethasone) as ordered.
Corticosteroids work by decreasing inflammation and swelling in the upper airways, which can help to relieve the airway obstruction and improve breathing. Corticosteroids are often used in combination with antibiotics, which are also typically prescribed to treat bacterial infections that can cause epiglottitis.

8. Prepare for intubation or tracheostomy; Anticipate the need for an artificial airway.
An artificial airway is required to promote oxygenation and ventilation and prevent aspiration.