Croup, also known as laryngotracheobronchitis, is a common respiratory condition in children characterized by a combination of symptoms including a barking cough, stridor (a high-pitched wheezing sound), and hoarseness.
It primarily affects young children, typically between 6 months and 3 years of age, and is usually viral in origin.
Causes
1. Viral Infections:
- Parainfluenza Virus: The most common cause of croup.
- Respiratory Syncytial Virus (RSV): Can also cause croup-like symptoms.
- Adenovirus and Rhinovirus: Less common but possible causes.
2. Other Factors:
- Bacterial Infections: Rarely, bacterial infections can lead to croup symptoms.
- Allergic Reactions: In some cases, allergies can exacerbate or mimic croup symptoms.
Pathophysiology
- Viral Infection: The infection typically starts in the upper respiratory tract and spreads to the larynx, trachea, and bronchi.
- Inflammatory Response: The viral infection triggers an inflammatory response, leading to edema and narrowing of the upper airway.
- Stridor: The swelling in the larynx causes a characteristic high-pitched, wheezing sound during inhalation.
- Barking Cough: The inflammation affects the vocal cords, resulting in a harsh, barking cough.
- Hoarseness: Inflammation of the larynx affects vocal cord function, causing voice changes and hoarseness.
Diagnostic Tests
1. Clinical Diagnosis: Diagnosis is typically based on clinical symptoms and history.
2. Radiological Tests:
- Neck X-ray: May be performed to rule out other conditions and show characteristic signs of croup, such as subglottic narrowing (steeple sign).
3. Laboratory Tests:
- Throat Cultures: To identify the causative pathogen if a bacterial infection is suspected.
- PCR Testing: Can detect specific viral pathogens.
Medical Management
1. Pharmacological Treatment:
- Corticosteroids: e.g., dexamethasone – reduce inflammation and improve symptoms.
- Nebulized Epinephrine: For severe cases, helps reduce airway swelling and improve breathing.
- Analgesics: e.g., acetaminophen or ibuprofen – to manage fever and discomfort.
2. Supportive Care:
- Hydration: Ensure adequate fluid intake to prevent dehydration.
- Humidified Air: Use of a cool-mist humidifier or steam inhalation to ease breathing and soothe the airway.
- Monitoring: Regular monitoring of vital signs, oxygen saturation, and respiratory status.
Nursing Implications
Assessment
- Collect information on the onset, duration, and severity of symptoms, as well as any recent illnesses or exposures.
- Assess for signs of stridor, barking cough, hoarseness, respiratory distress, and cyanosis.
- Monitor temperature, heart rate, respiratory rate, and oxygen saturation.
Diagnosis
- Impaired Gas Exchange related to airway inflammation and narrowing.
- Ineffective Airway Clearance related to swelling and mucus accumulation.
- Risk for Dehydration secondary to fever and decreased fluid intake.
Planning
- Develop an Individualized Care Plan to address the severity of symptoms, medication needs, and supportive measures.
- Plan to educate the family on the nature of croup, treatment options, and when to seek further medical attention.
Implementation
- Administer prescribed corticosteroids and nebulized medications as ordered.
- Provide humidified air, ensure proper hydration, and manage fever with appropriate analgesics.
- Continuously monitor the child’s respiratory status, response to treatment, and document any changes.
Evaluation
- Evaluate the reduction in symptoms such as cough, stridor, and respiratory distress.
- Watch for signs of worsening respiratory distress or signs that may indicate the need for further intervention.
- Ensure the family understands the management plan, including how to use medications and when to seek medical help.