PART B: SCHOLOARLY WRITING PAPER

Student number: 823-018-478

Part B: Scholarly Writing Paper

Harshpreet Lobana
823-018-478
March 15, 2015
NURS 252 Complex Issues and Patient Safety

Humber College

PART B: SCHOLOARLY WRITING PAPER

Student number: 823-018-478

Introduction
Croup syndrome is the respiratory infection that causes an inflammation of upper airway
tract, resulting in an interference with normal breathing. Croup syndromes are described
according to the anatomical area that is affected by the bacteria or virus (Simoes, Cherian, Chow,
Shahid-Salles, Laxminarayan & John, 2006). In this case, 14 month old female child with
potential diagnosis of epiglottis is brought to Dr. Office by her mother. Client had a new onset of
fever that started 48 hours ago and is currently getting treated with acetaminophen drops. Client
is drooling with difficulty swallowing. She is always leaning forward and gets fussy when lying
flat. Vital signs taken and they are as follow: 38.7, 32, 95/60, and 92% on Room air. There is no
past medical history and all immunizations are up-to-date.
Pathophysiology
Epiglottitis is an inflammation of epiglottis, the flap present at the base of the tongue that
prevents the food from entering trachea. Inflammation can be caused from several organisms but
H. Influenzae is considered the most responsible micro-organism. This infection occurs
predominantly in children from 2 to 8 year of age but it can also affect other age groups (Perry,
Hockenberry, Lowdermilk & Wilson, 2013, pg. 1329). However, children under the age of 5 are
at increased risk for this infection due to their immature immune system and lack of antibodies
present to fight this infection. This condition is considered medical emergency in children
because of the location of epiglottis. In infants, epiglottis is located more on anterior and superior
side than adults. Furthermore, diameter of the airway is much smaller in children than adults. So,
even a mild inflammation of the airway puts the child at increased risk for complete airway
obstruction.

PART B: SCHOLOARLY WRITING PAPER

Student number: 823-018-478

Epiglottitis in children, requires immediate attention because prolonged obstruction can

cause hypoxia and hypercapnia. Accumulation of excess carbon dioxide can lower the levels of
blood pH, thus causing acidosis (Perry et al., 2013, pg. 1330). Respiratory acidosis can cause
respiratory arrest and inadequate supply of oxygen to the brain can cause death, in extreme cases.
Infants can also experience developmental delays if the infection is not treated and oxygen
supply remains limited. Therefore, at risk for airway obstruction is the priority concern for the
infant with the diagnosis of epiglottitis.
Clinical manifestation
Difficulty breathing as evident by infant leaning forward and O2 reading of 92% on room
air is the priority clinical manifestation. As mentioned above, inflammation of the epiglottis can
cause complete or partial airway obstruction. This obstruction can limit the oxygen delivery to
the lungs and carbon dioxide delivery out of the lungs (Perry et al., 2013). Because of the
obstruction, infants tend to lean forward in tripod position, so that adequate supply of O2 can
reach the lung bases. Tripod position facilitate more effective exchange of air to the lungs and
increase the surface area of the lungs, allowing the diaphragm to rise with less physical effort.
Infant gets irritated and extremely restless when lying supine because of the closing of the
trachea by inflamed epiglottis (complete airway obstruction). Airway, breathing and circulation
is considered more important than any other clinical finding. In this case, client is experiencing
difficulty breathing and is at risk for airway obstruction due to the pathophysiology of the
disease. For healthy infant, O2 readings are usually from 95% to 100% on room air (Jarvis,
Browne, Jenkins & Flude, 2013). Reading of 92% does show slight impairment on 02 delivery
throughout the body. Therefore, interventions should be placed to accomplish adequate airway
management.

PART B: SCHOLOARLY WRITING PAPER

Student number: 823-018-478

Nursing Interventions
Nursing interventions are based on the assessment findings that have be collected
throughout the clients visit in the Dr. Office. Client with the diagnosis of epiglottitis is at
increased risk for respiratory arrest due to airway obstruction and difficulty breathing. So, it is
important that they are placed on closed observation to prevent respiratory collapse. Firstly,
assessment of O2 stat along with other vital signs will be done on regular intervals to understand
the progression of disease process. Such as monitoring of respiratory rate and pattern to see if
inflammation has caused complete obstruction of the airway. Humidified oxygen will be
delivered at 2 litres via face mask to compensate for the inadequate supply and also to prevent
further hypoxia (Lilley, Heitkemper, Dirksen & OBrien, 2014). Secondly, provide the child with
calm and holistic environment in a dim light with the parent holding the ill child because anxiety
can lead to acute airway obstruction. It is important not to separate the child from the parent
because separation can also cause the fear of the unknown and may facilitate the episode of
crying, further irritating the epiglottis. Thirdly, once the client and the parent is settled, antibiotic
therapy should be started to control the inflammation and clear the infection from the body. Most
children tend to have decreased swelling after 24 hours of antibiotic therapy. Additional
treatment for moderate and severe infection includes administration of nebulized epinephrine or
mixture of helium and oxygen to decrease edema (Perry et al., 2013). Corticosteroids are
considered the main therapy in the treatment of epiglottitis. Fourthly, it is important to use
therapeutic approach with the child, so they do not get agitated. The use intravenous line is not
recommended. Lastly, fluids are encouraged to keep the client hydrated and to fight off infection.
Fluids can also help reduce dryness in the mouth and the airway. The treatment of epiglottitis
should be done in the environment where emergency equipment are available.

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Student number: 823-018-478

Conclusions
Infants and children are at increased risk for infections due to immature immune system.
Their body does not have antibodies to fight to infection, so even a mild inflammation can
explicit the most dramatic response in their bodies. Epiglottitis, an inflammation of epiglottis,
can be a life threatening condition for infants, if left untreated. Infants are at risk for airway
obstruction due to inflamed epiglottis and the small diameter of their airway. Clinical findings of
the client shows difficulty breathing due to inflammation. Nursing interventions are crucial to
prevent the closing off of the trachea. Therefore, epiglottitis can be treatment with effective
airway management.

PART B: SCHOLOARLY WRITING PAPER

Student number: 823-018-478

Reference
Jarvis, C. (2014). In Browne, A., MacDonald-Jenkins, J., & Lucktkar-Flude, M. (Eds.),
Physical Examination and Health Assessment: Canadian Edition (2nd ed). Toronto: Elsevier.
Lilley L., Harrington, S, Snyder, J., & Swart, B. (2011). Pharmacology for Canadian
Health Care Practice (2nd Ed.). Toronto: Elsevier
Perry S., Hockenberry , M., Lowdermilk, D.,& Wilson, D., (2013) Maternal Child
Nursing Care in Canada (1st Edition.). Toronto: Elsevier
Simoes, E., Cherian, T., Chow, J., Shahid-Salles, S., Laxminarayan, R., & John, J.
(2006). Acute respiratory infections in children. Informally published manuscript, National
Center for Biotechnology Information,, US. National Library of Medicine, Bethesda, MD, .
Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK11786/