What is the primary reason for using a cool mist humidifier in the management of a toddler with mild stridor?

A) To increase oxygen concentration in the air

B) To soothe the child's anxiety

D) To eliminate inspiratory stridor

What is the primary nursing action to prevent the progression of respiratory distress in this toddler with croup?

B) Keep the child calm and provide cool mist humidification

A) Administer high-flow oxygen therapy

B) Keep the child calm and provide cool mist humidification

C) Position the child supine to ease breathing

D) Encourage frequent coughing to clear secretions

A toddler with croup is being monitored after administration of antipyretics and supportive interventions. Which assessment finding indicates an improvement in the child's respiratory status?

B) Diminished suprasternal retractions

A) Increased frequency of barking cough

B) Diminished suprasternal retractions

Which of the following interventions is most effective in reducing airway irritation and inflammation in a toddler with respiratory symptoms?

A) Administering humidified air

B) Providing a high-calorie diet

C) Encouraging vigorous physical activity

D) Applying cold compresses to the throat

What is the primary reason for maintaining a calm environment for a toddler with croup?

B) To reduce respiratory effort and distress

A) To improve the child's appetite

B) To reduce respiratory effort and distress

A toddler with mild croup is being monitored for signs of respiratory distress. Which of the following is the best initial action the nursing team should take if the child shows increased respiratory effort and mild suprasternal retractions?

B) Encourage the parents to calm the child and provide reassurance

A) Administer supplemental oxygen

B) Encourage the parents to calm the child and provide reassurance

C) Start an intravenous line for fluid administration

When monitoring a toddler with croup, which of the following signs would indicate an improvement in the child's respiratory status after administering dexamethasone?

B) Decreased suprasternal retractions

A toddler is being treated for croup with dexamethasone. What is the primary reason for administering dexamethasone in this case?

B) To reduce airway inflammation and improve breathing

A) To directly kill the virus causing croup

B) To reduce airway inflammation and improve breathing

C) To serve as a sedative to keep the child calm

D) To increase the child's immune response

Which of the following is the most appropriate action for the parents to take if they notice signs of worsening croup symptoms in their toddler at home?

D) Return to the hospital immediately

A) Increase the child's fluid intake and monitor closely

B) Administer over-the-counter cold medication

C) Use a humidifier and encourage rest

D) Return to the hospital immediately

A toddler recovering from croup is being prepared for discharge. Which of the following instructions should the nurse prioritize when educating the parents about home care?

C) Ensure the toddler stays well-hydrated by offering frequent sips of clear fluids

A) Encourage the toddler to engage in active play to improve lung function

B) Administer over-the-counter cough suppressants if coughing persists

C) Ensure the toddler stays well-hydrated by offering frequent sips of clear fluids

D) Keep the toddler in a cool, dry environment to ease breathing

Croup toddler - Nursing Case Study

Pathophysiology

• Primary mechanism: Croup is primarily caused by a viral infection, most commonly the parainfluenza virus, leading to inflammation of the upper airway, including the larynx and trachea. This inflammation causes swelling and narrowing, resulting in characteristic symptoms like a barking cough and stridor.

• Secondary mechanism: The subglottic region of the airway is particularly susceptible due to its small diameter in toddlers. Inflammation in this area further narrows the airway, increasing resistance to airflow and causing breathing difficulties.

• Key complication: If inflammation and narrowing become severe, it can lead to respiratory distress, requiring medical intervention to ensure adequate oxygenation and prevent hypoxia.

Patient Profile

Demographics:

2-year-old, male, daycare attendee

History:

• Key past medical history: No significant past medical history

• Current medications: None

• Allergies: No known allergies

Current Presentation:

• Chief complaint: Barking cough and hoarseness

• Key symptoms: Mild stridor, slight fever, runny nose

• Vital signs: Temperature 100.4°F (38°C), Heart rate 110 bpm, Respiratory rate 24 breaths per minute, Oxygen saturation 98% on room air

Section 1

As the young patient is admitted to the pediatric unit for observation, the initial assessment findings are conducted to further evaluate his condition. The toddler remains alert and is observed sitting up in his mother's lap, appearing slightly anxious but consolable. The characteristic barking cough persists intermittently, and the mild stridor noted on presentation is more pronounced when he becomes agitated. On auscultation, breath sounds are clear bilaterally with no wheezing or crackles evident, but inspiratory stridor is audible. His skin is warm to the touch, and capillary refill is brisk, indicating good peripheral perfusion.

Further assessment reveals mild retractions around the suprasternal notch during inspiration, consistent with increased effort needed to overcome the airway narrowing. His temperature remains elevated at 100.4°F (38°C), but he is otherwise hemodynamically stable with a heart rate of 110 bpm and a respiratory rate of 24 breaths per minute. Oxygen saturation continues to hold at 98% on room air, suggesting that, despite the airway inflammation, oxygenation is currently adequate.

To manage symptoms and prevent progression, the nursing team initiates supportive care, including keeping the child calm to prevent exacerbation of stridor and providing cool mist through a humidifier to help reduce airway swelling. The patient is closely monitored for any changes in respiratory status, with plans to reassess frequently. The nursing staff educates the parents about the signs of worsening symptoms, emphasizing the importance of seeking immediate attention if the child's breathing becomes more labored or if cyanosis develops. This careful observation and support aim to address the current mild complications and prevent further respiratory distress.

Section 2

Several hours into the toddler's admission, the nursing team conducts a follow-up assessment to evaluate the response to the supportive interventions initiated. The toddler's anxiety has visibly decreased, and he is now engaging in quiet play with his mother, a positive sign indicating some relief of symptoms. The barking cough remains present but appears less frequent, and the stridor, while still noticeable during agitation, is less pronounced when the child is calm. This suggests that the combination of humidified air and efforts to maintain a calm environment are effectively reducing airway irritation and inflammation.

The nursing staff notes that the mild suprasternal retractions have diminished slightly, correlating with a decreased effort to breathe. The child's temperature has decreased slightly to 99.8°F (37.7°C) after antipyretic administration, indicating a positive response in managing the fever. Vital signs are reassessed, revealing a heart rate of 105 bpm and a respiratory rate of 22 breaths per minute. Oxygen saturation remains stable at 98% on room air, reinforcing that oxygenation is still adequate despite the ongoing respiratory symptoms.

The parents express relief at the visible improvements and are more comfortable with the situation after receiving education about the condition and management strategies. The nursing team continues to monitor the toddler closely, poised to act should any new complications arise. The current focus remains on maintaining a stable respiratory status and providing reassurance to both the child and the parents. This ongoing observation and care plan position the team to promptly address any potential changes in the toddler's condition, ensuring safety and comfort as the recovery process continues.

Section 3

Several hours after the initial improvements, the nursing team conducts another routine assessment to ensure the toddler's condition continues to stabilize. During this assessment, they notice a slight increase in the toddler's respiratory effort, with mild suprasternal retractions becoming more apparent when the child becomes slightly agitated. The heart rate has increased to 112 bpm, and the respiratory rate has risen to 26 breaths per minute. While the oxygen saturation remains stable at 97% on room air, the team recognizes these subtle changes as potential early signs of fatigue or exacerbation of symptoms.

The clinical team decides to review recent laboratory results to further inform their assessment and ensure no underlying issues are contributing to the child's respiratory status. The results indicate a mild leukocytosis with a white blood cell count of 12,000/mm³, which can be expected with the inflammatory nature of croup but requires careful monitoring to rule out any secondary infections. No other significant abnormalities are noted in the complete blood count or metabolic panel.

Given these findings, the nursing team decides to reinforce the importance of maintaining a calm environment and optimizing hydration, as both play crucial roles in managing croup symptoms. They educate the parents on signs of increasing respiratory distress to watch for, emphasizing the importance of notifying staff immediately if these occur. The team also considers the possibility of administering an oral dose of dexamethasone if the respiratory effort does not improve, aligning with evidence-based practice for croup management. This proactive approach aims to prevent further complications and support the toddler's recovery, while maintaining a strong partnership with the family in the care process.

Section 4

The nursing team closely monitors the toddler over the next few hours to observe any changes following their initial assessment and education provided to the parents. During this period, the toddler remains in a calm environment, with the parents actively participating in comforting their child. Despite these efforts, a slight change in the toddler's condition is noted. The respiratory rate has increased to 28 breaths per minute, and the mild suprasternal retractions now occur even when the child is at rest. The toddler's heart rate remains elevated at 115 bpm, but oxygen saturation continues to hold steady at 97% on room air.

Recognizing the potential for symptom exacerbation, the nursing team decides to proceed with administering a single oral dose of dexamethasone, which is a standard approach in managing croup. They explain to the parents that this corticosteroid will help reduce airway inflammation, potentially leading to improved breathing and comfort for their child. The parents are reassured that the medication is well-tolerated and effective, and encouraged to continue maintaining a calm environment and ensuring the toddler stays hydrated.

Following the administration of dexamethasone, the team observes the toddler for any immediate changes in respiratory effort and overall comfort. Within an hour, there is a noticeable decrease in respiratory rate to 24 breaths per minute, and the suprasternal retractions become less pronounced. The toddler's heart rate decreases slightly to 110 bpm, indicating a positive response to the intervention. The nursing team documents these findings and continues regular assessments to ensure the child's condition continues to stabilize, while keeping the family informed and involved in making decisions about their child's care.

Section 5

As the nursing team continues to monitor the toddler, they note a gradual improvement in the child's breathing pattern following the administration of dexamethasone. The respiratory rate stabilizes at 22 breaths per minute, and the suprasternal retractions are now barely perceptible. The toddler appears more comfortable, with a heart rate that has further decreased to 105 bpm. The child's oxygen saturation remains stable at 97% on room air, indicating effective oxygenation without the need for supplemental oxygen. The toddler is more alert and responsive, engaging with the parents and showing interest in their surroundings, which further reassures the team.

Despite the positive response, the team remains vigilant for any new complications that might arise. They pay close attention to the toddler's hydration status, ensuring adequate fluid intake as per the parents' reports. The parents are educated on signs of dehydration, such as decreased urine output and lethargy, and are encouraged to offer small, frequent sips of clear fluids. The nursing team also discusses the possibility of a follow-up with the pediatrician to reassess the child's condition in the coming days, emphasizing the importance of continued observation at home.

The parents express relief and gratitude for the support and guidance provided by the nursing team. As the toddler's condition continues to stabilize, the team prepares to discharge the child with clear instructions for home care. They provide the parents with written materials outlining the signs of worsening croup symptoms, such as increased breathing effort or stridor, and emphasize the importance of returning to the hospital if these occur. With a comprehensive discharge plan in place, the family feels confident and prepared to manage their child's recovery at home.