NCLEX Review Guide: Pediatric Respiratory Conditions

Pathophysiology

• Epiglottitis is an acute inflammation of the epiglottis and surrounding structures typically caused by Haemophilus influenzae type B, though other bacteria like Streptococcus pneumoniae may be responsible. The infection causes rapid swelling of the epiglottis, which can obstruct the airway within hours.
• The inflamed epiglottis assumes a cherry-red, swollen appearance that can rapidly progress to complete airway obstruction if not treated promptly.

Clinical Manifestations

• Children with epiglottitis present with sudden onset of high fever, severe sore throat, muffled voice, drooling, and dysphagia. The child often assumes a characteristic position: sitting upright, leaning forward with the chin thrust out and mouth open (tripod position).
• Respiratory distress progresses rapidly with inspiratory stridor, tachypnea, and use of accessory muscles for breathing.

Nursing Interventions

• Never attempt to visualize the epiglottis or throat in suspected epiglottitis as this may precipitate complete airway obstruction. Keep the child as calm as possible and in a position of comfort.
• Prepare for emergency airway management including possible intubation or tracheostomy. Administer humidified oxygen as ordered and monitor respiratory status continuously.

1. Maintain a calm environment and allow child to remain in position of comfort
2. Avoid invasive procedures that might upset the child
3. Have emergency airway equipment immediately available
4. Administer IV antibiotics as ordered
5. Monitor for signs of increasing respiratory distress

Pathophysiology

• Laryngotracheobronchitis, commonly known as croup, is a viral infection that causes inflammation and edema of the upper airway, particularly in the subglottic region. The most common causative agent is parainfluenza virus.
• The inflammation narrows the airway diameter, resulting in the characteristic barking cough and inspiratory stridor, especially pronounced in children due to their smaller airway diameter.

Clinical Manifestations

• The classic presentation includes a barking or "seal-like" cough, hoarseness, and inspiratory stridor that typically follows 1-2 days of upper respiratory symptoms like rhinorrhea and low-grade fever.
• Respiratory distress can range from mild to severe, with retractions, nasal flaring, and cyanosis in severe cases. The Westley Croup Score is often used to assess severity based on stridor, retractions, air entry, cyanosis, and level of consciousness.

Nursing Interventions

• Maintain a calm environment and provide cool mist therapy to help reduce airway inflammation and ease breathing. In moderate to severe cases, administer corticosteroids and racemic epinephrine as ordered.
• Monitor respiratory status including rate, effort, stridor, and oxygen saturation. Educate parents on home management, including the use of humidified air and when to seek medical attention if symptoms worsen.

Pathophysiology

• Bronchiolitis is an acute inflammatory disease of the lower respiratory tract affecting the small airways (bronchioles). Respiratory syncytial virus (RSV) is the most common causative agent, though other viruses can also cause it.
• The infection leads to necrosis of the respiratory epithelium, increased mucus production, and bronchiolar obstruction. This results in air trapping, atelectasis, and ventilation-perfusion mismatching.

Clinical Manifestations

• Initial symptoms include rhinorrhea, low-grade fever, and cough, progressing to increased respiratory effort, wheezing, crackles, and irritability. Infants may present with apnea, especially those under 2 months or premature.
• As the disease progresses, tachypnea, nasal flaring, intercostal and subcostal retractions, and decreased feeding may occur. Dehydration is a common complication due to increased respiratory effort and decreased oral intake.

Nursing Interventions

• Provide supportive care including hydration, supplemental oxygen if needed, and frequent nasal suctioning to maintain airway patency. Position the infant with head of bed elevated 30-45 degrees.
• Monitor respiratory status, oxygen saturation, and hydration status. Small, frequent feedings may be better tolerated. Educate parents on proper nasal suctioning techniques and signs of respiratory distress.