# The nurse is discharging a 2-year-old after an emergency department visit for mild viral croup. Which discharge teaching points should be reinforced with the parents? Select all that apply.

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> language: en  
> subject: Health Promotion and Maintenance  
> category: HPM

## Question

The nurse is discharging a 2-year-old after an emergency department visit for mild viral croup. Which discharge teaching points should be reinforced with the parents? Select all that apply.

1

Return immediately to the ED for stridor at rest, drooling, retractions, or bluish color around the lips.

2

Keep the child calm and upright during a coughing episode because agitation can worsen upper-airway obstruction.

3

Administer a dose of over-the-counter cough medicine before bedtime each night to prevent the barky cough from recurring.

4

Have an adult stay with the child and observe breathing closely, including during sleep, after discharge.

5

Encourage frequent small sips of clear fluids and use weight-based acetaminophen or ibuprofen for fever; avoid over-the-counter cough suppressants in this age group.

## Explanation

Options 1, 2, 4, and 5 are appropriate. Stridor at rest, drooling, retractions, cyanosis, increasing fatigue, or difficulty drinking require urgent reassessment. Keeping the child calm and upright can reduce distress because agitation worsens upper-airway obstruction. A responsible adult should remain with the child and watch breathing closely after discharge. Offer frequent fluids and use weight-based antipyretics when indicated. Option 3 is incorrect because over-the-counter cough and cold medicines are not recommended for a 2-year-old and do not treat the upper-airway inflammation of croup. Hot steam is not required and creates a burn risk.

## In-depth explanation

For croup discharge teaching, emphasize calm positioning, close observation, hydration, and clear emergency return precautions. Avoid over-the-counter cough and cold medicines in a 2-year-old, and do not use hot steam because of scald risk.

## Clinical scenario

**2-year-old** seen in the ED for **mild viral croup**: barky cough, mild stridor with agitation only, no retractions at rest. Received **single-dose oral dexamethasone** and was observed for 4 hours before discharge home.

## Key concepts

- **Viral croup (laryngotracheobronchitis)** — Parainfluenza-driven upper airway inflammation in children causing barky cough, stridor, and hoarseness.
- **Dexamethasone (single-dose)** — 0.6 mg/kg PO/IM single dose given in the ED; long half-life eliminates need for home redosing in mild cases.
- **Return precautions** — Stridor at rest, drooling, retractions, cyanosis — return to ED immediately as these signal worsening obstruction.

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