5 Epiglottitis Nursing Care Plans

Epiglottitis is the acute inflammation of the epiglottis and surrounding laryngeal area with the associated edema that needs an emergency situation as the supraglottic area becomes obstructed. Commonly caused by Haemophilus influenzae type B, it affects children ages 2 to 7 years.

Children experiencing epiglottis typically appear ill with a high fever, sudden sore throat, muffled voice, rapid respirations, and prefers on sitting upright with the chin extended and mouth open. Drooling is common due to dysphagia and respiratory distress is progressive as the obstruction advances. Once epiglottitis is suspected, no examination of the oropharynx is initiated until emergency equipment and personnel are readily available.

The child may need endotracheal intubation or tracheostomy for some cases of severe respiratory distress. Onset is rapid (over 4-12 hours) and breathing pattern usually re-established within 72 hours following intubation and antimicrobial regimen.

Nursing Care Plans

Nursing care planning goals of a child with epiglottitis consists in providing the child with immediate emergency care to avoid the development of further complications. Other goals for the client with epiglottitis are maintaining airway patency, achieving thermoregulation, relieving anxiety, conserving energy to decrease oxygen requirements, enhancing parental/caregiver knowledge and absence of complications.

Here are five (5) nursing care plans (NCP) for epiglottitis:

1. Ineffective Airway Clearance

Ineffective Airway Clearance: Inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway.

May be related to

- Obstruction associated with edema and excessive mucus production in the upper airways

Possibly evidenced by

- Sudden high fever
- Muffled voice
- Sore throat
- Dyspnea
- Drooling
- Dysphagia
- Decreased breath sounds
- Rapid breathing with respiratory distress
- Bright red epiglottis with edema

Desired Outcomes

- The child’s airway will remain clear.

Nursing Interventions	Rationale
Assess respiratory rate, effort, pattern, and depth.	Nasal flaring, rapid breathing, dyspnea, chest retractions, and apnea signifies severe respiratory distress that requires immediate airway support.
Auscultate lungs for the presence of normal or adventitious lung sounds.	Absent or decreased lung sounds may reveal the presence of a mucous plug or airway obstruction. Stridor is a late ominous sign of epiglottitis that indicates emergency airway management.
Use pulse oximetry to monitor oxygen saturation; assess arterial blood gases (ABGs)	Pulse oximetry is used to detect changes in oxygenation. Oxygen saturation should be maintained at 90% or greater. Alteration in ABGS may result in increased pulmonary secretions and respiratory fatigue.
Encourage oral intake by offering warm, clear fluids.	Adequate hydration liquifies thick mucus/secretions.
Position the child in a sitting up and leaning forward position with mouth open and tongue out (“tripod” position).	Allows maximum entry of air into the lungs for improved oxygenation.
Administer humidified oxygen	Children need moist air to decrease the epiglottal inflammation and facilitates expectoration.
Administer IV antibiotics as ordered.	After obtaining blood and epiglottic cultures, second-or-third generation cephalosporins and beta-lactamase resistant antibiotic should be started as soon as possible.
Prepare for intubation or tracheostomy; Anticipate the need of an artificial airway.	An artificial airway is required to promote oxygenation and ventilation and prevent aspiration.

2. Hyperthermia

Hyperthermia: Body temperature elevated above normal range.

May be related to

- Inflammation/infection of epiglottis

Possibly evidenced by

- Sudden increase in body temperature above normal range
- Warm to touch
- Tachycardia
- Tachypnea
- Positive throat culture

Desired Outcomes

- Child’s body temperature will maintain between 36.4° C- 37.5°C.

Nursing Interventions	Rationale
Identify the precipitating factors.	Determination and management of the underlying cause are necessary to recovery.
Monitor the patient’s HR, BP, and especially the tympanic or rectal temperature.	HR and BP increase as hyperthermia progresses. Tympanic or rectal temperature gives a more accurate indication of core temperature.
Provide cooling measures such as lightweight clothing, decreasing room temperature, and cool compresses.	Room temperature may be accustomed to near normal body temperature and blankets and linens may be adjusted as indicated to regulate the temperature of the child.
Provide sufficient rest and encourage a stress-free environment.	Decreases metabolic requirements.
Encourage adequate fluid intake.	Fever can result in fluid loss and dehydration.
Raise the side rails at all times.	Ensure patient’s safety even without the presence of seizure activity.
Administer antipyretics (Acetaminophen) as prescribed.	Decreases fever and relieve throat pain.
Administer IV antibiotics as ordered.	Treats underlying cause or existing bacterial infection.
Teach child and family members about the signs and symptoms of hyperthermia and help in identifying factors related to the occurrence of fever.	Providing health teachings to the patient and family aids in coping with disease condition and could help prevent further complications of hyperthermia.

3. Anxiety

Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.

May be related to

- Change in the health status of the child
- Change in the environment (hospitalization)
- Change in role functioning (parenting)

Possibly evidenced by

- Verbalization of extreme fear and anxiety by parents
- Extreme expression of fear [child]
- Agitation
- Air hunger
- Crying
- Irritability

Desired Outcomes

- Parents will verbalize decreased anxiety.
- Child will appear calm without agitation, crying or irritability.

Nursing Interventions	Rationale
Assess severity of fear and anxiety of parents and child.	Provides information regarding the presence of severe anxiety as symptoms of the disease become more acute and breathing more difficult.
Provide a calm and supportive environment and reassure parents that amplest care is being given to the child.	Provides reassurance and lessens the anxiety of parents.
Encourage parents to stay with the child, provide a place for rest.	Promotes security needs for child and assists in decreasing parental anxiety.
Remain with the child at all times during acute stages.	Provides continuous evaluation for emergency interventions and reassurance for parents.
Maintain the child in a tripod position; Allow a familiar object (toy, blanket) during the hospitalization.	Promotes position of comfort and security for the child.
Educate parents regarding procedures, treatment, and modifications in the child’s condition.	Reduces anxiety caused by fear of the unknown.
Avoid any measures or procedures that are not needed during the acute stage.	Prevents raise of anxiety which increases respiratory distress.
Provide orientation to parents and child about the room, equipment, supplies, and policies.	Familiarizes them to the hospital environment.
Encourage expression of fears and feelings of parents and child and for caused by severe behaviors anxiety.	Lessens anxiety and humiliation.
Allow the child to remain seated on parent’s lap during all care, including lateral neck X-ray if ordered.	Decreases anxiety of the child and avoids precipitating a complete obstruction.
Educate parents that swelling subsides 24 hours after antibiotic therapy is started and epiglottis usually returns to normal in about 3 days.	Provides evidence of positive outcome and reduces anxiety.

4. Deficient Knowledge (Preventive Care)

Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.

May be related to

- The promotion of health-seeking behaviors within the hospital and/or home to prevent complications and speed recovery

Possibly evidenced by

- Parents asking information about caregiving and preventive actions; child readmitted to hospital with complications

Desired Outcomes

- Parents will verbalize an understanding of the condition of the child and its preventive care.

Nursing Interventions	Rationale
Educate parents about the signs and symptoms of respiratory distress such as nasal flaring, retractions, cyanosis, increasing respiratory rate and increased pulse.	Enables parents to gain knowledge in order to seek immediate medical intervention as necessary.
Educate parents on the administration of prescribed medications.	Promotes an understanding that may enhance consistent and proper medication administration and identification of untoward side effects.
Teach parents about the importance of sufficient rest and proper nutrition, to avoid illness.	Prevents secondary infections; promotes body’s own natural defenses.
Encourage and teach parents to render care for the hospitalized child at a level they are comfortable with and within the constraints of essential treatments.	Promotes parental identity and control; may reduce anxiety and stress.
Educate parents, child, and family members, as applicable, on good handwashing techniques and the proper disposal of soiled tissues, and so forth.	Avoids transmission of illness.
Assess parents’ understanding of teaching and reinforce as needed.	Provides information about further teaching needs.
Grant praise for efforts.	Positive reinforcement enhance self-esteem and pride in caring for the child properly.

5. Risk For Suffocation

Risk For Suffocation: Accentuated risk of accidental suffocation (inadequate air available for inhalation).

May be related to

- Disease process

Possibly evidenced by

- Extreme anxiety, with struggle to breathe
- Dysphasia
- Cyanosis
- Supraglottic edema
- Obstruction
- Hypoxia

Desired Outcomes

- Preventive measures are exerted to maintain a patent airway.
- Child’s airway remains open either naturally or by means of ET tube or tracheostomy.

Nursing Interventions	Rationale
Assess for changes in skin color from pallor to cyanosis, severe dyspnea and sternal and intercostal retractions, lethargy, increased pulse.	Provides information about increasing airway obstruction.
Discourage examining throat with a tongue blade or taking throat culture unless immediate emergency equipment and personnel at hand.	Leads to laryngospasm and airway obstruction.
Allow to sit up and avoid lying position.	Lying down may cause epiglottis to fall backward, causing airway obstruction.
Monitor oxygenation via pulse oximeter; Provide oxygen as prescribed.	Promotes oxygenation of tissues and prevents hypoxemia.
Endotracheal intubation must be readily available; assist with tracheostomy if needed or prepare for the procedure in surgery.	Establishes airway if obstruction present and respiratory failure and asphyxia is imminent.
Provide a brief clear explanation of care and all procedures and purpose and procedure for emergency intubation or tracheostomy if required while hospitalized.	Explanations provide information and support for parents who are unfamiliar with the care.
Inform parents of the rationale for restraints if an emergency procedure is done, that swelling is reduced after 24 hours of therapy and ET tube will probably be removed after 3 days.	Prepares parents with information of what to expect.

References and Sources : nurseslabs.com

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