Croup Syndrome: A Case Study

Jack, a 10 month old boy who was diagnosed of croup syndrome (Acute Laryngotracheobronchitis ) by the medical officer in emergency, was admitted to the pediatric ward. He was brought to the hospital due to his abnormal breathing and poor feeding. According to his parents, Jack has a 48 hour history of poor feeding, a clear runny nose, barking cough, high temperature, worsening cough, was grumpy and breathless during feeding. During assessment, his vital signs were beyond the normal range, moderate intercostal and sub-sternal recession were evident and only one wet nappy was noted for the day. Apparently, he is experiencing breathing difficulties and dehydration. In this essay, I will discuss about the relationship between the two priority

nursing problems and the patient’s assessment data. Also, I will be explaining the pathophysiology of ineffective breathing pattern and dehydration for better understanding about the link between the problem and the patient’s signs and symptoms with their corresponding nursing interventions.
The first nursing problem that needs to be given attention to is Jack’s ineffective breathing pattern that leads to poor lunch gas exchange. Ineffective breathing pattern happens when the exchange of air inspiration and expiration is inadequate and can eventually affects the oxygen saturation that is brought into the respiratory system. Jack was having noisy breathing, barking cough, moderate intercostal and sub-sternal recession and tracheal tug. The cough and other symptoms that are evident to Jack are the result of an inflammation of his larynx, trachea and bronchi, in which his airway becomes swollen and partially blocked because of the mucus. As a result, there is a partial collapse of the airway when he breathes in leading to breathing difficulties and a characteristic of a barking cough. Moreover, the inflammation of his respiratory tract may contribute to lack of oxygen in his blood that causes an abnormal physiologic response in his vital signs: respiratory rate of 44 breaths/min; oxygen saturation of 92% in room air; and heart rate of 144 beats/min. His body attempts to correct the low oxygen level in the blood by increasing the tidal volume, respiratory rate and cardiac rate (Hockenberry, 2009, p. 130). According to Sherwood (2007, p.104), when there is a decrease oxygen perfusion of cells, conversion from aerobic metabolism to anaerobic metabolism happens. An increase in the metabolic level in the body causes increase respiration in an attempt to reduce the acid load. Thus, there is manifestation of tachypnea. An increase in the cardiac rate is another way of dealing hypoxemic challenges for it causes an increase cardiac output and hyperventilation. Therefore, there will be an increase in oxygen delivery in the body. That is the reason why there is a need to have an in-depth clinical evaluation to ensure the breathing pattern, patency of his airway and maintenance of effective oxygenation and ventilation. There are ways on how to improve Jack’s breathing pattern. Firstly, proper manual handling should be done to the child. Jaklin (1971,p. 85) says that positioning him comfortably and placing him in a less stimulating environment that is a clam, clean and quiet may help in his situation. According to her, children with croup syndrome should be allowed to adopt the position that they find most comfortable. Moreover, multiple external stimuli that may cause respiratory distress should be avoided to promote relaxation and to conserve energy. Having enough sleep prevents over exhausting & reduces oxygen consumption demands to facilitate resolution of infection. To promote adequate rest, the nurse should organize and schedule necessary activities to provide periods of rest all interventions to limit disturbances and to prevent the child from crying because this contributes to the child’s difficulty breathing. Secondly, pharmacotherapy is another priority nursing intervention that is very helpful to Jack’s situation. Medications that would help decrease the swelling and bronchoconstriction of his airway should be given to him. Jack might need a course of oral dexamethasone (steroids) or inhaled budesonide, a long-lasting and effective treatment, because he is exhibiting moderate to severe croup.

It works by decreasing swelling of the larynx, usually within six hours of the first dose and it can minimize the need for hospitalization, decrease dose of other drugs and has no long-term consequences. In fact, there was a study about the effectiveness of steroids treatment at the pediatric ward of Hatyai Hospital. Chub-Uppakarn (2007) identified that both inhaled and systemic steroids work within one hour and dramatically reduce morbidity, hospitalization time and intubation. Interestingly, they have concluded that the use of a lower oral dose of a systemic steroid is acceptable and also effective as the larger doses. Another alternative medication that could be given to Jack is the nebulized Adrenaline (Epinephrine). It reduces swelling in the airway and works faster than dexamethasone too. It works for a short time period and may be given every 15 to 20 minutes for severe symptoms (Bjornson,2011). With regards in giving medications, it is the nurse’s responsibility to follow basic principles such as doing hand washing beforehand and doing the right preparation of the medications. Each time the nurse

would give a medication, he must systematically and conscientiously check the 6 rights, Right individual; Right medication; Right dose; Right time; Right route; Right documentation. (Potter PA, 2003). Additionally, The nurses should be aware of the unwanted side effects and the drug interactions. For instance, inhaled steroids may cause oral thrush. Oral thrush may cause further dehydration by causing the infant to be irritable and to have decrease appetite. It is also the nurse’s responsibility to clean the medical equipment and educate the parents regarding the equipment used. Tay (2009, p.153) says that if they are not cleaned, they won’t be functioning very well. Furthermore, Knowing the proper way to use the inhaler helps give the right amount of dose prescribed by the doctor. Giving Acetaminophen also helps the child to feel comfortable, may lower down a fever , alleviates pain and may lessen the need for breathing. However, according to Ogilvie (2012) , the nurse should be aware that an overdose of acetaminophen could be hepatotoxic.