A 5-year-old is brought to the ED with a temperature of 99.5°F (37.5°C), a barky cough, stridor, and hoarseness. Which nursing intervention should the nurse prepare for?

During the recovery stages of croup, the airway inflammation is decreasing, but the child may still be at risk for sudden worsening of symptoms, particularly at night or with viral reinfection. Parents need to be able to monitor for early signs of respiratory distress to ensure prompt intervention if symptoms recur.

Rationale for correct answer:

2. Recognizing signs of respiratory distress: Parents should be taught to observe for stridor at rest, retractions, nasal flaring, cyanosis, or increased work of breathing. Early recognition allows timely medical evaluation and prevents potential airway compromise. Education on when to seek immediate care is a key part of discharge teaching after croup.

Rationale for incorrect answers:

1. Limiting oral fluid intake: This is inappropriate since adequate hydration helps thin secretions and support recovery. Fluids should not be restricted.

3. Providing three nutritious meals per day: While nutrition is important, meal frequency is not critical during acute recovery. The priority is airway monitoring and hydration, not strict meal scheduling.

4. Allowing the child to go to the playground: Vigorous activity can increase respiratory demand and aggravate airway inflammation. Outdoor play should be gradual and based on the child’s energy and breathing after full recovery.

Take home points

• The primary focus during recovery from croup is airway safety and early recognition of respiratory distress.
• Educate parents on signs of worsening stridor, retractions, and cyanosis.
• Ensure children remain hydrated, avoid strenuous activity, and follow up with the healthcare provider as needed.
• Most children recover fully with supportive care, but vigilance during the first few days post-illness is crucial.

Acute epiglottitisis a life-threatening bacterial infection, most commonly caused by Haemophilus influenzae type B (Hib), that leads to rapid inflammation and swelling of the epiglottis, causing airway obstruction. Typical presentation includes sudden onset of high fever, drooling, severe sore throat, dysphagia, muffled voice, stridor, tripod positioning, absence of cough, anxiety and restlessness due to respiratory distress.

Rationale for correct answer:

4. Support the child in an upright position on the parent’s lap: This position helps maximize airway patencyand reduce respiratory effort. Allowing the child to remain with the parent provides comfort, minimizing crying and agitation, which can worsen airway obstruction. The nurse should stay calm, avoid unnecessary interventions, and notify the healthcare provider immediately for airway management (possible intubation).

Rationale for incorrect answers:

1. Check the child’s gag reflex with a tongue blade: Inserting anything into the mouth may trigger laryngospasm and complete airway obstruction. The throat should never be examined unless the airway is secure and emergency personnel are present.

2. Allow the child to cry to keep the lungs expanded: Crying increases airway edema and oxygen demand, potentially precipitating complete obstruction. The goal is to keep the child calm and quiet.

3. Check the airway for a foreign body obstruction:Although drooling and respiratory distress may resemble choking, in this case the classic tripod position and drooling point to epiglottitis, not a foreign body. Any airway manipulation could be fatal.

Take home points

• Never attempt to visualize or manipulate the throat in suspected epiglottitis.
• Keep emergency airway equipment (intubation and tracheostomy setup) immediately available.
• Do not leave the child unattended; stay calm and allow the parent to remain close.
• Prepare for immediate intubation and I.V. antibiotic therapy once the airway is secure.