What is the difference between management and leadership?

Condition: Spasmodic croup
2 actions: Administer a single dose of oral dexamethasone; Position the child upright and provide humidified air
2 parameters: Respiratory rate and oxygen saturation; Stridor and work of breathing

Rationale for correct condition
Spasmodic croup presents in toddlers with sudden onset of nighttime barking cough without fever. It is often associated with atopy, such as eczema. The child is playful and afebrile with no daytime distress. Lungs are clear with normal oxygen saturation (98%) and respiratory rate (28/min; normal 20–40/min for toddlers). No infectious signs are present, supporting a diagnosis of spasmodic croup.

Rationale for correct actions
Oral dexamethasone reduces airway inflammation in croup and decreases symptom duration through corticosteroid-mediated cytokine inhibition. A single dose is effective in mild-to-moderate cases, reducing subglottic edema.
Positioning the child upright and using humidified air improves airflow by decreasing upper airway narrowing and soothing inflamed mucosa. It is a first-line supportive measure to alleviate nocturnal symptoms.

Rationale for correct parameters
Monitoring respiratory rate and oxygen saturation assesses oxygenation and ventilation status. Tachypnea or desaturation may signal worsening airway obstruction.
Stridor and work of breathing are key signs of upper airway compromise. Increased inspiratory effort or stridor at rest requires escalation of care.

Rationale for incorrect conditions
Respiratory syncytial virus causes wheezing, fever, and lower respiratory symptoms, which are absent here.
Epiglottitis presents with high fever, drooling, and toxic appearance, not seen in this playful child.
Acute laryngitis lacks the barking cough and is uncommon in toddlers.

Rationale for incorrect actions
Preparing for intubation is reserved for airway obstruction, which is not present.
Broad-spectrum antibiotics are ineffective in non-bacterial etiologies like croup.
Ribavirin targets RSV, which this child does not have.

Rationale for incorrect parameters
Swallowing ability and drooling assess epiglottitis, not croup.
Fever and WBC count are normal and nonspecific.
Wheezing and lung sounds assess lower airway disease, not upper airway croup.

Take-home points:

• Spasmodic croup causes nighttime barking cough without fever in toddlers.
• Differentiate from RSV (wheezing), epiglottitis (drooling), and laryngitis (hoarseness).
• Steroids and humidified air reduce symptoms in mild croup.
• Key assessments include stridor and respiratory status, not fever or wheezing.

Choice A rationale

Applying wrist and leg restraints significantly restricts a client's movement and can exacerbate confusion and agitation, potentially leading to increased injury risk and psychological distress. This intervention can also impair circulation and skin integrity if not meticulously monitored, and should only be used as a last resort when less restrictive measures have failed. Normal physiological response to restraint includes increased anxiety.

Choice B rationale

Administering medication to sedate a client might reduce restlessness temporarily but could also deepen confusion, increase the risk of falls, and mask underlying medical issues causing the change in mental status. Pharmacological interventions should be carefully considered, with the lowest effective dose, and after a thorough assessment of the cause of the altered mental state. Normal sedation levels aim for calm without excessive drowsiness.

Choice C rationale

While involving family can be supportive, expecting them to stay with the client constantly in a hospital setting may not always be feasible or sustainable. Although family presence can provide comfort and reorientation, it does not directly address the immediate environmental safety needs of a confused and restless client in a hospital. Normal family roles are supportive.

Choice D rationale

Moving the client to a room closer to the nurses' station allows for more frequent and direct observation by nursing staff. This increased proximity enables prompt intervention if the client attempts to get out of bed, falls, or exhibits further changes in mental status, enhancing safety without resorting to restrictive measures. Normal nursing practice prioritizes close monitoring for at-risk clients.