Which action is the best intervention for parents to take if their child is experiencing an episode of “midnight croup,” or acute spasmodic laryngitis?
Give warm liquids.
Raise the heat on the thermostat.
Provide humidified air with cool mist.
Take the child into the bathroom with a warm running shower.
The Correct Answer is C
Acute spasmodic laryngitis (midnight croup) is a sudden-onset, viral-induced laryngeal inflammation that typically occurs at night in children aged 1–3 years. It presents with a barking, seal-like cough, inspiratory stridor, and respiratory distress. This condition is usually mild and self-limiting, often managed at home with supportive care.
Rationale for correct answer:
3. Cool mist helps reduce mucosal swelling and soothe inflamed airways, easing breathing and decreasing cough intensity. Exposure to cool, humid air, such as from a cool-mist vaporizer or stepping outside into the night air, can relieve laryngeal spasm and inflammation. This is the first-line, noninvasive management for mild croup episodes at home.
Rationale for incorrect answers:
1. Giving oral fluids during acute respiratory distress increases the risk of aspiration. Oral intake should be avoided until the child’s breathing improves and the airway is stable.
2. Warm, dry air can worsen airway inflammation and dry out secretions, making symptoms worse. The goal is cool, moist air, not warm air.
4. Although warm mist was once recommended, cool mist is now preferred because it is safer and equally effective. Warm mist can sometimes increase swelling in the inflamed airway and poses a burn risk.
Take home points
- Cool, humidified air is the best nonpharmacologic intervention for mild croup (spasmodic laryngitis).
- Avoid warm air and warm fluids during acute distress.
- Monitor for signs of worsening airway obstruction such as stridor at rest, retractions, cyanosis, and drooling, these require emergency medical evaluation.
- Calm reassurance and keeping the child in an upright position can also reduce airway spasms and distress.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D"]
Explanation
Croupis a common respiratory illness in toddlers characterized by a barking cough, often caused by viral inflammation leading to airway narrowing. Discharge teaching focuses on home management and recognizing signs of worsening illness.
Rationale for correct answers:
1. Cool mist helps soothe inflamed airwaysand can reduce airway irritation, making breathing easier. It is a safe, non-invasive home therapy to help alleviate symptoms.
3. Stridor at restindicates significantairway obstructionand respiratory distress that requires urgent medical evaluation to prevent respiratory failure.
4. Adequate hydration thins mucus secretions, prevents dehydration, and supports overall recovery.
Rationale for incorrect answers:
2. Over-the-counter cough syrups are not recommended for young children due to limited efficacy and potential side effects.
5. Aspirinis contraindicated in children because of the risk of Reye’s syndrome, a serious and potentially fatal condition.
Take home points
- Use cool-mist humidifiers and maintain hydration to support symptom relief in croup.
- Recognize signs of respiratory distress such as stridor at rest and seek emergency care promptly.
- Avoid cough syrups and aspirin in young children.
Correct Answer is D
Explanation
The child’s presentation of a high-pitched inspiratory squeal (stridor), high fever, gasping for breath, and tripod positioningare classic signs of severe upper airway obstruction, possibly caused by epiglottitis or another critical airway emergency. This situation requires urgent medical interventionto secure the airway and stabilize the child.
Rationale for correct answer:
4. The child is showing signs of respiratory distress with potential airway obstruction, which is a life-threatening emergency. Immediate medical attention is necessary to prepare for airway management and advanced interventions, including possible intubation or emergency airway procedures. Delays in obtaining help increase the risk of airway compromise and respiratory failure.
Rationale for incorrect answers:
1. Offering liquids to a child with airway obstruction and respiratory distress risks aspiration and worsened airway compromise. The child may be unable to swallow safely.
2. Inspecting the throat with a flashlight and tongue bladecan trigger gagging or laryngospasm, leading to sudden airway obstruction and respiratory arrest in a child with suspected epiglottitis or similar airway obstruction. Throat inspection should only be performed by experienced providers in a controlled environment with airway equipment ready.
3. While vital signs and lung auscultation are important, the immediate priority is securing airway and emergency care. Assessment should not delay urgent intervention.
Take home points
- Signs of airway obstruction with respiratory distress require immediate medical attention and emergency airway management.
- Avoid oral examinations or giving fluids in children with suspected epiglottitis or severe airway obstruction.
- Prompt recognition and action can prevent respiratory failure and death.
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