Laryngotracheobronchitis


  1. General information
    1. Viral infection of the larynx that may extend into trachea and bronchi
    2. Most common cause for stridor in febrile child
    3. Parainfluenza viruses most common cause
    4. Infection causes endothelial insult, increased mucous production, edema, low grade fever
    5. Affects children less than five years of age
    6. Onset more gradual than with croup, takes longer to resolve; usually develops over several days with upper respiratory infection
    7. Usually treated on outpatient basis; indications for admission include dehydration and respiratory compromise
  2. Medical management
    1. Drug therapy
      1. Aerosolized racemic epinephrine
      2. Antibiotics only if secondary bacterial infection present
      3. Steroids: still controversial
    2. Oxygen therapy: low concentrations to relieve mild hypoxia (concentrations greater than 30% may mask signs of obstruction and should not be used)
    3. Oral or nasotracheal intubation for moderate hypoxia
    4. IV fluids to maintain hydration
  3. Assessment findings
    1. Fever, coryza, inspiratory stridor, barking cough, tachycardia, tachypnea, retractions
    2. May have difficulty taking fluids
    3. WBC normal
  4. Nursing interventions
    1. Instruct parents to take child into steamy bathroom for acute distress.
    2. Keep child calm.
    3. After distress subsides, use cool mist vaporizer in bedroom.
    4. Child can vomit large amounts of mucus after the episode; reassure parents that this is normal.
    5. For hospitalized child
      1. Monitor vital signs, I&O, skin color, and respiratory effort.
      2. Maintain hydration.
      3. Provide care for the intubated child.
      4. Plan care to disturb the child as little as possible.
      5. Avoid direct examination of the epiglottis as it may precipitate spasm and obstruction.

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