Angelite Nurses: Laryngotracheobronchitis

Laryngotracheobronchitis

General information

Viral infection of the larynx that may extend into trachea and bronchi
Most common cause for stridor in febrile child
Parainfluenza viruses most common cause
Infection causes endothelial insult, increased mucous production, edema, low grade fever
Affects children less than five years of age
Onset more gradual than with croup, takes longer to resolve; usually develops over several days with upper respiratory infection
Usually treated on outpatient basis; indications for admission include dehydration and respiratory compromise

Medical management

Drug therapy

Aerosolized racemic epinephrine
Antibiotics only if secondary bacterial infection present
Steroids: still controversial

Oxygen therapy: low concentrations to relieve mild hypoxia (concentrations greater than 30% may mask signs of obstruction and should not be used)
Oral or nasotracheal intubation for moderate hypoxia
IV fluids to maintain hydration

Assessment findings

Fever, coryza, inspiratory stridor, barking cough, tachycardia, tachypnea, retractions
May have difficulty taking fluids
WBC normal

Nursing interventions

Instruct parents to take child into steamy bathroom for acute distress.
Keep child calm.
After distress subsides, use cool mist vaporizer in bedroom.
Child can vomit large amounts of mucus after the episode; reassure parents that this is normal.
For hospitalized child

Monitor vital signs, I&O, skin color, and respiratory effort.
Maintain hydration.
Provide care for the intubated child.
Plan care to disturb the child as little as possible.
Avoid direct examination of the epiglottis as it may precipitate spasm and obstruction.

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