Nursing Care Plan for Epiglottitis

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Pathophysiology

The epiglottis is the flap of cartilage that covers the trachea when swallowing that blocks airflow and prevents food from entering the lungs. When the epiglottis swells, it can completely block the airway and become life-threatening. Swelling can occur quickly and requires immediate intervention.

Etiology

The most common cause of epiglottitis is bacterial infection, specifically Haemophilus influenzae type b (Hib) and Groups A and C streptococci. In some cases, a bacterial superinfection that causes epiglottitis may be the result of a previous viral infection such as varicella-zoster or Epstein-Barr virus. Viruses usually do not cause epiglottitis on their own. Thermal or chemical injuries, burns from hot liquids or direct trauma may also cause epiglottitis.

Desired Outcome

Patient will have adequate airway clearance; patient will maintain body temperature within normal limits and be free from complications

Epiglottitis Nursing Care Plan

Subjective Data:

  • Quick onset of sore throat
  • Recent or current upper respiratory infection
  • Difficulty breathing
  • Pain or difficulty swallowing

Objective Data:

  • Drooling
  • Fever
  • Stridor
  • Increased respiratory effort (retractions)
  • Mouth-breathing
  • Difficulty speaking / muffled voice

Nursing Interventions and Rationales

  • Assess breathing pattern.
    • Note respiratory rate, depth and effort.
    • Auscultate for adventitious lung sounds.

 

See if patient is in respiratory distress to determine treatment; obstruction may require intubation or tracheostomy.

Stridor indicates advanced progression of disease and requires emergency airway management

 

  • Position patient sitting up and leaning forward; encourage mouth breathing

 

This position helps airflow and reduces effort required for breathing, thus minimizing edema

 

  • Assess vitals for fever, tachypnea, tachycardia

 

Fever may indicate underlying cause of condition if related to a bacterial infection

 

  • Monitor oxygen saturation and administer humidified oxygen

 

Oxygen saturation below 90% indicates decreased perfusion and requires advanced treatment.

Humidified oxygen help prevent drying of the mucous membranes and encourages thinning of secretions for easier removal

 

  • Maintain NPO status

 

To prevent choking and further airway obstruction

 

  • Initiate IV fluids

 

To maintain hydration, as well as thin and loosen secretions.

 

  • Administer medications by IV route

 

  • Antibiotics may be required to treat underlying infection.
  • Steroids may be given to help relieve swelling.
  • Antipyretics such as acetaminophen or ibuprofen may be given to reduce fever and relieve pain.
  • Oral medications should be avoided due to swallowing and breathing difficulty

 

  • Prepare patient and equipment for intubation and/or tracheostomy

 

To maintain adequate ventilation, patient may require tracheostomy or intubation with mechanical ventilation until swelling subsides.

 

  • Provide education for patient and parents / caregiver regarding treatment and prevention

 

Hib is the most common infectious cause of epiglottitis and can be prevented with routine immunizations.

 


References

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