Croup (laryngotracheobronchitis) is an acute respiratory condition primarily affecting young children, characterized by inflammation of the upper airway, particularly the larynx and trachea. This nursing diagnosis focuses on identifying and managing croup symptoms, preventing complications, and providing effective respiratory support.
Causes (Related to)
Croup can affect patients in various ways, with several factors contributing to its severity and progression:
- Viral infection (most commonly parainfluenza virus)
- Age (typically affects children 6 months to 3 years)
- Anatomical factors (narrow airways in young children)
- Predisposing factors such as:
- History of respiratory conditions
- Allergies
- Premature birth
- Previous episodes of croup
- Environmental triggers include:
- Cold air exposure
- Air pollution
- Second-hand smoke
- Respiratory irritants
Signs and Symptoms (As evidenced by)
Croup presents distinctive signs and symptoms that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient/Parent reports)
- Barking or seal-like cough
- Hoarseness
- Difficulty breathing
- Anxiety and distress
- Sore throat
- Difficulty swallowing
- Voice changes
Objective: (Nurse assesses)
- Inspiratory stridor
- Suprasternal and intercostal retractions
- Low-grade fever (typically <101.5°F)
- Tachypnea
- Decreased oxygen saturation
- Use of accessory muscles
- Cyanosis (in severe cases)
- Altered breath sounds
Expected Outcomes
The following outcomes indicate successful management of croup:
- The patient will maintain a patent airway
- The patient will demonstrate improved breathing patterns
- The patient will maintain oxygen saturation >95%
- The patient will show decreased work of breathing
- The patient will demonstrate reduced anxiety
- The patient will maintain adequate hydration
- The patient’s symptoms will resolve within 3-7 days
Nursing Assessment
Monitor Respiratory Status
- Assess breathing pattern and rate
- Monitor stridor and retractions
- Check oxygen saturation
- Evaluate the work of breathing
- Document cough characteristics
Evaluate General Status
- Monitor temperature
- Assess hydration status
- Check activity level
- Monitor anxiety level
- Assess sleep patterns
Check for Complications
- Monitor for signs of respiratory failure
- Assess for dehydration
- Watch for signs of exhaustion
- Evaluate mental status changes
- Check for cyanosis
Review Risk Factors
- Document age and previous episodes
- Assess environmental triggers
- Review medical history
- Check vaccination status
- Note any allergies
Nursing Care Plans
Nursing Care Plan 1: Ineffective Breathing Pattern
Nursing Diagnosis Statement:
Ineffective Breathing Pattern related to upper airway inflammation as evidenced by inspiratory stridor and increased work of breathing.
Related Factors:
- Laryngeal inflammation
- Anxiety
- Upper airway edema
- Increased secretions
Nursing Interventions and Rationales:
- Position the patient in an upright position
Rationale: Promotes optimal airway patency and reduces work of breathing - Implement cool mist therapy
Rationale: Helps reduce airway inflammation and ease breathing - Monitor respiratory status frequently
Rationale: Allows early detection of deterioration
Desired Outcomes:
- The patient will demonstrate an improved breathing pattern.
- The patient will maintain oxygen saturation >95%
- The patient will show decreased work of breathing
Nursing Care Plan 2: Anxiety
Nursing Diagnosis Statement:
Anxiety related to respiratory distress as evidenced by increased agitation and crying.
Related Factors:
- Difficulty breathing
- Unfamiliar environment
- Parental anxiety
- Physical discomfort
Nursing Interventions and Rationales:
- Maintain calm environment
Rationale: Reduces anxiety and prevents respiratory distress - Provide age-appropriate explanation
Rationale: Increases understanding and cooperation - Encourage parental presence
Rationale: Provides emotional support and comfort
Desired Outcomes:
- The patient will demonstrate decreased anxiety
- The patient will remain calm during interventions
- The patient will show improved cooperation with the treatment
Nursing Care Plan 3: Hyperthermia
Nursing Diagnosis Statement:
Hyperthermia related to inflammatory response as evidenced by elevated temperature and flushed skin.
Related Factors:
- Viral infection
- Inflammatory process
- Dehydration
- Increased metabolic rate
Nursing Interventions and Rationales:
- Monitor temperature regularly
Rationale: Allows evaluation of treatment effectiveness - Administer antipyretics as ordered
Rationale: Helps reduce fever and associated discomfort - Encourage fluid intake
Rationale: Prevents dehydration and supports temperature regulation
Desired Outcomes:
- The patient will maintain a normal temperature
- The patient will demonstrate adequate hydration
- The patient will show an improved comfort level
Nursing Care Plan 4: Risk for Impaired Gas Exchange
Nursing Diagnosis Statement:
Risk for Impaired Gas Exchange related to upper airway inflammation and increased work of breathing.
Related Factors:
- Airway edema
- Increased secretions
- Respiratory fatigue
- Altered breathing pattern
Nursing Interventions and Rationales:
- Monitor oxygen saturation continuously
Rationale: Enables early detection of hypoxemia - Assess breath sounds
Rationale: Identifies changes in respiratory status - Position for optimal breathing
Rationale: Promotes effective gas exchange
Desired Outcomes:
- The patient will maintain adequate oxygenation
- The patient will demonstrate clear breath sounds
- The patient will show no signs of respiratory distress
Nursing Care Plan 5: Risk for Fluid Volume Deficit
Nursing Diagnosis Statement:
Risk for Fluid Volume Deficit related to increased respiratory rate and decreased oral intake.
Related Factors:
- Increased respiratory effort
- Fever
- Poor oral intake
- Excessive sweating
Nursing Interventions and Rationales:
- Monitor intake and output
Rationale: Ensures adequate fluid balance - Encourage small, frequent sips of fluid
Rationale: Prevents dehydration while minimizing aspiration risk - Assess hydration status
Rationale: Enables early intervention for fluid imbalance
Desired Outcomes:
- The patient will maintain adequate hydration
- The patient will demonstrate appropriate urine output
- The patient will show moist mucous membranes
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Klassen TP, Watters LK, Feldman ME, Sutcliffe T, Rowe PC. The efficacy of nebulized budesonide in dexamethasone-treated outpatients with croup. Pediatrics. 1996 Apr;97(4):463-6. PMID: 8632929.
- Leung AK, Kellner JD, Johnson DW. Viral croup: a current perspective. J Pediatr Health Care. 2004 Nov-Dec;18(6):297-301. doi: 10.1016/S0891524504002688. PMID: 15523420.
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