Definition of Croup
Croup is a viral infection that affects the upper airway, specifically the larynx and trachea, leading to inflammation and swelling. It is commonly seen in children between the ages of six months and three years. Croup is characterized by a barking cough, hoarseness, and difficulty breathing, which can be alarming for both the child and their caregivers.
Defining Characteristics of Croup
- Parental report of a barking cough.
- Parental report of hoarseness.
- Parental report of difficulty breathing or stridor.
- Inspiratory stridor (high-pitched sound on inhalation).
- Substernal and suprasternal retractions.
- Increased respiratory rate.
- Use of accessory muscles for breathing.
- Cyanosis (late sign, indicates severe respiratory distress).
- Viral infection (parainfluenza virus, respiratory syncytial virus, adenovirus).
- Exposure to irritants or allergens.
- Smaller airways in children.
- Age (between six months and three years).
- History of recurrent respiratory infections.
- Reduced immune system function.
Children between the ages of six months and three years are at a higher risk of developing croup due to the anatomical and physiological characteristics of their airways. Additionally, children with a history of recurrent respiratory infections or reduced immune system function are also at an increased risk.
- Impaired gas exchange related to airway obstruction.
- Ineffective breathing pattern related to increased work of breathing.
- Acute pain related to inflammation and swelling of the airway.
- Anxiety related to difficulty breathing and distressing symptoms.
- Risk of fluid volume deficit related to increased respiratory effort and fluid loss due to tachypnea.
Suggestions for Use
When assessing a child with suspected croup, it is essential to gather both subjective and objective data to establish a nursing diagnosis accurately. Consider the child’s age, presenting symptoms, and any risk factors they may have. Collaborate with the healthcare team to determine appropriate interventions and evaluate the child’s response to treatment.
Suggested Alternative NANDA Diagnoses:
- Carefully assess the child’s respiratory status, noting any changes in breathing patterns, color, or use of accessory muscles.
- Maintain a calm environment to reduce anxiety and help alleviate the child’s distress.
- Administer prescribed medications as ordered, such as corticosteroids or nebulized epinephrine, to reduce airway inflammation and promote airway patency.
- Provide hydration and humidified air to help soothe the inflamed airways.
- Educate parents and caregivers on the signs and symptoms of croup, appropriate home management strategies, and when to seek medical assistance.
- Respiratory Status: Airway Patency
- Respiratory Status: Gas Exchange
- Pain Level
- Anxiety Level
- Knowledge: Disease Process
The desired outcomes for a child with croup would be:
- Maintenance of clear and patent airway.
- Adequate oxygenation and normal respiratory rates.
- Reduction in pain and discomfort.
- Decreased anxiety and improved coping mechanisms.
- Understanding of the disease process and appropriate home management strategies.
- Airway Management: Ensure a patent airway by maintaining proper positioning and providing suctioning if
- necessary. Monitor respiratory status closely and intervene promptly if airway obstruction worsens.
- Oxygen Therapy: Administer supplemental oxygen as prescribed to maintain adequate oxygenation and alleviate respiratory distress.
- Medication Administration: Administer prescribed medications such as corticosteroids and nebulized epinephrine to reduce airway inflammation and improve breathing. Monitor for any adverse effects and provide education on medication administration to parents or caregivers.
- Fluid Management: Assess fluid balance and provide adequate hydration to prevent dehydration. Monitor intake and output closely, and encourage oral fluids or administer intravenous fluids if necessary.
- Comfort Measures: Provide comfort measures such as a calm and quiet environment, reassurance, and distractions (e.g., toys, books) to alleviate anxiety and reduce distress.
- Education and Support: Provide education to parents or caregivers about croup, its management, and when to seek medical assistance. Offer emotional support and reassurance to help alleviate their concerns and empower them to care for their child effectively.
Croup Nursing Care Plan 1
Croup with Ineffective Airway Clearance Nursing Diagnosis
Nursing Diagnosis: Ineffective Airway Clearance related to airway inflammation and swelling secondary to croup.
- Viral infection causing upper airway inflammation.
- Edema and narrowing of the larynx and trachea.
- Presence of mucus or secretions obstructing the airway.
- Age-related anatomical factors (smaller airways in children).
- Maintain a patent airway with improved gas exchange.
- Demonstrate effective breathing pattern with decreased use of accessory muscles.
- Clear lung sounds with absence of adventitious breath sounds.
- Improved oxygen saturation levels within the expected range.
- Reduction in signs of respiratory distress, such as cyanosis and retractions.
Croup Nursing Interventions:
- Assess respiratory status:
- Monitor respiratory rate, rhythm, and effort.
- Auscultate lung sounds for presence of adventitious breath sounds (e.g., wheezing).
- Observe for signs of increased work of breathing (e.g., nasal flaring, use of accessory muscles).
- Maintain a patent airway:
- Ensure proper positioning of the child to optimize airway alignment.
- Encourage the child to maintain an upright position.
- Administer humidified oxygen as prescribed to improve oxygenation and alleviate airway inflammation.
- Implement suctioning as needed to remove secretions and maintain airway patency.
- Promote effective coughing and clearance of secretions:
- Encourage the child to cough and assist as needed to mobilize and expectorate secretions.
- Administer nebulized bronchodilators or mucolytic agents as prescribed to facilitate mucus clearance.
- Encourage fluid intake to promote hydration and thinning of secretions.
- Monitor oxygen saturation and provide supplemental oxygen:
- Continuously monitor oxygen saturation levels using pulse oximetry.
- Administer supplemental oxygen as prescribed to maintain oxygen saturation within the desired range.
- Provide a calm and soothing environment:
- Minimize environmental stimuli that may exacerbate anxiety and respiratory distress.
- Create a quiet and peaceful environment to help the child relax and breathe more comfortably.
- Educate parents/caregivers:
- Provide education about croup, its causes, and the importance of maintaining a humidified environment.
- Teach parents/caregivers about signs and symptoms of respiratory distress and when to seek immediate medical attention.
- Instruct parents/caregivers on proper administration of prescribed medications and techniques for airway clearance.
- Assess the child’s respiratory status regularly, including respiratory rate, effort, and breath sounds.
- Monitor oxygen saturation levels and ensure they are within the expected range.
- Evaluate the child’s ability to cough effectively and clear secretions.
- Observe for improvements in signs of respiratory distress, such as decreased retractions and cyanosis.
- Engage in open communication with parents/caregivers to assess their understanding of croup management and home care.
Croup Nursing Care Plan 2
Croup with Anxiety Nursing Diagnosis
Nursing Diagnosis: Anxiety related to difficulty breathing and distressing symptoms associated with croup.
- Fear of suffocation or inability to breathe due to airway obstruction.
- Unfamiliar environment (hospital setting) causing increased anxiety.
- Separation from parents or caregivers during medical interventions.
- Previous traumatic experiences related to respiratory distress.
- Reduction in anxiety levels as evidenced by the child appearing calm and relaxed.
- Utilization of effective coping strategies to manage anxiety.
- Verbalization of reduced fear and increased confidence in managing croup symptoms.
- Demonstration of improved cooperation during medical interventions.
Croup Nursing Interventions:
- Assess anxiety level and coping mechanisms:
- Observe the child’s behavior, restlessness, and signs of distress.
- Evaluate the child’s understanding of the disease and perceptions of their symptoms.
- Assess current coping strategies and provide guidance if needed.
- Provide a supportive and calm environment:
- Create a quiet and comforting space for the child.
- Maintain a consistent presence and offer reassurance throughout the care process.
- Use age-appropriate distraction techniques (e.g., toys, books) to divert attention from distressing symptoms.
- Educate the child and family:
- Provide developmentally appropriate explanations about croup, its symptoms, and treatment.
- Encourage parents or caregivers to ask questions and address any concerns they may have.
- Teach relaxation techniques (e.g., deep breathing, visualization) to the child and family to manage anxiety.
- Involve parents or caregivers:
- Encourage parental presence during medical interventions whenever possible to provide emotional support.
- Facilitate parental involvement in the child’s care, allowing them to participate in non-invasive procedures or comfort measures.
- Administer prescribed medications:
- Administer anxiolytic medications as prescribed to help alleviate anxiety and promote relaxation, if deemed necessary by the healthcare provider.
- Assess the child’s anxiety level regularly, using appropriate assessment tools and observation.
- Evaluate the child’s ability to utilize coping strategies and verbalize reduced fear or anxiety.
- Monitor the child’s cooperation during medical interventions and assess any changes in their response.
- Engage in open communication with the child and family to assess their understanding of croup, anxiety management techniques, and progress made.
Croup Nursing Questions:
Question 1: Which of the following is a common characteristic of croup?
b) Productive cough
c) Inspiratory stridor
d) Low-grade fever
Answer: c) Inspiratory stridorRationale: Inspiratory stridor is a high-pitched sound heard during inhalation and is a common characteristic of croup due to airway inflammation and obstruction.
Question 2: A child with croup presents with substernal retractions, increased respiratory rate, and cyanosis. What nursing diagnosis is most appropriate for this child?
a) Impaired Gas Exchange
c) Ineffective Breathing Pattern
d) Acute Pain
Answer: a) Impaired Gas Exchange
Rationale: The child’s symptoms indicate impaired gas exchange due to airway obstruction, leading to decreased oxygenation and potential cyanosis.
Question 3: Which age group is most commonly affected by croup?
a) Infants (0-6 months)
b) Toddlers (1-3 years)
c) Preschoolers (4-6 years)
d) School-age children (7-12 years)
Answer: b) Toddlers (1-3 years)Rationale: Croup commonly affects children between the ages of six months and three years due to the anatomical and physiological characteristics of their airways.
Question 4: What is the primary intervention for croup?
a) Antibiotic administration
b) Nebulized bronchodilators
c) Fluid restriction
d) Humidified air and hydration
Answer: d) Humidified air and hydration
Rationale: Providing humidified air and ensuring adequate hydration helps soothe the inflamed airways and reduce symptoms in croup.
Question 5: When educating parents of a child with croup, which instruction is important to include?
a) Administer over-the-counter antitussive medications.
b) Avoid exposure to others, especially children, until symptoms resolve.
c) Encourage the child to engage in physical activities to improve breathing.
d) Apply cold compresses to the child’s neck to reduce swelling.
Answer: b) Avoid exposure to others, especially children, until symptoms resolve.Rationale: Croup is a contagious viral infection, so it is important to prevent its spread by avoiding contact with others, particularly children, until symptoms have resolved.
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
Best Nursing Books and Resources
These are the nursing books and resources that we recommend.
This is an excellent reference for nurses and nursing students. While it is a great resource for writing nursing care plans and nursing diagnoses, it also helps guide the nurse to match the nursing diagnosis to the patient assessment and diagnosis.
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All introductory chapters in this updated version of a ground-breaking text have been completely rewritten to give nurses the knowledge they require to appreciate assessment, its relationship to diagnosis and clinical reasoning, and the goal and use of taxonomic organization at the bedside.
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Please follow your facilities guidelines, policies, and procedures.
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