Last updated on May 16th, 2022 at 12:26 pm
Epiglottitis Nursing Care Plans Diagnosis and Interventions
Epiglottitis NCLEX Review and Nursing Care Plans
Epiglottitis is an inflammatory disorder affecting the epiglottis and associated structures such as the arytenoids, aryepiglottic folds, and vallecular.
The disease is usually caused by infection. Epiglottitis is a potentially fatal condition that produces severe swelling of the upper airways, which can result in suffocation and respiratory arrest.
The majority of illnesses were caused by Haemophilus influenzae type B before the discovery of the vaccine, and the condition was significantly more frequent.
Pathogens responsible in the post-vaccine era are more diverse and can also be polymicrobial. As a result, the term “supraglottitis” is frequently used to describe infections that affect the supraglottic structures in general.
Edema of the epiglottis and supraglottic structures can proceed slowly until a critical mass is reached, at which point the clinical situation can quickly deteriorate, leading to airway blockage, respiratory distress, and death.
Because patient discomfort and agitation can exacerbate symptoms, especially in children, any patient diagnosed with true supraglottitis should have their airway secured under the most controlled conditions possible, with every effort made to keep the patient as calm and comfortable as possible until an airway is secured
. In clinics/outpatient settings or emergency rooms, the airway should not be instrumented for oral exams or endoscopy, and no patient with a potentially unstable airway should be referred to the radiology department for imaging.
Signs and Symptoms of Epiglottitis
The symptoms of epiglottitis may be moderate for hours or days before rapidly worsening, giving the appearance of a sudden beginning.
This normally happens within the last 24 hours, but it might also happen within the recent 12 hours. Prodromal signs are absent in the majority of youngsters.
The 3 D’s of epiglottis include:
- Drooling
- Dysphagia or difficulty swallowing
- Distress or anxiety
Other signs and symptoms of epiglottis may include:
- Pain
- Speech problems. Pediatric patients may be sitting upright with their mouth open in a tripod stance and a garbled speech
- Inspiratory stridor. Swelling of the upper airway causes turbulent airflow.
- Intercostal or suprasternal retractions
- Tachypnea, and cyanosis. These are signs of severe upper airway obstruction
- Lymphadenopathy. An anterior neck examination may detect lymphadenopathy.
Causes of Epiglottitis
Epiglottitis is almost always caused by an infectious agent, whether bacterial, viral, or fungal. Haemophilus influenzae type B (HIB) is still the most common cause of infection in younger patients.
However, since the widespread availability of vaccines, this has decreased considerably. Streptococcus pyogenes, Streptococcus pyogenes, Streptococcus py pneumoniae, and S. pneumoniae aureus has been linked to it.
Pseudomonas aeruginosa and Candida have been identified as pathogens in immunocompromised people. Traumatic noninfectious causes include heat, caustic, or foreign body ingestion.
Although viruses can not cause epiglottitis, a previous viral infection can lead to bacterial superinfection. Varicella-zoster, herpes simplex, and Epstein-Barr virus are among viruses that can cause a superinfection.
The airway of a child differs significantly from that of an adult. The epiglottis is positioned more superiorly and anteriorly in a young child than in an adult.
With the trachea, there is also an oblique angle. The subglottis is the narrowest part of the airway in infants and children, while the glottis is the narrowest part in adults. Furthermore, the cartilage of an infant’s epiglottis is significantly more pliable than that of an adult’s epiglottis, which is far harder.
This is the normal phase of cartilage development, which explains why laryngomalacia is more common in infants and toddlers. The pliancy of the cartilage provides a ball-valve effect, where each inspiration drags an edematous epiglottis over the laryngeal airway, creating discomfort. An isolated epiglottic infection and the resulting increase in epiglottic mass in adults with stiffer cartilages may be resisted by the more rigid laryngeal/epiglottic cartilage; however, an infection that encompasses more of the supraglottic tissues, leading to edema, can cause symptoms and an unstable airway.
H. Infections of the epiglottis, such as influenzae and other viruses, can cause significant edema and swelling of the epiglottis and supraglottis in people of all ages.
This edema can quickly spread to nearby structures, causing symptoms of airway blockage to develop quickly. Although H. While H. influenzae remains the most prevalent infection in both adults and children, other species such as S. pneumoniae and S. pneumoniae are also common. S. Pneumoniae Streptococcus sp., and beta-hemolytic Streptococcus aureus.
Both adults and children are susceptible to these viruses. The list of probable causes in immunocompromised patients is substantially wider and must include Mycobacterium tuberculosis, as well as a vast number of others, though the relative rates remain the same.
Risk Factors to Epiglottitis
In many nations throughout the world, the annual incidence of epiglottitis in children has reduced since the HIB vaccine was included in the baby immunization schedule.
Adult incidence, on the other hand, has remained steady. Furthermore, in the post-vaccine period, the average age of children with epiglottitis has risen from three to six to twelve years old.
While epiglottitis was once regarded to be primarily a condition of children, practitioners are today far more likely to meet epiglottitis/supraglottitis in adults.
Factors that may increase the risk of developing epiglottitis include:
- Gender. Males are more likely than females to get epiglottitis.
- A compromised immune system. The person is more susceptible to bacterial infections that cause epiglottitis if the immune system has been compromised by illness or treatment.
- Insufficient immunization. Immunizations that are delayed or missed can make a child prone to Hib and raise the risk of epiglottitis.
Diagnosis of Epiglottitis
- Lateral neck radiograph, This will show enlargement of the epiglottis, popularly known as the “thumb sign,” which is not required for diagnosis but can help narrow down the differential diagnosis. Only the most stable, comfortable, and compliant patients should undergo this procedure. Due to the risk of producing laryngospasm, a flexible fiberoptic laryngoscopy can only be performed in a tightly controlled situation, such as the operating room.
- Ultrasound. Ultrasonography has been suggested as another method of evaluating these patients, with a longitudinal view exhibiting an “alphabet P sign.” This must be considered against the clinical state, and in children, it may be harmful. Only patients with a secured ET tube should receive a full blood count with differential, blood culture, and epiglottal culture.
A CT scan of the neck is rarely necessary and can be fatal. Respiratory crises can be triggered by putting the patient in a supine position. If a CT scan reveals this diagnosis unexpectedly, the patient should not be left alone in the radiology suite and should be taken to the operating room right once for airway examination and intubation.
An oropharyngeal exam is rarely used to assess a suspected case of epiglottitis since oral cavity manipulation might result in serious complications, such as respiratory arrest. This is mostly a clinical suspicion.
In 10-15% of patients, a chest x-ray may indicate concurrent pneumonia. In some compliant patients, a lateral neck X-ray can be obtained as previously described (with great caution). A constriction of the laryngotracheal area, readily confused with the “steeple sign” of laryngotracheal bronchitis, may also imply the diagnosis on a typical portable P-A X-ray (croup). As a result, this is strictly a clinical diagnostic.
Treatment for Epiglottitis
- Securing a Patent Airway. Maintaining a secured and patent airway is the single most essential part of treatment. Intubation and tracheotomy, if required, must be performed by a skilled medical professional. Inhalation induction of general anesthesia and subsequent intubation is most likely expected; however, this varies from patient to patient.
- Admission to Intensive Care. After the airway is secured, the patient should be admitted to the intensive care unit, and culture swabs should be sent at the time of intubation. Extubation can be considered once a leak around the endotracheal tube can be demonstrated with the cuff deflated.
- Medications. The use of corticosteroids to minimize edema has been linked to a reduction in the length of time these patients spend in intensive care. Antimicrobials should be started empirically. Once the culture and sensitivity data are obtained, the antimicrobial should be changed accordingly.
- Observations. All non-intubated patients must be admitted for observation, with a tracheostomy tray at their bedside. If an emergency airway is required, the ENT surgeon and anesthesiologist must be notified of the admission. Nurses should ensure that the pediatric patient is not in a supine position.
If an emergency airway is required, it should be obtained in the operating room as soon as possible. A laryngoscope should be used to check the airway initially. A tracheostomy should be performed if endotracheal intubation is not a possibility. Antibiotics should cover the common flora of the respiratory and oral cavities.
Prevention of Epiglottitis
Epiglottitis can typically be avoided with adequate H influenza type B immunization (HiB). Adults rarely need the vaccine unless they have immune issues such as sickle cell anemia, splenectomy (splenectomy), malignancies, or other conditions that impact the immune system.
If other persons in the house are infected with HiB, preventative medications like rifampin should be given to everyone who is:
- Has not had all of the Hib immunizations and is under the age of four
- Has not completed the first series of HiB vaccine and is under the age of 12 months
- Under the age of 18 and suffering from a compromised immune system
This is done to ensure that the bacteria does not spread from the sick person to the rest of the family. This inhibits the emergence of a “carrier state,” in which a person carries the pathogen but is not actively ill. Carriers can still infect other members of their family.
Epiglottitis Nursing Diagnosis
Epiglottitis Nursing Care Plan 1
Nursing Diagnosis: Ineffective Airway Clearance related to obstruction of the upper airways induced by edema and increased mucus production secondary to epiglottitis as evidenced by high fever, muffled voice, throat discomfort, shortness of breath, drooling, dysphagia, decreased breath sounds, Respiratory distress caused by rapid breathing, and Epiglottis is bright red with edema.
Desired Outcome: The patient will demonstrate maintenance of airway clearance.
| Epiglottitis Nursing Interventions | Rationale |
| Evaluate the patient’s breathing rate, effort, pattern, and depth. | Nasal flaring, fast breathing, difficulty of breathing, chest retractions, and apnea all indicate severe respiratory distress and necessitate prompt airway care. |
| Examine the patient’s lungs for the existence of typical or unusual lung sounds. | A mucus plug or airway obstruction can be detected by the absence or reduction of lung sounds. Stridor is a late warning indication of epiglottitis, indicating the need for immediate airway treatment. |
| Monitor oxygen saturation with pulse oximetry, and evaluate arterial blood gases (ABGs) | Changes in oxygenation are detected by pulse oximetry. The oxygen saturation level should be kept at 90% or higher. Increased pulmonary discharges and respiratory exhaustion may arise from ABGS changes. |
| Warm, clear fluids are offered to encourage oral intake. | Thick mucus/secretions are liquefied by enough water. |
| Give the patient humidified oxygen. | Patients require moist air to help with expectoration and reduce epiglottal irritation. |
| As directed, administer IV antibiotics. | Second- or third-generation cephalosporins, as well as beta-lactamase resistant antibiotics, should be begun as soon as possible after acquiring blood and epiglottic cultures. |
| Prepare for tracheostomy or intubation; anticipate the necessity for an artificial airway. | An artificial airway is required to improve the patient’s oxygenation and ventilation and, at the same time, avoiding aspiration. |
| Assist the client in maintaining a comfortable position. Raising the head of the bed and leaning on the over-bed table or on the edge of the bed | Respiratory function is improved by elevating the head of the bed. However, a client in acute distress will seek medical help. The most comfortable breathing position Arms that support and Legs with table, cushions, and other props can help with muscle fatigue and chest expansion. |
Epiglottitis Nursing Care Plan 2
Nursing Diagnosis: Hyperthermia related to the inflammation of epiglottis secondary to epiglottitis as evidenced by a sudden rise in body temperature outside of the normal range, warm to touch, Tachycardia, Tachypnea, and positive throat culture.
Desired Outcome: The patient will maintain a body temperature between 36.0° C and 37.5°C.
| Epiglottitis Nursing Interventions | Rationale |
| Determine the precipitating factors to hyperthermia. | The underlying reason must be identified and managed in order to recover. |
| Monitor the patient’s heart rate, blood pressure, and, in particular, the tympanic or rectal temperature. | The patient’s cardiac rate and blood pressure elevate as hyperthermia progresses. A more precise indication of core temperature is tympanic or rectal temperature. |
| Cooling techniques include wearing light clothing, lowering the room temperature, and using cold compresses. | Room temperature can be modified to be close to normal body temperature, and blankets and linens can be altered as needed to keep the client warm. |
| Allow for adequate rest and promote a stress-free environment. | Reduces the metabolic demands. |
| Encourage adequate hydration. | Fever can cause dehydration and fluid loss. |
| Always maintain the side rails raised. | Even if there is no seizure activity, make sure the patient is safe. |
| As directed, take antipyretics (acetaminophen). | Reduces fever and relieves throat discomfort. |
| As directed, administer IV antibiotics. | Treats the underlying cause or a bacterial infection that has already developed. |
| Teach the patient and family members how to recognize the signs and symptoms of hyperthermia and how to identify factors that cause fever. | To aid in coping with the condition and to prevent further complications associated with hyperthermia, provide health education to the patient and his/her family. |
| Tepid sponge baths should be provided. Alcohol should be avoided. | Fever can be reduced by taking a tepid sponge bath. Chills can be caused by ice or alcohol, which raises the temperature. Alcohol can also dehydrate the skin. |
Epiglottitis Nursing Care Plan 3
Nursing Diagnosis:Anxiety related to a change in the client’s health status, a change in environment (i.e., hospitalization), changes in role performance (parenting) secondary to epiglottitis as evidenced by clients’ expressions of great dread and anxiety, agitation, hyperventilation, crying, and irritability.
Desired Outcomes:
- The patient will verbalize reduced anxiousness.
- The patient will demonstrate a calm disposition without expressing agitation, weeping, or irritability in the client.
| Epiglottitis Nursing Interventions | Rationale |
| Determine the intensity of the client’s worry and anxiety. | Provides information on the occurrence of extreme anxiety when the disease’s symptoms worsen and breathing becomes more difficult. |
| Assure the client is receiving the best possible care by creating a peaceful and supportive environment. | Provides reassurance to client and reduces their anxieties. |
| During the acute stages, stay with the client at all times. | Provides client with reassurance and continual review for emergency interventions. |
| Allow a familiar object to accompany the client throughout the hospitalization. | Encourages the client to be in a comfortable and secure position. |
| Educate the client about his/her illness, including procedures, treatments, and changes. | Reduces stress brought on by apprehension about the unknown. |
| During the acute period, avoid any unnecessary measures or treatments. | Prevents anxiety from rising, which causes respiratory distress. |
| Provide the client with an overview of the space, equipment, supplies, and policies. | It acclimates the client to the hospital setting. |
| Encourage the client to communicate their concerns and feelings. | Reduces anxiety and embarrassment. |
| Explain to the client that swelling goes down 24 hours after starting antibiotics, and the epiglottis normally returns to normal in 3 days. | Reduces anxiety by providing proof of a positive outcome. |
| Offer relaxing techniques like back massage and guided imagery. If culturally appropriate, use visuals and touch. | Relaxation can help with anxiety and fear reduction. |
| Analyze previously used coping techniques. | Reinforces previously effective coping techniques and use in adjusting to a new scenario |
Epiglottitis Nursing Care Plan 4
Nursing Diagnosis: Deficient Knowledge related to the promotion of health-seeking behaviors in the hospital and/or at home to prevent complications and promote healing secondary to epiglottitis as evidenced by parents inquiring about caring and preventative measures and readmission of the child to the hospital with complications.
Desired Outcome: The client will express an understanding of their condition and its preventive care.
| Epiglottitis Nursing Interventions | Rationale |
| Instruct clients on the signs and symptoms of respiratory distress, which include nasal flaring, retractions, cyanosis, increased breathing rate, and elevated pulse. | Allows the client to gather knowledge so that they can get quick medical help if necessary. |
| Educate the client on how to administer the medication. | Promotes knowledge that may lead to more consistent and proper pharmaceutical administration as well as the detection of unwanted side effects. |
| Instill in the client the value of education. To avoid disease, get enough rest and eat well. | Prevents subsequent infections and strengthens the body’s natural defenses. |
| Educate the client, if needed, on correct handwashing practices and the proper disposal of dirty tissues. | It prevents the spread of disease. |
| Examine and reinforce clients’ knowledge of the material. | Provides information about additional teaching requirements. |
Epiglottitis Nursing Care Plan 5
Risk For Suffocation
Nursing Diagnosis: Risk for Suffocation related to edema and inflammation of the epiglottis secondary to epiglottitis
Desired Outcomes:
- The patient will maintain a patent airway through preventative actions.
- The patient will keep an open airway either through natural methods or with the use of an ET tube or a tracheostomy.
| Epiglottitis Nursing Interventions | Rationale |
| Examine for skin changes ranging from pallor to cyanosis, as well as significant dyspnea. Lethargy, elevated pulse, and sternal and intercostal retractions should also be observent. | A through examination provides information regarding Increased airway blockage. |
| Avoid using a tongue blade to examine the throat or getting a throat culture. | Laryngospasm and airway blockage may result from the use of a tongue blade. |
| Instruct the patient to sit rather than lay down. | If the client lies down, the epiglottis may fall backward, obstructing their airway. |
| Monitor oxygenation using a pulse oximeter and administer oxygen as needed. | This promotes tissue oxygenation and avoids hypoxemia. |
| Endotracheal intubation should be readily available; if tracheostomy is required, help with it or prepare for it in surgery. | If there is an obstruction and respiratory failure or hypoxia is imminent, this procedure opens the airway. |
| Give a clear and concise description of the diagnosis and procedures while hospitalized, provide treatment and follow all procedures, including the purpose and process for emergency intubation or tracheostomy if necessary. | For parents who are inexperienced with medical care, explanations help reduce anxiety levels. |
| Inform parents of the reasoning behind the clinical decisions. Tell them that if emergency treatment is performed, the edema will subside within 24 hours of therapy, and the ET tube will most likely be removed after three days. | This rovides information to parents on what to expect and therefore help reduce their anxiety levels. |
Nursing References
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. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
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. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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