Croup-Syndrome.pptx and its consideration

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1. Prepared By: Sarada Panthi

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3. Croup Syndrome Croup is a common respiratory illness of the trachea, larynx, and bronchi characterized by croaking cough, Stridor, hoarseness, cold and fever. Dyspnea, cyanosis and restlessness may develop.  The term croup is used for variety of condition of upper airway illness in which a peculiar brassy cough is the main presenting feature .  3

4. Croup Syndrome The term is also used to describe a variety of respiratory condition including acute epiglottitis, laryngitis and laryngo-tracheobronchitis and spasmodic croup. 4

5. Croup is the clinical syndrome of: 5

6. Incidence It is the most common in children under the age of 5 years and specially those between 6 months -3 years of age. Male children are affected more than in female. 6

7. Incidence Annually in the United States, Croup accounts for 7% of hospitalizations in children younger than five years of age.  Croup affects about 3% of children per year, typically between the ages of 6 months and three years.  Parainfluenza virus accounts for more than 75% of croup infections. 7

8. Incidence It is more common in boys than girls with a 1.5:1 ratio. Approximately 85% of cases are defined as mild croup, and less than 1% are considered severe croup. 8

9. Causes The most common cause of croup is a viral infection (such as parainfluenza or influenza) that leads to swelling of the larynx and trachea. It is sometimes, but rarely, caused by bacteria, allergies, or reflux from the stomach. However, infection with these viruses is common and most children with these infections do not develop croup. The    parainfluenza    virus    is    the    most    common    cause of croup.  9

10. Four  strains  of  the  virus  are  responsible  for  most cases. These are:- 10 * Parainfluenza I is responsible  for  most  cases  of   croup

11. A number of other viruses can also cause croup. These include: Influenza A and B (flu viruses) The measles virus, in children who have not been immunized against measles. The rhinovirus (common cold virus) Enteroviruses The respiratory syncytial virus (RSV), which can cause severe breathing problems and pneumonia in babies. 11 Influenza A and B (flu viruses) The measles virus, in children who have not been immunized against measles. The rhinovirus (common cold virus) Enteroviruses The respiratory syncytial virus (RSV), which can cause severe breathing problems and pneumonia in babies.

12. A number of other viruses can also cause croup. These include: Influenza A is associated with severe respiratory disease as it  has been detected in children   with marked   respiratory compromise. The bacterial pathogen, Mycoplasma pneumoniae ha also  been  identified  in  a few  cases  of croup. 12

13. Note :-Children with croup should be considered contagious for three days after the illness begins or until the fever is gone. Bacterial Causes Staphylococcus Aureus Streptococcus Pneumoniae  13 Approximately  5%  of  children  experience  more  than 1  episode. Bacterial infection of  the  same areas  can  occur during the viral infection, but this does not happen very often. Bacterial co- infection  is  usually  more  severe  and  requires  a different treatment than a viral infection. 

14. Pathophysiology 14

15. Signs and symptoms 15 low-grade fever and coryza followed by a barking cough and various degrees of respiratory distress. In most children, the symptoms subside quickly with resolution of the cough within two days.

16. Classic Triad:  Barking Cough, Stridor, Hoarse voice, and Respiratory distress Agitation Inspiratory stridor Tracheal Tug Lethargy Abrupt onset of symptoms Symptoms worse at night 16

17. Types 17 * Croup’s Syndrome are the infections of Supraglottis , glottis and subglottis and trachea .

18. 1) Acute Epiglottitis It is an acute inflammation of the epiglottis-the flap at the base of the tongue that keeps food from going into the trachea. Due to its place in the airway, swelling of this structure can interfere with the breathing and constitutes a medical emergency. Infection can cause the epiglottis to obstruct or completely close of the windpipe. 18

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20. Causes:- Bacteria Haemophilus influenza type B (most common)although some cases are attributable : Streptococcus pneumonia, Streptococcus agalactiae, Staphylococcus aureus, Streptococcus pyogens , Haemophilus influenza and Moraxella catarrhails . 20

21. Signs and Symptoms 21 * In  survived child pulmonary edema and pneumothorax may developed.

22. Diagnosis Direct laryngoscopy-epiglottis appears angry red and swollen. X-ray of the lateral neck show epiglottal enlargement. Complete blood count with differential count Blood culture to detect bacteria. 22

23. 2)Acute Laryngitis It Acute infection and inflammation of the larynx is called laryngitis. It is a common illness in older children and adolescents. Viruses such as par-influenza type l, type 2 most common. 23

24. 2)Acute Laryngitis Child will be presented with hoarseness of voice, coryza, sore throat, nasal congestion, fever, headache, and malaise, etc. It is an infectious croup characterized by inflammation and narrowing of the laryngeal and tracheal areas It is the most common form of croup affects children less than 5 years of age. 24

25. Causes Usually caused by viruses. Common viruses are par-influenza virus, respiratory syncytial virus and adeno viruses. After getting infection there is production of tenacious mucous, this cannot be coughed out easily, and increases the respiratory obstruction. 25

26. Signs and Symptoms 26 *Gradual Onset 

27. 3) Acute Spasmodic Croup It is manifested by paroxysmal attack of laryngeal obstruction that occurs mainly at night. associated with genetic, allergic or emotional factors. reoccurs with respiratory tract infections and common in children between the ages of 1-3 years. 27

28. Signs and Symptoms 28 The child goes to bed well or with mild respiratory symptoms but wakes up suddenly in the early morning with brassy cough and noisy breathing, restlessness, anxious and frightened. The symptoms subsides in few hours reoccur in subsequent days.

29. Treatment 29

30. 4)Acute Laryngo-trachea-bronchitis It is found in children between 3 months to 5years of age. Peak age is 1 to 2years. 30

31. 4)Acute Laryngo-trachea-bronchitis Usually found in male child during late autumn or early winter.  Manifested with the history of URTI and mild brassy or barking cough, hoarseness, stidor , nasal flaring, chest retraction, labored breathing, air hunger, cyanosis, elevated temperature, tachycardia, crying restlessness and agitation.. 31

32. 4)Acute Laryngo-trachea-bronchitis Dehydration, hypercapnia, hypoxemia and airway obstruction is most common complications. 32

33. Diagnosis 33

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35. Management Mild:- S ymptomatic treatment liquids orally Parental Education Pitch deck title 35

36. Management In moderate cases to severe cases: Need hospitalization. Nebulize with epinephrine Intravenous or oral steroids Intravenous fluids replacement. IV antibiotics Pitch deck title 36

37. Management In moderate cases to severe cases: Keep the child in comfortable position. Avoid unnecessary handling. Avoid sedatives Keep intubation and tracheostomy set ready. Reassurance   Pitch deck title 37

38. Nursing Management Nursing Assessment History Taking Physical Examination Laboratory reports and x-ray Pitch deck title 38

39. Nursing Management Nursing Diagnosis Ineffective airway clearance related to respiratory tract inflammation, increased respiratory secretions, bronchospasm, and laryngeal edema. Pitch deck title 39

40. Nursing Management Nursing Diagnosis High risk for fluid volume deficit related to diaphoresis, difficulty swallowing, and increased metabolic rate. Anxiety related to dyspnea and air hunger and separation from parents. Pitch deck title 40

41. Nursing Management Nursing Diagnosis Sleep pattern disturbance related to respiratory distress. High risk for injury related to the use of combustible oxygen and electricity. Pitch deck title 41

42. Nursing Intervention Pitch deck title 42

43. Pitch deck title 43 Uprety K.(2021).Child Health Nursing.6rd ed. Akshav publication.katmandu Hockenberry J.M, Wilson D, Rodgers C.C (2018) Wong’s essential of pediatric nursing.10th ed. RELX Pvt. Ltd. New Delhi. India. Paul K .V. Bagga A. Ghai Essential Paediatrics . 9th ed(2019). CBS Publishers and Distributors pvt. Ltd. New Delhi Dutta P.Pediatric Nursing.2nd edition 2009.Jaypee Brothers Medical Publisher Pvt ltd New Delhi. http://nepmed.nhrc.gov.np/index.php/jgpeman/article/view/1012/838 https://www.hopkinsmedicine.org/health/conditions-and-diseases/croup#:~:text=Croup%20is%20a%20disease%20that,This%20is%20called%20stridor. References

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