Nursing Care Plan (NCP) for Epiglottitis

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Outline

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:

  • Pain/difficulty swallowing 
  • Difficulty breathing 
  • Recent/current upper respiratory infection 
  • Severe sore throat 
  • Anxious/restlessness

Objective Data:

  • Difficulty speaking/muffled voice 
  • Mouth-breathing
  • Fever
  • Stridor (high-pitched sound when breathing in)

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Assess respiratory status  include rate, depth, and effort. Auscultate for any adventitious lung sounds 

Respiratory Distress- any obstruction may lead to intubation or tracheostomy 

Stridor-indicates advancement of the disease and will require emergency airway management 

Position patient sitting up and leaning forward; encourage mouth breathing  this will help with airflow to the lungs and reduces respiratory effort required for breathing 
Assess vital signs for fever, tachypnea, tachycardia  fever may indicate underlining cause of the condition if related to a bacterial infection 
Monitor oxygen saturation and administer humidified oxygen as needed  an oxygen saturation below 90% indicates decreased perfusion and will require supplemental o2. Humidified o2 will help prevent drying out of the mucous membrane and encourage thinning of secretions for easier removal 
Maintain NPO status  prevent choking/any further airway obstruction 
Initiate IV fluids/medications  maintain hydration for the patient and also thin and loosen secretions 

Antibiotics may be required 

IV steroids for inflammation 

Antipyretics such as acetaminophen or ibuprofen to reduce fever and relieve pain 

Oral medications should be avoided due to swallowing and breathing difficulties 

Prepare patient for intubation and/or tracheostomy patient may require advanced airway treatment with mechanical ventilation until the swelling subsid
Provide patient/families/caregivers with education regarding treatment and prevention HIB is the most common cause of Epiglottitis and can be prevented by routine immunizations 

 

Writing a Nursing Care Plan (NCP) for Epiglottitis

A Nursing Care Plan (NCP) for Epiglottitis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Hey everyone, we’re going to be going over the nursing care plan for epiglottitis. So here we go. First, we want to go over the pathophysiology. So, epiglottitis is the flap of cartilage that covers the trachea, and, whenever swallowing, it blocks airflow and prevents food from entering the lungs. When the epiglottis swells, it completely blocks the airway and becomes pretty life threatening. If not treated, swelling can occur quickly and requires immediate intervention. Nursing considerations: you want to make sure you’re assessing respiratory status and vital signs. You want to make sure you’re keeping the patient NPO, initiate any sort of fluids and medications, and prepare the patient for possible intubation or a tracheostomy. Desired outcomes we have for the patient we’ll be having adequate airway clearance. The patient will maintain body temperature within normal limits and be free from any sort of complications. 

So, let’s get into the care plan. So, what we have here for the care plan, we’re going to first start by going over a lot of the subjective data, and we’re going to go over a lot of the objective data. So, what we’re going to see in a patient. Some subjective data that we’re going to see most commonly is a sore throat. They’re going to complain that they’ve had a sore throat for many, many days that has not gone away with treatment. They’re also going to have some pain in their throat and they’re going to have any sort of upper respiratory infection, which is pretty common. Some objective data that you’re going to see if it is an infant, you’re going to see some drooling. They’re going to have some difficulty speaking, Some other objective data. You’re going to see they’re going to have a fever, which is a classic. Also, in late stages of epiglottitis you’re going to hear a stridor when you do a respiratory assessment. And basically, this is a very high-pitched tone that you’re going to hear on a patient and to which this can become pretty life threatening. 

So, we’re going to go over some nursing interventions and some rationales that go with those interventions. One of the first things that you want to do with these patients, that’s very important, is you’re going to assess their respiratory status. So, with these patients, it is very common that they end up having decreased oxygenation, not getting enough oxygen, to the vital tissues that are needed and able to perfuse properly. And you want to make sure you’re looking for any sort of respiratory distress as this can become a medical emergency over time. The next thing that we’re going to be doing is you want to make sure with the patient that they’re positioned properly, because, with these patients, you don’t want them lying down. They can aspirate or they’re not getting enough perfusion. So usually when you have a patient that’s sitting upright, usually in a high Fowler position and 90 degrees, it allows for better oxygenation and allows for better airflow into those lungs, and into the surface area, and is able to breathe properly. Another thing that we’re going to be looking for is we’re going to be assessing any sort of signs of fever. So, you’re going to be doing some vital signs. Fever is very common with these patients. You also want to look for an increased respiratory rate and some tachypnea. They’re going to be breathing pretty rapidly because they’re not getting enough oxygen. One of the next things that we’re going to make sure that we’re doing, we’re going to be monitoring their O2 sats. Usually, you do want to have around 92% or more, but if they are less, they may need some O2. So, you may need to put them on a nasal cannula to give them some oxygen if they’re anywhere below 92%. Because again, if they’re not getting enough oxygen, they’re not, perfusing properly to all of the major organs. Another thing that we’re going to make sure we’re doing with these patients again, because this is inflamed, is keep this patient NPO status. And the reason being is because they are at a very high risk of aspiration. So, you want to keep them NPO for now until you’re able to get that swelling down. The next intervention that we’re going to do is initiate IV fluids and also any sort of medications. So, antibiotics, IV steroids, or antipyretic drugs. This is going to help with the inflammation and the antipyretics are going to help with pain and fever. And all of the fluids are going to be isotonic fluids and that’s going to help to make sure you keep your patient hydrated. It’s very, very important. And one of the things with epiglottitis is that because of the swelling, you don’t want to be giving any of these medications by mouth. So, you want to avoid anything by mouth because as we mentioned here, you want to keep the patient NPO status. So, medications are going to be through IV. Okay. And the last one is preparing the patient for intubation and the tracheostomy. So, unfortunately it may be required to have some sort of an advanced treatment such as mechanical ventilation for your patient, able for them to breathe properly, just because of that swelling that is happening, that you’re going to have difficulty breathing. And as always, you want to make sure you’re educating the patient and/or the caregiver just to make sure that treatment is working and that prevention measures are being taken into consideration since influenza type B is the most common cause of epiglottitis. You want to give them the information about getting certain vaccinations. 

some key points we want to go back over. So, we’re going to go over patho and etiology. So, epiglottitis is when it swells completely that the epiglottis blocks the airway. It is typically caused by the influenza B groups, A and C strep and possibly from burns or hot liquids. You want to do full assessments. So, you want to make sure you’re monitoring respiratory status and O2 saturation, making sure that they’re perfusing properly. Making sure they’re positioned properly, fluids, medications, and maintaining that patient on NPO status especially because of it being swollen., they’re not getting enough oxygen in. Giving fluids, medications such as antibiotics and steroids, and any sort of isotonic solutions. And lastly, intubate and tracheostomy. Make sure that you are educating the patient if they’re going to end up needing this type, have a procedure done, and any of the family members because they may need that mechanical ventilation until that swelling subsides. 

Awesome. Awesome job guys. You guys are doing amazing. We love you guys. We want you to be your best self today and as always happy nursing.

 

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