Buy a Nursing essay from nursingessays.us

Left your Nursing Assignment to the last minute? Let a qualified expert do your Nursing essay for you and deliver it before your deadline!

9.8
Buy Nursing essay Papers
Calculate your paper price
Pages (550 words)
Approximate price: -

Epiglottitis


Janey had a 102.8°F fever, difficulty of breathing, and drooling. She also always sits on a tripod position because this position makes her breathe easier. Her parents brought her in for a check-up and was informed that their child has epiglottitis.

Description


Acute epiglottitis and associated upper airway obstruction has significant morbidity and mortality and may cause respiratory arrest and death.

  • Epiglottitis is acute inflammation of the epiglottitis.
  • Epiglottitis, also termed supraglottitis or epiglottiditis, is an inflammation of structures above the insertion of the glottis and is most often caused by bacterial infection.
  • Affected structures include the epiglottis, aryepiglottic folds, arytenoid soft tissue, and, occasionally, the uvula.
  • The epiglottis is the most common site of swelling.

Pathophysiology


Haemophilus influenzae type b (Hib) or Streptococcus pneumoniae can colonize the pharynges of otherwise healthy children through respiratory transmission from intimate contact.

  • The epiglottitis becomes inflamed and swollen with edema.
  • Hib infection of the epiglottis leads to acute onset of inflammatory edema, beginning on the lingual surface of the epiglottis where the submucosa is loosely attached.
  • Swelling significantly reduces the airway aperture.
  • Edema rapidly progresses to involve the aryepiglottic folds, the arytenoids, and the entire supraglottic larynx.
  • The tightly bound epithelium on the vocal cords halts edema spread at this level.
  • Frank airway obstruction, aspiration of oropharyngeal secretions, or distal mucous plugging can cause respiratory arrest.

Statistics and Incidences


The use of the Haemophilus influenzae type b (Hib) vaccine has reduced incidence of epiglottitis in the United States, making this a rare condition in children.

  • Studies have shown an annual incidence rate of 0.63 cases per 100,000 persons, and studies of children of all ages with epiglottitis report a seasonal variation in incidence.
  • A retrospective case series of 107 patients admitted to a pediatric hospital’s intensive care unit (ICU) from 1997 to 2006 concluded that bacterial tracheitis is now 3 times more likely to be the cause of pediatric respiratory failure compared with viral croup and epiglottitis combined.
  • The international incidence of epiglottitis widely varies, with a significantly greater prevalence in countries without universal immunization.
  • Among countries with mandatory immunization, the reported incidences are 0.9 cases per 100,000 persons in Sweden and 0.6 cases per 100,000 in the United Kingdom, for example.
  • Most studies show no racial predominance for epiglottitis, although a recent study showed higher incidence among black and Hispanic individuals.
  • There also appears to be a 60% male predominance, which has remained true even with the changing epidemiology of epiglottitis.

Causes


Commonly caused by Haemophilus influenzae type B, epiglottitis most often affects children 2 to 7 years.

  • Haemophilus influenzae. Historically, Haemophilus influenzae type b (Hib) was the predominant organism (>90%) in pediatric epiglottitis cases.
  • Viral agents. Although viruses normally do not cause epiglottitis, a previous viral infection may allow bacterial superinfection to occur; viral agents may include herpes simplex virus (HSV), parainfluenzae virus, varicella-zoster virus (VZV), human immunodeficiency virus (HIV), [3] and Epstein-Barr virus (EBV); varicella can cause a primary or secondary infection often with group A beta-hemolytic streptococci.
  • Non-infectious causes. Noninfectious etiologies include thermal injuries, trauma-causing blind finger sweeps to remove a foreign body from the pharynx, angioneurotic edema, hemophagocytic lymphohistiocytosis, and acute leukemia.

Clinical Manifestations


The child may have been well or may have had a mild upper respiratory infection before the development of the symptoms.

  • Fever. Fever is usually the first symptom, and temperatures often reach 40°C.
  • Dysphagia. Dysphagia or difficulty in swallowing is one of the symptoms in the clinical triad.
  • Drooling. Due to dysphagia, drooling occurs and is also one of the symptoms in the clinical triad.
  • Respiratory distress. The last of the three symptoms in the triad, fever with associated respiratory distress or air hunger occurs in most patients.
  • Tripod position. The child is very anxious and prefers to breathe by sitting up and leaning forward with the mouth open and the tongue out.

Assessment and Diagnostic Findings


Securing an airway is the overriding priority; an expert in pediatric airway management should always perform an endotracheal intubation on any child with suspected epiglottitis before radiography or blood work is performed.

  • Laryngoscopy. Laryngoscopy is the best way to confirm the diagnosis, but it is not advised to attempt any procedures without securing the airway.
  • Blood and epiglottis cultures. Blood cultures and culture of the epiglottis should be performed only after the airway is secured; blood cultures may show Haemophilus influenzae type b (Hib) between 12-15% and 90% of cases.
  • Lateral neck radiography. Never obtain a lateral neck radiograph before achieving definitive airway control; if radiography is required, the safest procedure is to perform portable radiography at the bedside.
  • Percutaneous transtracheal ventilation. Also termed needle cricothyrotomy or translaryngeal ventilation, percutaneous transtracheal ventilation is a temporizing method used to treat cases of severe epiglottitis when the patient cannot be intubated before a formal tracheostomy.

Medical Management


Treatment in patients with epiglottitis is directed toward relieving the airway obstruction and eradicating the infectious agent.

  • Manage respiratory arrest. When a child has respiratory arrest, the first step is to administer bag-valve-mask ventilation with 100% oxygen; once the child is oxygenated and ventilated, the airway can be secured with an endotracheal tube, cricothyrotomy, or tracheostomy; these treatments should prevent cerebral anoxia, arrest, and death, the most feared complications.
  • Moist air administration. Moist air is necessary to help reduce the inflammation of the epiglottitis.
  • Pulse oximetry. Pulse oximetry is required to monitor oxygen requirements.
  • Endotracheal intubation. Once supplemental oxygen is provided, the next crucial step is to mobilize a team to establish an appropriate airway via endotracheal intubation; mortality rates for children who receive endotracheal intubation are less than 1%; children who do not receive intubation have mortality rates as high as 10%.
  • Tracheostomy. If endotracheal intubation is unsuccessful, perform a tracheostomy with percutaneous translaryngeal ventilation used as a temporizing measure.

Pharmacologic Management

Medications used for a child with epiglottitis are:

  • Antibiotics. Appropriate antibiotics include ceftriaxone, cefotaxime, and cefuroxime (for nonmeningitic infections); as in all invasive Haemophilus influenzae type b (Hib) infections, contacts should receive rifampin chemoprophylaxis; for epiglottitis due to other organisms, antibiotics should be tailored to the cause of the infection.
  • Corticosteroids. Corticosteroid administration, although advocated in the past based on anecdotal reports, remains controversial.

Nursing Management


Nursing management of a child with epiglottitis include:

Nursing Assessment

Assessing a child with epiglottitis should include:

  • Respiratory assessment. Assess the child’s breathing, any history of injury to the throat, breathing through the mouth, stridor, and hypoxia.
  • Cardiovascular assessment. Assess the child’s pulse; assess for tachycardia and a thready pulse.
  • Gastrointestinal assessment. Assess if there is an inability to swallow.

Nursing Diagnosis

Based on the assessment data, the major nursing diagnoses are:

Nursing Care Planning and Goals

Main Article: 5 Epiglottitis Nursing Care Plans

The major goals are:

  • Patient and family will verbalize strategies to reduce anxiety.
  • Patient and family will demonstrate an understanding of what has been taught.
  • Patient and family will Verbalize understanding of condition/disease process and treatment.
  • The patient’s temperature will be within normal range.
  • The patient will maintain adequate ventilation and oxygenation.
  • The patient will maintain a patent airway.

Nursing Interventions

The nursing interventions for a child with epiglottitis are:

  • Anxiety control. The child and the family should display personal actions to eliminate or reduce feelings of apprehension and tension from an unidentifiable source.
  • Learning facilitation. The nurse should promote the ability to process and comprehend information, and encourage improvement of the ability and willingness to receive information.
  • Medications. Administer antibiotics as prescribed, such as cefuroxime.
  • Hydration. Regulate IV fluid accordingly, since the child could not swallow.

Evaluation

Goals are met as evidenced by:

  • Patient and family verbalized strategies to reduce anxiety.
  • Patient and family demonstrated an understanding of what has been taught.
  • Patient and family verbalized understanding of condition/disease process and treatment.
  • The patient’s temperature is within normal range.
  • The patient maintained adequate ventilation and oxygenation.
  • The patient maintained a patent airway.

Documentation Guidelines

Documentation in a child with epiglottitis include:

  • Breath sounds, presence and character of secretions, use of accessory muscles for breathing.
  • Plan of care.
  • Teaching plan.
  • Responses to interventions and actions performed.
  • Attainment or progress towards desired outcomes.
  • Modifications to the plan of care.

Practice Quiz: Epiglottitis


Here’s a 5-item quiz for Epiglottitis study guide:

Exam Mode

In Exam Mode: All questions are shown but the results, answers, and rationales (if any) will only be given after you’ve finished the quiz.

Practice Quiz: Epiglottitis

Start
Congratulations - you have completed Practice Quiz: Epiglottitis. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%
Your answers are highlighted below.

Practice Mode

Practice Mode: This is an interactive version of the Text Mode. All questions are given in a single page and correct answers, rationales or explanations (if any) are immediately shown after you have selected an answer. No time limit for this exam.

Practice Quiz: Epiglottitis

Start
Congratulations - you have completed Practice Quiz: Epiglottitis. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%
Your answers are highlighted below.

Text Mode

1. Immunization of children with Haemophilus influenzae type B (Hib) vaccine decreases the incidence of which of the following conditions?

A. Bronchiolitis.
B. Laryngotracheobronchitis (LTB).
C. Epiglottitis.
D. Pneumonia.

1. Answer: C. Epiglottitis

  • Option C: Epiglottitis is a bacterial infection of the epiglottis primarily caused by Hib. Administration of the vaccine has decreased the incidence of epiglottitis.
  • Option A: Bronchiolitis is usually caused by Respiratory Syncytial Virus (RSV).
  • Option B: Acute LTB is of viral origin.
  • Option D: The most common bacterial organisms causing pneumonia in children are pneumococci, streptococci, and staphylococci.

2. Which of the following respiratory conditions is always considered a medical emergency?

A. Asthma.
B. Cystic fibrosis (CF).
C. Epiglottitis.
D. Laryngotracheobronchitis (LTB).

2. Answer: C. Epiglottitis

  • Option C: Epiglottitis, acute and severe inflammation of the epiglottis, is always considered an acute medical emergency because it can lead to acute, life-threatening airway obstruction.
  • Option A: Asthma is a chronic disease; however, status asthmaticus and acute attacks require prompt treatment.
  • Option B: CF is a chronic disease and is not considered an emergency.
  • Option D: Acute LTB requires close observation for airway obstruction, but this condition is not always an emergency.

3. Which statement is correct regarding the role of epiglottis?

A. This structure prevents food from entering the nasopharynx.
B. The epiglottis helps with vocal cord vibration.
C. After swallowing this structure moves downward to prevent swallowed contents from entering the trachea.
D. The epiglottis is found in between the vocal folds.

3. Answer: C. After swallowing this structure moves downward to prevent swallowed contents from entering the trachea.

  • Option C: The epiglottis is found on the inside of the thyroid cartilage and is at the back of the tongue.
  • Option A is wrong because this is the role of the uvula.
  • Option B is wrong because this is the role of the glottis.
  • Option D is where the glottis is found.

4. During a 2 month well visit with a patient and her mother, you educate the parent on the most common cause of epiglottitis. You explain to the mother the most common cause of this condition is the:

A. Respiratory syncytial virus.
B. Influenza virus.
C. Haemophilus influenzae type B.
D. Rotavirus.

4. Answer: C. Haemophilus influenzae type B.

  • Option C: Most common cases of epiglottitis are caused by a bacteria that attacks the epiglottis called haemophilus influenzae type B.
  • Options A, B, D: These options are incorrect; they do not cause epiglottitis.

5. A 3-year-old arrives in the ER. The child has a temperature of 102.4°F and is agitated. The child is diagnosed with epiglottitis. You note the child is sitting up, positioned forward with chin in the air and the tongue is protruding with the mouth open. Which nursing intervention below is not appropriate for this patient?

A. Assist the patient in a supine position.
B. Keep the child on the parent’s lap during treatments.
C. Keep the child nothing by mouth.
D. Avoid taking a temperature on the patient orally.

5. Answer: A. Assist the patient in a supine position.

  • Option A: Placing the child on a supine position is contraindicated because it impedes respiratory effort.
  • Option B: A nursing goal is to keep the child calm, so keeping the child on the parent’s lap during treatment is appropriate.
  • Options C&D: Never place anything in the patient’s mouth due to the risk of causing spasms which will further constrict the airway.

See Also


Related topics to this study guide:

Further Reading


Recommended resources and books for pediatric nursing:
  1. PedsNotes: Nurse's Clinical Pocket Guide (Nurse's Clinical Pocket Guides)
  2. Pediatric Nursing Made Incredibly Easy
  3. Wong's Essentials of Pediatric Nursing
  4. Pediatric Nursing: The Critical Components of Nursing Care

Questions?

Ask our team

Want to contact us directly? No problem. We are always here for you.

Frequently Asked Buy a Nursing essay Questions

See all
Is your service confidential?

When you place an order with our company, we ask you to provide us with such personal information as your name, phone number, and email address. We need this data to keep you updated on the important things related to your order or account, and never share it with any third parties. We also don’t use your contact details for spamming you.

Please note that our support team may contact you using only the phone number(s) stated on our website, such +1 (248) 599-2414 and/+44 (151) 528-2636. In order to secure our mutual cooperation, please do not communicate with those who introduce themselves as essaypapers support staff and reach you from different phone numbers.

Also, remember that we never ask you to provide your credit card information via phone conversations. You should enter this information only on PayPal or Gate2Shop billing forms when making an online payment on our website. The essaypapers support administrator will send a confirmation letter to your personal order page when your payment is received.

We also use a secure encrypted connection and do not store your private data if we do not need it anymore. For more details about how we ensure your confidentiality, check our Privacy Policy, which completely complies with the GDPR.

We offer original model papers that can be used legally in a number of ways if properly referenced:

  • As a source of arguments or ideas for your own research
  • As a source of additional understanding of the subject
  • Direct citing

Nonetheless, check your college’s/university’s policies, including their definition of plagiarism and paraphrasing before using our services. Make conscious decisions in regards to your education.

How do I order a paper from essaypapers?

We take care not only of your academic success, but also of your experience with us. That’s why we have made the process of placing your order as easy and fast as possible—usually, it takes no more than 2-3 minutes.

Let’s have a closer look at the simple steps you need to go through for submitting your order:

Fill in the order form.

Be sure to include specific instructions regarding your paper and to upload any of the required materials. If you have any questions while specifying your paper’s information, just click on the info sign at the end of every field name and you will see a detailed tip on what exact information is required.

Proceed with the payment.

After you are through with the order form, you will need to make a payment via a preferable system. Right after that, you will be automatically provided with your personal order page where you can track your order’s progress, provide additional requirements, and send messages to your writer or support manager.

A personal writer is assigned to your order.

Our qualified staff will choose the most suitable writer whose skills and experience match your field of study and paper’s details. In case the writer must have any particular software or literature in order to get the Nursing Assignment done, please do not forget to mention this in your initial instructions.

Your paper is completed and delivered to your personal order page.

When the writer finishes your paper, it is delivered to your personal order page as a PDF document, available for preview only. You will be able to download an editable MS Word version of the order right after you click the “Approve” button in the “Files” tab of your personal order page. If any changes are to be applied to the paper, you are always welcome to request a free revision with a new deadline for the writer (be sure to check more information about this in our revision policy).

You can check how easy the process is by going to the order page and submitting your paper details right now.

Is there a money-back guarantee? If yes, how can I receive a refund?

You can get more details about possible types and terms of refunds on our official money-back guarantee page.

How will I receive a completed paper?

You will get the first version of your paper in a non-editable PDF format within the deadline. You are welcome to check it and inform us if any changes are needed. If everything is okay, and no amendments are necessary, you can approve the order and download the .doc file. If there are any issues you want to change, you can apply for a free revision and the writer will amend the paper according to your instructions.

If there happen to be any problems with downloading your paper, please contact our support team.

What if I’m not satisfied with my order?

If your paper needs some changes, you can apply for a free revision that is available for 7 days after your paper is approved. To use this option, you have a “Revision” button on your personal page.

After the 7-day period, you cannot apply for a free revision, though you still can use a paid revision option. The price of such a revision will differ depending on the number of amendments needed to be done. Please contact our support team to find out how we can help you with the amendments to your paper.

If you think our writer didn’t manage to follow your instructions, and as a result, your paper is of poor quality, please contact us and we will do our best to solve the problem.

If the revisions didn’t give the desired result, you can apply for a refund. Our dispute department will process your inquiry to find out what kind of refund we can give you. To find out more, please visit our money-back guarantee page.

How do I request a refund?

You can’t apply for a refund on certain stages of your order, like when the order is not finished by the writer yet.

When the paper is delivered, the “Refund” button on your personal order page becomes clickable.

On the relevant tab of your personal order page, you will also be able to choose the type of refund you’re demanding and the reason why you applying for it. As soon as you do that, our dispute department will start working on your inquiry. All kinds of refunds concerning the quality or the lateness of your paper should be requested within 14 days from the time the paper was delivered, as in 14 days your paper, will be automatically approved.

Your inquiry should be submitted by clicking the “Refund” button on your personal order page only.

Order your essay today and save 15% with the discount code NURSINGHELP