This NCLEX review will discuss epiglottitis.
As a nursing student, you must be familiar with epiglottitis and how it affects the pediatric population. In addition to the signs and symptoms, nursing interventions, and treatment for this condition.
Don’t forget to take the free epiglottitis quiz after reviewing this material.
NCLEX Lecture on Epiglottitis
Epiglottitis NCLEX Review
What is epiglottitis? It is the inflammation of the epiglottis. This can lead to an upper airway obstruction.
What is the epiglottis and where is it?
It is a hinged piece of cartilage that attaches on the inside of the thyroid cartilage. It closes the entry way to the trachea during swallowing.
So, when you swallow the epiglottis moves downward to prevent swallowed contents from entering the trachea and instead the contents goes into the esophagus…..preventing aspiration! Furthermore, as you breathe, it stays open so air can move in and out of the lungs.
Therefore, if this structure becomes inflamed…….the patient will have an airway issue and issues swallowing and talking (see signs and symptoms below)!
Causes of Epiglottitis
The pediatric population (ages 2-5 years) tend to struggle with epiglottitis more than adults (but adults can get this condition).
Epiglottitis is spread via droplets, which harbors an infectious agent like bacteria.
NCLEX Tip: The most common cause of epiglottitis is caused by a bacteria that attacks the epiglottis called: Haemophilus influenza type B
It can be prevented! How?? Via the HIB vaccine
When is the HIB vaccine administered? It is part of the pediatric vaccination schedule and is given in 3-4 doses (depending on the brand used). It is administered at 2, 4, 6, and 12-15 months.
Epiglottitis can also be caused by other bacteria such as streptococcus pneumoniae etc.
Signs and Symptoms of Epiglottitis
“ADD AIR NURSE”
Abnormal position to breathe….tripod position…How does it look? The child will be sitting up and positioned forward with the chin in air (helps open the airway) and the tongue may be sticking out.
Dysphagia (difficulty swallowing)….lead to drooling
Difficultly talking…voice soft or muffled….sore throat
Increased Temperature (HIGH fever)
Uses accessory muscles to breathe…airway restriction
Retractions of chest
Epiglottis enlarged or swollen on x-ray of the neck
-NOTE: A cough is usually absent with this condition.
Nursing Interventions for Epiglottitis
****NCLEX Tip: As the nurse, do NOT insert ANYTHING in the patient’s mouth to assess it:
- Don’t use a tongue blade, oral thermometer, obtain a throat culture….WHY? This could cause a spasm, which will completely block the airway.
NEVER leave the patient alone! WHY? This patient is at risk for a SUDDEN airway obstruction!
Assess oxygen status:
- maintain airway (most patients with severe cases of epiglottitis will need to be intubated)
- assess respiratory effort and rate: >60 breaths per mintue abnormal for all age groups
- breath sounds…stridor VERY BAD!!
- color (cyanotic…lips blue?)
- heart rate increased? (hypoxia will cause the heart rate to increase)
- chest retractions?
- nasal flaring?
Keep emergency equipment at bedside and have trained staff readily available for possible intubation.
Monitor temperature? How will you take it? NOT ORALLY but other routes like rectal, tympanic, or temporal.
Keep child calm! WHY? When a child cries or becomes very anxious this increases the chances of an airway obstruction.
- Keep child with parent and on lap during treatments, if possible
- Don’t restrain child
- Never leave child alone
- Provide a calm environment
- Prevent doing things that make the child cry
- Allow the child to be in a comfortable positon that allows them to breathe (NO SUPINE because it impedes respiratory effort).
Keep the child nothing by mouth.
Medications per MD order: IV fluids, antibiotics, antipyretics, corticosteroids (decreases swelling)
Prevention? HIB vaccine
- Epiglottitis: MedlinePlus Medical Encyclopedia. Medlineplus.gov. Retrieved 5 February 2018, from https://medlineplus.gov/ency/article/000605.htm
- Haemophilus influenzae | Home | Hib | CDC. Cdc.gov. Retrieved 5 February 2018, from https://www.cdc.gov/hi-disease/