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N3200: Which One? Epiglottitis VS Croup Group 3 :tada:, (https://www…
N3200: Which One? Epiglottitis VS Croup Group 3 :tada:
Condition Clues: Samara
S&S: fever, barking cough, high respirations, strider, low energy, nasal flaring
Diagnosis: Croup
ENT: moist red, mucous membranes - clear drainage from nose & throat - redness of throat - no drainage noted in ears
Vital Signs: Blood Pressure: 95/60 mmHg, Temperature: 100.2 Degrees Fahrenheit, Pulse Rate: 100 beats/minute, Respiration Rate: 28 respirations/minute.
Respiratory: Olivia
Dry, barking cough, which is associated with croup due to air being forced through the swollen vocal cords. Epiglottitis does not cause a cough. While stridor could be a symptom of both, the barking cough is only indicative of croup
Nasal flaring is caused by mucus buildup in the air passages in the lungs. Nasal flaring often indicates trouble breathing. Croup causes this by narrowing the upper airway resulting in straining when breathing/coughing.
https://medlineplus.gov/ency/article/003055.htm#:~:text=Nasal%20flaring%20may%20be%20caused,passages%20in%20the%20lungs%20(bronchiolitis
)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120939/#:~:text=Epiglottitis%2C%20acute%20laryngitis%2C%20and%20croup%20are%20infections%20of%20the%20upper,croup%20are%20primarily%20viral%20infections
.
Cardiovascular: Elaina
Regular Heart Sounds, no murmurs, capillary refill = 3-5 seconds
Capillary refill time being longer than 2 seconds would indicate poor profusion/ oxygenation. Navarre's high respiration rate is conducive with this symptom which is also indicative of croup
Digestive
Renal
Group Process: Ellie
We chose croup as the pathophysiological process for a variety of reasons. The hallmark symptom of croup that immediately stood out to us was the barking cough. Before jumping to conclusions we wanted to compare other signs and symptoms of croup vs epiglottitis. Both diseases have similar respiratory symptoms including dyspnea and stridor, however, Navarre’s mother reported that the coughing worsens at night which is another major symptom of croup. Navarre appears to be alert and oriented with low energy levels which we can most likely attribute to his low-grade fever and coughing through the night. In epiglottitis cases, patients tend to present as pale and lethargic with high fevers, likely due to bacterial causes. This is another strong indicator that our patient has croup and not epiglottitis. Once we were finished reviewing and organizing the signs and symptoms we agreed that our patient has croup.
Diagnostic Testing: Elaina
history and symptoms
X-Ray and largyngoscopic exam
An X-ray could give us critical information in regards to a Croup Diagnosis. A steeple sign represents the glottic and subglottic narrowing of the airway. This would indicate a more advanced stage of Croup. A Laryngoscopic exam would show an inflamed larynx as well as a narrowed trachea.
Treatment: Samantha
To treat croup, a physician may order a mist treatment, which consists of cool, moist air to decrease swelling of the larynx and help coughing and stridor. The physician may also prescribe a glucocorticoid medication, such as dexamethasone and prednisone. These provide an effective and long-lasting treatment by decreasing swelling of the larynx within six hours of the first dose.
To avoid further irritation, the family and medical professionals should avoid airway stimulation so as to prevent cardiopulmonary arrest. I would also suggest that Navarre's father stop smoking inside the house. I would also suggest that they keep the cat away from Navarre so as not to exacerbate his condition.
Renal
Neurological: Olivia & Elaina
Navarre's minimal neurological symptoms deviate from classic manifestations of epiglottitis (high anxiety, etc.), guiding our diagnosis further toward Croup
Energy level appears lower than expected for his age
Alert & oriented
Muskuloskeletal
Madison-Williams, MD, J. (2022, January). Croup | CS mott children’s Hospital | Michigan Medicine. Croup.
https://www.mottchildren.org/posts/your-child/croup
Woods, MD, C. (2022, November 15). Patient education: Croup in infants and children . UpToDate.
https://www.uptodate.com/contents/croup-in-infants-and-children-beyond-the-basics#:~:text=Dexamethasone%20—%20Dexamethasone%20is%20the%20most,hours%20of%20the%20first%20dose
.
https://www.cedars-sinai.org/health-library/diseases-and-conditions---pediatrics/c/croup-in-children.html
