Croup & Epiglottitis Nursing Care Plan
Upper airway obstruction; humidified air, calm approach and no throat exam in epiglottitis.
Quick answer
A Croup & Epiglottitis nursing care plan centers on maintain a patent airway and be prepared for sudden obstruction; keep the child calm — crying and agitation increase airway turbulence and oxygen demand; distinguish croup from epiglottitis and act accordingly. Priority nursing diagnoses are Ineffective airway clearance, Anxiety, Impaired gas exchange. The plan below gives assessment cues, measurable goals, 5 intervention sets with rationales, and patient teaching.
Overview
Croup (laryngotracheobronchitis) is a viral inflammation of the larynx, trachea and bronchi, usually parainfluenza, in children 6 months to 3 years. Subglottic edema narrows the airway, producing the classic barking, seal-like cough, inspiratory stridor and hoarseness that worsen at night. Most cases are mild and improve with cool humidified air and a single dose of dexamethasone; moderate to severe cases receive nebulized epinephrine and observation for rebound.
Epiglottitis is a different and far more dangerous entity — a bacterial infection, historically Haemophilus influenzae type b, causing rapid supraglottic swelling. The child appears toxic, drools, refuses to swallow, sits in the tripod position and has no barking cough. Never inspect the throat, take an oral temperature or place the child supine: any of these can trigger complete airway obstruction. Keep the child calm on the parent's lap and get airway-skilled help immediately.
Key numbers to know
Croup triad
Barking cough, inspiratory stridor, hoarseness — worse at night and with crying.
Epiglottitis 4 D's
Drooling, Dysphagia, Dysphonia, Distress — plus tripod posture, high fever and a toxic appearance.
Absolute rule
No tongue depressor, no throat swab, no oral airway inspection with suspected epiglottitis.
Croup treatment
Dexamethasone for nearly all severities; nebulized racemic epinephrine for stridor at rest, with 2–4 hours of observation for rebound.
Worsening signs
Stridor at rest, retractions, agitation then unusual quietness, drooling, cyanosis — a quiet child with a previously loud stridor may be obstructing.
Nursing priorities
- Maintain a patent airway and be prepared for sudden obstruction.
- Keep the child calm — crying and agitation increase airway turbulence and oxygen demand.
- Distinguish croup from epiglottitis and act accordingly.
- Reduce airway edema with corticosteroids and nebulized epinephrine as ordered.
- Maintain hydration and oxygenation.
- Support terrified parents and prepare them for home management and return criteria.
Nursing assessment
Subjective data
- Parent describes a sudden barking or seal-like cough, worse at night
- Child reports sore throat or painful swallowing (epiglottitis)
- Reports of noisy breathing, hoarse voice or loss of voice
- Refusal to drink, decreased wet diapers
- Parental panic and exhaustion from a frightening night
Objective data
- Inspiratory stridor — note whether it occurs with agitation only or at rest
- Barking cough, hoarseness, prolonged inspiration
- Nasal flaring, suprasternal and intercostal retractions, use of accessory muscles
- Tachypnea, tachycardia, restlessness or lethargy, decreasing oxygen saturation, late cyanosis
- Drooling, tripod position, muffled 'hot potato' voice, toxic appearance and high fever — epiglottitis
- 'Steeple sign' on neck radiograph in croup; thumbprint sign in epiglottitis
- Decreasing air entry with a quieter chest despite ongoing distress — impending failure
Related factors
- Viral inflammation and edema of the subglottic airway
- Small pediatric airway diameter where slight edema causes large resistance change
- Bacterial supraglottic infection in unimmunized children
- Thick secretions and poor cough clearance
- Increased work of breathing with reduced oral intake
Key nursing diagnoses
Goals and expected outcomes
- The child will maintain a patent airway with no stridor at rest and oxygen saturation above 94%.
- The child will breathe with decreased work of breathing — no retractions or nasal flaring — within hours of treatment.
- The child will remain calm, resting comfortably with the caregiver present.
- The child will maintain hydration with moist mucous membranes and normal urine output.
- Parents will state the specific signs that require an immediate return to care.
Nursing interventions and rationales
1. Airway assessment and emergency readiness
- Assess respiratory rate, stridor at rest versus with activity, retractions, air entry and saturation continuously in moderate to severe cases.
- Keep age-appropriate intubation equipment, a smaller-than-usual tube, bag-mask and suction at the bedside and know who performs emergency airway management.
- Interpret decreasing stridor cautiously — with worsening effort and falling saturation it means less air is moving, not improvement.
- With suspected epiglottitis do not examine the throat, take oral temperatures, place the child supine or attempt IV access before the airway is secured; summon anesthesia and ENT immediately.
2. Minimizing agitation
- Keep the child on the parent's lap in a position of comfort; separation and restraint worsen obstruction.
- Cluster assessments, dim lights, lower voices and defer non-urgent procedures such as blood draws.
- Let the parent hold blow-by oxygen or the nebulizer mask near the face rather than strapping it on.
- Coach parents to stay calm because the child mirrors their anxiety.
3. Reducing airway edema and supporting oxygenation
- Give a single dose of dexamethasone as ordered, orally or IM, and explain that it takes a few hours to work but lasts 2–3 days.
- Administer nebulized racemic epinephrine for stridor at rest; monitor heart rate and observe for at least 2–4 hours afterward for rebound edema.
- Provide cool, humidified oxygen and elevate the head of the bed or hold the child upright.
- Suction the nares gently in infants who are obligate nose breathers, and avoid deep pharyngeal suctioning.
- Give antibiotics promptly once epiglottitis is confirmed and the airway is protected.
4. Hydration and comfort
- Offer small, frequent sips of clear fluid or popsicles once the airway is stable and the child can swallow safely.
- Withhold oral intake and start IV fluids if respiratory rate is very high or swallowing is unsafe, to prevent aspiration.
- Track intake, output and wet diapers, and assess mucous membranes and fontanel for dehydration.
- Treat fever with weight-based antipyretics for comfort and to lower metabolic demand.
5. Parent education and discharge planning
- Teach that croup episodes typically recur for two to three nights and are worse at night.
- Review home measures: cool night air or a cool-mist humidifier, upright holding, calm reassurance, and fluids.
- State return criteria explicitly — stridor at rest, retractions, drooling, blue lips, inability to speak or drink, or a child too tired to fight.
- Reinforce Hib and routine immunizations, which have made epiglottitis rare.
- Discuss hand hygiene and keeping the child home while febrile to limit viral spread.
Patient and family teaching
- Expect the barking cough to be worst at night for two or three nights, then improve.
- Hold the child upright and calm; cool outdoor air or a cool-mist humidifier often helps.
- Offer frequent small drinks and watch wet diapers for hydration.
- Return at once for noisy breathing at rest, sucking-in at the ribs or neck, drooling, blue lips, or a child too sleepy to respond.
- Never put anything in the mouth or try to look at the throat when your child is drooling and struggling to breathe — go to the emergency department.
- Keep immunizations, including Hib, up to date.
How to build this plan
- 1Assess the patient. Collect subjective and objective data through interview, physical assessment, labs and chart review. Complete, accurate data is the foundation of every later step.
- 2Analyze and cluster the data. Group related cues, compare them with normal findings, and identify patterns that point to actual or potential problems.
- 3Formulate nursing diagnoses. Write the problem statement using a recognized diagnostic label plus related factors and evidence (problem related to cause as evidenced by signs).
- 4Set priorities. Rank diagnoses as high, medium or low using ABCs, Maslow's hierarchy and the patient's own stated priorities. Life-threatening problems come first.
- 5Establish goals and outcomes. Write SMART, patient-centered outcomes: specific, measurable, attainable, realistic and time-bound (short-term and long-term).
- 6Select nursing interventions. Choose independent, dependent and collaborative actions that are safe, evidence-based and matched to the outcome.
- 7Provide rationales. State the scientific reason each intervention works. Rationales are what turn a task list into clinical reasoning.
- 8Evaluate the plan. Compare the patient's actual response with the expected outcome: met, partially met or not met — then continue, revise or discontinue.
- 9Document and communicate. Record the plan and the patient's response in the health record so the whole team works from the same information.
Summarized for study use. Always follow your school's or facility's approved care plan format and current clinical policy.
Practice Croup & Epiglottitis questions
These concepts are tested on the ATI proctored exams below — every set has answers and rationales.
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Common questions
What are the nursing diagnoses for Croup & Epiglottitis?
Priority nursing diagnoses for Croup & Epiglottitis: Ineffective airway clearance; Anxiety; Impaired gas exchange.
What are the nursing interventions for Croup & Epiglottitis?
Assess respiratory rate, stridor at rest versus with activity, retractions, air entry and saturation continuously in moderate to severe cases. Keep age-appropriate intubation equipment, a smaller-than-usual tube, bag-mask and suction at the bedside and know who performs emergency airway management. Interpret decreasing stridor cautiously — with worsening effort and falling saturation it means less air is moving, not improvement. With suspected epiglottitis do not examine the throat, take oral temperatures, place the child supine or attempt IV access before the airway is secured; summon anesthesia and ENT immediately. Keep the child on the parent's lap in a position of comfort; separation and restraint worsen obstruction. Cluster assessments, dim lights, lower voices and defer non-urgent procedures such as blood draws.
What are the nursing care goals for Croup & Epiglottitis?
The child will maintain a patent airway with no stridor at rest and oxygen saturation above 94%. The child will breathe with decreased work of breathing — no retractions or nasal flaring — within hours of treatment. The child will remain calm, resting comfortably with the caregiver present. The child will maintain hydration with moist mucous membranes and normal urine output. Parents will state the specific signs that require an immediate return to care.
What should you assess in a patient with Croup & Epiglottitis?
Parent describes a sudden barking or seal-like cough, worse at night; Child reports sore throat or painful swallowing (epiglottitis); Reports of noisy breathing, hoarse voice or loss of voice; Refusal to drink, decreased wet diapers; Parental panic and exhaustion from a frightening night; Inspiratory stridor — note whether it occurs with agitation only or at rest; Barking cough, hoarseness, prolonged inspiration; Nasal flaring, suprasternal and intercostal retractions, use of accessory muscles; Tachypnea, tachycardia, restlessness or lethargy, decreasing oxygen saturation, late cyanosis; Drooling, tripod position, muffled 'hot potato' voice, toxic appearance and high fever — epiglottitis; 'Steeple sign' on neck radiograph in croup; thumbprint sign in epiglottitis; Decreasing air entry with a quieter chest despite ongoing distress — impending failure