Question

Kim, a 5-year-old patient, is admitted to the emergency department in the early evening hours with a sore throat, pain on swallowing, drooling, and a fever of 39° C (102.2° F). She looks ill; her skin is flushed; she is agitated; and she prefers to sit up leaning on her arms. According to Kim's mother, she has not had anything to eat or drink since this morning. What nursing interventions should the nurse implement in this situation?

1. Evidence—Is there sufficient evidence to draw any conclusions about Kim's condition at this time?

2. Assumptions—Describe some underlying assumptions about each of the following:

a. Epiglottitis in children

b. Symptoms of epiglottitis

c. Precautions to be taken when a child has suspected epiglottitis

d. Immediate nursing interventions when caring for a child with epiglottitis

3. What priorities for nursing care can be drawn at this time?

4. Does the evidence objectively support your argument (conclusion)?

Answer 1

1. Yes. Based on the symptoms Kim is suffering with epiglottitis. However, she may need a laryngoscopy or X-ray.

2 a. The epiglottis is a flap of cartilage at the base of the tongue at the very back of the throat. It stops food from going into the windpipe when swallowing. When the epiglottis becomes swollen and inflamed, it's called epiglottitis. Epiglottitis makes difficult breathing and it is serious life-threatening if it is not treated since it affects lung function.

2 b. Sore throat, fever, drooling, swallowing difficult, muffled voice, stridor, anxious, feels better when sit and leaning forward.

2 c. Close monitoring of child’s airway. Breathing tube or ventilator to aid breathing if condition is worse.

2 d.

• Advise oral intake by clear warm fluids.
• Administer humidified oxygen and IV antibiotics
• Assess respiratory rate, breathing pattern and intensity of breathing.
• Prepare for artificial airway.
• Monitor oxygen saturation and assess arterial blood gases

3. Nursing care plan should focus on airway clearance, fever, agitation, suffocation risk, conserving energy to decrease oxygen.

4. The symptoms of sore throat, pain on swallowing, drooling, fever of 39° C, flushing, agitation and prefers to sit up leaning on her arms confirm epiglottitis. The above mentioned nursing care plan and precautionary measures required to avoid serious complications.