A nurse is caring for a 3-year-old child.
Exhibit 1
Exhibit 2 Nurses’ Notes
0730:
Child presents to the emergency department (ED). Guardians report the child woke up coughing with a low-grade fever. Child appears alert and restless in guardian’s arms.
Respirations easy, no cough noted.
0800:
Child became agitated. Hoarse cry noted with audible inspiratory stridor. Barking, nonproductive cough present.
For each of the following findings, click to specify if the finding is consistent with acute laryngotracheobronchitis or pneumonia. Each finding may support more than one disease process.
Assessment Findings: Acute laryngotracheobronchitis /Pneumonia
A.
Irritability
B.
Temperature
C.
Cough findings at 0800
D.
Stridor
The Correct Answer and Explanation is:
The findings from the scenario presented can be assessed in the context of acute laryngotracheobronchitis (also known as croup) and pneumonia. Here’s how each finding corresponds to these conditions:
A. Irritability
Consistent with: Acute laryngotracheobronchitis (Croup)
Explanation: Irritability is often seen in children with acute laryngotracheobronchitis due to discomfort and respiratory distress. The child’s agitation and restlessness reported in the notes indicate that they may be feeling unwell and anxious about their breathing difficulties. In contrast, pneumonia may also cause irritability, but it is typically less prominent than in croup.
B. Temperature
Consistent with: Both acute laryngotracheobronchitis and pneumonia
Explanation: A low-grade fever is common in both conditions. In acute laryngotracheobronchitis, fever can result from viral infections, which are the most frequent cause. Pneumonia, whether viral or bacterial, often presents with fever as the body responds to infection. The presence of a fever alone does not differentiate between the two conditions.
C. Cough findings at 0800
Consistent with: Acute laryngotracheobronchitis
Explanation: The barking, nonproductive cough described at 0800 is characteristic of acute laryngotracheobronchitis. This type of cough results from inflammation in the larynx and trachea. In pneumonia, the cough is generally more productive, involving mucus or phlegm.
D. Stridor
Consistent with: Acute laryngotracheobronchitis
Explanation: Stridor is a high-pitched sound resulting from obstruction or narrowing of the airway and is a hallmark sign of acute laryngotracheobronchitis. The presence of audible inspiratory stridor in this case strongly indicates croup. In pneumonia, stridor is not typically present; instead, wheezing may be more common due to bronchial involvement.
Summary
In summary, irritability and stridor are primarily indicative of acute laryngotracheobronchitis, while temperature can be associated with both conditions. The cough findings specifically point to acute laryngotracheobronchitis, making it the more likely diagnosis in this case.