croup /kro̅o̅p/ [Scot, to croak] , an acute infection of the upper and lower respiratory tract that occurs primarily in infants and young children 3 months to 3 years of age after an upper respiratory tract infection. It is characterized by hoarseness; irritability; fever; a distinctive harsh, brassy cough; persistent stridor during inspiration; and dyspnea and tachypnea, resulting from obstruction of the larynx. Cyanosis or pallor occurs in severe cases. The most common causative agents are the parainfluenza viruses, especially type 1, followed by the respiratory syncytial viruses and influenza A and B viruses. Croup can also be caused by bacteria, allergies, and inhaled irritants. Also called acute laryngotracheobronchitis, angina trachealis, exudative angina, laryngostasis. Compare acute epiglottitis. −croupous, croupy, adj. ▪ OBSERVATIONS: Transmission occurs through infection with airborne particles or with infected secretions. Leukocytosis with an increased proportion of polymorphonuclear cells may be present at first, followed by leukopenia and lymphocytosis. A lateral neck x-ray film shows subepiglottic narrowing and a normal-sized epiglottis, which differentiate the condition from acute epiglottitis. Onset of the acute stage is rapid, usually occurs at night, and may be precipitated by exposure to cold air. The child’s condition often improves in the morning, but it may worsen at night. ▪ INTERVENTIONS: Routine treatment consists of bed rest, adequate fluid intake, and alleviation of airway obstruction to ensure adequate respiratory exchange. Children with mild infections are usually managed at home with supportive measures, such as use of acetaminophen to reduce fever and vaporizers, humidifiers, or steam from hot running water in an enclosed bathroom to reduce the spasm of the laryngeal muscles and to free secretions. Hospitalization is indicated for children with dehydration; progressive stridor and respiratory distress; and hypoxia, cyanosis, or pallor. Endotracheal intubation and tracheostomy may be necessary. Humidity and oxygen are usually prescribed. The vital signs are continuously monitored; changes in pulse and respiration may be early signs of hypoxia and impending airway obstruction. Fluids are often given intravenously to reduce physical exertion and the possibility of vomiting, with its attendant increased risk of aspiration. Corticosteroids and inhaled racemic epinephrine are often used. Other drugs, such as expectorants, bronchodilators, and antihistamines, are rarely used, and sedatives are contraindicated because they exert a depressant effect on the respiratory tract. ▪ PATIENT CARE CONSIDERATIONS: The primary focuses of care are to ease breathing by providing humidity and to monitor continuously for signs of respiratory distress and impending airway obstruction, with intubation and tracheostomy equipment kept readily available. To conserve the child’s energy and to reduce apprehension, the health care provider encourages rest, disturbs the child as little as possible, remains in attendance, provides comfort with a familiar toy or other device, and encourages parental involvement whenever possible. Fever is usually reduced by the cool atmosphere of the mist tent; antipyretics are given as needed. To prevent chilling, frequent changes of clothing and bed linen are often necessary in the humid environment. The health care provider also explains the condition to the parents and discusses appropriate care after discharge, including continued use of humidity and ensuring of adequate hydration and proper nutrition. In most children the condition is relatively mild and runs its course in 3 to 7 days. The infection may spread to other areas of the respiratory tract and may cause complications, such as bronchiolitis, pneumonia, and otitis media. The most serious complication is laryngeal obstruction, which may cause death. If a tracheostomy is required, as may happen with a small percentage of children, other complications, such as infection, atelectasis, cannula occlusion, tracheal bleeding, granulation, stenosis, and delayed healing of the stoma, may develop.
