Lesson Objective for Epiglottitis

• Understanding Epiglottitis:
  • Define and comprehend the pathology of epiglottitis, including its rapid onset, potential causes, and the anatomical involvement of the epiglottis.
• Recognizing Signs and Symptoms:
  • Identify the characteristic signs and symptoms of epiglottitis, emphasizing the importance of prompt recognition to facilitate rapid intervention and prevent complications.
• Emergency Response and Stabilization:
  • Learn the immediate nursing interventions and emergency response measures required to stabilize a patient with suspected epiglottitis, ensuring airway management and respiratory support.
• Collaborative Interdisciplinary Care:
  • Understand the importance of collaboration with healthcare professionals, including physicians, respiratory therapists, and infectious disease specialists, in managing and treating epiglottitis effectively.
• Prevention and Patient Education:
  • Explore preventive measures and patient education strategies to minimize the risk of epiglottitis, including vaccinations, awareness of potential causative factors, and recognizing early symptoms for timely intervention.

Pathophysiology of Epiglottitis

• Bacterial Invasion:
  • Epiglottitis is primarily caused by the bacterium Haemophilus influenzae type B (Hib), with other bacteria like Streptococcus pneumoniae or Staphylococcus aureus being potential culprits.
• Rapid Inflammation:
  • Following bacterial invasion, the infection triggers a swift and aggressive inflammatory response in the epiglottis. This structure, located at the base of the tongue, helps cover the trachea during swallowing.
• Edema and Airway Obstruction:
  • The inflammatory response results in edema (swelling) of the epiglottic tissues. This edema can lead to partial or complete airway obstruction, compromising the passage of air to the lungs.
• Immune Response:
  • The host’s immune system responds to the bacterial infection by activating various immune cells and inflammatory mediators, contributing to the rapid onset of symptoms.
• Mucosal Barrier Dysfunction:
  • The infection compromises the integrity of the mucosal barrier in the epiglottis, allowing bacteria to penetrate the tissues and incite an inflammatory response.
• Vascular Permeability:
  • Increased vascular permeability in response to the infection causes fluid leakage and edema within the epiglottic tissues, further contributing to airway obstruction.
• Risk of Respiratory Distress:
  • Due to the swelling and potential obstruction, there is a significant risk of respiratory distress. In severe cases, this can progress to respiratory failure, highlighting the critical nature of the condition.
• Potential Complications:
  • If not promptly treated, Epiglottitis can lead to serious complications such as asphyxiation, respiratory arrest, or secondary infections. Pediatric populations are particularly vulnerable to these risks.

Etiology of Epiglottitis

• Bacterial Infection:
  • The primary causative agent is Haemophilus influenzae type B (Hib). Other bacteria, such as Streptococcus pneumoniae and Staphylococcus aureus, can also be implicated, especially in cases where Hib vaccination is widespread.
• Highly Contagious:
  • Epiglottitis is often the result of person-to-person transmission of the bacteria through respiratory droplets. Close contact with an infected individual increases the risk of acquiring the infection.
• Predominantly in Children:
  • Historically, epiglottitis was more common in children; however, the incidence has decreased significantly with the introduction of the Hib vaccine. It can still occur in unvaccinated or under-vaccinated populations.
• Immunization Status:
  • The immunization status of the individual plays a crucial role. Lack of immunization against Hib increases susceptibility to the infection, emphasizing the importance of routine vaccinations.
• Age Group:
  • While it can affect individuals of any age, epiglottitis is more prevalent in children, with a peak incidence in the preschool age group. Adults can also be affected, especially those with compromised immune systems.

Desired Outcome of Nursing Care for Epiglottitis

• Airway Patency:
  • Ensure and maintain a patent airway to facilitate adequate oxygenation and ventilation.
• Stabilization of Respiratory Status:
  • Achieve and maintain stable respiratory parameters, including normal respiratory rate and oxygen saturation levels.
• Reduction of Inflammation:
  • Manage inflammation of the epiglottis through appropriate medical interventions, such as antibiotics and anti-inflammatory medications.
• Prevention of Complications:
  • Prevent and promptly manage potential complications, including respiratory distress, respiratory failure, and secondary bacterial infections.
• Safe Discharge:
  • Facilitate a safe discharge by ensuring the resolution of symptoms, providing adequate education to caregivers, and arranging appropriate follow-up care.

Epiglottitis Nursing Care Plan

Nursing Assessment for Epiglottitis

• Airway Assessment:
  • Monitor the patient’s airway patency and look for signs of airway obstruction, including stridor, retractions, and difficulty breathing.
• Respiratory Status:
  • Assess respiratory rate, rhythm, and effort. Note any abnormal breath sounds, such as wheezing or diminished breath sounds.
• Vital Signs:
  • Monitor vital signs, including heart rate, blood pressure, and temperature. Elevated temperature and increased heart rate may indicate inflammation.
• Appearance and Behavior:
  • Observe the patient’s general appearance and behavior. Note signs of distress, agitation, or lethargy, which may indicate respiratory compromise.
• Positioning Preferences:
  • Document the patient’s preferred position. Patients with epiglottitis often prefer to sit upright and lean forward to ease breathing.
• Swallowing Difficulty:
  • Assess for difficulty swallowing or refusal to swallow, as swallowing may exacerbate discomfort in patients with epiglottitis.
• Drooling and Dropping Jaw:
  • Check for drooling and the tendency to keep the jaw dropped, which may suggest difficulty in managing secretions and a risk of airway obstruction.
• Stridor:
  • Listen for stridor during inspiration, as it may indicate upper airway obstruction due to epiglottitis.
• Cyanosis:
  • Assess for signs of cyanosis, especially around the lips and nail beds, indicating inadequate oxygenation.
• Communication:
  • Note the patient’s ability to communicate. Patients with severe epiglottitis may be unable to speak due to the compromised airway.
• Past Medical History:
  • Obtain a thorough medical history, including recent upper respiratory infections or illnesses, vaccinations, and any known risk factors for epiglottitis.
•  Laboratory and Imaging Studies:
  • Collaborate with the healthcare team to review laboratory results (such as blood cultures) and imaging studies (such as lateral neck radiographs) to confirm the diagnosis of epiglottitis.

Implementation for Epiglottitis

• Airway Management:
  • Maintain a patent airway and be prepared for possible intubation or tracheostomy if airway compromise is imminent.
  • Avoid using a tongue depressor for examination, as it may trigger spasm and worsen airway obstruction.
• Medical Interventions:
  • Administer antibiotics promptly, typically intravenous ceftriaxone or cefotaxime, to target the likely causative bacteria, Haemophilus influenzae type B (Hib).
  • Provide antipyretics and analgesics for fever and discomfort.
• Fluid and Nutrition Management:
  • Establish intravenous (IV) access for fluid resuscitation and administration of medications.
  • NPO (nothing by mouth) status may be necessary to prevent further irritation to the airway.
• Monitoring and Oxygen Therapy:
  • Continuously monitor vital signs, oxygen saturation, and respiratory status.
  • Administer supplemental oxygen as needed to maintain adequate oxygenation.
• Pediatric Advanced Life Support (PALS):
  • Be prepared to initiate PALS protocols in case of respiratory distress or failure.
  • Ensure the availability of necessary equipment for intubation and resuscitation.

Nursing Interventions and Rationales

Evaluation for Epiglottitis

• Airway Status:
  • Assess the effectiveness of airway management measures, such as intubation or tracheostomy, in maintaining a patent airway.
  • Monitor for signs of improvement or worsening in airway obstruction.
• Response to Antibiotics:
  • Evaluate the patient’s response to antibiotic therapy by assessing for resolution of infection-related symptoms.
  • Monitor laboratory results, such as blood cultures, to confirm the effectiveness of the chosen antibiotic.
• Vital Signs and Oxygen Saturation:
  • Assess vital signs, including heart rate, respiratory rate, and blood pressure, to determine the patient’s overall stability.
  • Monitor oxygen saturation levels to ensure adequate oxygenation.
• Fluid and Nutritional Status:
  • Evaluate the patient’s hydration status and nutritional intake.
  • Assess for signs of improvement in the patient’s ability to tolerate oral intake.
• Complication Prevention:
  • Monitor for the prevention of complications such as respiratory failure, sepsis, or the development of secondary infections.
  • Evaluate the effectiveness of interventions in preventing further deterioration.

References

• https://my.clevelandclinic.org/health/diseases/17844-epiglottitis
• https://www.mayoclinic.org/diseases-conditions/epiglottitis/symptoms-causes/syc-20372227