5 Epiglottitis Nursing Care Plans

Epiglottitis is an airway emergency. The epiglottis and surrounding supraglottic tissue swell fast and can close off the airway before you have room to react. From the moment you suspect it, keep emergency airway equipment and the people who can use it at the bedside.

What is Epiglottitis?

Epiglottitis is acute inflammation of the epiglottis and the surrounding laryngeal area, with edema that obstructs the supraglottic airway. It classically hits children ages 2 to 7 years and is caused by Haemophilus influenzae type B.

The child looks sick: high fever, sudden sore throat, muffled voice, rapid breathing. They sit upright with the chin thrust forward and mouth open, and they drool because swallowing hurts. Distress worsens as the airway narrows. Do not examine the oropharynx until emergency airway equipment and personnel are in the room. Inspecting the throat can trigger laryngospasm and complete obstruction.

Onset is rapid, over 4 to 12 hours. Severe distress may need endotracheal intubation or tracheostomy. Breathing usually re-establishes within 72 hours of intubation and antibiotics.

Nursing Care Plans and Management

Protect the airway, bring down the fever, calm the child, and keep parents informed. An agitated child burns oxygen and worsens the obstruction, so keeping everyone calm is airway management too.

Nursing Problem Priorities

• Maintaining a patent airway
• Managing hyperthermia

Nursing Assessment

Assess for the following subjective and objective data:

• See assessment cues under Nursing Interventions and Actions.

Nursing Diagnosis

After assessment, form a nursing diagnosis that fits this child's airway risk and clinical picture. The label matters less than your judgment at the bedside. Prioritize the airway.

Nursing Goals

Goals and expected outcomes may include:

• The airway stays patent with clear breath sounds, normal respiratory rate, and adequate oxygenation.
• Signs of respiratory distress (retractions, accessory muscle use) decrease.
• Temperature holds between 36.4°C and 37.5°C.
• Parents report less anxiety.
• The child stays calm, without agitation or constant crying.
• Parents understand the condition and how to protect the airway.
• The airway stays open, naturally or by ET tube or tracheostomy.

Nursing Interventions and Actions

1. Maintaining a Patent Airway and Respiratory Status

The swollen epiglottis blocks airflow, and mucus and edema make it worse. Your job is to keep air moving and be ready for an artificial airway the instant you need one.

Assess respiratory rate, effort, pattern, and depth. Nasal flaring, rapid breathing, dyspnea, chest retractions, and apnea signal severe distress and may call for immediate airway support.

Auscultate the lungs. Absent or decreased breath sounds point to a mucous plug or obstruction. Stridor is a late, ominous sign and means the airway needs to be secured now.

Monitor oxygen saturation with pulse oximetry and assess ABGs. Keep saturation at 90% or greater. Abnormal ABGs reflect rising secretions and respiratory fatigue.

Offer warm, clear fluids if the child can take them. Hydration thins thick secretions.

Position the child sitting up and leaning forward, mouth open and tongue out (tripod position). This opens the airway for maximum air entry.

Keep suction equipment at the bedside. You may need to clear secretions or debris fast.

Tell parents to limit the child's activity and talking. Agitation raises oxygen demand and worsens distress.

Administer humidified oxygen. Moist air reduces epiglottal inflammation and eases secretions.

Administer IV antibiotics as ordered. After blood and epiglottic cultures, start a second or third generation cephalosporin and a beta-lactamase-resistant antibiotic as soon as possible.

Administer corticosteroids (dexamethasone) as ordered. Steroids cut inflammation and swelling in the upper airway, opening it up alongside the antibiotics.

Prepare for intubation or tracheostomy. An artificial airway secures oxygenation and ventilation and prevents aspiration when distress is severe.

2. Managing Fever and Hyperthermia

Fever comes from the inflammatory response to the infection. It usually breaks once antibiotics take hold.

Identify the precipitating factors. You cannot manage the fever without managing its cause.

Monitor HR, BP, and tympanic or rectal temperature. HR and BP climb as hyperthermia worsens. Tympanic or rectal readings track core temperature most accurately.

Use cooling measures: lightweight clothing, a cooler room, cool compresses. Adjust the room and linens to bring the temperature toward normal.

Provide rest and a quiet environment. This lowers metabolic demand.

Encourage fluids. Fever drives fluid loss and dehydration.

Keep the side rails up. Protect the child even without seizure activity.

Teach parents the signs of hyperthermia and what triggers it. Informed parents cope better and catch problems early.

Administer antipyretics (acetaminophen or ibuprofen) as prescribed. These bring down fever and ease throat pain.

3. Reducing Anxiety and Providing Emotional Support

Fear of not being able to breathe, plus invasive treatment like intubation, drives real anxiety in both the child and the parents. A calm room is part of the treatment.

Assess the level of fear in the parents and child. Anxiety climbs as breathing gets harder, and it tells you how acute things are.

Keep the environment calm and reassure parents the child is getting everything they need. This steadies the whole room.

Let parents stay with the child and give them a place to rest. Their presence calms the child and lowers their own anxiety.

Keep the child in the tripod position and allow a familiar toy or blanket. Comfort and security matter, and the position protects the airway.

Explain procedures, treatment, and changes in the child's condition. Knowing what to expect cuts fear of the unknown.

Skip any procedure that is not essential during the acute stage. Every extra disturbance raises anxiety and distress.

Encourage parents and child to voice their fears. Naming the fear lowers it.

Let the child stay on the parent's lap during care, including a lateral neck X-ray if ordered. This keeps the child calm and avoids triggering complete obstruction.

Tell parents that swelling subsides about 24 hours after antibiotics start and the epiglottis returns to normal in about 3 days. Concrete timelines reassure.

4. Preventing Suffocation

The airway can close completely, and fast. Recognizing and acting on early signs is the whole game here.

Watch for color change from pallor to cyanosis, severe dyspnea, sternal and intercostal retractions, lethargy, and rising pulse. These mark worsening obstruction.

Monitor oxygenation and provide oxygen as prescribed. This prevents hypoxemia.

Assess the child's ability to swallow. Swelling impairs swallowing and raises aspiration risk.

Do not examine the throat with a tongue blade or take a throat culture unless emergency equipment and personnel are at hand. Either can trigger laryngospasm and obstruction.

Keep the child sitting up; avoid lying flat. Lying down lets the epiglottis fall back and block the airway.

Keep an intubation set at the bedside and be ready to assist with tracheostomy. You need to establish an airway the moment obstruction becomes critical.

Avoid sedatives or anything that impairs swallowing. Impaired swallowing raises aspiration and obstruction risk.

Offer small sips of water or ice chips as tolerated. This keeps the throat moist and supports the swallowing reflex.

Explain emergency intubation or tracheostomy plainly to parents. They are unfamiliar with this care and need to know what may happen.

Tell parents that swelling drops after 24 hours of therapy and the ET tube usually comes out after 3 days. This sets expectations during a frightening stretch.

5. Patient Education and Health Teachings

Epiglottitis is rare and hits suddenly, so most parents have no frame of reference. Clear teaching prevents complications and speeds recovery, in the hospital and at home.

Check what parents already understand and reinforce as needed. This shows you where the gaps are.

Acknowledge their efforts. Confidence helps parents care for the child well.

Teach the signs of respiratory distress: nasal flaring, retractions, cyanosis, rising respiratory rate and pulse. This lets parents seek help fast.

Teach how to give prescribed medications. Proper administration and side-effect recognition keep the child safe.

Stress the value of rest and good nutrition. Both shore up the child's defenses against secondary infection.

Let parents give care at the level they are comfortable with, within the limits of essential treatment. This restores their sense of control and lowers stress.

Teach good handwashing and proper disposal of soiled tissues. This stops the illness from spreading.