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Family Children Nursing (Name) Presented to (Instructor/Tutor) (Course/Subject) (Institution/University) (City, State) (Date) Assessment: Clinical Practical Guideline Case Study Analysis Abstract Clinicians and researchers in various healthcare institutions use Clinical Practice Guidelines to provide and manage clinical care…
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Download file to see previous pages Introduction Case Study Serena, a young girl of 20 months old is brought by her parents to the emergency department of their local hospital at around 0200 hours. An assessment conducted on her reveals the following: 2/7 history of sore throat Fevers Profuse nasal discharge The girls developed barking cough in the evening and Experienced difficulty in breathing. The Clinical Problem Initially in the 20th century, croup like illness were often confused with diphtheria but today croup is a term used to refer to several respiratory illnesses that vary in inspiratory stridor, barking cough, and hoarseness that result from obstruction in the larynx regions. Classification and Epidemiological Features Historically, croup illnesses have changed over time, but with imprecise classifications. Laryngotracheobronchitis is a term used to describe a spasmodic croup or laryngotrachetitis. The common classes of croup are; spasmodic croup, acute laryngotracheitis, LTB and LTBP and Laryngeal Diphtheria. Croup is an illness that attacks infants and children less than 6 years in age but rampant incidences occur between 7 to 36 months. Boys are more prone to its attacks than girls at a rate of 1.5 times. It has a biennial midautmn peak and annual summer trough (Cherry 2008. P.384). Croup Host factors Parainfluenza virus infections, especially type 3 is common in infants as well as young children. Despite this, croup develops only in a small percentage of children exposed. Reoccurrence of croup in children is linked to allergy. Spasmodic croup is triggered by parainfluenza virus type 1 and 2. Levels of Assessment for Severity Croup The levels of assessment of severity croup are mild, moderate, severe and impending respiratory failure. The mild level is characterized by occasional barking cough. At a rest position, the infant has no audible stridor. Retractions of the skin of the chest wall could be mild. At a moderate level, barking cough becomes frequent with easily audible stridor when the child is resting. Suprasternal and sternal retractions with no agitations are noticed. In the severe stage, barking cough remains frequent; inspiratory becomes prominent with occasional expiratory stridor. The expiratory stridor is marked with sterna retractions, agitations and distress. At impending respiratory failure level, the barking cough fails to be prominent with hard to hear audible stridor when the child is at rest. The sterna retractions cannot be recognised as the child experiences lethargy. In the absence of supplemental oxygen, the infant appears dusky (Scally & Donaldson 1998 p. 67 &68). Strategies and Evidence Evaluation Croup illnesses differ in severity and treatment and therefore require differential diagnosis (Cherry 2008.p388). Other acute obstructive illnesses in the larynx region must be diagnosed. These include epiglottitis, foreign body, and angioneurotic edema of the epiglottis. Epiglottitis is signified by lack of a croupy cough, sitting position of the child, a pushed forward chin and reluctance in lying down. Apprehension and anxiety in the child is spotted rather than inspiratory difficulties. Foreign body and angioneurotic edema cause obstruction in the upper airway. These occur suddenly without fever and infection signs. Lower airway signs like crackles, air trapping, wheezing ...Download file to see next pagesRead More
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