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CASE ANALYSIS PRESENTATION VIRAL CROUP PRESENTED BY RACHEL ADEJOH RN, BSN, MSRN COPPIN STATE UNIVERSITY. HELENE FULD SCHOOL OF NURSING DR. ROBIN WARREN PRIMARY HEALTH CARE OF CHILDREN- CLINICAL NURSING 641 DECEMBER 2, 2013

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Viral Croup which is also known as Laryngotracheobro nchitis caused by para-influenza virus will be discussed according to the rubric guide for case analysis and presentation. Viral Croup can be defined as an acute self -limiting inflammation of the larynx, trachea,and bronchial three. Hay, W., Levin, M., Sondheimer, J., Deterding, R., & Abzug, M., (2012). INTRODUCTORY STATEMENT

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A six months old African American baby boy brought in by his mother to the sick visit clinic hours after four days of running nose and cough with no fever. Mother denies nausea, vomiting, and diarrhea. baby is having normal diaper wetness and changing of six to seven diapers in a day, and the baby equally producing tears when he cries. A CONCISE CLINICAL PROFILE OF THE CASE

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The presenting problem was a history of running nose, cough with no fever for four days Mother was concerned about the cough characteristics that have changed to hoarse and barky. PRESENTING PROBLEM

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The baby was analyzed with differential diagnosis of upper respiratory infection, foreign body in the upper airway, epiglottitis, Allergic rhinitis, bacteria tracheitis, asthma and sinusitis. Mother denies drooling, baby rubbing his eyes, sneezing, wheezing, and any toddler in the house that can insert foreign object in the nose. mother agreed to the baby having hoarse voice and the cough sounds like he is barking and dry SYMPTOM ANALYSIS

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symmetrical chest with the use abdominal muscles when breathing. The baby was also retracting with positive nasal flaring at rest and audible stridor. The ear shows mild erythematous tympanic membrane. The nose shows mild nasal turbinate erythema. PERTINENT PHYSICAL EXAMINATION AND DIAGNOSTIC FINDING

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Respiratory distress as evidenced by audible stridor, retraction (use of abdominal muscle to breath) and a barking cough after four days of upper respiratory infection. No air hunger, cyanosis, fever, wheezing. SIGNIFICANT POSITIVE FINDINGS AND PERTINENT NEGATIVES

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Mother was re- assured, oxygen via nasal cannula placed. Pulmicort (inhaled budesonide) is also proven to be effective which was not available at the clinic. Nebulized racemic epinephrine was ordered at 8.4ml/kg to be diluted in inhale sterile water or saline was ordered but was out of stock. dexamethasone 0.6mg/kg Intramuscularly TREATMENT PLAN

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The baby was called in to emergency room right away giving a complete and concise history of physical examination. Follow up after discharge from the hospital with discharge recommendations. Call primary care provider or go to emergency room for worsening symptoms. Referral to pediatric pulmonologist for evaluation. FOLLOW UP PLAN TO INCLUDE REFERRAL/CONSULTATION; IF APPLICABLE

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mother was educated on the disease process to be a prodrome of upper respiratory infection and it affects children of three months to three years of age is mostly common in the fall and early winter which is the season we are in right now. INTEGRATED DEVELOPMENTAL AND HEALTH PROMOTION STRATEGIES

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Mother was also made to understand that in mild cases, supportive therapy can be adopted like keep the child well rehydrated; steam shower for ten to fifteen minutes followed by cool night air is helpful as well. Supportive therapy can be adopted like keep the child well rehydrated; steam shower for ten to fifteen minutes followed by cool night air is helpful as well. INTEGRATED DEVELOPMENTAL AND HEALTH PROMOTION STRATEGIES CONTD

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The need to keep well child visit and immunization up to date was emphasized. Having a humidifier at home will also help to decrease air dryness Minimal handling or avoiding crowded environment can be helpful since upper respiratory infection are mostly airborne ( breathed in the organism). INTEGRATED DEVELOPMENTAL AND HEALTH PROMOTION STRATEGIESCONTD

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The ability to recognize the presentation as Viral Croup from accurate history taking and a comprehensive physical. Initiation of treatment from the clinic by placing oxygen on the baby via nasal cannula We were to start nebulized racemic epinephrine with other medications like dexamethasone, budesonide inhaler before they were out of stock. STRENGTHS AND LIMITATIONS OF THE PRIMARY CARE DELIVERED

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The limitations of the care delivered were the unavailability of the rescue medications. Debriefing of the case was done with the medical director. Appropriate referral was made. place to have budesonide inhaler ( Pulmicort) ordered to be available as one of their formulary rescue medication. They concluded not to have the epinephrine nebulizer since it requires cardiac monitoring. STRENGTHS AND LIMITATIONS OF THE PRIMARY CARE DELIVERED CONTD

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Bjornson C, Russell K, Vandermeer B, Klassen TP, Johnson DW. (2013). Nebulized epinephrine for croup In children. Cochrane Database of Systematic Reviews. DOI:0.1002/14651858.CD00 6619. Hay, W., Levin, M., Sondheimer, J., Deterding, R., & Abzug, M. (2012). Current Pediatric Diagnosis &Treatment,(21 ed) The McGraw-Hill Companies, INC. Mohamad, N., Sjamun, A., Ismail, F., Solayar, L., Mohamed, S., Abidin, S., Tan, B., Yow, K., Hasan, N., Hamizol, S. (2013). Acute Stridor- Diagnostic Challenges in Different Age Groups. Emergency Medicine: 7 (2). doi:10.4172/21657548.1000 15 Wang, R., Waters, A., Clement, W., & Kubba, H.(2013). The management of recurrent croup in children. The Journal of Laryngology & Otology. 05 (127) DOI:http://dx.doi.org/10.1017 /S0022215113000418. REFERENCES