EPIGLOTITTIS
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PRESENTER
● NURAIN SAKINAH
BINTI RAZALI
● SAIDATUL MARSITA
BINTI MOHD DIAH
LEARNING OBJECTIVES
Learning
objectives
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1)Described about anatomy and physiology upper
respiratory airway.
2)Define regarding epiglotitis
3)Explain regarding phatophysiology and signs symptoms of
epiglotitis
4) State the treatment and education for patient with
epiglotitis
5) Identify nursing care plan for patient with epiglotitis
INTRODUCTION
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Acute epiglottitis is a medical emergency and
potentially life-threatening condition.
It is a serious obstructive inflammatory process
that occurs principally in children between 2 and 5
years of age but can occur from infancy to
adulthood.
The disorder is a medical emergency and requires
immediate medical attention.
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UPPER RESPIRATORY AIRWAY
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1) nose and nasal cavity
2)Pharynx
-nasopharynx
-Oropharynx
-Laryngopharynx
3) Larynx
NOSE AND NASAL CAVITY
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1) The nose is the first of the respiratory passages
through which the inspired air passes.
2) In the nasal cavity
air is Warmed - due to immense vascularity of the mucosa
moistened - Air travels over the moist mucosa, it becomes
saturated with water vapour.
Filtered- Hairs at the anterior nares trap larger particles.
Small particle trap by mucos.
3) Sense of smell – detect by olfactory epithelium carried
by olfactory nerves
PHARYNX
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The pharynx (throat) is a passageway about 12–14 cm long.
It extends from the posterior nares and runs behind the mouth
and the larynx to the level of the 6th cervical vertebra, where it
becomes the oesophagus.
Divide into 3 part
1)Nasopharynx
2)Oropharynx
3)Laryngopharynx
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Pharynx
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1) Nasopharynx
● The nasal part of the pharynx lies behind the nose
above the level of the soft palate
2) Oropharynx
● lies behind the mouth, extending from below the
level of the soft palate to the level of the upper
part of the body of the 3rd cervical vertebra.
3) Laryngopharynx
● from the oropharynx above and continues as the
oesophagus below, with the larynx lying anteriorly.
LARYNX
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The larynx, or ‘voice box’, links the laryngopharynx and
the trachea.
It lies in front of the laryngopharynx and the 3rd, 4th,
5th and 6th cervical vertebrae.
Main cartilage are:
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LARYNX CARTILAGE
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Thyroid cartilage
Cricoid cartilage
Arytenoid cartilage
Epiglotis
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EPIGLOTTIS
Epiglottis
epi means upon, -glottis means mouth of
windpipe
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Epiglottis
The epiglottis and the epiglottis reflex
protect the respiratory tract from invading
material, including infectious exudate from
the upper tract, and prevent such material
from being aspirated into the lower tract.
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EPIGLOTTIS
The epiglottis is a leaf-shaped fibroelastic
cartilage attached by a flexible stalk of
cartilage to the inner surface of the
anterior wall of the thyroid cartilage,
immediately below the thyroid notch.
Rises obliquely upwards behind the tongue
and the body of the hyoid bone
covered with stratified squamous
epithelium
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EPIGLOTTIS
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If the larynx is likened to a
box, then the epiglottis acts as
the lid
It closes off the larynx during
swallowing, protecting the lungs
from accidental inhalation of
foreign objects.
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WHAT IS EPIGLOTITTIS?
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Epiglottitis is a potentially
life-threatening condition
that occurs when the
epiglottis, a small cartilage
"lid" that covers your
windpipe is swells and
blocking the flow of air into
your lungs.
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EPIDEMIOLOGY
● The incidence of epiglottitis in children under age 5 years was as high as 15
cases per 100,000 population. The peak incidence occurred in children under
age 3.
● Since the introduction of the Hib vaccine in 1985, the incidence in children has
decreased to 0.5–0.7 cases per 100,000.
● In Finland, 50–60 cases per year of epiglottitis were seen throughout the
country in 1985–1986, and this decreased to only two cases in 1992, reflecting
the widespread use of the Hib vaccine .
● In Sweden, the incidence of epiglottitis in children under age 5 decreased from
21 to 0.9 cases per 100,000 following Hib vaccination .
DATA 4 MAY 2018
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EPIDEMIOLOGY
Retrospective review of acute epiglottitis at four
Victorian tertiary centres from 2011 to 2016 was
conducted.
Eighty-seven adult and six paediatric cases were
identified
Two of six required intubation and one underwent surgical
intervention. There were no deaths, but one patient
suffered a hypoxic brain injury.
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https://pubmed.ncbi.nlm.nih.gov/30207030/
TYPE OF EPIGLOTITIS
Acute epiglotitis
Serious obstructive
inflammatory process that
occurs in children 2 and 5
years old
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ETIOLOGY
1) Caused by Haemophilus influenzae type B (HiB).
2) Second most common cause is group A beta hemolytic
Streptococcus
3) Other causative organisms now include Streptococcus
pyogenes, S pneumoniae & Staphylococcus aureus
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PATHOPHYSIOLOGY
Inflammation and edema
Upper airway obstruction
Increased resistance to airflow
Increased intrathoracic negative pressure
Collapse of upper airway
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Respiratory failure
4 MAJOR SYMPTOMS OF EPIGLOTITTIS
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Dysphagia :Difficulty
swallowing
Drooling: When saliva
flows out of your
mouth involuntarily.
Distress: Difficulty
breathing or lack of
oxygen.
Dysphonia: Hoarseness
or an abnormal voice.
SIGNS AND SYMPTOM OF
EPIGLOTITIS
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Short history
High Fever
Rapid pulse and respiration
Extreme anxiety
Absence of spontaneous cough
Suprasternal and substernal retraction.
Dyspnoea,mild hypoxia -> cyanosis
Systemically unwell: pale, toxic, lethargic
Stridor / frog like croaking inspiration
Child often adopts the characteristic posture
of sitting upright, mouth open and their chin
thrust forward, known as tripod positioning
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IS EPIGLOTITTIS IS
CONTAGIOUS?
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It can be.
Can spread from person
to person through
droplets of saliva or
mucus.
Droplet isolation is
needed.
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COMPLICATION
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Respiratory failure.
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Spreading infection. Sometimes the bacteria
that cause epiglottitis cause infections
elsewhere in the body, such as pneumonia,
meningitis or a bloodstream infection.
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Hypoxia
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Death
INVESTIGATION
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Laryngoscopy
Culture tests: Takes swab of your
throat to test for bacteria or viruses.
Blood tests: May perform a variety of
blood tests to count your white blood
cells or see if there are any bacteria
or viruses in your blood.
Imaging tests: An X-ray or CT
(computed tomography) scan can help
determine the level of swelling and to
see if there’s an unwanted object in
your airway.
PREVENTION
• HIB Vaccine is
important for all
children.
• Taken 2 month, 3
month ,5 month and 18
month
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Vaccine HIB
MEDICAL TREATMENT
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If epiglottitis is suspected, then emergency intubation should be
performed to protect the airway
intravenous antibiotics are required immediately following
intubation; empiric regimes include ampicillin and ceftriaxone
combinations.
Antibiotic need to continue for 7 day.
Swollen might be decrease after 24 hours of antibiotic .
Patient can extubated on third day.
Corticosteroids used to reduce edema in initial stage and 24 hour
before extubation.
IMPORTANT NOTES!
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1) Examination of the throat should not be
attempted because it may trigger
laryngospasm and cause respiratory
collapse
2) Nurse should not visualised directly via
tongue depressor or throat culture but
seek for the doctor immediately and
prepare for intubation.
3) Don’t panic and anxiety!
4) Act quickly but calmly.
SURGICAL
MANAGEMENT
Tracheostomy
A tracheostomy tube is
placed into the hole to keep
it open for breathing. The
term for the surgical
procedure to create this
opening is tracheotomy.
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NURSING MANAGEMENT
1
Reduce anxiety
4
Nutritional status
2
Maintain airway
pattern
5
Prevent spread of
infection
3
Maintain and monitor
respiratory function
6
Maintain hydration
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HEALTH EDUCATION
Prevent the spread of infection:
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Cover his or her mouth when he or she sneezes
or coughs.
Wash his or her hands after he or she coughs,
sneezes, or uses the bathroom.
Ask your child's provider if he or she needs to
stay away from other children.
Also ask if you or other household members
need antibiotic medicine to prevent epiglottitis.
HEALTH EDUCATION
Contact your child's healthcare provider if:
● fever or sore throat returns.
● have questions or concerns about your child's condition or care.
Medicines :
● Do not give medicines to children younger than 6 months without direction from a
healthcare provider.
● Give your child's medicine as directed
Ask your child's healthcare provider about the Hib vaccine:
● Children usually get 3 or 4 doses of the vaccine starting at 2 months of age. Make
sure your child gets any missed or scheduled doses.
. Follow up with your child's doctor as directed:
● Write down your questions so you remember to ask them during your child's visits
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CASE PRESENTATION
● A 3 years old male arrived at the (ED) with a history of fever, vomit, and progressive
shortness of breath. According to his mother, the patient did not have any suggestive
event of choking or previous episodes of respiratory distress. The patient was febrile,
with nasal flaring, suprasternal and intercostal retractions and low pitched inspiratory
stridor. No sialorrhea or abnormal breath sounds were described on admission and he had
normal heart and abdominal examinations. It was also noted that the patient presented a
slight hyperextension of the neck and an oral breathing pattern.
● During his admission to the ED, he presented recurrent non-bloody or bilious vomit and
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signs of mild dehydration. A bolus of normal saline solution was administered and, due
to the possibility of severe croup, he was treated with a dose of IV dexamethasone at
0.6 mg/kg and nebulized adrenaline. The patient continued to have respiratory distress,
so a high-flow nasal cannula (HFNC) was placed and administered along with nebulized
budesonide, which resulted in an initial improvement of his respiratory pattern. The
patient was stabilized and transferred to the intensive care unit.
● Laboratory studies completed prior to his transfer included a complete blood count showing
leukocytosis with predominantly polymorphonuclear and a slightly elevated c-reactive protein. A
lateral neck x-ray was also performed and a "thumb sign" image suggestive of the enlarged
epiglottis.
● In the ICU, the patient got worse and nasotracheal intubation was required. An edematous
epiglottis with yellowish secretions was observed during the procedure. Blood cultures and
bronchoalveolar lavage were taken, and empirical antibiotic coverage was initiated with cefotaxime
and clindamycin. Subsequently, bronchoalveolar lavage culture was positive for S. pyogenes, which
was sensitive to cefotaxime, so clindamycin was discontinued.
● After 48 hours, the patient got better and was weaned off ventilatory support. He persisted
with significant upper airway edema, so nasotracheal intubation was kept for supplemental oxygen
for four days. Extubation was performed without complications, the patient was discharged after
10 days of IV cefotaxime with recommendations and follow-up with the pediatrician in his area.
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● https://www.cureus.com/articles/89784-streptococcus-pyogenes-epiglottitis-in-a-child-a-case-
report#article-information-publication-history
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Nasotracheal intubation
Chest xray thumb sign
NURSING CARE PLAN
Date and time
10/9/2020 @ 7am
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Nursing diagnosis
Ineffective airway clearance related
to obstructed upper airway due to
epiglotittis.
SUPPORTIVE DATA
Objective data:
Child A,3 years old 11 kg looks so restless,drooling,hoarseness of
voice,intercostal retraction, and stand with tripod position with and
clenched jaw.
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Vital signs shows :
● Temperature : 40 c
● Heart rate : 150 beat per minutes
● Blood pressure : 130/60mmhg
● Spo2 : 80% under room air
● Respiration : 50 breath per minutes
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SUBJECTIVE DATA :
Mother complaint of her child is difficult to swallow,
drooling, restless and seem like difficult to breath.
GOALS :
Patient will be maintain airway pattern as evident by good
saturation and prevent from respiratory arrest within 8
hours after nursing intervention given and during
hospitalization.
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1)Assess
patient general condition such
as restless,drooling,hoarseness of
voice,intercostal retraction and stand
with tripod position with and clenched
jaw.
Rationale : To act as baseline data to
plan an appropriate nursing intervention
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2)Monitor child A vital signs such as blood pressure,
respiration,SPO2, respiration rate every hourly.
Rationale : To monitored patient progress within the treatment and
plan for further interventions
3)Assess patient respiratory rate, effort, pattern and signs of upper
airway obstruction
Rationale : Abnormalities of breathing requires immediate airway
support.
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4) Administer oxygen such as high flow mask 15L
as doctor ordered.
Rationale : to support breathing patient.
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5) Position patient in tripod position, a sitting up
and leaning forward position with mouth open
and tongue out.
Rationale : to open airway and improved
breathing.
6)Avoid to open patient airway such as open the mouth
and lean patient backward
Rationale : To prevent upper airway block.
7) Rechecked patient vital signs such as blood
pressure, respiratory rate , SPO2 and heart rate
after intervention
Rationale : To observe for effectiveness nursing
intervention
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8) Inform doctor patient abnormalities such rate respiratory rate
and SPO2
Rationale : for further medical intervention.
9) Prepare equipment for intubation such as ETT, larygngoscope,
lignocaine gell and ETT plaster.
Rationale : to intubate the patient for support the breathing
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10) Administer sedation such as IV Midazolam 0.1mg/kg
STAT via peripheral line as doctor prescribed by using 10
right. Weight : 11 kg
Strength : IV Midazolam 5mg/5mls
Rationale : To sedate patient for intubation.
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11) Recheck back patient vital signs such as,respiratory
rate, SPO2 after intubation.
Rationale : To observe for efectiveness medical
intervention .
12)Perform septic workout such as blood culture, swab
throat Culture and sensitivity
Rationale : Investigation for trace infection and prescribe
proper antibiotic for patient
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13)Administer antibiotic such IV Ceftriaxone 100mg/kg
STAT and QID as prescribed by doctor followed by 10
right.
Rationale : treatment for infection.
14) Educate parent regarding vaccination such as HIB vaccine.
Rationale : To prevent epiglottitis happen due to HIB virus.
15) Inform doctor if condition not improving and patient
desaturation persist
Rationale : for further management and continous treatment.
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INTERVENTION
Patient able maintain airway
pattern as evident by good
saturation and prevent from
respiratory arrest within 8 hours
after nursing intervention given
and during hospitalization.
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Subjective data :
Mother explain child is more better with ventilator support.
Objective data :
Child A look calm,breathing effort is synchronized with ventilator
machine, no tachypnea seen.
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Vital signs:
Temperature : 36 C
Heart rate : 112 beat per minutes
Blood pressure : 80/40mmhg
Respiration : 25 breath per minutes
SPO2 : 100% under mechanical ventilator.
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Supportive data :
Objective data :
Baby C, 2 Years old, fever twicely in a week, with sore throat, pale
and lethargic looking.
Patient readmit to hospital twicely within 1 month
Vital signs shows :
Temperature : 38.3 c,
Heart rate : 156 beat per minutes
Blood pressure : 126/66mmhg
Spo2 : 80% under room air
Respiration : 53 breath per minutes
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Subjective data :
Parents asking information about
caregiving and preventive actions and
child readmitted to hospital with
complications.
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Goal :
Parents will be verbalize an
understanding of the condition of the
child and its preventive care within 8
hours during hospitalization
1) Assess level of education for parents about the
epiglottitis.
Rationale : To act as baseline data to plan appropriate
nursing care.
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2) Encourage parents to express their feeling in regards of
their child condition.
Rationale : To determine the parents feeling, and
understand parents need.
3) Educate parents about the signs and symptoms of
respiratory distress such as nasal flaring, retractions,
cyanosis, increasing respiratory rate and increased pulse.
Rationale : Enables parents to gain knowledge in order to
seek immediate medical intervention as necessary.
4) Encourage to parents to join, each time before doing any
procedure to the child, or carry out any treatment such as
vital sign , blood taking, and administer medication.
Rationale : Promote parents cooperation in providing the
child effective treatment.
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5) Reinforce parents on the administration of
prescribed medications.
Rationale : Promotes an understanding that may enhance
consistent and proper medication administer.
6) Teach parents about the importance of
sufficient rest and proper nutrition.
Rationale : Prevents secondary infections, and promote
body’s own natural defences.
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7) Educate parents, child, and family members, on
good handwashing techniques and the proper disposal of
soiled tissues.
Rationale : To avoids transmission of illness.
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8) Ressess parents understanding of teaching and reinforce
as needed.
Rationale : Provides information about further teaching
needs.
9) Grant praise for efforts of learning for parent.
Rationale : Positive reinforcement enhance selfesteem and pride in caring for the child properly.
10) Clarify with parents if there is any confusion
regarding treatment and diagnosis.
Rationale : To correct confusion and in the same time
to provide correct information.
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Evaluation :
Parents able to verbalize
an understanding of the
condition of the child
and its preventive care
within 8 hours during
hospitalization.
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Subjective data : Parents more understand regarding
caregiving and preventive actions and child reduce episode of
readmitted to hospital.
Objective data : Baby C, reducing trend of fever, resolved
sore throat, and now cheer looking.
Patient now no history of readmit to hospital within 1 month
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Vital signs shows :
● Temperature : 36.3 c,
● Heart rate : 128 beat per minutes
● Blood pressure : 85/42mmhg
● Spo2 : 98% under room air
● Respiration : 36 breath per minutes
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REFERENCES
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Oliver, m. m. (2015). paediatric nursing made incredibly easy. In m. m.
oliver, paediatric nursing made incredibly easy (p. 265). wolters
Kluwer.
Waugh, A. B., & Grant, A. B. (2018). Ross and Wilson Anatomy and
Physiology in Health and Illness. In A. B. Waugh, & A. B. Grant, Ross
and Wilson Anatomy and Physiology in Health and Illness. Elsevier
meg gulanick, j. L. (2022). nursing care plan 10th edition. In j. L. meg
gulanick, nursing care plan 10th edition. evolve.
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hockenberry, w. (2019). wong,s nursing care of infants and children. In
w. hockenberry, wong,s nursing care of infants and children. elsevier.
From website
Apuy, M. (2022, April 13). Streptococcus Pyogenes Epiglottitis in a Child: A Case
Report.
Retrieved from
Cureus:
https://www.cureus.com/articles/89784-streptococcus-pyogenes-epiglottitis-in-achild-a-case-report#article-information-publication-history
Baird, S. M. (2018, September 11). Review of epiglottitis in the post Haemophilus
influenzae type-b vaccine era. Retrieved from National Library of Medicine:
https://pubmed.ncbi.nlm.nih.gov/30207030/
Clinic, C. (2022). Epiglotittis. Retrieved from Cleveland clinic:
https://my.clevelandclinic.org/health/diseases/17844-epiglottitis
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Drug.com. (2022, August 31). Epiglotittis in Children. Retrieved from Drug.com:
https://www.drugs.com/cg/epiglottitis-in-children-discharge-care.html
FROM WEBSITE
● Durand, M. L. (2018, May 4). Epiglottitis, Acute Laryngitis, and Croup. Retrieved from National
Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120939/
● Vaskovic, J. (2022, July 27). Epiglotis. Retrieved from Kenhub.com:
https://www.kenhub.com/en/library/anatomy/epiglottis
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