NCLEX Daily Practice Questions

June 19, 2024

Wednesday

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The triage nurse is assessing an unvaccinated 4-month-old infant for fever, irritability, and open-mouthed drooling. After the infant is successfully treated for epiglottitis, the parents wonder how this could have been avoided. Which response by the nurse would be most appropriate?

1. 2. 3. 4. "There is nothing you could have done; the important thing is that your child is safe now."

"It's impossible to know for sure what could have caused this episode."

"Most cases of epiglottitis are preventable by standard immunizations."

"We are still waiting for the formal report from the microbiology laboratory."

"There is nothing you could have done; the important thing is that your child is safe now."

Your score is

The average score is 50%

Epiglottitis NCLEX Mastery

What is epiglottitis? It is the inflammation of the epiglottis. This can lead to an upper airway obstruction.

Anatomy & Physiology of Epiglottis

Anatomy

Location: The epiglottis is a leaf-shaped flap of cartilage located at the base of the tongue, at the entrance of the larynx (voice box). It is situated above the glottis, which is the opening between the vocal cords.

Structure:

Cartilage: The epiglottis is composed primarily of elastic cartilage, which provides flexibility and strength.
Covering: It is covered by a mucous membrane that helps protect the underlying cartilage and aids in the movement of the epiglottis.

Physiology

Function: The primary function of the epiglottis is to act as a switch between the trachea and the esophagus to ensure that food and liquids are directed into the esophagus and air is directed into the trachea.

Swallowing Mechanism:

Resting Position: When not swallowing, the epiglottis stands upright, allowing air to pass freely into the trachea.
During Swallowing: As you swallow, the larynx elevates, and the epiglottis folds backward to cover the glottis. This action prevents food and liquids from entering the trachea and directs them into the esophagus.

Protection of the Airway: By closing off the trachea during swallowing, the epiglottis protects the airway from aspiration of food and liquids, which could lead to choking or respiratory infections.

Causes of Epiglottitis

“EPI-GLOTTIS”

E	E. coli and other bacteria (Streptococcus pneumoniae, Staphylococcus aureus)
P	Pneumococcus (Streptococcus pneumoniae)
I	Injury (direct trauma, chemical burns, thermal burns)
G	Group A Streptococcus (Streptococcus pyogenes)
L	Laryngitis-related viruses (e.g., varicella-zoster, herpes simplex)
O	Other bacteria (Haemophilus influenzae type B – Hib)
T	Thermal injury (inhaling hot steam or smoke)
T	Trauma (direct throat injury)
I	Immune system issues (immunosuppression, diabetes)
S	Smoking and substance abuse (chronic irritation, drug inhalation)

The most common cause of epiglottitis is a bacteria that attacks the epiglottis called:
Haemophilus influenzae type B (Hib)
Prevention:
Via the Hib vaccine
When is the Hib vaccine administered?
It is part of the pediatric vaccination schedule and is given in 3-4 doses (depending on the brand used):
– At 2 months
– At 4 months
– At 6 months (if needed)
– At 12-15 months
Other Causes:
Epiglottitis can also be caused by other bacteria such as:
– Streptococcus pneumoniae
– Staphylococcus aureus
– Streptococcus pyogenes

Signs and Symptoms of Epiglottitis

“SORE THROAT”

S	Sore throat (severe, sudden onset)
O	Obstruction of airway (leading to Stridor)
R	Rapid breathing (difficulty breathing)
E	Elevated temperature (fever)

T	Tripod position (to ease breathing)
H	Hoarse voice or muffled voice
R	Restlessness and anxiety (due to breathing difficulty)
O	Oxygen desaturation (cyanosis)
A	Ability to swallow decreased (dysphagia, drooling)
T	Tachycardia (increased heart rate)

Nursing Interventions

“AIRWAY CARE”

A	Airway management
I	Intubation preparation
R	Respiratory status monitoring
W	Watch vital signs – Monitor Temperature
A	Administer oxygen and medications
Y	Yield throat examinations (avoid unless necessary) Don’t use a tongue blade, oral thermometer, obtain a throat culture – This could cause a spasm, which will completely block the airway.

C	Corticosteroids and antibiotics
A	Assess hydration status (IV fluids)
R	Reduce anxiety
E	Educate patient and family

Child Care with Epiglottitis

“CALM CARE”

C	Cry prevention: Prevent doing things that make the child cry.
A	Avoid supine position: Allow the child to be in a comfortable position that allows them to breathe (no supine position).
L	Lap of parent: Keep the child with a parent and on their lap during treatments, if possible.
M	Maintain calm environment: Provide a calm environment.

C	Continuous supervision: Never leave the child alone.
A	Avoid restraints: Don’t restrain the child.
R	Restrict oral intake: Keep the child nothing by mouth.
E	Ease anxiety: Keep the child calm to prevent airway obstruction.