this is cereth registered nurse sorry and calm and in this video i'm going to be going over epiglottitis in this video is part of an ink lex review series over pediatric nursing and as always i pin to this youtube video you can access the free quiz that will test you on this condition so let's get started first let's start out talking about what is this condition it is where there's inflammation of the epiglottis and whenever this happens it can lead to an upper airway obstruction which is a medical emergency and our pediatric patients tend to struggle with this condition more than adults but adults can get epiglottis now to help us understand the path though and why our patients are presenting with these certain signs and symptoms we have to understand what is the epiglottis like what is its role and where is it located okay the epiglottis is a hinged piece of cartilage found at the back of the tongue and here in this picture you can see where the epiglottis is located and it's found on the inside of the thyroid cartilage now what does its role what does this structure do well it closes the entryway to the trachea during swallowing so when a patient is consuming like some type of liquid or some type of food they just shoot it'll go over the tongue and then it'll go down through the throat and our epiglottis which again is found at the back of the tongue will flap downward and it will block that liquid or that food from going down into the trachea into the lungs instead it'll go down through the esophagus and hit the stomach and be digested so we're epiglottis helps with / mini aspiration so whenever we're breathing what's up a glottis doing it's staying open and it's allowing air to flow in and out of the lung so it's a very neat structure however whenever it becomes inflamed it can be a dangerous structure so what do you think can happen if your epiglottis is so implying well we're gonna have airway issues because right here it sets nice width in the airway and it can block air from being able to flow downward because it'll be swollen another issue is swallowing they won't be able to swallow because there's inflammation and with talking so a lot of times that's why with these patients these pediatric patients they're going to complain a pain in their throat because it hurts when the epiglottis is swollen also they may have drooling from where they're not able to swallow down their slava very well and their voice may be muffled or have a soft sound to it because they can't talk properly because the epiglottis and the vocal cords all of that are close together in their anatomy now let's look at the causes of epiglottitis and I would remember this for testing purposes remember the most common bacteria and how it is prevented because as a nurse you want to educate the parents on how to prevent this condition okay so epiglottitis is spread by infectious droplets there's this bacterium these droplets this kid breathes it in goes down to epiglottis and flames it and causes some major problems so the most common type of bacteria to cause epiglottitis is called Hamas influenza type B it can also be caused by other bacteria such as streptococcus pneumoniae now let's talk about this hemolysis influenza type B good thing about it is that it is preventable in that there is a vaccine available for children to take to help prevent this condition which is why over the years we have seen a decrease in children developing epiglottitis based on the Hamas 'less influenza type B bacteria so as a nurse I would be familiar with this vaccine the vaccine that they can get is called the hip vaccine and the child needs about three to four doses of it depending on what brand they're receiving and they will receive it at two months four months six months and 12 to 15 months in between that range now as a side note in my next video I'm going to be going over the pediatric vaccination schedule and give you some mnemonics on how to remember all those vaccines so be sure to check out that video look at the signs and the symptoms that a child can present with with epiglottitis and to help us remember those unique signs and symptoms let's remember the mnemonic add air nurse because they need some air because they have a possible upper airway obstruction so a for abnormal position a lot of times these children will be in what's called the tripod position and this is where they will be setting up positioned forward with their chin in the air which helps open the airway with their mouth open and the tongue protruding just to get that air in and out and that helps them breathe and then d4 dysphagia this is difficulty swallowing we talked about that at the beginning of the lecture and this will lead to the drooling that you may see and then the other D difficulties speaking their voice may be muffled or soft and that's again the close relationship to the epiglottitis and the vocal cords the difficulty swallowing all the drool and everything like that all the information going on and then a for apprehension patient may be irritable have anxiety their oxygen levels can be low they will have agitation apprehensive just because they can't breathe and it's a scary situation and then I for increased temperature their temperature is going to be high it's not going to be a low-grade fever so remember that it's a high fever in this condition and then are for a rapid onset doesn't come on slowly but fast and the patient may even report the patient's family may even report to you you know he or she went to bed last night they were fine and woke up with a really high fever and a sore throat because remember sore throat is one of those things that these children can complain of and then in for nasal flaring and this is again where they're not getting good amounts of air in so their nostrils may flare while they breathe you for using accessory muscles to breathe that's tied again to the obstruction of the airway and they're having to use those extra muscles to get that air in and then our four retractions retractions on the chest and if you see this along with nasal flaring and all that patient needs immediate medical attention and this is where it literally looks like this skin is just stretched so tightly across the chest you can see all the ribs is just sunken in and they're just trying to literally get air in but it's not really happening and then s4 Strider and this is ins matauri Strider and this represents from where that airway is literally being blocked and they cannot get any air in along with the sore throat and here is an example of what Strider can sound like and then II enlarged epiglottis whenever an x-ray is ordered to help diagnose this condition it will be large on the x-ray and in some cases it can be even visible and another thing I want to point out is that compared to other respiratory pediatric conditions a coffee is usually not present with epiglottitis now let's talk about the nursing interventions okay where you gonna do for this patient first thing I wanted to include is something that will probably be on your pediatric exam whenever you're being tested over this condition and it is to never ever insert anything in the patient's mouth to assess it whenever this condition is suspected or died no so no tongue blades so just depress the tongue and look at the throat even though you'll be tempted because they say they have a sore throat but you don't want to do that no oral temperatures and said you need to do other routes like rectally tympanic lis and no throat cultures so if there is something on an exam and it says we're gonna do for this patient do not select these options because that is not the correct answer and why is that why do you not want to do this well it can cause spasms which will completely cut off the patient's airway and cause them major issues the other thing is you want to make sure you have the crash car intubation equipment everything you're going to need at bedside to maintain that airway and that trained staff who can quickly intubate are present because most likely when these kids have this it's severe and they will need to be intubated to maintain that airway other things is that you're never going to leave this patient alone because this airway can just shut off quickly and you need to be there to intervene fast and you're going to be assessing that oxygen status you're going to be maintaining that airway you're going to be looking at the respiratory effort and the rate with the pediatric population it varies in what a normal respiratory rate is I would remember all those variations but if anything is greater than 60 that's not normal for all of them so they have a respiratory rate of 60 or 62 or whatever that is not good another thing listen to those breath sounds checking for that Strider is that present oxygen saturation is it normal their color that tells a lot about them what's their lips look like are they turning cyanotic is their skin looking blue that's not good they're not getting enough oxygen their heart rate long times when patients are very hypoxic that heart rate will shoot up really high they'll become tachycardic do you see any chest retractions nasal flaring agitation all this together that means that our airway is closing off fast and we need to do something also we want to keep the child calm we don't want to do anything that's gonna cause them to cry or become agitated because that can hurt the airway even more so what are some things we can do we can keep the child with the parent or their guardian during treatments like they said on the parents lap allow them to be as close as possible to help keep the child calm don't restrain the child children do not like that scream out cry make it even worse keep the environment calm and allow the child to be in the most comfortable position which is usually going to be that tripod position so it can help them breathe and you want to avoid lying them flat in the supine position because that impedes air flow also you're gonna keep them nothing by mouth we don't want them to eat or drink at this time they will have meds like IV fluids antibiotics to treat bacterial infection that's causing this condition antipyretics to decrease the temperature and then corticosteroids to help decrease the swelling going on at the epiglottis and again how do we prevent most cases of epiglottis through the hip vaccine so be sure to educate the parent about that vaccination okay so that wraps up this lecture on epiglottitis thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos