Unformatted text preview: WK 6 6501 discussion
According to scenario 2 for this week’s discussion; Kevin is a 6-year-old boy who is
brought in for evaluation by his parents. His parents report that his deep cough, which emulate
barking sounds have been present for a week and previously was in good health. His cough does
produce some mucus and occasional vomiting, however no blood in either. The parents report
that Kevin has only had a low-grade temperature as far as they know as they do not own a
thermometer. As for Kevin’s past medical history, they report Kevin has never had childhood
asthma or RSV. They also report they are not sure if his immunizations are current as they have
moved around a lot in the first two years of Kevin’s life.
Respiratory Alterations in Children
Leaning towards croup as the diagnosis for Kevin, according to Huether & McCance
(2017), croup occurs in children six months to 5 years of age almost always with acute
laryngotracheitis. In Kevin's case, a diagnosis of spasmodic croup since spasmodic croups
mostly occur in older children (Huether & McCance, 2017). The clinical manifestations of croup
include a few days of rhinorrhea, sore throat, low-grade fever, then slowly develops to a harsh
barking cough, hoarse voice and inspiratory stridor (Huether & McCance, 2017). Although we
cannot be sure on Kevin’s vaccines, croup can be viral like RSV, rhinovirus, adenovirus, rubella
virus, or atypical bacteria (Huether & McCance, 2017).
The Pathophysiology of Croup
Viral croup pathophysiology is mainly caused by subglottic inflammation and edema due
to the infection (Huether & McCance, 2017). The mucosal membrane of the larynx adheres
tightly to the underlying cartilage, whereas those of the subglottic space are looser and thus
allowing for the accumulation of mucosal and sub-mucosal edema (Huether & McCance, 2017).
Spasmodic croup also causes obstruction but with reduced inflammation and edema; increased
airflow resistance leads to increased respiratory work which results in more negative intrathoracic pressures, thus increasing the collapse of the upper airway in turn(Huether & McCance,
2017).
Gender and Genetics
Croup is more common among boys rather than girls (Rennie et al., 2013). About 15% of
the children affected have a strong family history of croup according to Huether & McCance
(2017). A study by Pruikkonen, Dunder, Renko, Pokka, & Uhari (2009), confirmed that croup's
family history was the main risk factor in croup and its recurrence among the siblings and
parents of the studied cases. Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis,
MO: Mosby.
Pruikkonen, H., Dunder, T., Renko, M., Pokka, T., & Uhari, M. (2009). Risk factors for croup in
children with recurrent respiratory infections: a case-control study. Paediatric And
Perinatal Epidemiology, 23(2), 153-159. doi:10.1111/j.1365-3016.2008.00986.x
Rennie, D. C., Karunanayake, C. P., Chen, Y., Nakagawa, K., Pahwa, P., Senthilselvan, A., &
Dosman, J. A. (2013). CD14 gene variants and their importance for childhood croup,
atopy, and asthma. Disease Markers, 35(6), 765-771. doi:10.1155/2013/434920 ...
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