A small compilation of nurse anesthesia care plans

These anesthesia care plans are meant to inspire nurse anesthesia residents when they are making their care plans. Always make sure you fully understand and "own" your care plan. Your plan must be specific for your patient and should always be with the most up-to-date information.

Croup

Etiology

It can be caused by post-intubation edema around the glottic and subglottic regions

Laryngotracheobronchitis is a viral infection of the upper airway.

It is more common in children due to smaller airways

Triggers: Multiple intubation attempts, large ETT size without air leak, exaggerated head movement

Usually, within three hours of extubation

Symptoms: respiratory stridor, barking cough

Treatment: inhalation of cool, moist oxygen, racemic epinephrine (0.5ml of a 2.25% solution in 2.5 mL of NS). Epinephrine is believed to exert its beneficial effect by reducing bronchial secretions and mucosal edema (alpha) and also through smooth muscle relaxation and inhibition of mast cell-mediated inflammation (beta).

Dexamethasone may be helpful 0.1-0.5 mg/kg

Anesthetic Considerations

Minimize intubating trauma

Leak around ETT at less than 40 cm H2O to prevent post-extubation croup

Avoid large-diameter endotracheal tubes

Post-extubation Croup from airway edema secondary to traumatic intubation, multiple intubations, and too large an ETT is treated with racemic epinephrine nebulized:

2.25% solution in Normal Saline (4-5ml total volume)

  • < 20 Kg – 0.25 mL
  • 20-40 Kg – 0.5 mL
  • > 40 Kg - 0.75 mL