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Nursing QUESTION #9266
Question 1
A 3-year-old child is admitted with sudden onset of high fever, drooling, muffled voice, and sitting in a 'tripod/sniffing position'. The child appears toxic and anxious. The nurse's FIRST priority action is:
  • Insert a tongue depressor to examine the throat
  • Start IV antibiotics immediately
  • Do NOT examine the throat; keep child calm, call physician immediately, and prepare for emergency airway management✔️
  • Place child supine and administer O₂ via face mask
Correct Answer Explanation

Acute Epiglottitis — a life-threatening supraglottic infection (typically Haemophilus influenzae type b in unvaccinated children).

Classic presentation:

  • Sudden high fever, toxic appearance
  • Drooling (inability to swallow secretions)
  • Muffled 'hot potato' voice
  • Tripod/sniffing position: leaning forward, neck extended, supporting on hands — maximizes airway opening
  • Stridor (late, ominous sign)
  • Anxiety, refuses to lie down

CRITICAL NURSING RULE:

NEVER examine the throat with tongue depressor, attempt IV access, take blood, agitate the child, or lay the child supine — ANY stimulation can cause complete airway obstruction.

Priority actions:

  1. Keep child calm, upright (let child maintain own position)
  2. Administer humidified O₂ gently
  3. Notify physician and anesthesiologist IMMEDIATELY
  4. Prepare for emergency intubation or tracheostomy (bedside)
  5. IV access and antibiotics ONLY after airway is secured

Treatment: Ceftriaxone \(100\,\text{mg/kg/day}\) IV after airway secured.

Differentiate from croup: croup has barking cough, subglottic involvement, not toxic, managed with steroids + nebulized epinephrine.